Release Date:  June 27, 2000

PA NUMBER:  PA-00-113

National Institute of Nursing Research
National Institute on Aging
National Institute of Diabetes and Digestive and Kidney Diseases
National Institute of Environmental Health Sciences



This Program Announcement (PA) solicits applications for investigator-
initiated research related to sociocultural, environmental, and behavioral 
mechanisms and biological/technological factors that contribute to successful 
and ongoing self-management of diabetes in minority populations. Applications 
that expand accepted intervention strategies in majority populations to 
minority populations are encouraged. Testing new interventions designed to 
promote self-management in minority diabetes populations will also be 
responsive to the PA. Self-management is defined as client strategies and 
behaviors that contribute to blood glucose normalization, improved health, and 
prevention or reduction of complications. The concept is broader than 
adherence to specific regimen components and incorporates deliberate problem 
solving and decision making processes. Applications are encouraged for both 
type 1 and type 2 diabetes and all age groups.


The Public Health Service (PHS) is committed to achieving the health promotion 
and disease prevention objectives of "Healthy People 2010," a PHS led national 
activity for setting priority areas.  This Program Announcement (PA), Diabetes 
Self-Management in Minority Populations, is related to one or more of the 
priority areas.  Potential applicants may obtain a copy of "Healthy People 
2010" at http://www.health.gov/healthypeople/.


Applications may be submitted by domestic and foreign, for-profit and non-
profit organizations, public and private, such as universities, colleges, 
hospitals, laboratories, units of State and local governments, and eligible 
agencies of the Federal government.  Racial/ethnic minority individuals, 
women, and persons with disabilities are encouraged to apply as principal 


This PA will use the National Institutes of Health (NIH) Research Project 
Grant (R01) award mechanism.  Responsibility for the planning, direction, and 
execution of the proposed project will be solely that of the applicant.  The 
total project period for an application submitted in response to this PA may 
not exceed 5 years.

Specific application instructions have been modified to reflect "MODULAR 
GRANT" and "JUST-IN-TIME" streamlining efforts being examined by the NIH. 
Complete and detailed instructions and information on Modular Grant 
applications can be found at 



More research is needed among minority populations to determine whether the 
same strategies to promote and support healthy lifestyle and diabetes self-
management behaviors are effective across ethnic groups. Relatively few 
behavioral studies are reported that focus on minorities with diabetes. This 
gap in minority diabetes knowledge applies to all age groups, both genders, 
and all ethnic minority groups. The increasing incidence and prevalence of 
diabetes in minority populations underscore the importance of the problem.

Diabetes continues to be the seventh leading cause of death in the U.S., with 
a higher mortality rate for many ethnic minority groups than for whites. The 
CDC statistics for 1995 indicate that African American, American Indian, and 
Hispanic ethnic groups had a diabetes death rate ranging from 19.3 to 28.5 
compared to 11.7 for Caucasian Americans. Although the prevalence and 
mortality rates vary by ethnic group, health disparities in minority 
individuals with diabetes is an increasing public health concern. 

The rate of diabetes is increasing faster in Blacks than Whites, although the 
reasons for this are not known. There is speculation about genetic admixtures 
and environmental factors but scientific data about the role of genetics and 
the environment are insufficient. African Americans appear to be at less risk 
for type 1 diabetes (insulin dependent) than White Americans. An increasing 
concern is the upward trend in type 2 (non insulin-dependent) diabetes in 
children and adolescents, with African American and Hispanic adolescents 
appearing to be at greater risk.

The prevalence of type 2 diabetes in Hispanics is two to three times that of 
non-Hispanic Whites. Diabetes is rare in Asian and Pacific Islanders although 
there is evidence that immigrants to this country are becoming susceptible to 
type 2 diabetes. This susceptibility is considered to be related to lifestyle 
behaviors prevalent in Western society, including poor nutrition and 
decreasing physical activity. 

The incidence of diabetes in various American Indian tribes ranges from 12% to 
over 50% with the higher rates documented in ages 35 and over. The Strong 
Heart Study of American Indians in four western states found prevalence rates 
of 33% to 72% in state samples of over 4000 individuals. The role of genetics 
in the risk for type 2 diabetes is evidenced by findings that the prevalence 
for diabetes in American Indians is much higher if one or both parents are 
diabetic. Another finding among American Indians is that cardiovascular 
disease, a common complication of diabetes and formerly rare among this 
population, is increasing at a time when it is decreasing in other ethnic 

Coping with a complex chronic illness such as diabetes affects the individual 
as well as family members throughout the entire lifespan. The daily 
responsibilities and knowledge of the risk for serious complications such as 
blindness, amputations, and heart disease, place a heavy burden of self-care 
on individuals with diabetes. Persons with diabetes are faced with decision 
making that involves establishing priorities in allocating time, effort, and 
resources to attain multiple types of health care (e.g., nursing, medical, 
ophthalmic, dental, nutrition, podiatry, and specialists related to 
complications). In general, much of the responsibility for managing diabetes 
falls on the individuals themselves, whose responsibilities, in addition to 
usual health maintenance, include regimens of meal planning and timing, 
physical activity, blood glucose monitoring, management of acute 
complications, and adjustments in therapies and lifestyle behaviors. Family 
members and family life, however, are also affected by the disease. Family 
members have greater responsibility for participating in diabetes care when 
the person with diabetes is a child, adolescent, or dependent older adult. 
These issues related to diabetes management are understudied in minority 

Self-management to achieve metabolic control includes, among other things, 
monitoring blood glucose levels, balancing insulin dosage with food intake and 
physical activity, prevention and treatment of hypoglycemia, and an active 
partnership with health care providers. Self-management involves daily problem 
solving and decision making about actions relevant to glucose-medication 
titration. Healthy lifestyle behaviors are also an important part of effective 
diabetes self-management. A satisfying quality of life and full participation 
in work or school are also important to effective self-management of diabetes. 
The acceptance and application of these self-management responsibilities in 
minority populations are not well described.

The outcomes of effective diabetes control are now well known. Clinical trials 
consistently show that intensive health care and self management make a 
positive difference. Results from the Diabetes Control and Complications Trial 
(DCCT) have shown that improving blood glucose control in type 1 diabetes, in 
which the body produces no insulin to regulate blood glucose levels, markedly 
reduces related complications of the eyes, kidneys, and nerves.  Results from 
the United Kingdom Prospective Diabetes Study (UKPDS) have similarly 
demonstrated that improved control of blood glucose in type 2 diabetes also 
reduces diabetes related complications. Although more effective medications, 
delivery devices, and methods for diabetes self-monitoring have improved the 
ability to control glycemia, normal metabolic control remains difficult to 
achieve for all populations.

Focusing research on groups that have disproportionate health problems 
compared to the overall population is important to society as a whole in terms 
of social and economic benefits. The results of previous research on self-
management strategies for diabetes can not be assumed to be effective for 
minority groups if their representation constituted a small proportion of the 
sample. Research that emphasizes minority populations must be increased if 
health disparities among varying ethnic groups with diabetes are to be reduced 
by 2010. 

A Congressionally-established Diabetes Research Working Group developed a 
comprehensive plan for diabetes research priorities in 1999.  The 
recommendations include studies related to the optimization of glucose control 
and the need for behavioral research.  The report notes that in many cases, 
successful metabolic control and prevention of complications depends on 
changing the behaviors of patients, providers, and persons at risk for 
development of diabetes. The DCCT, UKDPS, and a recent meeting at NIH on 
behavioral science research in diabetes all stress the need to extend research 
on self-management, adherence, and other biopsychosocial aspects of diabetes 
management to assist persons with diabetes to achieve normal blood glucose 
levels, to reduce complications, and to improve their quality of life. 

The investigation of factors associated with effective and long-term diabetes 
self-management is critical to improving diabetes health outcomes. This 
announcement is aimed at meeting the diabetes self-management research needs 
in minority populations.

NIA Statement.  NIA in interested in understanding biological, behavioral, and 
social factors which affect the aging process and the health and quality of 
life of older persons. We are especially interested in the interaction of 
disease and care factors with proposed studies explicitly examining the role 
of aging and life-course factors in disease onset, progression and/or 

NIEHS.  The mission of the National Institute of Environmental Health Sciences 
(NIEHS) is to reduce the burden of human illness and dysfunction from 
environmental causes by understanding each of these elements and how they 
interrelate. The NIEHS is interested in supporting collaborative partnerships 
between academic investigators and community based organizations that address 
physical and social environmental influences on diabetes self management 
protocols, (please visit 
http://www.niehs.nih.gov/dert/programs/translat/envjust/envjust.htm and 


Research on self-management for diabetes that affects psychosocial and 
physiological outcomes in minority populations is solicited through this 
program announcement. This announcement solicits proposals on both type 1 and 
type 2 diabetes populations and all age groups. The target populations are 
ethnic minorities although comparison studies may include a Caucasian group 
when warranted and when sample sizes are proportionate. Intervention proposals 
are solicited, especially those to test accepted strategies not adequately 
evaluated in minority populations. Applications with a focus on majority 
populations will not be considered responsive to this PA. Another current 
program announcement (PA-00-49) titled Enhancing Adherence to Diabetes Self-
Management Behaviors is appropriate for all ethnic populations and can be 
viewed at https://grants.nih.gov/grants/guide/pa-files/PA-00-049.html.    

The following research topics are provided as examples that would extend 
research currently funded by NIH.  They are not listed in any priority order 
and are not intended to be inclusive or restrictive.

o  Determine ways to accurately measure cultural/ethnic differences in self-
management behaviors;
o  Determine the influence of particular cultural/ethnic group differences in 
diabetes self-management behaviors and outcomes (examples: variations in blood 
glucose testing, symptom management, healthy behaviors);
o  Evaluate interventions for minority children or adolescents that 
incorporate family, health care providers, school staff, support systems, and 
psychosocial factors;
o  Identify culture/ethnic-specific facilitators and barriers relevant to 
self-management across the lifespan;
o  Investigate the influence of age, diet, education, environment, financial 
status, and physical activity in diabetes self-management in minority ethnic 
o  Investigate the efficacy of academic or health care provider agency 
collaborations with community-based organizations in the implementation of and 
adherence to self management protocols, as this relates to social support 
mechanisms, i.e., social capital. Social capital may be defined as social 
interactions that positively impact individuals/communities; 
o  Determine the influence of social support, burden of care, coping skills, 
quality of life, and self-efficacy on diabetes self-management in minority 
o  Test interventions previously shown to be effective and efficacious in 
majority populations within or across minority ethnic populations;
o  Test interventions and delivery systems that involve minority populations 
in active participation in self-management and related problem solving;
o  Examine physiological, genetic, and environmental factors that affect 
response to metabolic control and self-management in minority populations;
o  Determine the efficacy of technologies associated with self-management in 
minority populations (examples: glucose monitoring, computer based 
communications/strategies, insulin pump); and
o  Evaluate the influence of neighborhood characteristics on self-management 
capabilities, e.g., available venues for safe indoor and outdoor exercise and 
accessibility of fresh produce and other health promoting foods.  

1.  Congressionally-Established Diabetes Research Working Group.  (1999).  
Conquering Diabetes: A Strategic Plan for the 21st Century.  Bethesda, MD: NIH 
Publication No. 99-4398.

2.  National Institutes of Health (November, 1999) Behavioral Science Research 
in Diabetes meeting. Presented by National Institute of Diabetes and Digestive 
and Kidney Diseases and the Office of Behavioral and Social Sciences Branch, 


It is the policy of the NIH that women and members of minority groups and 
their subpopulations must be included in all NIH supported biomedical and 
behavioral research projects involving human subjects, unless a clear and 
compelling rationale and justification are provided that inclusion is 
inappropriate with respect to the health of the subjects or the purpose of the 
research.  This policy results from the NIH Revitalization Act of 1993 
(Section 492B of Public Law 103-43).

All investigators proposing research involving human subjects should read the 
"NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical 
Research," which have been published in the Federal Register of March 28, 1994 
(FR 59 14508-14513) and in the NIH Guide for Grants and Contracts, Vol. 23, 
No. 11, March 18, 1994 and is available on the web at the following URL 
address:  https://grants.nih.gov/grants/guide/notice-files/not94-100.html

It is the policy of NIH that children (i.e., individuals under the age of 21) 
must be included in all human subjects research, conducted or supported by the 
NIH, unless there are scientific and ethical reasons not to include them.  
This policy applies to all initial (Type 1) applications submitted for receipt 
dates after October 1, 1998.

All investigators proposing research involving human subjects should read the 
"NIH Policy and Guidelines on the Inclusion of Children as Participants in 
Research Involving Human Subjects" that was published in the NIH Guide for 
Grants and Contracts, March 6, 1998, and is available at the following URL 
address: https://grants.nih.gov/grants/guide/notice-files/not98-024.html

Investigators also may obtain copies of these policies from the program staff 
listed under INQUIRIES.  Program staff may also provide additional relevant 
information concerning the policy.


Some applications received in response to this program announcement are 
expected to focus on scientific issues related to aging and to aging-related 
aspects of disease. In describing the plan to recruit human subjects, 
investigators may cite a focus on aging or on aging-related aspects of disease 
as the justification for why children will be excluded from such applications. 
In this regard, applicants may use Justification 1, the research topic to be 
studied is irrelevant to children, from the policy announcement.


All applications and proposals for NIH funding must be self-contained within 
specified page limitations. Unless otherwise specified in an NIH solicitation, 
internet addresses (URLs) should not be used to provide information necessary 
to the review because reviewers are under no obligation to view the Internet 
sites. Reviewers are cautioned that their anonymity may be compromised when 
they directly access an Internet site.


Applications are to be submitted on the grant application form PHS 398 (rev. 
4/98) and will be accepted at the standard application deadlines as indicated 
in the application kit.  Application kits are available at most institutional 
offices of sponsored research and may be obtained from the Division of 
Extramural Outreach and Information Resources, National Institutes of Health, 
6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301/710-0267, email: GrantsInfo@nih.gov.

Applicants planning to submit an investigator-initiated new (type 1), 
competing continuation (type 2), competing supplement, or any amended/revised 
version of the preceding grant application types requesting $500,000 or more 
in direct costs for any year are advised that he or she must contact the 
Institute or Center (IC) program staff before submitting the application, 
i.e., as plans for the study are being developed.  Furthermore, the 
application must obtain agreement from the IC staff that the IC will accept 
the application for consideration for award.  Finally, the applicant must 
identify, in a cover letter sent with the application, the staff member and 
Institute or Center who agreed to accept assignment of the application.  

This policy requires an applicant to obtain agreement for acceptance of both 
any such application and any such subsequent amendment.  Refer to the NIH 
Guide for Grants and Contracts, March 20, 1998 at 

The modular grant concept establishes specific modules in which direct costs 
may be requested as well as a maximum level for requested budgets. Only 
limited budgetary information is required under this approach.  The 
just-in-time concept allows applicants to submit certain information only when 
there is a possibility for an award. It is anticipated that these changes will 
reduce the administrative burden for the applicants, reviewers and Institute 
staff.  The research grant application form PHS 398 (rev. 4/98) is to be used 
in applying for these grants, with the modifications noted below.



Modular Grant applications will request direct costs in $25,000 modules, up to 
a total direct cost request of $250,000 per year. (Applications that request 
more than $250,000 direct costs in any year must follow the traditional PHS 
398 application instructions.)  The total direct costs must be requested in 
accordance with the  program guidelines and the modifications made to the 
standard PHS 398 application instructions described below:

PHS 398

o FACE PAGE: Items 7a and 7b should be completed, indicating Direct Costs (in 
$25,000 increments up to a maximum of $250,000) and Total Costs [Modular Total 
Direct plus Facilities and Administrative  (F&A) costs] for the initial budget 
period Items 8a and 8b should be completed indicating the Direct and Total 
Costs for the entire proposed period of support.

of the PHS 398. It is not required and will not be accepted with the 

categorical budget table on Form Page 5 of the PHS 398. It is not required and 
will not be accepted with the application.

o NARRATIVE BUDGET JUSTIFICATION - Prepare a Modular Grant Budget Narrative 
page. (See https://grants.nih.gov/grants/funding/modular/modular.htm for sample 
pages.) At the top of the page, enter the total direct costs requested for 
each year.  This is not a Form page.

o Under Personnel, List key project personnel, including their names, percent 
of effort, and roles on the project. No individual salary information should 
be provided. However, the applicant should use the NIH appropriation language  
salary cap and the NIH policy for graduate student compensation in developing 
the budget request.

For Consortium/Contractual costs, provide an estimate of total costs (direct 
plus facilities and administrative) for each year, each rounded to the nearest 
$1,000. List the individuals/organizations with whom consortium or contractual 
arrangements have been made, the percent effort of key personnel, and the role 
on the project. Indicate whether the collaborating institution is foreign or 
domestic. The total cost for a consortium/contractual arrangement is included 
in the overall requested modular direct cost amount.  Include the Letter of 
Intent to establish a consortium.

Provide an additional narrative budget justification for any variation in the 
number of modules requested.

o BIOGRAPHICAL SKETCH - The Biographical Sketch provides information used by  
reviewers in the assessment of each individual's qualifications for a specific 
role in the proposed project, as well as to evaluate the overall 
qualifications of the research team. A biographical sketch is required for all 
key personnel, following the instructions below. No more than three pages may 
be used for each person. A sample biographical sketch may be viewed at:  

- Complete the educational block at the top of the form page;
- List position(s) and any honors;
- Provide information, including overall goals and responsibilities, on 
research projects ongoing or completed during the last three years;
- List selected peer-reviewed publications, with full citations.

o CHECKLIST - This page should be completed and submitted with the 
application. If the F&A rate agreement has been established, indicate the type 
of agreement and the date. All appropriate exclusions must be applied  in the 
calculation of the F&A costs for the initial budget period and all future 
budget years.

o The applicant should provide the name and phone number of the individual to 
contact concerning fiscal and administrative issues if additional information 
is necessary following the initial review. 

The title and number of the program announcement must be typed on line 2 of 
the face page of the application form and the YES box must be marked.

Submit a signed, typewritten original of the application, including the 
Checklist, and five signed photocopies in one package to:

BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express/courier service)


Applications will be assigned on the basis of established PHS referral 
guidelines.  Applications will be evaluated for scientific and technical merit 
by an appropriate scientific review group convened in accordance with the 
standard NIH peer review procedures.  As part of the initial merit review, all 
applications will receive a written critique and undergo a process in which 
only those applications deemed to have the highest scientific merit, generally 
the top half of applications under review, will be discussed, assigned a 
priority score, and receive a second level review by the appropriate National 
Advisory Council.
Review Criteria

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  In 
the written comments reviewers will be asked to discuss the following aspects 
of the application in order to judge the likelihood that the proposed research 
will have a substantial impact on the pursuit of these goals.  Each of these 
criteria will be addressed and considered in assigning the overall score, 
weighting them as appropriate for each application.  Note that the application 
does not need to be strong in all categories to be judged likely to have major 
scientific impact and thus deserve a high priority score.  For example, an 
investigator may propose to carry out important work that by its nature is not 
innovative but is essential to move a field forward.

(1) Significance:  Does this study address an important problem?  If the aims 
of the application are achieved, how will scientific knowledge be advanced?  
What will be the effect of these studies on the concepts or methods that drive 
this field?

(2) Approach:  Are the conceptual framework, design, methods, and analyses 
adequately developed, well-integrated, and appropriate to the aims of the 
project?  Does the applicant acknowledge potential problem areas and consider 
alternative tactics?

(3) Innovation:  Does the project employ novel concepts, approaches or method? 
Are the aims original and innovative?  Does the project challenge existing 
paradigms or develop new methodologies or technologies?

(4) Investigator:  Is the investigator appropriately trained and well suited 
to carry out this work?  Is the work proposed appropriate to the experience 
level of the principal investigator and other researchers (if any)?

(5) Environment:  Does the scientific environment in which the work will be 
done contribute to the probability of success?  Do the proposed experiments 
take advantage of unique features of the scientific environment or employ 
useful collaborative arrangements?  Is there evidence of institutional 

In addition to the above criteria, in accordance with NIH policy, all 
applications will also be reviewed with respect to the following:

o  The adequacy of plans to include both genders, minorities and their 
subgroups, and children as appropriate for the scientific goals of the 
research.  Plans for the recruitment and retention of subjects will also be 

o  The reasonableness of the proposed budget and duration in relation to the 
proposed research

o  The adequacy of the proposed protection for humans, animals or the 
environment, to the extent they may be adversely affected by the project  
proposed in the application.

Additional scientific/technical merit criteria specific to the objectives of 
the PA and the mechanism used must be included if they are to be used in the 


Applications will compete for available funds with all other recommended 
applications. The following will be considered in making funding decisions:  
Quality of the proposed project as determined by peer review, availability of 
funds, and program priority.


Inquiries are encouraged.  The opportunity to clarify any issues or questions 
from potential applicants is welcome.

Direct inquiries regarding GENERAL ISSUES to:

Dr. Nell Armstrong
Division of Extramural Activities
National Institute of Nursing Research
Building 45, Room Number 3AN12, MSC 6300
Bethesda, MD  20892-6300
Telephone:  (301) 594-5973
FAX:  (301) 480-8260
Email:  nell_Armstrong@nih.gov

Direct inquiries regarding specific PROGRAMMATIC ISSUES to the staff of the 
appropriate Institute/Center:

Dr. Nell Armstrong
Division of Extramural Activities
National Institute of Nursing Research
Building 45, Room Number 3AN12, MSC 6300
Bethesda, MD  20892-6300
Telephone:  (301) 594-5973
FAX:  (301) 480-8260
Email:  nell_Armstrong@nih.gov

Dr. Marcia G. Ory
Behavioral and Social Research Program
National Institute on Aging
7201 Wisconsin Avenue, Room 533 MSC 9025
Bethesda, MD 20892-9205
Telephone: 301-402-4156
FAX:  301-402-0051
Email: Marcia_Ory@NIH.GOV

Dr. Sanford A. Garfield
Senior Advisor for Biometry & Biomedical Research
National Institute of Diabetes and Digestive and Kidney Diseases
6707 Democracy Boulevard, Room 685
Bethesda, MD  20892-5460
Telephone: 301-594-8803
FAX: 301-402-6271
Email: garfields@extra.niddk.nih.gov

Dr. Frederick L. Tyson
Program Administrator
Chemical Exposures and Molecular Biology Branch
Division of Extramural Research and Training
National Institute of Environmental Health Sciences
P.O. Box 12233
Research Triangle Park, NC 27709
Telephone: (919) 541-0176
FAX: (919) 316-4606
Email: tyson2@niehs.nih.gov 

Direct inquiries regarding FISCAL MATTERS to:

Mr. Robert Tarwater
Office of Grants and Contracts Management
National Institute of Nursing Research
Building 45, Room Number 3AN12, MSC 6300
Bethesda, MD  20892-6300
Telephone:  (301) 594-2807
FAX:  (301) 480-8260
Email:  Robert_tarwater@nih.gov

Mr. David Reiter
Grants Specialist
Grants Management Office
National Institute on Aging
Gateway Building, Room 2N212
Bethesda, MD 20892
Tel: 30l-496-1472
FAX:   301-402-3672
Email: David_Reiter@NIH.GOV

Ms. Cheryl Chick
Grants Management Specialist
National Institute of Diabetes and Digestive and Kidney Diseases
6707 Democracy Boulevard, Room 606
Bethesda, MD  20892-5456 (FEDEX Zip Code 20817)
Telephone: 301-594-8825
FAX: 301-480-3504
Email: chickc@extra.niddk.nih.gov

Ms. Jacqueline M. Russell
Grants Management Specialist
Grants Management Branch
Office of Program Operations
Division of Extramural Research and Training
National Institute of Environmental Health Sciences
Telephone:  (919) 541-0751
Fax:  (919) 541-2860
Email: russell@niehs.nih.gov


This program is described in the Catalog of Federal Domestic Assistance Nos. 
93.361 (NINR); 93.866 (NIA); 93.849 (NIDDK); and 93.3, 93.113, 93.114 and 
93.866 (NIEHS).  Awards are made under authorization of sections 301 and 405 
of the Public Health Service Act as amended (42 USC 241 and 284) and 
administered under NIH grants policies and Federal Regulations 42 CFR 52 and 
45 CFR Parts 74 and 92.  This program is not subject to the intergovernmental 
review requirements of Executive Order 12372 or Health Systems Agency review.

The PHS strongly encourages all grant and contract recipients to provide a 
smoke-free workplace and promote the non-use of all tobacco products.  In 
addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking 
in certain facilities (or in some cases, and portion of a facility) in which 
regular or routine education, library, day care, health care or early 
childhood development services are provided to children.  This is consistent 
with the PHS mission to protect and advance the physical and mental health of 
the American people.

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