Release Date:  August 14, 1998

PA NUMBER:  PA-98-098


National Heart, Lung, and Blood Institute
National Institute on Aging
National Institute of Child Health and Human Development
National Institute of Environmental Health Sciences
National Institute of Mental Health


The National Heart, Lung, and Blood Institute (NHLBI), National Institute on
Aging (NIA), National Institute of Child Health and Human Development (NICHD),
National Institute of Environmental Health Sciences (NIEHS), and National
Institute of Mental Health (NIMH) seek research grant applications on the
cumulative and contemporaneous relationships between socioeconomic status
(SES) and physical and mental health and functioning over the life course and
across generations.  Given that the relationships between SES and physical and
mental health, morbidity, disability, and mortality have been long and
extensively documented, additional studies aimed at merely describing or
demonstrating these relationships are outside the scope of this program
announcement.  Encouraged are studies relating to:

o  Appropriate conceptualization and measurement of SES over the life course,
across generations, and in various population groups.

o  Specification of the processes through which SES influences cumulatively
and contemporaneously physical and mental health, disability, morbidity, and
mortality outcomes over the life course, and how these outcomes, in turn,
impact on SES.  Attention should also be given to whether and how various
indicators of socioeconomic disparities may have differential impacts on
health and functioning outcomes at different ages and time periods (short-term
vs. long-term).

o  The relationship between SES and physical and mental health, disability,
morbidity, and mortality over the life course in various population groups.


The Public Health Service (PHS) is committed to achieving the health promotion
and disease prevention objectives of "Healthy People 2000," a PHS-led national
activity for setting priority areas.  This program announcement, Socioeconomic
Status and Health Across the Life Course, is related to one or more of the
priority areas.  Potential applicants may obtain a copy of "Healthy People
2000" at


Applications may be submitted by foreign and domestic 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


The mechanism of support will be the individual research project grant (R01).
Responsibility for the planning, direction, and execution of the proposed
project will be solely that of the applicant.


The relationship between socioeconomic status (SES) and physical and mental
health, morbidity, disability, and mortality has been long and extensively
documented.  While the overall relationship of SES to mortality may attenuate
in older ages, socioeconomic position continues to be linked to the prevalence
of disability and chronic and degenerative diseases, including cardiovascular
disease, many cancers, and Alzheimer's disease.  Low SES may result in poor
physical and/or mental health by operating through various psychosocial
mechanisms such as poor or "risky" health-related behaviors, social exclusion,
prolonged and/or heightened stress, loss of sense of control, and low self-
esteem as well as through differential access to proper nutrition and to
health and social services.  In turn, these psychosocial mechanisms may lead
to physiological changes such as raised cortisol, altered blood-pressure
response, and decreased immunity that place individuals at risk for adverse
health and functioning outcomes.  Not only may SES affect health, but physical
and mental health may have an impact upon the various components of SES (e.g.,
education, income/wealth, occupation) over the life course.  For example,
bouts of serious illness may result in a significant and sustained loss of

The purpose of this program announcement is to encourage research on the
relationships between SES and physical and mental health over the life course
and across generations.  Acute or chronic occurrences of poor health (so-
called "health shocks") for one member of the family may result in significant
costs and sustained loss of wealth for all family members.  Therefore, the
immediate social context should be taken into account while examining the
cumulative relationship of SES and health over the life course as well as
their contemporaneous relationship at a given age.  The increasing ethnic and
racial diversity of the U.S. population heightens the need to understand
better the relationship between SES and physical and mental health in minority
groups.  Among key issues are the degree to which SES accounts for health
differences among population groups, how SES is related to the effects of
discrimination and prejudice, and whether SES can be conceptualized and
operationalized similarly among different population groups.

The following areas illustrate suitable topics for research.  Throughout this
program announcement, the terms "health" and "functioning" encompass both
physical and mental aspects of well-being and morbidity.  Applications need
not be limited to these topics nor must they encompass all of these issues.

1.  Conceptualizing and measuring SES

A life-course perspective leads to questions about the cumulative impact of
SES and physical and mental health on each other as well as on their current
or contemporaneous relationship.  For example, do critical periods (ages or
life stages) exist in which SES may have significant impact upon subsequent
health or, vice versa, when health may impact upon the various components of
SES? Recent research suggests that over the long-term SES affects health, but
over the short-term the relationship may be reversed.  How should such "time-
lags" and reversals in causality be conceptualized and measured? Do the
mediating variables and causal pathways between SES and health vary over the
life course? Do the various components of SES (e.g., educational attainment,
occupational status, wealth, and prestige) take on different weights in their
relationships to health at different ages?

Usually socioeconomic status is conceptualized as an attribute of an
individual (or the person's family or household) that consists of different
dimensions.  These dimensions may be additive or interactive in defining SES. 
A life-course perspective poses questions about the adequacy of current
conceptualizations, as noted in the preceding paragraph.  Research is needed
to develop and assess the construct and predictive validity of age-appropriate
measures, especially for children, adolescents, and older people, in relevant
population groups.  Particular attention should be directed to the
appropriateness of different measures by gender, race/ethnicity, nativity and
immigrant status, household structure, relation to the labor force (e.g., in
retirement), and rural-urban residence.  For example, the socioeconomic
position of women has been measured in terms of that of their husbands. 
However, with the significant changes in occupational and marital experiences
of women, this practice has become questionable.

In addition to measures based upon the characteristics of individuals or
households, measures are needed of larger social structural units.  For
example, what are the best measures of the socioeconomic characteristics of
neighborhoods (e.g., resources, location, quality of housing, services) that
may affect the risk of disability, morbidity, and mortality in early and/or
later life?

Educational attainment is often noted as being positively correlated with
health and functioning, absence of disability, lower incidence of some
illnesses (e.g., Alzheimer's disease), even among the oldest-old.  Higher
levels of maternal education are typically associated with more timely receipt
of prenatal care, contraceptive use, and less frequent and later childbearing. 
How is educational attainment best conceptualized and measured? What are the
relevant aspects or components of education that should be measured beyond
merely the number of years of schooling?

What are the relevant dimensions of occupation as a component of socioeconomic
position (e.g., supervisory position, type of industry, part vs. full-time
employment) for health and mortality risk over the life course? How can the
lifetime experience of different occupations, careers, or activities be
measured and summarized, especially for those who are retired?

Similarly, questions arise about the conceptualization and measurement of
economic well-being over the life course.  Should this aspect of SES be
considered in terms of income, wealth, or both? How can trajectories in
economic well-being be measured? Given the limitations of the construct of
"poverty" as officially defined, how do alternative measures of poverty affect
the relationship between SES and health? Can a measure of cumulative material
deprivation for individuals and households over the life course be developed
and refined?

2.  Specifying relationships between SES and physical and mental health

Although the general relationship between SES and health, disease, and
mortality has been long recognized, the pathways through which SES affects
health have yet to be satisfactorily specified.  A better understanding of the
mediators of the relationships between SES and health, disease, and disability
is essential for more efficacious clinical and policy interventions to reduce
adverse health impacts.  Specification should include consideration of various
aspects and measurements of health such as all-cause mortality, cause-specific
mortality and morbidity, perceived health status, life expectancy, active life
expectancy, and functional/disability status.  That is, SES and its components
may evidence varying relationships depending upon specific diseases or health
outcomes.  For example, SES appears to be positively associated with breast
cancer, but negatively associated with uterine cancer.

Research is needed to specify over the life course the nature, extent, and
variability of such potential mediators as:

a) Life-styles (health-related behaviors and practices, including high-risk
sexual behaviors).

b) Personality, self-concept, sense of control, social cognition, coping
resources, cognitive abilities, problem-solving skills and styles.

c) Access to and use of health-care and social services, including such
diverse factors as community characteristics and availability of health

d) Social networks and supports for receiving assistance or for managing
health care needs, encouraging health-promoting behaviors, and mobilizing
needed resources.  Social networks include those created by marriage, other
family ties, as well as nonfamilial relations.  Family and kin networks can
differ qualitatively from other social networks in their effects on SES,
health, and functioning.  To what extent does SES influence social networks
and their supportive functions (e.g., instrumental, affective) and resources,
which may affect health and functioning?  Do the manner and mechanisms through
which social networks are structured and operate differ by SES and as people

e) Interactions with significant gatekeepers such as health-care providers and
family members.  For example, some aspects of service utilization among
children and the oldest old are probably highly influenced -- or even
determined -- by family members.  When these are adult children, the decisions
are likely to reflect their educational level, income, and values.

f) Exposure to psychosocial, physical, chemical, and other environmental
stressors, taking into account their magnitude, duration, and periodicity. 
People in lower socioeconomic strata are more likely to live and work in the
most hazardous environments and occupations.

g) The occurrence, timing and sequencing of life events or demographic
processes such as childbearing, marriage, divorce, widowhood, education,
geographical mobility, employment, and retirement.  Demographic processes are
known to be fundamentally interrelated with both health and SES.

h) The nature of relationships between SES and disabilities associated with
physical and/or mental conditions.  For example, does SES increase risk for
particular behavioral disabilities (e.g., for work, self care, social
relations) and does this vary over the life course? How do specific
disabilities affect subsequent SES?

i) Intergenerational effects, beginning with pregnancy planning, the prenatal
environment, parental investments in their own health and human capital as
well as in those of their offspring, and including intergenerational transfers
(e.g., inheritance).

j) Biological mediators.  Which biological or neurochemical processes and
their measures (e.g., salivary cortisol, catecholamines, testosterone) are
most powerful, efficient, and acceptable in various research settings (e.g.,
laboratory, clinic, field) in capturing possible biological mediators of SES
and health relationships?

k) Status in multiple stratification systems.  Does holding a higher rank or
graded position in domains (e.g. social status based on age, race/ethnicity,
or gender; rank in recreation, church, civic organizations) other than
(current or prior) occupation modify or interact with the effects of
economic/occupational gradients? In addition to possible SES differences in
exposure to stressors (e.g., unemployment; occupational hazards), is the
experience of rank or hierarchy per se (e.g., having to show or failing to
receive respect or deference) a stressor and thereby a risk factor for adverse
health outcomes?

In addition to specifying mediating variables and their relationships to each
other and with SES and physical and mental health, consideration should be
given to such additional issues as:

a) Does the nature of processes linking SES and health vary over the life
course? If so, is the variation quantitative and/or qualitative (e.g., Are
different mediators involved at different ages?)  Do the various ways of
conceptualizing SES imply different relationships with health as people
develop and age?

b) Do the various components operate through different mediating variables?
For example, research is needed to distinguish the effects of education from
those of income, occupation, and other aspects of socioeconomic status.  Does
educational attainment operate directly, for example, on health-related life
styles, or through occupational careers, or via knowledge and skills? Does
education perhaps result in physiological changes (e.g., enhanced neural
networks) that protect against declines in cognitive functioning? How do the
content, meaning, and credentialing associated with different levels of
education affect health and mortality and how do these vary by cohort?

c) How should possible feedback between health and SES be incorporated? For
example, to what extent does the contemporaneous feedback from health to
income dominate as the direction of causation in a current period? What is the
long-term feedback from health status to socioeconomic status? Past health may
affect an individual's educational attainment, labor force participation
and/or wages.  The timing and sequencing of events throughout the life course,
including occupational and residential mobility, family formation and
disruption, disrupted employment, part-time employment, and unemployment, are
also likely to impact SES and health outcomes of individuals and their
children.  Understanding the extent to which these bi-directional effects
operate is crucial to specifying the relationship between SES and health.

d) How might changes in social policies, such as welfare reform, Medicare, and
Social Security Insurance modify the relationships among SES, health, and
mediating variables? The advent of welfare reform has heightened interest in
the relationship between SES and the health and well-being of poor families,
children, and older people.  Little is currently known about how
transformations in social policy, which have started in the human service
areas and now involve health entitlement programs, influence the allocation of
resources within families and across generations.  Families in different SES
situations are likely to be affected by, and to respond to, changed policies
differently, with potentially profound effects on the health and well-being of
family members.  How do diverse contextual environments condition the effects
of welfare reform? How are families in rural areas responding in comparison to
other communities? How do policies at the state and federal level interact
with community level factors to condition the response of various SES groups?
Better access to care and more knowledgeable strategies of actual utilization
are often postulated to characterize the advantages conferred by higher SES. 
With expansion of managed care systems, will SES differentials in services
utilization and health status at various ages shrink or swell?

3.  SES and physical and mental health in different population groups

Research is needed to understand how the bi-directional relationship between
SES and physical and mental health as well as the pathways and mediating
variables may differ by race/ethnicity, gender, nativity, and rural-urban
residence.  Of particular concern is the potential interaction between SES and
race/ethnicity-based discrimination and prejudice as they are related to
health and functioning.  Are the effects of SES and racism additive or
multiplicative? To what degree can SES explain racial and ethnic differences
in morbidity, disability, and mortality? What is the explanation for minority
status magnifying the effects of SES on some health outcomes?

American minority groups show considerable variation in their average
educational attainment.  On the one hand, the difference in years of school
completed between the Hispanic and white populations has markedly widened in
recent years.  Are these educational differences a significant factor in the
health and functional status of Hispanics over their lives in comparison to
other ethnic groups? Can an understanding of SES contribute to forecasting
Hispanic health and disability at advanced ages in the future? On the other
hand, Asian-American adults (ages 25-44) have attained educational levels far
exceeding those of other groups.  What health benefits, if any, is this
educational advantage likely to confer as they age?

The past decade has seen a sharp increase in both the volume and diversity of
U.S. immigration, with the majority drawn from Asia and Latin America. 
Although 18% of all U.S. births are to foreign-born women, 62% of Latino
births and 85% of Asian/Pacific Islander births are to foreign-born women.
Therefore, it is important to consider the possible impact of immigrant status
and the assimilation process among immigrants on their health over the life
course.  How does SES and changes in SES influence health and functioning
among immigrant groups?  For almost all ethnic groups, infants of immigrant
mothers experience lower rates of infant mortality and of low birth-weight
than infants of native-born mothers, despite the fact that foreign-born women
generally have lower education and income.  These differentials are
particularly striking among Mexicans, Puerto Ricans, and certain Asian
subgroups.  Is SES involved in the fact that Puerto Ricans living in New York
City have higher rates of psychological distress and major depression than
those living on the Island, who show rates comparable to the US population as
a whole? For some groups (e.g., Hmong), positive birth outcomes are coupled
with evidence of deteriorating health among older adults.  Do SES factors have
a role in explaining these apparent paradoxes?

4.  Methodological and data considerations

Until recently, many analyses of the relationship between SES and physical and
mental health have used cross-sectional data.  Social scientists who have long
been interested in the lifetime or intergenerational attainment of social
position have developed longitudinal data sets in order to follow individuals
and cohorts over time.  Longitudinal data are needed that include measures of
both health and SES processes and outcomes.  Such data sets, along with
statistical techniques for creating synthetic cohorts, could be used to
examine the critical chronological and developmental points in the life course
when the relationship between SES and health might be particularly salient.

Many of the questions outlined above may be addressed through such extant data
sets as the National Longitudinal Survey of Youth (NLSY), the Panel Study of
Income Dynamics (PSID), Health and Retirement Study (HRS), the study of Assets
and Heath Dynamics among the Oldest-Old (AHEAD), the National Longitudinal
Study of Adolescent Health (Add Health), the Longitudinal Study of Aging
(LSOA), the Wisconsin Longitudinal Survey (WLS), the Survey of Income and
Program Participation (SIPP), National Maternal and Infant Health Survey
(NMIHS), National Health and Nutrition Examination Survey (NHANES), National
Medical Expenditure Survey (NMES), Current Population Survey (CPS),
Epidemiologic Catchment Area (ECA) Program, and the Established Populations
for Epidemiologic Studies of the Elderly (EPESE).  Researchers are encouraged
to identify other appropriate extant data sets.  Moreover, a combination of
data sets and/or the use of geocode data to address contextual or multilevel
issues may be appropriate.  Similarly, researchers may want to use survey data
sets matched to death and/or birth records.  Micro-level rather than aggregate
analyses will be most appropriate for this initiative.

To address some questions, new data collection may be required.  In addition
to survey research approaches, the full range of quantitative and qualitative
approaches to hypothesis testing are appropriate, including field or
laboratory experiments, ethnographic and anthropological observational studies
that may provide insights into the relationship of SES and health throughout
the life course and across generations.

Multidisciplinary work is especially encouraged.  Advancing the understanding
of these issues is most likely to come from collaborations among disciplines
such as epidemiology, economics, demography, sociology, psychology,
neuroimmunology, endocrinology, and anthropology.  Biological approaches might
enrich demographic and behavioral research in several ways.  Potential
benefits may follow from including genetic information for use in both
behavior genetic and molecular models.  For example, understanding of race
differences in birth weight must consider biological models as well as social
factors.  The addition of genetic indicators and twin and sibling samples to
socio-behavioral surveys can help to measure the environmental component of
the gene-environment interaction.  Insights can also be gained from precedents
in nature and evolution for aging and intergenerational exchanges, and the
mathematics of intergenerational exchanges.

Cross-national data or data from other countries are appropriate if there is
demonstrated relevance to understanding of SES and health in U.S. populations. 
Examples of potentially useful survey data include, but are not limited to,
the British Child Development Survey, Russian Longitudinal Monitoring Survey,
China Health and Nutrition Survey, Cebu Longitudinal Health and Nutrition
Survey, Indonesian Family Life Survey, German Socio-Economic Panel, Second
Malaysian Family Life Survey, Luxembourg Income Study, Australian Longitudinal
Study of Aging, and Matlab (Bangladesh) Health and Socioeconomic Survey.


It is the policy of the NIH that women and members of minority groups and
their sub-populations must be included in all NIH supported biomedical and
behavioral research projects involving human subjects, unless a clear and
compelling rationale and justification is 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, Volume 23,
Number 11, March 18, 1994.

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


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


Applications are to be submitted on the grant application form PHS 398 (rev.
5/95) 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:  Applications are also available on
the World Wide Web at

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

Submit the signed, original, single-sided application, along with five exact,
single-sided copies and five collated sets of appendix materials to:

6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express/courier service)

Applicants should include sufficient funds in the budget for an annual two-day
meeting of investigators to be held at the National Institutes of Health,
Bethesda, Maryland.

Whenever original data are collected, the National Institutes of Health (NIH)
expects grantees to make available research data to the scientific community
for subsequent analyses.  Funds for data archiving and sharing may be
requested in the grant application.


Applications will be assigned on the basis of established PHS referral
guidelines.  Applications that are complete will be evaluated for scientific
and technical merit by an appropriate peer review group convened in accordance
with 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 or board.

Review Criteria

The goals of NIH-supported research are to advance our understanding of
biological systems, improve the control of disease, and enhance health.  The
reviewers will comment on the following aspects of the application in their
written critiques 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 by the reviewers 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 a 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.

o  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

o  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?

o  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?

o  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)?

o  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 support?

The initial review group will also examine: the appropriateness of proposed
project budget and duration; the adequacy of plans to include children, both
genders, and minorities and their subgroups as appropriate for the scientific
goals of the research, and plans for the recruitment and retention of
subjects; the provisions for the protection of human and animal subjects; and
the safety of the research environment.


Applications will compete for available funds with all other approved
applications.  The following will be considered in making funding decisions:

o  Quality of the proposed project as determined by peer review
o  Availability of funds
o  Program priority


Inquiries are encouraged.  The opportunity to clarify any issues or questions
from potential applicants is welcome.  Direct inquiries regarding programmatic
issues to:

Sidney M. Stahl, Ph.D.
Behavioral and Social Research
National Institute on Aging
7201 Wisconsin Avenue, Suite 533, MSC 9205
Bethesda, MD  20892-9205
Telephone:  (301) 402-4156
FAX:  (301) 402-0051

Rose Maria Li, M.B.A., Ph.D.
Center for Population Research
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8B13
Bethesda, MD  20892
Telephone:  (301) 496-1174
FAX:  (301) 496-0962

Emeline Otey, Ph.D.
Division of Mental Disorders, Behavioral Research, and AIDS
National Institute of Mental Health
5600 Fishers Lane, Room 18C-26
Telephone:  (301) 443-9400
FAX:  (301) 443-9876

Sarah S. Knox, Ph.D.
Division of Epidemiology and Clinical Applications
National Health, Lung, and Blood Institute
6701 Rockledge Drive, Room 8120, MSC 7936
Bethesda, MD  20892-7936
Telephone:  (301) 435-0409
FAX:  (301) 480-1773

Allen Dearry, Ph.D.
Division of Extramural Research and Training
National Institute of Environmental Health Sciences
P.O. Box 12233
Research Triangle Park, NC  27709
Telephone:  (919) 541-4943
FAX:  (919) 541-2843

Direct inquiries regarding fiscal matters to:

David Reiter
Grants and Contracts Management Office
National Institute on Aging
7201 Wisconsin Avenue, Suite 2N212, MSC 9205
Bethesda, MD  20892-9205
Telephone:  (301) 496-1472
FAX:  (301) 402-3672

Melinda B. Nelson
Grants Management Branch
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8A17
Bethesda, MD  20892
Telephone:  (301) 496-5481
FAX:  (301) 402-0915

Diana Trunnell
Grants Management Branch
National Institute of Mental Health
5600 Fishers Lane, Room 7C-08
Rockville, MD  20857
Telephone:  (301) 443-2805


This program is described in the Catalog of Federal Domestic Assistance No.
93.864, 93.866, 93.242, and 93.837.  Awards are made under authorization of
the Public Health Service Act, Title IV, Part A (Public Law 78-410), as
amended by Public Law 99-158, 42 USC 241 and 285) and administered under PHS
grants policies and Federal Regulations 42 CFR 52 and 45 CFR Part 74.  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, any 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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