BIOBEHAVIORAL RESEARCH FOR EFFECTIVE SLEEP

Release Date:  January 19, 2000

PA NUMBER:  PA-00-046

National Institute of Nursing Research
National Heart, Lung, and Blood Institute
National Institute on Aging
National Institute on Alcohol Abuse and Alcoholism
National Institute of Child Health and Human Development
National Institute on Drug Abuse
National Institute of Mental Health
National Cancer Institute

THIS PA USES THE "MODULAR GRANT" AND "JUST-IN-TIME" CONCEPTS.  IT INCLUDES 
DETAILED MODIFICATIONS TO STANDARD APPLICATION INSTRUCTIONS THAT MUST BE USED 
WHEN PREPARING APPLICATIONS IN RESPONSE TO THIS PA.

PURPOSE

The National Institute of Nursing Research (NINR), National Heart, Lung, and 
Blood Institute (NHLBI), National Institute on Aging (NIA), National Institute 
on Alcohol Abuse and Alcoholism (NIAAA), National Institute of Child Health 
and Human Development (NICHD), National Institute on Drug Abuse (NIDA), 
National Institute of Mental Health (NIMH), and the National Cancer Institute 
(NCI) invite applications to investigate sleep deprivation in health and 
illness.  The goal of this program announcement is to stimulate clinical and 
applied research on behavioral, psychosocial and physiological consequences of 
acute and chronic partial sleep deprivation in either chronically ill or 
healthy individuals and to develop environmental, clinical management, and 
other interventions with the potential to reduce sleep disturbances and 
significantly improve the health of large numbers of people.  Although sleep 
disorders are a cause of sleep loss in affected individuals, the questions to 
be addressed under this solicitation should focus on causes and consequences 
of sleep deprivation, apart from any sleep pathology.

HEALTHY PEOPLE 2000

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 PA, “Biobehavioral Research for 
Effective Sleep,” is related to the priority areas of health promotion and 
disease prevention.  Potential applicants may obtain a copy of "Healthy People 
2000" at http://odphp.osophs.dhhs.gov/pubs/hp2000.

ELIGIBILITY REQUIREMENTS
 
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 
Investigators.

MECHANISM OF SUPPORT

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 five years. 

Specific application instructions have been modified to reflect "MODULAR 
GRANT" and "JUST-IN-TIME" streamlining efforts being utilized by the NIH. 
Complete and detailed instructions and information on Modular Grant 
applications can be found at: 
http://grants.nih.gov/grants/funding/modular/modular.htm

RESEARCH OBJECTIVES

Background

Inadequate sleep or nonrestorative sleep has major implications for public 
health, safety, productivity, and well-being.  It has been estimated that more 
than 60 million Americans, or approximately one in three adults, experience 
inadequate sleep that can interfere with daily activities.  In fact, the 
report of the National Commission on Sleep Disorders Research concluded that 
inadequate sleep is such a pervasive problem that it appears to be accepted as 
a normal part of life.  Excessive sleepiness has been associated with 
accidents at work or at home, and at least three percent of serious automobile 
accidents and fatalities are due to a fatigued driver.  Accidents occurring as 
a result of sleep deprivation have major implications for public health and 
safety. In addition, partial and chronic sleep deprivation adversely affects 
individual job performance and quality of life.  The NIH National Sleep 
Disorders Research Plan identified research needed in basic, clinical and 
applied areas.  The basic and clinical areas of research have been the focus 
of other initiatives.  

The current program announcement focuses on the applied research areas; the 
sleep-related problems found in healthy and chronically ill individuals who 
have acute and chronic partial sleep deprivation.  Partial chronic sleep 
deprivation in healthy individuals is primarily due to external demands as 
found in shift workers, medical students, nurses and working parents.  In 
addition, sleep deprivation may be due to lifestyle choices as made by teens 
and young adults. Little is known about the consequences of sleep deprivation 
on quality of life and measures of behavioral, cognitive and psychosocial 
function.

There are many chronic health conditions that interfere with sleep.  Sleep 
disturbances are associated with Alzheimer’s Disease and other dementias, 
rheumatoid arthritis, fibromyalgia, AIDS, cancer, neurodegenerative disorders, 
chronic obstructive pulmonary disease, asthma, cardiovascular disease, urinary 
incontinence, drug abuse (as well as withdrawal from drug abuse) and chronic 
alcoholism.  Sleep deprivation can be exacerbated by pain and by environmental 
conditions associated with hospitalization and home care that are not 
conducive to restorative sleep.  Sleep deprivation can also increase the risk 
of depression in chronically ill individuals.  Research is needed on sleep 
deprivation associated with medical disorders, and their link to other mental 
disorders, symptoms, and related disabilities.

Little is known about sleep deprivation in children. A vast majority of 
children complain about feeling tired during the day and 15 percent of 
children have reported falling asleep during school at least once.  Acute and 
chronic partial sleep deprivation in children has been associated with 
decreased cognitive functioning and school performance.  Sleep deprivation may 
also be a risk factor for poor behavioral adjustment and behavioral problems 
such as attention deficit disorder. The potential consequences of sleep 
deprivation on behavior and growth across the different stages of development 
has not been well characterized.

It has been estimated that over half of the 33 million adults over 65 years of 
age have some chronic sleep complaint which contributes to personal discomfort 
and illness, to caregiver burden, and to overall health care costs.  Elderly 
individuals without sleep disorders may experience sleep disruption due to 
factors associated with the institutional care environment and/or poor sleep 
hygiene practices.

The etiology of sleep deprivation (i.e., shift work, environmental conditions, 
lifestyle, chronic illness, medical treatment related effects) needs to be 
determined and specific at-risk populations with adverse health consequences 
need to be identified, apart from sleep disorders.  Research is also needed to 
identify interventions (e.g., light therapy, behavioral interventions) to 
improve the quality of sleep in healthy and chronically ill individuals.  
Treatment approaches using sleep deprivation or phase shifting as an 
intervention for mental disorders in patients of any age is also an area of 
interest.

Listed below are examples of studies that would be responsive to this program 
announcement.  However, these are only illustrative examples and applicants 
are encouraged to propose other topics consistent with the goals of this 
program.  Not all areas are required in a single application. 

o  Identify specific chronically ill populations at increased risk (e.g., 
Alzheimer’s disease, rheumatoid arthritis, cardiopulmonary disease, cancer 
survivors, patients with alcohol problems) of chronic partial sleep 
deprivation and identify the etiology of excessive daytime sleepiness, apart 
from sleep disorders within these populations

o  Identify factors contributing to sleep deprivation (e.g., shift work, 
occupational demands, environmental conditions, alcohol and drug use, 
lifestyle choices, stress, medical treatment sequelae) and whether age, 
gender, and ethnicity may play a role

o  Determine the physiological, cognitive, behavioral, and psychosocial risks 
associated with varying lengths of sleep deprivation for both acute and 
chronic partial sleep deprivation in children, adolescents and adults

o  Elucidate the role of evening or bedtime alcohol use in sleep deprivation, 
and investigate the contribution of sleep deprivation to risk-taking behaviors 
such as drug and alcohol consumption

o  Identify effective recovery patterns following chronic partial sleep loss 
and whether rates of recovery vary by age and/or for physiological, behavioral 
and cognitive processes

o  Determine the restorative function of sleep in maintenance of health

o  Determine the relationship between menopause (natural or medically induced) 
and sleep disturbances

o  Develop interventions to improve the quality of sleep and to prevent sleep 
deprivation from occurring in healthy and chronically ill individuals across 
the lifespan including neonates, children, adolescents, adults, and older 
persons 

o  Identify strategies to help children and adults adapt to the sleep 
disturbance associated with hospitals, critical care settings, and nursing 
homes 

o  Develop and use improved approaches to assess acute and chronic sleep 
deprivation

o  Determine whether measurements of sleep quality can predict response to 
treatment of alcoholism and mental disorders across the life cycle

o  Determine how sleep patterns are affected by alcohol and psychoactive drug 
use and how the withdrawal from alcohol and drug use affects sleep patterns

o  Identify the relationship between partial sleep deprivation in children and 
adolescents and the relationship to possible effects on learning and behavior 
problems

o  Determine whether different stages of development alter the consequences of 
sleep deprivation in children and/or whether sleep is required for adequate 
growth and development

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS

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 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, Vol. 23, 
No. 11, March 18, 1994 available on the web at the following URL address: 
http://grants.nih.gov/grants/guide/notice-files/not94-100.html

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS

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: http://grants.nih.gov/grants/guide/notice-files/not98-024.html

NOTE FOR APPLICATIONS FOCUSED ON AGING RESEARCH

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 this regard applicants may use Justification 1, the 
research topic to be studied is irrelevant to children, from the policy 
announcement.

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.

APPLICATION PROCEDURES

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 301/435-
0714, 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 
http://grants.nih.gov/grants/guide/notice-files/not98-030.html

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.

BUDGET INSTRUCTIONS

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.

o DETAILED BUDGET FOR THE INITIAL BUDGET PERIOD - Do not complete Form Page 4 
of the PHS 398. It is not required and will not be accepted with the 
application.

o BUDGET FOR THE ENTIRE PROPOSED PERIOD OF SUPPORT - Do not complete 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 http://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:  
http://grants.nih.gov/grants/funding/modular/modular.htm

- 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. It is important to identify all exclusions that 
were used in the calculation of the F&A costs for the initial budget period 
and all future budget years.

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:

CENTER FOR SCIENTIFIC REVIEW
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040, MSC 7710
BETHESDA, MD 20892-7710
BETHESDA, MD 20817 (for express/courier service)

REVIEW CONSIDERATIONS

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 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. 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.

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?

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?

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?

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)?

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?

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 
evaluated.

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.

AWARD CRITERIA

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

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

Direct inquiries regarding programmatic issues to:

Karin F. Helmers, PhD
National Institute of Nursing Research
Building 45, Room 3AN-12
Bethesda, MD 20892
Tel: (301) 594-2177
Fax: (301) 480-8260
Email: karin_helmers@nih.gov

Michael Twery, Ph.D.
Division of Lung Diseases
National Heart, Lung, and Blood Institute
Rockledge 2, Suite 10018
Bethesda, MD 20892-7952
Tel: (301) 435-0202
Fax: (301) 480-3557
Email: TweryM@nhlbi.nih.gov

Andrew A. Monjan, Ph.D., M.P.H.
Neuroscience and Neuropsychology of Aging Program
National Institute on Aging
7201 Wisconsin Avenue, Suite 3C307, MSC- 9205
Bethesda, MD  20892-9205
Tel:  (301) 496-9350
Fax:  (301) 496-1494
Email:  am39m@nih.gov

Ellen Witt, Ph.D.
Division of Basic Research
National Institute on Alcohol Abuse and Alcoholism
Willco Bldg, Suite 402
6000 Executive Blvd, MSC 7003
Bethesda, MD 20892-7003
Tel:  (301) 443-6545
Fax:  (301) 594-0673
email:  ewitt@willco.niaaa.nih.gov

Lynne Haverkos, MD, MPH
Director, Behavioral Pediatrics and 
Health Promotion Research program
National Institute on Child Health and Development
6100 Executive Blvd. Rm. 4B05B  MSC 7510
Bethesda, MD  20892-7510
Tel: (301)435-6881
Fax : (301) 480-7773
email:  haverkol@mail.nih.gov

Harold W. Gordon, Ph.D.
Clinical Neurobiology Unit
Division of Treatment Research and Development 
National Institute on Drug Abuse
Neuroscience Building
Room 4234, MSC 9559
6001 Executive Boulevard
Bethesda, MD 20892-9559
Tel:  (301) 443-4877
Fax:    (301) 443-6814
Email: hg23r@nih.gov

Israel I. Lederhendler, Ph.D.
Coordinator for Sleep Research
National Institute of Mental Health
National  Institutes of Health 
6001 Executive Boulevard, Room 7-170, MSC 9637
Bethesda, MD  20892-9637 
Tel:  	301/443-1576
Fax: 301/443-4822
e-mail: ilu@helix.nih.gov

Noreen Aziz, MD, PhD, MPH
Office of Cancer Survivorship
Division of Cancer Control and Population Sciences
National Cancer Institute
6130 Executive Blvd, MSC 7339
EPN  Suite 539
Bethesda, MD  20892-7339
Tel:  (301) 496-0598
Fax: (301) 496-8675
Email:  na45f@nih.gov

Direct inquiries regarding fiscal matters to:

Cindy McDermott
Office of Grants and Contract Management
National Institute of Nursing Research
Building 45, Room 3AN-12
6300 Center Drive MSC 6301
Bethesda, MD  20892-6301
Telephone:  (301) 594-5979
Fax:  (301) 480-8260
E-mail:  cindy_mcdermott@nih.gov

Raymond Zimmerman
Grants Operations Branch
Division of Extramural Affairs
National Heart, Lung, and Blood Institute
6701 Rockledge Drive, Room 7154, MSC 7926
Bethesda, Maryland  20892_7926
Telephone:  301 435_0171
Fax:  301 480_3310
Email: ZimmermR@nih.gov  

Joe Ellis
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
E-mail:  ellisj@exmur.nia.nih.gov

Judy Simons
Grants Management Branch
National Institute on Alcohol Abuse and Alcoholism
Willco Building, Suite 504
6000 Executive Blvd, MSC 7003
Bethesda, MD 20892-7003
Phone:  (301) 443-2324
Fax:  (301) 443-3891
E-mail: jsimons@willco.niaaa.nih.gov

Edgar D. Shawver
Grants Management Branch
National Institute of Child Health and Human Development
Bldg. 6100, Rm. 8A17
9000 Rockville Pike  MSC 7510
Bethesda, Md. 20892-7510
Tel:  301 435-6999
Fax:  301 402-0915
Email:  ds117g@nih.gov

Gary Fleming, J.D., M.A.
Grants Management Branch
National Institute on Drug Abuse
The Neuroscience Center
6001 Executive Boulevard, Room 3119
Bethesda, MD 20892
Tel:  301-443-6710
Fax: 301-594-6849
e-mail:  gf6s@nih.gov

Diana S. Trunnell
Grants Management Branch
National Institute of Mental Health
6001 Executive Boulevard, MSC 9605
Bethesda, MD  20892-9605
Tel:  301-443-2805
Fax: 301-443-6885
e-mail:  Diana_Trunnell@nih.gov

Bill Wells
Executive Plaza South 243 
Grants Administration Branch 
National Cancer Institute 
Bethesda, MD, 20892 
Tel: 301-496-8796  
Fax: 301-496-8601
e-mail: ww14j@nih.gov

AUTHORITY AND REGULATIONS 

This program is described in the Catalog of Federal Domestic Assistance No. 
93.361 (NINR), No. 93.837 (NHLBI), No. 93.866 (NIA), No. 93.273 (NIAAA), No. 
93.865 (NICHD), No. 93.279 (NIDA), No. 93.242 (NIMH), and No. 93.399  (NCI). 
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 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. Awards will be administered under NIH grants policy as 
stated in the NIH Grants Policy Statement (10-98).

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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