PHARMACOLOGICAL APPROACHES TO ENHANCE NEUROMODULATION IN REHABILITATION 

RELEASE DATE:  July 22, 2002
 
RFA:  HD-02-023  
 
National Institute of Child Health and Human Development (NICHD) 
 (http://www.nichd.nih.gov) 

National Institute on Deafness and Other Communication Disorders (NIDCD)
 (http://www.nidcd.nih.gov) 

National Institute of Neurological Disorders and Stroke (NINDS)
 (http://www.ninds.nih.gov) 

LETTER OF INTENT RECEIPT DATE:  September 27, 2002

APPLICATION RECEIPT DATE:  October 25, 2002
 
THIS RFA CONTAINS THE FOLLOWING INFORMATION

o Purpose of this RFA
o Research Objectives
o Mechanisms of Support 
o Funds Available
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Where to Send Inquiries
o Letter of Intent
o Submitting an Application
o Peer Review Process
o Review Criteria
o Receipt and Review Schedule
o Award Criteria
o Required Federal Citations

PURPOSE OF THIS RFA  

Pharmacological compounds have the potential to enhance functional recovery 
in rehabilitation, especially when used in conjunction with behavioral and 
physical therapy.  This Request for Applications (RFA) supports studies 
relevant to the treatment of neurological conditions such as stroke, brain 
trauma, spinal cord injury, neurodevelopmental and neurodegenerative 
disorders, infections, and neurosurgery.  Applications in response to this 
RFA must focus on rehabilitative strategies rather than the reduction of 
acute pathology.  They may include studies involving synaptic plasticity, 
neurotransmitter interactions, neurotrophic mechanisms, pain or fatigue, or 
any other neurological mechanisms that accelerate the recovery process, 
enhance function or reduce disability.  Studies in validated animal models 
may be proposed, provided they include appropriate functional outcomes.  
Pilot clinical trials in humans may also be considered.   

RESEARCH OBJECTIVES  

Background

Several studies over the last few decades have examined the influence of 
environmental activity on the neural substrate.  Proper activity is necessary 
for the development of appropriate connections in motor, cognitive, and 
behavioral systems.  Animals raised in enriched environments develop more 
elaborate synaptic connections with corresponding functional benefits.  
Conversely, sensory deprivation has adverse effects on synaptic development 
with lasting functional consequences.  These same principles have been 
applied to clinical and educational settings where early experience and 
enriched environments are used to enhance development and learning in 
children.  

More recently, these principles have been extended into the rehabilitative 
setting, for many of the mechanisms that drive initial neuronal development 
reappear during regeneration and recovery.  Therapeutic exercise is used to 
enhance existing and regenerating neuronal pathways.  The NIH is currently 
supporting clinical trials to examine the use of weight-supported treadmill 
training to stimulate gait in individuals with spinal cord injury and 
constraint-induced therapy to enhance the use of impaired limbs by stroke 
patients.  Other rehabilitative approaches involve the use of therapeutic 
training to improve cognitive and behavioral function.    

Pharmacological compounds could further enhance the benefits of 
rehabilitative therapies through several possible mechanisms.  Psychoactive 
drugs that stimulate appropriate neurotransmitter pathways have the potential 
to enhance or modulate synaptic function.  Similar approaches have been used 
to delay cognitive decline in neurodegenerative disorders (e.g., cholinergic 
treatments for Alzheimer disease) or to sharpen attention in childhood 
behavioral disorders.  Another possibility is the use of neurotrophic 
compounds to stimulate synaptic regeneration, improve synaptic efficacy or 
enhance other neurocellular processes.  Drugs that reduce pain or fatigue 
could enhance the benefits of exercise and improve compliance.  
Neuroendocrine factors have been shown to influence recovery from traumatic 
brain injury and may explain gender differences.  This RFA provides incentive 
for multidisciplinary groups to develop proposals to extend these promising 
findings into clinical rehabilitation.

Research Scope

Applications submitted in response to this RFA should examine strategies for 
using pharmacological agents to enhance rehabilitation.  The focus must be on 
the rehabilitative phase, rather than on preventing injury, minimizing acute 
pathology or reducing ongoing degeneration.  Studies in animal models may be 
included if they have the potential for developing rehabilitative strategies.   

Rehabilitative strategies may target motor or sensory function, behavior, 
cognition, and/or memory.  The focus should be on neurological conditions 
rather than those primarily involving muscle, cardiovascular function or 
metabolism.  Applicants are encouraged to provide a mechanistic basis for the 
use of pharmacological interventions in a rehabilitative context and to 
discuss the potential for incorporation into clinical settings.

A major priority in the NIDCD strategic plan is the development and 
improvement of devices, pharmacologic agents, and strategies for 
habilitation/rehabilitation of human communication disorders.  The NIDCD 
would be specifically interested in applications responsive to this RFA 
focused in the areas of hearing (e.g., cochlear implants), balance, voice 
(e.g., spasmodic dysphonia), speech, language (e.g., aphasia), and the 
chemical senses of taste and smell (e.g., anosmia and ageusia).  
 
Applications responsive to this RFA may include studies in animal models or 
pilot clinical trials in humans.  Research topics may include, but are not 
limited to, the following:

o  Anatomical correlates of functional recovery, plasticity, and adaptation 
to evaluate pharmacological interventions;

o  Use of pharmacotherapy to accelerate recovery of sensory or motor 
functions following disease or injury (e.g., vestibular compensation);

o  Interaction of pharmacological compounds with behavioral and/or physical 
therapy approaches;

o  Use of pharmacological approaches to enhance the efficacy of or compliance 
with behavioral and physical therapy regimes;  

o  Improved models for evaluating the interaction of neuroactive compounds 
and therapeutic approaches in rehabilitation;

o  Studies of focal delivery of pharmacological agents to target specific 
areas of central nervous system and studies to investigate the effects of 
localized neuromodulation;
 
MECHANISM OF SUPPORT
 
This RFA will use the NIH Research Project Grant (R01) and the 
Exploratory/Developmental Research Grant (R21) award mechanisms.  As an 
applicant you will be solely responsible for planning, directing, and 
executing the proposed project.  This RFA is a one-time solicitation.  Future 
unsolicited, competing continuation R01 applications based on this project 
will compete with all investigator-initiated applications and will be 
reviewed according to the customary peer review procedures.  The anticipated 
award date is July 1, 2003.

The R01 mechanism is recommended for proposals in well-established areas, 
especially where there is significant preliminary data.  The R21 mechanism is 
used for support of creative, novel, and/or high risk/high payoff approaches 
that could produce innovative advances in this field.  This includes 
feasibility studies, protocol planning, and the incorporation of new 
disciplines and technologies.  The R21 provides the means to acquire the 
necessary pilot information, to attract talented new investigators from 
related disciplines, and to foster the development of interdisciplinary, 
inter-institutional collaborative efforts among investigators with diverse 
training and expertise.  R21 grants are non-renewable, and may not be used to 
supplement an ongoing project. 

This RFA uses just-in-time concepts.  It also uses the modular budgeting 
format (see http://grants.nih.gov/grants/funding/modular/modular.htm).   
Specifically, if you are submitting an application with direct costs in each 
year of $250,000 or less, use the modular format.

FUNDS AVAILABLE
 
 
The participating institutes intend to commit approximately $2.4 million 
(NICHD $1.5 million, NIDCD $500,000 and NINDS $400,000) in total costs 
[Direct plus Facilities and Administrative (F & A) costs] in FY 2003 to fund 
new and/or competitive continuation grants in response to this RFA.  An 
applicant for an R01 may request a project period of up to five years and a 
budget for direct costs of up to $250,000 per year.  An applicant for an R21 
may request a project period of up to three years and a budget of $100,000 
per year in direct costs.  Because the nature and scope of the proposed 
research will vary from application to application, it is anticipated that 
the size and duration of each award will also vary.  Although the financial 
plans of the NICHD, NIDCD, and NINDS provide support for this program, awards 
pursuant to this RFA are contingent upon the availability of funds and the 
receipt of a sufficient number of meritorious applications.
 
ELIGIBLE INSTITUTIONS
 
You may submit an application if your institution has any of the following 
characteristics: 

o For-profit or non-profit organizations 
o Public or private institutions, such as universities, colleges, hospitals, 
and laboratories 
o Units of State and local governments
o Eligible agencies of the Federal government  
o Domestic or foreign
 
INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS   

Any individual with the skills, knowledge, and resources necessary to carry 
out the proposed research is invited to work with their institution to 
develop an application for support.  Individuals from underrepresented racial 
and ethnic groups as well as individuals with disabilities are always 
encouraged to apply for NIH programs.   

WHERE TO SEND INQUIRIES

We encourage inquiries concerning this RFA and welcome the opportunity to 
answer questions from potential applicants.  Inquiries may fall into three 
areas:  scientific/research, peer review, and financial or grants management 
issues:

o Direct your questions about scientific/research issues to:

Ralph M. Nitkin, Ph.D.
Program Director, Biological Sciences and Career Development
National Center for Medical Rehabilitation Research
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 2A03, MSC 7510
Bethesda, MD  20892-7510
Telephone:  (301) 402-2242
FAX:  (301) 402-0832
Email:  rn21e@nih.gov 

Lana Shekim, Ph.D.
Program Director, Voice and Speech
Scientific Programs Branch, DER
National Institute on Deafness and Other Communication Disorders
6120 Executive Blvd., EPS-400-C, MSC 7180
Bethesda, MD  20892-7180
Telephone:  (301) 496-5061
FAX:  (301) 402-6251
Email:  shekiml@nidcd.nih.gov

Daofen Chen, Ph.D.
Program Director, Channels/Synapses/Circuits
National Institute of Neurological Disorders and Stroke
6001 Executive Boulevard, Room 2131, MSC 9523
Bethesda, MD 20892-9523
Telephone:  (301) 496-1917
FAX:  (301) 402-1501 
Email:  daofen_chen@nih.gov 

o Direct your questions about peer review issues to:

Robert Stretch, Ph.D.
Director, Division of Scientific Review
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 5B01, MSC 7510
Bethesda, MD  20892-7510
Telephone:  (301) 496-1485
FAX:  (301) 402-4104
Email:  rs365s@nih.gov 

o Direct your questions about financial or grants management matters to:

Christopher Myers
Grants Management Branch
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8A17H, MSC 7510
Bethesda, MD  20892-7510
Telephone:  (301) 496-6996
FAX:  (301) 496-0915
Email:  cm143g@nih.gov 

Sara Stone
Chief, Grants Management Branch
National Institute on Deafness and Other Communication Disorders
6120 Executive Boulevard, Room 400B, MSC 7180
Bethesda, MD 20892-7180 
Telephone:  (301) 402-0909
FAX:  (301) 402-1758
Email:  stones@nidcd.nih.gov

Aricia Cottman
Grants Specialist
National Institute of Neurological Disorders and Stroke
6001 Executive Boulevard, Room 3290, MSC 9537
Bethesda, MD  20892-9537
Telephone:  (301) 496-8072  
FAX:  (301) 402-0219   
Email:  ac195q@nih.gov 
  
LETTER OF INTENT
 
Prospective applicants are asked to submit a letter of intent that includes 
the following information:

o Descriptive title of the proposed research
o Name, address, and telephone number of the Principal Investigator
o Names of other key personnel 
o Participating institutions
o Number and title of this RFA 

Although a letter of intent is not required, is not binding, and does not 
enter into the review of a subsequent application, the information that it 
contains allows NICHD staff to estimate the potential review workload and 
plan the review.
 
The letter of intent is to be sent by the date listed at the beginning of 
this document.  The letter of intent should be sent to:

Ralph M. Nitkin, Ph.D.
National Center for Medical Rehabilitation Research
National Institute of Child Health and Human Development
Building 6100E, Room 2A03, MSC 7510
Bethesda, MD  20892-7510
Telephone:  (301) 402-2242
FAX:  (301) 402-0832
Email:  rn21e@nih.gov 

SUBMITTING AN APPLICATION

Applications must be prepared using the PHS 398 research grant application 
instructions and forms (rev. 5/2001).  The PHS 398 is available at 
http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive 
format.  For further assistance contact GrantsInfo, Telephone (301) 435-0714, 
Email: GrantsInfo@nih.gov.

SUPPLEMENTAL INSTRUCTIONS:  The Research Plan for an R21 application need not 
include preliminary data and should be limited to 15 pages.  Appendices may 
not be submitted.

SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS:  Applications 
requesting up to $250,000 per year in direct costs must be submitted in a 
modular grant format.  The modular grant format simplifies the preparation of 
the budget in these applications by limiting the level of budgetary detail.  
Applicants request direct costs in $25,000 modules.  Section C of the 
research grant application instructions for the PHS 398 (rev. 5/2001) at 
http://grants.nih.gov/grants/funding/phs398/phs398.html includes step-by-step 
guidance for preparing modular grants.  Additional information on modular 
grants is available at 
http://grants.nih.gov/grants/funding/modular/modular.htm.

USING THE RFA LABEL:  The RFA label available in the PHS 398 (rev. 5/2001) 
application form must be affixed to the bottom of the face page of the 
application.  Type the RFA number on the label.  Failure to use this label 
could result in delayed processing of the application such that it may not 
reach the review committee in time for review.  In addition, the RFA title 
and number must be typed on line 2 of the face page of the application form 
and the YES box must be marked.  The RFA label is also available at: 
http://grants.nih.gov/grants/funding/phs398/label-bk.pdf.
 
SENDING AN APPLICATION TO THE NIH:  Submit a signed, typewritten original of 
the application, including the Checklist, and three 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)
 
At the time of submission, two additional copies of the application must be 
sent to:

Robert Stretch, Ph.D.
Director, Division of Scientific Review
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 5B01, MSC 7510
Bethesda, MD  20892-7510
Rockville, MD 20852 (for express/courier service)
Telephone:  (301) 496-1485
 
APPLICATION PROCESSING:  Applications must be received by the application 
receipt date listed in the heading of this RFA.  If an application is 
received after that date, it will be returned to the applicant without 
review.
 
The Center for Scientific Review (CSR) will not accept any application in 
response to this RFA that is essentially the same as one currently pending 
initial review, unless the applicant withdraws the pending application.  The 
CSR will not accept any application that is essentially the same as one 
already reviewed. This does not preclude the submission of substantial 
revisions of applications already reviewed, but such applications must 
include an Introduction addressing the previous critique.

PEER REVIEW PROCESS  
 
Upon receipt, applications will be reviewed for completeness by the CSR and 
for responsiveness by the NICHD, NIDCD, and NINDS.  

Incomplete and/or non-responsive applications will be returned to the 
applicant without further consideration.  

Applications that are complete and responsive to the RFA will be evaluated 
for scientific and technical merit by an appropriate peer review group 
convened by the NICHD in accordance with the review criteria stated below.  
As part of the initial merit review, all applications will:

o Receive a written critique
o Undergo a process in which only those applications deemed to have the 
highest scientific merit, generally the top half of the applications under 
review, will be discussed and assigned a priority score
o Receive a second level review by the National Advisory Child Health and 
Human Development Council, the National Advisory Deafness and Other 
Communications Disorders Council, and the National Advisory Neurological 
Disorders and Stroke 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 your application in order to judge the likelihood that the 
proposed research will have a substantial impact on the pursuit of these 
goals: 

o Significance 
o Approach 
o Innovation
o Investigator
o Environment
  
The scientific review group will address and consider each of these criteria 
in assigning your application's overall score, weighting them as appropriate 
for each application.  Your 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, you 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 your study address an important problem? If the aims 
of your application are achieved, how do they advance scientific knowledge?  
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?  Do you acknowledge potential problem areas and consider alternative 
tactics?

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

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

(5) ENVIRONMENT:  Does the scientific environment in which your 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?

ADDITIONAL REVIEW CRITERIA:  In addition to the above criteria, your 
application will also be reviewed with respect to the following:

o PROTECTIONS:  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.

o INCLUSION:  The adequacy of plans to include subjects from both genders, 
all racial and ethnic groups (and subgroups), and children as appropriate for 
the scientific goals of the research.  Plans for the recruitment and 
retention of subjects will also be evaluated. (See Inclusion Criteria 
included in the section on Federal Citations, below.)

o DATA SHARING:  The adequacy of the proposed plan to share data. 

o BUDGET:  The reasonableness of the proposed budget and the requested period 
of support in relation to the proposed research.

RECEIPT AND REVIEW SCHEDULE

Letter of Intent Receipt Date:  September 27, 2002
Application Receipt Date:  October 25, 2002
Peer Review Date:  February/March 2003
Council Review:  May/June 2003
Earliest Anticipated Start Date:  July 1, 2003 

AWARD CRITERIA

Criteria that will be used to make award decisions include:

o Scientific merit (as determined by peer review)
o Availability of funds
o Programmatic priorities.
 
REQUIRED FEDERAL CITATIONS 

MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD:  Research components 
involving Phase I and II clinical trials must include provisions for 
assessment of patient eligibility and status, rigorous data management, 
quality assurance, and auditing procedures.  In addition, it is NIH policy 
that all clinical trials require data and safety monitoring, with the method 
and degree of monitoring being commensurate with the risks (NIH Policy for 
Data Safety and Monitoring, NIH Guide for Grants and Contracts, June 12, 
1998: http://grants.nih.gov/grants/guide/notice-files/not98-084.html).  

INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH:  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 clinical research projects unless a 
clear and compelling justification is provided indicating 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 clinical research should read the AMENDMENT "NIH 
Guidelines for Inclusion of Women and Minorities as Subjects in Clinical 
Research - Amended, October, 2001," published in the NIH Guide for Grants and 
Contracts on October 9, 2001 
(http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html); a complete 
copy of the updated Guidelines is available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm.
The amended policy incorporates: the use of an NIH definition of clinical 
research; updated racial and ethnic categories in compliance with the new OMB 
standards; clarification of language governing NIH-defined Phase III clinical 
trials consistent with the new PHS Form 398; and updated roles and 
responsibilities of NIH staff and the extramural community.  The policy 
continues to require for all NIH-defined Phase III clinical trials that: a) 
all applications or proposals and/or protocols must provide a description of 
plans to conduct analyses, as appropriate, to address differences by 
sex/gender and/or racial/ethnic groups, including subgroups if applicable; 
and b) investigators must report annual accrual and progress in conducting 
analyses, as appropriate, by sex/gender and/or racial/ethnic group 
differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS: 
The NIH maintains a policy 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 is available at 
http://grants.nih.gov/grants/funding/children/children.htm. 

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS:  NIH 
policy requires education on the protection of human subject participants for 
all investigators submitting NIH proposals for research involving human 
subjects.  You will find this policy announcement in the NIH Guide for Grants 
and Contracts Announcement, dated June 5, 2000, at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.

HUMAN EMBRYONIC STEM CELLS (hESC):  Criteria for federal funding of research 
on hESCs can be found at http://grants.nih.gov/grants/stem_cells.htm and at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-005.html.  Only 
research using hESC lines that are registered in the NIH Human Embryonic Stem 
Cell Registry will be eligible for Federal funding (see http://escr.nih.gov).   
It is the responsibility of the applicant to provide the official NIH 
identifier(s)for the hESC line(s)to be used in the proposed research.  
Applications that do not provide this information will be returned without 
review. 

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT:  The 
Office of Management and Budget (OMB) Circular A-110 has been revised to 
provide public access to research data through the Freedom of Information Act 
(FOIA) under some circumstances.  Data that are (1) first produced in a 
project that is supported in whole or in part with Federal funds and (2) cited 
publicly and officially by a Federal agency in support of an action that has 
the force and effect of law (i.e., a regulation) may be accessed through FOIA.  
It is important for applicants to understand the basic scope of this 
amendment.  NIH has provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this RFA in a public 
archive, which can provide protections for the data and manage the 
distribution for an indefinite period of time.  If so, the application should 
include a description of the archiving plan in the study design and include 
information about this in the budget justification section of the 
application.  In addition, applicants should think about how to structure 
informed consent statements and other human subjects procedures given the 
potential for wider use of data collected under this award.

URLs IN NIH GRANT APPLICATIONS OR APPENDICES:  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.  Furthermore, we 
caution reviewers that their anonymity may be compromised when they directly 
access an Internet site.

HEALTHY PEOPLE 2010:  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 RFA 
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.

AUTHORITY AND REGULATIONS:  This program is described in the Catalog of 
Federal Domestic Assistance Nos. 93.929, 93.173, and 93.853 and is not 
subject to the intergovernmental review requirements of Executive Order 12372 
or Health Systems Agency review.  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 described at 
http://grants.nih.gov/grants/policy/policy.htm and under Federal Regulations 
42 CFR 52 and 45 CFR Parts 74 and 92.  

The PHS strongly encourages all grant recipients to provide a smoke-free 
workplace and discourage the 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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