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ETHICAL, LEGAL, AND SOCIAL IMPLICATIONS (ELSI) OF HUMAN GENETICS AND GENOMIC RESEARCH SMALL GRANT PROGRAM Release Date: September 22, 2000 PA NUMBER: PA-00-132 National Human Genome Research Institute National Institute on Aging National Institute on Drug Abuse National Institute on Deafness and Other Communication Disorders National Institute of Mental Health THIS RFA 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 RFA/PA. This Program Announcement is complementary to the ELSI Regular Research Grant (R01) and ELSI Education Grant (R25) Program Announcements. PURPOSE This Small Grant (R03) Program Announcement (PA) is designed to solicit small research projects that anticipate, analyze, and address the ethical, legal, and social implications (ELSI) of the discovery of new genetic technologies and the availability and use of genetic information resulting from human genetics and genomic research. Of particular interest are studies that: 1) examine the issues surrounding the completion of the human DNA sequence and the study of human genetic variation; 2) examine the issues raised by the integration of genetic technologies and information into health care and public health activities; 3) examine the issues raised by the integration of knowledge about genomics and gene-environment interactions into non-clinical settings; 4) explore the ways in which new genetic knowledge may interact with a variety of philosophical, theological, and ethical perspectives; and 5) explore how socioeconomic factors, gender, and concepts of race, ethnicity and culture influence the use and interpretation of genetic information, the utilization of genetic services, and the development of policy. This Small Grant Program Announcement, which is limited to applications requesting up to $50,000 in direct costs per year, makes use of a streamlined application process and is designed to encourage the development of small, focused research projects by legal, historical, ethics and social sciences scholars whose analytical style of inquiry often has not been adequately encouraged or supported by the more traditional NIH R01 application process. It is also designed to support smaller exploratory studies that may provide preliminary findings for larger research proposals in all research areas of interest. Applications requesting more than $50,000 in direct costs should be submitted under the ELSI Regular Research Grant (R01) PA, which is available online at: http://grants.nih.gov/grants/guide/pa-files/PA-00-133.html. Education grant applications should be submitted under the ELSI Education Grant (R25) PA, which is available online at: http://grants.nih.gov/grants/guide/pa-files/PA-00-134.html. The ELSI Research Program also will accept conference grant (R13) applications. These applications are limited to $50,000 and to conferences that are highly focused and result in a specific product, such as the publication of conference proceedings or policy recommendations in a journal article or book. For specific application guidelines and instructions for each of the participating National Institutes of Health (NIH) Institutes and Centers (ICs), applicants should refer to the “Guidelines for Support of Scientific Meetings by NIH,” which are available online at http://grants.nih.gov/grants/guide/notice-files/not98-151.html. 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 PA, “Ethical, Legal, and Social Implications of Human Genetics and Genomic Research”, is related to one or more of the priority areas identified in that report. Potential applicants may obtain a copy of "Healthy People 2010" at http://www.health.gov/healthypeople/. ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic and foreign for-profit and non- profit organizations–either public or 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. Participation in the program by investigators at minority institutions is strongly encouraged. Investigators from foreign institutions should be aware that, in the area of ethical, legal and social issues, the standard NIH criteria for funding foreign applications are applied very strictly (see Award Criteria below). These investigators are strongly encouraged to contact program staff before preparing an application. To be eligible for this award, the proposed Principal Investigator must be an independent investigator. That is, he or she should be genuinely independent of a mentor. Individuals in the final stages of training may apply, but individuals can not be in a training status at the time the award is made. MECHANISMS OF SUPPORT This PA will use the NIH small grants (R03) mechanism. Applicants may request up to $50,000 in direct costs per year for up to two years. All applicants are encouraged to speak with ELSI Research Program staff before submitting an application. 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 http://grants.nih.gov/grants/funding/modular/modular.htm RESEARCH OBJECTIVES Background and Significance The NIH, along with several other federal and private national and international organizations, is currently engaged in a research effort known as the Human Genome Project (HGP). This project is designed to characterize the human genome and the genomes of selected model organisms. The HGP currently has several interrelated goals: the determination of the complete nucleotide sequence of human DNA and the DNA of several model organisms; the development of new technologies to make sustained high throughput DNA sequencing efficient, accurate and cost effective; the exploration of human genome sequence variation; the development of technologies for interpreting the function of DNA sequence; the identification and analysis of the ethical, legal, and social implications of this research; and research training. The knowledge and technologies that will become available as a result of accomplishing these goals will: serve as a resource for studies of gene structure and function; promote research into the genetic aspects of human growth, development, and variability; increase the understanding of genetic contributions to human diseases and disorders; and inform clinical and health policies related to genetics. This understanding will lead to insights into new ways of dealing with health and disease, including new risk identification, risk reduction, diagnostic and therapeutic options. It will also help to elucidate more clearly the interaction between genes and the environment in the development of disease. As the Human Genome Project draws closer to completion of the final “finished” human DNA sequence, researchers are focusing increasing attention on the discovery of variations found in the DNA sequences among individuals. The identification, classification, quantification and analysis of these genetic sequence variations is expected to constitute one of the most powerful, and direct, approaches to the study of a wide range of important biological questions. It will allow researchers to identify genetic contributions to many common diseases and disorders, such as diabetes, heart disease, depression and other forms of mental illness, deafness and hearing impairment, and some forms of cancer. It will also provide the basis for studying how genetic variation influences gene function in human growth and development. Knowing the entire sequence of the human genome and understanding more about genetic variation among individuals and groups will, however, raise a number of ethical, legal, and social issues. These include: how to design and conduct genetic and genomic research, not only in a scientifically sound, but also an ethical manner; how to interpret and use this information; whether and how to integrate this information into clinical settings; and what impact this information will have in non-clinical and research settings. Many of these issues may be of special concern to individuals from diverse communities who traditionally have not been involved in genetics and genomics research, or who may have been adversely affected in the past by certain types of research. On the one hand, the exclusion of certain groups from research studies has contributed to disparities in the diagnostic and treatment options available to members of these groups. On the other hand, the inclusion of members of these populations in some early genetic studies may have led to an increase in stigmatization and to the potential for discrimination in employment, health care, insurance, or society more broadly. These issues may become even more pressing if ongoing research reveals data on the interactions among genotype, diseases or traits, and traditional, socially-constructed concepts of race, ethnicity and culture. Research Scope and Objectives This program announcement emphasizes the ongoing commitment of the NIH to support research and educational activities related to these and other ethical, legal, and social implications of human genetics and genomic research. The ultimate mission of the ELSI Research Program is to support research and education activities that: 1) promote genetic privacy and fair use of genetic information; 2) encourage the responsible integration of new genetic information and technologies into clinical and non-clinical settings; 3) ensure that genetic research is conducted in an ethical manner; and 4) improve public and professional understanding about genetics, genome technology and related ethical, legal and social issues. In July 1997, the ELSI Research Planning and Evaluation Group (ERPEG) was created to evaluate the portfolio of ELSI research grants and develop goals and recommendations to help guide and strengthen the ELSI research program. In February 2000, ERPEG released their final report (http://www.nhgri.nih.gov:80/About_NHGRI/Der/Elsi/erpeg_report.pdf), which included five goals to help guide ELSI research over the next few years and a series of programmatic recommendations for enhancing the ELSI research program. The five research goals, which were originally published in the October 1998 issue of “Science” as part of the five year plan for the HGP were designed to capture some of the emerging topics in genetics research and to help focus the ELSI research agenda through the year 2003. The goals, described below, should be seen as a guide to areas of particular interest to the ELSI Research Program, but should not be interpreted as an exhaustive listing of all possible research topics. As genetic research evolves and the interpretation and use of genetic information continue to emerge, applicants are encouraged to identify additional research topics and issues. To demonstrate the breadth and complexity of these goals, examples of possible research questions are provided. These examples are meant only to give a flavor of the possible issues to be addressed, and are not, in any sense, exhaustive or comprehensive. (1) Examine the issues surrounding the completion of the human DNA sequence and the study of human genetic variation. o What strategies should be used to balance the needs for privacy and safety of individuals and groups with the scientific goals of creating resources for DNA sequencing and human variation research? o Will the discovery of DNA polymorphisms influence current concepts of race, ethnicity, and culture? o What new concerns are being raised by the commercialization and patenting of DNA sequence information in the public, academic and private sectors? o How will genetic data accumulated in research projects be protected when there is overlap with patient clinical records that might be more freely accessible by health care, public health and commercial interests? (2) Examine the issues raised by the integration of genetic technologies and information into health care and public health activities. o What are the clinical and societal implications of identifying common polymorphisms that predict disease susceptibility or resistance? o What are the potential risks and benefits of integrating genetic testing for complex diseases, behaviors, and other traits into health care? o What are the most effective strategies for integrating genetic information and technologies into clinical settings in ways that help practitioners see health and disease in a genetic context and what will be the ethical, legal and social consequences of their increasing availability and use? o Will the availability of genetic information influence provider practice? o Will the availability of genetic information influence individual behavior with regard to adherence to screening or therapeutic recommendations? o Will the availability of genetic information reduce morbidity and mortality, and/or reduce health care costs? o What factors influence: who develops and regulates new reproductive genetic technologies; which technologies are incorporated into medical practice; and which technologies are accepted or rejected by the public? (3) Examine issues raised by the integration of knowledge about genomics and gene-environment interactions into non-clinical settings. o What are appropriate and inappropriate uses of genetic testing in the employment setting? o What issues emerge from the collection, storage and use of blood and other tissue samples, including collections by the military, civil and criminal justice systems, commercial entities, and federal and state public health agencies? o What are the implications of obtaining genetic information for use in adoption proceedings and establishment of child custody and child support? o What are the implications of potential commercial applications resulting from the availability of genetic information about individuals and groups? o What are the potential uses and abuses of genetic information in educational settings? (4) Explore the ways in which new genetic knowledge may interact with a variety of philosophical, theological, and ethical perspectives. o Will continuing research in molecular biology and functional genomics affect how individuals and society view the relationship of humans to one another and to the rest of the living world? o What are the implications of behavioral genetics for traditional notions of personal, social and legal responsibility? o What are the implications of genetic enhancement technologies for conceptions of humanity? (5) Explore how socioeconomic factors, gender, and concepts of race, ethnicity and culture influence the use and interpretation of genetic information, the utilization of genetic services, and the development of policy. o How are individual views about the value of genetic research, the importance of access to genetic services, and the meaning and relevance of genetic information affected by concepts of race, ethnicity and culture and by socioeconomic factors? o How is the impact of genetic testing in clinical and non-clinical settings affected by concepts of race, ethnicity and culture and other social or economic factors? o In what ways are access to, and use of, genetic information and services affected by ethnicity, race, culture or socioeconomic status? o What are the most effective strategies to ensure that genetic counseling and other genetic services are culturally sensitive and relevant? o What if any effect will new genetic discoveries have on existing health disparities among various populations. The research design should be appropriate to the nature of the project(s) proposed and the discipline(s) involved. Interdisciplinary, collaborative projects between genome scientists, ethicists, clinical genetics researchers, other clinical researchers, nurse researchers, mental health researchers, social scientists, legal scholars, and/or educators are particularly encouraged. Applicants must address the full range of views on each issue they select to investigate in a responsible, scholarly, and balanced manner, with the goal of advancing scholarship, achieving better understanding, and/or developing useful recommendations. Projects that use the interpretive methods traditional to humanities, law, and the social sciences are encouraged. This program announcement is designed to be complementary to several other National Human Genome Research Institute (NHGRI), National Institutes of Health (NIH), and other Interagency Program Announcements. A complete listing of these announcements is available at the end of the “Research Objectives” section of the Regular Research ELSI PA [http address]. 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 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 are 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 research involving human subjects should read the UPDATED "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research," published in the NIH Guide for Grants and Contracts on August 2, 2000 (http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-048.html); a complete copy of the updated Guidelines are available at http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm: The revisions relate to NIH defined Phase III clinical trials and require: a) all applications or proposals and/or protocols to 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) all investigators to report accrual, and to conduct and report analyses, as appropriate, by sex/gender and/or racial/ethnic group differences. 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. 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. URLs IN NIH GRANT APPLICATIONS AND APPENDICES All applications and proposals for NIH funding must be self-contained within specified page limits. 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 the Internet site. 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, or on the Internet at http://grants.nih.gov/grants/funding/phs398/phs398.html 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. For the purposes of this ELSI small grant program announcement, all of the participating institutes have agreed on the following guidelines and will use the standard application receipt dates. Institute specific small grant program guidelines and receipt dates should not be used in responding to this announcement. 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. The application should not exceed a total of ten pages for the following sections: specific aims, background and significance, progress report/preliminary studies, and experimental design and methods. Tables and figures are included in the ten page limitation. The ten page limit does not include Sections 5-9 (Human Subjects, Consortia, Literature cited) or the appendices. All small grant (R03) applications must use the modular grant application instructions. Complete instructions and information on Modular Grant applications can be found at http://grants.nih.gov/grants/funding/modular/modular.htm. 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. SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS BUDGET INSTRUCTIONS Modular Grant applications will request direct costs in $25,000 modules, up to a total direct cost request of $50,000 per year. 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 $50,000) 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 all 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. 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. 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 to specific ICs 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. In the review of small grant (R03) applications, additional weight will be given to the qualifications and track record of the principal investigator and the significance and timeliness of the issue being addressed. 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 methods? 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 support? 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: scientific merit of the proposed project as determined by peer review, availability of funds, and program priority. Grant funds may be used for expenses clearly related and necessary to conduct the proposed research, including both direct costs and allowable facilities and administration (indirect) costs. Grant funds may not be used to create a treatment, rehabilitation or other service program. In order for the NIH to fund applications from foreign institutions, the application must meet the following three criteria: (1) The proposed project must have special relevance to the mission and objectives of the awarding organization and have the potential to advance knowledge that will benefit the United States; (2) The project must present special opportunities for furthering research programs through the use of unusual talent, resources, populations, or environmental conditions in other countries which are not readily available in the United States or which provide augmentation of existing U.S. resources; and (3) The foreign grant application must be in the upper half of the research grant priority scores. INQUIRIES Inquiries are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct general inquiries regarding programmatic issues to: The ELSI Research Program National Human Genome Research Institute Building 31, Room B2B07 31 Center Drive, MSC 2033 National Institutes of Health Bethesda, MD 20892-2033 TEL: (301) 402-4997 FAX: (301) 402-1950 E-mail: elsi@nhgri.nih.gov Specific programmatic contacts at each of the participating NIH Institutes can be found at the following website: http://www.nhgri.nih.gov/ELSI/R03contacts.html Direct general inquiries regarding fiscal matters to: Grants Administration Branch Division of Extramural Research National Human Genome Research Institute Building 31, Room B2B34 31 Center Drive, MSC 2031 Bethesda, MD 20892-2031 TEL: (301) 435-7858 FAX: (301) 402-1951 E-mail: jc166o@nih.gov Specific fiscal contacts at each of the participating NIH Institutes can be found at the following website: http://www.nhgri.nih.gov/ELSI/R03contacts.html AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.172, Human Genome Research; No. 93.866, National Institute on Aging; No. 93.865, National Institute of Child Health and Human Development; No. 93.279, National Institute on Drug Abuse; No. 93.173, National Institute on Deafness and Other Communication Disorders; No. 93.242, National Institute of Mental Health. Awards are made under authorization of sections 301 and 405 of the Public Health Service Act, Title IV, part A (public Law 78-410, as amended by Public Law 99-158, 43 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. 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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