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Title: Release Date: Comment


Ecology of Infectious Diseases November 16, 1999

NSF, NIH, USDA, USGS and NASA are jointly sponsoring a Special Competition in FY 2000 on the Ecology of Infectious Diseases. Because NIH, with input from all of the collaborating agencies, prepared the RFA, the original version is on the NIH website at

ECOLOGY OF INFECTIOUS DISEASES Release Date: RFA: November 16, 1999


Fogarty International Center National Institute of Environmental Health Sciences National Institute of General Medical Sciences National Institute of Allergy and Infectious Diseases National Science Foundation Agricultural Research Service National Aeronautics and Space Administration United States Geological Survey Letter of Intent: December 15, 1999 Application Receipt Date: March 14, 2000 PURPOSE The National Institutes of Health (NIH), the National Science Foundation (NSF), the Agricultural Research Service (ARS), the National Aeronautics and Space Administration (NASA) and the U.S. Geological Survey (USGS) (hereafter "the Government" or "the Participating Agencies") invite applications for the establishment of research programs to elucidate the underlying mechanisms that govern the relationships between anthropogenic environmental changes and the transmission dynamics of infectious diseases. This RFA calls for the development of interdisciplinary research programs on the ecology of infectious diseases in the context of anthropogenic environmental changes such as biodiversity loss, habitat transformation, environmental contamination, climate change and other influences. The focus of this RFA is on discovery of basic ecological and biological mechanisms and development of predictive models for the emergence and transmission of diseases in humans and other animals, and ultimately the development of strategies to prevent or control them. 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 Request for Applications (RFA), Ecology of Infectious Diseases, is related to one or

more of the priority areas. Potential applicants may obtain a copy of "Healthy People 2000" at ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic and foreign for-profit and non- profit organizations, both public and private, (including domestic institutions with foreign collaborators) 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 The participating agencies will jointly administer the program from receipt of proposals and throughout the duration of awards. Each award will be supported by NSF or NIH individually, or through joint awards from both agencies, per agreements among these organizations. Principal investigators may be requested to modify their budgets and work plans to comply with special requirements of the agency (agencies) supporting their award. Grant awards by the NIH will use the R01 research project grant mechanism. Participating NIH components are the Fogarty International Center, the National Institute of Environmental Health Sciences, the National Institute of General Medical Sciences and the National Institute of Allergy and Infectious Diseases. NSF participation is principally through the Directorate for Biological Sciences. If collaborative support from the ARS, NASA or USGS as described below is of interest, applicants should prearrange this collaboration with the appropriate agency representatives and document this support in their applications. Individual agency and institute contacts are listed later in this announcement. Responsibility for the planning, direction, and execution of the proposed project will be solely that of the applicant. The anticipated award date is August 15, 2000. ARS (Animal Health and Food Safety Programs) will provide, by agreement among investigators, support through collaboration with ARS laboratories for pathogen detection and identification, microbial genomics, epidemiology, immunology etc. Grant funds to support research or post-doctoral associates will not be available through ARS National Programs. Post-doctoral support will, however, be available through individual ARS laboratories. If such support is of interest you must arrange it with the appropriate ARS laboratory, describe it and provide supporting letters in your application. Information on potential collaborators and resources within ARS can be found on the World Wide Web at NASA (Life Sciences Division within the Office of Life & Microgravity Sciences & Applications) through the Center for Health Applications of Aerospace Related Technologies (CHAART) at the Ames Research Center in California will provide, on a case by case basis, pre-arranged training for developing country scientists in Geographic Information Systems and Remote Sensing technology, including travel and on site per diem expenses. Information on the CHAART program can be found at: or If such support is part of your proposed research plan you should include in your application a letter of support from the CHAART program leader outlining the terms of the collaboration. USGS (U.S. Geological Survey) will provide, by agreement among investigators, support through collaboration with USGS laboratories for research addressing needs related to the ecology of infectious diseases. These needs include, but are not limited to: access to data bases for water quality, the chemical and physical characteristics of earth materials, land (both natural and man-made attributes), and satellite and airborne remotely sensed data; laboratory analysis of wildlife diseases, including wildlife and environmental toxicology; and chemical analysis of water, plants, soils, rocks, and sediments. The USGS studies, assesses, and develops and maintains National Data Bases on the Nation's water (quantity and quality) resources, flora, fauna, land characteristics, and mineral and energy resources; and determines past ecological and climate histories. Grant funds to support research or post-doctoral associates will not be available through USGS National Programs. Post-doctoral support, may, however, be available through individual USGS laboratories. If such support is of interest, you must arrange it with the appropriate USGS laboratory, describe it, and provide supporting letters in your application. Information on potential collaborators and resources within the USGS can be found on the World Wide Web at Note that unconfirmed support from one of these agencies or any other collaborator cannot be considered during initial peer review of an application. While such collaborations could be added to a project after it has been funded, investigators are encouraged to develop these for the initial application. FUNDS AVAILABLE An applicant may request a project period of up to five years with a budget of up to $350,000 per year direct costs. We anticipate that the nature and scope of projects will vary, and accordingly the budget and duration of funded projects will also vary. Generally, we expect that total costs will range between $300,000-500,000 per year for three- to five-year projects. The Government anticipates that available funds from all collaborating agencies will total approximately $4 million in fiscal year 2000, providing for an estimated eight to ten awards. Because the anticipated award size is greater than $250,000 per year, the NIH modular approach will not be used for any award resulting from this RFA. RESEARCH OBJECTIVES Definitions For the purpose of this RFA some relevant terms are defined below. o Anthropogenic Environmental Change - A sustained change in the natural environment resulting from human activity such as deforestation, exotic species introduction, chemical effluent release, carbon dioxide release etc.

o Biocomplexity - A property of systems structured or influenced by living organisms, their components, or biological processes. This RFA focuses on biocomplexity that arises from the interactions of living organisms with all facets of their external environment, particularly those interactions involving multiple levels of biological organization and/or multiple spatial and temporal scales. o Biodiversity - The structural and functional variety of life forms at genetic, population, species, and ecosystems levels. o Biological Invasion - The mass movement or encroachment of organisms from one area into another, generally non-native area. o Ecology - The study of the abundance and distribution of organisms and of the relationships between organisms and their biotic and abiotic environments. o Habitat Fragmentation - The disruption of extensive habitats into isolated and smaller patches, typically by agriculture, human settlement or development projects. o Infection - The process of invasion and establishment by a microorganism or helminth within host tissues. o Infectious Diseases - Diseases resulting from presence of an infectious agent. o Species Richness - The absolute number of species in an assemblage or community. Background Over the past twenty years unprecedented rates of change in diversity of non- human biota have coincided with the emergence and reemergence of numerous infectious diseases around the world. Virtually all of the world's terrestrial and aquatic communities and ecosystems have undergone dramatic changes in biodiversity and biocomplexity due primarily to habitat transformation (deforestation, reforestation, agricultural intensification, fragmentation), invasions of exotic species, and chemical contamination. The coincidence of broad scale environmental changes and emergence of infectious diseases may point to underlying predictable ecological relationships. For example, habitat fragmentation may reduce populations of mammalian predators of animals that are natural reservoirs of disease agents, resulting in increased transmission to humans. Similarly, runoff from urban and rural sewage systems may carry pathogenic microorganisms and helminths that proliferate in shellfish and fish and eventually infect humans via consumption as food. While a descriptive understanding of some cases exists, there is little mechanistic understanding of basic ecological principles that may regulate such complex systems. The role of biological diversity and habitat structure in stabilizing communities of plants, animals and micro-organisms has received a great deal of attention from ecologists in recent years. As a result, our capacity to analyze and model biocomplexity and ecological dynamics, and to evaluate spatial and temporal aspects of environmental change has become increasingly sophisticated. However, few of these advances in

ecological science have yet contributed to biomedical research or to public health. Similarly, we have improved our ability to define the molecular identity of pathogens or infectious agents and their vectors, and our understanding of the defense systems of their hosts. These improvements have contributed significantly to our understanding of epidemiology and transmission patterns of diseases. However, the relationship of these factors to population dynamics of disease reservoirs or the biotic and structural complexity of ecological systems in which transmission occurs remains a poorly understood area. At present, basic and applied research in infectious disease ecology is largely piecemeal, due in part to the differentiated missions of federal science agencies that support research. The potential benefits of an interdisciplinary research program in this area include: development of disease transmission theory, improved understanding of unintended health effects of development projects, increased capacity to forecast outbreaks, and improved understanding of how diseases (re)emerge. An interdisciplinary program will also solidify long-term collaborative relationships among federal agencies that have been independently supporting research in ecological and health sciences. This RFA seeks to bring together advances in methods and understanding from these and other fields in an interdisciplinary program of research aimed at the interface of ecology and human health. Scientific Objectives Fundamentally, the goal of this effort is to encourage development of predictive models and discovery of principles for relationships between anthropogenic environmental change and transmission of infectious agents. To that end, research should focus on understanding the ecological determinants of transmission by vectors or abiotic agents, the population dynamics of reservoir species, and transmission to humans or other hosts. These anthropogenic environmental changes include, but are not limited to, deforestation, habitat destruction or fragmentation, biological invasion, climate change, agricultural practices, and environmental pollution. A variety of topics, questions and approaches are appropriate. Research could focus on particular infectious agents, individual diseases or groups of diseases, and might involve one or more regions, habitats or groups of organisms. Depending on the hypotheses being addressed, investigations might entail laboratory experiments, field observations or manipulations, novel analyses of existing data, theoretical investigations of ecological dynamics or all of the above. Field investigations that elucidate extensive temporal and/or spatial patterns from nature are among those most likely to yield important insights. Such insights are likely to be gained through integrating work among several scales of observation, including molecular, individual, population, and regional levels of analysis. Use of remote sensing, geographic information systems, and other information technologies may be useful in such efforts. Investigations may also consider dynamic processes using model biological systems, even in a laboratory setting. New insights gained from the study of biological interactions involving organisms or

ecological settings other than those of ultimate concern may very well improve our understanding of complex interactions in natural ecological systems. The primary focus should be on ecological dynamics related to disease agent transmission and infection. Analysis of environmental influences on the susceptibility of individuals or populations to infection by particular agents is appropriate. However, research that focuses largely on disease expression in individuals is outside the scope of this RFA. Investigators interested in such a focus are encouraged to examine other opportunities for NIH support in this area. Similarly, while the evolution of pathogens and hosts may be inseparable from many ecological questions, investigations focused primarily on genetic change in diseases or hosts are outside the scope of this RFA. Investigators interested in this area are encouraged to examine the NIH Program Announcement PA-99-147 Evolutionary Mechanisms in Infectious Diseases ( Furthermore, this RFA is intended to support research related to anthropogenic environmental changes. Therefore, investigators focused on the relationship of disease to normal climate variability, such as El Nino cycles, should seek other opportunities, including an upcoming program led by the National Oceanographic and Atmospheric Administration (NOAA) on Climate Variability and Human Health. Examples of the kinds of ecological relationships that may be studied include, but are not limited to, the following: o effect of changes in species richness on the persistence and relative abundance of pathogenic and non-pathogenic microorganisms, and their transmission to hosts, o identification and evaluation of habitats favorable to the emergence of new infections, o influences of climate change on transmission or risk of disease, o impact of chemical pollutants on abundance of pathogens and rates of transmission, o consequences of newly introduced species on competitive interactions among hosts, o impact of deforestation on human population density and the incidence of zoonotic and vector-borne disease, o habitat fragmentation and changes in the geographic range of disease transmission, o effects of pollution-related algal blooms on abundance of associated infectious organisms and their transmission to humans, o meta-analyses of historical patterns of transmission and the underlying environmental determinants, o factors affecting reservoir abundance and risk of zoonotic disease, o role of habitat-specific diseases in shaping the community structure of non- human hosts,

o ecology of migration and population structure on emergence or regional maintenance of disease. Funded research under this RFA will aim beyond description to achieve mechanistic insights into such phenomena. These kinds of problems are fundamentally interdisciplinary, and teams of investigators with expertise in a wide range of scientific training and skills from diverse disciplines are likely to be most effective. Integrated, collaborative efforts might involve infectious disease epidemiologists, population ecologists, statisticians, immunologists, parasitologists, taxonomists, molecular biologists, environmental health scientists, climatologists, and mathematical modelers, for example. A team approach is encouraged to answer questions that normally cannot be addressed within a single discipline. Work under this RFA can involve the collection or development of new data, the reanalysis of existing data, or a combination of both. SPECIAL REQUIREMENTS Each application should budget for travel by one or more investigators to the Washington D.C. area every year for a network meeting of all funded projects under this RFA. Protection of Research Subjects Applicants should be aware that provisions for the protection of human research subjects and laboratory animals must be met in research done in both domestic and foreign institutions including obtaining any necessary single project assurances. Applicants should see Title 45 CFR, Part 46 for information concerning Department of Health and Human Services regulations for the protection of human subjects and the PHS Policy on the Humane Care and Use of Laboratory Animals. These are available from the Office for Protection from Research Risks, National Institutes of Health, 6100 Executive Boulevard, MSC 7507, Rockville, MD 20892-7507 ( 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 was 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: 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: 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. LETTER OF INTENT Prospective applicants are asked to submit, by December 15, 1999, a letter of intent that includes a descriptive title of the proposed project, the name address, and telephone number of the Principal Investigator, the identities of other key personnel and participating institutions, and the number and title of the RFA in response to which the application may be submitted. The letter of intent is requested in order to provide an indication of the number and scope of applications to be reviewed, to assist in the formation of an initial peer review group, and to help identify proposals that may be clearly outside the bounds of this RFA. The letter of intent does not commit the sender to submit an application, nor is it a requirement for submission of an application. The letter of intent is to be sent to: Dr. Joshua Rosenthal Fogarty International Center National Institutes of Health 31 CENTER DRIVE MSC 2220 BETHESDA MD 20892-2220 FAX: 301-402-2056 Email: APPLICATION PROCEDURES The regular research grant application Form PHS-398 (Rev. 4/98) must be used in applying. General instructions for completing the Form PHS-398 are contained in the application package. Apply additional instructions as outlined in this RFA. The Form PHS-398 is available through the NIH pages on the World Wide Web ( These forms are available at most institutional offices of sponsored research and 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: The RFA label available in the PHS 398 (rev. 4/98) application form must be affixed to the bottom of the face page of the application and must indicate the RFA number. 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 sample RFA label available at: has been modified to allow for this change. Please note this is in pdf format. Submit a signed, typewritten original of the application, including a single Checklist, and three signed, single sided 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) 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. To ensure that your application receives appropriate consideration, it is essential to send two additional copies of your application with all appendices directly to: Dr. Joshua Rosenthal Fogarty International Center National Institutes of Health 31 CENTER DRIVE MSC 2220 BETHESDA MD 20892-2220 REVIEW CONSIDERATIONS Review Procedures Upon receipt, applications will be reviewed for completeness by CSR and for responsiveness by staff from the participating agencies. Incomplete applications will be returned to the applicant without further consideration. Applications that are judged to be non-responsive will be administratively withdrawn and the proposed Principal Investigator will be notified. Applications that are both complete and responsive to the RFA will be further evaluated, using the review criteria below, for scientific and technical merit by an appropriate interdisciplinary peer review group convened by the National Science Foundation. The composition of the initial review group, as well as the review procedures and criteria they employ will satisfy both NSF and NIH regulations. The initial review group will provide analytical and descriptive evaluation using adjectival criteria and rank order applications in terms of scientific

and technical merit. For NIH awards, a second level review will be provided by the Advisory Board or Council of the awarding Institute or Center. Based on recommendations from the peer review process, the Participating Agencies will recommend funding levels and priorities. Final funding decisions will be made considering the outcome of the above process. Review Criteria The goals of research supported under this RFA 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 rank, weighting them as appropriate for each application. Note that the application does not need to be strong in all categories to be judged likely to have major scientific impact and thus deserve a high priority score. For example, an investigator may propose to carry out important work that by its nature is not innovative but is essential to move a field forward. (1) Significance: Does this study address an important problem? If the aims of the application are achieved, how will scientific knowledge be advanced? What will be the effect of these studies on the concepts or methods that drive this field? (2) Approach: Are the conceptual framework, design, methods, and analyses adequately developed, well-integrated, and appropriate and 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: Are the investigators 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)? Are the nature and quality of the collaborations appropriate for the proposed research? (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? (6) Integration: Will the proposed research team and program function as a truly interdisciplinary unit that integrates models, methods, and expertise from both ecological and biomedical sciences? In addition, reviewers will be asked to comment on other issues including: a) How well does the activity advance discovery and understanding while promoting teaching, training, and learning? To what extent will it

enhance the infrastructure for research and education, such as facilities, instrumentation, networks, and partnerships? Will the results be disseminated broadly to enhance scientific and technological understanding? b) The adequacy of plans to include participation by underrepresented groups (e.g. gender, ethnicity, geographic, and children) as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. c) The reasonableness of the proposed budget and duration in relation to the proposed research. d) 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. e) Lastly, if working in a developing country context, are investigators from the host country participating substantially in the design and implementation of the program? AWARD CRITERIA Award 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. INQUIRIES It is strongly advised that prospective applicants contact program representatives early in their planning process to discuss their applications and to obtain any clarifying information or instructions that may be developed. You are encouraged to contact the agency representative below that is closest to your interest, background or affiliation. Dr. Joshua Rosenthal Program Director Fogarty International Center National Institutes of Health 31 CENTER DRIVE MSC 2220 BETHESDA MD 20892-2220 Telephone: 301-496-1653 FAX: 301-402-2056 Email: Dr. Allen Dearry Chief, Chemical Exposures and Molecular Biology Branch National Institute of Environmental Health Sciences (NIEHS) MD EC-21 P.O. Box 12233 Research Triangle Park NC 27709 Telephone: 919-541-4943 FAX: 919-541-2843 e-mail: Dr. Irene Eckstrand

Program Director Division of Genetics and Developmental Biology National Institute of General Medical Sciences (NIGMS) 45 Center Drive Bethesda MD 20892 Telephone: 301-594-0943 FAX: 301-480-2753 e-mail: Dr. Samuel M. Scheiner Program Director Division of Environmental Biology National Science Foundation (NSF) 4201 Wilson Blvd., Rm. 635 Arlington VA 22230 Telephone: 703-306-1481 FAX: 703-306-0817 e-mail: Dr. Kathryn Aultman Program Officer, DMID/PIP National Institute of Allergy and Infectious Diseases (NIAID) 6700B Rockledge Drive, Room 3100 Bethesda MD 20892 Telephone: 301-496-2544 FAX: 301-402-0659 e-mail: Dr. James A. Lindsay National Program Leader-Food Safety United States Department of Agriculture (USDA) Agricultural Research Service (ARS) National Program Staff 5601 Sunnyside Avenue Beltsville MD 20705-5138 Telephone: 301-504-4674 FAX: 301-504-5467 e-mail: Dr. Byron L. Wood CHAART Point of Contact (NASA) CHAART, Code SGE MS 242-4 NASA Ames Research Center Moffett Field CA 94035 Telephone: 650-604-4187 Fax: 650-604-4680 e-mail: Dr. Janet Hren Science Advisor for Environment U.S. Geological Survey 107 National Center Reston VA 20192 Telephone: 703-648-4480 Fax: 703-648-5470 Email:

Direct inquires regarding peer review of applications to: Dr. Samuel M. Scheiner Division of Environmental Biology National Science Foundation (NSF) 4201 Wilson Blvd., Rm. 635 Arlington VA 22230 Telephone: 703-306-1481 FAX: 703-306-0817 e-mail: AUTHORITY AND REGULATIONS NSF awards made as a result of this document are administered in accordance with the terms and conditions of NSF GC-1, "Grant General Conditions." FDP- III "Federal Demonstration Partnership General Terms and Conditions," depending on the grantee organization. Copies of these documents are available at no cost from the Clearinghouse, P.O. Box 218, Jessup, MD 20794- 0218, phone (301) 947-2722, or via e-mail to More comprehensive information is contained in the NSF Grant Policy Manual, GPM (NSF 95-26), for sale through the Superintendent of Documents, Government Printing Office, Washington, DC 20402. The telephone number at GPO is (202) 783-3238 for subscription information. The GPM is also be available on the NSF OnLine Document System located at the NIH Awards are made under authorization of the Public Health Service Act, Title III, Part A, Sections 301 and 307, and Title IV, Part A of Section 482 (P.L. 78-410, as amended by P.L. 99-158, 42 USC 241, 242l, and 287b) 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 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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