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   Further evidence of day care health and safety concerns were made clear in a recent study by the American Academy of Pediatrics which showed a disturbing trend among infants and Sudden Infant Death Syndrome (SIDS) in day care. The study examined 1,916 SIDS cases from 1995 to 1997 in 11 states, and found that about 20 percent, 391 deaths, occurred in day care settings. Most troubling was the fact that in over half of the cases where caretakers placed children on their stomach, the children were usually put to sleep on their backs by their parents.

   Parents and advocates who are dedicated in helping to eliminate the incidence of SIDS have urged that child care providers be required to have SIDS risk reduction education . I agree, which is why I included provision in the bill to carry out several activities, including the use of health consultants to give health and safety advice to child care providers on important issues like SIDS prevention.

   Overall the bill provides $200 million to states, including $4.2 million for my state of Tennessee, to help improve the health and safety of children in child care. The grants could be used for a number of activities, including child care provider training and education ; inspections and criminal background checks for day care providers; enhancements to improve a facility's ability to serve children with disabilities; transportation safety procedures; and information for parents on choosing a safe and healthy day care setting. The funding could also be used to help child care facilities meet health and safety standards or employ health consultants to give health and safety advice to child care providers.

   As a father, my highest concern is the safety of my three sons, and I understand the fears that so many parents have. Parents shouldn't be afraid to leave their children in the care of a licensed child care facility. This bill helps ensure that our child care centers will be safer.

   The major portion of Division A are provisions which were included in the ``Children's Public Health Act of 2000'' which I introduced on July 13, 2000 with Senators JEFFRODS and KENNEDY. Provisions in the ``Children's Public Health Act of 2000'' address a wide range of children's health issues including maternal and infant health, pediatric health promotion, and pediatric research.

   Unintentional injuries are the leading cause of death for every age group between 1 and 19 years of age, comprising 26 deaths per 100,000 children aged 1-14 and 62 deaths per 100,000 children aged 15-19. More than 1.5 million American children suffer a brain injury each year. Therefore, the bill reauthorizes and strengthens the Traumatic Brain Injury programs at the Centers for Disease Control and Prevention

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   Because birth defects are the leading cause of infant mortality and are responsible for about 30 percent of all pediatric hospital admissions, the bill also focuses on maternal and infant health. This legislation establishes a National Center for Birth Defects and Developmental Disabilities at the CDC to collect, analyze, and distribute data on birth defects. In addition, the bill authorizes the Healthy Start program to reduce the rate of infant mortality and improve perinatal outcomes by providing grants to areas with a high incidence of infant mortality and low birth weight.

   Furthermore, over 3,000 women experience serious complications due to pregnancy. Two out of three will die from complications in their pregnancy. Therefore, the bill develops a national monitoring and surveillance program to better understand maternal complications and mortality, and to decrease the disparities among populations at risk of death and complications from pregnancy.

   The bill also combats some of the most common childhood diseases and conditions. For instance, it provides comprehensive asthma services and coordinates the wide range of asthma prevention programs in the federal government to address the most common chronic childhood disease, asthma, which affects nearly 5 million children.

   We also focus on childhood obesity, which has doubled in just the past 15 years, and produced 4.7 million seriously overweight children and adolescents ages 6-19 years. To address this epidemic, the bill supports state and community-based programs to promote good nutrition and increased physical activity among American youth.

   In examining the problems affecting children across the nation and in Tennessee, I was very concerned to learn that in Memphis, over 12 percent of children under the age of 6 may have lead poisoning. Such poisoning can cause a variety of debilitating health problems, including seizure, and coma, and even death. Even at lower levels, lead can contribute to learning disabilities, loss of intelligence, hyperactivity, and behavioral problems. This bill includes physician education and training programs on current lead screening policies, tracks the percentage of children in the Health Centers program who are screened for lead poisoning, and conducts outreach and education for families at risk of lead poisoning,

   The May 2000 Surgeon General's report noted that oral health is inseparable from overall health, and that while a majority of the population has experienced great improvements in oral health, disparities affecting poor children and those who live in underserved areas represent 80 percent of all dental cavities in 20 percent of children. This bill encourages pediatric oral health by supporting community-based research and training to improve the understanding of etiology, pathogenesis, diagnoses, prevention, and treatment of pediatric oral, dental, and craniofacial diseases.

   Finally, the bill strengthens pediatric research efforts by establishing a Pediatric Research Initiative within the NIH to enhance collaborative efforts, provide increased support for pediatric biomedical research, and ensure that opportunities for advancement in scientific investigations and care for children are realized.

   I also want to highlight the critical issue of childhood research protections. Included in this bill are provisions to address safety issues in children's research by requiring the Secretary of HHS to review the current federal regulations for the protection of children participating in research, which address such issues as determining acceptable levels of risk and obtaining parental permission, and to report to Congress on how to ensure the highest standards of safety. Also, the provision requires that all HHS-funded and regulated research comply with these additional protections for children. During this year, the Senate Subcommittee on Public Health, which I chair, held two important hearings relating to gene therapy trials and human subject protections. The Subcommittee discovered that there was a lapse of protection for individuals participating as subjects in clinical trial research. Next Congress, I intend to make the further review and updating of human subject protections a major priority of the Subcommittee.

   Division B of the bill contains provisions which address the scourge upon children of drug abuse. The 1999 National Household Survey on Drug Abuse, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), reported that 10.9 percent of youths age 12-17 currently use illicit drugs. It further estimated that nearly 11.3 percent of 12-17 year-old boys and 10.5 percent of 12-17 year-old girls used drugs in the past month. But just as important is the growth in alcohol abuse among our youth, as SAMHSA reports that 10.4 million current drinkers are younger than the legal drinking age of 21 and that more than 6.8 million engaged in binge drinking. Tragically, all of these numbers among youth substance abuse have risen since 1992.

   To address the tragedy of drug use by our children, the bill incorporates the ``Youth Drug and Mental Health Services Act,'' which I introduced with Senator KENNEDY last spring and was first passed the Senate on November 3, 1999.

   The ``Youth Drug'' bill addresses the problem of youth substance abuse by reauthorizing and improving SAMHSA through a renewed focus on youth and adolescent substance abuse and mental health services, in conjunction with greater flexibility and new accountability for States for the use of federal funds.

   Created in 1992 to assist States in reducing the incidence of substance abuse and mental illness through prevention and treatment programs, SAMHSA provides funds to States for alcohol and drug abuse prevention and treatment programs and activities, as well as mental health services, with its block grants accounting for 40 percent and 15 percent respectively of all substance abuse and community mental health services funding in the States. In my own State of Tennessee, SAMHSA provides more than 70 percent of overall funding for the Tennessee Department of Health's Bureau of Alcohol and Drug Abuse Services.

   This bill accomplishes six critical goals: (1) promotes State flexibility by easing outdated or unneeded requirements governing the expenditure of Federal block grants; (2) ensures State accountability by moving away from the present system's inefficiencies to a performance based system; (3) provides substance abuse treatment services and early intervention substance abuse services for children and adolescents; (4) helps local communities treat violent youth and minimize outbreaks of youth violence through partnerships among schools, law enforcement and mental health services; (5) ensures Federal funding for substance abuse or mental health emergencies; and (6) supports and expands programs providing mental health and substance abuse treatment services to homeless individuals.

   The bill also includes a number of other important provisions, including those to address how to treat individuals with co-occurring mental health and substance abuse disorders the proper and safe use of restraints and seclusions in mental health facilities, and important ``charitable choice'' provision that permits Federal assistance for religious organizations providing substance abuse services. We know that no one approach works for everyone who needs and wants substance abuse treatment and that faith-based programs have strong records of successful rehabilitation. This provision will allow faith-based programs to continue to offer their assistance and expertise.

   The ``Youth Drug and Mental Health Services Act'' provides Tennessee and other states needed funds for community based programs helping individuals with substance abuse and mental health disorders, dramatically increasing State flexibility and ensuring that each State is able to address its unique needs. The bill provides a much needed focus on the troubling issue of drug use by our youth and helps local communities deal with the issue of children and violence.

   I would also like to highlight the ``Methamphetamine Anti-Proliferation Act of 1999,'' which is sponsored by Senator ASHCROFT and included in this comprehensive bill. This bill address the plague of methamphetamine which has severely impacted Tennessee, other

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   Finally the bill also tackles another devastating drug which has shown signs of increased use in our youth, the drug known as ``Ecstasy.'' In short, the bill directs the Sentencing Commission to review and amend the Ecstasy guidelines to provide for increased penalties to reflect the seriousness of the offenses of trafficking in and importing Ecstasy and related drugs.

   Mr. President, this legislation which has passed the Senate today is a comprehensive, multifaceted attack on the numerous threats to our children's health. I am thankful for all my colleagues for their support and willingness to help the children of this nation. I would especially like to thank Senators JEFFORDS and KENNEDY and Representatives TOM BLILEY, MICHAEL BILIRAKIS, JOHN DINGELL and SHERROD BROWN, and their excellent staffs for all the hard work and dedication which has gone into this bill. I would also like to thank Mr. Bill Baird and Ms. Daphne Edwards, of the Office of Senate Legislative Counsel, for their tireless work and for their great expertise in drafting this comprehensive bill. I would also like to personally thank Mr. Joseph Faha, Director of Legislation and External Affairs of the Substance Abuse and Mental Health Service Administration as well as other member of the Department of Health of Human Services. Finally, I would like to thank my Staff Director, of the Public Health Subcommittees, Anne Phelps and my Health Policy Advisor, Dave Larson. Finally, I would like to thank the may groups advocating on behalf of children and parents and families who have worked so hard to bring this bill to fruition. I look forward to swift action in the House on this measure and it's enactment into law.

   Mr. KENNEDY. Mr. President, this legislation will help millions of children in the years ahead. It takes needed action to improve children's health by expanding pediatric research and taking specific steps to deal with a wide range of childhood illnesses, disorders, and injuries. It also reauthorizes the Substance Abuse and Mental Health Services Adminstration, which has an important role in reducing substance abuse and maintaining and improving the mental health of the nation's children and adolescents. Coordinated efforts in these areas can lead to significant benefits for all children.

   Senator FRIST and I have worked closely with many of our Democratic and Republican colleagues on this important legislation. We have talked with experts and advocates in the children's health community and in the mental health and substance abuse treatment communities. This legislation will lead to significant progress in addressing many of today's most pressing pediatric public health problems.

   The legislation includes a variety of new and reauthorized children's health provisions. It represents a compromise with our colleagues in the House and addresses a wide range of pediatric public health issues raised by experts in the field and championed by numerous members from both sides of the aisle in both chambers.

   Division A of the bill focuses on general children's health. It includes programs to improve the health of pregnant women and prenatal outcomes, including prevention of birth defects and low birth weight. It establishes a new Center for Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention, in order to focus the nation's activities more effectively in these important areas. It also directs the Secretary of the Department of Health and Human Services to expand public education efforts on folic acid consumption in order to decrease neural tube birth defects.

   The bill also deals with traumatic brain injury which is the leading cause of death and disability in young Americans. The Centers for Disease Control and Prevention has estimated that 5.3 million Americans are living with long-term, severe disability as a result of brain injuries, and each year 50,000 people die as a result of such injuries. The Children's Public Health Act revises and extends the authorization for a series of important programs that were enacted in 1996 to deal with these injuries. This reauthorization will assure continued progress toward understanding, treating and preventing them.

   In addition, the bill includes the long overdue reauthorization of the CDC's Injury Prevention and Control Programs. There are steps we should take to modernize this authority and increase the authorization levels, but it is welcome progress at last to renew its authorization.

   Improving and protecting the safety of child care facilities is also a high priority for Congress. This legislation creates a new program to improve the safety of children in child care settings, and to encourage child care providers to take steps to prevent illness and injuries and protect the health of the children they serve.

   It is said that the 21st century will be the century of life sciences. Our national health policy will have the benefit of brilliant new scientific discoveries that have already begun to change how we diagnose, treat and prevent countless conditions. The legislation creates a new grant program that focuses on inherited disorders. Based on legislation introduced last year that has the strong support of a broad-based coalition of both the genetics and public health communities, our bill provides funds for state or local public health departments to expand existing programs or initiate new programs that provide screening, counseling or health services to infants and children who have genetic conditions or are at risk for such conditions. It also establishes an Advisory Committee to assist the Secretary on these issues.

   The bill also takes a number of steps to address other prevalent childhood conditions. Asthma is the most common chronic childhood illness, affecting more than seven percent of all American children. The death rate for children with asthma increased by 78 percent between 1980 and 1993, and asthma-related costs total nearly $2 billion annually in direct health care for children. The nation is handicapped by a lack of basic information on where and how asthma strikes, what triggers it, and how effectively the health care system is responding to those who suffer from this chronic disease. Our bill will provide greater asthma services to children, including mobile clinics and patient and family education , and it will help to reduce allergens in housing and public facilities.

   Poor nutrition and lack of physical activity are also hurting many American children and contributing to lifelong health problems. The nation spends $39 billion a year--equal to six percent of overall U.S. health care expenditures--on direct health care related to obesity. Twenty percent of American children--one in five--are overweight. Unhealthy eating habits and physical inactivity in childhood can lead to heart disease, cancer and other serious illnesses decades later. Children and adolescents who suffer from eating disorders, such as anorexia nervosa and bulimia, can have wide-ranging physical and mental health impairments. Our legislation establishes new grant programs to reduce childhood obesity and eating disorders, promote better nutritional habits among children, and encourage an appropriate level of physical activity for children and adolescents.

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