Lessons learned for the National Children's Study from the National Institute of Environmental Health Sciences/U.S. Environmental Protection Agency Centers for Children's Environmental Health and Disease Prevention Research

Environmental Health Perspectives, Oct, 2005 by Carole A. Kimmel, Gwen W. Collman, Nigel Fields, Brenda Eskenazi

This mini-monograph was developed to highlight the experiences of the National Institute of Environmental Health Sciences (NIEHS)/U.S. Environmental Protection Agency (EPA) Centers for Children's Environmental Health and Disease Prevention Research, focusing particularly on several areas of interest for the National Children's Study. These include general methodologic issues for conducting longitudinal birth cohort studies and community-based participatory research and for measuring air pollution exposures, pesticide exposures, asthma, and neurobehavioral toxicity. Rather than a detailed description of the studies in each of the centers, this series of articles is intended to provide information on the practicalities of conducting such intensive studies and the lessons learned. This explication of lessons learned provides an outstanding opportunity for the planners of the National Children's Study to draw on past experiences that provide information on what has and has not worked when studying diverse multiracial and multiethnic groups of children with unique urban and rural exposures. The Children's Centers have addressed and overcome many hurdles in their efforts to understand the link between environmental exposures and health outcomes as well as interactions between exposures and a variety of social and cultural factors. Some of the major lessons learned include the critical importance of long-term studies for assessing the full range of developmental consequences of environmental exposures, recognition of the unique challenges presented at different life stages for both outcome and exposure measurement, and the importance of ethical issues that must be dealt with in a changing medical and legal environment. It is hoped that these articles will be of value to others who are embarking on studies of children's environmental health. Key words: asthma, autism, children, environmental health, National Children's Study, NIEHS/EPA Children's Centers, obesity, pregnancy.

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The series of six articles in this mini-monograph developed out of a desire to learn from the collective experiences of the Centers for Children's Environmental Health and Disease Prevention Research (hereafter Children's Centers) in a way that could be useful for the design and implementation of the National Children's Study. The Children's Centers are co-sponsored by the National Institute for Environmental Health Sciences (NIEHS) and U.S. Environmental Protection Agency (EPA) and conduct both observational studies of etiology and intervention studies. Several of the exposures and outcomes studied by the Children's Centers are of interest for the National Children's Study. This mini-monograph highlights the experiences of the Children's Centers' studies, and the articles are meant to serve as a primer of lessons learned for the National Children's Study. The articles represent a synthesis of thoughts on several topics: methodologic issues for conducting longitudinal birth cohort studies (Eskenazi et al. 2005) and community-based participatory research (Israel et al. 2005) and issues in the measurement of air pollution (Gilliland et al. 2005), pesticide exposures (Fenske et al. 2005), asthma (Eggleston et al. 2005), and neurobehavioral toxicity (Dietrich et al. 2005). Summarizing the combined experiences of the Children's Centers at this time afforded an opportunity to inform the planning and protocol development of the National Children's Study and to provide information on what has worked and what has not worked when studying diverse multiracial and multiethnic groups of children with unique urban and rural exposures.

The National Children's Study

The idea for the National Children's Study originated from the Developmental Disorders Workgroup of the President's Task Force on Environmental Health Risks and Safety Risks to Children, established in 1997 as a result of Federal Executive Order 13045, signed by President Clinton on 21 April 1997. This Executive Order, titled "Protection of Children from Environmental Health Risks and Safety Risks" (Clinton 19971 required federal agencies involved in related activities to consider special environmental circumstances that could pose a health threat to children. In late 1999, the task force approved the exploration of the feasibility of the Longitudinal Cohort Study of Environmental Effects on Parents and Children (later renamed the National Children's Study). Subsequently, the Children's Health Act (2000), which Congress passed unanimously in October 2000, authorized the planning and implementation of this study. The Children's Health Act charged the director of the National Institute of Child Health and Human Development/National Institutes of Health together with a consortium of federal agencies, including the U.S. EPA, the Centers for Disease Control and Prevention, and other appropriate agencies to plan and implement this national longitudinal study of environmental influences on children's health and development. The NIEHS shortly thereafter became the fourth lead partner agency. The Children's Health Act broadly defined the environment to include physical, chemical, biologic, and psychosocial factors. Further, the act called for investigation of basic mechanisms of developmental disorders and environmental factors, both health adverse and health promoting.