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National Children’s Study (NCS)Answering Tough Questions About Child Health Frances J. Dunston MD, MPH The A J McClung Chair of Pediatrics Professor and Chair, Department of Pediatrics Morehouse School of Medicine Study Center Director, Community Engagement Presentation Overview • Describe the National Children’s Study (NCS) • What is the importance of the NCS? • What will we learn from the NCS? • How will the NCS benefit children?; society? • How will it answer tough questions, i.e. Autism? What is The National Children’s Study ? • The National Children’s Study is a long-term research project that will examine the environmental influences on children’s health and development • The largest long-term study of children’s health and development ever to be conducted in the United States • The scope and magnitude of the study provides the ability to answer tough, yet unanswered questions about the health and well-being of children. The National Children’s StudyScope of the Study • The NCS will examine the effects of the environment on the health and development of more than 100,000 children across the US, form pre-birth to age 21 years. • The study defines environment in the broadest terms: natural, man-made, biological, chemical, social, behavioral, genetic, cultural and geographic. The National Children’s StudyWhat is its Purpose? Why now? • The environment to which children are born and in which they must grow and develop has changed • Now we recognize the powerful influences of the environment on children’s health • New health problems have emerged that need new answers to tough questions • New knowledge can shape health polices and practices that can improve health The National Children’s StudyPriority Themes • A study of children’s physical, social, cultural, behavioral, and chemical environments • Involving children from diverse ethnicities and backgrounds • The first nationwide study to benefit from human genome mapping • Focused on understanding the causes of obesity, injury, asthma, pregnancy related outcomes, and developmental disorders such as autism Elements that Influence Health Outcomes Sources of Exposure Examples Physical Environment Housing quality, neighborhood Chemical Exposures Pesticides, phthalates, heavy metals Biologic Environment Infectious agents, endotoxins, diet Genetics Interaction between genes and environment Psychosocial milieu Family structure, socio-economic status, parenting style, social networks, exposure to media and violence Important Health Outcomes Examples Pregnancy Outcomes Preterm, Birth defects Neurodevelopment & Behavior Autism, learning disabilities, schizophrenia, conduct and behavior problems Injury Head trauma, Injuries requiring hospitalizations Asthma Asthma incidence and exacerbation Obesity & Physical Development Obesity, diabetes, altered puberty Converging Factors • Numerous environmental exposures can converge to impact children’s health and development • Which environmental exposures are most important in the occurrence or prevention of health problems in children • What factors in a child’s environment are most protective? The breadth and scope of the NCS has the power to answer these questions How will the National Children’s Study be conducted? National Children’s Study Locations National Children’s Study Sample All Births in the Nation ~4 million births in 3,141 counties Sample of Study Locations 105 Locations Sample of Study Segments Selection of neighborhoods Study Households All or a sample of households within neighborhoods Study Women All eligible women in the household National Children’s Study MAP OF GEORGIA DeKalb County Fayette County Partners in Our Children’s Health Communities of The National Children’s Study National Children’s Study (NCS) and Autism -Answers to tough questions Autism Autism in the Media © 2008 Cable News Network. Turner Broadcasting System, Inc.. Autism in the Media Copyright © 2008 ABCNews Internet Ventures Autism in the Media ©2008 Media General Communications Holdings, LLC. Autism in the Media © 2008 Cable News Network. Turner Broadcasting System, Inc. Autism in the Media Copyright ©2008 TWEAN News Channel of Syracuse, LLC, d/b/a News 10 Now Autism in the Media ©2008 Associated Newspapers Ltd Autism in the Media ©2008 About.com, a part of The New York Times Company. What we know about Autism • Autism and the autism spectrum disorders (Rett syndrome, Asperger syndrome, childhood integrative disorder) are now the most common set of developmental disorders in children, occurring in 1 in 150 children • The incidence of reported cases of autism has increased dramatically- from 1 in 10,000 in 1978 to 1 in 300 in 2006 • Autism is a complex, life-long biological disorder of developmental What we know about Autism • Autism may be confused with other neurodeveopmental conditions such as mental illness, hearing problems • Autism may co-exist with other distinct conditions • Universal screening of all children is now recommended for early identification and better treatment, education and lifetime outcomes. What we don’t know about Autism –tough, unanswered questions • What are the causes of autism? • Why is the incidence of autism increasing? • Is there an association between vaccines and autism? • How do environmental factors influence autism? • What are the best treatments for autism? • What are the best predictors of good outcomes? What tough questions will the NCS answer about autism? • The role of genes in autism: Is autism caused by a specific gene defect? • The role of infections during pregnancy and autism: Is there a link? • Multiple research studies have not been able to show a link between autism and MMR vaccine, the administration of multiple vaccines, or thimerosal as a preservative in vaccines. Is there more we can learn? • The interaction of environmental toxins and gene expression and autism: Retinoids and the HOX gene So, the NCS will Provide… • The answer to concerns about known exposures during childhood to potential toxicants • The power to determine absence of effects or benefit of exposures to various products important for our society • Causal factors for a number of diseases and conditions of children with suspected environmental causes • How multiple causes interact to result in multiple outcomes So, the NCS will Provide… • Large sample size required to apply knowledge of the human genome to understand multi-factorial genetic conditions • Identification of early life factors that contribute to many adult conditions • A national resource to answer future questions by using stored biological and environmental samples and the extensive data for decades to come So, the NCS will Provide… • An evidence base for decisions about health changes in health policy and practice • Economic benefits -cost avoidance • Improvements in health for all children Wednesday, April 30, 2008 1 p.m. – 5 p.m. Auditorium, Louis W. Sullivan National Center for Primary Care Morehouse School of Medicine 720 Westview Drive SW, Atlanta, Georgia 30310 Admission is free – Please RSVP: [email protected] Reception to follow