National Children’s Study (NCS)-National Children’s Study (NCS)-

Answering Tough Questions About Child HealthAnswering 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

•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?

Presentation Overview

• 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.

What is The National Children’s 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 Study- Scope of the Study

• 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 Study- What is its Purpose? Why now?

• 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

The National Children’s Study-Priority Themes

Elements that InfluenceHealth Outcomes

Sources of Exposure

Examples

Physical Environment Housing quality, neighborhood

Chemical Exposures Pesticides, phthalates, heavy metals

Biologic Environment Infectious agents, endotoxins, diet

GeneticsInteraction 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

InjuryHead trauma, Injuries requiring hospitalizations

Asthma Asthma incidence and exacerbation

Obesity & Physical Development

Obesity, diabetes, altered puberty

• 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

Converging Factors

How will the National Children’s Study be conducted?

National Children’s Study Locations

National Children’s Study Sample

~4 million births in 3,141 counties

All Births All Births in the Nationin the Nation

105 LocationsSample of Study Sample of Study LocationsLocations

Selection of neighborhoods

Sample of Study Sample of Study SegmentsSegments

All or a sample of households within neighborhoods

StudyStudyHouseholdsHouseholds

All eligible women in the household

Study WomenStudy Women

National Children’s Study

DeKalb County

Fayette County

MAP OF GEORGIA

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

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• 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 neuro-deveopmental 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 know about Autism

• 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 we don’t know about Autism –tough, unanswered questions

• 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

What tough questions will the NCS answer about autism?

• 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

So, the NCS will Provide…

Wednesday, April 30, 20081 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: casharpe@msm.edu

Reception to follow