1. 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

2. 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

3. 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 ?

4. 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

6. 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?

9. 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

10. 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 OutcomesPreterm, 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

11. 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

12. How will the National Children’s Study be conducted?

13. National Children’s Study Locations

14. National Children’s Study Sample ~4 million births in 3,141 counties All Births in the Nation 105 Locations Sample of Study Locations Selection of neighborhoods Sample of Study Segments All or a sample of households within neighborhoods Study StudyHouseholds All eligible women in the household Study Women Study Women

15. National Children’s Study

16. DeKalb County Fayette County MAP OF GEORGIA

17. Partners in Our Children’s Health

18. Communities of The National Children’s Study

19. National Children’s Study (NCS) and Autism - Answers to tough questions

20. Autism

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28. 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

29. 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

30. 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

31. 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?

33. 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…

34. 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…

35. 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…

36. 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: casharpe@msm.edu Reception to follow