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National Study on Children's Health to Provide Wealth of Information

Posted on: Tuesday, 3 May 2005, 03:00 CDT

Environmental factors to be tracked

THE LARGEST study of children's health in U.S. history is on course to make discoveries that could improve health for generations to come, according to its planners, including the possibility of new treatments and life-saving prevention strategies. However, proposed flat funding levels could slow the study's progress.

Created by the Children's Health Act of 2000, the National Children's Study will follow the health and development of 100,000 children from before birth until age 21, focusing on the links between environment and health. The study, led by the U.S. Department of Health and Human Services and Environmental Protection Agency, hopes to identify the root causes of various childhood dis eases and disabilities and uncover how a broad array of environmental factors impact development. In addition, the study is predicted to shed light on costly conditions such as asthma, diabetes and obesity.

The National Children's Study will track the well-being and health of more than 100,000 children into their adulthoods.

"This study is enormously important," said Peter Scheldt, MD, MPH, director of the National Children's Study at the National Institute of Child Health and Human Development. "It is the largest and most important study of children's health and development that will have ever been conducted in the foreseeable future."

The idea of a long-term children's study actually preceded the 2000 legislation, beginning with a proposal from the President's Task Force on Environmental Health Risk and Safety Risks to Children, which was formed under President Clinton in the late 1990s and still exists today. The task force was charged with proposing national strategies to reduce environmental exposures to children. However, task force members recommended that more information was needed - that they needed to know quantitatively what the risks were - and thus proposed the National Children's Study, according to Scheldt.

"To answer these questions, we must have a study that links exposures at early stages in life with outcomes in later stages in life in the same individuals with a large enough sample size," he told The Nation's Health.

Planning for the study began in 2000 and eventually gathered input from almost 2,500 professionals, Scheldt said. Currently, the study is in the process of establishing a clinical coordinating center as well as the initial implementation sites, which are called vanguard centers. Working with the National Center for Health Statistics, study organizers created a sample of 101 counties around the nation where the study will be conducted. Within those 101 counties will be up to eight vanguard centers, entities that can range from academic medical centers to health departments to regional hospitals, Scheldt said. Vanguard centers will be announced in September and, ideally, the study will begin enrolling participants by January 2007.

However, expanding the study beyond the initial vanguard centers will require more federal Funding, Scheldt noted. With about $12 million budgeted for fiscal year 2005, Scheldt said there are enough funds to proceed with the initial vanguard centers, but more is needed if the study is to remain on schedule.

Unfortunately, President Bush's proposed fiscal year 2006 budget seeks to keep the National Children's Study at level funding. APHA is advocating that the National Children's Study receive a significant funding increase in 2006, a sentiment Scheldt echoed.

"Our professional judgment is that to get back on a timeline and go forward with the remaining centers to carry out the study, we would need $69 million in 2006," Scheidt said.

Even with level funding, the study will continue, only at a slower pace. However, Scheidt said, if funding doesn't increase by 2007, the study can't go forward. When study enrollment does begin, participants will be identified based on geography and will reflect a cross-section of ethnic and socioeconomic groups. Study organizers will recruit pregnant woman and their partners, couples planning to have a child and women of childbearing age who are not planning to get pregnant. In addition to following the child's health, researchers will also follow the woman's health for two years after birth. Of particular interest to public health professionals, the National Children's Study is expected to provide substantial insights into access to care and health disparity issues.

"This study is a bold and unique scientific venture," said Leonardo Trasande, MD, MPP, assistant director of the Center for Children's Health and the Environment at the Mt. Sinai School of Medicine. "It will form the basis of child's health guidance and prevention policy for generations to come and will save the lives and improve the health of millions of American children."

According to Trasande, even if the National Children's Study only resulted in a 1 percent reduction in the cost of six major chronic diseases in American children, it would still save $6.4 billion per year - which is more than the cost of the study over a 25year span. In the end, it's a small investment to make for children's health, Trasande noted.

"In the past, studies that look at environmental links to children's health look at one chemical at a time, but the (National Children's Study) looks comprehensively at all environmental links," he told The Nation's Health. "These chemicals exist in the environment as a mixture...and only a study of this size will be able to assess for impacts for such a broad array of exposures simultaneously."

The study will also release information as it progresses so that health professionals can begin to build on the work as it's being done, said Nsedu Obot Witherspoon, MPH, interim executive director of the Children's Environmental Health Network and chair of APHA's Environment section.

"(The study) is going to help answer so many questions that we're just not able to answer now in terms of long-term impact," Witherspoon told The Nation's Health. "It's going to find the basic causes of many childhood diseases and disorders and help determine not only environmental factors that are harmful, but what is helpful to a child's development."

The Interagency Coordinating Committee discusses the National Children's Study at a meeting in February 2004. Pictured from left are Marshalyn Yeargin-Allsopp, MD; Sherry Selevan, PhD; Peter Scheldt, MD; and Sarah Keim, MA.

David Schonfeld, MD, chair of the committee on pediatrie research at the American Academy of Pediatrics and associate professor of pediatrics and child study at Yale University School of Medicine, noted that the National Children's Study differs from other research because instead of looking at certain pieces, this study will look at the entire puzzle.

"Everybody started as a child, so any information that you get from studying children...obviously has implications for the entire human population," he said. "Many of the health problems that adults develop are determined by childhood exposure. So, if you want to prevent illness in adulthood, the money should be in childhood research."

However, Schonfeld added, discovering ways to improve children's health is justification enough to fully support such an important study.

"Our country has not always put children first and that's something I would like to see change," he told The Nation's Health. "I can't think of anything more important in our country than the health and well-being of our children."

The National Children's Study is one of the many public health programs endangered by President Bush's proposed fiscal year 2006 budget. To draw attention to the issue, The Nation's Health is highlighting key programs that are facing cuts.

For more information on the National Children's Study, visit .

- Kirn Krisberg

Copyright American Public Health Association May 2005

Source: Nation's Health, The

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