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The National Childrens Study: Our Generations Best Hope of Preventing Disease of Environmental origi

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Title: The National Childrens Study: Our Generations Best Hope of Preventing Disease of Environmental origi


1
The National Childrens StudyOur Generations
Best Hope of Preventing Disease of Environmental
origin in Americas Children
  • Leonardo Trasande, MD, MPP
  • Philip J. Landrigan, MD, MSc
  • Center for Childrens Health and the Environment
  • Mount Sinai School of Medicine

2
What is The National Childrens Study?
  • A prospective epidemiological study of 100,000
    American children -- from conception to adulthood
  • Goal To examine the influence of the environment
    on childrens health,development and risk of
    disease
  • Environment in the NCS includes chemicals,
    diet, lifestyle and the built environment

3
Why is the NCS Needed?
  • Rates of chronic disease in American children are
    increasing- asthma, cancer, certain birth
    defects, learning disabilities and obesity
  • The environment is changing
  • The chemical environment
  • The built environment
  • Growing evidence that environmental factors are
    linked to disease in children
  • Disease of environmental origin is expensive
  • Environmental disease is preventable

4
Increasing Rates of Chronic Disease in American
Children - Asthma
5
Childhood Cancer (Age 0-19), Age-Adjusted
Incidence and Death Rates, 1975-1996
SourceNCI SEER data
6
(No Transcript)
7
U.S. Incidence of Testicular Cancer
8
Developmental Disabilities
  • Affect 3-8 of all American children
  • Include Dyslexia Attention Deficit
    Hyperactivity Disorder (ADHD) Mental
    Retardation Autism
  • Rates may be increasing

9
Overweight and Obesity
  • Prevalence has nearly quadrupled in American
    children
  • 2.5-fold increased risk of overall mortality
  • 4-fold risk of cardiovascular mortality
  • 5-fold risk of diabetes
  • Risk of hypertension, gall bladder disease, and
    some cancers

Source Willet et al., New Eng J Med, 1999
Source Willet et al., New Eng J Med, 1999
10
The Changing Chemical Environment
  • Today there are 80,000 chemicals in commerce -
    most newly developed since WW II
  • 2,863 chemicals are produced or imported in
    quantities of 1 million pounds or more per year
    (high production volume HPV chemicals).
  • HPVs are the chemicals to which children are most
    likely exposed.
  • For about half of the HPVs, no basic toxicity
    data are publicly available
  • For 80 of HPVs, there is no information on
    developmental or pediatric toxicity
  • Biomonitoring surveys from CDC have found body
    burdens of HPVs to be widespread in Americans
  • --EPA Chemical Hazard Data Availability Study,
    1998

11
  • The Changing Built Environment
  • Rapid population growth
  • Urbanization
  • Sprawl
  • Traffic
  • Sedentary life style
  • Changing diet

12
Children are especially vulnerable to
environmental toxins
  • Greater exposure pound-for-pound
  • Diminished ability to detoxify and excrete many
    chemical toxins
  • Heightened biological vulnerability
  • More years of future life
  • Pesticides in the Diets of Infants and Children
  • National Academy of Sciences, 1993

13
Growing Evidence of Links between Environment and
Disease - Asthma
  • Indoor triggers
  • House dust
  • Second-hand tobacco smoke
  • Mold and mites
  • Cockroach droppings
  • Animal dander
  • Certain pesticides
  • Outdoor triggers
  • Ground-level ozone
  • Fine particulates
  • NOx
  • Diesel exhaust

Prevention is Achieved Through Reducing Exposures
14
Increasing Evidence for the Role of the
Environment
  • At least 28 percent of developmental
    disabilities in children dyslexia, attention
    deficit disorder and mental retardation are due
    to at least in part environmental causes.
  • Exposures of pregnant women to toxic drugs and
    smoke released to the environment by the attacks
    on the World Trade Center on September 11, 2001
    caused a doubling in the number of babies who
    were small for gestational age.
  • Ionizing radiation, 1,3-butadiene, certain
    pesticides and benzene have all been
    etiologically associated with the development of
    cancer.

15
Disease of Environmental Origin in Children is
Expensive
  • Lead poisoning 43.4 billion/yr
  • Asthma 2.0 billion/yr
  • Cancer 0.3 billion/yr
  • Neurobehavioral
  • disorders 9.2 billion/yr
  • TOTAL 54.9 billion/yr

Source Landrigan et al., EHP, 2002
16
Cost of Methylmercury Toxicity in America
  • 316,588-637,233 children born in 2000 suffered IQ
    loss ranging from 0.2-24.4 IQ points
  • Associated lost economic productivity 8.7
    billion (2000 dollars, range 2.2-43.8 billion)
  • 1.3 billion of this cost attributable to
    American coal-fired power plants
  • Hundreds of thousands of children each year will
    continue to suffer this level of brain damage
    each year, costing America billions of dollars
    each year if mercury pollution is allowed to
    continue at this level.
  • (Trasande et al 2005)

17
Environmental Disease is Preventable - Declining
Blood Lead Levels in the U.S. 19761999
18
Prevention Depends on Science Critical Questions
to be Addressed in theNational Childrens Study
  • How does indoor and outdoor air pollution
    contribute to causation of asthma?
  • What are the still undiscovered environmental
    causes of developmental disabilities? ADHD?
    Autism?
  • What accounts for the rising incidence of
    pediatric cancer?
  • What are the causes of of birth defects?
    Hypospadias? Testicular cancer?
  • Where do we target prevention?

19
NCS Vanguard Sites
  • Eight Vanguard Sites for the Study
  • Recruit participants and test out the protocols
  • Ensure that the study goes smoothly when it ramps
    up to testing 100,000 children from birth to age
    twenty-one
  • Each county will reap significant economic
    benefits from being part of the Study, and the
    Study will improve the lives of children in each
    of the ninety-six Study locations.

20
The National Childrens Study
21
The National Childrens Study
  • Funding has never been more critical for this
    important study.
  • Delayed by one year because it did not receive
    funds it needed in Fiscal Years 2004 and 2005
  • Without at least 69 million in Fiscal Year 2006,
    the National Institute of Child Health and Human
    Development will likely be forced to cancel this
    important work in childrens environmental health.

22
The National Childrens Study
  • To implement the Study as planned in late 2005 in
    FY 06, and allow piloting NICHD needs a total of
    57 million in new dollars outside the
    Institutes regular budget in FY 06, to total 69
    million.
  • The first 12 million would be used to allow the
    eight Vanguard Sites to begin the study, and
    allow the other sites to plan for implementation
    in 2006.

23
Broad Support for the Study
  • American Academy of Pediatrics
  • American Chemistry Council
  • Center for Childrens Health and the Environment
  • March of Dimes
  • Childrens Environmental Health Network

24
Broad Support for the Study
  • Bipartisan support for authorizing language
    Childrens Health Act of 2000
  • Appropriations effort
  • Senate Clinton and Dewine
  • House Boehlert, Cannon, Slaughter, Saxton, Holt,
    King

25
Do pediatricians want the NCS?
  • 71.7 of WI pediatricians supported full federal
    funding for the National Childrens Study, even
    though it will cost 2.7 billion over twenty-five
    years. (Trasande et al, unpublished data)

26
  • Why Do We Need the NCS?
  • Chronic diseases in American children are
    increasing
  • Environmental disease in children is costly-
    54.9 billion each year
  • Environmental diseases cause untold misery, and
    they burden American society
  • Environmental disease is preventable, but
    prevention requires good science.
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