Title: The National Childrens Study: Our Generations Best Hope of Preventing Disease of Environmental origi
1The 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
2What 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
3Why 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
4Increasing Rates of Chronic Disease in American
Children - Asthma
5Childhood Cancer (Age 0-19), Age-Adjusted
Incidence and Death Rates, 1975-1996
SourceNCI SEER data
6(No Transcript)
7U.S. Incidence of Testicular Cancer
8Developmental Disabilities
- Affect 3-8 of all American children
- Include Dyslexia Attention Deficit
Hyperactivity Disorder (ADHD) Mental
Retardation Autism - Rates may be increasing
9Overweight 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
10The 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
12Children 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
13Growing 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
14Increasing 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.
15Disease 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
16Cost 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)
17Environmental Disease is Preventable - Declining
Blood Lead Levels in the U.S. 19761999
18Prevention 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?
19NCS 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.
20The National Childrens Study
21The 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.
22The 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.
23Broad 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
24Broad 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
25Do 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.