Feature

Supporters Build Awareness for the National Children's Study
Since its inception, many organizations have become involved in activities to raise awareness about the need for the National Children's Study. Through participation in Study planning and outreach efforts, these groups—from a range of children's health, environment, national, and community organizations—have worked on their own to gain support and to ensure that the needs of their communities and constituents are represented in the Study.

Here are some examples of how supporters have already made an impact:

• March of Dimes Medical Director Nancy Green, MD, frequently discusses the need for the Study in meetings with constituents and outside groups. "The Study is an important tool for our mission," said Dr. Green. "One of the great things about the National Children's Study is that it is not focused on one single disease area, thus serving the broad needs of childhood disease and prevention," she added.



• On April 28, a group of Study supporters co-sponsored a Congressional briefing about the Study at the Cannon House Office Building to generate interest among policy makers and the public. Approximately 100 Capitol Hill staffers and supporters attended the event, organized by the American Chemistry Council (ACC) and the American Chemical Society. The Honorable John Porter, former Congressman from Illinois, and Kim Thompson, ScD, creator and director of the Harvard School of Public Health's Kids Risk Project, were among the speakers.



• The ACC also supports Study efforts by lending expertise from Senior Scientist Judith A. Graham, PhD, who serves on the National Children's Study Advisory Committee. "Other groups can get involved by helping to get the science right, encouraging their members to join the Study Assembly listserv … so the Study can get the support it needs," said ACC Public Health Team Director Lee Salamone.



• The Partnership for Children's Health and the Environment sponsored a Senate briefing on April 28 where Lynn R. Goldman, MD, professor of Environmental Health Sciences at Johns Hopkins' Bloomberg School of Public Health, and Phil Landrigan, MD, chair of the Department of Community and Preventive Medicine at Mt. Sinai School of Medicine, among others, spoke about the need for the Study.



• The Teratology Society encourages its members to exchange ideas with Study planners by joining the Study Assembly and provides Study materials on its Web site, including a flyer, slides about the Study, and links to the National Children's Study Web site. Several Teratology Society members also served on Working Groups.



• Rick Rader, MD, editor-in-chief of Exceptional Parent Magazine, recently asked Marion Balsam, MD, director of the National Children's Study Research Partnerships Program, to write an article for the July issue called, "A Day in the Life of the National Children's Study."



• Dr. Balsam and others at the National Children's Study Program Office are working with the Foundation for the National Institutes of Health (FNIH) to facilitate the development of public-private partnerships. The FNIH has taken the lead in building the partnership program.

Through efforts such as these, supporters of the Study are helping to build a network of outreach that extends from community organizations and health professionals to families. By continuing to raise public awareness, they hope to foster and build trusting relationships with these groups based on a mutual goal: improving the health and well-being of children in their communities across the country.

National Children's Study Working Groups Near End of Tenure
As the National Children’s Study moves from planning into the implementation phase, many Working Groups will soon be disbanding, having achieved their goals of recommending hypotheses and offering input on key issues for consideration in Study design. The Study would like to thank the 662 members of the 22 Working Groups for their outstanding contributions over the past four years in guiding the development of workshops, white papers, and recommendations for pilot studies.

The important efforts of the Working Groups include a diverse range of contributions. The Pregnancy and the Infant Working Group proposed a set of measures of maternal stress that can be used to assess Study subjects without unreasonable burden; these are detailed in a report from the Psychosocial Stress in Pregnancy and the Infant Workshop. The Community Outreach and Communications Working Group developed a Guidance Document recommending ways in which Study planners can involve families in research to ensure Study success. As a final example, the Study Design Working Group informed the process for selection of a strategy for a national probability sample and evaluated several potential Study research questions.

Working Group members represent federal and non-federal organizations, experts in children’s health and environment, and community leaders from across the country.

Alan Fleischman and Cynthia Moore Join the National Children's Study Program Office
Alan R. Fleischman, MD, one of the country's leading experts on pediatric and research ethics, recently joined the National Children's Study Program Office to establish ethical guidelines to protect the interests of research participants. As a senior advisor at the New York Academy of Medicine, Dr. Fleischman currently works to create initiatives in health policy that focus on decreasing health disparities among the nation's most vulnerable populations. He is also a clinical professor of Pediatrics and clinical professor of Epidemiology and Population Health at the Albert Einstein College of Medicine in New York, where he teaches about ethical responsibilities of health care professionals and respect for the rights of patients.

As the National Children's Study protocol is developed,
Dr. Fleischman will work to reduce the potential burden to participating families resulting from the length and frequency of their visits to Study sites and/or methods of data collection. He will also address concerns of participants' privacy and confidentiality of data and develop guidelines about the type of information to give families, including how best to communicate with participants about the environmental exposures and health outcomes of their children.

Cynthia A. Moore, MD, PhD, of the Office of Genomics and Disease Prevention at the Centers for Disease Control and Prevention (CDC), will be working in the National Children's Study Program Office on protocol development, with a special emphasis on genetics. Dr. Moore has spent much of her career at CDC in birth defects and genetic disease epidemiology, most recently in the National Center for Birth Defects and Developmental Disabilities. Her research has focused on mechanisms of morphogenesis, the classification of birth defects and genetic syndromes, and genetic and environmental risk factors for birth defects.

Dr. Moore will explore many issues in the development of the genetics protocol for the National Children's Study, including: which genetic information to gather; data collection, processing, and storage; and the ethical, legal, and social implications of acquiring genetic information. In addition, Dr. Moore will determine what strategies help us better understand how genes interact with the environment to influence children's health.

Good To Know

To Eat or Not to Eat: Fish Consumption During Pregnancy and Beyond
Many advisory messages have been issued in recent years warning pregnant women about the risks of eating certain types of fish during pregnancy. These warnings advise pregnant women to avoid consuming fish that contain high levels of mercury due to its subsequent transformation into methylmercury, the toxic form. Because the developing nervous system of the unborn child is susceptible to methylmercury, babies exposed to high levels may experience developmental delays such as cerebral palsy and psychomotor retardation. This was evidenced in newborns of the fishing village in Minimata Bay, Japan, where methylmercury contaminated fish in a local bay in the late-1950s.

Although many reports underscore the danger of eating certain types of fish in high quantities, doctors and researchers advocate that pregnant women consume fish in moderation due to a number of potential benefits that arise from fish consumption. A recent study found that women who eat fish during the late stages of pregnancy appear to be less likely to have a low birth weight infant.¹ Omega-3 fatty acids in fish are thought to boost blood flow to the placenta, bringing more nutrients to the fetus. Researchers have also discovered a positive association between maternal intake of omega-3 fatty acids during pregnancy and lactation, and higher IQs of their children at age four.² Furthermore, other studies have established that the benefits of fish intake extend into adulthood with higher scores on cognitive functioning tests.³ Correlations have also been established between omega-3 fatty acid intake and a reduced risk of dementia, cardiovascular disease, and sudden cardiac death.^{4, 5} Finally, omega-3 fatty acid supplements may also help to stabilize volatile moods of people suffering from manic depression.⁶

Definite causal relationships between fish consumption and various outcomes cannot be known because of limitations in each of the aforementioned studies. Nonetheless, these studies provide an excellent foundation for researchers to further examine the links between dietary patterns, such as fish consumption, and a range of developmental outcomes. The National Children’s Study provides the size, scope, and design to test for such complex associations and offers an opportunity to validate the research presently established and augment it with valuable new information.

¹ Rogers J, Emmett P, Ness A, Golding J. Maternal fish intake in late pregnancy and the frequency of low birth weight and intrauterine growth retardation in a cohort of British infants. Journal of Epidemiology and Community Health. 2004;58:486-492.

² Helland I, et al. Maternal supplementation with very long chain n-3 fatty acids during pregnancy and lactation augments children's IQ at four years of age. Pediatrics. 2003;111:e38-e44.

³ Kalmijn S, et al. Dietary intake of fatty acids and fish in relation to cognitive performance at middle age. Neurology. 2004;62:275-280.

⁴ Kalmijn S, et al. Dietary fat intake and the risk of incident dementia in the Rotterdam Study. Annals of Neurology. 1997;42:776-782.

⁵ Siscovick DS, et al. Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. Journal of the American Medical Association. 1995;274:1363-1367.

⁶ Stoll AL, et al. Omega-3 fatty acids in bipolar disorder. Archives of General Psychiatry. 1999;56:407-412.