Understanding Risk Gradients from Environment on Native American Child Health Trajectories: Toxicants, Immunomodulation, Metabolic syndromes, & Metals Exposure

总结 纳瓦霍出生队列研究（NBCS）是第一个大规模的，特征良好的前瞻性队列研究， 评估部落中环境暴露、出生结果和儿童发育之间的关系 人口纳瓦霍人在国家欧共体人道主义组织队列中的代表性将大大有助于 通过比较土著居民的接触和结果，了解土著居民面临的风险， 欧盟人道处的其他土著居民和少数民族居民， 文化的贡献方面的相似性和差异。通过参加欧共体人道处， NBCS将建立在独特的特征组合，以了解社会人口， 营养、文化和接触健康结果以及积极的儿童健康的变量。我们会要求 利用更广泛的ECHO队列的规模和多样性来解决关键问题的研究问题 关于收入、教育和农村等变量如何与暴露变量联合收割机结合的问题， 有助于健康成果，包括复原力。我们将评估语言发展，学习，社交 沟通和神经发育诊断，以了解发育轨迹， 询问通过ECHO评估的早期生活经历和暴露如何影响这些轨迹。我们 还询问有关COVID-19感染和大流行可能如何影响发展的问题 轨迹，包括潜在的长期COVID影响。在接下来的7年ECHO周期2中，我们 建议提供累计5300例受试者的数据，包括妊娠、后代， 怀孕伴侣和当前参与者重新同意更新的方案。我们的招聘团队有一个 深入了解我们的研究参与者和员工所处的文化和生活环境 采取多种策略克服参与者招募、重新同意和保留的现有障碍。我们 建议每年招募至少30对夫妇参加孕前试点，以解决如何暴露于 在对混合金属或ECHO关注的其他有毒物质的偏见期间，影响生育力、出生结局 和后代的发展轨迹。在欧盟人道处纳入非战斗人员支助， 具有不同文化习俗和社会人口统计学特征的部落人口的儿童健康 大量接触有毒物质。欧共体人道处是包容性的唯一来源之一，即使在人口- 代表性的百分比，将允许相对于美国整体人口的儿童发展的评价。 国家边境管制局通过吸收传统上代表性不足的群体， 这种规模的人口研究，但受到ECHO规定的所有类别照射的不利影响， 通过ECHO核心要素解决所有关键结局中的临床关注结局。

SUMMARY The Navajo Birth Cohort Study (NBCS) is the first large-scale, well characterized prospective cohort study to assess the relationships between environmental exposures, birth outcomes, and child development in a tribal population. Representation of the Navajo population in the National ECHO cohort will contribute significantly to the understanding of risks to Indigenous populations through comparison of exposures and outcomes with other Indigenous populations and minority populations in ECHO, enhancing the understanding of the contributions of cultures with respect to both similarities and differences. Through participation in ECHO, the NBCS will build on the unique combination of characteristics to understand contributions of sociodemographic, nutritional, cultural, and exposure variables to health outcomes as well as to positive child health. We will ask research questions that take advantage of the size and diversity of the broader ECHO Cohorts to address key questions about how variables such as income, education, and rurality combine with exposure variables to contribute to health outcomes, including resiliency. We will assess language development, learning, social communication, and neurodevelopmental diagnosis over time to understand developmental trajectories and to ask how early-life experiences and exposures assessed through ECHO may influence these trajectories. We also ask questions about how the COVID-19 infection and the pandemic may have affected developmental trajectories, including potential long-covid effects. Over the course of the next 7 years in ECHO Cycle 2, we propose to contribute data on a cumulative total of 5300 participants, inclusive of pregnancies, offspring, conceiving partners, and current participants reconsented into the updated protocol. Our recruiting team has a deep understanding of the culture and life circumstances that exist for our study participants and employ multiple strategies to overcome existing barriers to participant recruitment, reconsent and retention. We propose to recruit a minimum of 30 couples per year into the preconception pilot to address how exposures during preconception to mixed metals or other toxicants of interest across ECHO, affect fertility, birth outcomes and developmental trajectories of offspring. Inclusion of NBCS in ECHO provides an opportunity to assess child health in a tribal population with diverse cultural practices and sociodemographics who experience significant exposures to toxicants. ECHO is one of the only sources where inclusion, even at a population- representative percentage, will allow for evaluation of child development relative to the US population overall. NBCS contributes to the diversity of ECHO through inclusion of a group traditionally underrepresented in population studies of this magnitude, yet adversely affected by exposures in all categories specified in ECHO, with outcomes of clinical concern in all key outcomes addressed through the ECHO core elements.