Columbia Center for Children's Environmental Health in ECHO II: Impact of environmental exposures on children's health and the co-morbidity of asthma and ADHD.

项目概要： 哥伦比亚儿童环境健康中心（CCCEH）提供了一个典型的记录， 以解决问题为导向的儿童环境健康研究。从妊娠期到青年期，CCCEH 已经成功地跟随孩子们解决了与北方曼哈顿和南方有关的研究问题 布朗克斯社区和更远的地方，对他们来说，许多复杂的儿童疾病是高度流行的。CCCEH已 优先招募代表性不足、有风险的黑人和/或西班牙裔孕妇。我们有 物理、化学和社会暴露对气道疾病（如儿童哮喘）的影响， 和神经发育障碍，如注意缺陷多动障碍（ADHD），两个高度流行的 并且经常与巨大的个人和社会负担共病。第二阶段 环境对儿童健康结果的影响（ECHO-II）联盟，在目标1中，我们将使用ECHO范围 核心数据元素，以检查产前物理、化学和社会暴露的常见模式， 与儿童哮喘和多动症联系起来，了解他们对这两种疾病的贡献，以及他们的健康- 已确定的共病，这需要大量人群，如ECHO进行研究。ECHO队列提供了 这是一个独特的机会，可以有力地检查产前暴露模式是否有助于哮喘/ADHD合并症 通过共同的或不同的因果途径。这项科学将解决目前的知识差距， 预防和治疗战略：1）提高风险意识; 2）增加转诊以评估 共病障碍;和3）允许早期干预。在目标2中，我们将促进 通过建议使用新的生物测定法测量产前化学品暴露的生物标志物， 并增加哮喘和多动症及其表型的年度测量，以确定产前身体， 与哮喘和ADHD事件相关的化学和社会暴露以及它们的表型， 可能有不同的病因这种对暴露和异质性结果的更细粒度的表征将 在进行初级和三级干预的沿着，制定更精确的早期识别和预防战略 治疗哮喘和多动症在目标3中，我们将以高保真度实现ECHO队列协议，最大限度地提高 保留现有的ECHO参与者，并支持继续招募新的怀孕和 先入为主的参与者，同时强调包容性的主题代表。在探索性目标4中，我们将 评估在怀孕前期化学品暴露对流产和早期妊娠的作用。 呼吸和神经发育健康的指标。最后，CCCEH网站提出了一个计划， 在实现所有四个目标的同时，加强将实施的各种观点。总之，这 该提案旨在通过促进儿童环境健康， 实质上，ECHO联盟，并通过领先的联盟科学，应积极影响临床 实践和政策。

PROJECT SUMMARY: The Columbia Center for Children’s Environmental Health (CCCEH) has provided an exemplary record of solution-oriented children’s environmental health research. From gestation through young adulthood, CCCEH has successfully followed children to address research questions relevant to the Northern Manhattan and South Bronx communities and beyond, for whom many complex childhood diseases are highly prevalent. CCCEH has prioritized enrollment of under-represented, at-risk Black and/or Hispanic pregnant individuals. We have documented effects of physical, chemical, and social exposures on airway diseases such as childhood asthma, and neurodevelopmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD), two highly prevalent and frequently comorbid conditions with a large individual and societal burden. For the second phase of the Environmental Influences on Child Health Outcomes (ECHO-II) consortium, in Aim 1 we will use ECHO-wide core data elements to examine common patterns of prenatal physical, chemical, and social exposures that associate with childhood asthma and ADHD to understand their contribution to both disorders and their well- established co-morbidity, which requires a large population such as ECHO to study. The ECHO cohort provides a unique opportunity to examine robustly if prenatal exposure patterns contribute to asthma/ADHD comorbidity via shared or distinct causal pathways. This science will address current gaps in knowledge that will improve strategies for prevention and treatment by: 1) raising risk-awareness; 2) increasing referrals for assessment of comorbid disorders; and 3) allowing for earlier intervention. In Aim 2, we will contribute to the development of specialized protocols by proposing to measure biomarkers of prenatal chemical exposure using a novel bioassay and adding annual measures of asthma and ADHD and their phenotypes to identify patterns of prenatal physical, chemical, and social exposures that associate with incident asthma and ADHD as well as their phenotypes that may have distinct etiologies. This more granular characterization of exposure and heterogenous outcomes will enable more precise strategies for early identification and prevention along with primary and tertiary interventions for asthma and ADHD. In Aim 3, we will implement the ECHO Cohort Protocol with high fidelity, maximizing the retention of existing ECHO participants and supporting the continued recruitment of new pregnant and preconception participants while emphasizing inclusive subject representation. In Exploratory Aim 4, we will evaluate the role of chemical exposures during the preconception period on pregnancy loss and early indicators of respiratory and neurodevelopmental health. Finally, the CCCEH site proposes a plan for enhancing diverse perspectives that will be implemented while conducting all four aims. Altogether, this proposal is intended to make a large scientific impact on children’s environmental health by both contributing substantially to the ECHO consortium, and by leading consortium science that should positively impact clinical practice and policy.