A Prospective Birth Cohort Study Involving Uranium Exposure in the Navajo Nation

项目摘要 应社区要求，将建立纳瓦霍出生队列，研究产前、围产期、 环境暴露于铀和相关采矿废物对儿童健康的影响 纳瓦霍母亲及其子女通过以下具体目标： 目的1：合作设计并进行一项妊娠期前瞻性流行病学出生队列研究 纳瓦霍族母婴对接触铀废物的结果和儿童发育。 1.征求社区、纳瓦霍人和联邦机构的意见，以告知最终研究设计，以确保其 尊重纳瓦霍文化，包括解决社区关切的适当措施 2.入组1，650名妊娠早期（妊娠早期或妊娠中期早期，如可行）的孕妇，并对其进行随访 整个怀孕和分娩期间（假设流产率为10%） 3.建立一个由1,500名这些妇女的后代组成的出生队列，这些后代将被评估和跟踪出生， 12个月龄时的生长和神经发育结局（随访初始阶段） 4.比较母亲及其母亲的健康终点（由扩大的研究小组最后确定）， 儿童接触铀和相关金属的可能性或多或少。 目标2：从流动性、暴露、共同暴露、人口统计学和文化方面描述队列特征 可能影响结果的特征 1.测量/估计人类对铀和其他有毒物质的接触，并确定接触途径 2.使用地理空间统计数据将暴露“热点”确定为暴露的替代物 3.收集易感性的潜在修饰因素的信息，如饮食和心理社会压力 目标3：在我们扩大的社区联络小组（CLG）的指导下，与社区合作 卫生工作者，提供广泛的宣传研究目标和结果，产前护理，可用的临床 服务，并减轻对纳瓦霍人造成的任何健康影响。 目标4：与纳瓦霍机构伙伴合作，发展其环境卫生能力， 持续跟踪队列的可持续性计划。 这项工作将通过与美国毒物和疾病登记署/疾病控制和预防中心的合作协议来完成， 科学家和社区参与最终设计的开发和实施。研究团队 结合了流行病学、毒理学、数学和建模以及环境方面的科学专业知识， 纳瓦霍文化和语言专家、传统医学家和纳瓦霍人参与的评估 国家机构以及临床护理提供者，以确保不仅尊重设计和实施， 有效地将结果转化为政策、保健和有效的社区外联和教育。

PROJECT ABSTRACT In response to community requests, a Navajo Birth Cohort will be developed to study the prenatal, perinatal, and early postnatal health effects of environmental exposures to uranium and associated mining wastes on Navajo mothers and their offspring through the following specific aims: Aim 1: Co-operatively design and conduct a prospective epidemiologic birth cohort study of pregnancy outcomes and child development in relation to uranium waste exposures among Navajo mother-infant pairs. 1. Solicit community, Navajo and federal agency input, to inform the final study design to ensure it is respectful of Navajo culture and includes appropriate measures to address community concerns 2. Enroll 1,650 pregnant women in early pregnancy (1st or early 2nd trimester, as feasible) and follow them throughout pregnancy and childbirth (assumes a pregnancy loss rate of 10%) 3. Establish a birth cohort of 1,500 offspring of these women who will be assessed and followed for birth, growth, and neurodevelopmental outcomes to 12 months of age (in the initial phase of follow-up) 4. Compare health endpoints (as finalized by the expanded Research Team) among mothers and their children who are more and less likely to be exposed to uranium and associated metals. Aim 2: Characterize the cohort with respect to mobility, exposures, co-exposures, demographic and cultural characteristics that may influence outcomes 1. Measure/estimate human exposures to uranium and other toxicants, and identify exposure pathways 2. Use geospatial statistics to identify exposure "hot spots" as surrogates for exposure 3. Collect information on potential modifiers of susceptibility, such as diet and psychosocial stress Aim 3: With guidance from our expanded Community Liaison Group (CLG) and collaboration with community health workers, provide extensive outreach on the study goals and results, on prenatal care, available clinical services, and mitigation of any exposure-induced health effects on Navajo. Aim 4: Work with Navajo agency partners to develop their environmental health capacity and to develop a sustainability plan for continued follow-up of the cohort. This work will be accomplished through a cooperative agreement with ATSDR/CDC and involve agency scientists as well as communities in development and implementation of the final design. The Research Team combines scientific expertise in epidemiology, toxicology, mathematics and modeling, and environmental assessment with participation of Navajo culture and language experts, traditional medicinemen, and Navajo Nation agencies as well as clinical care providers to ensure not only respectful design and implementation, but effective translation of the results to policy, health care, and effective outreach and education for communities.