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

项目摘要 应社区要求，将建立一个纳瓦霍出生队列，以研究产前、围产期、 环境暴露于铀及相关采矿废物对新生儿的早期健康影响 纳瓦霍族母亲及其子女通过以下具体目标： 目的1：合作设计和实施一项前瞻性妊娠流行病学出生队列研究 纳瓦霍母婴对中铀废物暴露的结局和儿童发展。 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，以确保它是 尊重纳瓦霍文化，并包括解决社区关切的适当措施 2.招募1650名怀孕早期(可行的第一个月或第二个月早期)的孕妇，并跟踪她们 在整个怀孕和分娩过程中(假设妊娠损失率为10%) 3.建立一个由这些妇女的1500名子女组成的出生队列，他们将接受评估并在出生时进行跟踪， 12个月大婴儿的生长发育和神经发育结果(在随访的初始阶段) 4.比较母亲及其母亲的健康终点(由扩大的研究小组最终确定) 儿童接触铀及相关金属的可能性越来越小。 目标2：从流动性、曝光率、共同曝光率、人口和文化等方面描述这群人的特征 可能影响结果的特征 1.测量/估计人类对铀和其他毒物的暴露，并确定暴露途径 2.使用地理空间统计来确定暴露“热点”作为暴露的替代 3.收集有关可能影响易感性的因素的信息，如饮食和心理社会压力 目标3：在扩大的社区联络小组(CLG)的指导下，与社区合作 卫生工作者，就研究目标和结果、产前护理、可用的临床服务提供广泛的宣传 服务，以及减轻任何暴露对纳瓦霍人的健康影响。 目标4：与纳瓦霍机构伙伴合作，发展其环境健康能力，并制定 该队列持续后续行动的可持续发展计划。 这项工作将通过与ATSDR/CDC的合作协议完成，并涉及机构 科学家以及社会各界都在开发和实施最终的设计。研究团队 结合流行病学、毒理学、数学和建模以及环境方面的科学专业知识 有纳瓦霍文化和语言专家、传统医生和纳瓦霍人参与的评估 国家机构以及临床护理提供者不仅要确保尊重设计和实施，而且 将成果有效地转化为政策、卫生保健以及社区有效的外联和教育。

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.