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.

项目总结： 哥伦比亚儿童环境健康中心(CCCEH)提供了 解决方案导向的儿童环境健康研究。从怀孕到成年，CCCEH 已经成功地跟踪儿童解决了与曼哈顿北部和南部相关的研究问题 布朗克斯社区和其他社区，对他们来说，许多复杂的儿童疾病非常普遍。CCCEH有 优先录取代表不足、有风险的黑人和/或西班牙裔孕妇。我们有 记录了物理、化学和社会暴露对呼吸道疾病的影响，如儿童哮喘， 以及神经发育障碍，如注意缺陷多动障碍(ADHD)，这两种疾病非常普遍 并经常与巨大的个人和社会负担并存。对于第二阶段的 环境对儿童健康结局的影响(ECHO-II)联盟，在目标1中，我们将使用全回声 核心数据元素，用于检查产前物理、化学和社交暴露的常见模式， 与儿童哮喘和ADHD联系在一起，以了解他们对这两种疾病的贡献以及他们的健康状况 建立共病，这需要像ECHO这样的大人群来研究。回声队列提供了 有力地研究产前暴露模式是否导致哮喘/ADHD共病的独特机会 通过共同或不同的因果路径。这项科学将解决当前知识差距的问题，这将改善 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；以及3)允许更早的干预。在目标2中，我们将为发展 专门的方案，建议使用一种新的生物测定方法来测量产前化学物质暴露的生物标志物 并增加哮喘和ADHD及其表型的年度测量，以确定产前体检的模式， 与哮喘和多动症及其表型有关的化学和社会暴露 可能有不同的病因。这种对暴露和异质结果的更细粒度的描述将 为早期识别和预防以及初级和第三级干预提供更准确的战略 治疗哮喘和多动症。在目标3中，我们将高保真地实施回声队列协议，最大限度地 保留现有的ECO参与者，并支持继续征聘新的孕妇和 在强调包容性主体表征的同时，对参与者进行先入为主的理解。在探索性目标4中，我们将 评估妊娠期化学物质暴露对妊娠丢失和早期妊娠的影响 呼吸和神经发育健康的指标。最后，CCCEH网站提出了一项计划 加强将在实现所有四个目标的同时实施的不同视角。总而言之，这 该提案旨在通过以下两项贡献对儿童的环境健康产生重大的科学影响 实质上捐赠给ECHO联盟，并通过领先的联盟科学应该对临床产生积极影响 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.