Our Kids: Under the Microscope

GRAND TRAVERSE COUNTY- Hundreds of area kids are about to take part in the largest human health study ever conducted in the United States. The National Children's Health Study, a project of the the National Institutes of Health (NIH), has one major purpose: to examine the effects of the environment, family dynamics, community and cultural influences and genetics on the development and health of children from birth to the age of 21.

The study's reach is huge; it will be conducted in more than 100 counties from 43 states. Ideally, its results will help researchers determine the causes of a number of conditions, including autism, asthma, birth defects and premature deaths, while improving the general health and well-being of kids everywhere.

Here in Grand Traverse, 1,000 families will be asked to participate in the study. The start date here is yet to be determined (read on for reasons why), but it has begun in the biggest participating counties, such as Michigan's Wayne County.

The Traverse City Business News recently spoke with Dr. Nigel Paneth, professor of epidemiology and pediatrics at Michigan State University College of Human Medicine, about Grand Traverse County's involvement and what researchers hope to learn from this ambitious, long-term study of children's health.

Why Grand Traverse County?

Pure luck really. The selection process looked at all of the counties in the U.S. and grouped them by size. The larger a county was, the better the chance was that it would be in the study. The largest 13 counties in the country, population-wise, were automatically selected, such as Wayne County.

But since we are including different categories of counties to get a good cross-section of the country, Grand Traverse fit into one of the smaller county stratums. In the end, Grand Traverse County was randomly selected, but we are really happy that it was. After visiting in February, I feel that Grand Traverse County may be the very best place in the country to conduct this study. I felt a strong community spirit with people who are eager to participate and realize the importance of taking part in something this big.

How many families in Grand

Traverse County will participate?

We are hoping for 250 families a year for four years. We are at a phase where we are still trying to determine how to do the study in Grand Traverse. We are looking for a realistic cross-section of participants.

For instance, if we discover that there is a large population of Hispanic women in the southern part of the county, we will make sure they are represented. If we find that there is a neighborhood worried about a particular environmental concern that may affect children's health, we would want to represent that area.

We have to define the different neighborhoods of the county. Essentially, we want to enroll 1 percent of women in Grand Traverse, which means women have a 1 in 4 chance of living in an area that will be a part of the study.

When will the study begin in Grand Traverse County?

That is the dilemma. We started wave one in Wayne County in mid-February. Grand Traverse is part of wave two, which was slated to begin a year later in February of 2012. But we don't know if we are going to stick to that timeline. The NIH recently had a 1-percent budget cut, and that has affected our process. But we are hopeful to start in the next 18 months. There are no promises though.

How will women be selected?

First we will need to identify the areas of the county to be studied and then the participants. We will probably recruit in prenatal care sites as that is the most efficient way of finding pregnant women. Grand Traverse has a very small number of hospitals where women deliver. 96 percent deliver at Munson, so that will make it easy for us to find pregnant women who want to participate. We may even try to identify some women just when they are trying to get pregnant.

Are there women who would be

prohibited from participating?

We are only recruiting women between the ages of 18 and 49. And women who are not in a position to give consent will not be recruited. For example, we have had two women in Wayne County with cognitive disabilities that we felt were not able to give consent. But other than that, no. We want a cross-section of the country. We want the women of America.

How will women participate and are there any benefits for them?

There will be a regular schedule of check-ups, and we begin with prenatal care. There will be a first-trimester visit and then one 60 days later. We will also conduct a home visit where we check the environment by taking samples of air, water, dust and soil. There will be a third trimester ultrasound and, once the baby is born, we will collect specimens, give the baby a check-up and interview the mother. After that, there will be telephone interviews and home visits.

As far as benefits go, there is the monetary one. We do compensate women for their time. There is also the medical care. There is the chance that the mother will learn something about their child's health. And, if we do discover a problem health-wise with the child, we will be very quick to help that family.

The individual studies begin with prenatal care. When do they end?

Under the current plan, the study will end [when the children studied reach] age 21. But there is always a chance we can continue. After collecting 21 years of research, future scientists are going to want to see how they do in middle age. That information will be more precious than gold!

What are you hoping to determine from this study? How will the results effect future generations?

I will give you an example. In the late '40s, the Framingham Heart Study began in Massachusetts. This study began with over 5,000 adult subjects and absolutely no knowledge on what caused heart disease. Now on its third generation of subjects, the Framingham study is the reason we now know how things like blood pressure and cholesterol affect our health. We now know that smoking is bad for the heart. The Framingham study has reduced heart disease by 50 percent over the years and saved countless lives. I have a friend who is a second generation participant in this study and he has grown very attached to participating in it.

Now, for this study, the whole point of it is to improve children's health. From home environments to diet and nutrition, we are looking to see what exactly affects children's health. There is no way of knowing what we will discover. This is the first study that will take a healthy person, the baby, and determine where the risk factors come from. And by determining what those risk factors are, we will be able to treat them by changing lifestyles. In the Framingham study, we were able to remove certain risk factors and that led to a two-thirds drop in heart disease since the 1960s. We want to apply this to children by learning about the causes of conditions like autism, diabities, asthma, birth defects and premature deaths. This is our chance to do this for children by getting at the root of what causes childhood diseases.

Is there anything else you want the people of Grand Traverse County

to know?

I will repeat a point I made when I came up to talk in February. People aren't aware of the dramatic results these long-term studies can have. This study creates a scenario that will allow us to make these discoveries. If we can find out what causes these risk factors, the payoff will be fantastic. I am not interested in research that does not have a high promise of results. The information that comes out of this will contribute to new knowledge that may help your children as well as your grandchildren.

I know that when we begin in Grand Traverse there is going to be great participation and collaboration with the participants, the hospitals and the physicians. BN