Lessons learned: NIEHS/EPA Children’s Centers Table 2. Primary outcomes, exposures, and populations studied by the Centers for Children’s Environmental Health and Disease Prevention Research. Outcomes or health concern Exposures or intervention Population Study Birth cohorts University of California, Berkeley Columbia University Mt. Sinai Medical Center University of Illinois Cincinnati Children’s Hospital School-age cohorts Johns Hopkins University University of Southern California University of Michigan University of Iowa Case-only and case–control studies University of California, Davis University of Medicine and Dentistry of New Jersey Intervention/prevention studies University of California, Berkeley Columbia University Mount Sinai Medical Center University of Illinois Cincinnati Children’s Hospital University of Michigan Johns Hopkins University University of Iowa University of Southern California Infant growth and development Pesticides, allergens Infant growth and development, asthma Infant growth and development, obesity Infant growth and development Infant growth and development Asthma Asthma Asthma Asthma Autism Autism, regression Agricultural pesticide exposure Household pesticides and allergens Chlorpyrifos use, cockroach allergen Birth outcomes and growth Lead Asthma symptoms Asthma symptoms Asthma symptoms Asthma symptoms Pesticides, lead, smoke, PAHs Chlorpyrifos, endocrine-disrupting chemicals, built environment PCBs, mercury Lead, pesticides, smoke Allergens, air pollution Air pollution Air pollution, allergens RSV, endotoxin Worker cleanup in ﬁelds Integrated pest management Integrated pest management Education about ﬁsh consumption (PCBs, mercury) Household cleanup and remediation Household cleanup Household cleanup Cleanup, medical management, personalized care plan Household cleanup University of Washington Agricultural pesticide exposure Pesticide reduction strategies Abbreviations: NYC, New York City; PAHs, polyaromatic hydrocarbons; RSV, respiratory syncytial virus. analysis of biologic or environmental speci- mens, but also for the assessment of question- naire, developmental testing, and other health outcome data. Data safety and monitoring procedures must be in place. Active and meaningful participation of the community is essential for determining the relevant research questions, enrolling and retaining the cohort in an intensive investiga- tion over the long term, and contributing to translation of scientiﬁc principles and research results for communities and the public at large. This requires establishing trust and respecting differences in culture and knowl- edge of the community. Sufficient time and resources are necessary to develop community partnerships. The ethical issues in a longitudinal birth cohort study are likely to become increasingly more complex in the changing medical and legal environment and must be carefully con- sidered in designing research protocols and following the cohort. It is necessary to develop clear plans of referral when children with dis- ease, developmental difficulties, or adverse social situations emerge. Communication of risk to participants and the community and translation of research ﬁndings into interventions and policies are of utmost importance and should be part of the research plan and cost consideration. Funding for a longitudinal birth cohort study must be adequate for the start-up period, continuous without gaps, and long term. Costs have often been underestimated because track- ing and maintaining study participants is labor intensive. The unique characteristics at each devel- opmental stage from birth through adulthood must be considered. Every age presents special challenges in both outcome and exposure assessment. Finally, the health and development of children are multifactorially determined. The greatest challenge is anticipating the data and specimens that will allow the questions of the future to be answered. This requires state-of- the-art tools for data collection and tracking participants, environmental and biologic specimen repositories, and anticipation of future human subject requirements in con- sent procedures. The unique challenges faced by the Children’s Centers in studying diverse popula- tions will be especially helpful for the National Children’s Study, which is intended to be a Environmental Health Perspectives • VOLUME 113 | NUMBER 10 | October 2005 Environmental and other risk factors Home chemical exposures Cases and controls identiﬁed throughout California, mentally retarded controls and healthy controls Autistic children with and without regression Latinos, in an agricultural community, Salinas Valley, California Urban Latinos (Dominican), African Americans, NYC Urban Latinos, African Americans, East Harlem, NYC Hmong, Wisconsin Urban African Americans, Cincinnati, Ohio African Americans, health care based, Baltimore, Maryland School children in 12 communities in Los Angeles, California African Americans, school based, Detroit, MI Rural Iowa Migrant workers in Salinas Valley, California African Americans and Latinos, North Manhattan, NYC African Americans and Latinos, East Harlem, NYC Hmong, Wisconsin African Americans, inner-city Cincinnati, Ohio African Americans and Latinos, Detroit, Michigan African Americans, Baltimore, Maryland Rural Iowa School children in 12 communities in Los Angeles, California Agricultural workers, Yakima Valley, Washington nationwide study representative of the many populations across the United States. Although the Children’s Centers have reported impor- tant ﬁndings from their individual studies, it is only by examining the collective experiences of the Children’s Centers in these lessons learned articles that we gain a better perspective of the potential challenges to be met in the many National Children’s Study sites. REFERENCES Berkowitz GS, Wetmur JG, Birman-Deych E, Obel J, Lapinski RH, Godhold JH, et al. 2004. In utero pesticide exposure, mater- nal paraoxonase activity, and head circumference. Environ Health Perspect 112:388–391. Bradman A, McKone T, Barr DB, Harnly ME, Eskenazi B. 2003. Cumulative organophosphate pesticide exposure and risk assessment among pregnant women living in an agricul- tural community: a case study from the CHAMACOS cohort. Environ Health Perspect 111:1779–1782. Children’s Health Act of 2000. 2000. Public Law 106-310. Clinton WJ. 1997. Executive Order 13045. Protection of Children from Environmental Health Risks and Safety Risks. Fed Reg 62:19883–19888. Dearry A, Collman GW, Saint C, Fields N, Redd S. 1999. Introduction: building a network of research in children’s environmental health. Environ Health Perspect 107(suppl 3):391–392. Dietrich KN, Eskenazi B, Schantz S, Yolton K, Rauh VA, Johnson CB, et al. 2005. Principles and practices of neuro- developmental assessment in children: lessons learned from the Centers for Children’s Environmental Health and 1417