Wisconsin Medical Journal 2006 • Volume 105, No. 2 50 WISCONSIN MEDICAL JOURNAL The National Children’s Study and the Children of Wisconsin Leonardo Trasande, MD, MPP; Christine E. Cronk, ScD; Steven R. Leuthner, MD, MA; Jeanne B. Hewitt, PhD; Maureen S. Durkin, PhD, DrPH; Jane A. McElroy, PhD; Henry A. Anderson, MD; Philip J. Landrigan, MD, MSc This research was supported by the Beldon Fund. This project has been funded in whole or in part with Federal funds from the National Institute of Child Health and Human Development, National Institutes of Health, under Contract Number HHSN275200503396C. The con- tent of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorse- ment by the US Government. Doctor Trasande is assistant director of the Center for Children’s Health and the Environment at the Mount Sinai School of Medicine in New York City. Dr Christine Cronk and Dr Maureen Durkin are the co-principal investigators for the Waukesha County National Children’s Study Vanguard Center. Doctor Leuthner is the lead pediatrician for the Waukesha County Vanguard Center. Dr Hewitt is associate director of the Institute of Environmental Health at the University of Wisconsin-Milwaukee. Dr McElroy is an associate scientist with the Comprehensive Cancer Center at the University of Wisconsin. Doctor Anderson is chief medical officer for the Wisconsin Division of Public Health. Doctor Landrigan is professor and chair of Community and Preventive Medicine at Mount Sinai, and is princi- pal investigator for the National Children’s Study Vanguard Center in Queens, New York, where Doctor Trasande is the Mount Sinai Site director. Please address correspondence to: Leonardo Trasande, MD, MPP, Center for Children’s Health and the Environment, Mount Sinai School of Medicine, 1 Gustave L. Levy Pl, PO Box 1057, New York, NY 10029; phone 212.241.8029; fax 212.996.0407; e-mail leo. trasande@mssm.edu. ABSTRACT Prospective, multi-year epidemiologic studies such as the Framingham Heart Study and the Nurses’ Health Study have proven highly effective in identifying risk factors for chronic illness and in guiding disease pre- vention. Now, in order to identify environmental risk factors for chronic disease in children, the US Congress authorized a National Children’s Study as part of the Children’s Health Act of 2000. Enrollment of a na- tionally representative cohort of 100,000 children will begin in 2008, with follow-up to continue through age 21. Environmental assessment and examination of biomarkers collected at specified intervals during preg- nancy and childhood will be a major component of the Study. Recruitment at 105 sites across the United States is planned, and will begin at 7 Vanguard Centers in 2008, including Waukesha County, Wis. The National Children’s Study will provide information on prevent- able risk factors for such chronic diseases as asthma, certain birth defects, neurobehavioral syndromes, and obesity. In addition, the National Children’s Study will provide training in pediatric environmental health for the next generation of researchers and practitioners. THE NEED FOR THE NATIONAL CHILDREN’S STUDY Patterns of illness among children in the United States and in other industrially developed nations have changed substantially in the past 100 years. 1 Infant mor- tality has declined while life expectancy has increased. With notable exceptions, such as HIV/AIDS, infectious diseases have receded as leading causes of illness and death. 2 Today the major illnesses confronting children in the United States are a group of chronic conditions including a number of psychosocial and behavioral conditions termed the “new pediatric morbidity.” 3 Many of these diseases may be caused or exacerbated by environmental factors. These include asthma, for which incidence and mortality have more than doubled. 4 Incidences of childhood and young adult cancers, such as acute lymphocytic leukemias, brain cancer, and testicular cancer have increased by 10%, 5 40%, 6 and 68%, 7 respec- tively, over the past 15-30 years, despite declining mortal- ity. The incidence rates of some birth defects, such as gas- troschisis, have increased sharply. 8,9 Neurodevelopmental disorders—including learning disabilities, dyslexia, men- tal retardation, attention deficit disorder, and autism— are highly prevalent and affect 5%-10% of the 4 million babies born in the United States each year. 10 Childhood obesity has become an increasingly important epidemic among American children. 11 Chronic childhood illness is very expensive both monetarily and in terms of parental days of work lost. A recent study of the direct medical and the indirect societal costs associated with 4 categories of illness that are linked to environmental exposures in American children—lead poisoning, asthma, cancer, and neurobe- havioral disorders—found the total costs to amount to