Appendix F
National Children Study Assembly Meeting
Breakout Session Summary: Other Child Health Outcomes in Your Community (Mental Health, Vision, Dental Problems)
December 17, 2003
Sheraton Atlanta Hotel
Atlanta, GA
Facilitators:
Adolfo Correa, M.D., Ph.D., M.P.H., National Center on Birth Defects and Developmental Disabilities, CDC, DHHS
Amy Branum, M.S.P.H., National Center for Health Statistics, CDC, DHHS
Dr. Correa opened the meeting by stating the meeting objectives: (1) to identify other important child health outcomes not already considered by the National Children’s Study and their environmental determinants and (2) to define strategies the National Children’s Study should use to set priorities for outcomes to study. He then asked participants for comments and suggestions.
Outcomes
Participants listed some health outcomes in children:
- Vision
- Mental health (needs and functions)
- Social/emotional (that is, negative and positive domains of child development)
- Relationships (for example, parent-child, sibling-sibling, child-peer, etc.)
- Child abuse/neglect exposure
- "Turbulence" (for example, residential/domestic instability)
- Oral health
- Violence (victim or witness)
- Health services utilization.
These outcomes were grouped into four categories: Vision, Mental/Social/Emotional Health, Relationships, and Oral Health.
Dr. Correa suggested that participants answer the following questions for each of these outcome groups:
- What aspects of the environment cause these childhood disorders or make them worse in your community?
- What aspects of the environment encourage or optimize prevention of these disorders?
- How will a focus on these outcomes help the Study get off the ground and sustain support and participation?
Vision
The following were identified as potential risks for vision problems (strabismus and refractive error) in children:
- Maternal smoking
- Maternal lead exposure
- Low birth weight
- Premature birth.
Factors that can help prevent vision problems are:
- Screening at 6 months, 3 years, and before school (currently screening is usually only done before school)
- Corrective surgery.
Why it could be beneficial to include this outcome in the National Children’s Study
Strabismus, if left unchecked, can lead to amblyopia (lazy eye) and eventual blindness, so potentially, these conditions could be prevented in some children. In addition, it is unknown why some children go on to do well with this condition or to what extent these conditions affect a child’s readiness to read. Screening can be done noninvasively and in conjunction with other well-child or Study exams.
Mental, Social, and Emotional Health
The following risk factors were identified as risks to children’s mental, social, and emotional health:
- Smoking
- Lead exposure
- Preterm delivery
- Low birth weight/small-for-gestational age
- Maternal age (young)
- Parental psychopathology (genetic or environmental)
- Poverty
- Parental marital status and discord
- Pregnancy (wanted and unwanted)
- Relationships
- Parental styles
- Child temperament
- Child gender
- Crowding
- "Turbulence."
Potential prevention factors for mental, social, and emotional problems include:
- Planned pregnancies
- Home visitation models (for example, WIC, Food Stamps)
- Social support
- Emotional vitality.
Why it could be beneficial to include this outcome in the National Children’s Study
There is a lack of normative data on children’s social and emotional development. In addition, there is a lack of "non-EPA"-type of exposure data. There are also links between social well-being and other health outcomes that could be explored further in a study like the National Children’s Study. For example, some children with asthma have internalizing problems, but it is not known when this problem begins. Previous studies have had good results with obtaining data on social and emotional status of children, as many parents want to talk about their children and raise concerns about their children’s negative and positive well-being.
Relationships
The following risk factors were identified as risks to children’s relationships with parents and siblings:
- See previous list-same factors apply
- Work patterns (for example, swing shifts, daycare continuity)
- "Turbulence"
- Chronically ill child.
Factors that can help prevent relationship problems include:
- Stability
- Occupation during pregnancy
- Social support.
Why it could be beneficial to include this outcome in the National Children’s Study
Similar to the previous outcome, exploration of factors relating to good and bad relationships of children could impact other health outcomes and may reveal opportunities for future intervention. Also, as stated previously, parents like to talk about their relationships with their children, which may help to reduce attrition in the Study and help researchers obtain data on this outcome.
Oral Health
The following risk factors were mentioned as risks to children’s oral health:
- Diet
- Nonutilization of dental services
- Maternal oral health
- Poor familial oral health hygiene habits
- Lead exposure
- Smoking in household
- Children with special needs
- Medications (liquids with high sugar content)
- Education of child.
Factors that can help prevent problems with oral health are:
- Sound diet
- Dental hygiene
- Fluoride.
Why it could be beneficial to include this outcome in the National Children’s Study
There are little data on the consequences of poor oral health as it relates to growth and development and social/emotional well-being. For example, it is unknown how chronic pain resulting from chronic oral health conditions affects the ability to learn and self-esteem. A lifecourse design could give researchers a better idea of the chronic nature of oral health problems and changing physical growth trajectories based on changes in extreme oral health conditions. In addition, there are virtually no data on the relationship between oral health and obesity. Other benefits include:
- Address health disparities
- Improve diet
- Prevent tooth related disabilities and problems
- Establish cost effectiveness of early intervention.
Dr. Correa asked the group how a focus on these outcomes might help the Study get started and help sustain support and participation.
- The need to know not only about the child but also the history of the parents and their relationship with the child
- National campaign-important to the response of the community that foreign nationalities be included
- If environmental, then there should be clusters
- The Study should be in-depth so the full broad spectrum is covered
- Possible sampling of women before pregnancy
- Compare the risk versus the benefits in order to prioritize the issues.
Participants in the breakout session suggested the following list of criteria for the Study to consider when determining what outcomes to list:
- Cost versus benefit of collecting the data
- How outcome contributes to well-being
- Level of interest of well-being and future "well-becoming"
- How well defined the problem is
- Measurability or malleability of the study problem
- Applicability of gene-environmental interaction without biological factors
- Synergy among all study topics.
Final Remarks
Dr. Correa thanked the group for attending the breakout meeting and for their input.
In Attendance:
Alice Carter, Ph.D., University of Massachusetts, Boston
Maxia Dong, Ph.D., National Center for Chronic Disease Prevention and Health Promotion, CDC, DHHS
Kristin Anderson Moore, Ph.D., Child Trends
Jeffrey J. Walline, O.D., Ph.D., Ohio State University
Susan A. Wang, M.D., M.P.H., National Center for HIV, STD, and TB Prevention, CDC, DHHS