A Look at the Diverse Communities of the National Children's Study
The National Children's Study will follow children in 105 Study locations across the country, capturing daily life in farms, desert regions, mountains, inner cities, suburbs, and other kinds of communities. Recruiting a representative sample of children from diverse groups will ensure that Study findings reflect the experiences of many different American families and not just those of one particular race, ethnicity, socioeconomic class, or region.
Local Study teams are currently conducting start-up activities in approximately one-third of the Study locations. They include counties with large Hispanic populations, such as Bexar County, TX, and large Asian populations like Honolulu, HI. Other locations are themselves uniquely diverse, such as Queens, NY, where 46% of individuals are foreign-born and 138 different languages are spoken.1, 2
The Study locations of Cache County, UT, Nassau County, NY, and Hinds County, MS, are profiled below to provide a closer look at some of the Study's unique communities and shed light on the challenges and opportunities recruitment will bring.
Cache County, Utah
Situated between two mountain ranges of the Rocky Mountains in northern Utah, Cache County is a rural, agricultural community of approximately 98,662 residents.3 The meat and dairy industries employ many, including a large part of the Hispanic population in the county. Eight percent of residents are Hispanic (of any race) and 95% percent are white.4
Recent investigations of undocumented workers have made the community less trusting of the government, illustrating the relevance and challenges for the National Children’s Study as it works in Study locations. "We will have to work closely with organizations that provide services to these communities to establish trust and help recruit them into the Study. Some of these groups already serve on our Community Advisory Board, including a Catholic priest and a representative from Migrant Head Start," said Pamela Silberman, M.A., Community Relations Director for the University of Utah Vanguard Center, which manages the Cache County location.
"Some residents perceive the Study as a way for the government to interfere in people's lives. To combat this misperception, we are emphasizing the local aspect of the Study, how the Study is being conducted in local hospitals by people who work and live in the county, whom they can trust," said Ms. Silberman.
Another unique aspect of Cache County is its religious make-up. Ninety-five percent of Cache County residents are Mormon.5 "We are meeting with church leaders and planning to present information about the Study during meetings with their members to lend added credibility to the Study," Ms. Silberman said.
In addition to Cache County Study location, the University of Utah also manages the Salt Lake County Vanguard location.
Nassau County, New York
Nassau County is a mostly suburban county situated on Long Island, NY. Nassau has 1.3 million residents and has the highest household income in New York state and eighth in the nation.6, 7 In the last few decades, the population of Nassau has grown older and more diverse in terms of its economic, ethnic, and racial make-up. Though 80% of the county is white, the number of African-American, Hispanic, Asian, and other residents has grown and continues to rise. Twenty-three percent of residents speak a language other than English at home.8
Recruiting families from non-English speaking communities will require Study staff that are not only fluent in the languages spoken, but are sensitive to the mores and customs of these communities, explained Leo Trasande, M.D., M.P.P., Principal Investigator for the Nassau County Team. "To meet the needs of different residents, we will also employ strategies like varying the times of day we visit and offering different types of transportation for getting participants to and from appointments," he said. Mount Sinai School of Medicine manages the Nassau County Study location.
"The diversity within Nassau County provides a terrific opportunity to examine differences in health outcomes within the county and when Nassau County is compared to rest of the country," added Dr. Trasande. For example, though Nassau has an average infant mortality rate that is lower than the national and state averages, the areas of Roosevelt and Inwood are more than double the average for the state at 15.6 and 11.9 per 1,000 live births respectively.9
Mount Sinai also manages the Queens Vanguard Location, the most ethnically diverse county in the United States.
Hinds County, Mississippi
Hinds County, MS, is the most populous county in the state, a predominantly urban area in west-central Mississippi and home to Jackson, the state capital and largest city. The county is bordered to the east by the Pearl River and to the northwest by the Big Black River. Among its approximately 250,000 residents, about 66% are African-American and 32% are white.10
Hinds County is also home to the Jackson Heart Study, a long-term study on cardiovascular disease in African-American men and women. For the Hinds Study Center team at The University of Mississippi Medical Center (UMMC), this is a critical benefit to the National Children's Study. The UMMC is part of a collaborative partnership with the National Heart Lung and Blood Institute, the National Center on Minority Health and Health Disparities, Jackson State University, and Tougaloo College to conduct the Jackson Heart Study. "The Medical Center is already well-known in the community because of the Jackson Heart Study and because many residents receive care at UMMC," explained Robin Wilkerson, R.N., Ph.D., Study Co-Director for the Hinds Study Center Team. "This will help us establish trust in the community as we recruit participants," she said.
The Study Team has also enlisted Sharon Wyatt, R.N., Ph.D., UMMC Professor of Nursing, as a Senior Investigator who will provide mentorship in their outreach efforts. Dr. Wyatt brings much expertise in the area of community outreach, engagement, and retention from her work in the Jackson Heart Study as a Co-Investigator. Because the two studies are enlisting different populations, the National Children's Study Center Team is not concerned about "over-tapping" the community for participation. "We will recruit pregnant women, generally a younger population, whereas the Jackson Heart Study enrolled men and women over age 35," said Dr. Wilkerson.
In January, the Study Team conducted its first meeting of their Community Advisory Board, co-chaired by a local news anchor and child advocate. The Board is also made up of community representatives from such areas as the local March of Dimes, the Boys and Girls Club, the Jackson Chamber of Commerce, neighborhood and volunteer organizations, and members of the faith community. "Faith-based organizations and others will be very important to our outreach efforts," said Dr. Wilkerson.
Looking ahead, the Study Team is planning to conduct focus groups related to community engagement. "We'll examine issues related to barriers to participation, community concerns, and ways to encourage participation and retention in the Study. We need the community's input all along the way because this has to be a partnership, or it's not going to work," said Dr. Wilkerson.
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National Children's Study Public Comments on Research Plan
The National Children's Study Program Office received more than 35 comments from members of the public about the Study's Research Plan, a plan that describes the Study's background, design, and measures, and the rationale for their selection. These comments, which were invited from the public from June through September, 2007, include suggestions about which child health concerns and environmental issues should be further explored by the Study. Topics recommended for further research ranged from autism to breastfeeding and pediatric sleep patterns. All of the comments can be viewed at the Study's Web site.
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Good to Know
New Study Reveals Correlation between Bullying and School Problems
In January, the Journal of Pediatrics published a cross-sectional study on the effects of bullying that surveyed middle school and high school students in an urban district. The results of "Bullying and School Safety,"11 which encompassed 5,391 children, provide an indication that bullying has a negative impact not just on its victims, but on those that practice bullying, as well.
Of the 7th, 9th, and 11th-graders surveyed, 26% reported involvement in bullying, either as a victim, bully, or both (what the study's authors term a "bully-victim"). All three groups were far more likely than bystanders (i.e., peers not involved in bullying) to feel unsafe at school and to feel sad most days. Victims, not surprisingly, were more likely to say they "do not belong" in their school, while both victims and bully-victims were more likely to say they often feel negative about themselves than were bystanders or bullies. Most ominously, of all the groups, bully-victims were more likely to express the belief that it is "not wrong" to take a gun to school.
Carried out in conjunction with the school district's annual survey of students, which aims to understand how the school climate can be improved, the study asked students whether they had been bullied; whether they had bullied others and how often; and where they had been bullied. Survey answers were correlated to data from school records, including grade point averages, attendance, expulsions, suspensions, and demographic characteristics. The study revealed that, for each 1-point rise in grade point average, the odds of being a victim versus being a bystander dropped by 10 percent.
The issue of bullying and its impact on education is far from being confined to the U.S. As a 2004 study by Peter C. Scheidt, M.D., M.P.H., Director of the National Children's Study, and others showed, bullying is an international educational issue, although it occurs with far greater frequency in certain nations than in others. The 2004 "Cross National Study of Violence-Related Behaviors in Adolescents"12 measured the frequency of such behaviors, including fighting, weapon carrying, injuries from fighting and bullying, in five countries: Ireland, Israel, Portugal, Sweden, and the U.S. While the frequencies of certain behaviors, such as fighting, were markedly similar across countries, bullying had the greatest disparity in prevalence with only 0.9 percent of Swedish adolescents saying they had engaged in bullying several times a week, contrasted with the 3.6 percent of U.S. students who reported such behavior.
The 2004 study was among the first to survey violent behavior in adolescents outside, and in relation to, the U.S. And while bullying rates varied dramatically across the five nations, the consequences of bullying did not; traditional risk-taking behaviors (smoking and drinking) and being bullied were, in the authors words, "highly associated with the expression of violence-related behavior."
While substantial work has been done on the impact of bullying in recent decades, the National Children's Study, because of its size, scope, and longitudinal design, will give researchers the opportunity to significantly build on this body of work by studying the gene and environmental factors that may contribute to these and other behavioral health problems.
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1 U.S. Census Bureau (2008). State and County Quick Facts: Queens, New York [Electronic Version]. Retrieved March 6, 2008, from http://quickfacts.census.gov/qfd/states/36/36081.html
2 New York State Office of the State Comptroller (2008). Queens: An economic review [Electronic Vrsion]. Retrieved March 6, 2008, from: http://queens.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn
3 U.S. Census Bureau (2008). State and County Quick Facts: Cache County, Utah [Electronic Version]. Retrieved March 6, 2008, from http://quickfacts.census.gov/qfd/states/49/49005.html
5 The Association of Religion Data Archives (2008). County Membership Report: Cache County [Electronic Version]. Retrieved March 7, 2008, from http://www.thearda.com/mapsReports/reports/counties/
6 U.S. Census Bureau (2008). State and County Quick Facts: Nassau County, New York [Electronic Version]. Retrieved March 6, 2008, from http://quickfacts.census.gov/qfd/states/36/36059.html
7 U.S. Census Bureau (2008). Income, Earnings, and Poverty Data From the 2006 American Community Survey, Table 3 [Electronic Version]. Retrieved March 6, 2008, from http://www.census.gov/prod/2007pubs/acs-08.pdf (1.49 MB)
8 U.S. Census Bureau (2008). State and County Quick Facts: Nassau County, New York [Electronic Version]. Retrieved March 6, 2008, from http://quickfacts.census.gov/qfd/states/36/36059.html
9 New York State Department of Health Vital Statistics as cited in Nassau County Community Health Assessment 2005-2010 [Electronic Version]. Retrieved March 6, 2008 from: http://www.nassaucountyny.gov/agencies/health/docs/pdf/
2005-2010_cha.pdf (PDF 4.1 MB)
10 U.S. Census Bureau (2008). State and County Quick Facts: Hinds County, Mississippi [Electronic Version]. Retrieved March 6, 2008, from http://quickfacts.census.gov/qfd/states/28/28049.html
11 Glew, G.M., Fan, M., Katon, W., & Rivara, F. P. (2008). Bullying and school safety. The Journal of Pediatrics, 152, 123-8.
12 Smith, K.E., Iachan, R., Scheidt, P.C., Overpeck, M.D., Gabhainn, S.N., Pickett, W., & Harel, Y. (2004). A cross-national study of violence-related behaviors in adolescents. The Archives of Pediatrics and Adolescent Medicine, 158, 539-544.
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Comments or Questions?
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Visit our Web site at http://nationalchildrensstudy.gov
The National Children's Study is led by a consortium of federal agency partners:
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
Centers for Disease Control and Prevention
U.S. ENVIRONMENTAL PROTECTION AGENCY