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Final Report: Neurobehavioral Effects of Prevalent Toxicants in Children

EPA Grant Number: R829389C001
Subproject: this is subproject number 001 , established and managed by the Center Director under grant R829389
(EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
Center: CECEHDPR - University of Cincinnati Center for the Study of Prevalent Neurotoxicants in Children
Center Director: Lanphear, Bruce
Title: Neurobehavioral Effects of Prevalent Toxicants in Children
Investigators: Lanphear, Bruce , Dietrich, Kim
Institution: Children Hospital of Cincinnati , University of Cincinnati
EPA Project Officer: Fields, Nigel
Project Period: November 1, 2001 through October 31, 2006
RFA: Centers for Children's Environmental Health and Disease Prevention Research (2001)
Research Category: Children's Health , Health Effects

Description:

Objective:

The HOME Study is a longitudinal cohort study which examines the effect of low-level exposures (pre- and postnatal) of prevalent toxicants on neurobehavioral outcomes and development disorders, and tests meconium levels as a measure of in utero exposures to numerous toxicants.  We are also conducting a nested, randomized controlled trial to test the efficacy of lead hazard controls on blood lead concentrations and developmental conditions and the efficacy of injury hazard controls on injury incidence and severity.   Finally, this study provides data that are essential for exposure assessment and risk characterization for prevalent residential pesticides in childhood. 

 
      Research Objectives: 
 
Lead & Injury Hazard Control
The purpose of the randomized trial is to test the efficacy of interventions to prevent lead toxicity and residential injuries in children.  All participants were enrolled during pregnancy and in April 2007, the NIEHS awarded additional funds to extend the study to follow children until they are 5 years of age.  The extension of this trial was essential to test the efficacy of the intervention on measures of cognitive abilities and behavioral problems that are not stable until 5 years of age.  It was also essential to test the efficacy of the injury intervention during the first 5 years of life, when children are particularly vulnerable to residential injury.  Enrolled families (n=408) were randomly assigned to either the lead hazard reduction arm or the injury reduction arm (n=355).  The remaining 53 participants fell into a “no intervention” control arm because property owners did not consent to the lead/injury hazard reduction repairs or the participant gave birth before completion of the baseline visit and randomization.
 
We conducted the lead hazard controls prior to birth, before the children are exposed to lead in their home environment.  The injury intervention was not implemented until the index child is between 3 and 6 months of age.  There are 174 families assigned to the lead treatment group and 181 assigned to the injury treatment group.  All initial lead and injury hazard reduction treatments have been completed.  We are currently following up with participants that moved to a new residence.  If a child in the lead treatment group relocated during the first 24 months of life, we conducted lead hazard controls in the new residence if hazards were present.  However, as of June 2007, the study was no longer able to maintain lead hazard controls in new residences due to funding constraints.  The last lead hazard control in a new residence was completed June 2008.   The study is continuing to conduct injury hazard controls if a child in the injury treatment group relocates during the first 30 months.

Summary/Accomplishments (Outputs/Outcomes):

Thus far, we have lead, mercury, PCBs, cotinine and pesticides results from maternal blood taken three times during pregnancy and cord blood.  We also have preliminary results for organophosphrous and pyrethroid pesticide metabolites from maternal urine during pregnancy for the
first 185 participants in the HOME Study.  We have collected approximately six meconium stools per newborn.  The meconium samples, which are being analyzed at the Centers for Disease Controls as
part of our NIH/EPA-Children’s Environmental Health Center, are pending.  Also note that we have collected numerous biomarkers of lead and tobacco to minimize exposure misclassification.  Childhood blood lead concentration is used both as an outcome and as a predictor of neurodevelopmental outcomes.  The other biomarkers of lead exposure are used as predictors for neurodevelopmental outcomes.  Thus far, we also have blood lead from the oldest children in the cohort, at 12, 24, and 36 months of age.  Although we are masked to the children’s group assignment, we have some evidence indicating that the prevalence of blood lead >10 mg/dL and injuries are lower than anticipated. 
 
Despite that residential injuries are a leading cause of pediatric morbidity and mortality, there are no validated surveys to assess injury hazards in the home environment.  Therefore, we have evaluated the reproducibility and reliability of our standardized survey quantifying residential injury hazards for children by quantifying the number and density (hazards/sq.ft.) of hazards in five high-exposure high-risk living areas (kitchen, main activity room, child’s bedroom, child’s bathroom and stairs) at baseline and 12-months.  There were166 women and households with measurements at all time points.  The mean number and density of injury hazards per household at the intervention visit in early infancy was 39.6 (range 1 to117) and 0.074 (range 0.004 to 0.134) hazards/sq.ft., respectively. The number and density of hazards were correlated between baseline and early infancy (r=0.66 number, r=0.66 density) and between baseline and 12 month (r=0.45 number, r=0.71 density) surveys, (p<0.001). The number of injury hazards was consistently higher in the kitchen (mean range 9.1 to 11.6) than any other room for all 3 time points (p<0.05).  Similarly, hazard density was highest in the child’s bathroom (p<0.05), with mean ranging from 0.15 to 0.16 hazards/sq.ft.  Poison and burn hazards were the most frequent (mean range 8.2 to 9.9 and 8.2 to 8.6 per household respectively, p<0.05) and of highest density (mean 0.02 and 0.01 hazards/sq.ft per household), p<0.05 for all 3 times. Baseline hazard density was significantly associated with maternal depressive symptoms (r=0.25), household income (r= -0.33), and maternal age (r= -0.23), being a single mother and not having a college degree (all p<0.03).   We found that the HOME Study Injury Hazard Survey was reliable and reproducible in our cohort.  Validity was shown for the estimated density of hazards by association with known risk factors for childhood residential injury.

Conclusions:

Data analyses continues.  Bruce Lanphear, MD, MPH received funding for an R01, project period ending April 2012, to extend the duration of follow-up of the birth cohort to the age of 5 years.

Journal Articles:

No journal articles submitted with this report: View all 19 publications for this subproject

Supplemental Keywords:

toxicology, ADHD, behavioral assessment, behavioral deficit, genetic susceptibility, pesticides, biomarkers, environmental agents, exposure, exposure assessment, hearing loss, lead, meconium, neurotoxicity, pesticide exposure, risk assessment, toxicants, lead-based paint, lead hazard control,

 , Toxics, ENVIRONMENTAL MANAGEMENT, Scientific Discipline, Health, RFA, Toxicology, Risk Assessment, Biology, Risk Assessments, Health Risk Assessment, Chemistry, Children's Health, pesticides, exposure assessment, toxicity, lead, pesticide exposure, biological markers, children, biomarker, behavioral deficits, behavioral assessment
Relevant Websites:

www.cincinnatichildrens.org/homestudy/     

Progress and Final Reports:
2003 Progress Report
2004 Progress Report
2005 Progress Report
Original Abstract


Main Center Abstract and Reports:
R829389    CECEHDPR - University of Cincinnati Center for the Study of Prevalent Neurotoxicants in Children

Subprojects under this Center: (EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
R829389C001 Neurobehavioral Effects of Prevalent Toxicants in Children
R829389C002 Validation of Meconium Markers of Fetal Neurotoxicant Exposures
R829389C003 Community-Based Research Project Identifying Residential Hazards Using Home Test Kits
R829389C004 Early Exposure to Lead and Adult Antisocial Outcome
R829389C005 Magnetic Resonance Assessment of Brain Function Altered by Lead Exposure

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The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.

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