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2002 Progress Report: Centers of Excellence in Children's Environmental Health and Disease Prevention Research
EPA Grant Number: R826709Center: CECEHDPR - University of California at Berkeley
Center Director: Eskenazi, Brenda
Title: Centers of Excellence in Children's Environmental Health and Disease Prevention Research
Investigators: Eskenazi, Brenda
Institution: University of California - Berkeley
EPA Project Officer: Fields, Nigel
Project Period: August 1, 1998 through July 31, 2003
Project Period Covered by this Report: August 1, 2001 through July 31, 2002
Project Amount: $2,830,746
RFA: Centers for Children's Environmental Health and Disease Prevention Research (1998)
Research Category: Children's Health , Health Effects
Description:
Objective:The objectives are to:
- Estimate sources, pathways, and levels of in utero and postnatal pesticide exposures of farmworker children by measuring biological and environmental samples.
- Determine whether exposure to pesticides is associated with poorer neurodevelopmental functioning and behavioral problems, delayed growth, and increased respiratory symptoms and disease. To determine whether exposure to environmental allergens and respiratory irritants is associated with increased respiratory symptoms and disease.
- Evaluate the impact of “Healthy Homes” interventions on the reduction of pesticide exposure to farmworker children.
Main Study
Enrollment closed October 30, 2000 (see Table 1). We are currently conducting the 24-month developmental assessments. We completed 601 baseline interviews and 525 prenatal home visits. We have collected and processed approximately 2978 urine, 778 maternal and cord blood samples, 524 breast milk samples, 286 12-month child blood samples, and 114 24-month child blood samples. Five hundred and twenty-eight babies have been born and Brazelton assessments were completed on 426. We have completed 428 6-month neurodevelopment assessments, 415 12-month neurodevelopment assessments, and 143 24-month neurodevelopment assessments. We have completed 385 6-month home visits, 374 12-month home visits, and 138 24-month home visits. Maternal medical records have been abstracted for 584 women for information on their pregnancy and delivery. We are currently abstracting pediatric medical records and have completed 60. The Centers for Disease Control and Prevention (CDC) have reported pesticide urinary metabolite levels for all maternal urine samples, which were collected at enrollment, 26 weeks gestation, and delivery, and also for 65 6-month child urines. CDC is currently analyzing the remaining 6- and 12-month child urines. Battelle Laboratories have completed measuring pesticides on 500 dust samples collected at the prenatal, 6-month, and 12-month home visits; preliminary data are available for 160 dusts and final data review will be completed in October, 2002. Intensive environmental sampling (air, dust, surfaces, and food) for pesticides in the homes of 20 children was done between June and September of 2002; these samples will be analyzed by Battelle Laboratories, the U.S. Environmental Protection Agency in Cincinnati, and CDC. Nearby pesticide use indices, based on California Pesticide Use Report data, have been developed for all pregnant women. Videotaping for the Time Activity Assessment (J. Leckie, PI) has been completed for 23 children. Additional funding was secured through a grant to the National Institute of Environmental Health Sciences (NIEHS) to support the Intervention Study. Intervention materials are currently being developed and the intervention will be in the field in the Spring of 2003. Additional funding was secured through a grant to the National Institute for Occupational Safety and Health (NIOSH) to support analysis of potentially endocrine disrupting pesticides in archived blood and urine samples; analyses by CDC are in progress.
Table 1. Gender and Minority Inclusion Number of subjects enrolled in the study to date |
||||||||
American Indian or Alaskan Native |
Asian or Pacific Islander |
Black, not of Hispanic Origin |
Hispanic |
White, not of Hispanic Origin |
Other or Unknown |
TOTAL |
||
Female |
16 |
|
844 |
9 |
6 |
875 |
||
Male |
11 |
3 |
519 |
5 |
2 |
540 |
||
Unknown |
|
|
|
|
|
|
||
TOTAL |
27 |
3 |
1363 |
14 |
8 |
1405 |
||
General Activities in Support of Exposure, Health, and Intervention Components
- The study instruments (e.g., questionnaire, home walk-through form) for administration at the 24-month neurodevelopment assessment and home visit have been developed, translated, piloted, and implemented.
- Data entry of Brazelton exams, prenatal medical records abstraction, 6-month walk-through forms, and 6-month questionnaires and neurodevelopment assessments has been completed. Data entry of 12-month home-walkthrough forms and maternal delivery questionnaires is in process. Other data entry is ongoing.
- Forms for the medical record abstraction for children have been developed, piloted, and implemented. Abstraction will continue through December of 2003, when the last baby turns 30 months old.
- Six- and 12-month contacts have been completed, including maternal interviews, child urine collections, child blood collections (at 12 months only), child neurodevelopmental assessments, and home visits.
- Six hundred and one women were enrolled. 163 have dropped (27%). This includes 25 miscarriages, stillbirths/neonatal deaths, and child deaths, and 86 families (14%) who have moved and cannot be located. An additional 32 women dropped but have been re-enrolled on a limited basis (either medical records only or phone interview only). The majority of drops occurred between enrollment and delivery (74) and between delivery and 6-months (50). A relatively small number of participants have dropped after completing their 6-month visit (40).
- Blood collections from 12- and 24-month-old children continue to be moderately successful. To date, we have collected 286 samples, out of 476 children who turned 12 months and 114 samples, out of 146 children who turned 24 months. In June 2001 we hired a pediatric phlebotomist, and this has greatly improved our success in collecting child blood samples since there is no pediatric phlebotomist in the Salinas Valley outside of Natividad Medical Center. This has also served to increase the proportion of children with the mandated blood lead screening.
- Statistical analyses of the pesticide urinary metabolite data to address specific aims for both the Exposure and Health studies are continuing.
- Lead study: In collaboration with the California Department of Health Services Childhood Lead Poisoning Prevention Branch, lead levels were measured in archived cord bloods and 50 maternal blood samples. Approximately 1.5 percent of the samples were elevated (> 10 µg/dL). All children whose mothers had elevated blood lead while pregnant or had elevated cord bloods were retested at 12 months and had normal levels. These data will allow us to respond to our Scientific Advisory Board’s recommendation that we assess lead levels as a possible confounder in our study.
- PON1: As part of a supplementary grant obtained through the NIEHS Environmental Health Sciences Core Center, paraoxonase genotype and phenotypes have been completed on 26 mother-child pairs and will be completed for a total of 76 pairs; cholinesterase measurements have been completed for 155 mother child pairs. Analysis of these data in relation to exposure and health outcome data (birthweight/growth) is in progress.
Also see discussion below under Research Changes and Future Activities.
Obstacles Encountered
- As discussed in previous progress reports, 6- and 12-month Autonomic Nervous System (ANS) assessments were less successful than planned due to repeated equipment problems and reticence on the part of some parents and children. Between September and December 2001, we attempted to complete the ANS during all 6-month assessments, which compensated for some of these difficulties.
- As discussed above, Autonomic Reactivity data were lost on 43 subjects in December 2001 due to a computer problem. All assessments done after that point were immediately copied onto a zip disk and were sent to Berkeley on a weekly basis. In addition, the copies of the data files on the harddrives on the laptop computers used for the assessments were deleted as soon as confirmation was received from Berkeley that the data had been received and were readable.
- Obtaining 12- and 24-month blood collections has been a challenge. Many children do not receive the required lead screen at these ages. The hiring of our own phlebotomist through Clinica de Salud to collect children’s blood for the state lead test and our study has helped solve this problem, although blood collections remain difficult. We have obtained blood from 60 percent of children at 12 months, and from 78 percent of children at 24 months.
- We have had a few children who at the 6-, 12-, and/or 24-month assessment appear to have a bilateral hearing problem or score 3 standard deviations or more below the norm on either the Motor or Mental Index of the Bayley. Because this could signal a severe neurodevelopmental delay, we have developed a protocol for intervening with these children with the help of Kie Johnson, the consulting neuropsychologist for the project, and the Committee for the Protection of Human Subjects at the University of California at Berkeley. First, the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) Field Coordinator contacts the mother by phone and explains that there are some areas of development that we feel should be looked at more closely. The Field Coordinator offers to have the Principal Investigator or the consulting Neuropsychologist speak with the baby’s doctor about the tests that we did. The mother is not provided with any scores, and emphasis is placed on the fact that our staff are not doctors or clinicians and that we are not making any kind of diagnosis. If the parent requests that we speak to the child’s doctor, a call is made and the testing that was done is explained, along with the reason(s) for concern. Documentation of all such calls is kept with the consent forms.
- We have continued to experience some loss to followup. For the most part, this is due to participants moving and our being unable to locate them. Study staff continue to make extraordinary efforts to find lost participants, including visiting last known addresses, calling contacts provided by the participant, and checking with Natividad Medical Center and Clinica de Salud. On several occasions, though, participants have returned to the area after sometimes more than a year and they have contacted the Field Office and resumed participation in the study. As discussed above, we have found that we have fewer lost after the 6- and 12-month visits.
- Other ongoing steps that we are taking to retain participants:
- We repeatedly remind participants to contact us if and when they move to provide the project with new contact information.
- At each baby visit they are given a picture of their child to put in a CHAMACOS keychain that has a reminder to call us if they move (and they are given a new keychain if they have lost theirs).
- We are continuing to offer two additional enrollment options to people who move or do not want to participate fully in the CHAMACOS study, medical record only enrollment and telephone enrollment.
- We are continuing to travel with the CHAMACOS recreational vehicle (RV) to outlying areas to conduct neurodevelopmental assessments and home visits with participants who have moved. At these visits we also attempt to collect urine and blood samples.
- At the end of August we sent an assessment team to Central California in the CHAMACOS RV to complete assessments with three participants who have moved and are currently phone or medical records enrolled. In early October, we took another trip to visit three participants in Southern California.
- During the late spring and early summer of this year, radio announcements were played on two local Spanish-language radio stations encouraging CHAMACOS participants who had returned to the area to call for an appointment.
- We are continuing to schedule evening and weekend appointments whenever possible, to accommodate the schedules of our participants.
New Funded Research and Outreach Initiatives
To accomplish our objective to build a true Center for Children’s Environmental Research, we have initiated the following new research activities to fully utilize the specimens and expertise we have developed:
- We received $11,000 from the UC Berkeley NIEHS Environmental Health Science Center to conduct a pilot study investigating pesticides in amniotic fluid.
- Stanford Time Activity Assessment collaborators received $541,000 from the EPA to utilize time activity videotape data for 80 children, including the 23 CHAMACOS children, to improve exposure modeling.
- We are preparing an application to the Wellness Foundation for $150,000 to support development of a prenatal environmental health education curriculum for pregnant women in California.
Community Interactions
Meetings with Community Organizations
- CHAMACOS Field Coordinator Selene Jaramillo continues to attend the monthly meetings of the South County Out-Reach Effort (SCORE), and she has served as chair of three SCORE meetings this year.
- Ms. Jaramillo also attends the following regular meetings:
- the Natividad Medical Center Bioethics Committee.
- manager meetings at the Natividad Medical Foundation.
- quarterly meetings of the Monterey County Health Department’s Lead Program.
Participation in Community Events
CHAMACOS has been an active participant in SCORE organized events that aim to bring the services of local agencies to the farm worker communities of southern Monterey County. This year these events included the Soledad YMCA Healthy Kids Day, Alisal Healthy Families, and the annual Dia del Trabajador Agricola (Farm Worker Day), a free festival that draws thousands of people to Greenfield every August. CHAMACOS participated in these events in a number of ways, including speaking and tabling. Ms. Jaramillo developed a series of hands-on demonstrations of sample collection techniques that were aimed at increasing familiarity of the local farmworker population with the methods and goals of large public health research studies. The demonstrations were very enthusiastically received.
Partnerships with Local Educational Institutions
- California State University Monterey Bay (CSUMB).
- CHAMACOS hosts CSUMB students as volunteers and interns.
- One student from CSUMB has chosen CHAMACOS as the site for her required Senior Capstone project. She has developed and will administer a survey to local health care providers to learn more about their knowledge and use of resources in environmental and occupational health.
- Selene Jaramillo is a frequent speaker in classes at CSUMB and was an invited panelist at the annual Spiritual Resources for Social Action Colloquium. This day long event focuses on providing tools and strategies to youth who are interested in pursuing careers in social and environmental action. CHAMACOS was featured as an example of socially conscious participatory based health research.
- During the summer, CHAMACOS hosts one full-time high school student volunteer through the Summer Youth Employment program.
- During the school year, CHAMACOS hosts between two and five volunteers through a High School Service Learning Program.
Community Advisory Board
The CHAMACOS Community Advisory Board (CAB) is made up of representatives from all facets of the local community, including farmworkers, farmworker advocates, health care workers, health department workers, agricultural growers, journalists, and politicians.
- On October 18, 2001, we met with the CAB. We presented preliminary urinary pesticide metabolite levels and plans for the newly funded Intervention Study.
- On October 1, 2002, we met again with the CAB. We presented further results from the study, solicited recommendations on the best way to communicate with the CAB and the larger community about results, and discussed plans for the Intervention Study.
Staff Trainings
- In May, Dr. Ernestina Cabrillo conducted a stress-management and mental health management workshop for the CHAMACOS Field Office staff. This workshop aimed to provide the staff with mechanisms for coping with hearing about many of the difficult situations that our participants face.
- In June, Guadalupe Sandoval led a pesticide safety train-the-trainer workshop for CHAMACOS staff and community partners. Participants became certified Worker Protection Standard (WPS) trainers.
Participant Outreach
- For 6 weeks this spring, a time when many farmworkers were returning to the Salinas Valley from working elsewhere for the winter, CHAMACOS ran a public service announcement on three local Spanish-language radio stations. The announcement was recorded by CHAMACOS staff member Marya Eugenya Rodriguez and reminded CHAMACOS participants and the larger Salinas Valley community that the CHAMACOS study will be continuing for another year. We also used the radio ads as a way to recruit participants for the Quantitative Pesticide Exposure Assessment (QEA) and videotaping studies that were conducted this summer.
- CHAMACOS was featured in two local television news broadcasts this year.
- At the beginning of the year, CHAMACOS published a Spanish-language wall calendar with tips on safety and nutrition. The calendar was distributed to CHAMACOS participants and community partners.
- In September of this year, CHAMACOS published the first edition of our bilingual newsletter, The Seed/La Semilla. The newsletter provided an update on the progress of the study and tips on child nutrition and preventing lead exposures. The newsletter was distributed to CHAMACOS participants, community partners, funders, and other interested parties.
Scientific Advisory Committee
On October 30, 2001, we held a Scientific Advisory Committee (SAC) meeting in Berkeley, California. This meeting resulted in a number of research changes, discussed above. We continue to consult individually with our scientific advisors on a regular basis. At the beginning of December of this year we are planning to hold a meeting by conference call with our Scientific Advisory Board to discuss study results and future projects.
Awards
- 2001-2002 “Outstanding Service Learning Partnership Award” from the California State University Monterey Bay Service Learning Institute, May 23, 2002.
- In September of 2001, CHAMACOS was honored by University of California at Berkeley Chancellor Robert Berdahl at the annual University/Community Partners Recognition reception.
Significance
In the last few years, several studies have demonstrated pesticide contamination in the homes of young children living in both agricultural and suburban areas. However, to date, only a few studies have been conducted to assess the extent of children’s exposure to pesticides, and no studies have examined whether low-level chronic exposure can lead to adverse health consequences. Our goal is to translate research findings into sustainable strategies to reduce pesticide exposure to children and thus reduce the incidence of environmentally related childhood disease. Our proposed Center will also generate information critical for new Federal policy mandates regulating pesticides in food. Specifically, the proposed prospective research will: (1) characterize the organophosphate pesticide burden of high risk children; (2) quantitatively evaluate the relationship between non-occupational exposure risk factors, home contamination, and children’s exposure; and (3) evaluate the potential health effects of these exposures, which directly contributes to the information needed by Federal agencies to implement the Food Quality Protection Act. Additionally, this will be one of the first studies to examine the role of effect modification between pesticides and allergens on respiratory outcomes, including asthma.
Future Activities:Future activities will include the following:
- Complete 24-month neurobehavioral assessments and home visits and urine and blood collections.
- Continue with data entry and integration of data sources (study instruments, CDC urine data, state Pesticide Use Reporting data, etc.).
- Continue data analysis.
- Continue NIOSH grant investigating endocrine disruptors and neurobehavioral outcomes.
- Continue the Intervention Study activities.
Journal Articles: 7 Displayed | Download in RIS Format
| Other center views: | All 110 publications | 7 publications in selected types | All 7 journal articles |
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Bradman A, Eskenazi B, Sutton P, Athanasoulis M, Goldman LR. Iron deficiency associated with higher blood lead in children living in contaminated environments. Environmental Health Perspectives 2001;109(10):1079-1084. |
R826709 (2001) R826709 (2002) R831710 (2005) |
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Bradman A, Barr DB, Claus Henn BG, Drumheller T, Curry C, Eskenazi B. Measurement of pesticides and other toxicants in amniotic fluid as a potential biomarker of prenatal exposure: a validation study. Environmental Health Perspectives 2003;111(14):1779-1782. |
R826709 (2001) R826709 (2002) R831710 (2004) R831710 (2005) R831710C001 (2004) |
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Castorina R, Bradman A, McKone TE, Barr DB, Harnly ME, Eskenazi B. Cumulative organophosphate pesticide exposure and risk assessment among pregnant women living in an agricultural community: a case study from the CHAMACOS cohort. Environmental Health Perspectives 2003;111(13):1640-1648. |
R826709 (2001) R826709 (2002) R831710 (2004) R831710 (2005) R831710C001 (2004) |
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Eskenazi B, Bradman A, Castorina R. Exposures of children to organophosphate pesticides and their potential adverse health effects. Environmental Health Perspectives 1999;107(Suppl 3):409-419. |
R826709 (2001) R826709 (2002) R826709C001 (1999) R826709C001 (2000) R826709C002 (1999) R826709C002 (2000) R826709C003 (1999) R826709C003 (2000) R831710 (2005) |
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Eskenazi B, Bradman A. Longitudinal investigation of pesticides and allergen exposures to children living in agricultural communities in California. Urban Health and Development Bulletin 2001;4(2):33-44. |
R826709 (2001) R826709 (2002) R831710 (2005) |
not available |
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Harley K, Eskenazi B, Block G. The association of time in the US and diet during pregnancy in low-income women of Mexican descent. Paediatric and Perinatal Epidemiology 2005;19(2):125-134. |
R826709 (2001) R826709 (2002) R831710 (2004) R831710 (2005) R831710C001 (2004) |
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Holland NT, Smith MT, Eskenazi B, Bastaki M. Biological sample collection and processing for molecular epidemiological studies. Reviews in Mutation Research 2003;543(3):217-234. |
R826709 (2001) R826709 (2002) R831710 (2004) R831710 (2005) |
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Water, Geographic Area, Scientific Discipline, Health, RFA, Risk Assessments, Analytical Chemistry, Health Risk Assessment, Epidemiology, Mercury, Ecological Risk Assessment, Children's Health, Biochemistry, State, exposure assessment, insecticides, risk assessment, California (CA), developmental neurotoxicology, neurodevelopmental toxicity, developmental disorders, health effects, epidemelogy, children's environmental health, prenatal exposure, farmworkers, age-related differences, harmful environmental agents, human health risk, epidemeology, developmental neurotoxicity, agricultural community, community-based intervention, dietary exposure, pesticide exposure, pregnancy, environmental health, children, environmental risks, pesticides, risk, latino, biomedical research, growth & development, children's vulnerablity, neurobehavioral effects, environmental health hazard, human exposure, Human Health Risk Assessment, neurotoxicity, farm worker
Relevant Websites:
Progress and Final Reports:
2001 Progress Report
Original Abstract
Subprojects under this Center:
(EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
R826709C001 Community Based Intervention to Reduce Pesticide Exposures to Young Children
R826709C002 The Epidemiological Investigation of the Effects of Pesticide Exposure on Neurodevelopmental, Growth, and Respiratory Health of Farmworker Children
R826709C003 A Comprehensive Assessment of Sources of Pesticide Contamination, Concentrations in Pathways, and Exposure-prone Behavior