Prospective, multiyear epidemiologic studies have proven to be highly effective in discovering preventable risk factors for chronic disease. Investigations such as the Framingham Heart Study have produced blueprints for disease prevention and saved millions of lives and billions of dollars. To discover preventable environmental risk factors for disease in children, the US Congress directed the National Institute of Child Health and Human Development, through the Children's Health Act of 2000, to conduct the National Children's Study. The National Children's Study is hypothesis-driven and will seek information on environmental risks and individual susceptibility factors for asthma, birth defects, dyslexia, attention-deficit/hyperactivity disorder, autism, schizophrenia, and obesity, as well as for adverse birth outcomes. It will be conducted in a nationally representative, prospective cohort of 100,000 US-born children. Children will be followed from conception to 21 years of age. Environmental exposures (chemical, physical, biological, and psychosocial) will be assessed repeatedly during pregnancy and throughout childhood in children's homes, schools, and communities. Chemical assays will be performed by the Centers for Disease Control and Prevention, and banks of biological and environmental samples will be established for future analyses. Genetic material will be collected on each mother and child and banked to permit study of gene-environment interactions. Recruitment is scheduled to begin in 2007 at 7 Vanguard Sites and will extend to 105 sites across the United States. The National Children's Study will generate multiple satellite studies that explore methodologic issues, etiologic questions, and potential interventions. It will provide training for the next generation of researchers and practitioners in environmental pediatrics and will link to planned and ongoing prospective birth cohort studies in other nations. Data from the National Children's Study will guide development of a comprehensive blueprint for disease prevention in children.

We used an interview to determine previously diagnosed diabetes and measured fasting plasma glucose to determine undiagnosed diabetes and IFG in a probability sample of 1,336 New York City adults. We assessed glycemic control and other clinical indicators using standardized NHANES protocols.RESULTS -The prevalence of diabetes among New York City adults was 12.5% (95% CI 10.3-15.1): 8.7% diagnosed and 3.8% undiagnosed. Nearly one-fourth (23.5%) of adults had IFG. Asians had the highest prevalence of impaired glucose metabolism (diabetes 16.1%, IFG 32.4%) but were significantly less likely to be obese. Among adults with diagnosed diabetes, less than one-half (45%) had A1C levels Ͻ7%; one-half (50%) had elevated blood pressure measures at interview, 43% of whom were not on antihypertensive medications; nearly two-thirds (66%) had elevated LDL levels, and only 10% had their glucose, blood pressure, and cholesterol all at or below recommended levels. Most adults (84%) with diagnosed diabetes were on medication, but only 12% were receiving insulin.CONCLUSIONS -In New York City, diabetes and IFG are widespread. Policies and structural interventions to promote physical activity and healthy eating should be prioritized. Improved disease management systems are needed for people with diabetes. Diabetes Care 32:57-62, 2009

Forest fires burned near the Hoopa Valley Indian Reservation in northern California from late August until early November in 1999. The fires generated particulate matter reaching hazardous levels. We assessed the relationship between patients seeking care for six health conditions and PM(10) exposure levels during the 1999 fires and during the corresponding period in 1998 when there were no fires. Multivariate logistic regression analysis indicated that daily PM(10) levels in 1999 were significant predictors for patients seeking care for asthma, coronary artery disease and headache after controlling for potential risk factors. Stratified multivariate logistic regression models indicated that daily PM(10) levels in 1999 were significant predictors for patients seeking care for circulatory illness among residents of nearby communities and new patients, and for respiratory illness among residents of Hoopa and those of nearby communities.

Although NYC enacted comprehensive smoke-free workplace legislation in 2003, findings suggest that exposure to SHS remains a significant public health issue, especially among certain subgroups. The finding of a higher prevalence of SHS exposure in NYC despite lower smoking rates is puzzling but suggests that SHS exposure in dense, urban settings may pose a particular challenge.

The rapid scale-up of HIV care and treatment in resource-limited settings has overwhelmed many public health laboratory services already burdened with human resource shortages, an aging and inadequate infrastructure, and a lack of quality systems. There is, however, a growing appreciation of the opportunity to use HIV-related laboratory strengthening as means to strengthen health systems in general. We briefly describe ongoing efforts to integrate HIV laboratory support into HIV care and treatment systems, thereby strengthening laboratory systems in support of both HIV scale-up and overall health systems strengthening.