PROS has accomplished two of its initial objectives-development of a structure and process for pediatric practice-based research and provision of research experience to practitioners. Successful and consistent achievement of a third objective-meaningful dissemination of study results to relevant audiences-will depend on meeting several challenges.

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Increasing recognition that children may be more susceptible than adults to environmental exposures and that they experience potentially life-long consequences of such exposures has led to widespread support for a large new cohort study in the United States. In this article, we propose a framework for a new cohort study of children, with follow-up beginning before birth and continuing to age 21 years. We also describe the administrative structure that has been built to develop the proposal further. The structure includes a partnership between federal and nonfederal scientists and relies on a collaborative, interdisciplinary research effort of unprecedented scale in medical research. We discuss briefly how the proposed cohort could be used to examine, among many other things, the effect of chemical contaminants in breast milk on children's health and development.

This paper examines the prevalence of multivitamin-mineral supplement use before and during pregnancy, as well as predictors of nonuse, in 9953 women who delivered live infants in the 1988 National Maternal and Infant Health Survey. Ninety-seven percent of the women were advised to take multivitamin-mineral supplements in prenatal care. Sixty-seven percent of Black mothers took supplements during pregnancy, as compared with 84% of White mothers. Multivariate analysis revealed that Black mothers; mothers who are less educated, younger, unmarried, and non-smokers; and mothers who participate in Women, Infants, and Children programs are at elevated risk for nonuse. These data help identify groups in need of supplementation guidance.