Growing up in Australia's Child Health CheckPoint: Using agile principles to embed a physical health and biomarkers module into a national longitudinal study
Jul 26, 09:00
Large-scale, responsive and translatable research is needed to solve today’s pressing child health problems and to prevent non-communicable diseases (NCDs) in the future. Both long-term observational environmental data and biological data are needed to reflect the biologic responses to cumulative environmental exposures that determine health.
Australia’s only national children’s study, Growing Up in Australia, has built more than a decade of data from 2004-2016 on environmental and social exposures for 10,000 children, 5,000 beginning in infancy (B cohort) and 5,000 at age 4-5 years (K cohort). Like many other cohort studies internationally, it lacked objective health measures and biosamples. We describe retro-fitting an intergenerational physical health and biomarkers module – the Child Health CheckPoint – to Growing Up in Australia. The funding mechanism (a successful competitive national research grant) dictated both timing and scope. Ultimately, the CheckPoint was conducted from February 2015 to February 2016 and comprised B cohort parent-child dyads at child age 11-12 years between biennial waves 6-7.
The child and parent participated in a comprehensive 3½ hour clinic visit. Paired cross-generational assessments of cardiovascular structure and function, respiratory function, body composition, hearing, vision, bone and oral health reflected the multiple body systems susceptible to NCDs, supplemented by blood, urine, saliva and other biosamples, and measurement of physical activity, fitness, time use and health-related quality of life.
The nature of the assessments and biocollections required a design rethink. Unlike the study’s usual biennial interviewer visits to the home to administer mainly questionnaire measures, the CheckPoint was a one-off 'pop-up' assessment clinic, delivered by a large team touring Australia with a single set of expensive medical and imaging equipment, supported by computerised adaptive testing capabilities, sophisticated intranet and cloud-based data transfer. Ethical issues (e.g. genetic risk disclosure, future unspecified analyses) and participant burden and engagement all required careful consideration.
The Child Health CheckPoint provides a case study of how a physical health and biomarkers module can be embedded into an existing longitudinal study, in a context of time and funding limitations. While challenging, this approach was cheaper and faster than mounting any new data collection, and enabled incorporation of cutting-edge measures responding directly to contemporary research and policy environments. Designing a new cohort study from scratch would have replicated effort, incurred enormous cost, and limited the ability to address pressing questions in the here and now: what is the fundamental role of biology in population health, and where should we intervene?