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Born to be Wise: a population registry data linkage protocol to assess the impact of modifiable early-life environmental exposures on the health and development of children
  1. Matilda van den Bosch1,2,
  2. Michael Brauer1,
  3. Rick Burnett3,
  4. Hugh W Davies1,
  5. Zoe Davis1,
  6. Martin Guhn1,
  7. Ingrid Jarvis1,
  8. Lorien Nesbitt1,
  9. Tim Oberlander1,
  10. Emily Rugel1,
  11. Hind Sbihi1,
  12. Jason G Su4,
  13. Michael Jerrett5
  1. 1 The School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 The Department of Forest and Conservation Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 HC-SC, Health Canada, Ottawa, Ontario, Canada
  4. 4 Department of Statistics, University of California, Berkeley, California, USA
  5. 5 Fielding School of Public Health, University of California, Los Angeles, California, USA
  1. Correspondence to Dr Matilda van den Bosch; matilda.vandenbosch{at}


Introduction Deficiencies in childhood development is a major global issue and inequalities are large. The influence of environmental exposures on childhood development is currently insufficiently explored. This project will analyse the impact of various modifiable early life environmental exposures on different dimensions of childhood development.

Methods Born to be Wise will study a Canadian cohort of approximately 34 000 children who have completed an early development test at the age of 5. Land use regression models of air pollution and spatially defined noise models will be linked to geocoded data on early development to analyse any harmful effects of these exposures. The potentially beneficial effect on early development of early life exposure to natural environments, as measured by fine-grained remote sensing data and various land use indexes, will also be explored. The project will use data linkages and analyse overall and age-specific impact, including variability depending on cumulative exposure by assigning time-weighted exposure estimates and by studying subsamples who have changed residence and exposure. Potentially moderating effects of natural environments on air pollution or noise exposures will be studied by mediation analyses. A matched case–control design will be applied to study moderating effects of natural environments on the association between low socioeconomic status and early development. The main statistical approach will be mixed effects models, applying a specific software to deal with multilevel random effects of nested data. Extensive confounding control will be achieved by including data on a range of detailed health and sociodemographic variables.

Ethics and dissemination The study protocol has been ethically approved by the Behavioural Research Ethics Board at the University of British Columbia. The findings will be published in peer-reviewed journals and presented at scholarly conferences. Through stakeholder engagement, the results will also reach policy and a broader audience.

  • childhood development
  • green space
  • early life exposure
  • air pollution
  • noise
  • mixed effect models

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  • Contributors MvdB drafted this manuscript on the basis of a grant proposal that was devised and written by her, MB, RB, HWD, MG, MJ, TO, HS and JGS. All of the authors contributed to the introduction and aims sections, providing input on existing knowledge, study design and falsifiable hypotheses (specifically MvdB, MG and TO on socioeconomically related health inequalities, the Early Development Instrument and developmental disorders; MB, RB, HWD, MJ, HS and JGS on harmful environmental exposures, exposure metrics and analytical tools; and MvdB, ZD, IJ, MJ, LN and ER on natural environment metrics and analytical tools). IJ drafted the primary data and preliminary analysis section and developed the map, and ER developed the NSI and corresponding text. The conceptual model was developed by MvdB, MG, MJ and JGS. The methods and analytical section, in which the conception and design of aspects of the work for which the respective authors are responsible in the Born to be Wise project are described, was developed with specific input from MvdB, MB, RB, HWD, MG, MJ, LN, HS and JGS. All coauthors contributed to the writing of the implementation and conclusion sections. MvdB subsequently prepared a final version of the manuscript based on coauthor contributions. All authors then read the final version, approved it for submission for publication and agreed to be accountable for all aspects of the work.

  • Funding This work is supported by the Canadian Institutes of Health Research, reference number 156152.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The University of British Columbia, Behavioural Research Ethics Board.

  • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.