ful in this area. Where biomarkers have been developed, such as the collection of urinary and salivary samples for cotinine levels, as biomarkers of environmental tobacco smoke, they have been very useful.

Finally, current biomarker methods are based mainly on analyzing one biomarker at a time. For biomarkers for which a battery of tests and an algorithm have been established, sensitivity and specificity improve, thus indicating that systems or arrays of biomarkers may have far more potential than isolated single measurement biomarkers. For gene expression alteration/biomarkers, further application of systems biology approaches with pattern identification/informatics technology are likely to be fruitful. A rapidly developing technology used for complex pattern recognition is the electronic nose. Inspired by the ability of dogs to determine complex patterns of odors, current testing on the device has been done on classifying bacteria or fungi by detecting their odors (such as identifying women with Type II diabetes by urine odor—(Mohamed et al., 2002). It is possible to imagine that this technology might be useful in measuring volatile biomarkers from skin (e.g., those emitted by melanomas and detected by dogs) (Church and Williams, 2001).

Currently, NHANES limits its biomarker assessment to children old enough to tolerate the drawing of blood. Smaller children are subjected to fewer laboratory assessments due to the smaller sizes of their blood samples. Development of more sensitive laboratory techniques using noninvasive biological samples is needed. Biomarkers in exhaled breath, urine, and saliva may prove very useful for this age group. Current examples of the usefulness of these techniques include using breath carbon monoxide levels to predict neonatal jaundice (Smith et al., 1984) and urine toxicology for parental substance use. Similarly, the development of programs, such as the newborn blood screen, could be extended to meconium, cord blood, cord, and placenta, which now are typically discarded. While some measures of infection are currently taken (e.g., rubella, herpes), development of biomarkers for emerging infectious diseases such as West Nile virus, Lyme disease, or hantavirus warrant additional research. Prior research has shown a correlation between the formation of chemical modifications of DNA (DNA-adduct) formation and health effects, yet current measurement activities do not include these genotoxic changes.


Given the central role of children’s behavior on their health, whether by active participation in health promotion or disease intervention efforts or by behaviors that increase the risk for poor health, a systematic strategy for assessing and monitoring such health influences is critical. However, apart from youth, parent, or teacher reports and limited use of urine or hair tests to detect the use of illicit drugs, there are no concrete or fully objective tests for the presence of such behaviors. Moreover, infants and young children pose especially difficult mea-

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