The Mediterranean Child Cohort Network (CHILDREN_FIRST) was created in early 2022. CHILDREN_FIRST is a Mediterranean network of a multi-country child cohort infrastructure that will focus its resources and activities on the longitudinal assessment of key environmental (non-genetic) risk factors in association with the temporal evolution of respiratory, cardiometabolic or neurodevelopmental outcomes in primary school children populations in five Mediterranean countries (Cyprus, Greece, Spain, Albania and Israel). The vision of the CHILDREN_FIRST network is to establish a world-class research infrastructure specializing in the development and application of personalized medicine/prevention models towards improved disease prevention and prediction in children. The mission of the CHILDREN_FIRST network is to design and apply research of the highest quality standards, education, advocacy and outreach protocols and activities towards improved disease prevention and prediction models; this will be achieved using the principles of personalized prevention and the suite of exposomic tools to characterize the environmental determinants of temporal disease process dynamics for the children of the Mediterranean region, and beyond.

The overall theme of the CHILDREN_FIRST network is based upon the personalized prevention approach and the exposome concept applications in children’s health. Personalized medicine or personalized prevention models study differences in children’s genes, environments and lifestyles, hence, they can provide knowledge about enhanced risk profiling and population stratification, but also about how such information can be used to improve children’s health (1). The exposome concept was proposed in an attempt to elucidate the role of the environment in the development of chronic diseases (2),  since it was shown that environmental factors contribute about 80-90% of the risk for some chronic diseases (3). To our best knowledge, CHILDREN_FIRST is the first globally comprehensive personalized prevention program for primary school aged children in the Mediterranean region, based on exposome methodologies and tools to generate important biomarkers of exposure/effect and also be able to better predict and prevent disease in this susceptible critical lifetime window.


Mediterranean region is considered a hot spot for climate change, as it is hit hard by rising air temperatures, wildfires, droughts, reduction in air quality, and adverse weather events, all of which are projected to increase in frequency in future years (4). Forecasts for the Mediterranean region show that the mean temperature is expected to rise by about 1–3°C in the next three decades and between 3.5–7 °C by the end of the 21st century, ranking the region ahead of projected global temperature changes (4).

In the last decade 2009-2019, the five most common causes of death in Cyprus, Greece, Italy, Albania and other Mediterranean (Med) countries remain almost the same, and these are: cardiovascular disease (i.e., coronary heart disease and stroke), diabetes, cancer and chronic obstructive pulmonary disease (5). Obesity is a major risk factor for several NCDs, including cardiovascular disease, diabetes and some cancers3 and childhood obesity rates have increased globally (6). Particularly in the Mediterranean countries (Cyprus, Greece, Italy, Spain), overweight prevalence rates in children are the highest in Europe (42-43%) (7). Data from the International Incidence of Childhood Cancer suggest that Mediterranean countries carry some of the highest world age-standardized cancer incidence rates for the ages 0-19 years old (8).

Children exhibit increased susceptibility to environmental exposures because of their rapid development, differences in behaviors and metabolism and their parents’ environmental exposures (9). Based on the predicted obesity prevalence rates among 2-year-old children from the CHOICES simulation model, a steep increase of obesity prevalence was estimated for their primary school years (5-11 years old), indicating that this period is a critical window of susceptibility (10).

Moreover, three out of six identified lung function risk trajectories, which were associated with childhood factors i.e. asthma, bronchitis, pneumonia, allergic rhinitis, eczema, contributed to 75% of chronic obstructive pulmonary disease cases and their impact was aggravated by adult factors (11). Preventing both early adverse exposures in children groups with varying risks of susceptibility to NCD risk factors is of utmost importance to EU (Fig. 1).


Figure 1 Indicative prevalence of obesity (black line) and lung function trajectories (blue and yellow) from birth to 20 years old. The primary school age group that is shown within the green frame. The figure shows 1) the critical window of susceptibility for children aged 6-11 years old and 2) the differential expression of lung function risk, depending on various risk factors and the importance of personalized prevention for children (10,11).



1.European Commission. Personalised Medicine. Published 2020.

2.Haddad N, Andrianou XD, Makris KC. A Scoping Review on the Characteristics of Human Exposome Studies. Curr Pollut Rep. 2019;5(4):378-393. doi:10.1007/s40726-019-00130-7

3.Willett WC. Balancing Life-Style and Genomics Research for Disease Prevention. Science. 2002;296(5568):695-698. doi:10.1126/science.1071055

4.Lelieveld J, Hadjinicolaou P, Kostopoulou E, et al. Climate change and impacts in the Eastern Mediterranean and the Middle East. Clim Change. 2012;114(3):667-687. doi:10.1007/s10584-012-0418-4

5.Murray CJL, Aravkin AY, Zheng P, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020;396(10258):1223-1249. doi:10.1016/S0140-6736(20)30752-2 Onis M, Blössner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr. 2010;92(5):1257-1264. doi:10.3945/ajcn.2010.29786

7.World Health Organization Regional Office for Europe. Childhood Obesity Surveillance Initiative. Highlights 2015-2017.; 2018.

8.Steliarova-Foucher E, Colombet M, Ries LAG, Hesseling P, Moreno F, Shin HY, Stiller CA,. International Incidence of Childhood Cancer, Volume III (Electronic Version). International Agency for Research on Cancer; 2017.

9.Vrijheid M, Casas M, Gascon M, Valvi D, Nieuwenhuijsen M. Environmental pollutants and child health—A review of recent concerns. Int J Hyg Environ Health. 2016;219(4-5):331-342. doi:10.1016/j.ijheh.2016.05.001

10.Ward ZJ, Long MW, Resch SC, Giles CM, Cradock AL, Gortmaker SL. Simulation of Growth Trajectories of Childhood Obesity into Adulthood. N Engl J Med. 2017;377(22):2145-2153. doi:10.1056/NEJMoa1703860

11.Bui DS, Lodge CJ, Burgess JA, et al. Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life. Lancet Respir Med. 2018;6(7):535-544. doi:10.1016/S2213-2600(18)30100-0

Core Members (in alphabetical order)



                        Ben Gurion University of the Negev





Centre for Research 





Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology




 Harvard Medical School







Harvard T.H. Chan School of Public Health




















                    Università Cattolica del Sacro Cuore








 University of Crete







University of Cyprus






                    University of Turin






                         University of Vlora "Ismail Qemali"





  • Bimonthly meetings have been taking place during the last 10 months of 2022.
  • The next meetings will mostly focus on the harmonization of outcomes/exposures instruments, including the related SOP preparations for all sites.  


For more info, contact us:


The Cyprus International Institute for Environmental and Public Health organizes organizes the 2024 CHILDREN_FIRST Network Webinar Series. In this webinar, it is our honor to host Prof. Constantinos Deltas, Director, Center of Excellence in Biobanking and Biomedical Research, University of Cyprus.

Webinar Title: The Biobank of Cyprus and opportunities for next generation research projects

Wednesday, 24 January, 2024 

2:00 PM CET (3:00PM CY time)

Click here to join the meeting

Abstract: Biobanks are sine qua non medical research infrastructures that are changing the world through the high-quality biological material they archive and provide for research, associated with detailed demographic and health data. We started the first Cyprus Biobank in 2011 and it was substantially upgraded in 2019 with European and national funding. I will present you the advantages of having access to biobanked medical data and material and give you examples of useful projects you can develop in collaboration with such infrastructures and the personnel at our Center of Excellence. I will also present general data concerning inherited kidney diseases and inherited cardiomyopathies that we are engaged for many years, canvasing the Cypriot genetic architecture. Finally, I will comment on how we can collaborate to advance biomonitoring projects of common interest, starting with the children first cohort.

CHILDREN_FIRST mentioned in Lancet Oncology

The CHILDREN_FIRST network was mentioned in a news article published in the LANCET Oncology on December 14, 2023. The article highlighted the need for measures for reducing the burden of cancer in Cyprus, as Cyprus has one of the highest incidence rates of thyroid cancer among children and adolescents in the world. Systematic epidemiological surveillance schemes are necessary for understanding the cancer risk factors and the CHILDREN_FIRST was reported as an example of primary school children monitoring program. Read more:


🗓 Wednesday, 06 December, 2023 

2:00 PM CET / 3:00 PM CY time

CHILDREN_FIRST Network Webinar Series 2023

The CHILDREN_FIRST network cordially invites you to the sixth webinar of the _ .

Webinar Title: Mapping of the state-of-the-art and bottlenecks for the adoption of personalized preventive approaches in Europe and beyond – insights from the PROPHET Project

Presenter: Ms. Sara Farina, MD, Resident in Hygiene, Preventive Medicine and Public Health at UCSC, Rome

Abstract: Personalised prevention has immense potential for public health. In the framework of the European Commission-funded project “PROPHET”, a scoping review delves into existing personalised preventive approaches for chronic diseases and the persisting bottlenecks hindering their full implementation. The findings underscore cancer as a primary target for personalised prevention, with tertiary prevention strategies being the most widely adopted. Despite promising strides, challenges in ethical aspects and limited knowledge among healthcare professionals represent significant barriers, emphasising the need to prioritise personalised prevention on research and policy agendas. Addressing these challenges worldwide is pivotal to fully unlocking the potential and transformative impact of personalised prevention on public health.

🗓 Wednesday, 01 November, 2023 

 12:00 PM CET – 1 PM CY time

CHILDREN_FIRST Network Webinar Series 2023

Webinar Title: Improving particulate matter simulations by integrating different type of measurements

Presenter: Dr. Ioanna Skoulidou, The Air quality and Emissions Research (AER) Department, TNO, The Netherlands.

Abstract: Official air quality monitoring networks are often scarce and unevenly spatially distributed. In recent years, the use of low-cost sensors next to official networks is increasing. These additional networks provide measurements of high spatial and temporal resolution and potentially reveal patterns and emissions sources that are hard to detect with conventional methods. The data assimilation method implemented around the LOTOS-EUROS chemistry transport model is employed to assimilate measurements from heterogenous low-cost sensor networks around the city.


🗓 Wednesday, 20 September, 2023 

 12:00 PM CET

CHILDREN_FIRST Network Webinar Series 2023

Webinar Title: Birth cohort studies: methodological challenges.

We have the pleasure to host Professor Mònica Guxens, MD, MPH, PhD, from the ISGlobal, Barcelona Institute for Global Health.

Prof. Guxens will lay out the methodological details and challenges associated with designing, executing birth cohort studies and reporting birth cohort study results.

🗓 7 June, 2023 

CHILDREN_FIRST Network Webinar Series 2023

Webinar Title: The Cypriot Children’s Health and Environment Observatory: first steps

The Cyprus International Institute for Environmental and Public Health (CII) cordially invites you to the third webinar of the CHILDREN_FIRST network.  The webinar is entitled The Cypriot Children’s Health and Environment Observatory: first steps by Corina Konstantinou, Ph.D. Candidate, CII.

Date: Wednesday, 07 June, 2023 

Time: 12:00 PM CET – 1 PM CY time

Abstract: The Mediterranean region is considered a hot spot for climate change, as it is hit hard by rising air temperatures, wildfires, droughts, reduction in air quality, and adverse weather events, all of which are projected to increase in frequency in future years. In the last 10 years (2009-2019), the five most frequent causes of death and the major disease risk determinants in Cyprus remained the same, or showed an increasing trend compared to 10 years ago. The newly established CHILDREN_FIRST network is focused on longitudinally assessing multiple environmental (non-genetic) risk factors in association with the temporal evolution of respiratory, cardiometabolic or neurodevelopmental outcomes in primary school children populations of the Mediterranean region. This cohort design is based on the principles of personalized prevention towards the better characterisation of individual phenotypes to determine disease predisposition risk and on the human exposome concept for better deciphering associations between multiple exposures and outcomes and the temporal disease process dynamics in childhood. During this period (May-June 2023), a feasibility study and focus groups with parents/teachers take place in Cyprus, and the key activities and challenges will be discussed.



🗓 26 April, 2023 

CHILDREN_FIRST Network Webinar Series 2023

Webinar Title: Federated real-world data studies and challenges

The Centre for Research & Technology Hellas (CERTH) cordially invites you to the second webinar of the CHILDREN_FIRST network on Federated real-world data studies and challenges by Dr. Pantelis Natsiavas.

Abstract: Along with the proliferation of the use of Information and Computing Technology (ICT) systems in health (e.g. Electronic Health Record – EHR, ePrescription etc.), the volume of relevant data has also increased dramatically. These data, especially if collected on a large scale, could be of significant value for very different use scenarios than those for which they were originally intended – secondary use (e.g. epidemiological studies, clinical practice quality assurance, policy making, drug safety signals identification, etc.). However, while in principle everybody could agree that these data could be valuable, still, exchanging Real World Data (RWD) is far from trivial as they are considered “sensitive” personal data. Thus, there is a number of legal, ethical, administrative issues preventing data sharing and thus data analysis. In technical terms, “interoperability” is a crucial issue as data exchange or federated analysis would require the use of a common data model (CDM). In this presentation, relevant initiatives are presented and challenges are discussed.


🗓 Feb 22, 2023 

CHILDREN_FIRST Network Webinar Series 2023

Webinar Title: The Association Between Prenatal Exposure to Heavy Metals and Newborns' Anthropometric measures

The Ben-Gurion University of the Negev (BGU), Department of Public Health organized the 1st network webinar on the Association Between Prenatal Exposure to Heavy Metals and Newborns' Anthropometric measures by Tal Michael MPH,  MD/ Ph.D. Candidate, BGU. The early stage researchers of all Departments across the CHILDREN_FIRST network were welcome to attend.

Abstract: Prenatal exposure to heavy metals and their mixtures has been linked to alterations in newborn anthropometric measures, including anogenital distance (AGD), which is considered sensitive to intrauterine exposures. Our studies conducted in Israel investigated the association between maternal urine samples and newborn AGD, as well as anthropometric measures. Eight metals were examined in our studies - including arsenic, cadmium, chromium, mercury, lead, nickel, selenium, and thallium. While our findings suggested relatively low levels of metals in maternal urine, chromium was negatively associated with birth weight and length as well as associated with increased anogenital measures. Birth weight was also negatively associated with thallium and positively associated with nickel. The findings highlight the importance of investigating the reproductive developmental effects of prenatal metal exposures, as well as the need for further exploration of metal exposure during pregnancy.