Author: Jodi Snare

ECHO Investigators Present Child Health Research at 2023 Joint Statistical Meetings

Posted on by Jodi Snare

At the 2023 Joint Statistical Meetings, ECHO researchers are hosting an ECHO session called “Methods for Large Multi-cohort Data Integration in Presence of Missing and Imbalanced Covariates.” The 2023 JSM will take place from August 5-8 in Toronto, Ontario, Canada and will feature topics ranging from statistical applications to methodology and theory to the expanding boundaries of statistics, such as analytics and data science. Make sure to register by June 29 to attend and hear from ECHO investigators about advancements in child health research.

ECHO Session Organizers

Ekaterina Smirnova, PhD
Assistant Professor, Virginia Commonwealth University

Amii Kress, PhD, MPH
Assistant Scientist, Johns Hopkins University

 

 

 

ECHO Session Participants

Miguel Hernan, MD, DrPH
Kolokotrones Professor of Biostatistics and Epidemiology
Harvard T.H. Chan School of Public Health

 

 

 

Nilanjan Chatterjee, PhD, MS
Bloomberg Distinguished Professor
Department of Biostatistics
Johns Hopkins Bloomberg School of Public Health

 

 

 

Debashree Ray, PhD, MStat
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health

 

 

 

Bryan Lau, PhD, ScM, MHS
Professor
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health

 

 

 

James Hodges, PhD
Professor
Division of Biostatistics
University of Minnesota

New Publication Highlights the ECHO Program’s Unique Design and Lasting Impact on Children’s Health Outcomes

Posted on by Jodi Snare

The American Journal of Epidemiology recently published an article, titled “The Environmental influences on Child Health Outcomes (ECHO)-wide Cohort,” describing the ECHO Program’s unique research design and lasting impact. The article provides an overview of the Program’s focus areas, participants, and data collection processes.

Established in 2016 by the National Institutes of Health (NIH), ECHO’s mission is to enhance the health of children for generations to come. ECHO investigators focus on solution-oriented research in five key areas of health—preconception, pregnancy, and birth; breathing; body weight; brain development; and well-being—to identify factors affecting child health outcomes and methods for improving those outcomes.

The ECHO Program’s national network brings together 69 existing cohorts that encompass over 90,000 participants, including pregnant women, caregivers, and over 60,000 children. ECHO children represent 49 states, Puerto Rico, and the District of Columbia, and are enrolled in the Program at various life stages from birth through adolescence. ECHO researchers collect biospecimens, genetic and epigenetic data, and residential history data from this large group of participants and use these data to investigate relationships between child health outcomes and various types of exposures.

The goal of ECHO research is to understand how early environmental influences—from society to biology—affect child health and development and identify ways to reduce children’s risk for developing disease and optimize their overall health and well-being. The ECHO Program is unique in that its investigators conduct both observational and intervention research with children, pregnant women, and caregivers from different backgrounds across the United States. The ECHO-wide Cohort (EWC) observational study’s large sample of geographically and socio-demographically diverse participants allows ECHO researchers to examine complex relationships between environmental exposures and child health outcomes. Furthermore, the inclusion of children at different life stages enables ECHO investigators to evaluate critical periods of child development and the effects of environmental exposures on children’s health over time.

To leverage existing data and standardize the collection of new data from thousands of ECHO participants, researchers from across the ECHO Program collaborated to develop the ECHO-wide Data Collection Protocol (EWCP). The EWCP identifies essential and recommended data elements, defines when each element should be collected, and outlines how each element should be measured. This data collection infrastructure, along with the expertise of ECHO researchers, have allowed ECHO to pivot to important and urgent issues affecting children’s health, such as the COVID-19 pandemic.

To date, ECHO researchers have published over 1,000 manuscripts on environmental exposures and ECHO’s key outcome areas, including 64 publications from the EWC. “The EWC brings together a large socio-demographically and geographically diverse participant population, extensive investigator expertise, and a network of successful cohort studies,” the article concludes. “With harmonized data and standardized data collection from 69 cohort studies, ECHO is poised to contribute to child health research, particularly research questions that are challenging to answer within a single study and methodological advances related to multi-cohort collaborations.”

NIH Study Links Prenatal Per- and Polyfluoroalkyl Substance Exposure to Higher BMI & Obesity Risk in Children

Posted on by Jodi Snare

FOR IMMEDIATE RELEASE

 

Exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy was linked to slightly higher BMIs and an increased risk of obesity in children, according to new research funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

“There is a growing interest in understanding the effects of PFAS exposure on children’s health,” said Joseph Braun, PhD, of Brown University. “Studies like this one can help researchers and policymakers better understand the risks of PFAS to take effective actions to protect vulnerable populations.”

The researchers analyzed the levels of seven different PFAS in blood samples collected from mothers during pregnancy. These so-called “forever chemicals” are long-lasting substances that can be found in many household materials, as well as food and drinking water.

Researchers then calculated each child’s BMI, an approximate measure of body fat. Higher levels of PFAS in mother’s blood were related to slightly higher BMIs and increased risk of obesity were seen equally for male and female children.

The study used data collected over two decades from 1,391 children between the ages of 2 and 5 years and their mothers who were enrolled in eight ECHO research sites in California, Illinois, Massachusetts, Colorado, New Hampshire, Georgia, and New York.

Future studies will examine the associations between maternal PFAS exposure and obesity-related health outcomes in older children.

Dr. Braun and Yun Liu, PhD, ECHO Program investigators at Brown University, led this collaborative research published in Environmental Health Perspectives.

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on Twitter.

ECHO Researchers Reveal Link Between PFAS Exposure During Pregnancy and Childhood Obesity Risk

Posted on by Jodi Snare

Collaborative ECHO research led by Yun Liu, PhD and Joseph Braun, PhD of Brown University investigates the relationship between maternal exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy and obesity risk among children and adolescents. The research team evaluated maternal PFAS levels during pregnancy and child body mass index (BMI) for 1,391 mother-child pairs across eight ECHO cohorts. The researchers found that higher levels of some PFAS during pregnancy were associated with higher BMIs and an increased risk of obesity in children. This research, titled “Associations of Gestational Perfluoroalkyl Substances Exposure with Early Childhood BMI Z-Scores and Risk of Overweight/Obesity: Results from the ECHO Cohorts,” is published in Environmental Health Perspectives.

This study included women who were pregnant between 1999-2019 in California, Illinois, Massachusetts, Colorado, New Hampshire, Georgia, and New York and their children who were evaluated between the ages of 2 and 5 years old. The researchers analyzed the levels of seven different PFAS in blood samples collected from mothers during pregnancy. They then used the children’s height and weight data to calculate their BMI, an approximate measure of body fat, while accounting for each child’s age and sex, as well as other factors related to PFAS exposure and body fat.

“There is growing interest in understanding the effects of PFAS exposure on children’s health,” said Dr. Braun. “Studies like this one will help researchers and policymakers better understand the risks of PFAS in order to take effective actions to protect vulnerable populations.”

Going forward, future studies will examine the associations between maternal PFAS exposure and obesity-related health outcomes in older children.

Read the research summary.

Prenatal Tobacco Exposure and Neurodevelopmental Outcomes in Middle Childhood

Posted on by Jodi Snare

A collaborative study led by ECHO researcher Liz Conradt, PhD of the University of Utah, examined the effects of simultaneous exposure to multiple substances—like tobacco, alcohol, and opioids—on outcomes in middle childhood. The team found that children ages 6 to 11 who were exposed prenatally to tobacco and multiple other substances were more likely to have below average verbal reasoning skills and higher levels of behavioral problems. Their research, titled “Prenatal Substance Exposure: Associations with Neurodevelopment in Middle Childhood,” is published in the American Journal of Perinatology.

To gather these results, the team collected data on prenatal exposure to substances such as alcohol, tobacco, marijuana, and opioids. A total of 256 mother-child pairs participated from two ECHO cohorts with locations in Rhode Island, Minnesota, Washington, California, and New York. When the children were between six and 11 years old, their caregivers were asked to report on the absence or presence of problem behaviors, such as aggression and anxiety. The team also collected data on verbal and nonverbal reasoning and problem solving skills.

Using this information, the researchers identified two specific groups—Group 1 had average verbal reasoning skills, average spatial reasoning skills, and normal levels of problem behavior. Children in this group were exposed to fewer substances before birth. Group 2 had below average verbal reasoning skills, but average spatial reasoning skills, and higher levels of problem behavior. The researchers found that children exposed to multiple substances prenatally, especially including tobacco, were more likely to be in Group 2. The effects of tobacco exposure on problem behavior and reasoning skills were stronger than expected.

“This study shows that children with prenatal tobacco exposure may be at risk for having higher levels of problem behaviors and more challenges with verbal reasoning during middle childhood,” said Conradt. “This is an important risk for pediatricians to keep in mind when conducting yearly check-ups on these children.”

The practice of grouping children based on problem behavior and reasoning skills was a novel approach and can be used in future studies to identify subgroups of children at risk for these outcomes.

Visit The Center for Parenting and Opioids and National Institute on Drug Abuse sites for more information on substance exposures and outcomes.

Read the Research Summary.

NIH Study Finds Prenatal Substance Exposure Linked to Child Behavior Problems

Posted on by Jodi Snare

Sarah Maylott, PhD

FOR IMMEDIATE RELEASE

 

Prenatal exposure to tobacco, alcohol, and illegal drugs may increase a child’s risk of displaying certain problem behaviors in later childhood, according to new research funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

Children ages 6 to 11 who were exposed to alcohol and tobacco before birth were more likely to display rule-breaking or aggressive behaviors, while children exposed to illegal drugs, such as cocaine, methamphetamine, or heroin, before birth were more likely to have higher rates of anxiety, depression, or withdrawn behaviors, according to findings published in the Journal of Pediatrics. However, ECHO researchers pointed out that not all children exposed to substances had behavioral problems.

“Our work shows that we may be able to identify children with certain behavioral challenges based on their mothers’ prenatal substance use profiles,” said Sarah Maylott, PhD of Duke University. “With further research, clinicians and researchers could use these results to identify and support children at higher risk for behavior problems.”

About 2,000 women from 10 ECHO cohorts across the country participated in the study from 2000-2020. The research team divided the women into two groups based on the types of substances used during pregnancy and then compared the behavior of both groups’ children.

Future large-scale studies can look at how the quantity and timing of substance use during pregnancy affect children’s risk for behavioral problems and how the home environment may contribute to that risk. Researchers can also explore what factors lead to resilient outcomes for children with prenatal substance exposure.

Dr. Maylott led this collaborative research published in the Journal of Pediatrics.

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on Twitter.

Prenatal Substance Exposure Associated with Problem Behaviors in Middle Childhood

Posted on by Jodi Snare

Sarah Maylott, PhD

A collaborative research effort led by Sarah Maylott, PhD of Duke University, suggests that prenatal exposure to substances may increase a child’s risk for displaying problem behaviors in middle childhood. Specifically, children exposed to prenatal tobacco and alcohol were more likely to display rule-breaking or aggressive behaviors, while children exposed to illegal drugs, such as cocaine, methamphetamine, or heroin, were more likely to have higher rates of anxiety, depression, or withdrawn behaviors. However, not all children exposed to substances had behavioral problems, suggesting that some children may be more resilient than others.

This research, titled “Latent Class Analysis of Prenatal Substance Exposure and Child Behavioral Outcomes” is published in the Journal of Pediatrics.

The results outlined in Dr. Maylott’s work are particularly important, as approximately 1 in 5 women in the United States report use of legal or illegal substances while pregnant, varying from tobacco and alcohol to psychoactive drugs, such as opioids and cocaine. Previous studies have investigated how prenatal exposure to multiple substances may affect the health of young children, but less is understood about how polysubstance exposures may affect the neurodevelopment of older children.

Leveraging data from approximately 2,000 women from 10 ECHO cohorts across the country from 2000-2020, the research team used a statistical analysis technique to group women based on the types of substances used during pregnancy and compared these groups based on their child’s behaviors. On average, pregnant women were 28 years old when they gave birth, and child behaviors were assessed between ages 6 to 11 using the Child Behavior Checklist. The team hypothesized that children with prenatal polysubstance exposure would have more instances of problem behavior in middle childhood than those children with little to no prenatal substance exposure.

“Our work shows that it could be possible to identify children with certain behavioral challenges based on their mothers’ prenatal substance use profiles,” said Dr. Maylott. “With further research, clinicians and researchers may be able to use these results to identify and support children at higher risk for behavior problems.”

Subsequent large-scale studies are needed that look at how the quantity and timing of substance use during pregnancy affect children’s risk for behavioral problems and how the home environment may contribute to that risk. Researchers also need to find factors that may lead to resilient outcomes for children with prenatal substance exposure.

Read the research summary.

NIH Study Finds Association Between Gestational Diabetes, Maternal Depression, and Early Childhood Behavior Problems

Posted on by Jodi Snare

FOR IMMEDIATE RELEASE

 

Gestational diabetes, prenatal depression, and postpartum depression were each individually associated with higher levels of early childhood behavior problems such as attentional problems, anxiety, and depression in new research funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

Previous research has linked gestational diabetes to prenatal and postpartum depression. Researchers wanted to determine how that combination of maternal symptoms affected early childhood behaviors.

“Our findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy could benefit from receiving additional monitoring for behavioral problems during early childhood,” said Lauren Shuffrey, PhD, an ECHO Program investigator at Columbia University.

The researchers also found that gestational diabetes was associated with autism-related behaviors only in children whose mothers reported higher levels of depressive symptoms during and immediately after pregnancy. Gestational diabetes was also associated with child behavioral problems only in male children.

This study included 2,379 children from ECHO research sites in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of participants were male, and 216 participants were born to mothers who were diagnosed with gestational diabetes.

During this study, ECHO researchers collected information from the participating mothers, including gestational diabetes diagnosis and self-reports of depression symptoms during and after pregnancy. To investigate the effect of these maternal conditions on child behavior, the researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5 years old.

Dr. Shuffrey led this collaborative research published in Child Development.

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on Twitter.

Celebrating Clinical Trials

Posted on by Jodi Snare

May 20 is Clinical Trials Day. This month, I’m pleased to be able to share important new findings from the ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN), which helps address disparities in pediatric research by including children from rural or underserved populations in clinical trials, and by building pediatric research capacity in states with historically low NIH funding.

New ISPCTN research, titled “Eat, sleep, console approach versus usual care for neonatal opioid withdrawal,” was recently published in the New England Journal of Medicine. Researchers found that the “Eat, Sleep, Console” (ESC) care approach for treating newborns exposed to opioids during pregnancy substantially decreases the time until infants are medically ready for discharge and reduces use of opioid medications to treat these babies. Until now, there hasn’t been strong evidence to support a standard care approach for babies with neonatal opioid withdrawal syndrome (NOWS). Hospitals currently have widely different approaches. This clinical trial gives hospitals an evidence-based care approach for babies with NOWS. You can learn more about this study in the ECHO Connector Research Spotlight.

I’m also pleased to share that on March 16–17, 2023, ECHO hosted a virtual workshop on the Return of Individual Research Results to Participants to identify principles and best practices to ethically and feasibly return individual research results to participants in large-sample studies that include pregnant women and children. Over 500 registrants heard 16 expert speakers and discussants present their work on the history and principles of returning individual results, and the value of results to participants, in addition to a fruitful discussion on which results to return, and how to return individual results. More information and recordings of the presentations are available here.

ECHO Researchers Examine Incidence Rates for Childhood Asthma With Recurrent Exacerbations and Suggest Possible Social and Environmental Risk Factors

Posted on by Jodi Snare

Collaborative ECHO research led by Rachel L. Miller, MD of Icahn School of Medicine at Mount Sinai and Christine C. Johnson, PhD, MPH of Henry Ford Health System investigates the factors that influence the rates of childhood asthma with recurrent exacerbations (ARE)—a subtype of asthma where children experience frequent, severe episodes of asthma. The researchers leveraged data from over 17,000 children born between 1990 and 2017 and found that children ages 2-4 years old, non-Hispanic Black and Hispanic Black children, and children who lived in the Northeast and Midwest had the highest incidence rates of ARE. Additionally, children with a parental history of asthma had ARE rates almost 3 times greater compared to those with no parental history. This research, titled “Incidence Rates of Childhood Asthma with Recurrent Exacerbations in the U.S. Environmental influences on Child Health Outcomes (ECHO) Program,” is published in The Journal of Allergy and Child Immunology.

While the prevalence of asthma has been reported widely in the United States and elsewhere, studies on childhood asthma incidence rates within specific populations and across various types of asthma and age ranges have been limited. “Describing the incidence rates of ARE across a large, diverse population of children is a critical first step for identifying potential risk factors and causes,” explained Dr. Johnson.

To conduct this research, the research team leveraged data from children enrolled in 60 ECHO cohorts across the U.S. and Puerto Rico. Child participants or their caregivers reported whether and when the child had an asthma diagnosis and any corticosteroids prescribed over time from their health care providers.  Recurrent exacerbations of asthma were based on reports of systemic (not inhaled) corticosteroid use. The researchers calculated incidence rates of ARE for the study population overall, along with rates for subsets of the population defined by the years the ARE were diagnosed, the decade children were born, their age and sex, their race and ethnicity, their residence at birth, and their parents’ history of asthma.

“While children with ARE are all different, these findings suggest that we should examine in the future key elements of the early environment, including viral respiratory tract infections, indoor allergens, environmental tobacco smoke, air pollution, stress, and socioeconomic status, which could contribute to ARE,” said Dr. Miller. “Understanding these causes will help researchers determine how to best prevent ARE and associated asthma outcomes.”

Read the research summary.­­