Author: Jodi Snare

Family Lifestyle and Behavior Changes During COVID-19 Pandemic Associated with Youth Mental Health

Posted on by Jodi Snare

Children and teens who experienced significant changes in their lifestyle and health behaviors during the COVID-19 pandemic may be more likely to experience symptoms of pandemic-related post-traumatic stress (PTS), according to a recent ECHO Cohort study led by Amy Margolis, PhD of The Ohio State University.

The United States is facing a growing youth mental health crisis with a significant increase in mental or behavioral health conditions, partly linked to changes during the COVID-19 pandemic. To understand how changes in family hardships, behaviors, and coping strategies during the COVID-19 pandemic influenced youth PTS symptoms, researchers collected information from 7,786 children and 1,353 teens and young adults and their parents or caregivers across the United States between April 2020 and August 2021.

Key Takeaways include:

  • Two groups of families were identified based on their experiences of hardships, changes in daily behaviors, and coping strategies during COVID-19. The first group had minimal changes in their lifestyle and behaviors, while the second group had significant changes. The low change group included a higher proportion of Black families, single-parent households, and lower income and education levels.
  • Children and teens in the group with significant changes had higher Pandemic-related Traumatic Stress Scale (PTSS) scores compared to the group with minimal changes.
  • Some aspects of parent or caregiver experiences, including their ability to isolate during the pandemic, were associated with lower PTSS scores in children. Youth whose parents or caregivers reported no change in their own behaviors were more likely to report lower PTSS scores.
  • Changes in youth health behaviors (like eating, physical activity, and media use) and access to healthcare were important factors associated with PTSS scores. Stability in these areas was linked to lower PTSS scores.
  • The use of coping strategies by children and teens did not significantly reduce PTSS scores. Some coping strategies, like increased media use and substance use, were linked to higher PTSS scores.

This study provides valuable insight that could help improve youth mental health now and in the wake of future public health emergencies. It demonstrates the importance of stability in health behaviors, access to healthcare, and the ability for parents to isolate safely as key factors in reducing youth PTS symptoms.

This collaborative research, titled “Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis,” is published in the Journal of Clinical Child & Adolescent Psychology.

Read the research summary.

ECHO Study Finds Exposure to Air Pollution During Early Pregnancy Associated with Lower Birthweight

Posted on by Jodi Snare

Exposure to fine particulate matter (PM2.5)—very small inhalable particles found in air pollution—during early pregnancy was associated with babies being slightly smaller at birth, according to a new ECHO Cohort study led by Daniel Enquobahrie, PhD, MD, MPH of the University of Washington School of Public Health and Adaeze Wosu Nzegwu, PhD, MPH of Johns Hopkins Bloomberg School of Public Health.

Exposure to PM2.5 is widespread and linked to various health risks, including respiratory, cardiovascular, and metabolic diseases. Previous research has examined the effects of PM2.5 exposure during pregnancy on birth outcomes, but gaps remain. More research is needed to understand whether there are critical windows during pregnancy when PM2.5 exposure is most impactful. For this study, researchers used information from 19,108 mothers and their babies from 51 ECHO Cohort Study Sites across the United States to evaluate how timing of PM2.5 exposure affects birth outcomes. They also explored whether associations differ by infant sex and maternal race and ethnicity.

Key Takeaways include:

  • Exposure to higher levels of PM2.5 during the first weeks of pregnancy was linked to babies being slightly smaller at birth and having a higher chance of being born small for their gestational age (smaller than average for the length of pregnancy).
  • There was no significant association between PM2.5 exposure and shorter pregnancies or preterm birth.
  • For baby girls, higher PM2.5 exposure in early pregnancy seemed to affect their birth size more than for baby boys, suggesting that the baby's sex can make a difference in how air pollution affects growth.
  • The effects of PM2.5 on birth outcomes like being born prematurely, birth size, or being small for gestational age varied depending on the mother's race and ethnicity.

“This study on PM2.5 exposure during pregnancy and birth outcomes can inform ongoing discussions on regulations that impact PM2.5 exposure, such as traffic-related air pollution.” said Dr. Enquobahrie.

Further research could help investigators better understand the mechanisms underlying differences in air pollution vulnerability by infant sex, and by maternal race and ethnicity. Additional studies could also help researchers understand how other factors, such as diet and lifestyle, influence the relationship between PM2.5 exposure and birth outcomes.

This collaborative research, titled “Gestational fine particulate matter exposure and perinatal outcomes in the ECHO cohort: Associations across pregnancy windows,” is published in Environmental Research.

Read the research summary.

Housing Conditions and Outdoor Air Pollution Together Affect Children’s Asthma Risk, New ECHO Study Shows

Posted on by Jodi Snare

Children growing up in homes with water damage or dampness and exposed to higher levels of outdoor air pollution during early childhood face a greater risk of developing asthma, according to new research supported by the NIH’s Environmental influences on Child Health Outcomes (ECHO) Program. The large multisite study found that early-life exposure to fine particulate matter (PM2.5) and indoor housing problems each independently raised asthma risk, while having a dog during infancy was linked to reduced risk.

Asthma affects millions of U.S. children, yet the environmental origins of the disease are complex. While previous research has tended to study exposures such as pollution or indoor allergens separately, this study shows that evaluating them together offers a more accurate picture of children’s risk. The ECHO Program, which brings together data from diverse U.S. populations, made this integrated analysis possible.

Drawing on data from 6,413 children across nine U.S. ECHO Study Sites, the research provides one of the clearest looks yet at how multiple early-life environmental factors interact to influence childhood asthma. The findings underscore the importance of assessing both indoor and outdoor environments together, rather than in isolation — an approach that prior studies often could not address due to limited sample sizes.

“Our research shows that to truly understand and prevent childhood asthma, we need to look at a child’s full environment—both the air they breathe outside and the conditions inside their home,” said Akihiro Shiroshita, a study author from Vanderbilt University School of Medicine. “Considering these factors together gives us a much clearer picture of what puts children at risk and how we can better protect them.”

Key Findings

  • Outdoor air pollution matters: Higher early life exposure to PM2.5 was associated with increased asthma risk.
  • Indoor environments matter too: Home dampness or water damage independently raised asthma risk, even after accounting for pollution exposure.
  • Pets may offer protection: Having a dog in the home during infancy was linked to a lower risk of developing asthma.
  • Large, diverse dataset: The study combines data from multiple U.S. ECHO Study Sites, offering a comprehensive view of environmental impacts on children’s respiratory health.

Researchers evaluated children’s exposure to PM2.5 during the first three years of life and combined that information with detailed data on early life housing conditions — including water damage, dampness, pet exposure, and dust mites. Childhood asthma was identified based on caregiver reports or physician diagnosis between birth and age five. The analysis also controlled for family and neighborhood factors to isolate the effects of environmental exposures.

The findings signal the need for additional research into how indoor and outdoor exposures interact and how early life interventions could help reduce asthma risk in children nationwide.

This collaborative research was published in Environmental Epidemiology.

About ECHO
The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

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

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

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Follow the ECHO Program on LinkedIn and X for the latest updates.

Exposure to Certain Flame-Retardant Chemicals During Pregnancy Associated with Child Cognition

Posted on by Jodi Snare

Exposure to certain organophosphate esters (OPEs)—chemicals commonly used as flame retardants and plastic softeners in a variety of household and industrial products—during pregnancy was associated with slightly lower scores on tests of mental skills in young children, according to a new ECHO Cohort study led by Akhgar Ghassabian, MD, PhD of New York University Grossman School of Medicine.

Previous studies have suggested that OPEs may affect child brain development. With increasing human exposure to these chemicals, especially during sensitive periods like pregnancy, there has been concern about the potential impact on child cognitive development. This study included data from 831 mother-child pairs from three ECHO Cohort Study Sites in the United States. When pregnant women had higher urine levels of diphenyl phosphate (DPHP), a compound produced during the breakdown of certain OPEs in the human body, their children tended to have slightly lower scores on tests of mental skills at ages 4–6. This pattern was seen in boys and girls. Unexpectedly, boys whose mothers had higher levels of certain other chemicals linked to OPE exposure during pregnancy scored higher on these tests, but this was not true for girls.

“Results from this study suggest that OPE exposure during pregnancy may be associated with minor decreases in cognitive functioning in offspring,” said Dr. Ghassabian. “Considering that DPHP is a widely detected OPE metabolite in the U.S. population, the overall population impact of this modest effect size can be significant.”

Additional studies could help researchers better understand the biological pathways underlying these associations. Additional studies could also help clarify the association between some chemical markers of OPE exposure and higher cognitive scores among boys.

This collaborative research, titled “Prenatal exposure to organophosphate ester flame retardants and child cognition: findings from the Environmental influences on Child Health Outcomes cohort,” is published in Environmental Pollution. Read the research summary.

Prenatal and Early-Life Pollution Exposures May Influence Childhood Blood Pressure Patterns, ECHO Study Finds

Posted on by Jodi Snare

A child’s blood pressure may be influenced by exposure to air pollution before and shortly after birth, according to a new study from the NIH-funded Environmental influences on Child Health Outcomes (ECHO) Program. The study focused on fine particulate matter (PM2.5) and nitrogen dioxide (NO2), common pollutants from vehicles, power plants, and other industrial sources.

High blood pressure in children is becoming more common worldwide and can lead to long-term health problems, including heart disease and impaired kidney function. Over the past two decades, childhood hypertension has increased by nearly 80 percent, particularly in countries with higher obesity rates, such as the United States. Because the roots of adult hypertension often begin in childhood, ECHO researchers examined whether early exposure to outdoor air pollution may influence blood pressure in children.

Air pollutants such as PM2.5 and NO2 are known contributors to cardiovascular disease in adults, but their effects on children’s blood pressure are less well understood. Previous studies have produced mixed results and were often limited to single locations. This ECHO study leveraged data from multiple cohort sites across the United States to better clarify these associations.

Researchers analyzed data from 4,863 children ages 5 to 12 from 20 ECHO Cohort Study Sites. They estimated outdoor air pollution exposure at participants’ home addresses during each trimester of pregnancy, across the full pregnancy, and during the child’s first two years of life. Children’s blood pressure was measured during study visits and compared with typical values for children of the same age, sex, and height. Blood pressure was considered high if it fell within the top 10 percent of these values.

Key Findings

  • PM2.5 exposure and higher blood pressure: Children who were exposed to higher levels of PM2.5 before and after birth had higher blood pressure on average between ages 5 and 12.
  • Early pregnancy as a sensitive period: Higher PM2.5 exposure during the first trimester was associated with a more pronounced systolic blood pressure and a greater likelihood of high blood pressure in childhood, indicating that early pregnancy may be a particularly sensitive period.
  • Unexpected findings for NO2: Higher maternal exposure to NO2 during pregnancy was associated with slightly lower blood pressure in children. This association was strongest during mid- to late pregnancy, particularly the second trimester, and was not linked to an increased risk of high blood pressure.
  • Timing matters: The results suggest that the timing of pollution exposure during pregnancy may be important for understanding its impact on children’s cardiovascular health.

“These findings add to growing evidence that early-life exposure to fine particulate air pollution may affect children’s cardiometabolic health, even at relatively low levels,” said study author Yu Ni, PhD, of San Diego State University. “The unexpected findings related to nitrogen dioxide suggest that more research is needed to understand how this type of air pollution may affect children’s developing bodies, as well as whether other environmental factors could be playing a role, such as transportation noise.”

This collaborative research was published in Environmental Research.

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 connector

Check 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 the ECHO Program on LinkedIn and X for the latest updates.

Exposure to Certain PFAS Associated with Maternal Depression & Stress for Pregnant and Postpartum Mothers, ECHO Study Finds

Posted on by Jodi Snare

Exposure to certain per- and polyfluoroalkyl substances (PFAS)  was associated with changes in depression and stress for pregnant and postpartum mothers, according to a new ECHO Cohort study led by Susanna Mitro, PhD and Lyndsay Avalos, PhD, MPH of Kaiser Permanente Northern California.

PFAS are a large, complex group of synthetic chemicals found in some household products such as cookware and stain-resistant fabrics. These substances are often referred to as “forever chemicals” because they don’t break down easily, causing them to build up over time in water, soil, and air. Previous studies have shown that PFAS can negatively affect the brain, and there is conflicting evidence about their potential effects on depression and perceived stress during and after pregnancy. This study included 4,403 pregnant participants from 16 ECHO Cohort study sites across the United States. Researchers measured the levels of seven PFAS in the mother’s blood during pregnancy, and participants reported on their depression and stress symptoms before and after giving birth.

Key Takeaways include:

  • Higher levels of N-methyl perfluorooctane sulfonamido acetic acid (N-MeFOSAA) were associated with slightly higher depressive symptoms and perceived stress, especially postpartum, while higher perfluorodecanoic acid (PFDA) levels were associated with a lower risk of diagnosed depression and lower prenatal perceived stress.
  • Exposure to perfluorooctanesolfonic acid (PFOS) showed a mixed pattern where moderate exposure was associated with increased depression risk, but the highest exposure was associated with lower depression risk.
  • When looking at all seven PFAS types as a group, there was generally no strong link to depression diagnosis or severity, but the data did show higher stress at low to moderate exposures, but lower stress as high exposure.
  • The effects of PFAS were different depending on social factors. For example, people who were not born in the U.S. or who had higher social vulnerability sometimes showed stronger links between PFAS and depression or stress.

“This study adds to mounting evidence that PFAS exposure during pregnancy may have negative health impacts on the pregnant individual, reinforcing the importance of minimizing exposure to PFAS during this sensitive time,” said Dr. Mitro.

Overall, the associations observed in this study were small, so more research is needed to fully understand the effects of PFAS on pregnancy mental health. Future studies could also help researchers clarify the biological mechanisms linking PFAS exposure to depression and stress and explore the role of social factors in influencing these associations.

This collaborative research, titled “Gestational PFAS concentrations in association with maternal depression and perceived stress during pregnancy and postpartum in the ECHO cohort,” is published in Environmental Research.

Pregnancy Stress Can Influence Relationship Between Chemical Exposures & Birth Outcomes, ECHO Study Finds

Posted on by Jodi Snare

Stress, anxiety, and depression during pregnancy and maternal adverse childhood experiences may influence the relationship between certain chemical exposures and birth outcomes, according to a new ECHO Cohort study led by Stephanie Eick, PhD, MPH and Anne Dunlop, MD, MPH of Emory University.

Most previous research on the effects of chemical exposures on birth outcomes has focused on a small number of well-established chemicals, such as bisphenol A (BPA) and certain phthalates. However, there are over 350,000 chemicals registered for global use, and the impact of many emerging or understudied chemicals on birth outcomes is not well understood. Additionally, prior studies have not adequately considered how different kinds of maternal stress (such as anxiety, depression, and adverse childhood experiences) might influence the effects of chemical exposures during pregnancy.

This study included 1,556 mother-child pairs from eleven ECHO Cohort Study Sites across the United States. Researchers analyzed urine samples from pregnant participants for 113 different chemicals from 10 chemical classes. Participants also reported on their stress, depression, anxiety, and adverse childhood experiences, allowing researchers to evaluate how these factors affect the relationship between different chemical exposures and birth outcomes.

Key Takeaways include:

  • Exposure to chemicals found in certain consumer and industrial products (such as phthalates, bisphenols, and insecticides) was associated with shorter pregnancies among women who experienced anxiety during pregnancy or in the early postpartum period.
  • Depression modified how exposure to certain chemicals (such as phthalates, parabens, and insecticides) affected birthweight and length of pregnancy.
  • Some chemicals positively correlated with length of pregnancy (duration) for mothers with more depression, while others were associated with lower birthweights when mothers had more depression symptoms.
  • The effects of a mother’s stress on the relationship between chemical exposures and birth outcomes depended on the type of chemical and type of stressor experienced.

“These findings suggest that screening for depression and anxiety during pregnancy could help identify women who may be at a higher risk of adverse birth outcomes,” said Dr. Eick.

Additional studies looking at the combined effects of multiple combined exposures could help researchers better understand the role of these factors in influencing birth outcomes. Future research could also further investigate potential biological effects of maternal adverse childhood experiences.

This collaborative research, titled “Psychosocial Stressors as Modifiers of the Associations Between Well-Studied and Understudied Chemicals and Birth Outcomes in the ECHO Cohort,” is published in Environmental Pollution.

Read the research summary.

Community Gun Violence Linked to Poorer Child Health, ECHO Study Finds

Posted on by Jodi Snare

Children living in neighborhoods with high levels of gun violence were 20% less likely to be reported in excellent or very good health compared with children in areas with lower levels of gun violence, according to a new study from the ECHO Cohort. The association was consistent across age groups and especially pronounced in high-poverty neighborhoods, where children exposed to gun violence were 23% less likely to be reported in excellent health.

The study included more than 13,450 children from birth to age 17 from 56 ECHO Cohort Study Sites across the United States. Researchers linked data on neighborhood gun violence, collected from the Gun Violence Archive, with parent-reported child health measures, while accounting for individual and neighborhood sociodemographic factors.

“This research highlights the profound impact of gun violence on the well-being of children, underscoring the critical importance of community-level violence prevention efforts and policies in fostering safer and healthier communities,” said study author Nandita Somayaji, MHS, MEd, of the Bloomberg School of Public Health at Johns Hopkins University.

These findings point to the importance of gun violence prevention strategies that can create safer environments for children.

This collaborative research titled “Associations between neighborhood-level gun violence and child general health status: An ECHO Cohort analysis” was published in Injury.

Reflecting on 2025, Looking toward 2026

Posted on by Jodi Snare

As we close out the year, I express my deep gratitude to our many ECHO partners who share our commitment to enhancing child health. As we look toward ECHO’s 10th anniversary in 2026, I have been reflecting on how far our research has come and how essential your partnership has been in shaping its impact.

Despite some challenges, this year saw sustained momentum across ECHO’s two components. The ECHO Cohort, now well into its second 7-year cycle as the nation’s largest longitudinal child health study, continues to answer solution-oriented questions about how a broad range of early environmental exposures affect child health and development. The Cohort Consortium now also examines influences on child health that begin even before conception, including exploring the role of fathers during this foundational period. The ECHO Cohort continues to make its data accessible to the wider scientific community through the DASH platform and the ancillary studies program, which we began earlier this year.

The IDeA States Pediatric Clinical Trials Network entered a new multiyear phase with several pilot studies underway. I’m pleased that, early in 2026, the Network will begin recruiting participants for a full-scale, FDA-monitored clinical trial evaluating the extent to which phentermine can safely and effectively reduce body mass index (BMI) among rural and underserved adolescents with obesity—a group for whom lifestyle modification alone is often insufficient and accessible pharmacologic options are limited. Phentermine is a potentially safe and accessible option approved by the FDA in 1959 for individuals 16 years old or older.

We were proud to host ECHO’s first annual Translating Science to Action Symposium in September 2025. The event brought together more than 1,000 child health researchers, clinicians, policymakers, advocates, community leaders, and families to bridge the gap between cutting-edge child health science and actionable solutions that can be implemented in real-world settings. Learn more here and watch this space for news about our 2026 Symposium.

Thank you for your continued support and partnership. I wish you and your loved ones a restorative holiday season and a bright start to the year ahead.

Matthew Gillman, MD, SM
Director of the ECHO Program

ECHO Symposium 2025: Slides and Full Videocast Now Available

Posted on by Jodi Snare

On September 15, 2025, the NIH Environmental influences on Child Health Outcomes (ECHO) Program hosted its inaugural ECHO Symposium: Translating Science to Action on the NIH campus in Bethesda, Maryland, and online. This free, one-day event brought together more than 1,000 researchers, clinicians, policymakers, advocates, community leaders, and families to explore how early environmental factors influence child health—and how to translate science into meaningful action.

The symposium featured a keynote address by Dr. Susan Kressly, President of the American Academy of Pediatrics; opening remarks by Dr. Matt Gillman, Director of the NIH ECHO Program, and former ECHO Cohort participant Jadine Benjamin; and a closing address by Dr. Michael Warren, Chief Medical and Health Officer of the March of Dimes.

Across three sessions—Chemical Exposures, Social and Neighborhood Factors, and Community Experiences—speakers highlighted research and perspectives on topics such as replacement chemicals and child health, environmental exposures in pregnancy, childhood trauma and toxic stress, neighborhood opportunity, media use, Indigenous community health, rural pediatric research, and parent experiences in pediatric studies.

Watch the videocast and view the slides
Missed the event or want to revisit a session? The full videocast and presentation slides are now available: