Author: Jodi Snare

Happy New Year

Posted on by Jodi Snare

Happy New Year! With a new year often comes a renewed sense of energy and focus. The ECHO Program is excited to start 2021 with the hope that the COVID-19 vaccine rollout will soon bring relief to our country after nearly a year in the pandemic. During this past year, our research staff and participants have shown patience, flexibility, and innovation, and they enter 2021 with enthusiasm for meeting the mission of ECHO.

On the cohorts side of ECHO, our researchers contribute data to the ECHO-wide Cohort data platform guided by the Year 5 goals we mentioned in the last ECHO Connector. These data will allow us to publish important information about the origins of child health outcomes that will ultimately help inform programs, policies, and practices.

On the IDeA States Pediatric Clinical Trials Network (ISPCTN) side, the network recently published its first ACT NOW Current Experience manuscript, “Site-Level Variation in the Characteristics and Care of Infants with Neonatal Opioid Withdrawal,” in Pediatrics. Additionally, the iAmHealthy trial continues to progress with families now in the final month of the 6-month intervention period. A full update on this study is included in this edition of the Connector.

Thank you for your continued support of ECHO’s mission to enhance the health of children for generations to come. We look forward to engaging more with you in 2021!

Silicone Wristbands Capture Chemical Exposures in Early Pregnancy

Posted on by Jodi Snare

Pregnant women are exposed to chemicals that may pose risks to their health or their babies’ health. However, the types of chemicals and the patterns of exposure are not well known. Therefore, ECHO researchers and Opportunities & Infrastructure Fund (OIF) investigators Brett Doherty, PhD, MSPH, and Megan Romano, PhD, MPH of Dartmouth College used silicone wristbands to collect data on chemical exposures during pregnancy. Their research, titled “Assessment of Multipollutant Exposures During Pregnancy Using Silicone Wristbands” is published in Frontiers in Public Health.

During this study, 255 women from the New Hampshire Birth Cohort Study (NHBCS) wore silicone wristbands for one week during early pregnancy. The women went about their normal activities while chemicals in their environment became trapped in the wristbands. At the end of the week, the participants returned the wristbands and the research team measured the captured chemicals.
The study found 199 unique chemicals in the wristbands worn by women in the study. A group of 16 chemicals, including chemicals in personal care products and consumer goods, was identified most often. Most women had relatively low amounts of these chemicals in their wristbands, but others had more unique combinations of chemical exposures. Education and behaviors, such as nail polish use, were predictive of the chemical exposures.

“We identified common exposures and exposure patterns in our study population, which may be studied in future research,” said Romano. The team will compare the wristband measurements to traditional measurements of chemical exposures to better understand the strengths and weaknesses of this new technology.
Additionally, the research team plans to link the chemical exposure data from the silicone wristbands to maternal and infant health outcomes and other biological data. “This linkage may indicate how chemicals influence human health and provide clues to prevent adverse health outcomes,” said Doherty.

Does Age Affect Susceptibility to Getting the Common Cold?

Posted on by Jodi Snare

Rhinovirus is a leading cause of the common cold and wheezing illnesses in young children and individuals with asthma. There are three species of rhinoviruses (A, B, and C), and the C viruses are often more likely to cause wheezing illnesses, especially in young children. Unfortunately, there are no treatments for these respiratory viruses.

To learn more about how age and other personal factors influence susceptibility to getting rhinovirus illnesses, ECHO researchers Timothy Choi, MS; James Gern, MD; and Yury Bochkov, PhD, of the University of Wisconsin School of Medicine and Public Health conducted a multi-year study with more than 4,000 children. This research, titled “Enhanced Neutralizing Antibody Responses to Rhinovirus C and Age-Dependent Patterns of Infection,” is now featured in the American Journal of Respiratory and Critical Care Medicine.

Children ages zero to 19 with illnesses of varying severity participated in 14 independent studies in the United States, Finland, and Australia. Between 2000 and 2019, each site collected and analyzed nasal samples for rhinovirus species and type. The investigators then tested whether characteristics such as age influenced which viruses were found.

“Our research shows that as children age, they are less likely to be infected with rhinovirus C,” said Choi. “This could be because the immune system has a stronger protective response to infection with rhinovirus C species compared to other species.” Other personal factors related to more frequent infections include wheezing respiratory illnesses and a genetic difference in a protein used by the viruses to enter cells.

The results of this study could help identify children at high risk for developing more severe illnesses with rhinovirus C based on young age and genetics. In addition, analyses of more than 10,000 mucus specimens identified viruses that were consistently more common and those more likely to be associated with illness.

“In the future, we want to focus on studying the magnitude and duration of immunity to rhinovirus C to determine why these viruses are able to produce such a strong immune response, and why rhinovirus C infections naturally decline with age,” said Dr. Gern. “This information may help researchers design a practical vaccine against rhinovirus C that could be used to protect high-risk children.”

Clinical Research Coordinators Share Experience on Blog Platform

Posted on by Jodi Snare

The Chemicals in Our Body Cohort, led by Principal Investigator Tracey Woodruff, PhD, MPH, at the University of California San Francisco, created a blog platform to share information regarding current research and policy updates.

This platform highlights content on various subjects, from children’s health, to environmental justice and defending science. Recently, two ECHO Program Clinical Research Coordinators (CRCs) from the university’s Program on Reproductive Health and the Environment (PRHE), published a blog post titled, “The researchers behind the headlines: Who are PRHE’s Clinical Research Coordinators and what do they do?,” which highlights their experience as CRCs working on the ECHO Program.

This write-up provides a “behind-the-scenes” look at the incredible work the Chemicals in Our Body Cohort does to engage with study participants and collect important data that will help meet ECHO’s mission to enhance the health of children everywhere. The article is written in both Spanish and English.

To read more posts from the Chemicals in Our Body Cohort, visit the blog here.

Identifying and Addressing Limitations: The Effects of Air Pollution on Children’s Behavior and Brain Development

Posted on by Jodi Snare
Heather Volk, PhD
Johns Hopkins Bloomberg School of Public Health

In a recent article published in Environmental Research, ECHO researcher Heather Volk, PhD, of Johns Hopkins Bloomberg School of Public Health and her team summarized information on different ways to measure prenatal air pollution exposure. They also reviewed what scientists know about how air pollution affects children’s behavior and brain development.

To collect this information, the team reviewed previous publications on air pollution and child development and summarized the study results. They then took these findings and developed a plan to address shortcomings of the earlier work to advance children’s health.

The plan involves using advanced geographic models for common air pollutant exposures. Since more than 90% of ECHO cohorts have collected a physical address for their participants, ECHO has the ability to study pollutant exposures by geographic area. This has been a limitation commonly seen in this area of research. This summary data also allows researchers to determine if there may be enough ECHO participants in the future to study how air pollution can affect children’s brain development and behavior.

“This research confirms that ECHO provides a unique opportunity to study how air pollution can affect children’s brain development and behavior in a large, diverse study population,” Volk said. Given this information, the team hopes that future studies will examine prenatal air pollution exposure in ECHO participants to examine how it affects the brain.

Year-end Reflections

Posted on by Jodi Snare

Around this time each year, I find myself reflecting on where the ECHO Program was a year ago, where we have gone, and where we are heading. For all of us, 2020 has looked wildly different from all previous years of our lives, and it has come with many challenges. I feel a sense of pride, however, for the way our ECHO teams have stepped up, adapted, and overcome COVID-19-related barriers to continue our important work to enhance the health of children for generations to come.

During this past year, the ECHO Program team publicly launched our ECHO Discovery Series and the ECHO Connector and mapped out a plan for this 5th year of the program to ensure we continue down a successful road toward meeting our mission.  Our investigators continue their research, both on the observational and intervention fronts, and there are many research results in the pipeline for publication during this coming year.

As we enter Year 5 of ECHO, our plan outlines goals and objectives to foster a collaborative environment so that our investigators can publish important research that will inform healthcare practices, new health programs in our communities, and health policies. In addition to the goals set forth by the ECHO Components, the NIH ECHO Program Office has created a strategic plan that will help steer the program in the right direction. You may read more about this plan below.

2020 has also seen increased engagement with our stakeholder organizations.  I hope that you are enjoying receiving these updates on the ECHO Program, and we look forward to sharing many more in the New Year. We hope you have a wonderful and safe end of the year, and we will be back with the first ECHO Connector of 2021 in January.

Literature Review Finds Connection between Chemical Exposure and Time to Pregnancy

Posted on by Jodi Snare

Some human-made chemicals can cause problems with the reproductive system, and several studies have looked at whether these chemicals affect how long it takes to get pregnant.

Linda Kahn, PhD, MPH
NYU Langone Health

In a literature review recently published in Human Reproduction Update, ECHO researcher Linda Kahn, PhD, MPH, of NYU Langone Health, and her research team compared the results of past studies on human-made chemicals and their impact on pregnancy. The research found a connection between certain chemicals and time to pregnancy, and also identified chemicals that need further research.

To conduct this research, the team reviewed all papers published in English on this topic from January 1, 2007 to August 6, 2019. After searching five science libraries and finding more than 4,500 articles, they narrowed it down to 28 articles with information from 19 studies that took place in North America, Europe, and East Asia.

The review found a strong connection between a chemical group called polychlorinated biphenyls, formerly used in electrical and hydraulic equipment, and longer time to pregnancy. Even though production of these chemicals stopped in the late 1970s, individuals are still exposed to them through soil, water, and building materials. More research needs to be done on brominated flame retardants, found in furniture, clothing, and other household products, and per- and polyfluoroalkyl substances, found in non-stick cookware and stain-resistant fabrics, to determine their impact on time to pregnancy.

“This review is especially important because it shows that certain long-lasting chemicals may increase the time it takes for couples to become pregnant, which can be stressful and lead couples to seek expensive fertility treatment,” Dr. Kahn said. “Although many of the chemicals covered in the review are no longer produced or used in the United States, they can last for years—even decades—in the environment and our bodies, affecting our health.”

The team believes we need more research on newer chemicals that have been invented to replace dangerous ones to figure out exactly how these chemicals interfere with healthy reproduction. For example, there may be certain life stages such as puberty when being exposed to them may be especially damaging.

ECHO Researchers Explore Validity of Shortened Social Communication Questionnaire

Posted on by Jodi Snare

Are short questionnaires as valid as longer versions when identifying autism spectrum disorder (ASD) and other social communication behaviors?

Kristen Lyall, Sc. D.

ECHO researchers Kristen Lyall, Craig Newschaffer, and others hoped to answer this question in their research titled, “Distributional properties and criterion validity of a shortened version of the Social Responsiveness Scale: Results from the ECHO program and implications for social communication research.” This publication, featured in Journal of Autism and Developmental Disorders, examines how well a shortened version of a social communication questionnaire identified behaviors related to ASD and social communication compared to the longer, established version.

More than 3,000 parents from across the United States participated in this study, nearly 200 of which had a child with ASD.

In all, the team found that the short form did well predicting ASD diagnosis and measuring social communication behaviors. These results suggest that shorter surveys can provide correct information about ASD, which would be quicker and easier for the participant to complete. However, more research is needed to see how the short questionnaire compares in other ways to the longer version.

This work is especially important because it may help address the needs of people who do not have autism but face challenges in social communication and could benefit from help. Additionally, it may help reduce the time it takes to complete surveys while still accurately capturing and addressing social communication challenges in those with and without ASD.

For more information, read the study summary.

Awards Announced for Cycle 2 of IDeA States Pediatric Trials Network

Posted on by Jodi Snare

The ECHO Program is excited to share that all 17 existing clinical sites within the IDeA States Pediatric Clinical Trials Network (ISPCTN), along with the Data Coordinating and Operations Center (DCOC), will continue to the Network’s second cycle. In addition, the Network is adding one clinical site, South Dakota Pediatric Clinical Trials Network, led by MPIs Dr. Amy Elliott and Dr. Katherine Wang.

The purposes of the ISPCTN are 1) to conduct clinical trials among children from rural or underserved populations, and 2) to build pediatric research capacity in historically low-resource institutions to conduct these trials. In this next cycle, ISPCTN will continue its four ongoing trials, including two trials to address care of newborns exposed to opioids in utero. The Network will also stand up at least three new trials. Opportunities to address the COVID-19 pandemic are of particular interest. Learn more about two of the ISPCTN’s current trials below.    

IDeA States Pediatric Trials Network Update on VDORA and iAmHealthy

Infants and children living in rural parts of the United States are less likely than children in urban centers to have a chance to enroll in clinical trials. In 2016, the NIH started the ISPCTN to bring research to children in rural and underserved parts of the country. This group of pediatric researchers from 18 states is working to make sure that children in states with historically low funding for research have access to clinical trials as part of ECHO.

Asthma is one of the most common illnesses in children and impacts families across the country. Children with higher body mass index or BMI can have more severe asthma symptoms than other asthmatic children with lower BMI. Vitamin D is a vitamin that helps many parts of the body, including bones and the immune system. Because vitamin D is stored in fat, doctors do not currently know the ideal amount of vitamin D that children with higher levels of body fat and a BMI greater than or equal to 85% for their age and sex, should take in order to get the most health benefits. Vitamin D Oral Replacement in Asthma (VDORA) is a study that ECHO ISPCTN is currently running to begin to answer this question.

The focus of the VDORA1 study is to help determine what dose of vitamin D would work best for children with higher BMI than other children their age with asthma, and low vitamin D levels in their blood. The children in the study will take vitamin D at different doses and have their blood-levels of vitamin D measured at regular times. The study team will also ask about asthma symptoms, to see if these symptoms change while the child is taking vitamin D. Over 70 children have participated in this study so far and the study will continue through spring 2021.

Childhood obesity is an increasing problem throughout the country and is an important outcome that the ECHO Program studies. It can be hard for families in rural areas to work with health care providers to learn healthy food and activity habits. Over 100 children and their families from four states are now participating in the iAmHealthy feasibility study. This is a 6-month trial, studying the best ways to teach children who live in rural areas how to eat and exercise daily to create a healthier mind and body. Half of the children and families will receive a monthly newsletter in the mail with healthy diet, activity, and lifestyle tips. The other half will have individual and group sessions with health care coaches via video conferences.

Importantly, this trial is also studying the best ways to recruit children and families into research studies, which may be harder in rural and other areas with little research experience. The study is being done virtually without any face-to-face visits required, using electronic communication for consenting, measuring height, weight, and activity, and delivering all the other parts of the study. The lessons learned about research in rural areas and without face-to-face visits will help other studies reach a larger number of children.

Establishing a Standard of Care for Babies Born Dependent on Opioids

Posted on by Jodi Snare

Lead Investigators: Leslie Young, University of Vermont, Lori Devlin, University of Louisville, Stephanie Merhar, University of Cincinnati

As the opioid epidemic continues to affect families across the United States, opioid exposure in the womb has attracted more attention. When a woman uses opioids while she is pregnant, her newborn baby can have symptoms of withdrawal such as intense fussiness, inability to eat well, and poor sleep. Neonatal Opioid Withdrawal Syndrome, or NOWS, has increased five-fold over the last decade, but evidence as to the best approach for assessing and treating these infants is lacking.

That’s why ECHO—in partnership with the NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)—is launching the Advancing Clinical Trials in Neonatal Opioid Withdrawal (ACT NOW) initiative. One intervention trial slated to begin in late summer 2020 is Eating, Sleeping, and Consoling for Neonatal Opioid Withdrawal (ESC-NOW). In this study, researchers will test the effectiveness of ESC, a new method that nurseries can adopt for assessing and treating infants with NOWS. Comparing ESC to the usual care NOWS babies receive, they’ll evaluate how the ESC approach affects the short term—being ready for discharge from the hospital–as well as longer-term: how this approach affects family and infant well-being, as well as how well the baby’s brain is developing, during the first 2 years of life.

The ESC approach engages parents and other primary caregivers in the treatment of NOWS. It emphasizes tactics like holding, swaddling, and rocking in low stimulus environments, thus potentially lowering the need for medication.

Up to 3,000 infants and their primary caregivers will be included in this clinical trial across 26 sites in the United States. By filling gaps in our knowledge of how to take care of these babies, the results of this study may very well set a standard for improving the care of infants with NOWS.

ESC-NOW is one of several ACT NOW studies funded through the National Institutes of Health Helping to End Addiction Long-term (HEAL) Initiative.