Author: Jodi Snare

Welcome to the First Issue of the ECHO Connector

Posted on by Jodi Snare

As ECHO Program Director, it is my pleasure to introduce you to the first issue of the ECHO Connector.

The ECHO Connector is a forum to share information, inform you of recent publications and upcoming events, and spark conversation and collaboration. I hope that these emails will serve as a way for ECHO to connect with organizations like yours and individuals across the country who are interested in child health research.

ECHO focuses on five key pediatric outcomes with large public health impact: Pre-, peri-, and postnatal; Upper and lower airway; Obesity; Neurodevelopment; and Positive Health, or well-being.

The program has two major components, the ECHO Cohorts—for observational research, and the ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN)—for interventional research.

In an observational cohort study, researchers investigate what is happening with study participants’ health over time, and why, without intervention. ECHO weaves together information from 72 long-term ongoing maternal-child cohort studies totaling about 50,000 children from racially, socioeconomically, and geographically diverse backgrounds.

In an interventional clinical trial, researchers test how well a new prevention or treatment strategy works. ISPCTN conducts this type of research across 17 sites with rural or underserved children.

Together within this program, these two types of research have the potential to answer big questions about how influences in early human development—even before birth—affect us throughout our lives and across generations. This information can help inform state and/or national policies, public health programs, or clinical care to help kids live healthier lives.

ECHO can also address pressing public health needs—like the ongoing opioid crisis and the current COVID-19 pandemic. We’ve quickly mobilized to look at how the coronavirus affects pregnant women and children. You can read more about our efforts in ECHO’s Response to COVID-19 and Establishing a Standard of Care for Babies Born Dependent on Opioids below.

I believe that ECHO has the right formula of cohorts, clinical trials, and supporting resources to provide evidence to move the needle in child health. I look forward to sharing information about our research and partnering with you.

ECHO Study Summaries Now Available

Posted on by Jodi Snare

Updated July 21, 2020

THE ECHO PROGRAM HAS ADDED PLAIN-LANGUAGE SUMMARIES FOR ITS PROGRAM-WIDE PUBLICATIONS

A new resource on the ECHO Program website—the Study Summaries page  under the Sharing Our Science tab on the ECHO website—invites visitors to read plain-language study summaries of ECHO publications. The new page continues our commitment to sharing results for ECHO Program studies.

Summaries include research on:

  • General health and life satisfaction in children with chronic illness
  • Prenatal opioid exposure and its effects on child health outcomes
  • The potential role of Vitamin E in preventing or treating bronchopulmonary dysplasia

The ECHO Coordinating Center will continue to post ECHO study summaries as they become available.

ECHO Researchers Learn How Children’s Sleep Quality Is Associated With Overall Life Satisfaction

Posted on by Jodi Snare

Updated July 21, 2020

Most sleep research focuses on how poor sleep may cause health problems. Taking a different approach, ECHO researcher Courtney Blackwell and her team recently conducted a study to determine how better sleep quality may lead to positive health outcomes. In an article published in Quality of Life Research, Blackwell and team found that better sleep quality in school-age children was associated with lower psychological stress and better general health status, which in turn, predicted better life satisfaction

“Existing literature primarily focuses on the negative impacts of sleep. Our team is excited to contribute to the growing body of research on associations of sleep quality on children’s positive well-being,” said Blackwell.

To conduct this study, ECHO researchers asked parents and caregivers to complete surveys about their children’s sleep quality, general health, stress, and life satisfaction. More than 1,000 caregivers of 5- to 9-year-old children from three ECHO Cohorts participated in this study, creating a diverse population that none of the Cohorts offered individually.

Overall, this study suggests that children whose sleep quality is better experience higher levels of life satisfaction.

For more information, read the study summary.

ECHO Program’s Response to COVID-19

Posted on by Jodi Snare

Updated January 25, 2021

ECHO’s approach to innovative research practices in the era of COVID-19

As the novel coronavirus pandemic continues to affect communities across the world, ECHO is committed to protecting the health and safety of its staff and participants while advancing our research mission of enhancing the health of children for generations to come. In addition to following guidance from our national and local governments, many of our studies have, at least temporarily, limited activities to those they can do at a distance.

In response, ECHO researchers are working together to find innovative approaches to keep research going remotely.

Many ECHO Cohorts are moving toward collecting data from a distance. Fortunately, the ECHO-wide Cohort Data Collection Protocol includes online, mail, and phone surveys, as well as remote sample collection. Like the ECHO Cohorts, the ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN) paused ongoing clinical trials in early Spring 2020, but has resumed with a shift toward remote research tools for informed consent, interventions, and data and sample collection.

In these ways, ECHO is responding to the ongoing pandemic by introducing new ways of conducting research, some of which may continue once the pandemic subsides.

ECHO’s contribution to COVID-19 research

ECHO is also joining with researchers around the world to contribute to understanding how COVID-19 affects pregnant women and children.

ECHO researchers are working together in record time to incorporate COVID-19 research in ongoing and new studies. This work is being led by a COVID-19 task force for ECHO ISPCTN and a COVID-19 working group for ECHO Cohorts.

The ISPCTN task force, chaired by Paul Palumbo, MD, includes eight members with a range of expertise such as pediatric infectious diseases, perinatal transmission of disease, and vaccine delivery. The task force is identifying specific COVID-19-related intervention trials that this network of rural and underserved children could mount.

The ECHO Cohorts rapidly produced COVID-19-specific questions that are now part of the ECHO-wide Cohort Data Collection Protocol.  To be maximally useful for other researchers, two public NIH websites feature these questionnaires: https://dr2.nlm.nih.gov and https://www.phenxtoolkit.org/covid19.

During the summer of 2020, the NIH Program Office issued a Notice of Special Interest to encourage and foster time-sensitive ECHO-wide Cohort science related to the COVID-19 pandemic. In September, NIH funded six projects, which include participation from 24 ECHO Pediatric Cohorts or Centers. Co-chaired by Kaja LeWinn, ScD and Leonardo Trasande, MD, MPP, the ECHO Cohorts COVID-19 Working Group continues to facilitate implementation of these new projects, and to foster other COVID-19 related research questions that the ECHO cohorts are uniquely suited to address.

ECHO COVID-19 Projects

  • Amplification of racial and social inequalities in response to the COVID-19 pandemic: Impacts on child positive health outcomes
    • Aim 1: Examine if long term racial/ethnic inequities in sociodemographic resources contribute to more COVID-19 hardships and higher levels of school and social disruptions within communities of color.
    • Aim 2: Examine independent and joint impacts of COVID-19 hardships, school practices, and children’s emotional support on 4-18-year-old’s positive health, as measured by academic competence and well-being.
  • Microbial Mediators of the Impact of Maternal Psychosocial Stress on Perinatal and Neurodevelopmental Outcomes
    • Aim 1: Determine the impact of a) maternal SARS-CoV-2 infection and b) psycho-social stress during the COVID-19 pandemic on length of gestation. We will also consider whether the maternal vaginal or fecal microbiomes in pregnancy mediate this relationship using whole shotgun metagenomic sequencing.
    • Aim 2: Determine the impact of maternal psychosocial stress on infant neurodevelopment and if alterations in infant gut microbiota during the first nine months of life mediate this association.
  • Examining the impact of societal changes during the COVID-19 pandemic on obesity related behaviors
    • Aim 1: Compare diet, physical activity, screen time and sleep prior to versus during the pandemic, with a focus on identifying children at high risk for adverse changes.
    • Aim 2: Using a mixed method approach, examine families’ daily routines during the pandemic, and parent perceptions of how societal changes influence children’s behaviors.
  • Changes in environmental exposures resulting from the COVID-19 pandemic and impacts on child health outcomes
    • Aim 1: Environmental exposures and levels of stress have dramatically changed since March 2020 consequent to the COVID-19 pandemic.
    • Aim 2: These changes have influenced birth outcomes (e.g., birthweight, gestational age) and child respiratory outcomes (wheeze, asthma diagnoses).
    • Aim 3: Exposures and their associations with the outcomes of interest vary by: a) measures of familial stress; b) urban/rural residential location; and c) race/ethnicity. Changes in environmental exposures will be assessed using a questionnaire (all cohorts); silicon wristbands (subset of cohorts); and using urinary biomarkers (subset of cohorts).
  • Impact of COVID-19 and associated stressors on neurodevelopment in marginalized populations
    • Aim 1: Collect time-sensitive responses on stress and parenting in the participating cohorts.
    • Aim 2: Create an efficient remote data collection system and build capacity by expanding the range and quality of developmental screening and assessment conducted by community staff.
    • Aim 3: Optimize a system for routine, timely, and efficient transfer of data collected in the field to the NBCS/ECHO data portal.
  • SARS-CoV-2 stress, infection and immunity: associations with birth outcomes in three ECHO cohorts
    • Aim 1: Study associations of COVID-19 symptomatology, salivary RNA, and SARS-CoV-2 seropositivity with birth outcomes among pregnancies newly enrolled into ECHO.
      • Hypothesis 1. Symptoms consistent with the WHO probable case definition and SARS-CoV-2 seropositivity are associated with shortened gestation, consistent with possible hypercoagulability identified in COVID-19 cases.
    • Aim 2: Examine whether stress (assessed via questionnaire and cortisol measured in hair) modifies associations of COVID-19 case definition, salivary RNA, and SARS-CoV-2 seropositivity with birth.
      • Hypothesis 2. Stress augments effects of SARS-CoV-2 on birth outcomes.

ECHO Researchers Analyze Potential Toxicity of Chemicals, Discover Gaps in Chemical Research

Posted on by Jodi Snare

link to articles byEdo Pellizzari
Edo Pellizzari, PhD, RTI International, ECHO Researcher

In a recent article in Environmental Health Perspectives, ECHO researchers discuss their work on identifying and ranking chemicals that have not been biomonitored nationally but may negatively affect child health. Biomonitoring is a process that detects chemicals that people are exposed to and measures how much of those chemicals get into the body.

To collect information, researchers examined different environmental elements (i.e., food, water, air, house dust) and household products that may contain toxic chemicals. Among other tasks, they put the chemicals into three groups:

  1. Chemicals recommended for biomonitoring
  2. Chemicals that need more information
  3. Chemicals that are a low priority for biomonitoring

Of the identified 720 chemicals, 155 were selected for prioritization, and of these, 36 were recommended for biomonitoring, 108 need additional research, and 11 were considered low priority. The chemicals recommended for biomonitoring add to the list of those currently studied by the ECHO Program. The chemicals that did not meet the three criteria – prevalence in environmental media or biospecimens, toxicity and a biomarker for its measurement – show the gap in current chemical research.

“There is a large opportunity to expand our ability to measure and evaluate chemicals to which the public is likely exposed,” the authors note. “These opportunities include performing exposure measurements, developing methods for biomonitoring, and toxicity testing of chemicals.”

While several thousand chemicals are approved for use in the United States, there is little information on biomonitoring of exposures in pregnant women, babies, and children. This limits the ability to evaluate the potential health impact of a variety of chemicals.

Through this study, the research team hopes others in the science community will be encouraged to study the identified chemicals and improve understanding of the potential health consequences they present in pregnant women, infants, and young kids.

International Journal Highlights ECHO’s Novelty and Necessity in Obesity Research

Posted on by Jodi Snare

A recent article on childhood obesity in the US, published in the International Journal of Obesity, details results from an ECHO study of more than 37,000 babies and kids and describes the unique features that make the ECHO Program exceptionally valuable for obesity research.

The authors note that ECHO “holds promise to provide insight into the mechanisms that promote overweight and obesity in US children and provides rigorous data for novel programs to lessen the burden on individuals, families, and society.”

The study found that overweight and obesity were more common in older children than in younger children and varied with race/ethnicity. About 1 in 10 children age 1 to <2 years had a high BMI, and about 1 in 3 adolescents age 12 to <18 years was overweight or obese. Hispanic and black children had the highest rates of both overweight and obesity.

The results were similar to those from the large National Health and Nutrition Examination Survey (NHANES), pointing to the generalizability of ECHO’s population for further obesity research.

Despite the growing obesity epidemic, few programs provide an accurate insight into the many factors that promote overweight and obesity in children in the United States. However, due to the diversity and size of the ECHO Program’s population, it is well positioned to provide a comprehensive view of the impact of various environmental influences on childhood obesity.

“ECHO has assembled a large racially/ethnically diverse US cohort poised to provide much-needed answers to important questions regarding the early life determinants of childhood obesity risk,” the article states.

Because of the program’s size, it will have the statistical power to answer questions about environmental and preventable causes of childhood obesity even for less common exposures. Through the collection of existing and forthcoming data, ECHO also has the ability to examine genetic modifications and unravel the complexity of gene-environment interactions as contributors to obesity.

Find more information on ECHO research at echochildren.org/about.

ECHO Researchers Identify Gaps in Prenatal Opioid Exposure Research

Posted on by Jodi Snare

Elisabeth Conradt, PhD

This week, Pediatrics published results from ECHO researcher Elisabeth Conradt and her team’s efforts to learn more about prenatal opioid exposure and its effects on child development. Conradt and her team reviewed 52 publications to summarize what is known and make suggestions on how to expand knowledge in this area. The resulting article includes perspectives on how the ECHO Program can help learn more about this important topic.

“The number one question mothers, fathers, and clinicians have when they see that a mother is using opioids while pregnant is ‘how will this opioid exposure affect the child’s health?’ We cannot answer that question right now with the existing data,” Conradt said.

The team analyzed existing publications on three age groups: birth, infancy, and 2 years and older. Because of inconsistent and limited data, Condradt’s team was not able to understand a connection between prenatal opioid exposure and how children’s minds develop throughout life. However, they predict that the effects of the exposure at birth and infancy are small and subtle, but may increase as children age and have more demands on their attention at home and school.

Current studies were limited because of small sample sizes and difficulty controlling for confounding factors such as where a person lives or how much money their family makes.

Moving forward, the team will use ECHO data to test how prenatal opioid exposure affects learning, understanding, behavior, and attention span in middle childhood. They will also consider other possible factors such as poverty. Conradt noted that the team will also look at whether newborns who have neonatal opioid withdrawal syndrome (NOWS) have worse effects compared with newborns exposed to opioids who do not have NAS/NOWS.

Read the study summary and full media release.

ECHO Program Activates First Sites under the ECHO-wide Cohort Data Collection Protocol

Posted on by Jodi Snare

PASS Cohort Group Picture

The Environmental influences on Child Health Outcomes (ECHO) Program announced today that it has activated its first sites to begin data collection under the ECHO-wide Cohort Data Collection Protocol. Congratulations to the Safe Passage Study (PASS) Cohort, led by Principal Investigator Amy Elliott, sites at Avera Health – Rapid City and Avera Health – Sioux Falls.

“This site activation marks the beginning of ECHO’s next chapter, allowing us to begin collecting data that will enhance the health of children for generations to come,” said ECHO Program Director Matthew Gillman, NIH. “ECHO is uniquely positioned, through an innovative study design, to answer transdisciplinary research questions that have not been explored in observational research to date.”

The ECHO cohorts seek to improve the health of children and adolescents by conducting observational research that will inform high-impact programs, policies, and practices across the United States. ECHO uses information from existing longitudinal research projects (cohorts) that will include more than 50,000 children from diverse backgrounds across the United States. Together, these cohorts follow participants from before they are born, through childhood and adolescence.

The studies focus on five key pediatric outcomes that have a high public health impact:

  • Pre-, peri-, and postnatal
  • Upper and lower airways
  • Obesity
  • Neurodevelopment
  • Positive Health

To learn more about the ECHO Program, visit our About ECHO Page.

New ECHO-funded Research Shows Chronic Illnesses in Children Do Not Necessarily Lead to Dissatisfaction

Posted on by Jodi Snare

The ECHO researchers’ findings suggest that children with chronic illnesses are just as happy as their peers who do not have chronic illnesses.

The May 2019 issue of Pediatrics published findings from a recent study by ECHO researchers Courtney Blackwell, Amy Elliott, Jody Ganiban, Julie Herbstman, Kelly Hunt, Chris Forrest, and Carlos Camargo. The publication, titled “General Health and Life Satisfaction in Children With Chronic Illness,” focuses on children’s general health and life satisfaction in the context of chronic illness.

The study found that while children with chronic illnesses have worse health overall, their life satisfaction was comparable with that of their peers without chronic illnesses, suggesting that children with chronic illnesses may still lead happy lives.

As reported by the American Academy of Pediatrics, the authors noted, “the current study suggests that having a chronic illness is certainly a health challenge (evidenced by lower parent-reported general health) but does not preclude these children from having happy and satisfying lives that are comparable with those of peers without illness.”

This multi-cohort study evaluated results from questionnaires completed by 1113 caregivers completed on behalf of 1253 children aged 5-9 years with illnesses such as asthma, attention deficit hyperactivity disorder (ADHD), and digestive disorders. The study used the Patient-Reported Outcomes Measurement Information System Parent-Proxy measures for Global Health and Life Satisfaction.

Consistent with one of the primary goals of ECHO to leverage existing cohorts through harmonization of extant data and standardization of newly collected data, this study evaluated data from existing cohorts associated with the ECHO Program, with a specific focus on ECHO’s Positive Health outcome area.

“Overall, this work highlights clinical opportunities to broaden the perspective of health beyond the absence of disease to one in which all children, regardless of illness or impairment, can have well-being,” the authors said.

Read the full article to learn more.

Related links:

Link to AAP story

NIH, ECHO, and the Navajo Nation Make History with New Data-Sharing and Use Agreement

Posted on by Jodi Snare

This landmark agreement enables the Navajo Birth Cohort Study (NBCS) to continue as part of the ECHO Program.

A Mother’s Love. Mallery Quetawki (Zuni Pueblo). University of New Mexico College of Pharmacy-Community Environmental Health Program

May 8, 2019

The National Institutes of Health (NIH) facilitated a data-sharing and use agreement between the Navajo Nation and NIH grantees of the Environmental influences on Child Health Outcomes (ECHO) Program at the Navajo Nation Head Start Center in Leupp, Arizona. This agreement, signed by the Navajo Nation, Johns Hopkins University, and RTI International, enables the Navajo Birth Cohort Study to continue participating in the ECHO Program while maintaining respect for Navajo Nation cultural beliefs, Tribal sovereignty, and community values. Additionally, the agreement serves as the first Tribal data-sharing agreement for a nationwide research consortium creating a large-scale database.

“Through this agreement I am confident that data sharing will benefit our Navajo people and allow us to further understand the relationship between uranium exposure, birth effects and childhood development,” said Navajo Nation President Jonathan Nez. “I am optimistic that through this partnership, the Navajo Birth Cohort Study will continue to progress and clarify the environmental impacts on our children’s health.”

The landmark agreement is the culmination of two years of discussion facilitated by NIH, and lays the groundwork for discussions with other Tribal Nations considering participation in biomedical research programs. Most importantly, the study is poised to benefit Navajo mothers and children as well as mothers and children everywhere. More information about the agreement can be found in the NIH news release here.