ECHO Program’s Response to COVID-19

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

As the novel coronavirus epidemic continues to affect our global and national communities, ECHO is committed to protecting the health and safety of its staff and participants while advancing our 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 are, at least temporarily, limiting activities to those that they can do at a distance.

In response, ECHO Program researchers are working together to use innovative approaches to keep research going during and after the current limits on in-person interactions.

Many ECHO cohorts are moving toward collecting data from a distance. Fortunately, the ECHO-wide Cohort protocol includes data, such as online, mail and phone surveys, as well as sample collection by mail, that cohorts can collect remotely.  Ongoing ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN) clinical trials, while currently paused, are also considering remote options for consent, data gathering, and interventions themselves.

In these ways, ECHO is responding to the ongoing pandemic by introducing new ways of conducting research, some of which may very well continue once the pandemic is under better control.

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 two COVID-19 task forces, one for ECHO Cohorts and one for ECHO ISPCTN

The cohort task force is co-chaired by ECHO investigators Tracy Bastain, PhD, and Carrie Breton, PhD, and made up of 23 ECHO study investigators and representatives from the National Institutes of Health (NIH). This task force quickly created questionnaires to study effects on health outcomes of being infected, as well as the psychological, social, and behavioral aspects of living during the time of the pandemic. This task force created several versions of the questionnaires, for adult caregivers, pregnant women, and teens. To view these questionnaires and learn more about how the task force developed them , please visit the NIH website.

The ISPCTN task force, chaired by Paul Palumbo, MD, includes 8 members with a range of expertise that includes pediatric infectious diseases, perinatal transmission of disease, and vaccine delivery. The goal of the ISPCTN task force is to identify specific COVID-19-related content areas for which the Network could develop and implement intervention trials.

ECHO’s next steps during COVID-19

As the pandemic continues to evolve, The ECHO Program Office is closely monitoring its many aspects. We will continue to prioritize the needs of our staff and participants while exploring opportunities for innovation in research practices and in ECHO science. Thank you for your continued support of the ECHO Program.

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

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

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

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.

ECHO Leaders Spotlight Child Health Research at Pediatric Academic Societies Annual Meeting

ECHO will have a strong presence at the 2019 Pediatric Academic Societies (PAS) Annual Meeting in Baltimore, MD.

The ECHO Program will spotlight its advancement of child health research through three special ECHO-wide sessions at this year’s PAS Meeting in Baltimore, MD. These sessions are in addition to numerous abstracts that ECHO investigators are presenting in oral or poster sessions. You may find a list of all presentations by ECHO investigators here.

In the 3 special sessions, NIH Program Director Matt Gillman and several ECHO Investigators will present various perspectives on ECHO science, both from ECHO’s Cohorts and its IDeA States Pediatric Clinical Trials Network.  One is a state-of-the-art plenary session devoted to outlining the goals and early findings of the ECHO Program.

“The mission of ECHO to enhance the health of children for generations to come will resonate with the PAS community,” said Gillman. “We are looking forward to sharing our early findings with the larger pediatrics community. We hope that these presentations will generate excitement around ECHO as we forge the next steps of the Program, both on the observational side, where we are building the ECHO-wide Cohort of more than 50,000 children, and on the intervention side, where the IDeA States Network is providing access for children from rural and underserved backgrounds to participate in state-of-the-art clinical trials.”

Descriptions of each ECHO-related special session:

Precision Pediatrics: The Promise of Integrating Advanced Science and Technology with Prospective Birth Cohort Studies

Saturday, April 27th, 2:45 PM – 4:15 PM, Convention Center 301-302

This 90-minute session will focus on the impact that population-based cohort studies can have on advancing knowledge in child health. The session will feature overviews of the NIH All of Us Program, the Boston Birth Cohort Study, and the ECHO Program. Dr. Gillman will present an overview of ECHO, titled Environmental Influences on Child Health Outcomes: Leveraging Multiple Cohort Studies.

Applying Team Science to Building Research Collaboratives

Saturday, April 27th, 3:00 – 6:00 PM, Convention Center 313

This 3-hour workshop will focus on empowering residents, fellows, faculty, program directors, and departmental leadership with the tools to successfully build research collaboratives through team science. IDeA States Pediatric Clinical Trials Network PI Jessica Snowden will introduce and close the workshop as one of the session chairs.

The NIH Environmental Influences on Child Health Outcomes (ECHO) Program: Goals and Early Findings

Tuesday, April 30th, 9:45 AM – 11:45 AM, Convention Center 316

This 2-hour State of the Art Plenary session will focus solely on the ECHO Program, featuring an introduction by Dr. Gillman. ECHO PIs Drs. Nigel Paneth and Robert Wright will moderate the session, and three ECHO investigators will present current findings from their ECHO-funded projects. Presentations within this session include:

  • Leslie Young MD, FAAP, University of Vermont, will describe how ECHO addresses the Neonatal Opioid Abstinence Syndrome
  • Anne Dunlop MD, MPH, Emory University, will present a paper entitled: Geographic and Temporal Variation in the Effects of Socio-demographic Factors on Risk of Preterm Birth in the US.
  • Aruna Chandran MD, MPH, FAAP, Johns Hopkins University, will present a paper entitled: Epidemiology of Incident Asthma in Children across the US: Unique insights from the ECHO multi-cohort consortium.

In preparation for these talks, we sat down with a few ECHO presenters to learn more about what they planned to cover. Watch our videos below.


The ECHO Program looks forward to sharing its learnings with PAS attendees at this year’s meeting. To learn more about PAS presentations, or to add these presentations to your PAS schedule, visit the PAS website here.

ECHO Program Receives Green Light to Begin Expansive Child Health Research

Single institutional review board approves the NIH’s ECHO cohort research to proceed, which promises answers to high-impact research questions related to early influences on child health outcomes.

February 1, 2019

The Environmental influences on Child Health Outcomes (ECHO) Program today announced it has received single institutional review board (sIRB) approval to begin its research under the ECHO-wide Cohort Data Collection Protocol. The purpose of the sIRB is to ensure that research follows guidelines to protect participants. ECHO research will investigate the effects of a broad range of early exposures—including physical, chemical, biological, social, behavioral, natural, and built environments—on child health and development.

“The sIRB approval of the ECHO-wide Cohort Data Collection Protocol gives us the green light to start finding answers to important questions that will enhance the health of children for generations to come,” said ECHO Program Director Matthew Gillman. “We know that a child’s exposures from before birth through the first few years of life are tremendously formative, and yet, until now, child health research in this area has been limited, leaving us with lots of questions. We look forward to turning that tide.”

The ECHO-wide Cohort is made up of more than 70 individual cohorts, or groups, of mothers and children from ongoing research projects. Researchers follow participants through different life stages, some starting before birth and through adolescence. Together, they form a massive virtual “cohort of cohorts” that includes more than 50,000 children from diverse backgrounds across the United States. By bringing together data collected under a single protocol, ECHO researchers can answer high-impact, complex research questions.

Looking at the whole child

ECHO’s promise is not only in its breadth of data, but also its approach, which brings together multiple disciplines to address child health. Historically, many research projects have looked at children through a single, narrow lens. However, the body’s development process includes millions of interacting factors that all play a part in a child’s overall health. Researchers from 44 states, Puerto Rico, and the District of Columbia are involved in the ECHO-wide Cohort Data Collection Protocol. These researchers bring expertise from hundreds of disciplines. As a result, knowledge from ECHO research can offer a richer understanding of child health and development to help guide a healthier, happier childhood for our nation’s children.

Emily Oken, of Harvard University and the principal investigator for an ECHO Pediatric Cohort Award, and David Cella, of Northwestern University and one of the principal investigators for the ECHO Person-Reported Outcomes Core, led the trans-disciplinary development of the ECHO-wide Cohort Data Collection Protocol. They worked collaboratively with all ECHO components and gathered input through a public comment period. The research will include participants that are often excluded from traditional research, such as pregnant women, children, and caregivers. ECHO’s researchers hope that this wide view of the child will shed light on important patterns and trends in child health that have not been captured to date.

“It was a Herculean effort to develop a protocol of this scale with so many interacting variables,” said Gillman. “Through collaboration and a shared passion to enhance the health of all children, we are now positioned to begin this important work. Our team is energized and ready to go, and our nation’s children are waiting.”

ECHO-funded study sheds light on second- and third-hand smoke exposure in kids

A recent study funded by the ECHO Program, National Institute of Child Health and Human Development (NICHD), and National Institute on Drug Abuse, shows that infants and toddlers in low-income, rural areas may be at higher risk for second- and third-hand smoke than previously reported in the National Health and Nutrition Examination Survey. Findings were dependent on the detectable presence of cotinine – the byproduct formed when the body breaks down nicotine – in the children’s systems.

Based on an analysis of saliva samples collected from 1,218 children, 15 percent were in the high exposure group when tested for cotinine, demonstrating levels that are comparable to active adult smokers. Forty-eight percent of the children classified as moderate exposure and 37 percent fell in the low exposure group.

Other key findings from the study include lower smoke exposure for children in center-based daycare facilities and higher smoke exposure for infants, compared with toddlers. This is partially attributed to crawling and infants’ tendencies to put objects into their mouths. Additionally, according to the study, “lower income, less education, frequent residential moves and fluctuations in the number of adults within the home were associated with high smoke exposure.”

“Our results, if supported by future studies, can help educate parents and caregivers, as well as improve prevention programs that seek to reduce children’s smoke exposure,” said Clancy Blair, Ph.D., M.P.H., a professor at New York University’s Steinhardt School of Culture, Education and Human Development, and the senior author of the study.

The study was published in Nicotine & Tobacco Research December 5, 2018.


Research Review: Intergenerational transmission of disadvantage: epigenetics and parents’ childhoods as the first exposure

Scorza P, Duarte CS, Hipwell AE, Posner J, Ortin A, Canino G, Monk C.

Show Details

Scorza P, Duarte CS, Hipwell AE, Posner J, Ortin A, Canino G, Monk C. J Child Psychol Psychiatry. 2018 Feb 23. doi: 10.1111/jcpp.12877. [Epub ahead of print]. PubMed PMID: 29473646

Topics: Epigenetics


Advancing the Science of Children’s Positive Health in the National Institutes of Health Environmental Influences on Child Health Outcomes (ECHO) Research Program

Forrest C, Blackwell C, Camargo CA Jr.

Show Details

Forrest C, Blackwell C, Camargo CA Jr. J Pediatr. 2018 May;196:298-300. doi: 10.1016/j.jpeds.2018.02.004. Epub 2018 Mar 19. PubMed PMID: 29567045

Topics: Positive Health

‘Current Opinion in Pediatrics’ Publishes Seven Manuscripts from ECHO Program

The April 2018 issue of Current Opinion in Pediatrics features seven manuscripts authored by and about the Environmental influences on Child Health Outcomes (ECHO) research program, supported by the National Institutes of Health. Readers can find each of the manuscripts, one from each active ECHO Program Component, in the journal’s “Therapeutics and Toxicology” section. Together, they offer readers a glimpse into ECHO’s mission and progress from diverse vantage points.

Current Opinion in Pediatrics gives us a forum to showcase how each of ECHO’s Components is working collectively toward the ECHO mission to enhance the health of children for generations to come,” said Matthew Gillman, ECHO program director, National Institutes of Health. “We developed ECHO on the premise that the whole is greater than the sum of its parts. That premise applies equally to the ECHO Cohorts and the IDeA States Pediatric Clinical Trials Network. Their combined intellectual capital, disciplines, innovation, and analyses will bring us closer to our mission than individual cohorts or clinical trial sites could ever reach alone. I am inspired by the work across all ECHO Components to bring this premise to life.”

Current Opinion in Pediatrics is a great platform for ECHO. As a publication that spans all the subspecialties and primary care, it represents a product that is more than the sum of its parts, just like ECHO,” said Robert Wright, the publication’s editor. “It is critical for the pediatric health care community to learn about ECHO and the exciting work that will one day change the way pediatrics is practiced.”

Readers can access all seven articles electronically in the journal’s April 2018 (volume 30, issue 2) publication or via the links below: