Announcements

New Publication Highlights ECHO Program’s Contribution to Studying COVID-19 Pandemic’s Effect on Child Health and Well-being

Posted on by Jodi Snare

Frontiers in Pediatrics recently published an article, titled “Opportunities for Understanding the COVID-19 Pandemic and Child Health in the United States: The Environmental influences on Child Health Outcomes (ECHO) Program,” describing the ECHO Program’s unique opportunity to contribute to knowledge about the pandemic’s effects on child health outcomes. The article also provides an overview of ECHO data related to COVID-19, which is now publicly accessible through the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s (NICHD) Data and Specimen Hub (DASH).

Data that ECHO collected during the pandemic can help researchers understand how pandemic-related social and economic disruptions and COVID-19 infection may have affected the health and well-being of children in the United States.

Established in 2016 by the National Institutes of Health (NIH), the ECHO Program focuses 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. By 2019, ECHO research sites had pooled existing data and collected additional data from enrolled children and caregivers.

In April 2020, the program used that unified infrastructure to quickly roll out a novel ECHO COVID-19 questionnaire to capture family experiences during the pandemic. The questionnaire included three versions: caregiver self-report, adolescent self-report, and caregiver report for children 12 years and younger. This original questionnaire aimed to assess COVID-19 infection rates, access to health services, changes in employment, and changes in mental and physical health among children and parents.

As the pandemic evolved, ECHO modified the survey to capture the effects of vaccines and remote schooling. From April 1, 2020, to August 31, 2021, 60 ECHO research sites examined COVID-19-related environmental conditions and health outcomes among 13,725 children and their caregivers. The children ranged in age from early childhood through adolescence and up to age 21.

While continuing to collect data in person, as allowed, the ECHO Program shifted partially to remote data collection methods, including remote collection of biospecimens, online surveys, phone-based questionnaires, and telehealth assessments. The program also expanded to include time-sensitive evaluations of COVID-19 infection rates and pandemic-related mental and social impacts.

ECHO data collected during the pandemic can be used to conduct solution-oriented research to inform the development of programs and policies to support child health during and beyond the COVID-19 pandemic. Indeed, the ECHO Program has already used this data to publish studies describing families’ experiences during the COVID-19 pandemic and the effects the pandemic has had on children’s screen time, sleep habits, behavior, and well-being; infant development; and mothers’ mental health.

This data is now publicly available through the DASH website. ECHO data on DASH includes information collected on a diverse group of more than 41,299 participants across the U.S. and can serve as a resource for the scientific community.

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.”

ECHO Researchers Showcase Child Health Research at 2023 Pediatric Academic Societies Meeting

Posted on by Jodi Snare

Several ECHO researchers are showcasing ECHO research at the Pediatric Academic Societies (PAS) Annual Meeting in Washington D.C. this weekend. The PAS Meeting will take place from April 27-May 1, and will feature presentations, posters, and exhibitions from physicians and researchers sharing the latest advancements in pediatric health. In addition to the in-person events at the Walter E. Washington Convention Center, PAS registrants have access to on-demand, pre-recorded presentations and a bank of e-posters.

ECHO-related Sessions:

Determining Subpopulations of Children with Multiple Chronic Health Outcomes using Unsupervised Clustering
Friday, April 28, 2023, 5:15-7:15 p.m. ET (Poster number 514)
Drew Day, PhD, Seattle Children’s Research Institute

 

 

 

Psychosocial and Neonatal Risk Factors Associated with Behavioral Dysregulation Trajectories from 18 to 72 Months of Age Among ECHO Children
Saturday, April 29, 2023, 3:00-3:15 p.m. ET (Convention Center, 202 B)
Julie Hofheimer, PhD, University of North Carolina at Chapel Hill School of Medicine

 

 

 

The Epigenetic Response of Bronchopulmonary Dysplasia and Antenatal Steroids on the HPA-axis System
Sunday, April 30, 2023, 11:00-11:15 a.m. ET (Convention Center, 208 AB)
Kenyaita Hodge , MPH, Emory University

 

 

 

Eat, Sleep, Console versus Usual Care for Neonatal Opioid Withdrawal Syndrome – ESC-NOW a Cluster Randomized Controlled Trial
Sunday, April 30, 2023, 3:15-3:30 p.m. ET (Convention Center, Ballroom A)
Leslie Young, MD, University of Vermont

 

 

 

Perceived Discrimination and Neurocognitive Development Among Black and White Children: An Analysis from ECHO Cohorts
Sunday, April 30, 2023, 3:30-6:00 p.m. ET (Poster number 662)
Jennifer Porter, MD, University of Louisville

 

 

 

Associations of Non-nutritive Suck (NNS) and Gestational Phenol Exposure in Full-term Infants from Two U.S. Birth Cohorts in the ECHO Program
Sunday, April 30, 2023, 3:30-6:00 p.m. ET (Poster number 616)
Megan Woodbury, PhD, Northeastern University
Emily Zimmerman, PhD, CCC-SLP, Northeastern University

First Public-use Version of ECHO-wide Cohort Data Now Available

Posted on by Jodi Snare

The ECHO Program is excited to announce that de-identified new and extant ECHO data is now available through the Data and Specimen Hub (DASH). DASH is a centralized resource established by the National Institute of Child Health and Human Development (NICHD) that allows researchers to share and access de-identified data from studies via a controlled-access mechanism.

The ECHO-wide Cohort combines 69 cohorts across the U.S. and allows researchers to access information from a large and diverse population of children followed from the prenatal period through adolescence. This first public-use version of ECHO-wide Cohort data covers information collected on 41,299 participants and provides a valuable resource for the scientific community. This momentous step fulfills both a key strategic goal of the ECHO Program and an obligation to U.S. taxpayers for their investment in our research.

Researchers can now request access to these data by creating a DASH account and submitting a Data Request Form. The NICHD DASH Data Access Committee will review the request and provide a response in approximately two to three weeks. Once granted access, researchers will be able to use the data for three years. See the DASH Tutorial for more detailed information on the process.

ECHO Researchers Showcased Child Health Research at Pediatric Academic Societies Annual Meeting

Posted on by Jodi Snare

Updated May 10, 2022

ECHO researchers Michael O’Shea, MD, MPH of the University of North Carolina at Chapel Hill and Elisabeth McGowan, MD of the Woman & Infants Hospital of Rhode Island showcased ECHO research at the Pediatric Academic Societies (PAS) Annual Meeting in Denver, CO. The 5-day PAS Meeting featured presentations, posters, and exhibitions from physicians and researchers sharing the latest advancements in pediatric health. In addition to the in-person events, PAS registrants had access to on-demand, pre-recorded presentations and a bank of e-posters.

ECHO-related Sessions:

Michael O’Shea, MD, MPH

ECHO Program Cohorts of Individuals Born Preterm: Five Year Progress Report
Sunday, April 24, 2022, 10-11:30 AM MT (12-1:30 PM ET)

Dr. O’Shea led a session highlighting the research findings coming out of three ECHO cohorts that have enrolled preterm infants—including the Developmental Impact of NICU Exposure (DINE), Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI), and Extremely Low Gestational Age Newborn (ELGAN) cohorts. The session reviewed some of the key findings that have come out of the wealth of child health data these cohorts have collected over the past 5 years. Dr. O’Shea was joined by Dr. McGowan along with ECHO investigators Judy Aschner, MD, Todd Everson, PhD, Rebecca Fry, PhD, Carmen Marsit, PhD, and Annemarie Stroustrup, MD, MPH.

 

 

Elisabeth McGowan, MD

Evaluating Prenatal and Perinatal Factors Associated with Neurobehavior in Preterm and Full-term Infants
Sunday, April 24, 2022, 9-9:15 AM MT (11-11:15 AM ET)

Dr. McGowan presented on the results of collaborative ECHO research investigating the link between pre- and perinatal factors and infant neurobehavioral outcomes (e.g., reflexes, behavior, signs of stress).

Healthcare Utilization during COVID-19 Pandemic among Children Born Preterm
Sunday, April 24, 2022, 3:30-6 PM MT (5:30-8 PM ET)

Dr. McGowan also presented a poster on collaborative, ECHO-wide research analyzing how the COVID-19 pandemic has affected the healthcare resources utilized by preterm infants.

ECHO Director, Researchers Featured in Article on the Effects of Perinatal Stress on Babies

Posted on by Jodi Snare

ECHO researchers Catherine Monk, PhD and Johnnye Lewis, PhD, as well as Program Director Matt Gillman, MD, were recently featured in an article regarding perinatal stress during the pandemic and its effects on babies. Featured in Undark.org, a non-profit digital magazine that explores the intersection of society and science, the article references previous studies regarding in-utero stress, including Dr. Monk’s 2016 study on stress and the effect of excess cortisol being passed via the placenta to the fetus.

Monk and her team hypothesized that high levels of stress passed on to the fetus would cause changes to the expression of a fetal gene responsible for deactivating, or neutralizing, cortisol in the body. This was the first study to link pregnant women’s stress with changes in placental genes.

In addition to extreme stress during pregnancy, Monk notes that another factor that may affect the fetus is climate change, which “is affecting the air their mothers breathe while they’re pregnant, and it’s going to be affecting their development in so many ways, and the quality of their lives in the future,” Dr. Monk said.

Additionally, the article highlights Dr. Lewis’s efforts as founder and director of the Community Environmental Health Program at University of New Mexico’s College of Pharmacy, as well as her collaborative ECHO work comparing how stressors related to the COVID-19 pandemic may affect mental health and neurodevelopment among Indigenous, Black, and White communities.

“The beauty of ECHO is it lets us compare across several different populations,” Dr. Lewis said. Based on a preliminary review of Lewis’s data, Black and Indigenous communities surveyed reported more pandemic-related stressors in comparison to a rural white community. This may suggest poorer outcomes for these populations due to the complex relationship linking stress to disease, behavioral health, and neurodevelopmental problems.

Regarding the news that stress plays a large role in the development of fetuses and newborns, Gillman stresses the importance of early intervention. “If you can do interventions early when systems and organs are most plastic, then it’s easier,” he said.

Series Highlighting ECHO Program Now Available in Pediatric Research

Posted on by Jodi Snare

Pediatric Research recently published a series of articles highlighting the ECHO Program’s progress. In the introductory article, titled “The NIH ECHO Program: investigating how early environmental influences affect child health,” the NIH Program Office provides a broad overview of the program and its achievements to date. The second and third articles, written by members of the ECHO Coordinating Center (CC) and various ECHO investigators, focus on the program’s construction, challenges overcome during development, and the scientific opportunities that have already resulted from ECHO’s uniquely broad dataset.

The introductory article highlights the origins of the ECHO Program, dating back to September 2016. Authored by members of the NIH Program Office, this article details the breadth of the ECHO Program’s national network of cohorts, which includes 57,000 children and over 1,200 researchers participating through observational and interventional research. This piece also outlines program goals, including ECHO’s commitment “to enable high-impact research evidence that will inform clinical practices, policies, and programs for child health; and establish a national data platform and biorepository for the scientific community.”

Given its size and span, the program faced unique challenges. To tackle these head-on, governing committees facilitated the establishment of several specialized working groups to address challenges and direct the program in pursuing its goals. For example, the purpose of the Team Science Working Group was to “maximize ECHO’s scientific excellence and productivity by fostering team building and collaboration through effective communication.”

Another logistical challenge that ECHO faced from the beginning was the coordination of a dispersed set of established pediatric cohorts and the harmonization of their existing data to create a nationwide standardized dataset. As many of these individual cohorts had their own research focal points and routine sets of measurements, building a consistent dataset required ECHO to develop a unified set of required measurements and standard protocols. From this problem came the Protocol Working Group.

ECHO aims to enhance the health of children and adolescents through research that may help inform healthcare practices, programs, and policies. The third article details program strategies for fostering solution-oriented research that helps accomplish this goal, some of which include promoting ECHO research through publications and Opportunities and Infrastructure Fund (OIF) grants.

In the five years since its inception, the ECHO Program has made great strides in the development of a diverse, nationwide pediatric research framework with the power to inform children’s health policies and practices. Its large, varied population of participants, emphasis on multidisciplinary science, and capacity for pioneering innovative methods and technologies have shaped the program into an unprecedented resource in pediatric research.

“ECHO represents exciting new opportunities for pediatric research,” the third article concludes, “allowing for the investigation of scientific questions related to less common childhood outcomes and increasing inclusiveness of children participating in research in the United States.”

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.

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.