Home Conditions and Outdoor Air Pollution May Together Influence Children’s Asthma Risk, ECHO Study Finds

Authors: Akihiro Shiroshita, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Childhood asthma may be influenced by multiple indoor and outdoor environmental exposures. Prior research has examined indoor and outdoor exposures separately and frequently lacked the power to fully evaluate their cumulative or interacting effects on childhood asthma. The ECHO Cohort allowed researchers to bring together data from many sites across the country, providing a clearer picture of how different environmental factors may influence childhood asthma.

What were the study results?

The study found that several environmental exposures during early childhood were linked to asthma risk. First, exposure to ambient fine particulate air pollution (PM_2.5) was associated with an increased risk of developing asthma. In addition, water damage or dampness in the home was also linked to a higher asthma risk, even after accounting for PM_2.5exposure, indicating an independent effect. In contrast, having a dog in the home during infancy was associated with a reduced risk of childhood asthma.

What was this study's impact?

The study demonstrated the importance of considering multiple early-life exposures together when assessing risk factors for childhood asthma. It highlighted that both indoor (home dampness, pets) and outdoor (PM_2.5) exposures should be considered in prevention strategies.

Who was involved?

Participants included 6,413 children born between 1987 and 2016, enrolled in nine ECHO Study Sites across the United States. These sites included both general-risk and high-risk populations at higher risk, defined by a parental history of asthma or allergy.

What happened during the study?

The study looked at children’s early-life environments to understand how they relate to asthma risk. Researchers examined levels of outdoor air pollution during the first three years of life, along with conditions inside the home, such as water damage or dampness, whether dogs or cats were present during infancy, and exposure to dust mites. Childhood asthma was identified based on reports from caregivers or a doctor’s diagnosis between birth and age five. The analysis considered differences in family and neighborhood factors that could also affect asthma risk, helping to isolate the role of these environmental exposures.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Additional studies examining how indoor and outdoor exposures interact could help researchers better understand their role in childhood asthma risk. Future research could also explore ways to reduce or prevent harmful exposures in early life.

Where can I learn more?

Access the full journal article, titled “Individual and combined effects of indoor home exposures and ambient PM_2.5during early life on childhood asthma in US birth cohort studies,” in Environmental Epidemiology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published December 23, 2025

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Home Conditions and Outdoor Air Pollution May Together Influence Children’s Asthma Risk, ECHO Study Finds

Children in High Gun Violence Areas Less Likely to Report Excellent Health, ECHO Study Finds

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Children in High Gun Violence Areas Less Likely to Report Excellent Health, ECHO Study Finds

Authors: Aruna Chandran, Emily Knapp, Nandita Somayaji, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Gun violence has been the leading cause of death in children and teens in the United States since 2021. In addition to fatalities, exposure to gun violence in communities has been linked to adverse mental health outcomes in children. However, most prior studies have focused on mental health effects in older children and have not fully examined developmental or physical health impacts in younger children. This study aimed to explore the association between neighborhood-level gun violence and the general health status of children nationwide.

What were the study results?

The study found that parents of children living in areas with high levels of gun violence were 20% less likely to report their child’s health as excellent or very good compared with children who had experienced less gun violence, even after accounting for age and neighborhood economic disadvantage. This association was consistent across age groups, with both younger and older children in high gun violence areas less likely to report excellent or very good health. The effect was strongest in children that lived in neighborhoods with high poverty and high gun violence, where they were 23% less likely to be reported as having excellent or very good health.

What was the study's impact?

The findings underscore the importance of community violence prevention efforts and the need to strengthen our understanding of community risk factors such as gun violence that hinder optimal child growth and development.

Who was involved?

The study included 13,450 children from birth to 17 years old from 56 ECHO Cohort Study Sites.

What happened during the study?

Researchers used data from the Gun Violence Archive to identify how much gun violence occurred in different neighborhoods, categorized into low, medium, and high levels. Then they looked at how parents rated their children’s overall health and compared it across neighborhoods. A statistical model was used to measure the link between children’s health and the amount of gun violence in their neighborhood.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Future research following children over time could help researchers better understand how exposure to gun violence affects children's health as they grow. Additional studies could also help researchers separate the impacts of gun violence exposure from other factors and explore how and why this exposure influences children’s health.

Where can I learn more?

Access the full journal article, titled “Associations between neighborhood-level gun violence and child general health status An ECHO Cohort analysis,” in Injury.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published November 2025

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Children in High Gun Violence Areas Less Likely to Report Excellent Health, ECHO Study Finds

ECHO Study Observes Health Disparities in Air Pollution-associated Risk of Childhood Asthma

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ECHO Study Observes Health Disparities in Air Pollution-associated Risk of Childhood Asthma

Authors: Veronica A. Wang, Rima Habre, Diane R. Gold, Antonella Zanobetti, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Asthma is one of the most common chronic childhood diseases in the United States, affecting over 4.5 million children. Although air pollution levels have decreased over the past decades, individuals living in certain areas have seen lower reductions in air pollution and may also be more vulnerable to its effects. For this study, researchers examined sociodemographic disparities in the association between air pollution and incident childhood asthma until age 10.

What were the study results?

The study found that higher exposures to fine particulate matter, nitrogen dioxide, and ground ozone were associated with a higher incidence of asthma in the first 10 years of a child’s life. For fine particulate matter and nitrogen dioxide, children from areas with a higher proportion of Black residents or higher population density were identified being at a higher risk for air pollution-associated asthma.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study showed that sociodemographic disparities in air pollution-associated asthma persist despite reductions in the overall air pollution levels. The study highlighted the potential to mitigate childhood asthma risk by reducing air pollution and addressing the root causes of these disparities.

Who was involved?

The study involved over 23,000 children, born between 1981-2021, from 34 sites in the Environmental influences on Child Health Outcomes (ECHO) Program with data on asthma diagnosis until age 10 in the contiguous US.

What happened during the study?

During the study, the study team collected data on each participant’s asthma status, month of diagnosis, and length of their follow-up. They also collected sociodemographic data that included sex, race/ethnicity, maternal education, and more. Lastly, they used area-level data from the 1980-2019 Census Bureau and the American Community Survey on the percent of low-income residents, Black residents, residents with less than a high school education, unemployed residents, and female residents, and overall population density. The study team then analyzed this data, first examining the association between air pollution exposures (fine particulate matter, nitrogen dioxide, and ground ozone) and childhood asthma, then determining whether the sociodemographic and economic variables modified the air pollution-asthma association.

What happens next?

Future studies could help researchers better understand the root causes of susceptibility to air pollution. Additional studies with longer follow-up could also help researchers understand how asthma risk may change throughout childhood as the climate and environmental conditions change. Lastly, additional studies may help researchers understand how personal exposures affect asthma in children, including indoor sources of air pollution.

Where can I learn more?

Access the full journal article, titled “Disparities in the Association of Ambient Air Pollution with Childhood Asthma Incidence in the ECHO Consortium: a US-wide Multi-cohort Study,” in Environmental Epidemiology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 2025

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ECHO Study Observes Health Disparities in Air Pollution-associated Risk of Childhood Asthma

Children Born in Lower-Opportunity Neighborhoods Had Higher Rates of Asthma with Recurrent Exacerbations

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Children Born in Lower-Opportunity Neighborhoods Had Higher Rates of Asthma with Recurrent Exacerbations

Authors: Rachel Miller, Christine C. Johnson, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health supported this research.

Why was this study needed?

Neighborhood conditions—such as access to housing, healthy food, transportation, and education—can influence the development of childhood asthma. Researchers often use the Child Opportunity Index (COI) to measure these conditions, linking residential addresses at different stages of early life to data about the resources available in the surrounding neighborhood. This index looks at various aspects of a neighborhood to see how they might affect children's chances of success and health. It combines information from 29 indicators, such as access to good schools, healthy food, parks, clean air, and job opportunities. Studies have shown that neighborhoods with higher COI scores tend to have better conditions that help children grow up healthier and have more opportunities for economic success. So, the higher the COI score, the better the neighborhood is believed to be for children's development and future prospects. Previous research suggests that these factors can all play a role in shaping different types of childhood asthma. This ECHO study was needed to explore how conditions before and at the time of birth can affect children’s rates of asthma with recurrent exacerbations (ARE)—a type of asthma where children experience frequent, severe episodes of asthma.

What were the study results?

The study found that children born in neighborhoods with low community opportunity, when measured at birth and as measured by the COI, had a much higher incidence rate of asthma with recurrent exacerbations compared to those from other neighborhoods. Non-Hispanic Black children had significantly higher rates than non-Hispanic White children across all neighborhood categories. Among children from very low-opportunity neighborhoods, the rates were several times higher for non-Hispanic Black and Hispanic Black children compared to White children. Even after accounting for individual factors, children from these low-opportunity areas had higher adjusted incidence rates for asthma with recurrent exacerbations, especially those aged 2 to 4 years or those who had a parent with asthma.

What was the study's impact?

Earlier ECHO research found that living in a neighborhood with higher opportunity at birth was associated with lower asthma incidence than living in a neighborhood with lower opportunity. This study highlights the importance of addressing neighborhood-level conditions to help prevent asthma flare-ups in children. It supports the idea that improving conditions in under-resourced areas can positively impact children’s health.

Who was involved?

The study used data from 15,877 children born between 1990 and 2018. These children were from 60 ECHO cohorts across the U.S.

What happened during the study?

In this study, researchers followed children from ages 2 to at least 5, and up to age 19. They collected information on asthma diagnoses and the use of corticosteroids, a medication that helps reduce inflammation in the body. ARE was identified if a child used corticosteroids at least twice while being monitored by ECHO researchers. The study also looked at the connection between the COI and the children's birth addresses, examining how neighborhood conditions influenced the rates of asthma flare-ups while considering individual factors like child race and ethnicity, sex and parental history of asthma.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Additional studies could help researchers further understand the prenatal and early childhood determinants of ARE at both the individual and neighborhood levels.

Where can I learn more?

Access the full journal article, titled “Child Opportunity Index at Birth and Asthma with Recurrent Exacerbations in the U.S. ECHO Program,” in the Journal of Allergy and Clinical Immunology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published March 13, 2025

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Children Born in Lower-Opportunity Neighborhoods Had Higher Rates of Asthma with Recurrent Exacerbations

Executive Functioning May Be Connected to Child Health Behaviors, ECHO Cohort Study Suggests

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Executive Functioning May Be Connected to Child Health Behaviors, ECHO Cohort Study Suggests

Author(s): Nichole Kelly, Derek Kosty, Leslie Leve et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, National Institutes of Health supported this research.

Why was this study needed?

Executive functioning refers to the cognitive processes that relate to a person’s ability to shift attention (cognitive flexibility), control impulsive actions (behavioral inhibition), and remember multiple pieces of information while solving a problem (working memory). Studies with adults suggest that lower executive functioning is related to less engagement in health-promoting behaviors, which increases risk for chronic disease. This study aimed to understand how these three domains of executive functioning relate to health behaviors in different age groups (early childhood, middle childhood, and adolescence). The goal was to inform more specific and developmentally tailored intervention strategies that target executive functioning to improve health behaviors and ultimately reduce chronic disease risk in children.

What were the study results?

Across all age groups, children with higher working memory also had more health-promoting eating behaviors, such as less frequent intake of sugary drinks and saturated fats. In middle childhood, children who showed more cognitive flexibility and behavioral inhibition also ate more fruits and vegetables and engaged in more physical activity. In adolescence, children with higher scores in all three executive function domains reported more engagement in physical activity. Researchers did not find significant connection between child sleep and executive functioning in this study.

What was the study's impact?

The results of this study can help researchers and clinicians plan better interventions that target children’s executive functioning to improve their health behaviors and, ultimately, their risk for chronic disease. For example, the results of this study suggest that early intervention targeting children’s working memory may help improve their dietary behaviors throughout childhood. However, associations with executive functioning observed in this study were small, so other interventions may be needed to support families in developing health-promoting behaviors. Additionally, because this study looked at this association at only one point in time for each child, it isn’t clear whether executive functioning influences health behaviors or vice versa.

Who was involved?

The study included children and their parents/caregivers from 38 ECHO Cohort Study Sites across 78 locations in the U.S. and Puerto Rico. Children from three life stages participated in the study: 2,074 in early childhood (age 5–8 years), 3,230 in middle childhood (age 8–12 years), and 1,416 in adolescence (age 12–18 years).

What happened during the study?

During the study, participating children completed computer tasks to measure their executive functioning. Participants also shared details about their diet, physical activity, and sleep through parent- and/or child-reported questionnaires. Additionally, information on income, positive parenting, neighborhood crime, and greenspace was collected.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

To continue identifying the best health intervention strategies, researchers could continue to explore how executive functioning relates to health behaviors by collecting data on how these effects change over time.

Where can I learn more?

Access the full journal article, titled “Children’s executive functioning and health behaviors across pediatric life stages and ecological contexts,” in the Journal of Behavioral Medicine.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published January 9, 2025

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Executive Functioning May Be Connected to Child Health Behaviors, ECHO Cohort Study Suggests

ECHO Study Investigates Pollution Exposure and Birth Outcomes in Pregnant Women Living in Historically Redlined Neighborhoods

Authors: Teresa Herrera, Akhgar Ghassabian, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Exposure to tiny air pollutants known as PM2.5 during pregnancy can lead to outcomes like low birth weight and preterm birth. Factors such as weather, government policies, and social conditions can affect how much exposure pregnant women have to these pollutants. One factor that may have affected exposure is redlining, the historical practice of designating certain neighborhoods, often where minority groups lived, as risky investments for lenders. This grading system ranked neighborhoods on an A through D scale—A being the most desirable—which often led to disinvestment and lack of resources in lower-rated areas. While redlining was made illegal following the 1968 Fair Housing Act, it continues to affect the health outcomes of people living in historically redlined areas.

ECHO researchers wanted to learn whether living in historically redlined areas during pregnancy affects air pollution exposure and birth outcomes in New York City (NYC). Understanding what influences PM2.5 levels and their impact on birth outcomes can help improve the health of mothers and their children.

What were the study results?

The study found that living in lower-graded or ungraded census tracts during pregnancy was associated with higher exposure to PM2.5. These women also tended to have babies with lower birth weights. This association was strong even when considering factors such as race, ethnicity, and income at individual and community levels.

What was this study's impact?

The study supports the literature linking redlining to contemporary outcomes. This study highlights the multifaceted nature of structural racism. Findings from non-graded areas indicate that there are likely additional factors, along with redlining, that play a role in perpetuating modern-day inequality.

Who was involved?

The participants were 3,160 pregnant mothers and their babies in the NYC metropolitan area who were enrolled in six ECHO Cohort research sites. The study included pregnant mothers from 2005 to 2022 who had air pollution estimates available for their residential address. Most participants who identified as Black or White lived in neighborhoods that had been given a D grade, the lowest rating. Most participants who identified as Hispanic lived in neighborhoods with B or C grades.

What happened during the study?

Researchers used statistical methods to explore whether living in neighborhoods that were historically redlined was associated with higher exposure to air pollution (PM2.5) during pregnancy. They also examined if living in these neighborhoods was associated with the baby's birth weight, the likelihood of being born early, and the chances of having a low birth weight.

Note: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

The authors note that future research could look at other practices like racial exclusionary zoning to fully understand the ongoing systemic effects of redlining.

Where can I learn more?

Access the full journal article, titled “Redlining in New York City: Impacts on Particulate Matter Exposure During Pregnancy and Birth Outcomes,” in Journal of Epidemiology and Community Health.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published September 5, 2024

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ECHO Study Investigates Pollution Exposure and Birth Outcomes in Pregnant Women Living in Historically Redlined Neighborhoods

Fish But Not Supplements Consumed in Pregnancy Associated With Lower Rates of Autism Diagnosis And Related Traits, ECHO Cohort Study Finds

Authors: Emily Oken, Kristen Lyall, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Fish consumption during pregnancy provides an important source of omega-3 fatty acids, an essential nutrient for supporting child health and neurodevelopment. However, in the U.S., people who are pregnant or can become pregnant are not eating enough fish or get enough omega-3 fatty acids through diet or supplements. Few studies have explored prenatal fish consumption and supplement use in association with autism spectrum disorder (ASD) diagnosis or autism-related traits. This study aims to investigate the relationship between fish consumption or omega-3 supplement use and an ASD diagnosis or the presence of autism-related traits.

What were the study results?

Fish consumption during pregnancy was associated with a 20% lower likelihood of ASD diagnosis and fewer autism-related traits in offspring. The associations were somewhat stronger for female offspring. Taking fish oil supplements containing omega-3 fatty acids during pregnancy was not associated with an ASD diagnosis or autism-related traits. However, supplement use was associated with a slight increase in scores on the Social Responsiveness Scale (SRS), a widely used survey completed by parents or caregivers to report on their child’s possible autism-related traits.

What was the study's impact?

These findings are consistent with current dietary guidelines that support fish intake during pregnancy and support continued public health efforts to encourage fish intake.

Who was involved?

The participants were children born between 1999 and 2019 and their parents at three of the Environmental influences on Child Health Outcomes (ECHO) Cohort research sites. The sites selected from samples considered a higher likelihood for autism, either due to family history or preterm birth.

What happened during the study?

The researchers studied the relationship between maternal fish intake and omega-3/fish oil supplement use during pregnancy and the occurrence of clinician-diagnosed autism and parent-reported autism-related traits. These traits were measured using the Social Responsiveness Scale (SRS), a widely used survey completed by parents or caregivers. Fish consumption and supplement use were assessed based on self-reported dietary information from participants.

Note: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Future research could examine how chemical contaminants found in some fish could potentially influence child health and development. Additional studies could look at the relationship between self-reported data on fish consumption and supplement use during pregnancy, biological markers of fish consumption, and child health outcomes. Combining biological data and self-reported data could provide a more complete picture of the overall benefits of fish consumption during pregnancy.

Where can I learn more?

Access the full journal article titled “Association of Maternal Fish Consumption and Omega-3 Supplement Use During Pregnancy with Child Autism-Related Outcomes: Results from a Cohort Consortium Analysis” in the American Journal of Clinical Nutrition.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published September 2024

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Fish But Not Supplements Consumed in Pregnancy Associated With Lower Rates of Autism Diagnosis And Related Traits, ECHO Cohort Study Finds

Eating Fish But Not Omega-3 Supplements During Pregnancy Associated With Lower Likelihood Of Autism Diagnosis, NIH-Funded Study Finds

Posted on September 3, 2024August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

Eating any amount of fish during pregnancy was associated with about a 20% lower likelihood of autism spectrum disorder (ASD) diagnosis, particularly in females, and a slight reduction in autism-related traits in offspring, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

However, researchers did not find the same association with supplements containing omega-3 fatty acids.

Fish is an important source of omega-3 fatty acids, an essential nutrient during pregnancy for supporting maternal health and child neurodevelopment. A recent analysis of ECHO Cohort data revealed that about 25% of the pregnant participants reported never eating fish or consuming it less than once a month during their pregnancy. Even fewer participants reported taking omega-3 fish oil supplements.

ECHO Cohort researchers wanted to see whether low fish consumption and omega-3 supplement use during pregnancy might be associated with the occurrence of an autism diagnosis or parent-reported autism-related traits.

“Our study contributes to a growing body of evidence that demonstrates the role that prenatal diet can play in autism-related outcomes in offspring,” said ECHO Cohort researcher Emily Oken, MD, MPH, of Harvard Medical School.

Dr. Oken said the findings underscored the need for better public health messaging about guidelines for fish consumption for pregnant women, considering the low fish intake in the U.S. and the rising diagnoses of autism.

What happened during the study?

Researchers analyzed data from about 4,000 participants, examining the relationships among fish intake, supplement use, and neurodevelopmental outcomes related to autism.

Fish consumption and omega-3 supplement use were measured with dietary information reported by participants. Participants’ fish consumption was categorized as less than once a month, more than once a month but less than weekly, weekly, and two or more servings per week. About 20% of adult participants reported no fish intake, and most reported not using omega-3 or fish oil supplements.

The researchers then looked at the relationship between maternal fish intake and omega-3 fish oil supplement use during pregnancy and the occurrence of clinician-diagnosed autism and parent-reported autism-related traits. These traits were measured using the Social Responsiveness Scale (SRS), a widely used survey completed by parents or caregivers. Higher scores on the SRS indicate the presence of more autism-related behaviors.

Consuming fish during pregnancy was associated with a lower likelihood of offspring being diagnosed with autism and a slight decrease in total SRS scores compared to not eating fish. These results were consistent across all levels of fish consumption, from "any" amount or "less than once per week" to "more than twice per week." No significant associations were found between omega-3 fish oil supplements and autism diagnosis compared to no use.

Experts recommend that people consume additional omega-3 fatty acids during pregnancy. Prenatal fish intake is a key source of omega-3 fatty acids that are critical for fetal brain development. However, fish and omega-3 fatty acid supplementation in the U.S. is low.

“This study provides yet more evidence for the safety and benefit of regular fish consumption during pregnancy,” said Dr. Oken. “Other proven benefits include lower risk for preterm birth and improved cognitive development.”

Dr. Oken led this collaborative research published in the American Journal of Clinical Nutrition.

Oken, E. & Lyall, K. (2024) Association of maternal fish consumption and ω-3 supplement use during pregnancy with child autism-related outcomes: results from a cohort consortium analysis. American Journal of Clinical Nutrition. 10.1016/j.ajcnut.2024.06.013

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About ECHO: Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

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ECHO Study Suggests Living Near Green Space Is Associated with Lower Anxiety and Depression in Preschool-Age Kids

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ECHO Study Suggests Living Near Green Space Is Associated with Lower Anxiety and Depression in Preschool-Age Kids

Authors: Nissa Towe-Goodman

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

While previous research has suggested that access to nature is important for mental health, there are a limited number of studies that have examined these effects on young children. ECHO investigators addressed this research gap by looking at whether exposure to green space was associated with internalizing symptoms (e.g., anxiety, depression) and externalizing symptoms (e.g., aggression, rule-breaking) among children.

What were the study results?

The ECHO researchers found that higher levels of green spaces, up to three-fourths of a mile from a child’s home, were linked with lower symptoms of anxiety and depression from ages 2 to 5. Although green space was also linked with symptoms of aggression and rule-breaking in early childhood, this association was reduced after accounting for factors such as poverty levels, unemployment, and housing costs. Researchers found no significant association between residential green space and internalizing or externalizing symptoms in middle childhood, ages 6 to 11.

Note: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was this study's impact?

Most research evaluating the effect of green space on health so far has been limited in children and studied one or a few cities at a time. ECHO Program researchers were able to examine data from children in 199 counties across 41 U.S. states, exploring the connection between exposure to green spaces from birth and anxiety, depression, aggression, and other symptoms during early or middle childhood. These findings suggest that green initiatives such as parks, urban forest programs, or protected natural areas may influence early emerging anxiety and depression symptoms.

Who was involved?

The 2,103 children included in the study were born between 2007 and 2013 and ranged in age from 2 to 11, spanning early and middle childhood.

What happened during the study?

Researchers analyzed information from parents who completed the Child Behavior Checklist for their children from ages 2 to 11 and combined this data with the family’s residential address since the child was born and satellite-based imagery of vegetation density around their homes. Green space exposure was measured using the Normalized Difference Vegetation Index (NDVI), a widely used metric for quantifying vegetation density using sensor data. NDVI values range from -1 to 1. High NDVI values (approximately 0.6 to 0.9) represent dense vegetation, such as forests; values approaching 0 represent areas without live vegetation.

What happens next?

Future studies can explore the types of natural areas linked with early mental health and examine the role of green space around schools. Investigating how early exposure to nature influences mental health into adolescence and adulthood could also be an important area to study.

Where can I learn more?

Access the full journal article, titled “Green space and internalizing or externalizing symptoms among children,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published April 10, 2024

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ECHO Study Suggests Living Near Green Space Is Associated with Lower Anxiety and Depression in Preschool-Age Kids

ECHO Study Suggests Placenta Development for Male, Female Infants May Differ

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ECHO Study Suggests Placenta Development for Male, Female Infants May Differ

Authors: Catherine Bulka, Rebecca Fry, et al

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

This study found that gene activity in the placenta might differ based on the infant’s sex, suggesting that the placentas of males and females develop differently. The placenta is an organ formed during pregnancy to nourish the fetus that goes through many changes during the length of the pregnancy to support the development of the infant.

Previous studies have found that a number of changes occur in the genetic make-up of the placental tissue throughout pregnancy. The current study suggests that some of these genetic changes may differ based on whether the baby is male or female. The researchers looked at gestational age (the amount time the baby spent in-utero) to compare placentas among males and female fetuses at different points in time. Among females, the researchers saw modifications in genes related to the immune system. Among males, there was modifications in genes related to the transport of molecules into the placenta.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study identified differences in the location of modifications of placental DNA between male and female infants at different gestational ages. The most prominent differences were linked to genes that play significant roles in immunity, inflammation, and pregnancy complications. These differences seen between male and female infants may be important when looking at sex-specific health and developmental outcomes.

Why was this study needed?

The placenta is crucial for fetal growth and development. No previous study had considered the role of infant sex in placental development, despite accumulating evidence that females and males develop differently in utero.

Who was involved?

This study included 774 infants from 4 ECHO research sites. In total, the study included 355 female and 419 male infants. One of the research sites enrolled infants born at less than 28 weeks, which provided samples from the earliest viable births.

What happened during the study?

Research sites compared the placental tissue of male and female infants to determine associations between gestational age and modifications of placental DNA. Researchers then located the modifications and identified the closest genes, allowing them to analyze the biological significance of the modifications.

What happens next?

Researchers are now using this data to estimate an infant’s “biological” rather than “chronological” gestational age based on the modification of placental DNA. The findings of this study suggest that it may be important to consider the infant’s sex when calculating “biological” gestational age.

Where can I learn more?

Access the full journal article, titled “Sex-based differences in placental DNA methylation profiles related to gestational age: an NIH ECHO meta-analysis,” in Epigenetics.

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Published December 2023

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ECHO Study Suggests Placenta Development for Male, Female Infants May Differ