ECHO Study Suggests Eating Processed Foods May Affect How Long Mothers Breastfeed Their Babies

Authors: Emily Zimmerman, 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?

The results from this study suggested that pregnant women who reported eating the most processed food and take-out tended to breastfeed for an average of 16 weeks (4 months), while pregnant women who reported eating the least amount of processed food and take-out breastfed for an average of 41 weeks (10 months).

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 is the first large and diverse cohort study examining the potential link between maternal food quality during pregnancy and breastfeeding duration. The results from this study suggest that pregnant women who eat a lot of processed food or take-out during pregnancy, tend to breastfeed for a shorter period of time.

Why was this study needed?

Breastfeeding promotes positive health outcomes for infants, but few studies have looked at the connection between the quality of mothers’ food during pregnancy and the length of time they breastfed. This study examined the relationship between self-reported food quality and preparation (e.g., organic foods, processed foods, take out) during pregnancy and breastfeeding duration.

Who was involved?

This study included 751 mothers who were at least 18 years old and their infants from 12 ECHO cohorts located across the United States.

What happened during the study?

Mothers reported on their food source and preparation during pregnancy and were placed in one of three groups: high, moderate, or low food source quality. Mothers also reported on their breastfeeding duration. Researchers investigated whether there was a relationship between the mothers’ food quality during pregnancy and the length of time they breastfed.

What happens next?

Future studies are needed to understand the relation between breastfeeding duration and maternal food quality over time. These studies can also provide more specific information on maternal diet, food source, and preparation during pregnancy while considering other important factors, like socioeconomic status, that may affect the types of foods mothers have access too.

Where can I learn more?

Access the full journal article, titled “Association Between Quality of Maternal Prenatal Food Source and Preparation and Breastfeeding Duration in The Environmental influences on Child Health Outcome (ECHO) Program,” in Nutrients.

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

Published November 21, 2022

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ECHO Study Suggests Eating Processed Foods May Affect How Long Mothers Breastfeed Their Babies

ECHO Study Suggests Oxidative Stress Contributes to Mother’s Risk for Preterm Birth

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ECHO Study Suggests Oxidative Stress Contributes to Mother's Risk for Preterm Birth

Authors: Stephanie Eick, Rachel Morello-Frosch, et al.

Who sponsored this study?

Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health (NIH).

What were the study results?

Pregnant participants who had higher levels of oxidative stress biomarkers during pregnancy were more likely to deliver preterm babies. This association was stronger for participants who experienced preterm birth that was sudden and unexpected or occurred prior to 34 weeks.

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 is the largest to date to look at the relationship between oxidative stress and preterm birth.

The study included a large group of racially, ethnically, and demographically diverse pregnant participants from across the mainland United States and Puerto Rico. The results from this study support prior findings that oxidative stress is higher among pregnant women who deliver preterm. The methods used in this study may help doctors identify pregnant women who may be at risk for preterm birth and plan targeted interventions.

Why was this study needed?

Oxidative stress is a process that can trigger cell damage and can play a role in the development of some diseases. Previous research has shown that oxidative stress in pregnant women may be linked to preterm birth. However, prior studies on this topic have involved small, primarily White populations, which does not reflect the diversity in the United States.

Who was involved?

This study involved 1,916 pregnant participants in the United States and Puerto Rico who were enrolled in one of four ECHO cohorts.

What happened during the study?

The researchers measured the levels of oxidative stress biomarkers from urine samples collected from participants during the second and third trimesters of pregnancy. They used these measurements to determine whether levels of oxidative stress were higher among participants who delivered their babies before 37 weeks (preterm birth).

What happens next?

Next, the researchers will study how exposure to environmental chemicals may lead to an increase in oxidative stress, ultimately leading to preterm birth. Future research will also identify what risk factors lead to higher oxidative stress during pregnancy.

Where can I learn more?

Access the full journal article, titled “A pooled analysis of four birth cohorts examining urinary oxidative stress biomarkers and preterm birth” in the American Journal of Obstetrics and Gynecology.

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

Published November 15, 2022

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ECHO Study Suggests Oxidative Stress Contributes to Mother's Risk for Preterm Birth

Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

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Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

Author(s): Lauren Shuffrey, 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?

The study found that participants with gestational diabetes were more likely to be classified as having prenatal depression compared to those without gestational diabetes. Participants with both gestational diabetes and prenatal depression had an increased risk of developing postpartum depression. But gestational diabetes on its own, without prenatal maternal depression, was not linked to an increased risk of postpartum depression.

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?

These findings underscore the importance of universal depression screenings during pregnancy and for at least a year following birth.

Why was this study needed?

There is a lack of research into how the combination of gestational diabetes (a type of diabetes that develops during pregnancy) and prenatal depression affects a person’s risk for postpartum depression.

Who was involved?

This study included 5,822 participants from 16 ECHO cohorts across 13 U.S. states and Puerto Rico. A total of 4,606 participants had neither gestational diabetes nor prenatal depression, 416 had gestational diabetes only, 689 had prenatal maternal depression only, and 111 had both gestational diabetes and prenatal maternal depression.

What happened during the study?

Researchers collected information from the participants including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The researchers then used that data to evaluate the relationship between gestational diabetes, prenatal depression, and postpartum depression.

What happens next?

Future studies should examine potential mechanisms underlying the relationship between gestational diabetes, prenatal depression, and postpartum depression. The ECHO Program is currently working towards analyzing blood samples collected during pregnancy to identify potential factors involved in this relationship.

Where can I learn more?

Access the full journal article, titled “Gestational Diabetes Mellitus, Prenatal Maternal Depression, and Risk for Postpartum Depression: An Environmental Influences on Child Health Outcomes (ECHO) Study” in BMC Pregnancy and Childbirth.

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

Published October 8, 2022

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Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

ECHO Researchers Investigate Effects of Preterm Birth, Environmental Exposures on Child Health

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ECHO Researchers Investigate Effects of Preterm Birth, Environmental Exposures on Child Health

Authors: Michael O’Shea, Monica McGrath, Judy Aschner, Barry Lester, 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?

ECHO researchers are collecting extensive data from very preterm infants, including data on learning and intellectual impairments, asthma, obesity, sleep health, and the effects of the COVID-19 pandemic. This article provides an overview of how data from ECHO cohorts are being used to address questions about the combined effects of preterm birth and environmental exposures on child health outcomes.

What was the study's impact?

Researchers can use the information in this review to enhance their knowledge of the ECHO Program’s resources to study preterm infants. Researchers can use ECHO data to investigate the relationship between preterm birth, environmental exposures, and childhood risk of chronic and developmental health conditions.

Why was this study needed?

Infants who are born premature (before 32 weeks of pregnancy) are at a high risk for multiple health disorders. This review paper outlines resources available within the ECHO Program for researchers seeking to study the effects of preterm birth and environmental exposures on child health outcomes.

Who was involved?

This review article includes ECHO cohorts that enrolled infants who were born premature. These cohorts enrolled almost 1,800 preterm infants across 14 states that were born between April 2002 and March 2020, including three ECHO cohorts that are almost exclusively comprised of preterm infants.

What happened during the study?

A team of experts reviewed the characteristics of the ECHO cohorts that are collecting data on preterm infants. Through this review, they sought to describe the research goals, participant selection criteria, key environmental exposures, and child health outcomes of each cohort.

What happens next?

ECHO researchers will continue to investigate early life factors and environmental exposures that may affect children’s health outcomes later in life. Researchers not participating in the ECHO Program will be able to obtain de-identified data from preterm children in the ECHO-wide Cohort, along with data from around 30,000 children born at term through a controlled-access public use database. This data will include information about a broad range of environmental exposures and outcomes related to chronic illness among children in the United States. Using this data, researchers can continue to build off of ECHO’s mission to enhance the health of children for generations to come.

Where can I learn more?

Access the full journal article, titled “Environmental influences on Child Health Outcomes: Cohorts of Individuals Born Very Preterm,” in Pediatric Research.

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

Published August 10, 2022

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ECHO Researchers Investigate Effects of Preterm Birth, Environmental Exposures on Child Health

During the COVID-19 Pandemic, Children Gained Weight Faster

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During the COVID-19 Pandemic, Children Gained Weight Faster

Authors: Emily Knapp, Aruna Chandran, 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?

Results from this study show that during the COVID-19 pandemic, children gained weight at an increased rate compared to the years before the pandemic. Children who had obesity before the pandemic gained weight at a faster rate during the pandemic compared to children who were in a healthy weight range pre-pandemic. Children in higher income households were at a lower risk of excess weight gain during the pandemic.

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 highlights the need for programs and services to prevent and reduce the physical and mental health effects of the COVID-19 pandemic on children.

Why was this study needed?

Childhood obesity is a serious health condition that can affect long-term health and quality of life. There was concern among researchers and doctors that the COVID-19 pandemic may cause incidence of childhood obesity to increase due to the closure of schools and cancellation of recreational activities, leading to less physical activity and changes in eating habits.

Who was involved?

This study included 1,966 participants ages 2 through 18 years old from 38 ECHO cohorts across the United States.

What happened during the study?

The researchers compared annual changes in children’s body mass index (BMI)—a measure used to estimate body fat—before and during the pandemic. The researchers also took into account child’s age, sex, race and ethnicity, pre-pandemic BMI, mother’s education, and household income.

What happens next?

Future studies should explore strategies to support families during the COVID-19 pandemic. As the pandemic continues to alter children’s lives, it will be important to monitor changes in health outcomes among children and use these data to build programs to reduce health inequities.

Where can I learn more?

Access the full journal article, titled “Changes in BMI during the COVID-19 Pandemic” in Pediatrics.

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

Published June 30, 2022

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During the COVID-19 Pandemic, Children Gained Weight Faster

Depression in New Mothers Is Common, Especially When Babies Are Born Too Early

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Depression in New Mothers Is Common, Especially When Babies Are Born Too Early

Author(s): Nicole Bush, Danielle Roubinov, Rashelle Musci, 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.

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

What were the study results?

During the first five years following childbirth, one out of every five mothers who gave birth to a preterm baby had symptoms of depression, while one out of every ten mothers who gave birth to a full-term baby had symptoms of depression. For mothers of preterm infants, it was also more common to have symptoms that got worse over time compared to women who gave birth to full-term babies. The most severe symptoms of depression were seen in women who gave birth early.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

This study supports previous reports that many mothers struggle with their mental health after giving birth, and women who have preterm babies may be particularly at risk for symptoms of depression—such as sadness, stress, anxiety, and feelings of being overwhelmed. Maternal mental health can influence their child’s health and development. Right now, doctors only screen women for depression symptoms when they are pregnant and for six months after they have their babies. This study shows that some women continue to struggle with depression for years after they give birth or start experiencing depression when their children are older. This trend was especially true for women whose babies were born prematurely. This study shows the importance of asking women about their mental health for much longer than six months after they give birth and helping them find supportive interventions.

Why was this study needed?

The postpartum period can be especially hard for mothers when babies are born prematurely, but researchers don’t know much about the effect that preterm births can have on a mother’s mental health. This study assessed postpartum depressive symptom trajectories for mothers of preterm and full-term babies, and followed participating mothers for five years after birth to better understand the long-term risks for depression and potential opportunities for treatment.

Who was involved?

The study involved 11,320 pregnant women aged 18 to 52 years old from 35 ECHO cohorts across the United States. About 11% of these women had babies that were born before they were due (preterm infants) and 89% had babies that were born on or near their due date (full-term infants).

What happened during the study?

Researchers analyzed self-reported depression measurements for women when they were pregnant and after they had their babies. These women also completed at least one follow-up assessment before their children were 5 years old.

What happens next?

It is important for future research to study what factors put some women at higher risk of experiencing depression after giving birth, particularly mothers of premature babies. Future research should also investigate what types of programs can help support mothers and their mental health during pregnancy and after birth.

Where can I learn more?

Access the full journal article titled, “Trajectories of Depressive Symptoms Among Mothers of Preterm and Full-Term Infants in a National Sample” in Archives of Women's Mental Health.

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

Published June 16, 2022

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Depression in New Mothers Is Common, Especially When Babies Are Born Too Early

ECHO Study Identifies Biological, Behavioral, and Social Factors Affecting Pregnancy Health

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ECHO Study Identifies Biological, Behavioral, and Social Factors Affecting Pregnancy Health

Authors: Stephanie Eick, Rachel Morello-Frosch, 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?

Pregnant participants who were over 30 years old and had a college degree had lower levels of oxidative stress. Levels of oxidative stress were higher among pregnant participants who were overweight or obese and unmarried. Also, current smokers or those with less than a high school education had higher levels of a oxidative stress biomarker. These results help identify how social, biologic, and behavioral factors may contribute to poor health in mothers and children.

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 is the largest study to date looking at the relationship between biological, social, and behavioral factors and oxidative stress during pregnancy. The results of this study provide important clues into how socioeconomic inequalities can contribute to poor health in pregnant women. This study may also inform future studies looking at risk factors for preterm birth.

Why was this study needed?

There is little data on what can cause oxidative stress during pregnancy. Oxidative stress is a process that can trigger cell damage and it is thought to play a role in the development of some diseases. By identifying biological, behavioral, and socioeconomic factors in a mother’s day-to-day life that may lead to increased risk for oxidative stress, research can help inform the development of targeted strategies for the prevention of poor prenatal health outcomes.

Who was involved?

This study involved approximately 2,000 pregnant participants in the mainland United States and Puerto Rico who were enrolled in one of four ECHO cohorts.

What happened during the study?

Researchers collected urine samples from participants and measured the levels of biomarkers for oxidative stress. Researchers calculated how levels of oxidative stress biomarkers changed in response to biological, behavioral, and social factors. Maternal age, pre-pregnancy body mass index, marital/partnered status, parity, and smoking status were included as biological and behavioral factors while race/ethnicity, maternal education, and stressful life events were considered social factors.

What happens next?

The research team is examining the impact of oxidative stress on adverse pregnancy outcomes, such as preterm birth.

Where can I learn more?

The full journal article, titled “Associations between social, biologic, and behavioral factors and biomarkers of oxidative stress during pregnancy: Findings from four ECHO cohorts” is published in Science of the Total Environment.

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

Published April 29, 2022

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ECHO Study Identifies Biological, Behavioral, and Social Factors Affecting Pregnancy Health

Obesity and Diabetes During Pregnancy Linked to Higher Risk of Autism-Related Traits in Children

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Obesity and Diabetes During Pregnancy Linked to Higher Risk of Autism-Related Traits in Children

Authors: Kristen Lyall, Christine Ladd-Acosta, 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?

Maternal obesity and gestational diabetes were associated with indicators of autism-related social behaviors. Investigators did not see increases in these behaviors for children of mothers with preeclampsia or gestational hypertension. Neither preterm birth or low birth weight, which are common complications of obesity and gestational diabetes, did not seem to drive the associations with these pregnancy conditions.

What was the study's impact?

Obesity and gestational diabetes are common pregnancy conditions, so understanding their impact on the developing child is an important public health issue. This study suggests that these conditions may increase the likelihood of ASD-related traits, highlighting the need for better prenatal care and more monitoring of pregnant women experiencing conditions like obesity.

Why was this study needed?

Many studies have linked childhood autism diagnosis back to maternal health conditions during pregnancy—like obesity, gestational diabetes (high blood sugar during pregnancy), gestational hypertension (high blood pressure during pregnancy), and preeclampsia (high blood pressure during pregnancy and signs of kidney/liver damage). But less is known about how these conditions may relate to subtler changes in child social development. This research looks at how risk factors of obesity, gestational diabetes, gestational hypertension, and preeclampsia relate to autism-related traits like social communication more broadly.

Who was involved?

This study included nearly 7,000 participants from 40 ECHO cohorts across the United States. Eight of these cohorts included participants considered to be at higher risk for autism spectrum disorder (ASD) based on known risk factors. The study only included cohorts that collected information on at least one of the four pregnancy conditions listed above and child social development/autism-related behaviors. Children were between the ages of 2.5-18 years, with an average age of approximately 8 years old.

What happened during the study?

The research team pulled together information on maternal health conditions during pregnancy, maternal age, child social development/autism-related behaviors, and participant demographics. They then examined the relationship between each pregnancy condition, separately and in combination, and child social development outcomes.

What happens next?

More work is needed to determine the underlying biologic and social mechanisms linking maternal obesity to child social behaviors and autism.

Where can I learn more?

Access the full journal article, titled “Cardiometabolic pregnancy complications in association with autism-related traits as measured by the Social Responsiveness Scale in ECHO” in the American Journal of Epidemiology.

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

Published March 31, 2022

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Obesity and Diabetes During Pregnancy Linked to Higher Risk of Autism-Related Traits in Children

ECHO Study Links Fast Growth During First Five Years of Life With Younger Onset of Puberty in Children

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ECHO Study Links Fast Growth During First Five Years of Life With Younger Onset of Puberty in Children

Author: Izzuddin M. Aris, et al.

Who sponsored this study?

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

What were the study results?

In male children, gaining weight or growing faster than their peers in the first five years of life was associated with entering puberty at a younger age. The researchers found similar results in female children, but only among those with faster weight gains during early childhood (two to five years of age). Female children with faster weight gains during infancy (six months to two years of age) and early childhood started their periods earlier and had more advanced pubic hair development.

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 has a direct clinical impact. As pediatricians regularly measure weight and height during routine visits and use growth curves to identify abnormal growth predictions, they could closely monitor children who have faster weight and height gains in the first five years of life for earlier onset of puberty. These study results may also inform future studies that aim to develop and/or test interventions to potentially help prevent earlier onset of puberty, such as good nutrition, environmental exposures, physical activity, and other behaviors related to growth during the first five years of life.

Why was this study needed?

Puberty is a key stage during child development. Previous research indicates that children in the United States are entering puberty at younger ages. These children may be in danger of developing certain diseases, such as type 2 diabetes, later in life. A better understanding of how early life factors affect puberty development is important for combating earlier puberty onset.

Who was involved?

This study included almost 7,500 children from 36 birth cohorts. All participating cohorts had documented at least one measure of weight and height in the first five years of the child’s life and at least one measure of puberty development.

What happened during the study?

The researchers used participants’ weight and height data to look at the following signs of puberty: age when the child experienced the most growth due to puberty; age of their first period (in female children only); puberty development score; and pubic hair development. The team then examined how gains in weight, height, and body mass index at different stages between birth and age 5 were related to puberty development, controlling for maternal and child characteristics.

What happens next?

The team planned follow-up studies that will aim to identify the mechanisms behind these initial observations. They also aim to identify the role of puberty in explaining the relationship between early life factors and longer-term chronic diseases, such as type 2 diabetes.

Where can I learn more?

Access the full journal article, titled “Analysis of early life growth and age at pubertal onset in US 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 February 4, 2022

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ECHO Study Links Fast Growth During First Five Years of Life With Younger Onset of Puberty in Children

ECHO Study Suggests Negative Associations Between Chronic Conditions and Positive Health May Be Primarily Attributed to a Co-Occurrence of Depression

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ECHO Study Suggests Negative Associations Between Chronic Conditions and Positive Health May Be Primarily Attributed to a Co-Occurrence of Depression

Author(s): Julia Schuchard, Courtney K. Blackwell, Jody M. Ganiban, Angelo P. Giardino, Monica McGrath, Phillip Sherlock, Dana M. Dabelea, Sean C. L. Deoni, Catherine Karr, Cindy T. McEvoy, Barron Patterson, Sara Santarossa, Sheela Sathyanarayana, Irene Tung, Christopher B. Forrest

Who sponsored this study?

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

What were the study results?

Of the 16 mental and physical health conditions included in this study, only depression showed a meaningful association with lower life satisfaction among children aged 8 to 17. Ninety-five percent of children with depression also had another chronic condition.

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?

The study results suggest that negative associations between chronic conditions and positive health may be primarily attributed to a co-occurrence of depression. The symptoms of physical and developmental health conditions may last for years, or even a lifetime. However, interventions like regular screening for depression, particularly among children with other health conditions, could help minimize the effects these conditions have on life satisfaction.

Why was this study needed?

Although medical science has primarily focused on the negative outcomes of chronic conditions, looking at the effect of these conditions on positive health is equally important to help children thrive. Pediatric positive health refers to children's assessments of their well-being. Understanding the relationship between different types of chronic conditions and positive health outcomes may help clinicians promote children’s well-being and adaptability to health challenges.

The ECHO Program provides opportunities to study positive health—one of its five outcome areas—in large, diverse samples of children.

Who was involved?

Participants in this study included 1,764 children aged 8 to 17 in 13 cohorts across the United States. Of these children, 45% were teenagers, 50% were girls, 8% were Latinx, and 23% were Black. Also, 54% of participating children had a chronic physical or mental health condition.

What happened during the study?

Children completed questionnaires about their own physical, mental, and social health and life satisfaction. Parents reported on their children’s chronic health conditions, including a variety of physical, developmental, and mental health conditions.

What happens next?

More research is needed to understand the potential impact of mental health interventions, such as increasing the availability of mental health assessments for children and adolescents.

Where can I learn more?

Access the full journal article, titled “Influences of chronic physical and mental health conditions on child and adolescent positive health,” in Academic Pediatrics.

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

Published: February 1, 2022

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ECHO Study Suggests Negative Associations Between Chronic Conditions and Positive Health May Be Primarily Attributed to a Co-Occurrence of Depression