Stress During Pregnancy & Adverse Experiences in Mom’s Own Childhood May Be Associated with Child Mental Health, ECHO Study Finds

Authors: Shaikh Ahmad, Alexandra Sullivan, Marie Churchill, Rosa Crum, Nicole Bush, 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?

The global rise in pediatric mental health problems has highlighted the importance of identifying factors that may affect children’s mental health. Previous research has suggested that maternal stress—both adverse experiences during the mother’s own childhood and stress during pregnancy—may affect child mental health, but large-scale, diverse studies examining both exposures together, and their effects across childhood and adolescence, are needed to help researchers identify effective screening and intervention strategies.

What were the study results?

The study found that mothers’ own adverse childhood experiences (ACEs)—such as abuse or neglect—and experiences of stress during pregnancy were each independently associated with a higher risk of mental health problems in their children, suggesting that maternal stressors during each period may have contributed to the child’s risk in a potentially accumulative manner. These effects on children included both internalizing (e.g., anxiety, depression) and externalizing (e.g., ADHD, behavior problems) mental health issues. The effects of maternal ACEs and pregnancy stress on child mental health problems were similar for boys and girls and were seen throughout childhood and adolescence.

What was the study's impact?

The findings from this diverse nationwide study strengthen the evidence showing that maternal stress before and during pregnancy can increase the risk for child mental health problems. These results also highlight the potential benefits across generations of early screening and intervention related to maternal stress and childhood adversity—not only in improving maternal health, but also in reducing mental health problems in children and teens.

Who was involved?

The study included 6,513 mother-child pairs enrolled in 34 ECHO Cohort Study Sites across 19 U.S. states, Washington, D.C., and Puerto Rico. Children ranged in age from 1.5 to 18 years old. The sample was racially, socioeconomically, and geographically diverse.

What happened during the study?

The researchers collected information from mothers on their childhood adverse experiences and stress during pregnancy. Later, a parent or caregiver provided information on the child’s mental health using either the preschool-age or school-age child behavior checklist (CBCL). Researchers then used statistical analyses to evaluate the relationship between maternal ACEs, pregnancy stress, and child mental health.

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 research could help researchers identify other factors that may influence the risk of child mental health problems (e.g., paternal ACEs) and factors that could buffer this risk. The authors of this paper also suggest that increased screening for ACE exposure and current social needs in pregnant populations and enhanced access to prenatal mental health support could help to improve mental health for both mothers and their children.

Where can I learn more?

Access the full journal article, titled “Maternal Adverse Childhood Experiences and Prenatal Stress: Intergenerational Transmission and Offspring Mental Health in the ECHO Cohort,” in Psychological Medicine.

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

Published March 11, 2026

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Stress During Pregnancy & Adverse Experiences in Mom’s Own Childhood May Be Associated with Child Mental Health, ECHO Study Finds

Perceived Stress During Pregnancy Associated with Autism-related Traits in Children, ECHO Study Finds

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Perceived Stress During Pregnancy Associated with Autism-related Traits in Children, ECHO Study Finds

Authors: Luke Grosvenor, 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?

Many mothers experience higher levels of stress and other mental health challenges during pregnancy. Previous studies have found that pregnancy stress may be associated with increased risk of autism spectrum disorder (ASD) in children, but these studies have mostly focused on the occurrence of isolated adverse or stressful events that occur in the mother’s life during pregnancy. Fewer studies have measured general perceived stress among mothers during pregnancy. This study examined the potential association between perceived stress during pregnancy and autism-related traits in children and evaluated how that association may differ according to the child’s sex or the mother’s experience of depression during pregnancy.

What were the study results?

Higher perceived stress during pregnancy was associated with slightly more severe autism‑related traits in children. At higher prenatal perceived stress levels, children showed slightly higher scores on tests measuring social and behavioral traits related to autism. Children whose mothers had either moderate or high categorical stress scored higher than those whose mothers reported low or no stress. The link between pregnancy stress and autism‑related traits did not differ between boys and girls. The relationship between prenatal stress and autism‑related traits remained consistent even when the researchers accounted for mothers’ co-occurring prenatal depressive symptoms.

What was the study's impact?

Stress during pregnancy is normal and common to experience. While the results of this study indicate that there may be a small association between pregnancy stress and autism-related traits, they do not imply that stress during pregnancy causes autism spectrum disorder or autism-related traits to occur in children.

Who was involved?

The study included 4,115 mother–child pairs from 20 ECHO Cohort Study Sites across the United States. Children ranged in age from about 2.5 to 18 years old.

What happened during the study?

Mothers reported their stress levels during pregnancy using a standard questionnaire. Later, parents reported on their children’s autism-related traits using a validated survey. Researchers analyzed the data using statistical models that accounted for factors such as child age, sex, and study site.

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 studies could help researchers better understand the specific periods in pregnancy when stress may have the greatest association with child health and development and how other related social and emotional factors may influence this effect.

Where can I learn more?

Access the full journal article, titled “Associations between Prenatal Perceived Stress and Child Autism-Related Traits in the ECHO Cohort,” in The Journal of Pediatrics.

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

Published March 2, 2026

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Perceived Stress During Pregnancy Associated with Autism-related Traits in Children, ECHO Study Finds

ECHO Study Investigates Relationship Between Chemical Exposures, Pregnancy Stress, & Birth Outcomes

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ECHO Study Investigates Relationship Between Chemical Exposures, Pregnancy Stress, & Birth Outcomes

Authors: Stephanie Eick, Anne Dunlop, 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?

Most previous research on the effects of chemical exposures on birth outcomes has focused on a small number of well-established chemicals, such as bisphenol A (BPA) and certain phthalates. However, there are over 350,000 chemicals registered for global use, and the impact of many emerging or understudied chemicals on birth outcomes is not well understood. Additionally, prior studies have not adequately considered how different kinds of maternal stress (such as anxiety, depression, and adverse childhood experiences) might influence the effects of chemical exposures during pregnancy. This study examined a broader range of chemicals and evaluated the role of stress in influencing their associations with birth outcomes.

What were the study results?

Exposure to chemicals found in certain consumer and industrial products (such as phthalates, bisphenols, and insecticides) was associated with shorter pregnancies among women who experienced anxiety during pregnancy or in the early postpartum period. Depression modified how exposure to certain chemicals (such as phthalates, parabens, and insecticides) affected birthweight and length of pregnancy. Some chemicals positively correlated with length of pregnancy (duration) for mothers with more depression, while others were associated with lower birthweights when mothers had more depression symptoms. The study suggested that the effects of a mother’s stress on the relationship between chemical exposures and birth outcomes depended on the type of chemical and type of stressor experienced.

What was this study's impact?

This study found that exposure to chemicals commonly found in consumer products was associated with shorter pregnancies and lower among women experiencing anxiety during or after pregnancy. While the results were mixed, the researchers observed some patterns where effects of chemical exposures were strongest among mothers who experienced depression and anxiety. These findings suggest that screening for depression and anxiety during pregnancy could help identify women who may be at a higher risk of adverse birth outcomes.

Who was involved?

The study included 1,556 mother-child pairs from 11 ECHO Cohort Study Sites. 810 of these participants provided information on perceived stress, depression, and anxiety. Additionally, participants provided information on adverse childhood experiences.

What happened during the study?

Pregnant participants provided urine samples, which researchers analyzed for 113 chemicals from 10 chemical classes. Pregnant participants also reported on their stress, depression, anxiety, and adverse childhood experiences. Researchers collected information on each mother’s birth outcomes, including the length of their pregnancy (in weeks) and the baby’s birthweight. The researchers performed statistical analyses to examine associations between chemical exposures, stress, and birth outcomes.

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 looking at the combined effects of multiple combined exposures could help researchers better understand the role of these factors in influencing birth outcomes. Future research could also further investigate potential biological effects of maternal adverse childhood experiences.

Where can I learn more?

Access the full journal article, titled “Psychosocial Stressors as Modifiers of the Associations Between Well-Studied and Understudied Chemicals and Birth Outcomes in the ECHO Cohort,” in Environmental Pollution.

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

Published January 15, 2026

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ECHO Study Investigates Relationship Between Chemical Exposures, Pregnancy Stress, & Birth Outcomes

Sleep Habits Vary for Children Living in Medically Underserved Areas But Not in Rural Communities, ECHO Study Finds

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Sleep Habits Vary for Children Living in Medically Underserved Areas But Not in Rural Communities, ECHO Study Finds

Authors: Brittany Lancaster, Christy W. Hockett, Anna Wallisch, 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?

People who live in rural communities or in medically underserved areas often face challenges like long travel distances, limited medical services, and fewer health resources. A medically underserved area is defined as having too few primary care providers, high infant mortality, or high poverty and/or high elderly population. These barriers make it harder to get routine care and treatment, which can worsen existing health disparities between communities. Few studies have evaluated how living in a rural or medically underserved area shapes children’s access to health-promoting resources. Because these geographic and healthcare barriers can influence key behaviors such as sleep, this study aimed to clarify how these conditions could contribute to differences in youth sleep health across the United States. Learning about these differences could help identify which groups may need more support and guide efforts to reduce health disparities.

What were the study results?

Children living in medically underserved areas tended to have different sleep patterns than those in communities with more resources. They generally went to bed later, woke up later, and were less likely to get the recommended amount of sleep for their age, especially among children ages 1 – 12 years. By contrast, differences between rural and non‑rural children were small; rural children typically went to bed and woke up earlier, while preschoolers in non‑rural areas slept longer overall because they napped more often. Bedtime habits were also mostly similar across all groups, though toddlers and teens in well-resourced areas were more likely to follow a regular bedtime routine, and preschoolers in underserved areas were more likely to use electronics before bed.

What was the study's impact?

This study suggests that living in a medically underserved areas may contribute to differences in children’s sleep health, with youth in medically underserved areas reporting later bedtimes, later wake times, and lower rates of getting the recommended amount of sleep. In contrast, only small differences were observed between children from rural and nonrural communities, suggesting that rurality alone may play a smaller role in shaping sleep patterns. The slight differences in bedtime habits—such as routines and screen use—indicate that family practices may vary across communities but are not the primary drivers of these sleep disparities. Together, these findings highlight the need for targeted efforts to support healthy sleep in medically underserved communities and suggest that researchers should continue to examine rurality and medically underserved status separately to better understand how different environments influence children’s sleep.

Who was involved?

The study included 22,234 youth aged 1–17 years. Of these, 6,976 lived in a medically underserved area and 908 of them lived in areas that were both medically underserved and rural. Overall, 1,853 youth lived in rural communities, and roughly half (945) of these lived in rural areas that were not medically underserved.

What happened during the study?

Researchers used participants' residential addresses and federal guidelines to sort children into four groups based on whether they lived in rural areas, medically underserved areas, both, or neither. Using parent or self-completed questionnaires, they collected information about children’s sleep, such as how long they slept, what time they went to bed and woke up, and how long it took them to fall asleep. They also asked about bedtime habits such as routines and screen use. The researchers then compared these sleep patterns across the different groups and looked at whether the results varied by age, from toddlers through adolescents.

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 studies could help communities develop effective sleep health programs, especially in medically underserved areas, potentially through daycares, community centers, and schools.

Where can I learn more?

Access the full journal article, titled “Exploring Sleep Outcomes in Youth Across Settings: Are There Differences based on Rurality or Medically Underserved Status in the ECHO Cohort?” in Sleep Medicine.

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

Published December 27, 2025

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Sleep Habits Vary for Children Living in Medically Underserved Areas But Not in Rural Communities, 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 Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

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ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

Authors: Amy Margolis, Andrew Law, 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?

The United States is facing a growing youth mental health crisis with a significant increase in mental or behavioral health conditions, partly linked to changes during the COVID-19 pandemic. This study examined changes in family hardships, behaviors, and coping strategies during the COVID-19 pandemic and evaluated whether these changes were associated with youth pandemic-related post-traumatic stress (PTS) symptoms.

What were the study results?

The study identified two groups of families based on their experiences of hardships, changes in daily behaviors, and coping strategies during COVID-19. The first group had minimal changes in their lifestyle and behaviors, while the second group had significant changes. The low change group included a higher proportion of Black families, single-parent households, and lower income and education levels.

Children and teens in the group with significant changes had higher Pandemic-related Traumatic Stress Scale (PTSS) scores compared to the group with minimal changes. Some aspects of parent or caregiver experiences, including their ability to isolate during the pandemic, were associated with lower PTSS scores in children. Youth whose parents or caregivers reported no change in their own behaviors were more likely to report lower PTSS scores. Changes in youth health behaviors (like eating, physical activity, and media use) and access to healthcare were important factors related to PTSS scores. Stability in these areas was linked to lower PTSS scores. The use of coping strategies by children and teens did not significantly reduce PTSS scores. Some coping strategies, like increased media use and substance use, were linked to higher PTSS scores.

What was the study's impact?

This study provides valuable insight that could help improve youth mental health now and in the wake of future public health emergencies. It demonstrates the importance of stability in health behaviors, access to healthcare, and the ability to isolate safely as key factors in reducing youth PTS symptoms.

Who was involved?

The participants included 9,139 youth and their parents or caregivers from across the United States, including 7,786 children (aged 2-12 years) and 1,353 teens and young adults (aged 13-21 years).

What happened during the study?

The study looked at information from ECHO families between April 2020 and August 2021 to understand how the pandemic affected them. Researchers grouped families into different categories based on their experiences and background characteristics from before the pandemic. The researchers then looked at symptoms of PTS in both children and teens within these family groups. The study explored how COVID-19 influenced family hardships, changes in parent and child behavior, and the ways families coped.

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 studies could help researchers examine what factors contribute to ongoing PTS symptoms or the occurrence of mental health diagnoses. Interviewing participants about acute stress when collecting PTSS survey responses could also help researchers confirm the validity of the survey.

Where can I learn more?

Access the full journal article, titled “Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis,” in the Journal of Clinical Child & Adolescent Psychology.

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

Published October 17, 2025

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ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

Toddler Emotional and Behavioral Problems Decreased Slightly During Pandemic, ECHO Study Finds

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Toddler Emotional and Behavioral Problems Decreased Slightly During Pandemic, ECHO Study Finds

Authors: Lauren Shuffrey, Anahid Akbaryan, 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?

The COVID-19 pandemic disrupted family patterns and children’s environments, both of which play a role in early brain development. Early childhood is a period of rapid brain growth and increased sensitivity to environmental influences, making the early social environment important for children's health and well-being. Previous research raised concerns about the development of infants born during the pandemic, but there is limited evidence on how the pandemic affected the behavioral and emotional well-being of toddlers. In this study, researchers wanted to look at the association between growing up during the pandemic and behavioral outcomes in toddler-aged children.

What were the study results?

The study found that children who experienced the pandemic had fewer emotional and behavioral problems compared to children born and assessed before the onset of the pandemic, based on results from the Preschool Child Behavior Checklist (CBCL). Specifically, their scores for internalizing problems, such as anxiety or sadness, were about 1.5 to 2 points lower, and their scores for externalizing problems, such as aggression or hyperactivity, were about 1.7 to 3.2 points lower than those born and assessed before the pandemic.

Although these differences were small, researchers report that they were consistent. The study also found that these links between growing up during the pandemic and lower emotional and behavioral problems were significantly stronger for children whose mothers did not have a bachelor’s degree.

What was the study's impact?

The study suggests that toddler-age children may have shown resilience despite the disruptions of the pandemic. These findings could help identify potential protective factors that could have buffered the impact of the pandemic on child behavior and inform future interventions to support children's well-being during and after global crises.

Who was involved?

The study included 3,438 toddlers (average age of 2 years) across the U.S. and Puerto Rico. Researchers grouped children based on when they were born and when they were assessed: before the pandemic, born before but assessed after March 2020, or both born and assessed during the pandemic.

What happened during the study?

During the study, researchers compared young children’s behavior and emotions before and during the pandemic using data from the ECHO Cohort collected between September 2009 and July 2023. Parents filled out the Preschool CBCL, a commonly used tool to assess the child’s emotions and behaviors, like anxiety, sadness, or hyperactivity. Researchers then analyzed these results to see how the pandemic may have affected children’s emotional and behavioral well-being.

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?

Further research could help researchers identify potential protective factors that may have promoted resilience among children whose daily life was disrupted by the COVID-19 pandemic.

Where can I learn more?

Access the full journal article, titled “COVID-19 pandemic exposure and toddler behavioral health in the ECHO Program,” 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 September 3, 2025

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Toddler Emotional and Behavioral Problems Decreased Slightly During Pandemic, ECHO Study Finds

Children Living in Low-income Neighborhoods with Low Food Access at Higher Risk of Developing Asthma, ECHO Study Finds

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Children Living in Low-income Neighborhoods with Low Food Access at Higher Risk of Developing Asthma, ECHO Study Finds

Authors: Veronica Wang, Antonella Zanobetti, Diane Gold, Rima Habre, 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 characterized by chronic inflammation in the lungs, and prior research shows that a nutritious diet can reduce airway inflammation. However, access to affordable and healthy foods is often difficult for many communities that have limited access to supermarkets or grocery stores. In this study, the researchers wanted to learn whether residing in a low-income-low-food access neighborhood was associated with childhood asthma and whether this association was modified by sociodemographic factors.

What were the study results?

This study found that living in a low-income neighborhood with low food access was associated with higher risks of developing asthma in both cumulative early (age 0-5 years) and cumulative middle (age 0-11 years) childhood, with stronger associations observed in cumulative early childhood. The increased risk of asthma was more prominent among girls, Hispanic children, and children whose mothers had less than a high school education.

What was the study's impact?

This study demonstrates the importance of the neighborhood food environment to children’s respiratory health, particularly in early childhood. The findings suggest that food access in the immediate vicinity of residence and that vehicle access may be important and may contribute to disparities in childhood asthma development.

Who was involved?

The study included 16,012 children from 35 ECHO Cohort study sites, born between 1998 and 2021, from across the United States.

What happened during the study?

During the study, researchers collected information on participants’ residential addresses and whether they were diagnosed with asthma in cumulative early childhood (by age 5) or middle childhood (by age 11). Using the U.S. Department of Agriculture’s Food Access Research Atlas, the researchers evaluated whether each child lived in a low-income neighborhood that was within 0.5-1 mile of a supermarket (for urban areas) or 10-20 miles (for rural areas). They also evaluated whether each child lived in a low-income area where more than 100 households do not have a vehicle or a nearby supermarket. Using this data, researchers looked at how living in a low-income-low-food-access neighborhood might affect childhood asthma incidence. They also took into account factors like the child's sex, race/ethnicity, mother's education, whether the mother smoked during pregnancy, and whether the parents had 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 better understand how community access to healthy, nutritious foods affects asthma development. Future studies could also consider how other influences, such as the affordability of healthy foods and school-based food programs, might influence child health outcomes.

Where can I learn more?

Access the full journal article, titled “Residing in a low-income-low-food-access neighbourhood and asthma in early and middle childhood in the Environmental influences on Child Health Outcomes (ECHO) program: a multisite cohort study,” in BMJ Open.

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, 2025

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Children Living in Low-income Neighborhoods with Low Food Access at Higher Risk of Developing Asthma, ECHO Study Finds

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

Black Children and Especially Black Girls May Be Less Likely to Receive an Autism Diagnosis

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Black Children and Especially Black Girls May Be Less Likely to Receive an Autism Diagnosis

Authors: Kristen Lyall, Bob Joseph, 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?

Research suggests that autism spectrum disorder is diagnosed less often in minority groups, possibly due to limited access to healthcare, potential biases, and delays in diagnosis. This study explored how sociodemographic factors like race, ethnicity, and education relate to autism diagnoses and parent-reported autism-related behaviors. Researchers wanted to learn whether these factors showed similar patterns in diagnosis and behavior scores and whether they might help explain why some children are less frequently diagnosed.

What were the study results?

The study found that non-Hispanic Black children had lower odds of receiving an autism diagnosis compared to non-Hispanic White children, despite similar levels of autism-related traits. Additionally, Black girls were less likely to be diagnosed with autism but more likely to have high SRS scores, indicating potential under-recognition of autism in this group. Separately, higher maternal education was also associated with reduced odds of both autism diagnosis and autism-related traits, as measured by the Social Responsiveness Scale (SRS).

What was the study's impact?

The study highlighted potential differences in how autism is recognized in children, particularly among non-Hispanic Black children. The results suggest a need to address clinical inequalities and consider ways to ensure accurate identification of autism across all sociodemographic groups.

Who was involved?

The study included 8,224 children from diverse backgrounds, with data gathered from 46 ECHO sites across the United States.

What happened during the study?

The study used data from the ECHO Cohort to examine relationships between demographic factors, autism diagnoses, and parent-reported autism-related traits. Researchers focused on two main outcomes—autism diagnoses and scores on the Social Responsiveness Scale (SRS), a parent-report questionnaire capturing autism-related traits. They used statistical methods to compare associations between sociodemographic characteristics and the likelihood of autism diagnosis and high SRS scores. The goal was to understand whether these factors influenced the two outcomes differently.

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 research could address strategies to reduce barriers to diagnosis and consider increased screening for minority and low-education groups. Efforts to help doctors and healthcare providers better recognize autism in underserved communities and ensure equitable access to diagnostic resources may improve early diagnosis and reduce disparities in care.

Where can I learn more?

Access the full journal article, titled “Demographic Correlates of Autism: How Do Associations Compare Between Diagnosis and a Quantitative Trait Measure?,” in Autism Research.

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

Published January 8, 2025

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Black Children and Especially Black Girls May Be Less Likely to Receive an Autism Diagnosis