ECHO Cohort Study Finds Amount of Time Spent in Childcare Not Associated With Mental Health Risks in Young Children, Including Those Facing Family Challenges

Authors: Michelle Bosquet Enlow, 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?

Children who face early life adversity—such as parental mental illness and household economic hardship—may be at a higher risk for mental health difficulties. Researchers in this study wanted to examine the extent to which attending out-of-home childcare might buffer or magnify the effects of those experiences.

In the U.S., many children under age 5 spend some time in nonparental childcare. However, previous findings on the role of childcare in child mental health have produced mixed results. While many studies highlight positive associations with attending childcare, some raise concerns that childcare may increase the risk for poor child developmental outcomes.

What were the study results?

The study found that children with higher exposure to factors such as family stress and mental illness were more likely to have higher levels of internalizing symptoms (such as anxiety or depression) and externalizing symptoms (such as aggression and hyperactivity), especially if their families also faced socioeconomic hardship. However, researchers also found that the number of hours in childcare did not seem to change the effects of these risks on children’s mental health, nor was childcare attendance significantly associated with improvement or worsening of their symptoms overall. This was true whether they looked at all types of non-parent childcare that were included in the study—including center-based care, home-based non-relative care, and care by a relative—or looked at just center-based care.

What was the study's impact?

The study found that the amount of time spent in childcare didn’t have a clear positive or negative effect on children’s mental health. The findings suggest that challenges like social or emotional stressors and financial hardships should be looked at separately to better understand the risks to children’s mental health in early life.

Who was involved?

The participants in the study were a diverse sample of 2,024 parent-child pairs from three ECHO Cohort Study Sites. Participants were recruited from hospitals in North Carolina, Pennsylvania, and Tennessee, as well as from U.S. adoption agencies across the United States.

What happened during the study?

The study collected data on the type and frequency of childcare attendance from birth to age 3 years. It also looked at early life challenges during that time, such as whether parents had experienced difficult childhood events, showed signs of depression, or had certain factors like age, education, or relationship status that could affect their child’s well-being. Between ages 3 and 5.5 years, the study evaluated children’s symptoms such as anxiety, depression, aggression, or hyperactivity. By following these children over time, researchers could explore the associations among early adversity, childcare attendance, and child mental health outcomes.

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 work could examine how and whether childcare quality is associated with child mental health, including whether high-quality care may be associated with a reduction of any adverse effects of early adversity on child outcomes.

Where can I learn more?

Access the full journal article titled “The Influence of Early Childhood Education and Care on the Relation between Early Life Social Adversity and Children’s Mental Health in the Environmental influences for Child Health Outcomes Program” in Development and Psychopathology.

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

Published December 2024

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ECHO Cohort Study Finds Amount of Time Spent in Childcare Not Associated With Mental Health Risks in Young Children, Including Those Facing Family Challenges

Black Children May Benefit from Race-Neutral Assessments for Asthma Diagnosis, Study Finds

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Black Children May Benefit from Race-Neutral Assessments for Asthma Diagnosis, Study Finds

Authors: Amy Non, James Gern, 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?

Spirometry (spy-ROM-uh-tree) is a test used to check how well your lungs work. It measures how much air you breathe in, how much you breathe out, and how quickly you breathe out. Healthcare professionals use spirometry to diagnose asthma and other respiratory conditions. Historically, healthcare providers have used different spirometry equations based on a person’s race for interpreting test results, relying on the assumption that Black and White bodies are biologically different. For this study, researchers wanted to know whether using the same spirometry equations for everyone (race-neutral) or different ones for specific races (race-specific) changes the reliability of lung function tests used to check for asthma in children. This research addresses concerns that race-specific test interpretations might hide lung problems in children from certain backgrounds and could lead to differences in how asthma is diagnosed and treated in kids from racial and ethnic minority groups.

What were the study results?

Black children may be more likely to be identified as having reduced lung function when doctors use the same spirometry equations to interpret test results for everyone (race-neutral) instead of race-specific ones. The study found that using the race-neutral equations resulted in significantly lower lung function scores for Black children compared to the race-specific equations. This led to a higher percentage of Black children being classified as having low lung function. Furthermore, Black children were more likely to be diagnosed with asthma, regardless of the equation The way lung function was measured did not seem to make much difference in how often children needed asthma-related healthcare, like emergency room visits or hospital stays.

What was the study's impact?

The study's findings support using race-neutral equations when evaluating children for asthma, as they may provide a more uniform assessment of lung function across different racial and ethnic groups.

Who was involved?

The research included 8,719 children aged 5 to 12 years from 27 research sites across the United States. These children were grouped by parent-reported race and ethnicity, including Black, non-White Hispanic, and White children, with a smaller percentage classified as "Other Race."

What happened during the study?

The study examined how using the same equations for everyone changes how lung function tests are understood. These tests measure how much air a child can blow out in one second, the total amount of air they can blow out in one breath, and the balance between the two. Researchers also checked if the test results matched real-life asthma problems, like being diagnosed with asthma, needing emergency care, or staying in the hospital.

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 is needed to better understand the racial differences in lung function and asthma outcomes. Future studies could also explore the impact of environmental and social factors affect respiratory health in children from different racial and ethnic groups.

Where can I learn more?

Access the full journal article, titled “Comparison of Race-neutral Versus Race-specific Spirometry Equations for Evaluation of Child Asthma,” in American Journal of Respiratory and Critical Care 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 3, 2024

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Black Children May Benefit from Race-Neutral Assessments for Asthma Diagnosis, Study Finds

ECHO Study Finds Maternal Stress During and After Pregnancy May Be Linked to Child Sleep Problems

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ECHO Study Finds Maternal Stress During and After Pregnancy May Be Linked to Child Sleep Problems

Authors: Sarah Dee Geiger, Aruna Chandran, Marie L. Churchill, Susan Schantz 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?

This study aimed to explore the associations between perceived maternal stress during and after pregnancy and child sleep problems and disturbances. Previous research has suggested prenatal stress could be associated with negative child sleep outcomes, but less is known about how postnatal stress may contribute to this association. This study aimed to address these gaps and provide insights into the potential public health implications of stress during and after pregnancy.

What were the study results?

The study found that maternal stress during pregnancy showed a small but significant association with child sleep problems and sleep disturbance. This effect was seen even when the researchers accounted for the influence of maternal stress after pregnancy.

What was the study's impact?

Maternal stress during and after pregnancy and child sleep problems are both very common, so even small effects may have important public health implications. Interventions that can help mothers manage stress during and after pregnancy could have positive effects on their children’s sleep quality, setting them up for a healthier childhood and adulthood.

Who was involved?

This study used data from a diverse group of 1,965 mother-child pairs enrolled in ECHO Study Sites in 7 U.S. states and Puerto Rico. The study included mothers who reported their stress during and after pregnancy and their child’s sleep at least once between the ages of 4 and 8, resulting in a racially and ethnically diverse sample, with up to 50% of these children being reported as Hispanic by their parents.

What happened during the study?

During the study, researchers measured maternal perceived stress using the Perceived Stress Scale (PSS) and used statistical analysis to investigate the relationship between maternal stress during pregnancy and child sleep quality, adjusting for various factors such as the mother’s age at delivery and level of education and the child’s sex, gestational age at birth, and age when sleep was evaluated. The researchers also conducted an analysis to assess the degree to which stress after pregnancy affected the relationship between prenatal stress and child sleep quality.

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 can help researchers understand the relationship between prenatal stress and child sleep outcomes. Future studies could also investigate the biological mechanisms and social factors underlying the association between prenatal stress and sleep outcomes in childhood.

Where can I learn more?

Access the full journal article, titled “Association Between Maternal Stress and Child Sleep Quality: A Nationwide Environmental Influences on Child Health Outcomes Program Prospective Cohort Study,” 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 October 11, 2024

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ECHO Study Finds Maternal Stress During and After Pregnancy May Be Linked to Child Sleep Problems

Vulnerable Populations More Likely to be Impacted by Small Environmental Effects, ECHO Study Finds

Authors: Janet L. Peacock, 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?

A challenge in public health is determining when the effect of an environmental exposure is large enough to be clinically important. Vulnerable populations—defined by sociodemographic factors such as race, ethnicity, and maternal education—tend to have a higher risk of poor health outcomes than the general population when exposed to the same environmental exposures. This study aimed to interpret the differences in outcomes between different population types, particularly focusing on vulnerable sub-populations, by analyzing differences arising from hypothetical small effects on these groups.

What were the study results?

The researchers used statistical models to examine how different levels of exposures would affect different sub-populations within the nationwide ECHO Cohort. Specifically, the study team considered a hypothetical environmental exposure that could affect a child’s birthweight. They considered four scenarios in which the hypothetical exposure could affect average birthweights in a population: a very small effect reducing average birthweight by 50g, a small effect reducing it by 125g, a medium effect reducing it by 167g, and a large effect reducing it by 250g.

The study found that the percentage of children with low birthweight (LBW) (birthweight<2500g) varied by socioeconomic categories with the greatest percentage LBW seen in the most vulnerable socioeconomic groups. After analyzing the four scenarios, a clear trend was seen such that the greatest impact of an exposure was seen in the most vulnerable sub-populations. This trend was observed for all scenarios including the impact of a small environmental exposure.

What was this study's impact?

This study showed how vulnerable groups, who already face higher risks of poor health, may be more affected by small environmental exposures than the general population. This demonstrates why small effects, which may be overlooked, are actually important when considering vulnerable populations. These results can be used in planning future studies and for designing preventive programs. The findings also help explain how exposures impact vulnerable groups and highlight the need to stratify by socioeconomic variables when assessing health outcomes.

Who was involved?

This simulation study modeled data from more than 28,000 mother-child pairs from the ECHO Cohort.

What happened during the study?

The research team conducted a simulation using data from ECHO Cohort participants to explore how hypothetical exposures could affect babies’ average birthweight and LBW in vulnerable subgroups. The study calculated average birthweight in groups by sociodemographic categories, and then compared the differences in average birthweight and the percentage of LBW.

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?

These findings are relevant for studies where researchers aim to identify the adverse effects of environmental exposures. Future research that uses more social factors and/or outcomes is needed to understand the impact of small environmental exposures on the general population and vulnerable sub-populations, and how these effects contribute to health disparities.

Where can I learn more?

Access the full journal article, titled “Do Small Effects Matter More in Vulnerable Populations? An Investigation Using Environmental influences on Child Health Outcomes (ECHO) Cohorts,” in BMC Public 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 28, 2024

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Vulnerable Populations More Likely to be Impacted by Small Environmental Effects, ECHO Study Finds

Food Insecurity in Pregnancy & Early Life May Be Linked to Higher Chance of Obesity in Children & Adolescents

Authors: Izzuddin M. Aris, 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?

Previous studies have linked food insecurity with obesity in adults, but evidence around the impact in children isn’t as clear. Many of these studies have looked at food insecurity and obesity at a single point in time rather than following the children over time. Because of this, it’s difficult to understand whether childhood obesity is directly influenced by food insecurity. Additionally, the few long-term studies that have addressed food insecurity and childhood obesity have primarily focused on late childhood or adolescence. ECHO Cohort researchers aimed to explore how food insecurity during pregnancy and early life—stages that may be particularly important to influencing long-term health outcomes—could be related to obesity in childhood and adolescence.

What were the study results?

Children who lived in low-income, low-food-access (LILA) neighborhoods during early childhood or whose mothers lived there during pregnancy were found to have higher body mass index (BMI) at ages 5 and 15. Living in those conditions was also associated with a 50% greater chance of developing obesity or severe obesity at ages 5, 10, and 15 years—regardless of individual sociodemographic factors. The association was strongest for those living in LILA neighborhoods during early childhood and their mother’s pregnancy. A LILA neighborhood is defined as a low-income neighborhood where a third or more residents live more than one half mile from a grocery store in urban areas or more than 10 miles in rural areas.

What was this study's impact?

These findings suggest that pregnancy and early childhood may be life stages when neighborhood food access can play the biggest role in long-term health outcomes. Living in neighborhoods with access to healthy foods during these stages may be important in preventing the development of obesity later in childhood and adolescence.

Who was involved?

The study included 28,359 participants from 55 ECHO Cohort Study Sites, including racially, ethnically, and geographically diverse mother-child pairs. Approximately 23% of the participants lived in a LILA neighborhood during pregnancy, and around 24% lived in these areas during early childhood.

What happened during the study?

Researchers mapped out where participants lived during pregnancy (from 1994 to 2023) or early childhood (from 1999 to 2023), matching each address to a specific neighborhood based on census data. They then linked these neighborhoods to food access data from the USDA Food Access Research Atlas for the years closest to when the participants lived there. The database offers information on household income, vehicle availability, and food access in neighborhoods.

Child weight and height data were collected from birth to adolescence through in-person research visits, medical records, and parent or caregiver reports. Researchers compared this data with information on where the children lived to determine if there was a link between neighborhood food access and child BMI or obesity.

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 studies are needed to learn whether improving access to healthy food early in life helps prevent childhood obesity. Improvements could include encouraging new supermarkets in existing food deserts, offering healthy food options at food pantries, or making healthier choices available in small retail and convenience stores.

Where can I learn more?

Access the full journal article, titled “Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity,” in JAMA Pediatrics.

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

Published September 16, 2024

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Food Insecurity in Pregnancy & Early Life May Be Linked to Higher Chance of Obesity in Children & Adolescents

COVID-19 Pandemic Altered Relationship Between Neighborhood Environment and Child Well-Being, ECHO Study Suggests

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COVID-19 Pandemic Altered Relationship Between Neighborhood Environment and Child Well-Being, ECHO Study Suggests

Authors: Xueying Zhang, 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?

Understanding how neighborhood characteristics affect child well-being is important. Prior studies have found an association between neighborhood characteristics and children’s health and development. During the COVID-19 pandemic, stay-at-home policies limited people’s interactions with their neighborhood environment. However, researchers have not considered how the pandemic might have changed these effects. ECHO researchers wanted to address this gap by exploring how the pandemic, as a natural experiment, may have changed the relationship between neighborhood characteristics and child well-being. Additionally, since COVID-19 has impacted racial and ethnic groups differently, this study examined these differences to identify potential disparities.

What were the study results?

The study found that the relationship between neighborhood characteristics and child well-being changed during the COVID-19 pandemic. It also revealed racial disparities, showing that the pandemic's impact on child well-being varied across different racial and ethnic groups.

For non-Hispanic White children, the number of people who lived in their homes and the diversity of their neighborhood were linked to lower well-being. For children of other races and ethnicities, living in areas with higher percentages of Hispanic residents and more adults working as essential workers were associated with lower well-being.

What was the study's impact?

These findings highlight how neighborhood characteristics, the pandemic, and child well-being interact, emphasizing the importance of addressing disparities during unique events like the pandemic.

Who was involved?

The study involved 1,039 children, mostly between the ages of 11 and 19, from more than 10 ECHO Cohort Study Sites across the U.S.

What happened during the study?

Researchers conducted an analysis of children who completed a well-being questionnaire called the Patient-Reported Outcomes Measurement Information System (PROMIS) before (2019 to March 1, 2020) and during (March 1, 2020 to August 31, 2021) the pandemic. The PROMIS survey measures children's mental and physical health and peer and family relationships.

The researchers then matched U.S. Census tract data with a child’s residential address to examine the neighborhood characteristics. They looked at factors including the race, education, and occupation composition of residents, as well as house capacities and property features. They analyzed how these factors were associated with child well-being, considering the impacts of the pandemic, as well as differences across child racial groups.

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 explore how specific aspects of neighborhoods affect children's well-being, especially when these factors interact.

Where can I learn more?

Access the full journal article, titled “Associations between neighborhood characteristics and child well-being before and during the COVID-19 pandemic: A repeated cross-sectional study in the Environmental influences on Child Health Outcomes (ECHO) program,” in Environmental Research.

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

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Published July 1, 2024

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COVID-19 Pandemic Altered Relationship Between Neighborhood Environment and Child Well-Being, ECHO Study Suggests

Harsh Parenting and High Socioeconomic Stress May Be Associated with Higher Internalizing Problems Like Anxiety in Children, ECHO Study Finds

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Harsh Parenting and High Socioeconomic Stress May Be Associated with Higher Internalizing Problems Like Anxiety in Children, ECHO Study Finds

Authors: Lue Williams, Veronica Oro, Leslie Leve, 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?

Internalizing problems in childhood such as chronic internal distress may be early indicators of problems associated with disorders such as depression and anxiety. Internalizing by children can be influenced by biological and environmental factors, including parent-child relationships and socioeconomic status.

This study examined the relationship between two early childhood stress factors, harsh parenting and socioeconomic stress, and children’s development from childhood through adolescence. For this study, the researchers characterized harsh parenting, or “parental hostility” as non-supportive and controlling parenting practices, displays of anger and disappointment in children, and discipline through punishment. Socioeconomic stress reflects disadvantages associated with factors like household income. Few studies have examined early childhood predictors of internalizing behavior development, so this research fills an important gap by examining the role of diverse risk factors in early life, between the ages of 18 months and 5 years, on patterns of internalizing symptoms later in childhood. The study design, which used data collected from participants over a long period, also allowed the research team to explore the long-range impact of early life influences across critical stages of children’s physical, social, and psychological development.

What were the study results?

Researchers observed that, within the study sample, children fell into three main groups based on the severity of their internalizing behaviors and how those behaviors progressed with age: low, moderate-increasing, and higher-increasing. Some of the internalizing behaviors reported include feeling anxious or depressed, being withdrawn, and complaining of aches and sickness. Parents who reported more negative interactions with children in early childhood had children who were more likely to be in the group with the highest internalizing behaviors. Children with more socioeconomic stress in their households were also most likely to be in the highest internalizing behaviors group, as compared with both the low- and moderate-internalizing symptoms groups.

Researchers also observed that household socioeconomic stress directly predicted children’s mental health. Study investigators did not find any significant relationship between child sex assigned at birth and how likely they would be to show internalizing behaviors.

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 this study's impact?

The findings from this study suggest that in addition to focusing on children’s symptoms when treating internalizing problems, health service providers may also wish to consider the broader context of caregiver behavior and access to resources for care.

Who was involved?

The study included two samples—a nationwide sample of 481 children who were adopted at birth and a sample of 1,053 children from six predominantly low-wealth, rural communities in eastern North Carolina and central Pennsylvania. Adopted children from the Early Growth and Development Study (EGDS) have lived in their adoptive homes since birth and were recruited into the study between 2003 and 2009. Children from the Family Life Project (FLP) were raised by their biological parents and were recruited into the study at birth, between September 2003 and 2004. Results may not be representative of the general population.

What happened during the study?

The researchers analyzed data collected from children and families that participated in the EGDS and FLP. EGDS children and families completed assessments approximately every nine months when adoptees were under the age of 3, and every one to two years after that. FLP participant families completed an initial home visit assessment when children were 2 months old and participated in annual assessments thereafter.

What happens next?

Future studies are needed to further support programming and research efforts by exploring mechanisms that underlie the relationship between socioeconomic stress, parenting styles, and children’s internalizing behaviors identified in the current study.

Where can I learn more?

Access the full journal article, titled “Influence of Early Childhood Parental Hostility and Socioeconomic Stress on Children’s Internalizing Symptom Trajectories from Childhood to Adolescence,” in Frontiers in Psychiatry.

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

Published April 16, 2024

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Harsh Parenting and High Socioeconomic Stress May Be Associated with Higher Internalizing Problems Like Anxiety in Children, ECHO Study Finds

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 Evaluates Influence of Neighborhood-Level Poverty and Food Insecurity During Pregnancy on Birthweight

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ECHO Study Evaluates Influence of Neighborhood-Level Poverty and Food Insecurity During Pregnancy on Birthweight

Authors: Izzuddin Aris, Emily Oken, 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?

Previous studies have shown that diet during pregnancy can impact the physical and mental health of the pregnant women. However, less is known about how food insecurity affects health outcomes for newborns. For this study, ECHO researchers analyzed data to understand what connections might exist between where a pregnant woman lives, their access to food, and birth outcomes.

What were the study results?

The study found that living in neighborhoods where residents have lower incomes, limited food access, or limited vehicle access was associated with lower birthweights and an increased risk of babies born small for gestational age. However, researchers didn’t find any association between individual experiences of food insecurity 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 was this study's impact?

Given the long-term effects of adverse birth outcomes on later cardiovascular disease risk and other conditions, more research is needed to evaluate whether interventions and policies that improve food access during pregnancy would be effective in improving birth outcomes and promoting child health. A variety of strategies could be effective at improving birth outcomes, including strategies to increase neighborhood food access, improve food affordability in neighborhoods with low food access, or directly provide healthy foods to individuals during pregnancy.

Who was involved?

This study included 22,206 pregnant participants enrolled in 53 ECHO research sites that collected information on neighborhood-level food access data and birth outcomes. Of these participants, 24% lived in a low-income neighborhood where a third or more residents lived over one mile from a grocery store (or more than 10 miles in rural areas). About 14% of the participants in this study lived in neighborhoods with high poverty rates where more than 100 households had no access to a vehicle and lived more than half a mile from the nearest grocery store.

What happened during the study?

To conduct this study, researchers matched pregnant individuals' home addresses with information about nearby food availability from the U.S. Food Access Research Atlas, which provided data on household income, the availability of a household vehicle, and where people can access food in different neighborhoods. Researchers also assessed individual-level food insecurity during pregnancy using the Crisis in Family Systems-Revised questionnaire.

What happens next?

Additional studies are needed to examine how health habits, chemical exposures, and other related factors may also influence birth outcomes.

Where can I learn more?

Access the full journal article, titled “Birth Outcomes in Relation to Neighborhood Food Access and Individual Food Insecurity During Pregnancy in the Environmental influences on Child Health Outcomes (ECHO)-Wide Cohort Study,” in 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 March 1, 2024

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ECHO Study Evaluates Influence of Neighborhood-Level Poverty and Food Insecurity During Pregnancy on Birthweight

ECHO Study Shows Fish Consumption and Omega-3 Supplement Use Uncommon During Pregnancy

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ECHO Study Shows Fish Consumption and Omega-3 Supplement Use Uncommon During Pregnancy

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?

Omega-3 fatty acids are essential nutrients for supporting positive health outcomes. Getting enough of these nutrients during pregnancy is vital for child health and neurodevelopment and may also improve other pregnancy outcomes. Prior research on the demographic characteristics associated with fish and supplement use during pregnancy has been limited, involving fewer participants and older data that may not represent current intake.

What were the study results?

During the study, about 25% of pregnant participants did not eat any fish or ate it less than once per month. Older participants were more likely to eat fish. Participants who were non-Hispanic Black, non-Hispanic Asian, or Hispanic ate less fish on average when compared to those who identified as non-Hispanic White. Participants categorized as overweight were also less likely to eat fish. Only about 1 in 6 pregnant participants reported taking omega-3 supplements. Supplement use was more common in participants who were older and had more education, had a lower body mass index (BMI), and ate fish.

What was the study's impact?

One-quarter of participants in this large, nationwide study rarely or never consumed fish during pregnancy, and omega-3 supplement use was uncommon, even among those who did not consume fish. Given the role of omega-3 fatty acids in preventing preterm birth and supporting child health and neurodevelopment, experts recommend pregnant women get at least 500 mg of omega-3 fatty acids per day through supplements or consuming fish that is low in mercury.

Learn more about the FDA’s and EPA’s current recommendations for eating fish during pregnancy here.

Who was involved?

This study included 10,800 pregnant participants enrolled in 23 ECHO research sites that collected information on fish consumption and 12,646 participants at 35 ECHO research sites that collected information on omega-3 supplement use. Information on fish consumption and omega-3 supplement use was collected from pregnant participants from 1999 to 2020.

What happened during the study?

The researchers collected information on fish intake during pregnancy and grouped participants based on the frequency of their fish consumption: never or less than once per month, once per month to less than once per week, one to two times per week, or more than twice per week. The researchers also collected information on participants’ omega-3 supplement intake. They then compared participant fish consumption and supplement use information across various demographic and lifestyle characteristics, including age, race, ethnicity, education, weight, and smoking status.

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 diet without first consulting your healthcare professional.

What happens next?

Future research may examine how fish consumption during pregnancy relates to childhood developmental outcomes such as autism-related traits.

Where can I learn more?

Access the full journal article titled “Demographic and health characteristics associated with fish and n-3 fatty acid supplement intake during pregnancy: results from pregnancy cohorts in the ECHO program” in Public Health Nutrition.

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

Published February 27, 2024

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ECHO Study Shows Fish Consumption and Omega-3 Supplement Use Uncommon During Pregnancy