ECHO Program Receives Green Light to Begin Expansive Child Health Research

Single institutional review board approves the NIH’s ECHO cohort research to proceed, which promises answers to high-impact research questions related to early influences on child health outcomes.

February 1, 2019

The Environmental influences on Child Health Outcomes (ECHO) Program today announced it has received single institutional review board (sIRB) approval to begin its research under the ECHO-wide Cohort Data Collection Protocol. The purpose of the sIRB is to ensure that research follows guidelines to protect participants. ECHO research will investigate the effects of a broad range of early exposures—including physical, chemical, biological, social, behavioral, natural, and built environments—on child health and development.

“The sIRB approval of the ECHO-wide Cohort Data Collection Protocol gives us the green light to start finding answers to important questions that will enhance the health of children for generations to come,” said ECHO Program Director Matthew Gillman. “We know that a child’s exposures from before birth through the first few years of life are tremendously formative, and yet, until now, child health research in this area has been limited, leaving us with lots of questions. We look forward to turning that tide.”

The ECHO-wide Cohort is made up of more than 70 individual cohorts, or groups, of mothers and children from ongoing research projects. Researchers follow participants through different life stages, some starting before birth and through adolescence. Together, they form a massive virtual “cohort of cohorts” that includes more than 50,000 children from diverse backgrounds across the United States. By bringing together data collected under a single protocol, ECHO researchers can answer high-impact, complex research questions.

Looking at the whole child

ECHO’s promise is not only in its breadth of data, but also its approach, which brings together multiple disciplines to address child health. Historically, many research projects have looked at children through a single, narrow lens. However, the body’s development process includes millions of interacting factors that all play a part in a child’s overall health. Researchers from 44 states, Puerto Rico, and the District of Columbia are involved in the ECHO-wide Cohort Data Collection Protocol. These researchers bring expertise from hundreds of disciplines. As a result, knowledge from ECHO research can offer a richer understanding of child health and development to help guide a healthier, happier childhood for our nation’s children.

Emily Oken, of Harvard University and the principal investigator for an ECHO Pediatric Cohort Award, and David Cella, of Northwestern University and one of the principal investigators for the ECHO Person-Reported Outcomes Core, led the trans-disciplinary development of the ECHO-wide Cohort Data Collection Protocol. They worked collaboratively with all ECHO components and gathered input through a public comment period. The research will include participants that are often excluded from traditional research, such as pregnant women, children, and caregivers. ECHO’s researchers hope that this wide view of the child will shed light on important patterns and trends in child health that have not been captured to date.

“It was a Herculean effort to develop a protocol of this scale with so many interacting variables,” said Gillman. “Through collaboration and a shared passion to enhance the health of all children, we are now positioned to begin this important work. Our team is energized and ready to go, and our nation’s children are waiting.”

ECHO-funded study sheds light on second- and third-hand smoke exposure in kids

A recent study funded by the ECHO Program, National Institute of Child Health and Human Development (NICHD), and National Institute on Drug Abuse, shows that infants and toddlers in low-income, rural areas may be at higher risk for second- and third-hand smoke than previously reported in the National Health and Nutrition Examination Survey. Findings were dependent on the detectable presence of cotinine – the byproduct formed when the body breaks down nicotine – in the children’s systems.

Based on an analysis of saliva samples collected from 1,218 children, 15 percent were in the high exposure group when tested for cotinine, demonstrating levels that are comparable to active adult smokers. Forty-eight percent of the children classified as moderate exposure and 37 percent fell in the low exposure group.

Other key findings from the study include lower smoke exposure for children in center-based daycare facilities and higher smoke exposure for infants, compared with toddlers. This is partially attributed to crawling and infants’ tendencies to put objects into their mouths. Additionally, according to the study, “lower income, less education, frequent residential moves and fluctuations in the number of adults within the home were associated with high smoke exposure.”

“Our results, if supported by future studies, can help educate parents and caregivers, as well as improve prevention programs that seek to reduce children’s smoke exposure,” said Clancy Blair, Ph.D., M.P.H., a professor at New York University’s Steinhardt School of Culture, Education and Human Development, and the senior author of the study.

The study was published in Nicotine & Tobacco Research December 5, 2018.

‘Current Opinion in Pediatrics’ Publishes Seven Manuscripts from ECHO Program

The April 2018 issue of Current Opinion in Pediatrics features seven manuscripts authored by and about the Environmental influences on Child Health Outcomes (ECHO) research program, supported by the National Institutes of Health. Readers can find each of the manuscripts, one from each active ECHO Program Component, in the journal’s “Therapeutics and Toxicology” section. Together, they offer readers a glimpse into ECHO’s mission and progress from diverse vantage points.

Current Opinion in Pediatrics gives us a forum to showcase how each of ECHO’s Components is working collectively toward the ECHO mission to enhance the health of children for generations to come,” said Matthew Gillman, ECHO program director, National Institutes of Health. “We developed ECHO on the premise that the whole is greater than the sum of its parts. That premise applies equally to the ECHO Cohorts and the IDeA States Pediatric Clinical Trials Network. Their combined intellectual capital, disciplines, innovation, and analyses will bring us closer to our mission than individual cohorts or clinical trial sites could ever reach alone. I am inspired by the work across all ECHO Components to bring this premise to life.”

Current Opinion in Pediatrics is a great platform for ECHO. As a publication that spans all the subspecialties and primary care, it represents a product that is more than the sum of its parts, just like ECHO,” said Robert Wright, the publication’s editor. “It is critical for the pediatric health care community to learn about ECHO and the exciting work that will one day change the way pediatrics is practiced.”

Readers can access all seven articles electronically in the journal’s April 2018 (volume 30, issue 2) publication or via the links below:

 

NIH Releases Report Summary of ECHO-wide Cohort Data Collection Protocol Request for Information (RFI) Responses

On August 11th, 2017 the NIH published an RFI seeking feedback from stakeholders and the general public on the ECHO-wide Cohort Data Collection Protocol. The RFI specifically requested feedback and recommendations on the data element concepts, types of biospecimens, and innovative data collection methodology. The NIH received a number of responses from researchers, professional organizations, nonprofit organizations, and research foundations. View the responses to this RFI here. The NIH thanks all responders for their input.

NIH-Funded Study to Focus on Newborns Affected by Opioids

 

Experts plan clinical trial to test treatments for withdrawal syndrome.

The National Institutes of Health is funding a new study to evaluate treatment options for newborns with opioid withdrawal syndrome, a condition caused by exposure to opioids during pregnancy. Currently, health care providers in the United States lack standard, evidence-based treatments for neonatal opioid withdrawal syndrome, despite states reporting more cases in recent years. The study, called Advancing Clinical Trials in Neonatal Opioid Withdrawal Syndrome (ACT NOW), aims to inform clinical care of these infants.

ACT NOW is funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the NIH Office of the Director’s Environmental Influences on Child Health Outcomes (ECHO) Program.

Opioids are a class of drugs commonly prescribed for pain relief. Prescriptions for these drugs have quadrupled since 1999 in the United States, putting more reproductive-age women at risk of developing opioid use disorder. Use of these drugs during pregnancy can affect the health and well-being of women and lead to withdrawal symptoms in newborns. Symptoms often include tremors, excessive crying, sleep deprivation and swallowing difficulties.

Read the full press release here to learn more about this study. 

 

 

The NIH Invites Comments on the ECHO-wide Cohort Data Collection Protocol

On August 10, 2017, the National Institutes of Health (NIH) released a Request for Information (RFI) to solicit input from a wide variety of stakeholders on the Environmental influences on Child Health Outcomes (ECHO)-wide Cohort Data Collection Protocol. Stakeholders that the NIH hopes will respond to the RFI include: non-ECHO researchers, advocacy groups, professional organizations, and the general public. Comments are due by September 13, 2017. For more information and to contribute, please visit: https://grants.nih.gov/grants/guide/notice-files/NOT-OD-17-090.html.

Background

Environmental influences on Child Health Outcomes (ECHO) is a nationwide NIH-funded research program whose mission is to enhance the health of children for generations to come. The program consists of observational and intervention components. This RFI pertains to the observational component, the ECHO Pediatric Cohorts. The overall scientific goal of the ECHO Pediatric Cohorts is to investigate associations of a broad array of early environmental influences with child health and development. ECHO prioritizes addressing research questions that have impact on policies, practices, and programs.

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ECHO’s Early Progress and Plans to Enhance Child Health in 2017 & Beyond

As we begin 2017, I reflect on the promising strides ECHO has made and look forward to successes in 2017 and beyond. In November 2016, we kicked off ECHO in a big way. Bringing together all of ECHO’s Components under one roof, we hit the scientific ground running and began to foster the culture of collaboration that is vital to ECHO’s success. We witnessed ECHO’s investigators taking leadership positions in our Working Groups.  We observed rapid progress when these investigators collaborated in small groups and shared what they learned in larger group discussion.

Most importantly, we rallied around ECHO’s core mission: “to enhance the health of children for generations to come.” This mission speaks to all parts of ECHO: the observational studies of our Cohorts, the interventional studies within the IDeA States Pediatric Clinical Trials Network, and the Centers and Cores — including the Children’s Health and Exposure Analysis Resource (CHEAR) Core, the Patient Reported Outcomes (PRO) Core, the Data Analysis Center (DAC), and our ECHO Coordinating Center (CC) — that support this research.

ECHO’s long-term goals are both scientific and strategic. From a scientific perspective, our goal is to improve the health of children and adolescents by conducting solution-oriented research that informs high-impact programs, policies, and practices. From a strategic perspective, we aim to institute best practices for how to conduct Team Science in the 21st century. We’ve set an ambitious agenda for our first year, which includes 1) achieving early scientific wins by capitalizing on one of ECHO’s most powerful features: the extant data of its existing Cohorts, and 2) crafting a robust infrastructure for the IDeA States Pediatric Clinical Trials Network to begin initiating trials in our second year.

I am thrilled with the progress we have made, but ECHO’s most exciting days will be in 2017 and beyond. ECHO is underpinned by the fundamental notion that when we all row in the same direction, the whole is greater than the sum of our parts. For ECHO’s Cohorts, this means knitting a tapestry of the ECHO-wide Cohort and harmonizing its extant data. For CHEAR Core, PRO Core, and the DAC, it means analyzing existing and new insights and standardizing data collection. On the interventional side, the IDeA States Network is endeavoring to prioritize trials that examine focus areas that are similar to the Cohorts’:  pre-, peri- and postnatal health, childhood obesity, airways disorders, and neurodevelopment.

As we continue to bring ECHO to life in 2017, we will begin to address questions that link a broad range of early environmental influences to the health of a highly diverse population of children and adolescents. We are eager to begin this journey to move the needle in improving child health.

Matthew W. Gillman, MD, SM