News

New ECHO Research Finds Significant Changes in Children’s Sleep Habits during the COVID-19 Pandemic

Posted on by Jodi Snare
Maristella Lucchini, PhD

Collaborative ECHO research led by Maristella Lucchini, PhD of Columbia University Irving Medical Center investigates changes in childhood sleep behaviors during the COVID-19 pandemic. The researchers looked at data from 528 children across the United States and found that, during the COVID-19 pandemic, children went to bed later, woke up later, and took longer to fall asleep, but their overall time spent asleep did not change. The study also found that children in minority communities went to bed later, slept less, and took naps more frequently. This research, titled “Impact of the COVID-19 pandemic on children’s sleep habits: an ECHO study,” is published in Pediatric Research.

This study included children aged 4 to 12 from 14 ECHO cohorts across the United States. The ECHO Program’s Sleep Health of Children and Adolescents Questionnaire was used to evaluate children’s sleep habits before the pandemic began and at two time periods during the pandemic. The researchers also collected sociodemographic information from self-reports and medical records.

ECHO researchers found significant changes in children’s sleep habits, as well as differences in children’s sleep behaviors between racial/ethnic groups. However, parental knowledge of the importance of sleep might have contributed to children sleep health. Interviews with 38 participant caregivers revealed they prioritized routines to maintain their children’s amount of sleep but were generally more flexible about bedtimes.

“This is the first study investigating changes in childhood sleep habits in the United States during the COVID-19 pandemic using data collected before and during the pandemic,” said Dr. Lucchini. “The results highlight potential targets for future interventions and support the need to examine and address the root causes of racial and ethnic sleep disparities in childhood.”

Using data from the same cohort of children, ECHO researchers are in the process of analyzing and publishing results on changes in diet, physical activity, and screen time during the COVID-19 pandemic.

Read the research summary.

ECHO Researchers Examine Associations Between Gestational Diabetes, Prenatal Depression, and Postpartum Depression

Posted on by Jodi Snare

Collaborative ECHO research led by Lauren C. Shuffrey, PhD of Columbia University examines the effects of gestational diabetes, a type of diabetes that develops during pregnancy, and prenatal depression on a person’s risk for developing postpartum depression. The study found that people with gestational diabetes were more likely to be classified as having prenatal depression. Those with both gestational diabetes and prenatal depression were at an increased risk for postpartum depression. But gestational diabetes on its own, without prenatal depression, was not associated with increased risk for postpartum depression.

This research, titled “Gestational Diabetes Mellitus, Prenatal Maternal Depression, and Risk for Postpartum Depression: An Environmental Influences on Child Health Outcomes (ECHO) Study,” is published in BMC Pregnancy and Childbirth.

Previous research has yet to examine the association between the combination of gestational diabetes and prenatal maternal depression and postpartum depression. To address this question, the researchers looked at data from 5,822 participants in 16 ECHO cohorts across 13 U.S. states and Puerto Rico. A total of 4,606 participants had neither gestational diabetes nor prenatal maternal depression, 416 had gestational diabetes only, 689 had prenatal maternal depression only, and 111 had both gestational diabetes and prenatal maternal depression. Participants self-reported on their depression symptoms during and after pregnancy using the PROMIS-D (Patient-Reported Outcomes Measurement Information System) scale. The researchers used this data to evaluate the relationships between maternal depression symptoms and gestational diabetes.

“Our findings underscore the importance of universal depression screening during pregnancy and in the first postpartum year,” said Dr. Shuffrey. “Future studies should examine potential biological mechanisms underlying the relationship between gestational diabetes and maternal depression.”

The ECHO program is currently working towards analyzing blood samples collected during pregnancy to identify potential factors involved in the relationship between gestational diabetes, prenatal depression, and postpartum depression.

Read the research summary.

ECHO Researchers Investigate How the COVID-19 Pandemic Affected Children’s Health Behaviors

Posted on by Jodi Snare

Collaborative ECHO research led by Traci Bekelman, PhD, MPH of the University of Colorado, Anschutz Medical Campus investigates how the COVID-19 pandemic affected children’s diet, physical activity, screen time, and sleep. The study found that children’s screen time increased significantly during the pandemic with Hispanic children and non-Hispanic Black children having the most noticeable increase in screen time. The amount of time children spent asleep also increased, but only among children whose sleep time was below the recommended range before the pandemic. The study didn’t find any significant increase in the amounts of sugary drinks and unhealthy snack foods children consumed in the full study sample, but it did find a more noticeable increase among Hispanic children and older children.

This research, titled “Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children,” is published in the International Journal of Environmental Research and Public Health.

This study included 347 children between the ages of 4 to 12 and their caregivers recruited from ECHO cohorts in California, Colorado, North Dakota, and New Hampshire. Of these participants, 47% percent were female and 62% were non-Hispanic White. ECHO researchers compared children’s diet, physical activity, screen time, and sleep data collected before the pandemic (July 2019 to March 2020) to data collected during the pandemic (December 2020 to April 2021).

For many children, public health measures to mitigate the spread of the COVID-19 pandemic disrupted their daily routines, and prevented them from using community resources, such as parks and organized sports. During the first few months of the pandemic, we know that there were changes in children’s health behaviors—such as their diet, screen time, physical activity, and sleep habits. However, there are limited data on what happened to children’s health behaviors after the earliest, most restrictive lockdown period.

“Our study is one of the first to report that increases in screen time persisted into 2021,” said Dr. Bekelman. “Screen time has been linked to physical and mental health outcomes in children, so it will be important to provide families with more support to help them re-establish healthy routines.”

In the future, researchers will continue to investigate children’s health behaviors at other points in the pandemic to reveal whether changes are sustained, and the pathways by which social and economic disruption impacted children’s behaviors. Future studies can also look at changes in more nuanced measures of health behaviors among more diverse groups of children.

Read the research summary.

ECHO Researchers Propose Eye-Tracking Technology Can Provide a Non-Biased, Cross-Cultural Tool for Assessing Attention Patterns in Young Children

Posted on by Jodi Snare

Collaborative ECHO research led by Sara Nozadi, PhD, of the University of New Mexico and Andréa Aguiar, PhD of the University of Illinois Urbana-Champaign suggests that eye-tracking technology can be used as a robust measure across diverse populations and settings to assess attention patterns linked to socially withdrawn behavior in preschool children. Their research, titled “Cross-Cultural Applicability of Eye-Tracking in Assessing Attention to Emotional Faces in Preschool-Aged Children” is published in the Emotion Journal.

Humans tend to give more attention to emotional information than neutral information. Past research indicates departures from this pattern typically occur in children with socially withdrawn behaviors. However, most of this research has been very limited and only conducted in controlled settings among primarily White children from urban areas.

In this study, ECHO researchers wanted to determine the extent to which two eye-tracking–based measures could be used cross-culturally to assess attention biases and how these biases might relate to socially withdrawn behaviors in children.

The researchers leveraged ECHO’s large sample size and diverse population to compare information from children in two ECHO cohorts that were very different demographically, geographically, racially and culturally. They analyzed data from 125 children aged 3.5 to 5.5 years from the Navajo Birth Cohort Study (NBCS) and 70 children aged 3.8 to 4.0 years from the Illinois Kids Development Study (IKIDS). NBCS is a cohort of indigenous children who live in rural Tribal lands across New Mexico, Utah, and Arizona and tend to have relatively low socioeconomic status (SES). In contrast, children from IKIDS are primarily Non-Hispanic White and high-SES, living around the University of Illinois at Urbana-Champaign campus in central Illinois. Children in the NBCS historically have not been included in developmental studies, including those investigating attention biases, whereas the IKIDS sample closely resembles the children assessed in most of the previously published eye-tracking studies of attention bias toward emotional stimuli.

Researchers had both groups of children complete two eye-tracking tasks that measured their attention to photos of human faces with positive, negative, and neutral expressions. Indigenous children were assessed in different locations in the Navajo territory, whereas IKIDS children came to a research laboratory in the University campus. Mothers also reported on their child’s socially withdrawn behaviors using the Child Behavioral Checklist (CBCL)—a standardized survey commonly used in research and clinical settings to evaluate risk for behavioral and emotional problems in children.

Attention patterns were similar across the two samples of children irrespective of differences in their cultures, demographics, or assessment settings. Overall, children paid more attention to emotional faces compared to neutral faces, and they were particularly quick to detect angry faces—because this expression may signify a threat. These findings replicate results of previous research with both adults and children. Indigenous children with socially withdrawn behaviors were more likely than other children in the study to avoid emotional faces—a response that has been observed in children with higher levels of socially withdrawn behaviors.

“This work shows that eye tracking can be used to measure patterns of attention towards emotional facial cues—both adaptive patterns and those that underlie socially withdrawn behaviors—in young children,” said Dr. Nozadi. “Because eye tracking technology does not rely on limited clinical observations or parents’ reports, it can be used as a more objective and less biased measure across various settings and communities.”

Moving forward, the researchers will look at how the responses they see in these young children change with age and determine whether eye tracking continues to be an unbiased tool for assessing attention throughout development.

Read the research summary.

New ECHO Research Finds Pregnant Women are Exposed to Dangerous Chemicals Found in a Variety of Household Products

Posted on by Jodi Snare

Collaborative ECHO research led by Giehae Choi, PhD and Jessie Buckley, PhD, both of Johns Hopkins University, along with Tracey Woodruff, PhD, MPH of the University of California, San Francisco, investigates whether pregnant women are exposed to potentially dangerous chemicals commonly found in a variety of household products, including plastics, disinfectants, and products that contain dyes or pigments. Two of these chemicals, melamine and cyanuric acid, were found in over 99% of study participants, and exposure to four different types of aromatic amines were also found in nearly all participants. Levels of these chemicals were higher among participants of color and those exposed to tobacco smoke. This research, titled “Exposure to melamine and its derivatives and aromatic amines among pregnant women in the United States: The ECHO Program,” is published in Chemosphere.

This research focused on melamine, along with related chemicals like cyanuric acid and aromatic amines. Even though these chemicals are found in a wide variety of household products, their exposures are not regularly monitored in human populations. In general, people can be exposed to harmful chemicals through the air, contaminated food, household dust, water, plastics, products that contain dyes and pigments, tobacco smoke, diesel fumes, and more. Melamine is known to cause health problems in children, but there is limited research on its effects in pregnant women, and in adults in general.

To address this gap, this study used new methods to measure the levels of 45 chemicals in urine samples from 171 pregnant participants across nine ECHO cohorts. Of these participants, 40% were Hispanic, 34% were White, 20% were Black, 4% were Asians, and the remaining 2% were from other or multiple racial groups. The researchers also examined data on the participants’ race and ethnicity, age, education, and marital status to determine whether chemical exposure was higher in different sociodemographic groups. Levels of most chemicals were higher among Black and Hispanic women. For example, levels of 3,4-dichloroaniline—a chemical used in the production of dyes and pesticides—were more than 100% higher among Black and Hispanic women compared to White women.

“This is the first national study to reveal that pregnant women in the U.S. are widely exposed to melamine, cyanuric acid, and aromatic amines—chemicals that may be harmful to maternal health and child development,” said Dr. Choi. “This raises concerns for the health of pregnant women and babies.”

Future research will expand this study to include over 1,700 pregnant participants and investigate whether higher exposure to these chemicals during pregnancy might be related to negative child health outcomes.

Read the research summary.

Ongoing ECHO Research Investigates the Effects of Preterm Birth and Environmental Exposures on Child Health Outcomes

Posted on by Jodi Snare

A recent review paper authored by Michael O’Shea, MD of the University of North Carolina at Chapel Hill, Monica McGrath, PhD of Johns Hopkins University, and Judy Aschner, MD of Hackensack University, and Barry Lester, PhD of Brown University’s Alpert Medical School provides an overview of the collaborative work ECHO has been doing to study and collect data on the effects of premature birth on child health outcomes. The article describes ECHO cohorts that have enrolled premature infants (born before 32 weeks of gestation) between April 2002 and March 2020, including three ECHO cohorts that are almost exclusively comprised of preterm infants. Researchers can use ECHO data to investigate the relationship between preterm birth, environmental exposures, and childhood chronic and developmental health conditions. This research, titled “Environmental influences on Child Health Outcomes: Cohorts of Individuals Born Very Preterm,” is published in Pediatric Research.

The ECHO Cohorts included in this review recruited almost 1,800 preterm infants from 14 states. ECHO researchers are collecting extensive data from these preterm infants, including data on learning and intellectual impairments, asthma, obesity, sleep health, and the effects of the COVID-19 pandemic. Researchers can use this data to address questions about 1) the effect of preterm birth on a child’s risk for chronic and developmental health conditions; 2) socioeconomic disparities in child health outcomes; and 3) the relationship between early life exposures and health outcomes later in life among individuals born preterm.

“Our goal is for this review article to serve as a ‘roadmap’ to aid child health researchers in their efforts to apply data from the ECHO preterm cohorts toward the broad goals of the ECHO program,” said Dr. O’Shea. “This resource provides researchers with many opportunities to improve their understanding of modifiable risk factors and mechanisms leading to chronic illness in children, pointing the way towards interventions that can optimize the well-being of children in the United States.”

Researchers not affiliated with the ECHO Program will be able to obtain de-identified data from very preterm children in the ECHO-wide Cohort, along with data from around 30,000 children born at term through a controlled-access public use database. This data will include information about a broad range of environmental exposures and outcomes related to chronic illness among children in the United States. Using this data, researchers can continue to build off of ECHO’s mission to enhance the health of children through research that may help inform healthcare practices, programs, and policies.

Read the research summary.

ECHO Researchers Investigate Child Weight Gain During the COVID-19 Pandemic

Posted on by Jodi Snare

Collaborative ECHO research led by Emily Knapp, PhD and Aruna Chandran, MD of Johns Hopkins Bloomberg School of Public Health investigates the effects of the COVID-19 pandemic on children’s body mass index (BMI), an estimation of overall body fat. The study looked at the BMI of 1,966 children ages 2 through 18 years old from 38 ECHO cohorts across the United States during the COVID-19 pandemic. The results of this study suggest that, on average, children gained weight at a higher rate during the pandemic. This research, titled “Changes in BMI during the COVID-19 Pandemic,” is published in Pediatrics.

Childhood obesity is a serious health condition that can affect long-term health and quality of life. At the start of the COVID-19 pandemic, there was concern among researchers and doctors that the closure of schools and the cancellation of recreation and sport activities would cause an increase in childhood obesity.

To understand the pandemic’s impact on children’s weight, researchers analyzed yearly changes in children’s body mass index (BMI) before and during the pandemic, considering each child’s age and sex. The researchers also investigated whether changes in BMI were different across specific sociodemographic traits including race, ethnicity, pre-pandemic BMI, and household income.

The results of this study indicated that on average children gained weight at an increased rate during the pandemic, and children who had obesity before the pandemic gained weight at a faster rate compared to children who were at a healthy weight pre-pandemic. Additionally, children in higher income households were at a lower risk of excess BMI gain during the pandemic.

“This study highlights the need for interventions to mitigate the physical and mental health consequences of the COVID-19 pandemic,” said Dr. Knapp. “The conditions faced by families during the COVID-19 pandemic may have led to an acceleration of weight gain in children. This study highlights the need to support less resourced families, who have borne the worst consequences of the pandemic.”

Future studies can explore strategies to help families and communities thrive amidst the challenges faced during the ongoing COVID-19 pandemic. As the pandemic continues to alter children’s lives, it will be important to monitor changes in health outcomes among children and use these data to build programs to reduce health inequities.

Read the research summary.

The Effect of Air Pollution on Time to Pregnancy

Posted on by Jodi Snare
Linda Kahn, PhD, MPH

Collaborative ECHO research, led by Linda Kahn, PhD, MPH at NYU Langone Health, suggests traffic-related air pollution, secondhand smoke, and formaldehyde are associated with longer time to pregnancy. Specifically, exposure to particulate matter and nitrogen oxide gases lowered couples’ chances of becoming pregnant. Traffic and the burning of other types of materials besides gas and diesel, such as wildfires or other sources of combustion, create particulate matter and nitrogen oxide gases.

These results are based on a systematic review of 33 articles pertaining to air pollution and time to pregnancy, an indicator of a couple’s reproductive health. The team’s research, titled “Indoor and outdoor air pollution and couple fecundability: a systematic review,” is published in Human Reproduction Update.

Mounting evidence suggests an association between air pollution and longer time to pregnancy. The goal of this review was to compare results from previous studies and identify whether different types of pollution, such as pollution from traffic, chemicals in the workplace, and secondhand smoke, are consistently related to time to pregnancy.

To conduct this research, the team searched six science libraries and reviewed 33 relevant articles published in English between January 1, 1990 and February 11, 2021. Of these 33 articles, eight examined air quality, six looked at secondhand smoke exposure, and 19 studied air quality in the workplace. Researchers assigned each article a quality score based on the study design and extracted relevant data on time to pregnancy.

“This review shows that certain chemicals can increase the amount of time it takes for a couple to conceive, which may cause stress and lead them to seek fertility treatments,” said Dr. Kahn.

Researchers still need more insight into exactly how these chemicals affect reproduction. Future studies should be designed to collect more accurate exposure data, ideally from personal air monitors.

“Our team is still uncertain about whether the air people breathe around time of conception is most important or if there are certain life stages such as puberty when individuals may be especially susceptible to the harmful effects of air pollution,” Dr. Kahn added.

The ECHO Program will provide a useful framework for collecting more detailed information on how chemical exposures across the life course affect reproduction.

Read the research summary.

ECHO researchers study the effects of neighborhood environmental and social conditions on pregnancy and infant health

Posted on by Jodi Snare

Collaborative ECHO research led by Sheena Martenies, PhD, MPH of the University of Illinois at Urbana-Champaign investigates the combined effects of environmental hazards and social stressors on pregnancy and infant health. This research included information on more than 13,000 infants born between 2010 and 2019 from 41 ECHO cohorts located throughout the United States. In this study, researchers found that pregnant women living in neighborhoods with higher combined exposures had shorter pregnancies and smaller babies. This research, titled “Associations between combined exposure to environmental hazards and social stressors at the neighborhood level and individual perinatal outcomes in the ECHO-wide cohort,” is published in Health & Place.

Previous studies have found that neighborhood conditions can influence pregnancy and infant health, but few have examined the effects of exposure to a combination of environmental and social conditions. It is important to look at multiple exposures simultaneously because this more closely mirrors real-world experiences. There are existing tools for looking at combined exposures to environmental hazards and social stressors in neighborhoods, but they either do not have national coverage or they do not cover the time frames needed.

ECHO researchers developed an exposure index which combined data on multiple environmental hazards and social circumstances—including air pollutants, vehicle traffic, poverty, and crowded housing—into a single measure of neighborhood conditions. Pregnant participants were assigned an index score based on where they lived during their pregnancy. Then, the researchers looked at how this index score was associated with birthweight, length of pregnancy, and other pregnancy outcomes.

The researchers found that pregnant women living in neighborhoods with higher combined exposures had shorter pregnancies and smaller babies. For Black pregnant participants, there was a higher risk of preterm birth associated with increased combined exposures during pregnancy compared to White pregnant participants. The researchers also found that pregnant participants living in rural areas had shorter pregnancies and smaller babies compared to pregnant participants living in urban areas who had similar index scores.

More research is needed to determine which factors included in the exposure index are most important in pregnancy and child health outcomes. Some members of the research team are currently studying data from two ECHO cohorts (Healthy Start and MADRES) to explore how neighborhood-level exposures might interact to influence obesity later in life.

Read the research summary.

ECHO Research Explores Sleep Differences Among Pregnant Participants Across Racial and Ethnic Groups

Posted on by Jodi Snare
Maristella Lucchini, PhD

Findings from a collaborative research effort led by Maristella Lucchini, PhD of Columbia University Irving Medical Center, report differences in pregnant individuals’ sleep quality across racial and ethnic groups. Based on the team’s research, pregnant non-Hispanic Black participants slept less and had more sleep disturbances compared with non-Hispanic White participants. Hispanic participants slept longer, had better sleep quality, and experienced fewer sleep disturbances compared with non-Hispanic White participants. This research, titled “Racial/ethnic disparities in subjective sleep duration, sleep quality and sleep disturbances during pregnancy: an ECHO study” is published in Sleep.

The team analyzed data from 2500 pregnant participants in 14 ECHO cohorts nationwide. Information was collected via questionnaire, in which participants reported sleep duration, quality, and disturbances, as well as education level, height, age, and pre-pregnancy weight.

The size of the ECHO cohort created an avenue to investigate and report differences in pregnant individuals’ sleep quality across racial and ethnic groups. “Research shows that pregnant individuals from minority groups are more likely to experience complications during pregnancy, and there is an association between poor sleep and poor maternal health,” said Dr. Lucchini. “We wanted to know if sleep was a factor that contributed to racial and ethnic disparities in overall maternal health.”

Expanding on these findings in future studies may suggest the need for targeted interventions to improve sleep health in pregnancy. Additionally, future studies should explore the factors that contribute to sleep disparities on various levels, including personal, family, neighborhood, and societal.

Read the Research Summary.