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ECHO Cohort Researchers Investigate How Fish Consumption During Pregnancy Affects Child Health

Posted on by Jodi Snare

Fish is an important part of a healthy diet, especially during pregnancy. For example, the evidence-based Dietary Guidelines for Americans recommend that pregnant and breastfeeding women consume 8 to 12 ounces of fish per week.

However, relatively little information is available about how much fish people actually consume in pregnancy, and more research is needed on health outcomes related to consumption of fish, or the omega-3 fatty acids for which fish is a rich source, during pregnancy.

ECHO Cohort researchers addressed these gaps at a recent ECHO Discovery webinar on the science of fish consumption.

Kristen Lyall, ScD of the A.J. Drexel Autism Institute; Emily Oken, MD, MPH of Harvard Medical School and the Harvard Pilgrim Health Care Institute; and Margaret Karagas, PhD of the Geisel School of Medicine and Dartmouth College presented the latest science and discussed what ECHO researchers are hoping to contribute.

These ECHO Cohort researchers described what is currently known about fish consumption during pregnancy and childhood and why the ECHO Program is uniquely positioned to further explore how fish can enhance the health of pregnant women and children.

Fish is rich in omega-3 fatty acids, essential nutrients for healthy fetal brain and eye development, Oken explained. Omega-3 fatty acid consumption during pregnancy also reduces the risk of preterm and early preterm birth, as summarized in a  2023 publication in the American Journal of Obstetrics & Gynecology.

The ECHO Program’s large, diverse participant population allows researchers to better understand the impact of fish consumption and omega-3 supplement intake among pregnant women in the U.S.

Because of the representative sample size, ECHO Cohort researchers are examining consumption of  fish intake and docosahexaenoic acid (DHA) supplements, an omega-3 fatty acid naturally found in seafood, during pregnancy.

Analysis of ECHO Cohort data found that around a quarter of the pregnant participants reported no fish intake during pregnancy. Even fewer participants reported taking omega-3 supplements. (Read the full analysis in the Journal of Public Health Nutrition.)

The data also show that people who did not consume enough fish also did not take DHA supplements. The people who ate enough fish took more supplements, Oken explained. She highlighted that in addition to a positive impact on brain and eye development, taking DHA supplements during pregnancy is associated with decreased preterm birth.

Prenatal fish consumption and autism spectrum disorder

In other recent work, ECHO investigators have examined how eating fish or taking DHA supplements affects childhood autism spectrum disorder (ASD) diagnoses and autism-related traits. (Read the full analysis in the American Journal of Clinical Nutrition.)

ECHO Cohort researchers are in a unique position to examine the relationship between fish intake and supplement use during pregnancy and childhood autism spectrum disorder (ASD) diagnosis and autism-related traits because of the large and representative study population.

A research article published July 1, 2024 in the American Journal of Clinical Nutrition provides an analysis of ECHO Cohort data to address this relationship. This analysis suggests that eating more fish, rather than taking supplements, may be associated with a lower likelihood of ASD diagnosis and, to a lesser extent, a lower likelihood of autism-related traits.

Fish consumption and child growth and development

Many questions remain regarding fish consumption in pregnancy.

The National Academies of Sciences, Engineering, and Medicine (NASEM) recently released a report on the role of maternal and child seafood consumption in child growth and development. Drs. Oken and Karagas served on the report committee, as did ECHO Cohort investigator Julie Herbstman, PhD, of Columbia Mailman School of Public Health; Dr. Herbstman also participated in the ECHO Discovery presentation.

Using data from the National Health and Nutrition Examination Survey (NHANES), the NASEM report found that children ages 1 to 2 years ate fewer than two seafood meals per month on average; only 6 percent of children ages 2 to 19 years reported eating two or more seafood meals per week.

In future work, ECHO Cohort researchers will continue to study how fish consumption impacts child growth and development.  ECHO’s ongoing follow-up, broad focus on health outcomes, and diverse participants allow the initiative to address the many research gaps surrounding the role of fish consumption on child health outcomes.

Reminder: Through the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Data and Specimen Hub (DASH), the ECHO Program provides de-identified data about ECHO participants so that the larger scientific community can discover new insights about pediatric health.

New ECHO Research Finds Association Between Weight Gain in Preterm Infants and Higher Obesity Risk in Children

Posted on by Jodi Snare

Collaborative ECHO research led by Michael O’Shea, MD, MPH of the University of North Carolina, Chapel Hill, School of Medicine investigates the effects of growth and weight gain during infancy on neurodevelopment and obesity in children born very preterm. This research, titled “Association of Growth During Infancy with Neurodevelopment and Obesity in Children Born Very Preterm: The Environmental influences on Child Health Outcomes Cohort,” is published in the Journal of Pediatrics.

Infants born preterm typically have a period of poor growth in their first few months. After this stretch, they typically exhibit “catch-up” growth defined by an increase in weight z-score—a measure to classify a child’s nutritional status—during childhood and adolescence.

Prior research suggested that a “trade-off” may be associated with catch-up growth, such that individuals with more rapid weight gain during infancy have better neurodevelopmental outcomes than individuals with less weight gain. However, rapid catch-up growth during infancy has also been associated with a higher risk of becoming overweight or obese.

This study involved 1,400 children born before 32 weeks of gestation in hospitals in multiple states in the U.S. between 2002 and 2020. A majority of these children experienced neonatal complications—issues faced during the first 28 days of life—the most common of which was neonatal chronic lung disease. These children were followed for 1 to 4 years, at which point their BMI and neurodevelopmental outcomes were assessed. The data collected allowed for analyses of relationships between weight gain following NICU discharge and neurodevelopmental outcomes and BMI at 1 to 4 years of age.

The study team found that in comparison to infants with low weight gain after birth, infants with very high weight gain after NICU discharge, experienced by 13.6% of participants, had higher body mass index (BMI) scores and a higher risk of obesity at 12-48 months.

The study team also found no evidence that very high weight gain after NICU discharge was associated with better neurodevelopmental outcomes at 12 to 48 months of age. However, infants with very low weight gain after NICU discharge had lower scores on cognitive and language assessments. No significant differences were found between girls and boys.

These results suggest there are possible benefits of close monitoring of post-NICU growth and healthier feeding practices to prevent obesity, which is associated with multiple adverse health outcomes.

“Because this study suggests that very preterm infants who experienced a very high increase in body weight during the first four years after NICU discharge were more likely to have a high BMI with similar neurodevelopmental outcomes, avoiding high weight gain might be beneficial to very preterm infants’ health,” Dr. O’Shea said. “However, as single studies rarely provide sufficient evidence to change clinical practice, this study should not be the sole basis for such changes. If the findings of this ECHO study are replicated in other studies, changes in clinical practice might then be appropriate.”

Future studies are needed to evaluate the relationship between the pace of weight gain during early childhood, long-term developmental outcomes, and changes in children’s BMI. This study focused on weight gain among infants born very preterm after discharge from the NICU. Additional studies are needed to observe the effects of different rates of catch-up growth on infants born closer to term.

Read the research summary.

ECHO Presentations at Upcoming Conferences

Posted on by Jodi Snare

From posters and symposiums to oral presentations and flash talks, 19 Environmental influences on Child Health Outcomes (ECHO) Program teams will present at three upcoming conferences.

ISEE: International Society for Environmental Epidemiology: August 25-28, 2024

The International Society for Environmental Epidemiology (ISEE) Conference will be held in Santiago, Chile Aug. 25-28. This year’s conference addresses how the scientific community faces current health environmental justice, and epidemiological challenges, including empirical evidence, methodological approaches, ethical and theoretical developments.

Title Primary Author(s) Type Status
Cord Blood Metabolic Signatures of In-utero Per- and Polyfluoroalkyl Exposure: A Multicohort Study

 

 Leda Chatzi Abstract Accepted as presentation
Prenatal Air Pollution Exposure and Risk of Autism: Findings from ECHO Cohorts

 

 Akhgar Ghassabian Abstract Accepted as oral presentation
Do Area- and Individual-level Sociodemographic Characteristics Modify the Association of Air Pollution with Incident Asthma in the ECHO Program?

 

 Antonella Zanobetti, Rima Habre Abstract Accepted as oral presentation
Patterns of Pediatric Chronic Health Outcomes in the United States: The Environmental influences on Child Health Outcomes (ECHO) Program

 

 Drew B. Day; presented by Christine Loftus) Abstract Accepted as flash talk
Cross-sectional Associations Between Prenatal Maternal Per-/Poly-fluoroalkyl Substances (PFAS) and Bioactive Lipids in Three Environmental influences on Child Health Outcomes Cohorts

 

 Himal Suthar; Max Aung Abstract Accepted as flash talk
Racial and Ethnic Disparities in Prenatal Environmental Phenol and Paraben Exposures in the ECHO Cohorts

 

 Michael Bloom Abstract Accepted as a flash talk
Wildfire-specific Fine Particulate Matter and Adverse Birth Outcomes in the U.S. ECHO-wide Cohort

 

 Allison R. Sherris Abstract Accepted for oral presentation
Drought Exposure Assessment During Pregnancy in the Environmental influences on Child Health Outcomes (ECHO) Cohort

 

 Amii M. Kress Abstract Accepted for oral poster
Drought Exposure During Pregnancy and Birth Outcomes in the Environmental influences on Child Health Outcomes (ECHO) Cohort

 

 Amii M. Kress Abstract Accepted for oral poster
Changes in Prenatal Urinary Concentrations of Triclocarban and Triclosan Following U.S. FDA Ban in 2016

 

 Adaeze C. Wosu Abstract Accepted for flash
oral presentation

 

WCE: World Congress of Epidemiology: September 24-27, 2024

The 23rd World Congress of Epidemiology (WCE) will take place in Cape Town, South Africa Sept. 24-27. This year’s theme is “Epidemiology and complexity: challenges and responses.” WCE brings together epidemiologists and public health experts with the goal of promoting dialogue, the interchange of ideas, and scientific research.

Title Primary Author(s) Type Status
Associations Between the Community Food Environment and Fruit and Vegetable and Sugar-sweetened Beverage Consumption in Children in the ECHO Study

 

 Christine Hockett, Lacey McCormack Abstract Accepted for oral poster

 

ISES: International Society of Exposure Science: October 20-24, 2024

International Society of Exposure Science (ISES) 2024 Annual Meeting will be held Oct. 20-24 in Montreal, Canada. The meeting brings together communities from academia, government and the non-profile sector to discuss issues around exposure science, epidemiology, toxicology, and risk assessments to explore this year’s theme, “Exposures that Impact Health in Vulnerable Populations.”

Title Primary Author(s) Type Status
Exposures to Legacy and Emerging Contaminants in the United States and Associated Determinants and Developmental Outcomes in the Environmental influences on Child Health Outcomes Cohort

 

 Lesliam Quiros-Alcala, Jiwon Oh Symposium Accepted, proposals participating: EC0381, EC0409, EC0646, EC0681, EC0723, EC0716
Widespread Exposure to Legacy and Emerging Contaminants During Pregnancy and Associations with Birth Weight and Gestational Length: The ECHO Program

 

 Jessie P. Buckley Abstract Part of EC0726 symposium. Accepted as presentation
Dietary Predictors of Exposure to Legacy and Emerging Chemicals in Pregnancy: The ECHO Program

 

 Diana Pacyga Abstract Part of EC0726 symposium. Accepted as presentation
Prenatal Exposure to Organophosphate Ester Flame Retardants and Early Life Growth Trajectories of Child Weight and Adiposity

 

 Anne P. Starling Abstract Part of EC0726 symposium
Accepted as presentation
Prenatal Exposure to Phthalates and Alternative Plasticizers and Behavioral Outcomes in Early Childhood: The Environmental influences on Child Health Outcomes (ECHO) Program

 

 Jiwon Oh Abstract Part of EC0726 symposium. Accepted as oral presentation
Prenatal Pesticide Exposure and Airway Outcomes in Infancy and Early Childhood: An ECHO-wide Analysis

 

 Allison R. Sherris Abstract Part of EC0726 symposium. Accepted as an oral presentation
Investigating Disparities in Toxic Chemical Exposures with Neurodevelopmental Effects

 

 Teresa Herrera Abstract Part of EC0726 symposium. Accepted as a poster
Exposures to Contemporary and Emerging Chemicals Among Young Children in the United States Environmental influences on Child Health Outcomes (ECHO) Program

 

 Jiwon Oh Abstract Accepted as poster

Neighborhood Impact on Children’s Well-Being Shifted During COVID-19 Pandemic, ECHO Study Suggests

Posted on by Jodi Snare

FOR IMMEDIATE RELEASE

 

The COVID-19 pandemic significantly disrupted daily life and has raised concerns about its impact on children’s well-being. A new study from the NIH Environmental influences on Child Health Outcomes Program (ECHO) sheds light on how a neighborhood’s physical and social environment influenced a child’s well-being before and during the pandemic.

According to an analysis of ECHO Cohort data, the neighborhood environment was less likely to be associated with child well-being during the pandemic than in the pre-pandemic period. The pandemic brought unprecedented social changes, altering how people and families interacted with their neighborhoods. For example, during the pandemic, neighborhood safety was less of a concern for children who spent more time indoors at home and less time outside. Likewise, the closure of parks and playgrounds limited access to green spaces and recreation, making those factors less important to a child’s well-being at that time.

The study authors point out that the new findings align with previous research showing a link between neighborhood characteristics and child well-being. For instance, previous studies indicate that living in neighborhoods with higher poverty levels, lower educational attainment, and poorer housing conditions are associated with worse child health outcomes, including physical and mental health, cognitive development, and academic achievement.

“Neighborhood characteristics were widely known to be associated with children's well-being. Until now, we hadn't looked at how the COVID-19 pandemic might change their relationships,” said Xueying Zhang, PhD, of Baylor College of Medicine. “Additionally, the impacts of the pandemic may be different among children of different races.”

The study involved 1,039 children from more than 10 ECHO Cohort Study sites across the U.S., mostly between the ages of 11 and 19. These children 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 mental and physical health as well as peer and family relationships in children.

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 race, education, occupation composition of residents, house capacities, and property features. They analyzed how these factors were associated with child well-being, considering the impacts of the pandemic and differences across child racial groups.

"Our findings highlight the significance of how child race intersects with the impact of the pandemic on child well-being,” said Dr. Zhang.  “Future research could examine how people respond differently to environmental impacts during the pandemic and help to address disparities.”

Dr. Zhang led this collaborative research published in Environmental Research.

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About ECHO: Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth on X for the latest ECHO Program updates.

ECHO Cohort Study Finds Link Between Infant Gut Microbiome and Autism-Related Traits

Posted on by Jodi Snare

Collaborative ECHO research led by Vanja Klepac-Ceraj, PhD, of Wellesley College, and Juliette C. Madan, MD, MS, of Dartmouth Hitchcock Medical Center, investigates the relationship between the infant gut microbiome and childhood autism-related traits. This research, titled “Prospective Association of the Infant Gut Microbiome with Social Behaviors in the ECHO Consortium,” is published in Molecular Autism.

The study sought to identify gut bacteria linked to social traits and brain development in two ECHO Cohort Study Sites. Researchers found that certain features of the gut microbiome of infants were associated with higher scores on the Social Responsiveness Scale-2 (SRS-2), a questionnaire that measures autism-related traits. Specifically, certain bacteria and their functional genes, particularly those related to the production of short-chain fatty acids, were linked to autism-related traits. These associations varied between sex and age groups.

“The findings of this study help us understand the potential likelihood of autism-related traits through the gut-brain axis,” said Dr. Klepac-Ceraj. “This understanding could open up new avenues for targeted early interventions.”

Researchers studied 481 samples from 304 healthy child participants from ECHO Cohort study sites in New Hampshire and Rhode Island. The children were between 6 weeks and 2 years old when they provided stool samples and between 3 and 19 years old when social traits were assessed.

In this study, researchers compared groups of participants from two different study sites, focusing on their gut microbiomes when they were younger and social traits related to ASD at a later age. Both study sites contributing to this analysis had previously sequenced bacterial DNA from fecal samples collected from infants or toddlers. They calculated how common certain bacteria were in each sample and related that to the participant’s social behavior scores.

Future studies could explore interventions that could change the gut bacteria and potentially influence how the brain develops. Researchers also plan to investigate the influence of the developing gut microbiome on other neurobehavioral outcomes, such as anxiety and depression.

Read the research summary.

New ECHO Research Investigates Relationship Between Phthalate Exposure and High Blood Pressure, Related Complications During Pregnancy

Posted on by Jodi Snare

Collaborative ECHO research led by John Meeker, ScD of the University of Michigan, and Jordan Kuiper, PhD of George Washington University, investigates the relationship between phthalate exposure and high blood pressure during pregnancy. This research, titled “Urinary concentrations of phthalate metabolites in relation to preeclampsia and other hypertensive disorders of pregnancy in the Environmental influences on Child Health Outcomes (ECHO) program,” is published in Environment International.

This study aimed to evaluate whether phthalate exposures could be linked to ongoing high blood pressure during pregnancy and more severe pregnancy complications like preeclampsia or eclampsia.

“The findings of this study suggest that exposure to certain phthalates found in plastics and other consumer products may be associated with pregnancy complications such as gestational hypertension or preeclampsia,” said Meeker.

Researchers evaluated data from 3,430 participants from eight ECHO sites across the U.S., which enrolled pregnant participants from 1999 to 2019. In the study, researchers measured the levels of 13 metabolites linked to phthalate exposure in urine samples collected at least once during pregnancy. They then evaluated the association between individual phthalates, as well as the combined mixture of phthalates, with the risk of developing preeclampsia, eclampsia, or ongoing high blood pressure during pregnancy.

The researchers measured phthalate exposure by checking urine levels of certain small molecules, called metabolites, that the body makes when it breaks down chemicals. They found that higher levels of these metabolites were linked to a higher risk of pregnancy complications like preeclampsia, eclampsia, and ongoing high blood pressure. For example, if the level of a metabolite called mono (3-carboxypropyl) phthalate (MCPP) doubled, the risk of developing preeclampsia or eclampsia increased by 12%. MCPP is related to phthalates found in PVC plastics and insect repellents.

The researchers also examined combined phthalate exposure by dividing participants into four groups based on their exposure levels. Each increase in exposure level was linked to a 27% higher risk of preeclampsia or eclampsia, which was generally higher for pregnant women carrying female fetuses.

Future studies can help researchers understand how exposure to phthalates might be linked to high blood pressure during pregnancy, how this happens in the body, and what we can do to reduce the risk of these pregnancy complications.

Read the research summary.

ECHO Researchers Examine the Effect of Perinatal Synthetic Oxytocin Exposure and Maternal BMI on Child Neurodevelopmental Outcomes

Posted on by Jodi Snare

Lisa Kurth, PhD

Collaborative ECHO Cohort research led by Lisa Kurth, PhD of the University of Colorado, Anschutz Medical Campus investigates the potential influence of maternal exposure to synthetic oxytocin during childbirth—and the contribution of maternal obesity—on neurodevelopmental outcomes in children. Synthetic oxytocin (e.g., Pitocin, Syntocinon) is a drug commonly used to assist women during childbirth by stimulating uterine contractions.

The researchers examined data from over 12,000 mother-child pairs to look at possible associations between maternal exposure to synthetic oxytocin, maternal pre-pregnancy body mass index (BMI), and childhood ADHD and Autism Spectrum Disorder (ASD). The results of this study found no significant correlation between synthetic oxytocin exposure and the risk of ADHD and ASD in children. However, an unexpected finding in this study was that synthetic oxytocin exposure was associated with a decreased childhood risk of ADHD in children born to mothers with pre-pregnancy obesity. Additionally, mothers with pre-pregnancy obesity demonstrated a modest trend toward labor intervention with synthetic oxytocin. This research, titled “Intrapartum Exposure to Synthetic Oxytocin, Maternal BMI and Neurodevelopmental Outcomes in Children within the ECHO Consortium,” is published in the Journal of Neurodevelopmental Disorders.

Previous studies on the association between synthetic oxytocin and children’s risk of ADHD and ASD have been decidedly mixed, and the potential impact of the mother’s pre-pregnancy BMI on this association has, until now, not yet been examined. This study analyzed data from participating mothers, 48% of whom were exposed to synthetic oxytocin during childbirth, and their children from ECHO Cohort research sites across the U.S.

Although no significant correlation was found between synthetic oxytocin-assisted childbirth and neurodevelopmental outcomes in children, future research may further unravel the effects of childbirth factors such as synthetic oxytocin dosage, maternal labor duration, maternal gestational obesity and Caesarean delivery rationale, indicators of newborn health (e.g., initial Apgar score, meconium stain, newborn birthweight), and maternal BMI at time of delivery on infant well-being in relationship to child neurodevelopmental outcomes. Important next steps include analysis of biospecimens (placental tissue and cord blood) aimed at understanding the specific mechanism(s) of action involved in synthetic oxytocin exposure.

“Casting a wider net and including additional factors will allow future studies to more precisely examine the effects of important perinatal factors, including environmental exposures, and effect modifiers, such as maternal obesity, on child neurodevelopmental outcomes,” said Dr. Kurth.

Read the research summary.

New ECHO Research Suggests Harsh Parenting and High Socioeconomic Stress May Be Associated With Higher Internalizing Problems in Children

Posted on by Jodi Snare

Collaborative ECHO research led by Lue Williams, MA, MS, Veronica Oro, PhD and Leslie Leve, PhD of the Prevention Science Institute at the University of Oregon investigates the relationship between two early childhood stress factors, harsh parenting and socioeconomic stress, and children’s development from childhood through adolescence. This research, titled “Influence of Early Childhood Parental Hostility and Socioeconomic Stress on Children’s Internalizing Symptom Trajectories from Childhood to Adolescence,” is published in Frontiers in Psychiatry.

Internalizing problems in childhood 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 looked at how harsh parenting and socioeconomic stress were associated with internalizing problems in children. 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.

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, from September 2003 through 2004.

The researchers analyzed data collected from the EGDS and FLP, and 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, but did not find any significant relationship between child sex assigned at birth and how likely they would be to show internalizing behaviors.

“Not many studies have examined early childhood predictors of internalizing behavior developments, so our research fills an important gap by examining the role of diverse risk factors in early life on patterns of internalizing symptoms later in childhood,” Williams said. “Our findings 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.”

Future studies are needed to further support programming and research efforts by exploring how socioeconomic stress and parenting styles can influence children’s internalizing behaviors identified in the current study.

Read the research summary.

Living Near Green Space Associated With Fewer Emotional Problems in Preschool-Age Kids, NIH Study Finds

Posted on by Jodi Snare

FOR IMMEDIATE RELEASE

 

Children who live in areas with natural spaces (e.g., forests, parks, backyards) from birth may experience fewer emotional issues between the ages of 2 and 5, according to a study funded by the NIH Environmental Influences on Child Health Outcomes (ECHO) program.

While research has suggested that time in nature is important for mental health, studies examining the effects on young children are limited. ECHO investigators addressed this research gap by analyzing information from parents about the behavior of their children from ages 2 to 11. They combined this data with the family’s residential address when the child was born and satellite data on live vegetation density around their homes.

What researchers found in their analysis, published in JAMA Network Open, was that higher levels of green spaces up to three-fourths of a mile from a child’s home were linked with lower anxiety and depression symptoms from ages 2 to 5 years. The association persisted even after researchers factored in the child’s sex, parent education, age at birth, and neighborhood socioeconomic vulnerability. Researchers did not find a significant association between green space around the home and mental health symptoms in later childhood years from ages 6 to 11, when children spend more time at school.

“Our research supports existing evidence that being in nature is good for kids,” said Nissa Towe-Goodman, PhD, an ECHO researcher from the Frank Porter Graham Child Development Institute at the University of North Carolina, Chapel Hill. “It also suggests that the early childhood years are a crucial time for exposure to green spaces.”

Most research so far has been limited to studying one or a few cities at a time, and focused on adult health. Because the ECHO Program collects data nationwide, 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.

The study included children born between 2007 and 2013 and whose parents completed the Child Behavior Checklist, a common survey to rate a child’s emotional and behavioral symptoms. The 2,103 children included in the study ranged in age from 2 to 11, spanning early and middle childhood.

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 close to zero represent areas without live vegetation.

“In the future, researchers could look into what kinds of experiences in nature are connected to kids' early mental health,” said Dr. Towe-Goodman. “Also, we should study how creating or preserving natural areas around homes and schools might make a difference in a child’s mental health.”

Dr. Towe-Goodman lead this collaborative research in JAMA Network Open.

###

About ECHO:

Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

 

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth on X for the latest ECHO Program updates.

New ECHO Research Reveals Link Between Phthalate Exposure During Pregnancy and Multiple Health Outcomes in Children

Posted on by Jodi Snare

Drew Day, PhD

Collaborative ECHO research led by Drew Day, PhD of Seattle Children’s Research Institute uses machine learning statistical algorithms to explore patterns of health outcomes in children. The researchers also investigated how exposures during pregnancy to phthalates—chemicals widely used in plastics that have previously been linked with preterm birth—can influence the development of multiple health conditions during childhood. This research, titled “Subpopulations of children with multiple chronic health outcomes in relation to chemical exposures in the ECHO-PATHWAYS consortium,” is published in Environment International.

Chronic health conditions, such as asthma and obesity, can develop together during childhood but are usually studied separately. The goal of this study was to use data from ECHO Cohort research sites across six U.S. cities to characterize “clusters,” or patterns, of obesity-related, lung health, and brain development outcomes in children and to investigate how these patterns relate to mothers’ exposures to phthalates during pregnancy.

ECHO researchers looked at 15 health outcomes in 1,092 children between the ages of 4 and 9 across six U.S. cities and collected measurements of phthalate exposure during pregnancy from 856 of these children’s mothers. Outcomes collected during this study included body mass index (BMI), IQ, anxiety, depression, irritability, learning disabilities, speech problems, asthma, wheeze, and nasal allergies. The researchers evaluated how children developed multiple outcomes and investigated how the probability of being in a particular group was affected by exposure to 15 plastic-associated phthalate chemicals during pregnancy. The researchers measured phthalate exposure during pregnancy using urine samples collected from 2007–2014 from mothers during late pregnancy.

The researchers identified three groups of children with a pattern of health outcomes that occurred together:

  1. A group of relatively healthy children;
  2. A group of children with lower IQs, elevated obesity, and slightly elevated asthma-related outcomes such as asthma, wheezing, and allergies; and
  3. Another group of children with high asthma-related outcomes along with elevated obesity and some increase in anxiety- and depression-related outcomes.

Compared to children in the healthy group, other groups had more male children, mothers with higher BMI and lower education attainment, and lower household incomes. The researchers found that children—particularly boys—were more likely to be in the third group if their mothers were exposed to phthalates during pregnancy.

These findings suggest that exposure to phthalates during pregnancy might be associated with an increased risk of developing not only asthma and related lung outcomes, but also obesity and mental health issues such as anxiety and depression. This study also suggests that low-income households are at higher risk for worse childhood health outcomes.

“The three patterns of health outcomes seen in this study reveal more about how pediatric diseases might arise together,” said Dr. Day. “The insights from this study could help inform future research on what biological processes contribute to these health outcome patterns as well as better treatments and interventions to enhance child health.”

This study’s multi-outcome approach can be used in future studies to identify public health risks that may affect central biological processes that result in multiple negative health outcomes. ECHO Cohort researchers are working to extend this method to include several additional U.S. research sites, which will allow them to evaluate whether similar patterns are observed in a larger dataset. Larger studies will also help researchers characterize how demographic differences like income and sex may influence the development of multiple health outcomes during childhood.

Read the research summary.