Press Releases

Prenatal Smoking Associated with Higher Risk of Mental Health Challenges in Children

Posted on by Jodi Snare

Mother and toddler laughingChildren exposed to maternal smoking before birth are more likely to experience behavioral and mental health challenges, according to a large study funded by the National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) Program.

While previous research had linked prenatal smoking to acting out or rule-breaking, it was less clear whether smoking during pregnancy also affects broader mental health outcomes and whether effects differ by sex.  The new study sheds light on these questions, examining thousands of children across the U.S. and identifying periods when exposure may be most impactful.

“These findings show that prenatal nicotine exposure can affect more than just acting-out types of behavior problems—it can influence children’s overall mental health and experiences of both emotional and behavioral problems at the same time,” said Kristine Marceau, PhD, of Purdue University. “Understanding when kids are most vulnerable can help families and healthcare providers provide support at the right time.”

Researchers analyzed data from 16,335 children ages 1 to 18 from 55 ECHO Cohort Study Sites. Behavioral assessments measured emotional and behavioral symptoms using standardized questionnaires.

Key Findings

  • Widespread Impact: Children exposed to prenatal smoking were more likely to have multiple mental health or behavioral symptoms at the same time.
  • Critical Windows: The strongest effects appeared in early childhood (under age 7) and early puberty (ages 9–12).
  • Similar Effects for Boys and Girls: Both sexes were affected in comparable ways, with slightly higher symptom levels in boys only at ages 13–14.
  • Independent of Family Background: Associations persisted even after considering family history and other environmental factors, such as maternal age, education, and additional substance exposures.

Future studies could take a closer look at the timing, amount, and frequency of smoking during pregnancy. Researchers could also work to better understand which effects are due to smoking itself—rather than other family factors—and how nicotine and other chemicals in smoke may affect how children grow and develop.

This collaborative research, titled “Prenatal Smoking and Child Psychopathology Associations by Age and Sex in the ECHO Cohort,” is published in Development and Psychopathology.

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.

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Housing Conditions and Outdoor Air Pollution Together Affect Children’s Asthma Risk, New ECHO Study Shows

Posted on by Jodi Snare

Children growing up in homes with water damage or dampness and exposed to higher levels of outdoor air pollution during early childhood face a greater risk of developing asthma, according to new research supported by the NIH’s Environmental influences on Child Health Outcomes (ECHO) Program. The large multisite study found that early-life exposure to fine particulate matter (PM2.5) and indoor housing problems each independently raised asthma risk, while having a dog during infancy was linked to reduced risk.

Asthma affects millions of U.S. children, yet the environmental origins of the disease are complex. While previous research has tended to study exposures such as pollution or indoor allergens separately, this study shows that evaluating them together offers a more accurate picture of children’s risk. The ECHO Program, which brings together data from diverse U.S. populations, made this integrated analysis possible.

Drawing on data from 6,413 children across nine U.S. ECHO Study Sites, the research provides one of the clearest looks yet at how multiple early-life environmental factors interact to influence childhood asthma. The findings underscore the importance of assessing both indoor and outdoor environments together, rather than in isolation — an approach that prior studies often could not address due to limited sample sizes.

“Our research shows that to truly understand and prevent childhood asthma, we need to look at a child’s full environment—both the air they breathe outside and the conditions inside their home,” said Akihiro Shiroshita, a study author from Vanderbilt University School of Medicine. “Considering these factors together gives us a much clearer picture of what puts children at risk and how we can better protect them.”

Key Findings

  • Outdoor air pollution matters: Higher early life exposure to PM2.5 was associated with increased asthma risk.
  • Indoor environments matter too: Home dampness or water damage independently raised asthma risk, even after accounting for pollution exposure.
  • Pets may offer protection: Having a dog in the home during infancy was linked to a lower risk of developing asthma.
  • Large, diverse dataset: The study combines data from multiple U.S. ECHO Study Sites, offering a comprehensive view of environmental impacts on children’s respiratory health.

Researchers evaluated children’s exposure to PM2.5 during the first three years of life and combined that information with detailed data on early life housing conditions — including water damage, dampness, pet exposure, and dust mites. Childhood asthma was identified based on caregiver reports or physician diagnosis between birth and age five. The analysis also controlled for family and neighborhood factors to isolate the effects of environmental exposures.

The findings signal the need for additional research into how indoor and outdoor exposures interact and how early life interventions could help reduce asthma risk in children nationwide.

This collaborative research was published in Environmental Epidemiology.

About ECHO
The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

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 connector

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

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Prenatal and Early-Life Pollution Exposures May Influence Childhood Blood Pressure Patterns, ECHO Study Finds

Posted on by Jodi Snare

A child’s blood pressure may be influenced by exposure to air pollution before and shortly after birth, according to a new study from the NIH-funded Environmental influences on Child Health Outcomes (ECHO) Program. The study focused on fine particulate matter (PM2.5) and nitrogen dioxide (NO2), common pollutants from vehicles, power plants, and other industrial sources.

High blood pressure in children is becoming more common worldwide and can lead to long-term health problems, including heart disease and impaired kidney function. Over the past two decades, childhood hypertension has increased by nearly 80 percent, particularly in countries with higher obesity rates, such as the United States. Because the roots of adult hypertension often begin in childhood, ECHO researchers examined whether early exposure to outdoor air pollution may influence blood pressure in children.

Air pollutants such as PM2.5 and NO2 are known contributors to cardiovascular disease in adults, but their effects on children’s blood pressure are less well understood. Previous studies have produced mixed results and were often limited to single locations. This ECHO study leveraged data from multiple cohort sites across the United States to better clarify these associations.

Researchers analyzed data from 4,863 children ages 5 to 12 from 20 ECHO Cohort Study Sites. They estimated outdoor air pollution exposure at participants’ home addresses during each trimester of pregnancy, across the full pregnancy, and during the child’s first two years of life. Children’s blood pressure was measured during study visits and compared with typical values for children of the same age, sex, and height. Blood pressure was considered high if it fell within the top 10 percent of these values.

Key Findings

  • PM2.5 exposure and higher blood pressure: Children who were exposed to higher levels of PM2.5 before and after birth had higher blood pressure on average between ages 5 and 12.
  • Early pregnancy as a sensitive period: Higher PM2.5 exposure during the first trimester was associated with a more pronounced systolic blood pressure and a greater likelihood of high blood pressure in childhood, indicating that early pregnancy may be a particularly sensitive period.
  • Unexpected findings for NO2: Higher maternal exposure to NO2 during pregnancy was associated with slightly lower blood pressure in children. This association was strongest during mid- to late pregnancy, particularly the second trimester, and was not linked to an increased risk of high blood pressure.
  • Timing matters: The results suggest that the timing of pollution exposure during pregnancy may be important for understanding its impact on children’s cardiovascular health.

“These findings add to growing evidence that early-life exposure to fine particulate air pollution may affect children’s cardiometabolic health, even at relatively low levels,” said study author Yu Ni, PhD, of San Diego State University. “The unexpected findings related to nitrogen dioxide suggest that more research is needed to understand how this type of air pollution may affect children’s developing bodies, as well as whether other environmental factors could be playing a role, such as transportation noise.”

This collaborative research was published in Environmental Research.

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.

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

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Wildfire Smoke Exposure During Pregnancy Linked to Higher Risk of Preterm Birth, ECHO Study Finds

Posted on by Jodi Snare

Study highlights increased risk, especially in Western states and during intense smoke events

Exposure to wildfire smoke during pregnancy was associated with a higher risk of preterm birth, especially in the Western United States and during periods of intense or prolonged smoke, according to a study funded by the National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) Program.

Wildfires are becoming more frequent and severe, raising concerns about their impact on public health. While previous studies suggested a link between wildfire smoke and preterm birth, ECHO’s research built on this by studying a diverse population from prospective cohort sites nationwide. Researchers also looked closely at the role of exposure intensity, duration, and timing.

“Our study adds to growing evidence that wildfire smoke is a concern for maternal and child health. Incorporating wildfire smoke considerations into prenatal care and public health guidance could help expecting parents protect themselves during smoke events, especially in areas where wildfires are common,” said Allison Sherris, PhD, of the University of Washington.

Researchers analyzed data from over 20,000 births between 2006 and 2020 at 30 study sites across the U.S. They matched daily levels of air pollution from wildfire smoke (fine particulate matter, or PM2.5) to each participant’s home address during pregnancy. They tracked both the average amount of smoke and the number of “smoke days,” as well as “smoke waves”—stretches of consecutive days with high smoke levels.

The team used statistical methods to compare pregnancies week by week and adjusted for many factors, including maternal age, race, ethnicity, neighborhood poverty, season of conception, birth year, and more.

Key Findings

  • Widespread Exposure: Nearly all pregnant participants (99.2%) experienced at least one day of wildfire smoke, with an average of 22 smoke days during pregnancy.
  • Preterm Birth Risk: The overall rate of preterm birth was 8.4%, with higher rates among Black (11.7%) and American Indian or Alaska Native (13.5%) participants compared to White (7.6%) and Asian, Native Hawaiian, or Pacific Islander (8.0%) participants.
  • Link Between Smoke and Preterm Birth: For every 1 microgram per cubic meter (µg/m³) increase in average wildfire PM2.5 during pregnancy, the odds of preterm birth increased by about 7%. The association was even stronger in the Western U.S., where wildfire smoke is more intense and frequent.
  • Intensity and Duration Matter: The risk of preterm birth was higher with more intense smoke and longer-lasting smoke events. The strongest associations were seen for mid-pregnancy exposure to lower levels of smoke and late-pregnancy exposure to high-intensity smoke days.
  • Critical Windows of Vulnerability: Certain periods during pregnancy—especially mid-pregnancy for lower-intensity smoke and late pregnancy for high-intensity smoke—were linked to the greatest risk increases for preterm birth.

“Preterm birth has strong implications for future child health. Better understanding of how to prevent preterm birth will pay off as a healthier population into the future,” said Catherine Karr, MD, PhD, of the University of Washington.

The study points to the need for more research on why some regions or groups may be more affected, how wildfire smoke combines with other risks like extreme heat, and which prevention strategies work best. It also highlights the importance of public health agencies and healthcare providers offering ways to help keep pregnant people safe during wildfire events.

This collaborative research was published in The Lancet Planetary Health.

About ECHO
The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

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 the ECHO Program on LinkedIn and X for the latest updates.

Toddlers Showed Slightly Fewer Behavioral Problems During COVID-19 Pandemic, NIH Study Finds

Posted on by Jodi Snare

Toddlers assessed during the COVID-19 pandemic had slightly fewer emotional and behavioral problems compared to children assessed before the pandemic, suggesting some toddlers may have shown resilience during this time. This finding comes from a study of over 3,000 children across the United States using data from the Environmental influences on Child Health Outcomes (ECHO) Cohort Consortium collected between September 2009 and July 2023.

The COVID-19 pandemic disrupted family patterns and children’s environments, both critical for early brain development and well-being. While earlier research raised concerns about infants born during the pandemic, there is limited information about how toddlers’ emotional and behavioral health might have been affected.

To explore this, the study examined data from 3,438 toddlers (average age of 2 years) across the U.S. and Puerto Rico. Researchers used the Preschool Child Behavior Checklist (CBCL), a parent-reported measure of child behavior and emotions, to compare children assessed before and during the pandemic.

Children were grouped based on when they were born and when their behavior was assessed: before the pandemic, born before but assessed after March 2020, or both born and assessed during the pandemic. Parents completed the CBCL, which asks about behaviors such as anxiety, sadness, and aggression. These reports helped researchers understand how growing up during the pandemic might have influenced toddler emotional and behavioral health.

Key findings include:

  • Children who experienced the pandemic had significantly lower scores for internalizing problems (such as anxiety and sadness) and externalizing problems (such as aggression or hyperactivity) compared to children assessed before the pandemic.
  • Internalizing problem scores were about 1.5 to 2 points lower, and externalizing problem scores were about 1.7 to 3.2 points lower than those born and assessed before the onset of the pandemic.
  • Although the differences were small, they were consistent. The associations were stronger among children whose mothers did not have a bachelor’s degree.

“Our findings suggest that even during periods of widespread pandemic-related disruption, toddler-aged children may have experienced opportunities for resilience,” said study author Anahid Akbaryan, a Research Associate at NYU Grossman School of Medicine. “Future research should explore within-home factors that may have supported child mental health outcomes during this time, such as consistent caregiving routines, household stability, and positive parental coping strategies to identify potential protective influences during times of instability.”

Study author Lauren Shuffrey, PhD, of NYU Grossman School of Medicine, added, “These findings suggest that some families may have adapted in ways that buffered young children from behavioral challenges during the pandemic, highlighting the importance of identifying and strengthening those protective supports.”

The researchers emphasized that further studies are needed to identify these protective factors and develop strategies to help families support child well-being during and after times of global disruptions.

This collaborative research is published in JAMA Network Open.

About ECHO
The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

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 the ECHO Program on LinkedIn and X for the latest updates.

Exposure to Low Levels of Arsenic in Public Drinking Water Linked to Lower Birthweight, Preterm Birth, Study Finds

Posted on by Jodi Snare

Babies born to mothers potentially exposed to low levels of arsenic in public drinking water—even at levels below the federal safety standard—were more likely to be born preterm, with lower birthweight, or be smaller than expected, according to a study funded by the National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) Program.

While the U.S. Environmental Protection Agency sets a maximum contaminant level of 10 micrograms per liter for arsenic in public water systems, this study examines how even lower-level arsenic exposures may still affect pregnancy outcomes in a large population. Previous research largely focused on private wells or smaller study groups.

Because arsenic occurs naturally, water that comes in contact with certain rocks and soils may contain it. Contamination from various industrial processes also contributes to increased levels of arsenic in some areas.

“Most U.S. residents rely on public drinking water, and our findings suggest that further reducing arsenic in public water systems could be an important step to improve infant health across the U.S.,” said Anne Nigra, PhD, of Columbia University’s Mailman School of Public Health. “Even low levels of arsenic in public drinking water were associated with low birthweight and other adverse birth outcomes in U.S. infants.”

Key takeaways include:

  • Potential arsenic exposure during pregnancy—even at levels below the current federal safety standard—may be linked to adverse birth outcomes.
  • Mothers exposed to higher levels of arsenic in public drinking water were more likely to have babies born with low birthweight or smaller than expected for the number of weeks of pregnancy.
  • These patterns were seen across several racial and ethnic groups, including White, Black, and Hispanic/Latino families. Similar risks were also observed among babies born to American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander parents.
  • Babies born to Black parents faced higher risks of being born early, having low birthweight, or being smaller than expected.

Researchers analyzed data from nearly 14,000 mother-infant pairs from the ECHO Cohort. Arsenic exposures during pregnancy were estimated by combining water quality data with the residential histories of participants. No actual arsenic levels were tested for these participants.

This collaborative research was published in JAMA Network Open.

Nigra, A., et al. (2025) Public water arsenic and birth outcomes in the Environmental influences on Child Health Outcomes Cohort. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2025.14084

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About ECHO
The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

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 for the latest ECHO Program updates on X.

Early Childhood Weight Patterns May Signal Future Obesity Risk, NIH Study Finds

Posted on by Jodi Snare

Happy boy eating apple while communicating with his teacher during lunch time.Researchers identified growth patterns and early-life factors linked to higher obesity risk at age 9.

Not all children grow the same way. A new study from the Environmental influences on Child Health Outcomes (ECHO) Program suggests that body weight changes in early childhood may be associated with later obesity risk.

Funded by the National Institutes of Health (NIH), the study tracked children’s body mass index (BMI) from infancy through age 9 and found two distinct growth patterns. Most children followed a typical curve, with BMI decreasing in early childhood before gradually rising again. But a smaller group followed a trajectory marked by a sharp rise in BMI, which put them at higher risk of developing obesity by age 9.

Key takeaways:

  • Researchers found two main BMI growth patterns in children. Most children (89.4%) had a typical pattern where their BMI declined from ages 1 to 6, then rose slowly. A smaller group (10.6%) had an atypical pattern where their BMI stayed the same from ages 1 to 3.5, then increased rapidly from ages 3.5 to 9.
  • By age 9, children in the atypical group were more likely to develop obesity, with an average BMI higher than the 99th percentile.
  • Several early-life factors were associated with the child’s risk of developing obesity, including high birthweight, maternal smoking during pregnancy, high maternal BMI before pregnancy, and excessive maternal weight gain during pregnancy.

Childhood obesity—defined as having a BMI at or above the 95th percentile for a child’s age and sex—is often the result of excess body fat. Without support or intervention, children with higher BMI patterns in early life are more likely to carry that weight into adolescence and adulthood, increasing their chances of developing serious health conditions like diabetes and heart disease.

“The fact that we can identify unusual BMI patterns as early as age 3.5 shows how critical early childhood is for preventing obesity,” said ECHO researcher Chang Liu, PhD, of Washington State University.

The study included 9,483 children across the United States who are part of the ECHO Cohort. Researchers looked at weight and height data collected over time from medical records, caregiver reports, and in-person or at-home measurements. They tracked how children's BMI changed as they grew and looked for patterns related to experiences early in life.

“Our findings suggest there are important opportunities to reduce childhood obesity, such as helping pregnant women quit smoking and manage healthy weight gain, as well as closely monitoring children who show early signs of rapid weight gain,” said Liu.

This collaborative research is published in JAMA Network Open.

Liu, Chang, M., et al. (2025) Early-Life Factors and Body Mass Index Trajectories Among U.S. Children in the ECHO Cohort. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2025.11835

 

About ECHO
The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

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 for the latest ECHO Program updates on X.

Maternal Cardiometabolic Health During Pregnancy Associated with Higher Blood Pressure in Children, NIH Study Finds

Posted on by Jodi Snare

Children born to mothers with cardiometabolic health issues before or during pregnancy may face a higher risk of elevated blood pressure in childhood and adolescence, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health (NIH).

High blood pressure in childhood often continues into adulthood and is linked to a greater risk of heart problems later in life. This ECHO research offers insights into how a mother’s heart and metabolic health before and during pregnancy may contribute to her child’s long-term cardiovascular well-being.

The study analyzed data from 12,480 mother-child pairs in the ECHO Program. Researchers looked at how three maternal cardiometabolic risk factors—pre-pregnancy obesity, gestational diabetes, and high blood pressure during pregnancy—were related to children’s blood pressure from ages 2 to 18.

Key Findings:

  • 44% of mothers in the study had at least one cardiometabolic risk factor during pregnancy.
  • Children whose mothers had more than one condition, such as gestational diabetes combined with high blood pressure or pre-pregnancy obesity, had higher blood pressure than those whose mothers had only one condition.
  • Children born to these mothers had higher average blood pressure readings, even after accounting for age, sex, and height of the child.
  • These children also experienced an increased rate of change in blood pressure over time, suggesting a long-term impact.
  • The effect was especially strong for diastolic blood pressure in girls and systolic blood pressure in non-Hispanic Black children whose mothers had gestational diabetes or high blood pressure.

“With declines in cardiometabolic health, it’s important to focus on prevention starting as early as possible,” said ECHO researcher Zhongzheng Niu, PhD, of the Keck School of Medicine at the University of Southern California. “Our study suggests that helping people improve their health before and during pregnancy could benefit both mothers and future generations."

The researchers in this study call for further studies to understand how combinations of maternal health issues and broader social and structural factors contribute to these long-term risks.

This collaborative research is published in JAMA Network Open.

Niu, Z. Maternal Cardiometabolic Risk Factors in Pregnancy and Offspring Blood Pressure at Age 2-18 Years. JAMA Network Open, DOI: 10.1001/jamanetworkopen.2025.9205.

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 for the latest ECHO Program updates on X.

Children Born in Lower-Opportunity Neighborhoods May Face Higher Incidence Rates of Asthma with Recurrent Exacerbations, NIH Study Finds

Posted on by Jodi Snare

Children born in neighborhoods with fewer opportunities are more likely to experience repeated asthma flares requiring emergency care or medical treatment, with non-Hispanic Black children having the highest incidence rates of asthma with recurrent exacerbations, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

Asthma with recurring exacerbations (AREs) is a more severe form of childhood asthma linked to worsened health, high medical costs, and significant challenges for both the patient and their family, especially compared to well-controlled asthma. ARE affects many children in the U.S., with about 6 and a half cases per 1,000 children per year in the nationwide ECHO program.

Neighborhood factors—such as access to housing, healthy food, transportation, and education—can impact childhood asthma development. The Child Opportunity Index (COI) is one measure used to assess these conditions, connecting residential addresses at different early-life stages to data on neighborhood resources. This index combines information from 29 factors, such as access to good schools, healthy food, parks, clean air, and job opportunities. Studies have shown that neighborhoods with higher COI scores tend to have better conditions that help children grow up healthier and have more opportunities for economic success.

ECHO researchers used the COI to analyze how these factors influenced the development of this severe type of childhood asthma. The study included data from 15,877 children born between 1990 and 2018 across 60 ECHO study sites in the U.S.

“This study suggests that individual- and neighborhood-level exposures may affect the risk for developing childhood ARE,” said Rachel Miller, MD, of the Icahn School of Medicine at
Mount Sinai.

Researchers found that:

  • Children from low-opportunity neighborhoods had significantly higher incidence rates of asthma with recurrent exacerbations (ARE) than those from higher-opportunity areas.
  • Non-Hispanic Black children had the higher rates across all neighborhood categories when compared to Non-Hispanic White children.
  • Among children in very low-opportunity neighborhoods, non-Hispanic Black and Hispanic Black children had rates of ARE several times higher than non-Hispanic White children.
  • Young children (ages 2 to 4) and those with a parent who had asthma had a higher risk of ARE. .

What happened during the study

In this study, researchers followed children from ages 2 to at least 5, and up to age 19. They collected information on asthma diagnoses and the use of corticosteroids, a medication that helps reduce inflammation in the body. ARE was identified if a child used corticosteroids at least twice during the follow-up period while being monitored by ECHO researchers.

The study also examined the link between COI scores and children's birth addresses. Researchers analyzed how neighborhood conditions influenced the development of asthma with recurrent exacerbations while accounting for individual health history and other factors.

“This study adds to the mounting evidence that investing in neighborhood resources may have a myriad of respiratory health benefits for children,” said Dr. Miller.

Additional studies could help researchers further understand the prenatal and early childhood determinants of ARE at both the individual and neighborhood levels.

This collaborative research was published in the Journal of Allergy and Clinical Immunology.

About ECHO
The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

Miller, R. and Johnson, C. Child Opportunity Index at Birth and Asthma with Recurrent Exacerbations in the U.S. ECHO Program. Journal of Allergy and Clinical Immunology, DOI: 10.1016/j.jaci.2025.02.036

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 for the latest ECHO Program updates on X.

For Teens’ Mental Health, Strong Friendships Matter More Than Social Media Use, NIH Study Finds

Posted on by Jodi Snare

Teens who report strong, high-quality friendships tend to have better mental health—an influence that appears nearly three times stronger than the link between social media use and mental health challenges, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

Today’s teens spend a lot of time online. This has raised concerns about how digital interactions affect teens’ well-being. As social media use has grown, some wonder if it’s playing a role in the rise of teen mental health challenges. Such concerns prompted the U.S. Surgeon General to issue a warning in 2023 about the potential impact of social media on youth mental health.

“Social media use does not occur in a vacuum—it’s one piece of a much larger picture,” said Courtney K. Blackwell, PhD, of Northwestern University’s Feinberg School of Medicine. “Our study found that peer relationships seem to matter a lot more than social media when it comes to teen mental health outcomes.”

In the study, researchers found that a teen with strong, supportive friendships is likely to experience positive mental health, regardless of how much time they spend on social media. By contrast, teens who report poor-quality friendships and nearly the same level of social media use are more likely to report poor mental health. In comparison, the amount of time spent using social media had a much smaller influence on teen mental health outcomes.

Teens ages 13 to 18 reported how much time they spend on social media and whether they use it actively (like posting and commenting) or passively (like scrolling and browsing). Researchers used the PROMIS® assessment tools and the Strengths and Difficulties Questionnaire to measure their mental well-being, including life satisfaction, sense of purpose, symptoms of depression, and the quality of their friendships.

A 2021 national survey of 8th and 10th graders, cited in the U.S. Surgeon General’s report on social media and youth mental health, found that teens spent an average of 3.5 hours daily on social media. More recently, a 2023 Gallup survey of 13- to 19-year-olds reported that the average had increased to 4.8 hours per day.

The study included 963 teens aged 13 to 18 from across the United States. Teens completed surveys on social media habits, peer relationship quality, and mental health outcomes. The results provide insight into how social media use and mental health influence each other during the teenage years, extending beyond negative outcomes like anxiety and depression to also include positive mental health indicators.

“Instead of just focusing on limiting adolescents’ social media use, perhaps emphasizing ways to bolster the quality of their social relationships would help address the current youth mental health crisis in the U.S.,” said Dr. Blackwell.

Looking ahead, the research team plans to use data collected over time to understand better how social media use and mental health influence each other during this sensitive development period. Future studies could focus on improving peer relationship quality as a pathway to better teen mental health outcomes.

This collaborative research was published in the Journal of Adolescent Health.

 

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