New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

Authors: Elena Jansen, Kristine Marceau, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

While few studies on parental health and child development include fathers in any substantial way, a growing body of literature emphasizes their vital role—even in the period before birth. This study reviewed existing literature on what is known about the father’s role in child development. It highlights how a father’s history and personal characteristics before the baby is born, during pregnancy, and after birth can influence their child directly via their parenting behaviors and indirectly by influencing the child’s mother. The study also discusses how the ECHO Program can address key gaps in the literature by designing studies that address unanswered questions.

What were the study results?

The researchers reviewed the existing literature to find out which characteristics or behaviors of fathers have been connected to children’s development, especially their physical and mental health. While many studies give some information about the role of fathers, often fathers do not provide this information themselves, or existing data do not allow researchers to compare the role of fathers to that of mothers. Compared to the pregnancy and pre-pregnancy stages, this study allows researchers to better understand a father’s role once a baby is born. The study team created a model to guide future inquiry and suggest methods researchers can use to help fill in some knowledge gaps in the future. One unique aspect of this work is describing how fathers can impact the child by first influencing the mother, for example, by helping her follow healthy behaviors, such as cooking or helping to cook healthy meals and eating healthy food himself.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was this study's impact?

This review of other publications reveals gaps in the research community’s understanding of the father’s role in child development. First, very little is known about the father’s role in child development before birth. The study authors noted that more studies are needed to research mothers and fathers before they have children, focusing on including fathers in a substantial way. Some of the father data collected in the existing literature was reported by the mother. This highlights a gap in the literature and the need to incorporate maternal and paternal reported data on father characteristics. Second, this review demonstrates how studying the effect of fathers on child development has revealed additional insights into children’s health outcomes, including reasons for declines in physical or mental health.

This study also introduces a model designed to guide other researchers in focusing on pieces of the puzzle that are currently less understood. The model may help explain how each parent interacts with their child and which influence has a stronger impact or is more prevalent for which parent.

Who was involved?

This literature review involved an in-depth look into existing research on the role of fathers in child development and evaluated its quality. The study focuses on three specific child outcome areas of the ECHO program: obesity, neurodevelopment, and positive health.

What happened during the study?

This literature review begins by describing data collected by the ECHO Cohort and identifying critical gaps in the research related to the role of fathers in ECHO’s five key health outcome areas. After understanding the program’s data collection methods, the research team analyzed multiple research papers categorized into three broad stages of child development—preconception, prenatal, and postnatal. The review concludes with the presentation of a new proposed conceptual model to guide future studies considering paternal influences in ECHO and beyond.

What happens next?

With more data becoming available from the ECHO Program, information on fathers' characteristics can be connected to the rich data on family characteristics, mothers' influences, and child development. Additional data will be gathered to provide further insights and answer remaining questions.

Where can I learn more?

Access the full journal article, titled “The Role of Fathers in Child Development from Preconception to Postnatal Influences: Opportunities for the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program” in Developmental Psychobiology.

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

Published December 27, 2023

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New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

ECHO Study Suggests Early Breastfeeding May Be Linked to Lower Risk of Childhood Obesity

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ECHO Study Suggests Early Breastfeeding May Be Linked to Lower Risk of Childhood Obesity

Authors: Gayle Shipp, Adaeze Wosu, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Obesity in kids is becoming more common around the world. When children have obesity, they often carry it into adulthood, affecting their long-term health outcomes. While previous studies have shown that breastfeeding may protect children against obesity and other chronic conditions, this relationship has not been studied much in women with obesity. ECHO Cohort researchers wanted to explore the possible link between breastfeeding practices in women with obesity and overweight prior to pregnancy and a child’s BMIz score. Researchers use BMIz scores to compare children’s height and weight to those of their peers while the more familiar BMI assesses body weight in relation to height.

What were the study results?

This study found that consistently breastfeeding infants in any amount during their first three months was associated with lower BMIz scores during early childhood (between the ages of 2 and 6) and a lower risk of childhood obesity, regardless of the mother’s pre-pregnancy BMI. This protective association appeared stronger for children with mothers who had obesity before pregnancy (BMI of 30 or higher) compared to those categorized as overweight (BMI between 25 and 29.9) during the same time.

Exclusive breastfeeding at three months was associated with a lower child BMIz score only among women with a pre-pregnancy BMI in the normal range. Each additional month of any or exclusive breastfeeding correlated with a significantly lower child BMIz, particularly for mothers categorized as overweight (in the case of any breastfeeding) or as having obesity (for any or exclusive breastfeeding) prior to pregnancy.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was this study's impact?

The results of this study highlight that each additional month of breastfeeding, whether a consistent amount or exclusive, may contribute to a lower weight later in childhood, especially for mothers who had obesity before pregnancy. Health professionals can use this study’s findings as an opportunity to encourage and promote breastfeeding among all women, especially those who have obesity.

Who was involved?

The study looked at BMI measurements from 8,134 pairs of mothers and kids at 21 study sites in 16 states and Puerto Rico.

What happened during the study?

The researchers calculated BMI and BMIz scores from measurements taken at study visits, medical records, or self-reported data for the mother and child. Additionally, the study examined two breastfeeding situations: whether the mother ever breastfed or whether the mother was exclusively breastfeeding the infant at 3 months old. This continuous breastfeeding measure included the duration of any breastfeeding allowing for formula or other food and the duration of exclusive breastfeeding with no formula feeding or other food.

What happens next?

Future research and public health prevention efforts could continue to focus on addressing disparities in breastfeeding duration and obesity among mothers that can affect child health outcomes.

Where can I learn more?

Access the full journal article titled “Maternal Pre-pregnancy BMI, Breastfeeding, and Child BMI” in Pediatrics.

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

Published December 19, 2023

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ECHO Study Suggests Early Breastfeeding May Be Linked to Lower Risk of Childhood Obesity

ECHO Study Suggests Placenta Development for Male, Female Infants May Differ

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ECHO Study Suggests Placenta Development for Male, Female Infants May Differ

Authors: Catherine Bulka, Rebecca Fry, et al

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

This study found that gene activity in the placenta might differ based on the infant’s sex, suggesting that the placentas of males and females develop differently. The placenta is an organ formed during pregnancy to nourish the fetus that goes through many changes during the length of the pregnancy to support the development of the infant.

Previous studies have found that a number of changes occur in the genetic make-up of the placental tissue throughout pregnancy. The current study suggests that some of these genetic changes may differ based on whether the baby is male or female. The researchers looked at gestational age (the amount time the baby spent in-utero) to compare placentas among males and female fetuses at different points in time. Among females, the researchers saw modifications in genes related to the immune system. Among males, there was modifications in genes related to the transport of molecules into the placenta.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study identified differences in the location of modifications of placental DNA between male and female infants at different gestational ages. The most prominent differences were linked to genes that play significant roles in immunity, inflammation, and pregnancy complications. These differences seen between male and female infants may be important when looking at sex-specific health and developmental outcomes.

Why was this study needed?

The placenta is crucial for fetal growth and development. No previous study had considered the role of infant sex in placental development, despite accumulating evidence that females and males develop differently in utero.

Who was involved?

This study included 774 infants from 4 ECHO research sites. In total, the study included 355 female and 419 male infants. One of the research sites enrolled infants born at less than 28 weeks, which provided samples from the earliest viable births.

What happened during the study?

Research sites compared the placental tissue of male and female infants to determine associations between gestational age and modifications of placental DNA. Researchers then located the modifications and identified the closest genes, allowing them to analyze the biological significance of the modifications.

What happens next?

Researchers are now using this data to estimate an infant’s “biological” rather than “chronological” gestational age based on the modification of placental DNA. The findings of this study suggest that it may be important to consider the infant’s sex when calculating “biological” gestational age.

Where can I learn more?

Access the full journal article, titled “Sex-based differences in placental DNA methylation profiles related to gestational age: an NIH ECHO meta-analysis,” in Epigenetics.

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

Published December 2023

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ECHO Study Suggests Placenta Development for Male, Female Infants May Differ

ECHO Researchers Measure Pandemic-Related Traumatic Stress in Families

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ECHO Researchers Measure Pandemic-Related Traumatic Stress in Families

Authors: Courtney K. Blackwell, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health with co-funding from the Office of Behavioral and Social Sciences Research.

Why was this study needed?

The COVID-19 pandemic and subsequent social distancing strategies may have ongoing negative effects on mental health. To measure this, ECHO researchers developed the Pandemic-related Traumatic Stress Scale (PTSS) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Acute Stress Disorder criteria. This study describes the development and validation of this new measurement tool and reports differences in pandemic-related traumatic stress in a large sample of children and adults.

What were the study results?

On average, caregivers had the highest levels of pandemic-related traumatic stress, followed by adolescents, pregnant/postpartum individuals, and children. Within these groups, the researchers found additional differences related to age and gender. Adolescents, females, and caregivers of children under 5 had higher PTSS scores on average than younger children, males, and caregivers of children 5 and older, respectively.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The researchers found that PTSS is a reliable way to measure pandemic-related traumatic stress in the context of the COVID-19 pandemic. Higher levels of pandemic-related traumatic stress were associated with greater symptoms of distress and lower life satisfaction. Unlike previous measures that capture traumatic stress reactions to a single event, the PTSS was developed to evaluate potential traumatic stress reactions to ongoing large-scale threats without defined time limits. Researchers and doctors can use this scale to distinguish general stress, depression, and anxiety from traumatic stress, helping them to identify people with higher levels of traumatic stress who may need mental health support.

Who was involved?

This study included 17,830 children and adults from 47 ECHO Cohort study sites representing all 50 states, Washington, DC, and Puerto Rico. Researchers split the sample into four groups including 1,656 pregnant or postpartum individuals; 11,483 adult caregivers; 1,795 adolescents aged 13 to 21; and caregivers who reported on 2,896 children aged 3 to 12.

What happened during the study?

Between April 2020 and August 2021, caregivers reported on behaviors observed in children aged 3 to 12, and adolescents and adults completed self-reported surveys on pandemic-related traumatic stress, depressive symptoms, anxiety, general stress, and life satisfaction.

What happens next?

The PTSS can be used beyond the immediate COVID-19 pandemic context. The PTSS could be adapted to evaluate reactions to other severe stressors that last a long time.

Where can I learn more?

Access the full journal article, titled “Development and Psychometric Validation of the Pandemic-related Traumatic Stress Scale for Children and Adults,” in Psychological Assessment.

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

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Published November 3, 2023

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ECHO Researchers Measure Pandemic-Related Traumatic Stress in Families

ECHO Program Collects Valuable Data on Nutrition During Pregnancy and Early Life

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ECHO Program Collects Valuable Data on Nutrition During Pregnancy and Early Life

Authors: Megan Bragg, Kristen Lyall, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was the study needed?

Improving nutrition during pregnancy and childhood is a key focus for public health in the United States. Many pregnant women and children face deficiencies in essential vitamins and minerals coupled with excess salt, saturated fats, and sugars in their diets. Socioeconomic factors may affect access to nutritious food, contributing to disparities in rates of diet-related chronic disease that could affect pregnancy outcomes and child growth and development. Often, data collected on diet provide only a snapshot that can't address how early-life diet affects later child health outcomes. The ECHO Cohort Consortium is addressing these challenges by gathering information over time about the dietary habits of individuals during pregnancy and childhood from a large, diverse group of participants. This study examines the types of diet information collected from the ECHO Cohort and provides examples of how researchers can use this data to learn more about the role of nutrition in child health outcomes.

What were the study results?

This study aimed to describe dietary intake data available in the ECHO Program as of August 2022, from pregnancy through adolescence, including estimated sample sizes, and to highlight the potential for future analyses of nutrition and child health. As of that date, 66 ECHO Cohort Study Sites across the country had collected diet information using a variety of methods, including dietary recalls, food frequency questionnaires, and questionnaires about supplement use. Diet information from these study sites is especially useful because it has been collected from a large group of diverse people, and because many families provided information more than once over the course of pregnancy and childhood.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

This study highlights the large amount of diet information already available from the ECHO Cohort and the opportunities for researchers to access this publicly available resource to answer important questions about nutrition and child health outcomes.

Who was involved?

This study examined data from pregnant women and children at 66 ECHO Cohort Study Sites in 34 U.S. states who answered questions about their diets by August 2022. Data about more than 26,000 pregnant women and 27,000 children is publicly available.

What happened during the study?

Researchers examined the diet information that study sites collected from pregnant women and children through August 2022, including questionnaires and medical records. Researchers sorted this information by the type of questionnaire and whether it was from a pregnant woman or a child. Many participants contributed data from both the pregnant woman and the child and reported on their diet more than once.

What happens next?

The ECHO Program will continue to collect diet information from participants. Information from over 33,000 pregnancies and more than 31,000 children in the ECHO Program is now accessible to researchers. This de-identified data is publicly available to researchers through the National Institute of Child Health and Human Development Data and Specimen Hub (DASH) to encourage broad use to answer important questions about nutrition and child health.

Where can I learn more?

Access the full journal article, titled “Opportunities for examining child health impacts of early-life nutrition in the ECHO Program: Maternal and child dietary intake data from pregnancy to adolescence” in Current Developments in Nutrition.

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

Published November 2023

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ECHO Program Collects Valuable Data on Nutrition During Pregnancy and Early Life

ECHO Study Finds No Association Between Arsenic Exposure and Birth Outcomes

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ECHO Study Finds No Association Between Arsenic Exposure and Birth Outcomes

Authors: Jonathan Lewis, Emily A. Knapp, Amii M. Kress, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

Why was this study needed?

Arsenic is a naturally occurring, toxic chemical that can be present in groundwater and surface water. Drinking water, as a result, is one of the most common ways people are exposed to arsenic in the U.S. and globally. There have been a limited number of small studies of the association between arsenic and birth outcomes, mostly outside of the U.S. In this study, ECHO researchers examined a diverse group of pregnant participants from across the country to determine if birth outcomes—birth weight, gestational age at birth, preterm birth, and size at birth—are influenced by arsenic concentrations that are above regulatory action levels.

What were the study results?

Researchers found that low birth weight, gestational age at birth, preterm birth, and birth size were not associated with potential exposure to arsenic among pregnant women living in a county with active arsenic level violations. There was a statistically significant increase in birth weight among infants whose mother’s experienced continuous exposure (from three months before conception through birth) compared with infants from areas without violations.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was this study's impact?

Overall, drinking water violations for arsenic that could indicate the presence of the chemical above regulatory action levels are relatively uncommon. Researchers captured proxy exposure using residential history arsenic violations from the preconception period throughout pregnancy, a time when environmental influences could disrupt fetal growth.

Who was involved?

The study included over 15,000 mother-child pairs at 51 ECHO Cohort Study Sites across the United States. The children were born in 2006 or later, as the U.S. Environmental Protection Agency (EPA) changed the enforceable standard for arsenic concentrations in drinking water to 10 parts per billion during that year. Only 794 participants experienced arsenic violations.

What happened during the study?

Researchers grouped pregnant participants based on where they lived three months before conception and during pregnancy. Within those areas, investigators determined which public water systems had violations for arsenic. Then they looked at how living in a county with an arsenic violation might affect birth outcomes.

What happens next?

Future research could better identify ECHO participants’ exposure to arsenic by considering other sources of drinking water (e.g., bottled or filtered water) and exposure to arsenic in foods.

Where can I learn more?

Access the full journal article, titled “Associations Between Area-Level Arsenic Exposure and Adverse Birth Outcomes: An ECHO-Wide Cohort Analysis,” in Environmental Research.

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

Published November 1, 2023

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ECHO Study Finds No Association Between Arsenic Exposure and Birth Outcomes

New ECHO Cohort Research Finds Adolescents with Disabilities May Have Been More Vulnerable to Social Disruptions During COVID-19 Pandemic

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New ECHO Cohort Research Finds Adolescents with Disabilities May Have Been More Vulnerable to Social Disruptions During COVID-19 Pandemic

Authors: Phillip Sherlock, Maxwell Mansolf, Courtney Blackwell, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Although researchers have looked at how the COVID-19 pandemic affected the mental health of children of all ages, few studies have examined the pandemic’s impact on children and teens with pre-existing mental, emotional, behavioral, and developmental (MEBD) disabilities like depression, anxiety, attention-deficit hyperactivity disorder (ADHD), and Autism Spectrum Disorder (ASD).

Health policies that were put in place to prevent the spread of COVID-19 caused disruption of normal activities for children and families. Schools paused in-person learning, extracurricular activities were cancelled, and stay-at-home orders meant children spent more time quarantined with family members instead of engaging with friends and peers.

This study was needed to understand how the stresses of the COVID-19 pandemic impacted life satisfaction for adolescents with disabilities, as adolescence is a critical period of social development. Researchers aimed to learn which groups of adolescents were most affected by the pandemic, so that mental health practitioners, pediatricians, and family physicians might be better informed of potential intervention and prevention practices that could be implemented to help particularly vulnerable adolescents through difficult times in the future.

What were the study results?

When exposed to certain stresses during the COVID-19 pandemic, adolescents with a history of depression, anxiety, ASD, or ADHD had lower life satisfaction compared to their peers. These stresses included decreased social connectedness, decreased family engagement, stress related to medical care access, pandemic-related traumatic stress, and living in a single-caregiver household.

This study also found that 80% of adolescents, regardless of pre-existing conditions, reported decreases in social connectedness during the COVID-19 pandemic. Although the detrimental effect of decreased social connectedness was amplified among individuals with certain pre-existing MEBD conditions, this risk factor was widespread among the majority of adolescents.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study found that adolescents with decreased social connectedness typically had lower life satisfaction across several groups with different life circumstances. However, decreased social connectedness was more harmful for individuals with disabilities. This study allowed researchers to identify the groups of adolescents with disabilities who are most vulnerable and may need additional support during future emergencies. Findings from this study also highlight the importance of interventions aimed specifically at increasing social connectedness, family engagement, and access to medical support for all adolescents, and especially for those with disabilities.

Who was involved?

This study included COVID-19 survey data collected from April 2020 to August 2021 from a sample of 1,084 adolescents ages 11–21 years old, and their caregivers. The sample included individuals with and without disabilities from seven ECHO observational research sites in the U.S.

What happened during the study?

In addition to using pre-existing ECHO Cohort data about adolescents and their families, researchers administered a COVID-19-specfic survey to better understand the physical, mental, and social impact of the pandemic on young people and their families. Data were analyzed using a machine-learning process.

What happens next?

Findings from this study showed evidence of potential differences between adolescents with disabilities and their peers in terms of life satisfaction. Future research is needed to design studies that focus on the vulnerable subgroups identified in this study. Additionally, future studies may look into the long-term effects of decreased social connections and other risks resulting from the COVID-19 pandemic during developmentally critical time periods.

Where can I learn more?

Access the full journal article, titled “Life Satisfaction for Adolescents with Developmental and Behavioral Disabilities during the COVID-19 Pandemic,” in Pediatric Research.

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

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Published October 24, 2023

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New ECHO Cohort Research Finds Adolescents with Disabilities May Have Been More Vulnerable to Social Disruptions During COVID-19 Pandemic

New ECHO Research Reveals Communication, Collaboration, and Team Science Are Central to the Success of Large, Multi-Site Research Programs

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New ECHO Research Reveals Communication, Collaboration, and Team Science Are Central to the Success of Large, Multi-Site Research Programs

Authors: Elissa Faro, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

Why was the study needed?

Large research collaboratives often have more success than single investigators conducting research alone. They produce more publications in journals with higher impact factors that result in more citations and continued research opportunities. As a result, funding agencies continue to increase their support for large, transdisciplinary research groups to address complex and challenging health problems.

The National Institutes of Health’s (NIH) Environmental influences on Child Health Outcomes (ECHO) Program developed multi-site collaboration strategies to promote high-impact, collaborative, observational research on child health. However, few studies have investigated the perspectives of researchers and staff of large research projects like ECHO. Many questions remain about team science, including the effects of research structures and funding mechanisms on team functioning. To address these questions, ECHO researchers sought to develop an in-depth understanding of the elements and conditions that influence the implementation of observational research in the ECHO Program.

What were the study results?

Researchers interviewed 24 ECHO investigators and staff and found that communication and working as a team were important for successful collaborations. Most interviewees expressed a desire for more opportunities for direct connection, learning, and sharing with their colleagues. While respondents mostly spoke positively about ECHO’s investigative network and opportunities to collaborate, researchers learned that some respondents felt the network could benefit from engaging more team members across various roles in decision-making processes.

Some interviewees also expressed that communication and the decision-making process within the program may need improvement, but they shared that they had observed the ECHO Program improving in this regard. They also recognized that the size of the program might contribute to delays with timely, clear, and efficient communication. Overall, respondents felt the ECHO Program excels at conducting solution-oriented, high-impact child health research, but also that the Program has an opportunity to further improve communication, collaboration and decision-making across its vast network of sites and components.

What was the study's impact?

This study contributes insight on the implementation of a large, multidisciplinary research consortium, and these lessons may be transferable to other large research consortia. The findings also offer an in-depth understanding of why and how research stakeholders collaborate, and what strategies work better to produce high-impact science.

The study found that ECHO researchers highly valued team science, co-learning, and collaboration. The range of experiences across the program suggests that best practices for large research ventures like ECHO may not be one-size-fits-all but may instead need to be tailored for different groups. However, the collected responses may inform new methods to enhance communication and collaboration across large research consortia in the future.

This study will benefit a variety of research stakeholders, including government agencies and other funding organizations, when they support and design large research projects.

Who was involved?

Researchers conducted 24 interviews with ECHO researchers and staff. Most interviewees were affiliated with a study site, but the research team was also able to gather the perspectives of all ECHO Program components except for the Human Health Exposure Analysis Resource (HHEAR)—the ECHO component responsible for testing samples from ECHO participants to help researchers assess the effects of chemical exposures—and the NIH.

What happened during the study?

In early 2022, researchers conducted 24 virtual interviews. The research team interviewed internal stakeholders from the ECHO study sites and components, seeking broad representation of research and administrative roles across ECHO. All internal stakeholders were informed of the study via email, and those interested were able to contact the research team and schedule an interview via Zoom. From the respondents, researchers selected a sample to maximize variation and represent diverse perspectives from across ECHO.

The research team developed a semi-structured interview guide, and analyzed both the quantitative and qualitative data collected to understand how individual researcher’s experiences and perspectives reflect the overall implementation of the ECHO Program. As part of this analysis, the researchers tracked metrics organized around four central goals: (1) enrolling and retaining a large and diverse group of participants in ECHO to answer key scientific questions; (2) collecting high-quality data and making it available for analysis; (3) collecting, storing, and using biospecimen samples and data; and (4) publishing and disseminating high-quality, impactful science. These metrics provide complementary, quantitative assessment of ECHO implementation and progress toward key goals and priorities.

What happens next?

Future studies are needed to understand how collaborative research affects the experiences of ECHO study participants as well as the perspectives of external stakeholder groups.

Where can I learn more?

Access the full journal article, titled “A Mixed-Methods Analysis to Understand the Implementation of a Multi-stakeholder Research Consortium: Environmental influences on Child Health Outcomes (ECHO),” in the Journal of Clinical and Translational Science.

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

Published October 12, 2023

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New ECHO Research Reveals Communication, Collaboration, and Team Science Are Central to the Success of Large, Multi-Site Research Programs

ECHO Cohort Study Identifies Best Tests of Biological Age to Use for Different Types of Pediatric Tissue Samples

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ECHO Cohort Study Identifies Best Tests of Biological Age to Use for Different Types of Pediatric Tissue Samples

Authors: Fang Fang, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

Why was the study needed?

A molecular process called DNA methylation, or DNAm, that adds a tag to the DNA that can control gene expression. Certain well-studied DNAm have been associated with many age-related chronic diseases, including aging itself.

Researchers have developed biochemical models called epigenetic clocks that use DNAm to estimate an individual’s biological age. Scientists have studied these clocks in adult populations in whom accelerated biological age (DNAm-predicted age older than actual chronological age) seems strongly connected to age-related health complications. However, only epigenetic clocks for pediatric populations have only recently been built. Epigenetic clocks also allow scientists to evaluate the impact of various environmental exposures on early-life development and children’s health outcomes.

This study conducted a comprehensive evaluation on seven of these epigenetic clocks—Horvath, Knight, Bohlin, Lee, Mayne, PedBE, and NeoAge—all of which researchers developed for different purposes and tissue types. It is important for scientists to understand how these clocks perform in different tissue types and developmental stages throughout early life to ensure researchers are designing studies appropriately and then correctly interpreting the results of these studies.

What were the study results?

The results of this study suggest that the best epigenetic clock to use depends on the type of sample being studied. For example, the Bohlin and Knight clocks were very similar when predicting gestational age from blood cell samples; the Lee clock outperformed the Mayne clock in predicting gestational age from placental samples; and the PedBE clock was more accurate than the Horvath clock at predicting chronological age from buccal cells. However, the Horvath clock was better at predicting chronological age when using blood cells samples. The study results suggest the importance of researchers choosing the appropriate clock depending on the focus of their study.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study provides practical recommendations for selecting the most appropriate epigenetic clock in different research contexts, therefore leading to more accurate estimates of biological age. The findings of this study may help scientists make better research tools, improving child health research.

Who was involved?

Researchers used data from 3,789 children, who contributed a total of 4,555 samples, from 20 ECHO research sites. The sample set consisted of 2,273 male and 2,282 female samples.

What happened during the study?

The researchers evaluated seven different epigenetic clocks based on the DNAm data generated from the selected sample set. The study evaluated each clock in corresponding tissues based on previous study results, and then compared clocks across different tissue samples. After comparing the suitability of various epigenetic clocks for each tissue type, researchers evaluated their performance across diverse populations. This evaluation included comparing epigenetic clocks between preterm and term infants within the same tissue type, across different self-reported racial groups, between males and females, and across different tissue types within the same set of participants.

What happens next?

Future studies may use the various epigenetic clocks as recommended to check the health of babies and children. However, researchers should interpret this data with caution as it pertains to conclusions about the performance of specific epigenetic clocks in pediatric populations with varied health backgrounds. Future studies may examine the effects of genetics on the performance of different epigenetic clocks.

Where can I learn more?

Access the full journal article, titled “Evaluation of Pediatric Epigenetic Clocks Across Multiple Tissues,” in Clinical Epigenetics.

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

Published October 9, 2023

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ECHO Cohort Study Identifies Best Tests of Biological Age to Use for Different Types of Pediatric Tissue Samples

ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

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ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

Authors: Claudia Lugo-Candelas, Tse Hwei, Seonjoo Lee, Cristiane Duarte, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Sleep difficulties are common in pregnancy. Poor prenatal sleep may relate to negative outcomes for both parent and child, including pregnancy complications and certain birth outcomes. The impact of poor prenatal sleep may also extend beyond pregnancy and birth and may increase the risk for neurodevelopment disorders in offspring, particularly attention-deficit/hyperactivity disorder (ADHD).

In this study, ECHO researchers aimed to study potential associations between poor prenatal sleep and an increased risk of ADHD symptoms and sleep problems in offspring.

What were the study results?

Prenatal sleep quality and duration, particularly in the second trimester, appeared related to children’s risk for ADHD, emotional reactivity, and sleep problems at age 4. Longer sleep duration in the second trimester was associated with fewer ADHD symptoms in children. Poorer sleep quality scores in the second trimester were associated with greater offspring ADHD symptomatology. Shorter duration and poorer quality of sleep during the second trimester were also associated with more sleep difficulties in children.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

This study extends prior work by examining the associations between self-reported prenatal maternal sleep health and offspring ADHD symptoms in early childhood in a large, socio-demographically diverse sample in the U.S., including Puerto Rico.

Who was involved?

The research team used data from 794 mother-child pairs across five ECHO research sites. All enrolled pairs with available prenatal sleep and offspring ADHD assessments before age seven were included. The pregnant participants were between 27 and 37 years old.

What happened during the study?

Pregnant participants reported on their sleep during pregnancy using self-report questionnaires and reported on children's symptoms and behaviors when children were between 3 and 5 years old. The study assessed the children’s ADHD symptoms and associated characteristics using the Child Behavior Checklist Preschool Version, a widely used parent report that measures behavior problems in children.

What happens next?

Future studies are needed to replicate these findings, as well as investigate the possible mechanisms. Poor sleep may impact inflammation in pregnancy and offspring development, but studies have not examined that association.

Where can I learn more?

Access the full journal article, titled “Prenatal sleep health and risk of offspring ADHD symptomatology and associated phenotypes: A prospective analysis of timing and sex differences in the ECHO Cohort,” in The Lancet Regional Health - Americas.

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

Published October 9, 2023

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ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood