Different Viruses that Cause Wheezing Illnesses Provide Limited Protection Against Each Other

Authors: Yury Bochkov, James Gern, 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?

Rhinovirus (RV) is the most common virus detected in both mild and acute respiratory illnesses, such as the common cold and wheezing. While three species of rhinoviruses (A, B, and C) can cause upper respiratory illnesses, RV-A and RV-C are more likely to cause wheezing illnesses in preschoolers and in children and adults who have asthma. No specific vaccines for these viruses exist yet, in part because the large range of rhinovirus strains makes vaccine development difficult.

After a natural infection, neutralizing antibody responses develop in infected persons that help reduce the risk of illness on a second exposure. The goal of this study was to test whether RV-C infections are more likely than RV-A infections to induce long-lasting antibodies that can protect against other RV-C strains.

What were the study results?

Both RV-A and RV-C infections induced neutralizing antibody responses of similarly long durations but did not provide strong protection against each other. The researcher’s data analysis suggests that RV-C types are less likely than RV-A types to create a strong immune response against different virus strains. 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?

The results showed that while protective antibody responses to RV-C last for several years, they have only modest cross-protection that is limited to genetically similar viruses. These findings suggest that vaccines against RV-C might need to include many of the most common RV-C types to offer broad protection.

Who was involved?

Over 4,000 children were enrolled in 14 independent studies across Australia, Finland, and the United States. Study participants varied in age from 0 to 19 years and had RV-induced illnesses of varying severity. Some studies included participants with asthma, in addition to healthy participants.

What happened during the study?

Researchers tested whether RV-C infections cause protection against multiple RV-C types. Researchers analyzed samples collected between 1998 and 2019. Each of the 14 sites collected nasal samples that were analyzed for RV species and type. Data from 11 studies and 3,199 children included serial sampling for analysis across more than one RV illness. Many children in this study contracted a series of illnesses caused by various RV-A and RV-C types. The investigators examined the sequence of illnesses that children had experienced to understand which kinds of rhinovirus might provide protection against which other kinds of rhinovirus. Researchers also analyzed blood specimens to see whether RV-C infections are more likely to create antibodies to fight other rhinoviruses or produce antibody responses of longer duration than RV-A infections do.

What happens next?

Researchers want to determine why RV-C infections occur so frequently in preschool children, and why they are more likely to cause wheezing illnesses. These studies aim to help researchers design a practical RV-C vaccine that could protect high-risk children.

Where can I learn more?

Access the full journal article, titled “Rhinoviruses A and C Elicit Long-lasting Antibody Responses with Limited Cross-neutralization,” in the Journal of Medical Virology.

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

Published August 28, 2023

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ECHO Researchers Find Different Rhinoviruses Can Provide Limited Protection Against Each Other

Educational Background and Child Age Influenced Experiences of Caregivers During COVID 19 Pandemic

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Educational Background and Child Age Influenced Experiences of Caregivers During COVID‑19 Pandemic

Authors: Kaja Z. LeWinn, Lisa Jacobson, 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?

The COVID-19 pandemic and resulting public health measures presented unique challenges for families, frequently influenced by factors such as income and educational background. Yet while research has highlighted the sociodemographic factors that influenced adults’ experience, the COVID-19 pandemic generally interfered with population-based studies of children and families. However, in April 2020, the ECHO Program introduced a COVID‑19‑specific questionnaire that allowed researchers to gather information on how the pandemic and its effects on daily life were influencing the health of children. This study used ECHO data collected from April 2020 to March 2022 to examine sociodemographic differences in pandemic-related experiences.

What were the study results?

The study suggested that caregivers with less than a high school education were more likely to report challenges accessing COVID-19 testing for their children, were less likely to work remotely, and reported financial concerns and access to necessities such as food as top sources of stress. Caregivers with a master’s degree or higher, on the other hand, were more likely to name social distancing as the top source of their pandemic stress. The study also noted that caregivers with higher education had a significantly greater likelihood of having the option to work remotely. Caregivers with children between the ages of 1 and 5 reported the least support from school systems, the most difficulty finding childcare, and fewer remote learning options; were more likely to have healthcare appointments canceled due to COVID‑19 concerns, and were most concerned about how the pandemic would affect their ability to work.

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 underscores the importance of understanding how children and caregivers from various backgrounds experienced the COVID-19 pandemic. This understanding can help uncover social inequities that could worsen conditions for some populations during future public health crises. These findings suggest that families with young children may be in particular need of more support related to childcare and work flexibility during future public health crises that involve school disruption.

Who was involved?

The study analyzed data from 14,646 ECHO children and 13,644 ECHO caregivers between April 2020 and March 2022.

What happened during the study?

Researchers measured COVID‑19 pandemic‑related experiences using three characteristics—caregiver education, child life stage, and urban or rural residence. Caregivers completed ECHO COVID‑19 surveys about their experiences during the pandemic for their children and themselves. Among children, researchers examined items related to COVID‑19 infection, access to COVID‑19 testing, changes to healthcare, and disruptions to school, preschool, or daycare. For caregivers, researchers examined remote work, childcare challenges, and their subjective ranking of pandemic‑related stressors.

What happens next?

Future research could explore the complex connections between the outcomes examined as well as the long-term impacts of COVID‑19 infection and pandemic‑related adversities for children in the ECHO Cohort over time.

Where can I learn more?

Access the full journal article, titled “Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States,” in JAMA Network Open.

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 August 23, 2023

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Educational Background and Child Age Influenced Experiences of Caregivers During COVID‑19 Pandemic

Prenatal Depression May Be Linked to Autism-Related Traits in Children

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Prenatal Depression May Be Linked to Autism-Related Traits in Children

Authors: Lyndsay A. Avalos, Lisa A. Croen, 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?

Previous research suggests an association between prenatal depression or a history of depression prior to pregnancy and autism spectrum disorder (ASD) in children, but most studies have focused on a formal ASD diagnosis, rather than autism-related traits. Studying social communication and other autism-related traits can help researchers and clinicians understand how prenatal depression may be associated with these traits present in children at varying levels without a formal diagnosis. This is critical because autism‑related traits can impact children’s physical, social, and psychological development, regardless of whether they receive a clinical diagnosis.

What were the study results?

Children of mothers with prenatal depression had slightly more autism-related traits compared to those without. The association was similar among boys and girls. Prenatal depression also increased the likelihood of moderate to severe autism-related traits, indicating a higher likelihood of ASD diagnosis.

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 adds to the understanding of how prenatal depression may be associated with neurodevelopment in children, such as social communication and behavioral characteristics that may not reach a clinical threshold but can still impact a child’s social and behavioral functioning. These findings highlight the need for early ASD screening for children whose parents had prenatal depression to promote early intervention and support their healthy development. Mental health screening and prevention efforts for depression in pregnant individuals could also be beneficial.

Who was involved?

The study involved 33 prenatal and pediatric research sites with information on depression in birth parents and autism-related traits in children. The primary analysis included 3,994 parent-child pairs with prenatal depression diagnosis data; a secondary analysis included 1,730 parent-child pairs with depression severity data.

What happened during the study?

Researchers measured the incidence and severity of prenatal depression and assessed autism-related traits using the Social Responsiveness Scale (SRS) for children up to 12 years of age.

What happens next?

While this study didn’t explore the reason for the association between autism-related traits in children and prenatal depression in mothers, future research may analyze parent and child genetic data to clarify whether certain genes increase the likelihood of depression and autism-related traits, or what other factors affect the findings.

Where can I learn more?

Access the full journal article, titled “Prenatal Depression and Risk of Child Autism-Related Traits Among Participants in the Environmental influences On Child Health Outcomes Program,” in Autism Research.

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

Published August 1, 2023

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Prenatal Depression May Be Linked to Autism-Related Traits in Children

Shortened Social Responsiveness Scale (SRS) Observed to be Comparable to Full SRS in Autism Risk Factor Estimation

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Shortened Social Responsiveness Scale (SRS) Observed to be Comparable to Full SRS in Autism Risk Factor Estimation

Authors: Marisa Patti, 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 this study needed?

The Social Responsiveness Scale (SRS) is a questionnaire used to measure social communication and autism spectrum disorder (ASD)-related traits. Researchers have developed a shortened version of the SRS, which included only 16 questions out of the original 65. This shortened version is intended to provide a very similar summary of behaviors and traits as the longer version but takes less time to complete.

As a new tool, the short SRS has been previously tested to ensure that it measures autism spectrum-related traits. However, it was not clear prior to this study if the short SRS can measure associations in epidemiologic analyses of autism spectrum risk factors in the same way as the full SRS so that research findings can be comparable across studies using both versions. In other words, do scores from both the short and long versions suggest the same associations? Or does shortening the SRS reduce our ability to detect risk factors due to differences in measurement? In this study, the authors tested associations with an established risk factor for autism diagnosis, preterm birth, or gestational age, to see if patterns were consistent across versions.

What were the study results?

Younger gestational age and preterm birth were associated with higher full SRS scores. The same associations were seen with short SRS scores. These associations are also consistent with associations seen for autism diagnosis, suggesting the ability of both the full and short SRS to detect risk factor associations.

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?

Gathering meaningful information for research studies can be a lengthy and time-consuming process for participants. This study shows that in some studies information collected using shorter assessments can be as useful as that captured using longer assessments, helping to reduce the time participants spend answering questionnaires.

Who was involved?

The study included 2,760 child-parent pairs from 11 different research sites within the ECHO Program. Participating children were between 2.5 and 18 years in age. The study sample included participants from research sites drawn from the general population, pre-term birth research sites, and familial-autism research sites, the last consisting of participants with a child diagnosed with autism.

What happened during the study?

Researchers collected caregiver-reported responses from both the full and shortened SRS. Information on gestational age and pre-term birth were collected from maternal reports on standardized questionnaires and from medical records.

What happens next?

Future studies are needed to investigate how comparable estimates are between the full and short SRS using other types of risk factors, such as genetic factors, and in other study populations. Researchers may also consider using the short SRS in future studies as an efficient measure of social behaviors.

Where can I learn more?

Access the full journal article, titled “A Comparative Analysis of the Full and Short Versions of the Social Responsiveness Scale in Estimating an Established Autism Risk Factor Association in ECHO: Do we Get the Same Estimates?” in the Journal of Autism and Developmental Disorders.

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

Published July 22, 2023

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Shortened Social Responsiveness Scale (SRS) Observed to be Comparable to Full SRS in Autism Risk Factor Estimation

ECHO Study Suggests No Association Between Maternal Stress in the First Year After Birth and Childhood BMI

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ECHO Study Suggests No Association Between Maternal Stress in the First Year After Birth and Childhood BMI

Authors: Callie Brown, Charles Wood, 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 affects millions of adults, adolescents, and children in the United States. Many children in the United States enter their school years with obesity, and children with obesity at 3 years of age have a 90% probability of having overweight or obesity as an adolescent.

While existing literature suggests a relationship between parental stress and childhood body mass index (BMI), the exact way in which parental stress might affect BMI in children isn’t fully understood. There has been some disagreement in what types of stress and at what time points during childhood stress is related to child BMI. This study allowed researchers to look at a large, diverse sample of mothers and children over time to evaluate how maternal stress might be associated with the child’s BMI.

What were the study results?

This study suggests that there is no association between stress of mothers during the first year after birth and the risk of their child having obesity between ages 2 and 4.

While the study did not find an association between maternal stress levels and childhood obesity, it did reveal other information about both maternal stress and childhood BMI. In this study, the researchers found that higher stress levels were more likely among Hispanic and Black mothers, and less likely among mothers with private health insurance. Higher child BMI was more likely among Hispanic mothers, when the mothers’ BMI before birth was higher, and when the child’s birth weight was higher.

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?

Doctors and researchers are working to identify opportunities to prevent childhood obesity. There are many factors in the first year of life that are related to higher weight gain and earlier obesity in children, but this study’s results suggest that the level of a mother’s stress in the first year of life does not appear to be a risk factor for higher obesity risk in very young children. This may be because other factors are stronger predictors of differences in childhood BMI.

Who was involved?

The study included 1,694 mothers and their children from across the United States.

What happened during the study?

ECHO researchers analyzed data from single pregnancies where maternal stress was measured in the child’s first year of life and a child’s weight and height were measured between 2 and 4 years of age.

In addition to examining maternal stress levels and childhood BMI, researchers analyzed information including a mother’s BMI before pregnancy, the baby’s birthweight, a mother’s race, ethnicity, and age at the time of the child’s birth, and the type of health insurance they had. They also looked at the number of children a mother had and her education level.

What happens next?

Future studies may look into additional factors that can influence children’s risk for increased BMI such as BMI later in childhood, other periods or types of stress, and parent- or caregiver-measured stress.

Where can I learn more?

Access the full journal article, titled “Maternal stress and early childhood BMI among US children from the Environmental influences on Child Health Outcomes (ECHO) program,” 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.

Published July 21, 2023

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ECHO Study Suggests No Association Between Maternal Stress in the First Year After Birth and Childhood BMI

ECHO Study Suggests Caregiver Stress May Be Linked to Child Sleep Issues

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ECHO Study Suggests Caregiver Stress May Be Linked to Child Sleep Issues

Authors: Maxwell Mansolf, Courtney K. 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?

Up to 50% of children and adolescents in the United States might experience sleep problems. Poor sleep can negatively affect brain development, learning, and physical and emotional well-being. Existing studies suggest there could be a link between poor sleep outcomes in children and teens and stress experienced by their caregivers, but these studies have primarily been limited to infants and young children. In this study, researchers used ECHO’s diverse data to study this association in school-age children and teens.

What were the study results?

Children of caregivers who reported feeling stress from their life circumstances were more likely to experience sleep disturbances. This association was consistent across different groups of child and caregiver pairs studied, even after accounting for mental and physical health conditions.

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 research suggests that children whose caregivers report increased perceived stress may be at higher risk for sleep issues. Screening for caregiver stress may help healthcare providers identify and plan interventions for children who may be at risk for sleep issues.

Who was involved?

The study included data from 2,641 children between ages 6 and 18 and their caregivers from 12 ECHO research sites. Most caregivers (78.6%) had at least some college education. About a third of the children (34.7%) had at least one mental health condition, and a quarter of the children (25%) had at least one physical health condition.

What happened during the study?

Researchers analyzed data provided by caregivers who completed the Perceived Stress Scale (PSS) about their own stress as well as the Child Behavior Checklist (CBCL), a common parent-reported child behavior survey, about their children’s emotional and behavioral well-being, including their sleep habits. The PSS is a widely used self-report survey that measures how much a person perceives their life as unpredictable, uncontrollable, and overloading over the previous month. To evaluate how caregiver stress affected child sleep patterns, researchers looked at responses to questions from the CBCL that addressed children’s experience with nightmares, insomnia, excessive sleep, troubled sleep, and ongoing tiredness.

What happens next?

Future sleep interventions may consider a more global approach to improving child and adolescent sleep health. Continued research on the factors that influence family health and well-being may guide interventions that address the entire family and the dynamics of the family relationship.

Where can I learn more?

Access the full journal article, titled “Caregiver Perceived Stress and Child Sleep Health: An Item-Level Individual Participant Data Meta-Analysis,” in the Journal of Child and Family Studies.

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

Published July 15, 2023

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ECHO Study Suggests Caregiver Stress May Be Linked to Child Sleep Issues

ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

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ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

Authors: Matt Kasman, 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?

Health experts agree that sugar-sweetened drink consumption by children in the U.S. should be reduced but finding effective strategies has been a challenge. Large-scale interventions are costly and have shown limited effects. Computer modeling to explore what drives consumption in specific populations could lead to tailored strategies that yield better results.

What were the study results?

Through a computer simulation based on data collected over several years from thousands of real children, researchers found that limiting access to sugary drinks in the home could reduce childhood consumption by as much as 87%. Reducing sugar-sweetened drink availability at school and childcare facilities was also helpful. The amount of the reductions also varied between the groups of children simulated.

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 importance of tailoring interventions to reduce sugar-sweetened drink consumption for different populations. Using computer models, researchers may gain more information about populations that can help to identify effective targeted interventions.

Who was involved?

This study examined data from children ages 2 to 7 years old in three ECHO research sites across the U.S. These children spent time in different environments as they grew—home, childcare, and school—where they had varying access to sugary beverages.

What happened during the study?

Researchers entered data based on children from three ECHO research sites into a computer model to recreate their sugar-sweetened beverage consumption. Based on the computer model, researchers simulated potential interventions and measured their impact on reducing consumption in different populations. Computer models can be affected by certain factors, including socioeconomic status, BMI, time spent in a specific setting, accessible beverages in the home, and access to a pediatrician.

What happens next?

In future studies, researchers plan to include older children and adjust computer models to explore the consumption of other foods and beverages with health implications.

Where can I learn more?

Access the full journal article, titled “Childhood Sugar-sweetened Beverage Consumption: An Agent-based Model of Context-specific Reduction Efforts,” in the American Journal of Preventive Medicine.

A summary of a previous study that applied computational modeling to a single ECHO research site can be found here.

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

Published July 13, 2023

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ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

ECHO Researchers Develop a National Exposure Index for Combined Environmental Hazards and Social Stressors

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ECHO Researchers Develop a National Exposure Index for Combined Environmental Hazards and Social Stressors

Authors: Sheena Martenies, 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?

There is growing interest in understanding the combined effect of environmental hazards and social stressors on the health and development of children. While there are a number of tools for assessing the impact of environmental and social stressors, these tools can be limiting in the number of indicators they measure, the geographical area they cover, or the period of time they include for their observations. In this study, researchers developed a combined exposure index with national coverage that compiled available data on several environmental and social indicators during prenatal and early-life periods. This index is now being used to facilitate ECHO-wide analyses that consider multiple neighborhood-level exposures at the same time.

What were the study results?

The combined exposure index, which summarized exposures to multiple environmental hazards and social stressors at the neighborhood level, differed by region. The level of combined exposures were highest in the western and northeastern regions of the United States. Researchers also found that pregnant participants who identified as Black and Hispanic had higher exposures compared to White and non-Hispanic participants. Exposure values were also higher for pregnant participants with lower educational attainment.

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 study analyzed how the combined exposure to several environmental hazards and social stressors during pregnancy may impact health. Researchers found that pregnant participants from minority groups were more likely to have higher exposures to these hazards. These results support findings from similar studies that suggest that neighborhood quality might influence maternal and child health outcomes, and may contribute to health disparities.

Who was involved?

This study included data from 14,072 pregnancies from 46 different ECHO research sites across the United States.

What happened during the study?

Researchers developed a combined exposure index using publicly available data on environmental hazards and social stressors. The data included variables such as air pollution, features of the built environment, and neighborhood socioeconomic status, and then estimated the likelihood of exposure to these variables for participants in the study, based on where they lived.

What happens next?

Researchers can use this exposure index in future studies to look at how neighborhood features influence child health outcomes. Future studies would benefit from national datasets for key environmental health concerns, such as water contaminants and pesticides, and social stressors that may disproportionally affect certain groups.

Where can I learn more?

Access the full journal article, titled “Developing a National-Scale Exposure Index for Combined Environmental Hazards and Social Stressors and Applications to the Environmental Influences on Child Health Outcomes (ECHO) Cohort,” in the International Journal of Environmental Research and Public Health.

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

Published July 10, 2023

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ECHO Researchers Develop a National Exposure Index for Combined Environmental Hazards and Social Stressors

Maternal PFAS Exposure During Pregnancy Increases Children’s Risk of Obesity

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Maternal PFAS Exposure During Pregnancy May Increase Children’s Risk of Obesity

Authors: Yun Liu, Joseph Braun, 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.

Why was this study needed?

Per- and polyfluoroalkyl substances (PFAS) are long-lasting chemicals that can be found in many household materials, as well as food and drinking water. Maternal PFAS exposure during pregnancy may be linked to increased weight and a higher risk of obesity among children and adolescents. However, existing studies looking at these associations have had inconsistent findings.

What were the study results?

The study found that higher levels of some PFAS were linked with slightly higher BMIs in children and an increased risk of obesity. This trend was seen across male and female children and wasn’t affected by the presence of other factors linked to childhood obesity.

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?

Recently, there has been growing interest in understanding the effects of PFAS exposure on children’s health and establishing policies to address PFAS pollution. The US Environmental Protection Agency (EPA) has created a Roadmap to address PFAS contamination. Studies like this one can help better understand the risks of PFAS to take effective actions to protect vulnerable populations.

Who was involved?

The researchers used data from 1,391 children between the ages of 2 and 5 years and their mothers who were enrolled in eight ECHO cohorts across United States from 1999 to 2019.

What happened during the study?

The researchers measured levels of seven different PFAS in maternal blood samples collected during pregnancy. The researchers also used data on children’s weight and height to calculate each child’s body mass index (BMI), an approximate measure of body fat.

What happens next?

Future studies are needed to examine potential links between maternal PFAS exposure during pregnancy and obesity-related health concerns in older children.

Where can I learn more?

Access the full journal article, titled “Associations of Gestational Perfluoroalkyl Substances Exposure with Early Childhood BMI Z-Scores and Risk of Overweight/Obesity: Results from the ECHO Cohorts,” in Environmental Health Perspectives.

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

Published June 7, 2023

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Maternal PFAS Exposure During Pregnancy May Increase Children’s Risk of Obesity

Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

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Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

Authors: Rachel L. Miller; Christine C. Johnson, 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.

Why was this study needed?

While the prevalence of asthma has been reported widely in the United States and elsewhere, studies on childhood asthma incidence rates within specific populations and across various types of asthma and age ranges have been relatively sparse. Describing the incidence rates of ARE across various pediatric populations is a critical first step for identifying potential risk factors and causes.

What were the study results?

In this study, investigators wanted to gather more information about factors that influence the rates of childhood asthma with recurrent exacerbations (ARE)—a subtype of asthma where children experience frequent, severe episodes of asthma.

ARE incidence rates were highest among children ages 2-4 years old, and among non-Hispanic Black and Hispanic Black children. ARE rates were also higher among children living in the Northeast and Midwest compared to those living in the West. Children with a parental history of asthma had ARE rates 2.9 times greater compared to those with no parental history.

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 impact?

Higher incidence rates of ARE among young children, non-Hispanic Black and Hispanic Black children, and children living in the Northeast and Midwest suggest that differential environmental exposures may play a significant role in the onset of recurring asthma issues in children. ARE rates are consistently higher among children with a parental history of asthma, especially for young children, which may be due to a combination of genetic, environmental, and family lifestyle factors.

Who was involved?

The research team leveraged data from 17,246 children born between 1990 and 2017 who were enrolled in 60 ECHO research sites in the U.S. and Puerto Rico. Child participants or their caregivers reported whether and when the child had an asthma diagnosis and any oral corticosteroids prescribed from a health care provider. Incidence rates of ARE were based on reports of systemic (not inhaled) corticosteroid use.

Of the 4,114 children diagnosed with asthma during this study, there were 2,061 children with at least one asthma episode when they used oral steroid medication; 734 of these children had 2 or more asthma episodes with steroid medication use and met the conditions for ARE.

What happened during the study?

The researchers calculated the incidence rates of ARE for the study population as a whole, along with the rates for subsets of the population defined by the year of ARE diagnosis, the decade they were born, their age and sex, their race and ethnicity, their residence at birth, and their parents’ history of asthma. The researchers followed the children from birth until they developed ARE, reached the age of 20 years or the study period ended. The study identified children who developed ARE based on at least two reports of systemic steroid medication use at any time during the entire follow-up period. Children who received asthma diagnoses before age 5 years were required to have confirmation after 5 years, either by a parent or caregiver, adolescent self-report of asthma symptoms, hospitalization, emergency department or urgent care visit for asthma, provider visits due to asthma, or asthma medication use.

What happens next?

ECHO researchers are planning new studies that examine key early environmental exposures that could contribute to ARE, including viral respiratory tract infections, indoor allergens, environmental tobacco smoke, air pollution, stress, socioeconomic status, and where children live.

Where can I learn more?

Access the full journal article, titled “Incidence Rates of Childhood Asthma with Recurrent Exacerbations in the U.S. Environmental influences on Child Health Outcomes (ECHO) Program,” in The Journal of Allergy and Clinical Immunology.

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

Published March 25, 2023

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Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations