Prenatal Exposure to Organophosphate Esters Associated with Increased Autism-Related Outcomes, ECHO Study Finds

Author(s): Jennifer Ames, 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?

Organophosphate esters (OPE) replaced harmful polybrominated diphenyl ethers (PBDEs) as flame retardants and plastic softeners in the mid-2000s. They are now present in various household and industrial products, including polyurethane foam, furniture, electronics, construction materials, infant products, textiles, and fabrics. Health officials and researchers currently know little about how OPEs affect child development. Earlier studies have suggested a link between prenatal exposure to these chemicals and birth outcomes and cognitive and behavioral problems in children. This study investigated the potential effects of prenatal exposure to nine OPEs on child autism-related outcomes.

What were the study results?

The study found generally small associations between three OPEs and child autism-related outcomes. Specifically, high exposure to bis(butoxyethyl) phosphate (BBOEP) was associated with higher scores for autism-related traits and greater odds of autism diagnosis. Another OPE, bis(1-chloro-2-propyl) phosphate (BCPP) showed associations with higher autism-related trait scores. High exposure to bis(2-chloroethyl) phosphate (BCETP) was associated with lower odds of autism diagnosis. The study also found that the association between BBOEP and higher autism-related traits scores was stronger in boys than in girls.

What was the study's impact?

This study underscores the need to better understand and address the potential developmental toxicity of these widely used chemicals.

Who was involved?

The study included 4,159 mother-child pairs with children born from 2006 to 2020 from 15 study sites in the ECHO Cohort.

What happened during the study?

Researchers analyzed urine samples from pregnant mothers for nine OPE biomarkers. The researchers then assessed child autism-related traits via the Social Responsiveness Scale (SRS) and collected information on whether they received a clinical autism diagnosis to examine associations between prenatal OPE exposure and child neurodevelopment.

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 happens next?

Future research could replicate these findings in different populations and use multiple measures of OPEs throughout pregnancy to better understand the critical exposure windows and long-term effects of OPEs on child neurodevelopment. Additionally, further studies could help researchers explore the potential sex-specific effects of prenatal OPE exposure.

Where can I learn more?

Access the full journal article, titled “Exposure to organophosphate ester flame retardants and plasticizers during pregnancy and autism-related outcomes in the ECHO Cohort,” 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 11, 2025

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Prenatal Exposure to Organophosphate Esters Associated with Increased Autism-Related Outcomes, ECHO Study Finds

Unusual Early Childhood Weight Patterns Associated with Higher Risk of Future Obesity

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Unusual Early Childhood Weight Patterns Associated with Higher Risk of Future Obesity

Authors: Chang Liu, Jody Ganiban, 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?

Childhood obesity is defined as having a body mass index (BMI) 0at or above the 95^th percentile for age and sex. Without early support or intervention, children who show patterns of high BMI during childhood are more likely to become overweight or obese as teenagers and adults. This increases their risk for long-term health issues, including diabetes and heart disease. To prevent these outcomes, it's important to understand how children's BMI changes over time and identify early-life factors—especially those that can be changed—that influence childhood growth patterns. This study aimed to identify unusual BMI patterns (sometimes called atypical BMI trajectories) in early childhood and understand which early-life factors may contribute to them.

What were the study results?

In this study, researchers found two common patterns in how children’s BMI changes over time. Most children (89.4%) had a typical pattern where their BMI went down from ages 1 to 6, then slowly increased. A smaller group (10.6%) had an atypical pattern where their BMI stayed the same from ages 1 to 3.5, then showed rapid increases from ages 3.5 to 9. By age 9, these children were more likely to develop obesity, with an average BMI higher than the 99th percentile. Some factors that associated with the risk of a child developing obesity included high birthweight, maternal smoking during pregnancy, high maternal BMI before pregnancy, and greater maternal weight gain during pregnancy.

What was this study's impact?

The study highlights key prenatal risk factors and early childhood growth trajectories related to childhood obesity, offering opportunities for early prevention and intervention to help children stay on a healthy growth path and reduce their chances of becoming obese.

Who was involved?

The study included 9,483 children from diverse racial, geographical, and socioeconomic backgrounds from the ECHO Cohort.

What happened during the study?

Researchers looked at data collected over time about children’s weight and height from medical records, measurements taken by staff, reports from caregivers, or measurements taken at home. They tracked how children's BMI changed as they grew and looked for patterns.

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 happens next?

Future studies could help researchers understand the biological mechanisms and social/environmental factors linked to childhood obesity, helping to develop targeted intervention programs that can redirect unhealthy BMI trajectories.

Where can I learn more?

Access the full journal article, titled “Early-Life Factors and Body Mass Index Trajectories Among U.S. Children in the ECHO Cohort,” 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.

Published May 22, 2025

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Unusual Early Childhood Weight Patterns Associated with Higher Risk of Future Obesity

Obesity, Diabetes, & High Blood Pressure Before and During Pregnancy are Associated with Higher Blood Pressure in Children

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Obesity, Diabetes, & High Blood Pressure Before and During Pregnancy are Associated with Higher Blood Pressure in Children

Authors: Zhongzheng Niu, 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?

High blood pressure in childhood is linked to a higher risk of experiencing high blood pressure and other heart-related complications later in life. Preventing high blood pressure during childhood could be a promising strategy to improve cardiovascular health into adulthood. Growing evidence suggests that maternal health during pregnancy may be a contributor. For this study, researchers wanted to look at how three common cardiometabolic risk factors— pre-pregnancy obesity, gestational diabetes, and high blood pressure (hypertension) during pregnancy—are related to blood pressure in their children between ages 2 and 18.

What were the study results?

A new finding from this study is that when mothers had more than one health issue during pregnancy—especially when high blood pressure occurred alongside gestational diabetes or pre-pregnancy obesity—their children’s blood pressure was higher than when the mother had only one of these conditions. Of the mothers included in this study, 44% had at least one cardiometabolic risk factor during pregnancy. The most common was pre-pregnancy obesity at 26%, followed by high blood pressure at 14% and gestational diabetes at 7.3%. Children whose mothers had any of these health issues during pregnancy had higher average blood pressure when compared to those born to mothers who did not. This was true for the top (systolic) and the bottom (diastolic) numbers in a blood pressure reading, even after accounting for the child’s age, sex, and height. These children also showed an increased rate of blood pressure change between ages 2 and 18. The association was stronger for diastolic blood pressure in female children and for systolic blood pressure in non-Hispanic Black children whose mothers had gestational diabetes or high blood pressure during pregnancy.

What was this study's impact?

This study can help researchers and clinicians better understand how a mother’s heart and metabolic health during pregnancy may influence a child’s long-term cardiovascular health. This highlights the potential value of early-life interventions aimed at monitoring and managing blood pressure in children with prenatal exposure to these maternal risk factors.

Who was involved?

The research included 12,480 mother-child pairs from study sites in the ECHO program. The mother's average age at pregnancy was 30 years, and 47% of participating mothers were non-White. At least one maternal cardiometabolic risk factor was present in 44% of the mothers.

What happened during the study?

Researchers gathered information about mothers’ heart and metabolic health from medical records or surveys. They also collected blood pressure readings from their children, either during study visits or from their medical records. They used statistical methods to look at how a mother’s health before and during pregnancy might be linked to her child’s blood pressure—both at the youngest age and as the child grew from age 2 to 18. They also looked at whether these links were different depending on the child’s sex or race and ethnicity.

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 happens next?

More research could help researchers understand how combinations of maternal cardiometabolic risk factors influence children’s blood pressure over time. Future studies could also examine how structural and social factors contribute to maternal health during pregnancy and shape long-term cardiovascular health in children.

Where can I learn more?

Access the full journal article, titled “Maternal cardiometabolic risk factors in pregnancy and offspring blood pressure at age 2-18 years,” 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.

Published May 08, 2025

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Obesity, Diabetes, & High Blood Pressure Before and During Pregnancy are Associated with Higher Blood Pressure in Children

Children Born in Lower-Opportunity Neighborhoods Had Higher Rates of Asthma with Recurrent Exacerbations

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Children Born in Lower-Opportunity Neighborhoods Had Higher Rates of Asthma with Recurrent Exacerbations

Authors: Rachel Miller, Christine C. Johnson, et al.

Who sponsored this study?

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

Why was this study needed?

Neighborhood conditions—such as access to housing, healthy food, transportation, and education—can influence the development of childhood asthma. Researchers often use the Child Opportunity Index (COI) to measure these conditions, linking residential addresses at different stages of early life to data about the resources available in the surrounding neighborhood. This index looks at various aspects of a neighborhood to see how they might affect children's chances of success and health. It combines information from 29 indicators, 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. So, the higher the COI score, the better the neighborhood is believed to be for children's development and future prospects. Previous research suggests that these factors can all play a role in shaping different types of childhood asthma. This ECHO study was needed to explore how conditions before and at the time of birth can affect children’s rates of asthma with recurrent exacerbations (ARE)—a type of asthma where children experience frequent, severe episodes of asthma.

What were the study results?

The study found that children born in neighborhoods with low community opportunity, when measured at birth and as measured by the COI, had a much higher incidence rate of asthma with recurrent exacerbations compared to those from other neighborhoods. Non-Hispanic Black children had significantly higher rates than non-Hispanic White children across all neighborhood categories. Among children from very low-opportunity neighborhoods, the rates were several times higher for non-Hispanic Black and Hispanic Black children compared to White children. Even after accounting for individual factors, children from these low-opportunity areas had higher adjusted incidence rates for asthma with recurrent exacerbations, especially those aged 2 to 4 years or those who had a parent with asthma.

What was the study's impact?

Earlier ECHO research found that living in a neighborhood with higher opportunity at birth was associated with lower asthma incidence than living in a neighborhood with lower opportunity. This study highlights the importance of addressing neighborhood-level conditions to help prevent asthma flare-ups in children. It supports the idea that improving conditions in under-resourced areas can positively impact children’s health.

Who was involved?

The study used data from 15,877 children born between 1990 and 2018. These children were from 60 ECHO cohorts across the U.S.

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 while being monitored by ECHO researchers. The study also looked at the connection between the COI and the children's birth addresses, examining how neighborhood conditions influenced the rates of asthma flare-ups while considering individual factors like child race and ethnicity, sex and parental history of asthma.

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 happens next?

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

Where can I learn more?

Access the full journal article, titled “Child Opportunity Index at Birth and Asthma with Recurrent Exacerbations in the U.S. 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 13, 2025

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Children Born in Lower-Opportunity Neighborhoods Had Higher Rates of Asthma with Recurrent Exacerbations

No Significant Associations Observed Between Prenatal Antibiotic Use and Wheezing Symptoms in Infants

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No Significant Associations Observed Between Prenatal Antibiotic Use and Wheezing Symptoms in Infants

Authors: Rachel Greenberg, 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?

Wheezing symptoms occur in 20-40% of infants, contributing to a substantial impact on children’s quality of life and their use of healthcare. Multiple early exposures, such as prenatal exposure to cigarette smoking, have been associated with these wheezing symptoms.

Previous studies have suggested a possible link between antibiotic exposure during pregnancy and an increased risk of wheezing and cough in children, caused by an imbalance in the birthing parent’s microbiome due to antibiotic use. However, these studies had some limitations. Additional research was needed to include enough participants to produce reliable results and account for other factors that might have influenced outcomes. This study examined the association between prenatal antibiotic exposure and the development of wheezing during infancy using a large national sample of infants and birthing parents.

What were the study results?

In this study, 36% of pregnant participants used at least one antibiotic while pregnant, and about 26% of infants had a report of wheezing. Overall, the research team observed that exposure to antibiotics during pregnancy was not associated with infant wheezing during the first 18 months after birth. Note that most outcome data were based on birthing parent/caregivers’ self-reports.

Prenatal antibiotic exposure was also not associated with an increase in emergency room visits or hospitalizations for wheeze during infancy. However, prenatal antibiotic use was associated with higher odds of medication use for wheeze or dry cough during infancy, which could imply more severe symptoms and a medical provider’s diagnosis. It is important to note that the study team found an association between prenatal antibiotic exposure and medication use for wheeze or cough during infancy only among children born via vaginal delivery and thus exposed to the birthing parent's microbiota. This finding supports the theory that a change in the microbiome of the birthing parent and infant is related to this association.

The researchers also observed an association between prenatal antibiotic exposure and wheeze in research sites that recruited participants who had a family history of asthma, suggesting that a genetic or environmental risk within these families may increase the likelihood of wheeze.

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 results of this study raise the possibility of an association between prenatal use of prenatal antibiotics and medication use for wheezing in the 18 months after birth. It suggested that prenatal antibiotics may influence respiratory outcomes during infancy, but further studies are needed to understand how the timing and type of antibiotic use may influence these effects.

Who was involved?

This study included 4,721 pregnant participants and their 4,779 infants from 12 study sites in the ECHO Cohort Consortium. Most pregnant participants were between 25 and 35 years old, non-Hispanic White, and had a college degree or more. Overall, 36% of the pregnant participants used at least one antibiotic during their pregnancy.

What happened during the study?

The study team analyzed data collected using questionnaires, interviews, or medical records to analyze associations between prenatal antibiotic exposure and airway symptoms (e.g., wheeze, cough) during infancy. The study team confined the outcome of wheezing to infancy (prior to the age when asthma is typically diagnosed), and they evaluated antibiotic exposure throughout pregnancy.

What happens next?

Future research is needed to understand how the timing and type of antibiotic use during pregnancy influences infant wheeze outcomes. Additional studies are also needed to replicate these findings, which could then lead to clinical implications.

Where can I learn more?

Access the full journal article, titled “Association Between Prenatal Antibiotic Exposure and Infant Wheeze Outcomes,” in Acta Paediatrica.

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 February 27, 2025

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No Significant Associations Observed Between Prenatal Antibiotic Use and Wheezing Symptoms in Infants

Prenatal Exposure to Phenols and Parabens Higher Among Minority Populations, ECHO Study Finds

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Prenatal Exposure to Phenols and Parabens Higher Among Minority Populations, ECHO Study Finds

Authors: Michael S. Bloom, Adaeze Wosu Nzegwu, et al.

Who sponsored this study?

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

Why was this study needed?

Exposure to endocrine-disrupting chemicals (EDCs), such as environmental phenols (EPs) and parabens, is common during pregnancy through everyday products like plastics, food packaging, and personal care items. These chemicals can cross the placenta and, despite their short breakdown time in the body, EPs are often detected in human tissue. Prenatal exposure has been linked to risks such as pregnancy complications, developmental issues, and long-term health problems, particularly in underserved populations. Low-income and minority communities may face higher exposure to chemicals like EPs due to closer proximity to factories and waste facilities, as well as limited access to a broader range of consumer products and fresh foods. This study investigated racial and ethnic differences in prenatal exposure to EPs and parabens across the U.S., addressing the limitations of earlier, smaller studies that did not fully explore these differences among pregnant women.

What were the study results?

Urinary levels of most EPs examined varied significantly by race and ethnicity, with non-Hispanic Black and Hispanic participants having higher levels of certain EPs than non-Hispanic White participants. Specifically, non-Hispanic Black and Hispanic participants had higher average levels of a chemical that comes from paradichlorobenzene in their urine compared to non-Hispanic White participants. Paradichlorobenzene is found in mothballs, fumigants, and air fresheners, and it is mainly inhaled. Non-Hispanic Black participants also had higher levels of specific parabens, which are preservatives used in processed foods and personal care products. These chemicals can be absorbed through eating or using such products.

What was this study's impact?

The study highlighted the disproportionately high levels of exposure to EPs among pregnant racial and ethnic minorities in the U.S.

Who was involved?

The study included 4,006 pregnant participants from 11 ECHO Cohort Study Sites across the U.S., representing various racial/ethnic identities, including Hispanic, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White individuals.

What happened during the study?

The study analyzed 7,854 urine specimens collected during pregnancy. Researchers measured the levels of 10 different urinary EPs.

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 happens next?

Further studies could examine the sources of these exposure differences.

Where can I learn more?

Access the full journal article, titled “Racial and ethnic differences in prenatal exposure to environmental phenols and parabens in the ECHO Cohort,” in the Journal of Exposure Science and Environmental Epidemiology.

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

Published February 15, 2025

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Prenatal Exposure to Phenols and Parabens Higher Among Minority Populations, ECHO Study Finds

Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds

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Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds

Authors: 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?

Teens spend a significant amount of time using social media, raising questions about how their digital and social experiences intersect. Recent concerns outlined by the U.S. Surgeon General’s Advisory suggest potential negative influences of social media on youth mental health. 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 per day 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. While a large number of previous studies focus on negative mental health outcomes such as depression and anxiety, ECHO researchers examined teen social media use in relation to both positive and negative mental health effects.

What were the study results?

High-quality peer relationships were the strongest predictor of teen well-being, regardless of social media use, with a magnitude nearly three times as large as the association between social media use and poor mental health. Teens who reported high quality peer relationships were more likely to experience positive mental health, while teens who reported poor quality relationships were more likely to report worse mental health, even at similar levels of social media use.

What was the study's impact?

The study highlights the importance of improving the quality of peer relationships rather than merely limiting social media use to enhance teens’ mental health.

Who was involved?

The study included 963 teens aged 13 to 18 from three ECHO Cohort Study Sites across the United States.

What happened during the study?

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 teens’ mental well-being, including life satisfaction, sense of purpose, symptoms of depression, and the quality of their friendships.

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 happens next?

Studying social media use and mental health over the course of adolescence could help researchers better understand how these factors influence each other throughout this sensitive stage of development. Future research could also focus on finding ways to strengthen peer relationships to support teens' mental health.

Where can I learn more?

Access the full journal article, titled “Adolescent social media use and mental health in the Environmental influences on Child Health Outcomes (ECHO),” in the Journal of Adolescent Health.

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

Published February 5, 2025

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Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds

COVID-19 Pandemic May Have Altered Exposures to Environmental Chemicals, ECHO Study Finds

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COVID-19 Pandemic May Have Altered Exposures to Environmental Chemicals, ECHO Study Finds

Authors: Megan Romano, et al.

Who sponsored this study?

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

Why was this study needed?

The COVID-19 pandemic caused unprecedented disruptions in the daily lives of children and families worldwide. In the United States, recommendations to stay home and wear masks may have altered people's exposure to various potential endocrine-disrupting chemicals (EDCs). For example, changes in the use of certain consumer products, such as N-95 masks, and decreased exposure to air pollutants due to lockdown may have influenced these exposures. ECHO researchers wanted to learn whether exposures during pregnancy changed during the COVID-19 pandemic.

What were the study results?

During the COVID-19 pandemic, urinary levels of certain chemicals changed, reflecting shifts in exposure. Levels of specific polycyclic aromatic hydrocarbons (PAHs), which are air pollutants from car exhaust, fire smoke, and some grilled foods, decreased. Some synthetic phenols, used in plastics and disinfectants found in household cleaners and consumer products like mouthwashes, also showed a decline. However, levels increased of certain organophosphate esters (OPEs)—chemicals used in plastics, flame retardants, and cleaning agents, and more recently in surgical, KN95, and N95 masks. - The increase in these chemicals may be linked to the use of face masks during the pandemic. When people wore masks regularly, they may have unknowingly inhaled small amounts of these chemicals, leading to higher levels in their bodies. In contrast, urinary concentrations of chemicals commonly found in plastics, personal care products, and pesticides remained largely unchanged.

What was this study's impact?

The study highlighted how significant behavioral changes during the pandemic may have contributed to changes in exposures to harmful environmental chemicals.

Who was involved?

The study included 47 participants from three ECHO Cohort Study Sites who contributed urine samples before and during the COVID-19 pandemic.

What happened during the study?

Researchers collected urine samples from participants before (between October 2018 and February 2020) and during (between March 2020 and April 2021) the COVID-19 pandemic. They tested the samples for various chemicals.

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 happens next?

Researchers could continue tracking changes in chemical exposures and their potential health effects to better understand how these environmental exposures change over time, particularly during significant societal changes like the COVID-19 pandemic.

Where can I learn more?

Access the full journal article, titled “Changes in urinary concentrations of contemporary and emerging chemicals in commerce during the COVID-19 pandemic: Insights from the Environmental influences on Child Health Outcomes (ECHO) program,” in PLoS One.

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

Published January 24, 2025

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COVID-19 Pandemic May Have Altered Exposures to Environmental Chemicals, ECHO Study Finds

Executive Functioning May Be Connected to Child Health Behaviors, ECHO Cohort Study Suggests

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Executive Functioning May Be Connected to Child Health Behaviors, ECHO Cohort Study Suggests

Author(s): Nichole Kelly, Derek Kosty, Leslie Leve et al.

Who sponsored this study?

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

Why was this study needed?

Executive functioning refers to the cognitive processes that relate to a person’s ability to shift attention (cognitive flexibility), control impulsive actions (behavioral inhibition), and remember multiple pieces of information while solving a problem (working memory). Studies with adults suggest that lower executive functioning is related to less engagement in health-promoting behaviors, which increases risk for chronic disease. This study aimed to understand how these three domains of executive functioning relate to health behaviors in different age groups (early childhood, middle childhood, and adolescence). The goal was to inform more specific and developmentally tailored intervention strategies that target executive functioning to improve health behaviors and ultimately reduce chronic disease risk in children.

What were the study results?

Across all age groups, children with higher working memory also had more health-promoting eating behaviors, such as less frequent intake of sugary drinks and saturated fats. In middle childhood, children who showed more cognitive flexibility and behavioral inhibition also ate more fruits and vegetables and engaged in more physical activity. In adolescence, children with higher scores in all three executive function domains reported more engagement in physical activity. Researchers did not find significant connection between child sleep and executive functioning in this study.

What was the study's impact?

The results of this study can help researchers and clinicians plan better interventions that target children’s executive functioning to improve their health behaviors and, ultimately, their risk for chronic disease. For example, the results of this study suggest that early intervention targeting children’s working memory may help improve their dietary behaviors throughout childhood. However, associations with executive functioning observed in this study were small, so other interventions may be needed to support families in developing health-promoting behaviors. Additionally, because this study looked at this association at only one point in time for each child, it isn’t clear whether executive functioning influences health behaviors or vice versa.

Who was involved?

The study included children and their parents/caregivers from 38 ECHO Cohort Study Sites across 78 locations in the U.S. and Puerto Rico. Children from three life stages participated in the study: 2,074 in early childhood (age 5–8 years), 3,230 in middle childhood (age 8–12 years), and 1,416 in adolescence (age 12–18 years).

What happened during the study?

During the study, participating children completed computer tasks to measure their executive functioning. Participants also shared details about their diet, physical activity, and sleep through parent- and/or child-reported questionnaires. Additionally, information on income, positive parenting, neighborhood crime, and greenspace was collected.

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 happens next?

To continue identifying the best health intervention strategies, researchers could continue to explore how executive functioning relates to health behaviors by collecting data on how these effects change over time.

Where can I learn more?

Access the full journal article, titled “Children’s executive functioning and health behaviors across pediatric life stages and ecological contexts,” in the Journal of Behavioral Medicine.

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

Published January 9, 2025

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Executive Functioning May Be Connected to Child Health Behaviors, ECHO Cohort Study Suggests

Black Children and Especially Black Girls May Be Less Likely to Receive an Autism Diagnosis

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Black Children and Especially Black Girls May Be Less Likely to Receive an Autism Diagnosis

Authors: Kristen Lyall, Bob Joseph, 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?

Research suggests that autism spectrum disorder is diagnosed less often in minority groups, possibly due to limited access to healthcare, potential biases, and delays in diagnosis. This study explored how sociodemographic factors like race, ethnicity, and education relate to autism diagnoses and parent-reported autism-related behaviors. Researchers wanted to learn whether these factors showed similar patterns in diagnosis and behavior scores and whether they might help explain why some children are less frequently diagnosed.

What were the study results?

The study found that non-Hispanic Black children had lower odds of receiving an autism diagnosis compared to non-Hispanic White children, despite similar levels of autism-related traits. Additionally, Black girls were less likely to be diagnosed with autism but more likely to have high SRS scores, indicating potential under-recognition of autism in this group. Separately, higher maternal education was also associated with reduced odds of both autism diagnosis and autism-related traits, as measured by the Social Responsiveness Scale (SRS).

What was the study's impact?

The study highlighted potential differences in how autism is recognized in children, particularly among non-Hispanic Black children. The results suggest a need to address clinical inequalities and consider ways to ensure accurate identification of autism across all sociodemographic groups.

Who was involved?

The study included 8,224 children from diverse backgrounds, with data gathered from 46 ECHO sites across the United States.

What happened during the study?

The study used data from the ECHO Cohort to examine relationships between demographic factors, autism diagnoses, and parent-reported autism-related traits. Researchers focused on two main outcomes—autism diagnoses and scores on the Social Responsiveness Scale (SRS), a parent-report questionnaire capturing autism-related traits. They used statistical methods to compare associations between sociodemographic characteristics and the likelihood of autism diagnosis and high SRS scores. The goal was to understand whether these factors influenced the two outcomes differently.

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 happens next?

Additional research could address strategies to reduce barriers to diagnosis and consider increased screening for minority and low-education groups. Efforts to help doctors and healthcare providers better recognize autism in underserved communities and ensure equitable access to diagnostic resources may improve early diagnosis and reduce disparities in care.

Where can I learn more?

Access the full journal article, titled “Demographic Correlates of Autism: How Do Associations Compare Between Diagnosis and a Quantitative Trait Measure?,” 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 January 8, 2025

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Black Children and Especially Black Girls May Be Less Likely to Receive an Autism Diagnosis