ECHO Researchers Analyze Potential Toxicity of Chemicals, Discover Gaps in Chemical Research


Edo Pellizzari, PhD, RTI International, ECHO Researcher

In a recent article in Environmental Health Perspectives, ECHO researchers discuss their work on identifying and ranking chemicals that have not been biomonitored nationally but may negatively affect child health. Biomonitoring is a process that detects chemicals that people are exposed to and measures how much of those chemicals get into the body.

To collect information, researchers examined different environmental elements (i.e., food, water, air, house dust) and household products that may contain toxic chemicals. Among other tasks, they put the chemicals into three groups:

  1. Chemicals recommended for biomonitoring
  2. Chemicals that need more information
  3. Chemicals that are a low priority for biomonitoring

Of the identified 720 chemicals, 155 were selected for prioritization, and of these, 36 were recommended for biomonitoring, 108 need additional research, and 11 were considered low priority. The chemicals recommended for biomonitoring add to the list of those currently studied by the ECHO Program. The chemicals that did not meet the three criteria – prevalence in environmental media or biospecimens, toxicity and a biomarker for its measurement – show the gap in current chemical research.

“There is a large opportunity to expand our ability to measure and evaluate chemicals to which the public is likely exposed,” the authors note. “These opportunities include performing exposure measurements, developing methods for biomonitoring, and toxicity testing of chemicals.”

While several thousand chemicals are approved for use in the United States, there is little information on biomonitoring of exposures in pregnant women, babies, and children. This limits the ability to evaluate the potential health impact of a variety of chemicals.

Through this study, the research team hopes others in the science community will be encouraged to study the identified chemicals and improve understanding of the potential health consequences they present in pregnant women, infants, and young kids.

International Journal Highlights ECHO’s Novelty and Necessity in Obesity Research

A recent article on childhood obesity in the US, published in the International Journal of Obesity, details results from an ECHO study of more than 37,000 babies and kids and describes the unique features that make the ECHO Program exceptionally valuable for obesity research.

The authors note that ECHO “holds promise to provide insight into the mechanisms that promote overweight and obesity in US children and provides rigorous data for novel programs to lessen the burden on individuals, families, and society.”

The study found that overweight and obesity were more common in older children than in younger children and varied with race/ethnicity. About 1 in 10 children age 1 to <2 years had a high BMI, and about 1 in 3 adolescents age 12 to <18 years was overweight or obese. Hispanic and black children had the highest rates of both overweight and obesity.

The results were similar to those from the large National Health and Nutrition Examination Survey (NHANES), pointing to the generalizability of ECHO’s population for further obesity research.

Despite the growing obesity epidemic, few programs provide an accurate insight into the many factors that promote overweight and obesity in children in the United States. However, due to the diversity and size of the ECHO Program’s population, it is well positioned to provide a comprehensive view of the impact of various environmental influences on childhood obesity.

“ECHO has assembled a large racially/ethnically diverse US cohort poised to provide much-needed answers to important questions regarding the early life determinants of childhood obesity risk,” the article states.

Because of the program’s size, it will have the statistical power to answer questions about environmental and preventable causes of childhood obesity even for less common exposures. Through the collection of existing and forthcoming data, ECHO also has the ability to examine genetic modifications and unravel the complexity of gene-environment interactions as contributors to obesity.

Find more information on ECHO research at

ECHO Researchers Identify Gaps in Prenatal Opioid Exposure Research

Elisabeth Conradt, PhD

This week, Pediatrics published results from ECHO researcher Elisabeth Conradt and her team’s efforts to learn more about prenatal opioid exposure and its effects on child development. Conradt and her team reviewed 52 publications to summarize what is known and make suggestions on how to expand knowledge in this area. The resulting article includes perspectives on how the ECHO Program can help learn more about this important topic.

“The number one question mothers, fathers, and clinicians have when they see that a mother is using opioids while pregnant is ‘how will this opioid exposure affect the child’s health?’ We cannot answer that question right now with the existing data,” Conradt said.

The team analyzed existing publications on three age groups: birth, infancy, and 2 years and older. Because of inconsistent and limited data, Condradt’s team was not able to understand a connection between prenatal opioid exposure and how children’s minds develop throughout life. However, they predict that the effects of the exposure at birth and infancy are small and subtle, but may increase as children age and have more demands on their attention at home and school.

Current studies were limited because of small sample sizes and difficulty controlling for confounding factors such as where a person lives or how much money their family makes.

Moving forward, the team will use ECHO data to test how prenatal opioid exposure affects learning, understanding, behavior, and attention span in middle childhood. They will also consider other possible factors such as poverty. Conradt noted that the team will also look at whether newborns who have neonatal opioid withdrawal syndrome (NOWS) have worse effects compared with newborns exposed to opioids who do not have NAS/NOWS.

Read the study summary and full media release.

ECHO Program Activates First Sites under the ECHO-wide Cohort Data Collection Protocol

June 19, 2019

PASS Cohort Group Picture

The Environmental influences on Child Health Outcomes (ECHO) Program announced today that it has activated its first sites to begin data collection under the ECHO-wide Cohort Data Collection Protocol. Congratulations to the Safe Passage Study (PASS) Cohort, led by Principal Investigator Amy Elliott, sites at Avera Health – Rapid City and Avera Health – Sioux Falls.

“This site activation marks the beginning of ECHO’s next chapter, allowing us to begin collecting data that will enhance the health of children for generations to come,” said ECHO Program Director Matthew Gillman, NIH. “ECHO is uniquely positioned, through an innovative study design, to answer transdisciplinary research questions that have not been explored in observational research to date.”

The ECHO cohorts seek to improve the health of children and adolescents by conducting observational research that will inform high-impact programs, policies, and practices across the United States. ECHO uses information from existing longitudinal research projects (cohorts) that will include more than 50,000 children from diverse backgrounds across the United States. Together, these cohorts follow participants from before they are born, through childhood and adolescence.

The studies focus on five key pediatric outcomes that have a high public health impact:

  • Pre-, peri-, and postnatal
  • Upper and lower airways
  • Obesity
  • Neurodevelopment
  • Positive Health

To learn more about the ECHO Program, visit our About ECHO Page.

New ECHO-funded Research Shows Chronic Illnesses in Children Do Not Necessarily Lead to Dissatisfaction

The ECHO researchers’ findings suggest that children with chronic illnesses are just as happy as their peers who do not have chronic illnesses.

The May 2019 issue of Pediatrics published findings from a recent study by ECHO researchers Courtney Blackwell, Amy Elliott, Jody Ganiban, Julie Herbstman, Kelly Hunt, Chris Forrest, and Carlos Camargo. The publication, titled “General Health and Life Satisfaction in Children With Chronic Illness,” focuses on children’s general health and life satisfaction in the context of chronic illness.

The study found that while children with chronic illnesses have worse health overall, their life satisfaction was comparable with that of their peers without chronic illnesses, suggesting that children with chronic illnesses may still lead happy lives.

As reported by the American Academy of Pediatrics, the authors noted, “the current study suggests that having a chronic illness is certainly a health challenge (evidenced by lower parent-reported general health) but does not preclude these children from having happy and satisfying lives that are comparable with those of peers without illness.”

This multi-cohort study evaluated results from questionnaires completed by 1113 caregivers completed on behalf of 1253 children aged 5-9 years with illnesses such as asthma, attention deficit hyperactivity disorder (ADHD), and digestive disorders. The study used the Patient-Reported Outcomes Measurement Information System Parent-Proxy measures for Global Health and Life Satisfaction.

Consistent with one of the primary goals of ECHO to leverage existing cohorts through harmonization of extant data and standardization of newly collected data, this study evaluated data from existing cohorts associated with the ECHO Program, with a specific focus on ECHO’s Positive Health outcome area.

“Overall, this work highlights clinical opportunities to broaden the perspective of health beyond the absence of disease to one in which all children, regardless of illness or impairment, can have well-being,” the authors said.

Read the full article to learn more.

Related links:

Link to AAP story

NIH, ECHO, and the Navajo Nation Make History with New Data-Sharing and Use Agreement

This landmark agreement enables the Navajo Birth Cohort Study (NBCS) to continue as part of the ECHO Program.

A Mother’s Love. Mallery Quetawki (Zuni Pueblo). University of New Mexico College of Pharmacy-Community Environmental Health Program

May 8, 2019

The National Institutes of Health (NIH) facilitated a data-sharing and use agreement between the Navajo Nation and NIH grantees of the Environmental influences on Child Health Outcomes (ECHO) Program at the Navajo Nation Head Start Center in Leupp, Arizona. This agreement, signed by the Navajo Nation, Johns Hopkins University, and RTI International, enables the Navajo Birth Cohort Study to continue participating in the ECHO Program while maintaining respect for Navajo Nation cultural beliefs, Tribal sovereignty, and community values. Additionally, the agreement serves as the first Tribal data-sharing agreement for a nationwide research consortium creating a large-scale database.

“Through this agreement I am confident that data sharing will benefit our Navajo people and allow us to further understand the relationship between uranium exposure, birth effects and childhood development,” said Navajo Nation President Jonathan Nez. “I am optimistic that through this partnership, the Navajo Birth Cohort Study will continue to progress and clarify the environmental impacts on our children’s health.”

The landmark agreement is the culmination of two years of discussion facilitated by NIH, and lays the groundwork for discussions with other Tribal Nations considering participation in biomedical research programs. Most importantly, the study is poised to benefit Navajo mothers and children as well as mothers and children everywhere. More information about the agreement can be found in the NIH news release here.

ECHO Leaders Spotlight Child Health Research at Pediatric Academic Societies Annual Meeting

ECHO will have a strong presence at the 2019 Pediatric Academic Societies (PAS) Annual Meeting in Baltimore, MD.

The ECHO Program will spotlight its advancement of child health research through three special ECHO-wide sessions at this year’s PAS Meeting in Baltimore, MD. These sessions are in addition to numerous abstracts that ECHO investigators are presenting in oral or poster sessions. You may find a list of all presentations by ECHO investigators here.

In the 3 special sessions, NIH Program Director Matt Gillman and several ECHO Investigators will present various perspectives on ECHO science, both from ECHO’s Cohorts and its IDeA States Pediatric Clinical Trials Network.  One is a state-of-the-art plenary session devoted to outlining the goals and early findings of the ECHO Program.

“The mission of ECHO to enhance the health of children for generations to come will resonate with the PAS community,” said Gillman. “We are looking forward to sharing our early findings with the larger pediatrics community. We hope that these presentations will generate excitement around ECHO as we forge the next steps of the Program, both on the observational side, where we are building the ECHO-wide Cohort of more than 50,000 children, and on the intervention side, where the IDeA States Network is providing access for children from rural and underserved backgrounds to participate in state-of-the-art clinical trials.”

Descriptions of each ECHO-related special session:

Precision Pediatrics: The Promise of Integrating Advanced Science and Technology with Prospective Birth Cohort Studies

Saturday, April 27th, 2:45 PM – 4:15 PM, Convention Center 301-302

This 90-minute session will focus on the impact that population-based cohort studies can have on advancing knowledge in child health. The session will feature overviews of the NIH All of Us Program, the Boston Birth Cohort Study, and the ECHO Program. Dr. Gillman will present an overview of ECHO, titled Environmental Influences on Child Health Outcomes: Leveraging Multiple Cohort Studies.

Applying Team Science to Building Research Collaboratives

Saturday, April 27th, 3:00 – 6:00 PM, Convention Center 313

This 3-hour workshop will focus on empowering residents, fellows, faculty, program directors, and departmental leadership with the tools to successfully build research collaboratives through team science. IDeA States Pediatric Clinical Trials Network PI Jessica Snowden will introduce and close the workshop as one of the session chairs.

The NIH Environmental Influences on Child Health Outcomes (ECHO) Program: Goals and Early Findings

Tuesday, April 30th, 9:45 AM – 11:45 AM, Convention Center 316

This 2-hour State of the Art Plenary session will focus solely on the ECHO Program, featuring an introduction by Dr. Gillman. ECHO PIs Drs. Nigel Paneth and Robert Wright will moderate the session, and three ECHO investigators will present current findings from their ECHO-funded projects. Presentations within this session include:

  • Leslie Young MD, FAAP, University of Vermont, will describe how ECHO addresses the Neonatal Opioid Abstinence Syndrome
  • Anne Dunlop MD, MPH, Emory University, will present a paper entitled: Geographic and Temporal Variation in the Effects of Socio-demographic Factors on Risk of Preterm Birth in the US.
  • Aruna Chandran MD, MPH, FAAP, Johns Hopkins University, will present a paper entitled: Epidemiology of Incident Asthma in Children across the US: Unique insights from the ECHO multi-cohort consortium.

In preparation for these talks, we sat down with a few ECHO presenters to learn more about what they planned to cover. Watch our videos below.


The ECHO Program looks forward to sharing its learnings with PAS attendees at this year’s meeting. To learn more about PAS presentations, or to add these presentations to your PAS schedule, visit the PAS website here.

ECHO Program Receives Green Light to Begin Expansive Child Health Research

Single institutional review board approves the NIH’s ECHO cohort research to proceed, which promises answers to high-impact research questions related to early influences on child health outcomes.

February 1, 2019

The Environmental influences on Child Health Outcomes (ECHO) Program today announced it has received single institutional review board (sIRB) approval to begin its research under the ECHO-wide Cohort Data Collection Protocol. The purpose of the sIRB is to ensure that research follows guidelines to protect participants. ECHO research will investigate the effects of a broad range of early exposures—including physical, chemical, biological, social, behavioral, natural, and built environments—on child health and development.

“The sIRB approval of the ECHO-wide Cohort Data Collection Protocol gives us the green light to start finding answers to important questions that will enhance the health of children for generations to come,” said ECHO Program Director Matthew Gillman. “We know that a child’s exposures from before birth through the first few years of life are tremendously formative, and yet, until now, child health research in this area has been limited, leaving us with lots of questions. We look forward to turning that tide.”

The ECHO-wide Cohort is made up of more than 70 individual cohorts, or groups, of mothers and children from ongoing research projects. Researchers follow participants through different life stages, some starting before birth and through adolescence. Together, they form a massive virtual “cohort of cohorts” that includes more than 50,000 children from diverse backgrounds across the United States. By bringing together data collected under a single protocol, ECHO researchers can answer high-impact, complex research questions.

Looking at the whole child

ECHO’s promise is not only in its breadth of data, but also its approach, which brings together multiple disciplines to address child health. Historically, many research projects have looked at children through a single, narrow lens. However, the body’s development process includes millions of interacting factors that all play a part in a child’s overall health. Researchers from 44 states, Puerto Rico, and the District of Columbia are involved in the ECHO-wide Cohort Data Collection Protocol. These researchers bring expertise from hundreds of disciplines. As a result, knowledge from ECHO research can offer a richer understanding of child health and development to help guide a healthier, happier childhood for our nation’s children.

Emily Oken, of Harvard University and the principal investigator for an ECHO Pediatric Cohort Award, and David Cella, of Northwestern University and one of the principal investigators for the ECHO Person-Reported Outcomes Core, led the trans-disciplinary development of the ECHO-wide Cohort Data Collection Protocol. They worked collaboratively with all ECHO components and gathered input through a public comment period. The research will include participants that are often excluded from traditional research, such as pregnant women, children, and caregivers. ECHO’s researchers hope that this wide view of the child will shed light on important patterns and trends in child health that have not been captured to date.

“It was a Herculean effort to develop a protocol of this scale with so many interacting variables,” said Gillman. “Through collaboration and a shared passion to enhance the health of all children, we are now positioned to begin this important work. Our team is energized and ready to go, and our nation’s children are waiting.”

ECHO-funded study sheds light on second- and third-hand smoke exposure in kids

A recent study funded by the ECHO Program, National Institute of Child Health and Human Development (NICHD), and National Institute on Drug Abuse, shows that infants and toddlers in low-income, rural areas may be at higher risk for second- and third-hand smoke than previously reported in the National Health and Nutrition Examination Survey. Findings were dependent on the detectable presence of cotinine – the byproduct formed when the body breaks down nicotine – in the children’s systems.

Based on an analysis of saliva samples collected from 1,218 children, 15 percent were in the high exposure group when tested for cotinine, demonstrating levels that are comparable to active adult smokers. Forty-eight percent of the children classified as moderate exposure and 37 percent fell in the low exposure group.

Other key findings from the study include lower smoke exposure for children in center-based daycare facilities and higher smoke exposure for infants, compared with toddlers. This is partially attributed to crawling and infants’ tendencies to put objects into their mouths. Additionally, according to the study, “lower income, less education, frequent residential moves and fluctuations in the number of adults within the home were associated with high smoke exposure.”

“Our results, if supported by future studies, can help educate parents and caregivers, as well as improve prevention programs that seek to reduce children’s smoke exposure,” said Clancy Blair, Ph.D., M.P.H., a professor at New York University’s Steinhardt School of Culture, Education and Human Development, and the senior author of the study.

The study was published in Nicotine & Tobacco Research December 5, 2018.


Research Review: Intergenerational transmission of disadvantage: epigenetics and parents’ childhoods as the first exposure

Scorza P, Duarte CS, Hipwell AE, Posner J, Ortin A, Canino G, Monk C.

Show Details

Scorza P, Duarte CS, Hipwell AE, Posner J, Ortin A, Canino G, Monk C. J Child Psychol Psychiatry. 2018 Feb 23. doi: 10.1111/jcpp.12877. [Epub ahead of print]. PubMed PMID: 29473646

Topics: Epigenetics