Welcome to the ECHO Connector! The Environmental influences on Child Health Outcomes (ECHO) Program is a research program, at the NIH, with the mission to enhance the health of children for generations to come. The ECHO Connector will keep you informed of program news and our latest research findings.
Message from Matt
A message from the ECHO Director, Matthew W. Gillman, MD
In May, the NIH ECHO Program Office released a Request for Information (RFI) to seek input from the scientific community and the general public about enhancing ECHO science. We are currently reviewing the valuable feedback you provided, and we will share a summary of the comments in the coming weeks.
Additionally, last month, ECHO hosted a two-day workshop on the preconceptional origins of child health. The workshop featured a welcome by NIH Director Dr. Francis Collins and presentations by experts who discussed the state of the science, research gaps, and opportunities related to how preconception exposures may influence child health outcomes.
Thank you to those who participated in these opportunities to enhance ECHO Program science and future pediatric research.
In this issue of the ECHO Connector, we are pleased to share our latest news and findings on topics including the role epigenetics may play in the inheritance of health risks, clinical trials recruitment, and the progress of the ECHO Program. In addition, this month’s Connector highlights insights about diversity, disparity, and resilience from the Principal Investigator of our Navajo Birth Cohort, which shares data with ECHO grantees as part of the first Tribal data-sharing agreement for a nationwide research consortium.
I would also like to thank ECHO Connector readers and ECHO participants for their continued support. Below you will find information regarding a survey on the current state of the ECHO Connector, with opportunities to provide feedback on the ECHO Program’s website materials and resources. The survey should take no longer than 5 minutes to complete. With your participation and feedback, we hope to enhance ECHO’s communications and resources.
—Matthew W. Gillman, M.D., S.M.
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ECHO Website and Digital Communication Survey
The ECHO Program Coordinating Center is seeking feedback on its website and digital communications, including our bi-monthly newsletter, the ECHO Connector.
Please complete this survey to provide your feedback. We will share results in upcoming communications and strive to implement your feedback in future materials and digital communications.
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ECHO Research Spotlight
ECHO Publication Reviews Current Research on Epigenetic Influences on Intergenerational Health
In the past few decades, researchers have found mounting evidence that environmental influences could affect health across multiple generations. Epigenetics studies how your behaviors and environment can cause changes that affect the way your genes work. This may affect the health of an individual’s children or grandchildren, even when those exposures happen prior to conception. Researchers are only just beginning to untangle the intricate web connecting environmental exposures and epigenetics to intergenerational health with the help of large, ongoing study populations, like ECHO.
In order to evaluate the role epigenetics may play in the inheritance of health risks, a writing team of ECHO researchers led by Carrie Breton, ScD of the University of Southern California, reviewed the current state of epigenetics research.
“While complex childhood disorders clearly have genetic components, it is increasingly clear that the environment can play a substantial role in affecting risk, even across generations,” said Breton. “Our question was how much evidence exists to support epigenetic mechanisms as one route for conveying that risk.”
The review pulls together the results of many different animal and human studies that have investigated the role of epigenetic mechanisms in intergenerational inheritance of health risks. Breton’s team found robust evidence in many animal models, including mammals like mice and rats, that environmental exposures can influence health across multiple generations.
According to the review, it is much harder to generate strong data for epigenetic inheritance in humans, as it can be difficult to pick apart the competing influences of epigenetics, genetics, and ongoing environmental and social factors. To control for these influences, studies of epigenetics in humans need to gather detailed information about large groups of people across multiple generations.
ECHO’s diverse, nationwide cohort of mothers and children gives our researchers a unique opportunity to lead cutting-edge investigations into the intergenerational influence of environment on child health.
The review, titled “Exploring the evidence for epigenetic regulation of environmental influences on child health across generations,” is published in Communications Biology.
ECHO Program Spotlight:
ISPCTN Data Coordinating and Operations Center
Meet ECHO Investigator Jeannette Y. Lee, PhD
Dr. Jeannette Lee is a Principal Investigator (PI) for the ISPCTN Data Coordinating and Operations Center (DCOC) and Professor of Biostatistics at the University of Arkansas for Medical Sciences (UAMS) in Little Rock, AR. The DCOC manages a number of activities for the ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN), including protocol development and biostatistical expertise data coordination and standards, quality control and assurance, and operational coordination for ECHO ISPCTN clinical trials.
She provides valuable perspectives on multicenter clinical trials, including extensive work with the pharmaceutical industry. In addition to her role as PI of the DCOC, Dr. Lee serves as a temporary voting member on the FDA’s Vaccine and Related Biological Products Advisory Committee (VRBPAC). Most recently, she participated in the advisory committee’s review of the emergency use authorization applications for the Pfizer, Moderna, and Johnson & Johnson vaccines for COVID-19.
Dr. Lee’s career began at the Washington University Division of Radiation Oncology in St. Louis, where she was introduced to the world of multicenter cancer clinical trials through the Radiation Therapy Oncology Group. Through her work in this position, Dr. Lee became interested in the 'recruitment piece' of clinical trials, specifically identifying reasons why potential participants are excluded and eligible participants choose not to participate.
"From my professional experiences, recruitment of study participants is key to the success of any clinical trial,” states Dr. Lee. “Pediatric studies involve getting buy-in from children, their caregivers, and their health care providers so the messaging has to be in multiple levels."
"Barriers to recruitment are manyfold, from misconceptions about disease and treatments, mistrust of research, concern about side effects, logistical barriers (transportation, time available for study visits), and concern about expenses," explains Dr. Lee.
While logistical barriers can often be met by allocating resources, addressing misconceptions requires gaining trust from potential participants and addressing their concerns. Within the ISPCTN, specific teams work on materials to inform participants about clinical research and address some of their concerns. At the site-level, our investigators and coordinators work closely with participants to ensure to address their concerns.
"For studies involving participants who enroll through a health care provider, there are often barriers at the provider level (e.g. extra time involved in meeting study requirements, staffing requirements for the study). The ISPCTN is addressing provider barriers by recognizing and supporting the additional personnel time required," continues Dr. Lee. "Maintaining participant retention requires keeping participants engaged and ensuring that participants feel that their involvement is valued."
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News You Can Use
ECHO Publications Featured in Pediatric Research
Pediatric Research recently published a series of papers highlighting the ECHO Program’s progress to date. Authored by ECHO investigators, the publications cover a variety of program-related topics including its commitment to investigating the effects of early environmental influences on child health.
The first article in this series provides an overview of the ECHO Program’s structure and governance, and gives context behind the ECHO-wide Cohort and its protocol. Authors emphasize the diversity and size of the ECHO Program and how it created a data platform and biorepository that investigators can utilize for large research efforts. Other topics include sharing ECHO science, policies, stakeholder engagement, and lessons learned since launching in September 2016.
The second article in the series provides examples of ECHO Program potential Big Wins, which are solution-oriented research questions that help inform programs, policy, and practice. Authors of this article provide examples of how the ECHO Program and its researchers develop tools and methods for pediatric research to allow for successful research outcomes.
Additionally as part of this special series, the NIH authored an introductory article on the ECHO Program, detailing its origin and accomplishments thus far.
New Interactive ECHO Maps Available on ECHOChildren.org
New maps depicting the distribution of ECHO cohorts, ISPCTN clinical study sites, and ECHO Program supporting components are now available on the ECHO website. These interactive maps feature the ability to search around the U.S. and Puerto Rico, zoom in and out, and click on individual sites for more information about ECHO’s expansive network of studies.
Upcoming Events for You to Join
Register Now: 33rd Annual Conference of the ISEE
The International Society for Environmental Epidemiology (ISEE) will host its annual conference August 23-26, 2021. This year’s conference, focused on “Promoting Environmental Health and Equity in a Shifty Climate,” will include presentations from a number of ECHO investigators:
- Akhgar Ghassabian, MD, PhD: Real-time characterization of personalized air pollution exposure in pregnant women participating in a birth cohort study
- Marcia Pescador Jimenez, PhD: Street-View Greenspace Exposure and Objective Sleep Characteristics
- Peter James, ScD, MHS: Street-View Greenspace Exposure and Objective Daily Rest-Activity Patterns
- Tracey Woodruff, PhD, MPH, and Jessie Buckley, PhD, MPH: Widespread Exposure to Emerging and Previously Unmeasured Chemicals in Commerce in Pregnant Women Across the US
- Donghai Liang, PhD, MPH, and Rong Che Jung Chang, MS: Prenatal per- and polyfluoroalkyl substance (PFAS) exposure, metabolomic petrubation, and lower birth weight in African American women: a meet-in-the-middle approach
Conference details are available online.
Register by August 20.
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ECHO Discovery
ECHO Discovery is a monthly webinar series with educational presentations for the ECHO community, stakeholders, and the public.
June ECHO Discovery:
Navajo Birth Cohort: Understanding Diversity, Disparity, and Resilience through ECHO
On June 9, Dr. Johnnye Lewis of the University of New Mexico gave an ECHO Discovery presentation where she discussed the ECHO Program’s Navajo Birth Cohort.
In 2019, NIH facilitated a data-sharing and use agreement between the Navajo Nation and ECHO Program grantees. The agreement was created to respect Navajo Nation cultural beliefs, Tribal sovereignty, and community values. The first Tribal data-sharing agreement for a nationwide research consortium creating a large-scale database, it lays the groundwork for discussion with other Tribal Nations considering participation in biomedical research programs.
During her presentation, Dr. Lewis highlighted the importance of understanding diversity, disparity, and resilience of indigenous peoples in research and ECHO’s role in building and maintaining diversity of these peoples among its cohorts.
In a follow-up conversation with Dr. Lewis, she discussed the Navajo Birth Cohort and why it’s important to include indigenous peoples in child health research.
Understanding Tribal Sovereignty
The Navajo population holds a unique position in the country as the first and only peoples who retain their sovereign (self-governance) status within the U.S., says Dr. Lewis. Sovereignty is the basis for holding a negotiation status on policies of the federal government that impact tribal members, and for their control and ownership of data collected on tribal lands.
“The mistreatment of indigenous peoples has occurred through a series of broken treaty promises since the time of first contact,” Dr Lewis notes. “This process has been formally documented within the congressional record as lands guaranteed in perpetuity have been taken away.”
The Navajo Birth Cohort and ECHO
While the Navajo Birth Cohort is not the only source of tribal participants in ECHO, their recruitment across tribal lands and by tribal members makes this cohort the most representative of an indigenous population as a whole still living on tribal land.
“The Navajo Birth Cohort has already raised questions on the appropriateness of assessment tools, understanding the potential variability in developmental trajectories, and continuing to remain sensitive to the appropriateness for our tools and methods before interpreting our data and generalizing our results,” says Dr. Lewis.
Through inclusion of the broad range of cohorts in ECHO, and making sure that all remain included and the variability continues to be examined, ECHO provides the opportunity through its research efforts to truly understand factors that contribute to child health and development in the U.S. population.
July ECHO Discovery:
Community Engagement and Report Back the Story of PROTECT-ECHO in Puerto Rico
Speaker
Dr. Carmen M. Vélez Vega
University of Puerto Rico
View more information on the July ECHO Discovery Presentation
Upcoming August ECHO Discovery:
Understanding Health Disparities: What You Don't Know Can Hurt You
Speaker:
Dr. Nathan Stinson, Jr., MD, PhD, MPH
Division of Scientific Programs
National Institute on Minority Health and Health Disparities
Register to attend the August ECHO Discovery Presentation
Learn More about ECHO Discovery
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Questions?
Contact the ECHO Program Office.
Past Issues
May 2021
March 2021
January 2021
November 2020
September 2020
July 2020