Welcome to the ECHO Connector! The Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director 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, SM
Welcome to the November 2023 edition of the ECHO Connector, the last of this year.
The end of the calendar year is a time for celebration. Today we celebrate ECHO’s many recent successes and how they showcase the principles that guide our work, and we anticipate even greater impact in 2024.
ECHO's solution-oriented approach means that we focus our research on informing programs, policies, and practices to promote long-lasting health for our country’s children. For example, our work on child health disparities demonstrates that they may be present as early as infancy, how they widen as children grow, and, equally importantly, what may drive them in the first place. This type of research emphasizes our approach to real-world solutions, aided by collaboration with many organizations, like yours, with whom we share our commitment to enhancing child health for generations to come.
The next year holds great promise for both the observational work of the ECHO Cohort Consortium, which has just launched its second 7-year cycle, and the intervention research of the ECHO Institutional Developmental Award (IDeA) States Pediatric Clinical Trials Network (ISPCTN). In early 2024, ECHO Cohort Study Sites will launch our new protocol that will follow over 30,000 current child participants and will enroll approximately 30,000 new pregnancies and their offspring. A novel addition is our preconception cohort that will follow several thousand women and their partners to examine how environmental factors even before pregnancy begins can affect their children.
Our investigators have published many papers in peer-reviewed journals this year, bringing our program lifetime total to more than 1500. These publications span a broad spectrum of topics across ECHO's child health focus areas, highlighting our collaborative team approach to science. We are excited to continue producing high-impact research in the next year and beyond. Please see the ECHO publication database to explore these papers and check back often to find our most recent work.
—Matthew W. Gillman, MD, SM
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ECHO Data Available
De-Identified ECHO Cohort Data Available Online
Researchers external to ECHO can now access de-identified ECHO Cohort data through the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Data and Specimen Hub (DASH).
A resource for the scientific community, ECHO Cohort longitudinal data on DASH come from more than 41,000 participants across the U.S. and focus on child health outcomes including pre-, peri- and postnatal outcomes; upper and lower airway health; obesity; neurodevelopment; and positive health.
Researchers can access data such as:
- Demographic information including race, ethnicity, gender, socioeconomic status, and education
- Early development data including growth, milestones, physical activity, and sleep
- Environmental exposure data including physical, chemical, psychosocial, and natural and built environments
- Pregnancy and birth information including maternal diet and physical activity, maternal smoking during pregnancy, weight gain, and delivery outcomes
- Data related to public health crises including the effects of the COVID-19 pandemic
The above are just examples of a subset of the ECHO data available on DASH. Read the current ECHO Cohort Data and Biospecimen Protocol v3.0 for more information on the types of data you can find on DASH.
How does this work?
- Create a DASH account and submit a Data Request Form.
- The NICHD DASH Data Access Committee will review your request and respond within three weeks.
- Use the data for three years. DASH will notify you three months before your DASH Data Use Agreement expires. A renewal request can be submitted at that time.
- See the DASH Tutorial for more detailed information on the process.
Job Opportunity
Leadership Opportunity with HEALthy Brain and Child Development (HBCD) Study
The National Institute on Drug Abuse (NIDA) at the National Institutes of Health is seeking exceptional candidates for the position of Project Director, HEALthy Brain and Child Development (HBCD) Study, Division of Extramural Research (DER). For more details on this opportunity, which closes December 15, 2023, please see the job announcement on the NIH website. https://hr.nih.gov/jobs/search/scientific/job-80096
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ECHO Research Spotlight
New ECHO Cohort Research Finds Apparent Association Between Some Prenatal Chemical Exposures and Postpartum Depression
Background and Introduction
Collaborative ECHO Cohort research led by Melanie Jacobson, PhD, MPH of the NYU Grossman School of Medicine investigates the role of prenatal synthetic chemicals in postpartum depression (PPD). This research, titled “Prenatal Exposure to Nonpersistent Environmental Chemicals and Postpartum Depression,” is published in JAMA Psychiatry.
PPD affects up to 20% of new mothers, making it the most common pregnancy complication to occur after delivery. PPD can impact a mother’s daily functioning, quality of life, and long-term health. Furthermore, it is associated with poor mother-child attachment, which can impact child health and development.
“Not only is PPD the most common pregnancy complication to occur after delivery, but it also impacts the health of two generations: the mother and the child,” Dr. Jacobson explained. “Paired with this burden, hormonal changes in pregnancy and delivery are associated with PPD, and various environmental chemicals are known to affect these same hormones, which prompted me to think about the potential connection between endocrine-disrupting chemicals and PPD.”
Factors like genetics and stress can make some people more likely to experience PPD, but researchers are still trying to understand how synthetic chemicals might also play a role. Chemicals such as phenols, phthalates, and parabens can be found in plastics and personal care products. While these chemicals are nonpersistent, meaning that they don’t linger in the environment, their presence in people is widespread due to frequent exposure through diet, absorption through skin, and inhalation.
Understanding the Link: Phthalates and PPD
Researchers used data from 2,174 pregnant individuals across five ECHO research sites to examine the extent to which exposure to these chemicals might be associated with PPD symptoms. The study measured the concentrations of nonpersistent chemicals in urine samples during pregnancy and collected data using self-reported postnatal depression assessments completed by the same individuals after delivery.
“By conducting this study through the ECHO Program, we were able to leverage a much larger sample size than any one site alone,” Dr. Jacobson said. “Given the resources needed to answer this study question, including longitudinal biological samples throughout pregnancy and maternal depression data after delivery, we not only needed a large sample size but a unified and harmonized data collection scheme, which ECHO provided.”
The study found that prenatal phthalate concentrations were associated with increased odds of slightly higher PPD scores. Of the many synthetic chemicals investigated, only phthalate concentrations were associated with increased odds of PPD. This suggests that finding ways to reduce prenatal exposure to phthalates might reduce the frequency of PPD. Researchers also observed that PPD was more likely in people who were Hispanic, had lower educational attainment, and had prenatal depression.
Public Health and Future Implications
“From a public health perspective, any way to help prevent PPD would be important, since most known risk factors such as genetics, psychiatric history, and stressful life events cannot be easily changed,” Dr. Jacobson said. “Therefore, focusing on prenatal exposure to these types of chemicals represents a novel interventional target.”
While this is believed to be the largest study to-date examining the effects of environmental chemicals on PPD, future studies are needed to replicate this research with larger sample sizes in diverse populations.
“Future research may also examine how social factors, such as stress, may interact with chemical exposures on the risk for PPD,” Dr. Jacobson said. “If the association found in this study is repeatedly observed, given that exposure to nonpersistent chemicals like phthalates can be potentially modifiable, this work has important implications for PPD prevention.”
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ECHO In the News: Recent Media Coverage
Highlights of ECHO research coverage in the media
Research led by Katherine Sauder, PhD, titled “Identifying Foods that Optimize Intake of Key Micronutrients During Pregnancy,” was featured in Newsweek.
Research titled “Associations of Neighborhood Opportunity and Vulnerability with Incident Asthma Among U.S. Children in the ECHO cohorts,” led by Izzudin Aris, PhD, was featured in U.S. News & World Report and MedPage Today.
Research led by Melanie Jacobson, PhD, titled “Prenatal Exposure to Nonpersistent Environmental Chemicals and Postpartum Depression,” was featured in The Hill and MedPage Today.
News You Can Use
ECHO Cohort Researchers Evaluate New Scale for Measuring Pandemic-related Traumatic Stress in Children and Adults
Collaborative ECHO Cohort research led by Courtney K. Blackwell, PhD of Northwestern University evaluated COVID-19 pandemic-related traumatic stress in a large sample of children and adults. In March 2020, ECHO researchers developed the Pandemic-related Traumatic Stress Scale (PTSS) to measure stress related to the COVID-19 pandemic. The PTSS can be used to identify children and adults with higher levels of traumatic stress and who may need additional mental health support. This research, titled “Development and Psychometric Validation of the Pandemic-related Traumatic Stress Scale for Children and Adults,” is published in Psychological Assessment.
The study included 17,830 children and adults from 47 ECHO research sites representing all 50 states; Washington, DC; and Puerto Rico. Researchers split the sample into four groups including 1,656 pregnant or postpartum individuals; 11,483 adult caregivers; 1,795 adolescents ages 13 to 21; and 2,896 children ages 3 to 12.
Between April 2020 and August 2021, adolescents and adult caregivers (including pregnant or postpartum individuals) completed surveys about their pandemic-related traumatic stress, depressive symptoms, anxiety, general stress, and life satisfaction. Caregivers of children ages 3 to 12 reported on the behaviors observed in their child.
On average, caregivers had the highest levels of pandemic-related traumatic stress, followed by adolescents, pregnant or postpartum individuals, and children. Within these groups, the researchers found additional differences related to age and gender. Adolescents, females, and caregivers of children under 5 had higher PTSS scores on average than younger children, males, and caregivers of children 5 and older, respectively. Higher levels of pandemic-related traumatic stress were associated with greater symptoms of distress and lower life satisfaction.
The researchers found that the PTSS is a reliable way to measure pandemic-related traumatic stress in the context of the COVID-19 pandemic. Researchers and doctors can use this scale to distinguish general stress, depression, and anxiety from traumatic stress, helping them to identify people who may need more support to improve their mental health.
“The PTSS can be used beyond the immediate COVID-19 pandemic context,” said Dr. Blackwell. “Unlike previous measures that capture traumatic stress reactions to a single event, the PTSS was developed to evaluate potential traumatic stress reactions to ongoing large-scale threats. In the future, the PTSS could be adapted to evaluate reactions to other acute onset stressors with lengthy durations.”
New ECHO Research Cohort Suggests Bias in Child Behavior Assessment Tool
Collaborative ECHO Cohort research led by Shuting Zheng, PhD, of the University of California, San Francisco; Maxwell Mansolf, PhD, of Northwestern University; and Somer Bishop, PhD, of the University of California, San Francisco suggests that scores from a commonly used measure of behavior problems in young children may be skewed depending on the primary language, education, and sex of the caregiver who fills out the survey. This research, titled “Measurement Bias in Caregiver-Report of Early Childhood Behavior Problems across Demographic Factors in an ECHO-wide Diverse Sample,” is published in the Journal of Child Psychology & Psychiatry Advances.
Behavior problems observed in a young child can provide information on that child’s risk for certain developmental conditions and later mental health issues. A valid and unbiased measure of childhood behavior can help researchers and clinicians answer questions about the development of behavior problems in children from different backgrounds.
The Child Behavior Checklist 1.5–5 (CBCL) is a commonly used, caregiver-reported measure of internalizing (i.e., anxious) and externalizing (i.e., aggressive) behavior problems in children ages 1.5 to 5 years. Researchers wanted to find out if scores from this test could be affected by demographic factors such as the child’s age or the caregiver’s sex, education level, and primary language, even after accounting for mental health disparities between these groups. The study aimed to identify factors contributing to measurement bias and to identify a subset of questions on the CBCL that were less impacted by bias but still reliably captured childhood behavior problems.
The study included caregivers of over 9,000 children between the ages of 18 and 71 months from 26 ECHO research sites across the United States. The data collected was used to evaluate how the characteristics of the child and the caregiver influenced the caregiver responses to the CBCL questions. Researchers found that caregiver or child demographic factors affected caregiver responses to many questions on the CBCL. The language (English vs. Spanish) the caregiver used to complete the survey contributed most to measurement bias, followed by their education level and sex. The child’s age and race also influenced caregiver responses to many CBCL questions.
Researchers then selected the CBCL questions that showed the least amount of bias and compared how well they worked as a set to evaluate childhood behavior problems when compared to the full CBCL survey. The researchers also mapped the scores from the less biased question sets to the scores provided by the full item set, allowing users to derive comparable scores to the original CBCL scale.
New ECHO Cohort Research Identifies Energy-efficient Foods to Boost Prenatal Nutrient Intake
Collaborative ECHO Cohort research led by Katherine Sauder, PhD and Catherine Cohen, PhD, RD of the University of Colorado Anschutz Medical Campus identified more than 2,300 energy-efficient foods that could help provide the right amounts of six key nutrients for a healthy pregnancy. This research, titled “Identifying Foods that Optimize Intake of Key Micronutrients During Pregnancy” is published in The Journal of Nutrition.
Most pregnant people in the U.S. are at risk of not getting enough of the nutrients vitamin A, vitamin D, folate, calcium, iron, and omega-3 fatty acids from foods alone. Previous ECHO Cohort research found that only one prenatal supplement available in the U.S. may give pregnant people the optimal amounts of each of these six nutrients. However, that supplement costs $200 per month and requires the patient to take seven pills a day.
Researchers in this study wanted to identify nutrient-rich foods to supplement a pregnant person’s diet and meet nutrient targets, in the same way that supplements do. They identified more than 2,300 low-calorie foods with enough of at least one of the six nutrients important in pregnancy, including many with reasonable serving amounts to avoid excessive intake. However, no single food evaluated gave enough of each nutrient to fill all six nutrient gaps. One food—raw seaweed—contained five of the key nutrients—vitamin A, folate, calcium, iron, and omega-3 fatty acid—but required up to 7 cups a day to meet daily requirements. Twenty-one other foods and beverages (mainly fish, vegetables, and beverages) provided target amounts of four of the six key nutrients. Few foods met targets for vitamin D or iron, suggesting that dietary supplements may be necessary to meet those nutrient needs. Other foods could be added in limited amounts to help meet intake targets without exceeding caloric recommendations or nutrient safety limits.
The study included 2,450 pregnant people from six ECHO research sites across the U.S. ECHO Cohort researchers looked at foods and drinks that pregnant participants consumed during their pregnancies and then calculated how much of these six nutrients they were getting from their diet. The researchers compared the participants’ diets to nutrition recommendations for pregnancy to determine the amount of nutrients the participants would need from foods to make up for the gaps in their diet.
“Our analysis indicates that more substantial shifts in dietary intake are likely needed to meet nutrient intake targets, as well as improve prenatal intake more generally,” Dr. Sauder said. “Clinicians can encourage pregnant people to reduce intake of nutrient-poor, energy-dense foods so that more nutrient-rich foods can be consumed without inducing excess calorie intake.”
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ECHO Discovery
ECHO Discovery is a monthly webinar series with educational presentations for the ECHO community and anyone else interested in environmental influences on child health.
Join Us for December ECHO Discovery!
Wednesday, December 13, 1pm ET
Akhgar Ghassabian, MD PhD
NYU Grossman School of Medicine
NYU Langone’s Center for the Investigation of Environmental Hazards
Prenatal Air Pollution Exposure and Risk of Autism: New Insight from ECHO Cohorts
In the past decade, air pollution has substantially declined in the U.S. because of policies informed by environmental monitoring and research. Nonetheless, a recent analysis of EPA data shows a shift in trends, confirming that a national decade-long tendency toward better air quality might be reversing. Moreover, concerns are increasing regarding adverse health outcomes of low levels of air pollution. Given the emerging evidence that shows the potential role of environmental chemical exposures in the etiology of autism, the need to identify air pollution exposure as a modifiable risk factor of autism is warranted.
November ECHO Discovery
Understanding the Natural History of Cardiovascular Health Across Early-Life
On November 8, Wei Perng, PhD, MPH of the Colorado School of Public Health and the University of Colorado Anschutz Medical Campus presented for ECHO Discovery on the natural history of cardiovascular health in children and adolescents.
Many of the factors influencing the development of cardiovascular disease (e.g., diet, physical activity, weight, tobacco exposure, sleep) take root during the first decade of life, so it’s important to identify early-life strategies for improving the heart health of children and adolescents. During this presentation, Dr. Perng presented on the findings of the Healthy Start and Project Viva ECHO research sites that have collected data on characteristics and behaviors linked to heart health among children and adolescents and analyzed the role of sociodemographic, behavioral, and environmental factors in influencing early-life cardiovascular health.
By assessing how cardiovascular health changes over the course of childhood and into adulthood, researchers can start to identify key factors that influence the link between maternal and childhood characteristics and long-term cardiovascular health. In the future, Dr. Perng and her team will continue to leverage the ECHO Cohort’s large, diverse population of participants to assess how cardiovascular health changes over the course of childhood and adolescence, link differences in early-life cardiovascular health with childhood characteristics, and identify factors that promote optimal cardiovascular health and mitigate the effects of lower cardiovascular health on long-term health outcomes.
View the presentation recording
October ECHO Discovery
Environmental influences on Child Health Outcomes (ECHO): A Nationwide Resource for Child Health Research
On October 11, Claudia Thompson, PhD of the National Institute of Environmental Health Sciences (NIEHS) presented for ECHO Discovery on the effects of climate change on child health outcomes.
The NIH Climate Change and Health Initiative aims to reduce health threats across the lifespan and build health resilience in individuals, communities, and nations around the world, especially among those at highest risk. To achieve this goal, the initiative supports transdisciplinary, transformative research. This research seeks to identify health effects of climate change, examine the effects of climate change on health equity, provide training and build capacity for climate change research, and design interventions to mitigate or adapt to the effects of climate change.
Children and pregnant women are particularly vulnerable to health effects from climate change. During the presentation, Dr. Thompson reviewed recent research that has found links between climate change and lower birthweights, more pediatric emergency department visits and hospitalizations, higher rates of childhood asthma, changes in childhood cognitive development, and increased risk for severe childhood pneumonia. A variety of social determinants of health—such as race, ethnicity, access to healthcare, and neighborhood conditions—also influence health effects, and can worsen health and increase healthcare costs disproportionately for vulnerable communities.
View the presentation recording
Learn More about ECHO Discovery
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Questions?
Contact the ECHO Program Office.