News You Can Use

ECHO ISPCTN BREATHE (Bronchiolitis Recovery and the Use of HEPA Filters) Study Celebrates Successful Recruitment

The BREATHE Study is a randomized, double-blinded, multi-center clinical trial that began recruitment across 17 ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN) Clinical Sites in November 2022 with the goal of working to enroll children younger than 12 months of age who are hospitalized with bronchiolitis.

The goal of this study is to learn if using high efficiency particulate air (HEPA) filters in the home after hospitalization for bronchiolitis decreases the number of days over the next 24 weeks that infants have breathing problems such as coughing or wheezing. Eligible families who consent to enter the study are randomized to either an intervention group or control group. The intervention group is using HEPA units containing active filters, and the control group is using HEPA units containing inactive (control) filters. As part of the study protocol, participant caregivers are asked to place the HEPA units where the child sleeps and in a common space where the child spends a large amount of time. Small air pollution monitors in the home measure air quality (levels of fine particle pollution) throughout the follow-up period.

Study teams met and exceeded monthly enrollment targets since the study launch, even during months predicted to be a slow period for enrollment. Teams have already screened around 331 participants and randomized around 141 with a target enrollment of 218 participants. The child participants are being followed for respiratory outcomes over 24 weeks.

“It has been encouraging to see enrollment numbers exceed expectations so far. While no parent wants to see their child hospitalized, these numbers suggest that parents are seeing the importance of this study and how air pollution relates to their child’s health,” explains Ethan Walker, PhD. “The study progress is even more impressive from a logistics standpoint. Our team has delivered and set up HEPA filters and air pollution monitoring equipment for participants across 17 diverse and largely rural states, all of which has been done remotely without ever visiting a study household in-person. The fact that the study has gone so smoothly is a testament to our team. We hope that all of this work will lead to a meaningful impact in the lives of the infants enrolled in the BREATHE study."

Dr. Walker is a co-investigator on the team from University of Montana and leads the equipment and air sampling parts of the study along with Principal Investigators Erin Semmens, PhD also from University of Montana and Kelly Cowan, MD from University of Vermont. To follow ECHO ISPCTN clinical trial progress and learn more about the BREATHE study, click here.

New ECHO Cohort Research Explores Role of Caregiver Pandemic-Related Stress in Child Behavior

Collaborative ECHO Cohort research led by Patricia Brennan, PhD, of Emory University and Sara S. Nozadi, PhD, of the University of New Mexico investigates the role of caregiver stress in child behavior outcomes during the COVID-19 pandemic, suggesting support and aid for caregivers benefited all families during that period. This research, titled “Examining the Roles of Discrimination and Social Support in the Association between COVID-19 Related Stress and Child Behavior Problems in Racially Diverse ECHO Cohorts,” is published in the Journal of the American Academy of Child and Adolescent Psychiatry.

During the COVID-19 pandemic, many families experienced social isolation, economic hardship, and disruptions in daily routines. Previous research on the effects of pandemic-related caregiver stress on children has been conducted internationally but with low representation of children from communities of color in the U.S. This study aimed to examine the influences of caregiver COVID-19-related stress, support for caregivers, and discrimination on children’s behavior across diverse populations.

The study focused on nearly 2,000 sets of caregivers and children from diverse racial and ethnic backgrounds at 14 ECHO research sites across the U.S. Most caregivers were either living with a partner or married and had a bachelor's degree or higher education.

The researchers used the Child Behavior Checklist for Ages 6-18 to assess outward behaviors like rule-breaking and aggression and inward behaviors like feeling anxious or withdrawn. They also studied the support caregivers received. Emotional support questions measured how cared for and valued caregivers felt, and instrumental support questions looked at whether support was available to meet tangible needs.

The study found that higher levels of support for caregivers were associated with fewer behavior problems overall. On the other hand, higher amounts of stress from the COVID-19 pandemic were associated with more child behavior problems. The findings suggest that support for caregivers positively impacted child behavior across the board, regardless of the specific challenges posed by the pandemic. Researchers looked separately at a subset of Black American participants, as they likely experienced unique discrimination during the pandemic. In that group, researchers found that as reported experiences of discrimination increased, the relationship between COVID-19-related stress and child behavior problems grew stronger.

“Our findings suggest that particular subgroups of Americans, in this case, Black American children, may have been at risk for higher levels of depression or anxiety due to the compounding stressors posed by the COVID-19 pandemic and discrimination,” Dr. Brennan said. “Prevention programs designed specifically to meet these families’ needs may have particularly high payoffs in terms of improving children’s mental health outcomes.”

Future studies can further assess how COVID-19 stress, discrimination, and social support may be related to children's behavior problems during the pandemic. In addition, researchers can focus on Indigenous populations as a separate group, which was not possible in this study due to a small sample size.

Read the research summary.

ECHO Cohort Researchers Investigate Link Between Neighborhood Conditions During Childhood and Asthma Incidence 

Collaborative ECHO Cohort research led by Izzuddin Aris, PhD, of Harvard Medical School examined the way conditions and resources available in neighborhoods are linked to childhood asthma incidence rates during different stages of child development.

Neighborhood conditions, such as access to housing, healthy food, transportation, and education centers, can influence the development of childhood asthma. Researchers often measure these conditions using the Child Opportunity Index and the Social Vulnerability Index, which together link residential addresses at birth, infancy (age 0.5‒1.5 years), and early childhood (age 2.0‒4.8 years), respectively, to census-tract data about the opportunities and resources available in the surrounding neighborhood.

ECHO researchers used data from 10,516 children in 46 ECHO research sites. The participants had at least one residential address from birth and a parent or caregiver report of a physician’s diagnosis of asthma.

Children born in high-opportunity neighborhoods had an asthma incidence rate of 23.3 cases per 1,000 children, while those born in very low- and low-opportunity neighborhoods had rates of 35.3 per 1,000 and 27 per 1,000, respectively.

“Neighborhood conditions could help researchers identify vulnerable children who are at high risk for developing asthma,” said Dr. Aris. “This information can also guide policymakers, researchers, and community groups to improve children’s health and foster equity across neighborhoods.”

Future studies may explore the impact of investing in early life health and environmental, social, and economic resources on improving health outcomes for children in disadvantaged neighborhoods. Follow-up studies might also focus on how these neighborhood-level factors affect asthma rates and how moving may alter asthma development.

This research, titled “Associations of Neighborhood Opportunity and Vulnerability with Incident Asthma Among U.S. Children in the ECHO cohorts,” is published in JAMA Pediatrics.

Read the research summary.

New ECHO Cohort Research Suggests Caregiver Education Levels and Child Age Shaped Family Concerns During the COVID-19 Pandemic 

Collaborative ECHO Cohort research led by Kaja LeWinn, ScD of the University of California, San Francisco and Lisa Jacobson, ScD of Johns Hopkins University investigates the influence of a caregiver’s educational background and their child’s age on the experiences of children and families during the COVID-19 pandemic. This research, titled “Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States,” is published in JAMA Network Open.

The COVID-19 pandemic and resulting public health measures presented unique challenges for families, frequently influenced by factors such as income and caregiver educational background as well as their children’s ages during the pandemic. Using the ECHO Program’s existing research sites and COVID-19 questionnaires, researchers were able to observe the social and economic factors that were affecting families and children at the height of the pandemic while many population-based studies were put on hold. The study analyzed data from 14,646 ECHO children and 13,644 ECHO caregivers between April 2020 and March 2022.

Researchers found that caregivers with less than a high school education were more likely to report difficulties getting COVID-19 tests for their children, were less likely to work remotely, and reported financial concerns and access to necessities such as food as top sources of stress. Caregivers with a master’s degree or higher, on the other hand, were more likely to name social distancing as the top source of their pandemic stress and were more likely to have the option to work remotely.

Caregivers with children between the ages of 1 and 5 years reported the least support from school systems, the most difficulty finding childcare, and fewer remote learning options. They were also more likely to have healthcare appointments canceled due to COVID-19 concerns and were most concerned about how the pandemic would affect their ability to work.

This study underscores the importance of understanding how children and caregivers from various backgrounds experienced the COVID-19 pandemic. This insight can help uncover social inequities that could worsen conditions for some populations during future public health crises and can be used to create safeguards to protect vulnerable populations.

“Programs and policies that provide financial assistance and mandate more work flexibility for families of lower socioeconomic status during times of crisis may help mitigate their burdens,” said study author Dr. LeWinn. “Our findings also suggest that families with young children may need more support related to childcare and work flexibility, especially when school disruptions are involved.”

Future research may look into the long-term effects these pandemic challenges may have on child participants in the ECHO Cohort.

Read the research summary.

New ECHO Cohort Research Suggests Association Between Prenatal Depression and Autism-Related Traits

Collaborative ECHO Cohort research led by Lyndsay A. Avalos, PhD and Lisa A. Croen, PhD of Kaiser Permanente Northern California Division of Research investigates the potential link between prenatal depression or a history of depression prior to pregnancy and autism-related traits in children. This research, titled “Prenatal Depression and Risk of Child Autism-Related Traits Among Participants in the Environmental influences On Child Health Outcomes Program,” is published in Autism Research.

Previous research suggests an association between prenatal depression or a history of depression prior to pregnancy and autism spectrum disorder (ASD) in children, but most studies have focused on a formal ASD diagnosis, rather than autism-related traits.

This study examined parent-child pairs at 33 prenatal and pediatric ECHO research sites in the U.S. The primary analysis included 3,994 parent-child pairs with prenatal depression diagnosis data; a secondary analysis included 1,730 parent-child pairs with depression severity data. Children of mothers with prenatal depression had slightly more autism-related traits compared to those without. The association was similar among boys and girls. Prenatal depression also increased the likelihood of moderate to severe autism-related traits, indicating a higher likelihood of ASD diagnosis.

“Autism-related traits can significantly impact a child’s physical, social, and psychological development, regardless of their clinical diagnosis. Screening and treating pregnant patients for depression and detecting autism-related traits in these children early on can lead to timely support of healthy development and outcomes for mothers and children,” said study author Dr. Avalos.

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

Read the research summary.

Other News

Researching COVID to Enhance Recovery (RECOVER)

We are all still learning about the long-term effects of COVID, also called Long COVID. What is RECOVER? RECOVER is an initiative funded by the National Institutes of Health (NIH) to understand why some people are sick for a long time after their COVID infection, and why others get better quickly. RECOVER studies have a diverse group of participants, including adults, pregnant people, and children. RECOVER is focusing on enrolling children and young adults through the end of the year.

Go to the RECOVER website to learn more.

Back to top