The American Journal of Epidemiology recently published an article, titled “The Environmental influences on Child Health Outcomes (ECHO)-wide Cohort,” describing the ECHO Program’s unique research design and lasting impact. The article provides an overview of the Program’s focus areas, participants, and data collection processes.

Established in 2016 by the National Institutes of Health (NIH), ECHO’s mission is to enhance the health of children for generations to come. ECHO investigators focus on solution-oriented research in five key areas of health—preconception, pregnancy, and birth; breathing; body weight; brain development; and well-being—to identify factors affecting child health outcomes and methods for improving those outcomes.

The ECHO Program’s national network brings together 69 existing cohorts that encompass over 90,000 participants, including pregnant women, caregivers, and over 60,000 children. ECHO children represent 49 states, Puerto Rico, and the District of Columbia, and are enrolled in the Program at various life stages from birth through adolescence. ECHO researchers collect biospecimens, genetic and epigenetic data, and residential history data from this large group of participants and use these data to investigate relationships between child health outcomes and various types of exposures.

The goal of ECHO research is to understand how early environmental influences—from society to biology—affect child health and development and identify ways to reduce children’s risk for developing disease and optimize their overall health and well-being. The ECHO Program is unique in that its investigators conduct both observational and intervention research with children, pregnant women, and caregivers from different backgrounds across the United States. The ECHO-wide Cohort (EWC) observational study’s large sample of geographically and socio-demographically diverse participants allows ECHO researchers to examine complex relationships between environmental exposures and child health outcomes. Furthermore, the inclusion of children at different life stages enables ECHO investigators to evaluate critical periods of child development and the effects of environmental exposures on children’s health over time.

To leverage existing data and standardize the collection of new data from thousands of ECHO participants, researchers from across the ECHO Program collaborated to develop the ECHO-wide Data Collection Protocol (EWCP). The EWCP identifies essential and recommended data elements, defines when each element should be collected, and outlines how each element should be measured. This data collection infrastructure, along with the expertise of ECHO researchers, have allowed ECHO to pivot to important and urgent issues affecting children’s health, such as the COVID-19 pandemic.

To date, ECHO researchers have published over 1,000 manuscripts on environmental exposures and ECHO’s key outcome areas, including 64 publications from the EWC. “The EWC brings together a large socio-demographically and geographically diverse participant population, extensive investigator expertise, and a network of successful cohort studies,” the article concludes. “With harmonized data and standardized data collection from 69 cohort studies, ECHO is poised to contribute to child health research, particularly research questions that are challenging to answer within a single study and methodological advances related to multi-cohort collaborations.”