Pre-, Peri-, and Postnatal
(pregnancy and birth)
Upper and Lower Airway (breathing)
Obesity
(body weight)
Neurodevelopment
(brain development)
Positive Health
(well-being)well-being
ECHO researchers use data from more than 64,000 diverse children and their families across the U.S. to explore early determinants of child well-being, such as maternal health during pregnancy, family and social support, sleep, media use, physical activity, family hardships, and chronic health conditions.
Positive Health Resources
CDC: Promoting Social and Emotional Health
Provides articles and tools promoting social and emotional health of children and adults.
U.S. Department of Health & Human Services: Early Childhood Learning & Knowledge Center
Provides information on how to promote children’s social and emotional well-being. Helps families and educators understand the connections between childhood mental health and overall well-being.
QUESTIONS
For information or to request an interview, contact the ECHO Program Coordinating Center echocc@dm.duke.edu.
If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.
How ECHO Advances Research on Positive Health
Positive health research in ECHO examines a child’s sense of well-being, as measured by overall health, life satisfaction, and meaning and purpose. Positive health differs from the mere absence of disease. It is a health outcome that spans the whole child rather than focusing on one or more organs or systems.
ECHO also takes an asset- or strength-based approach to positive health and its other four health focus areas. An asset-based approach looks at factors that promote health or prevent disease alongside more typical approaches that examine disease causes. Some assets may reflect resilience factors or the ability to cope in harmful biological, behavioral, or social environments.
By including positive health as one of its five priority outcomes, ECHO seeks to advance scientific understanding of the developmental pathways that help explain how children can lead happy and healthy lives.
What We're Learning
The ECHO Program has published more than 2,200 articles about the results of its research, including many that looked at positive health outcomes.
Here are some research highlights:
Smoking During Pregnancy Linked to Mental Health Challenges in Children, ECHO Study Finds
April 6, 2026
Children exposed to smoking before birth may be more likely to struggle with a combination of emotional and behavioral issues.
Stress During Pregnancy & Adverse Experiences in Mom’s Own Childhood May Be Associated with Child Mental Health, ECHO Study Finds
March 11, 2026
A mother's own adverse childhood experiences and stress during pregnancy may be independently associated with an increased risk of mental health problems in her children.
Sleep Habits Vary for Children Living in Medically Underserved Areas But Not in Rural Communities, ECHO Study Finds
December 27, 2025
Children living in medically underserved areas go to bed later, wake up later, and are less likely to get the recommended amount of sleep compared to those in well-resourced communities.
Children in High Gun Violence Areas Less Likely to Report Excellent Health, ECHO Study Finds
November 2025
Parents reported worse health for children living in areas with high levels of gun violence, with the largest effects in high-poverty, high-violence neighborhoods.
Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds
February 2025
High-quality peer relationships were the strongest predictor of teen well-being, regardless of social media use, with a magnitude nearly three times as large as the association between social media use and poor mental health.