New ECHO Research Investigates Increase in Screen Time for Children During the Pandemic

Posted on February 15, 2023December 5, 2023 by Jodi Snare

Collaborative ECHO research led by Monique Hedderson, PhD and Assiamira Ferrara, MD, PhD, of the Division of Research at Kaiser Permanente Northern California, investigates the changes in screen time habits of children during the COVID-19 pandemic. The study found that total screen time among children ages 4 to 12 increased between December 2020 and April 2021 when school closures and lockdowns were widespread and remained even after several restrictions were lifted. The research, titled “Trends in screen time use among children during the COVID pandemic, July 2019 through August 2021,” is published in JAMA Network Open.

The study included 228 parent-child pairs from three ECHO cohorts across the United States (Colorado, California, and South Dakota). Parents reported their children’s screen time. The geographically, racially, and ethnically diverse participants ranged in age from 4 to 12 at the start of the study. ECHO researchers surveyed parents about their children’s media use before, during the early, and later periods of the pandemic. The study assessed total, educational (not including remote school), and recreational screen time and examined trends in screen use before and at two points during the pandemic.

Excessive screen time is associated with obesity-promoting health behaviors and adverse mental health. The COVID-19 pandemic initially led to widespread school closures, shelter-in-place laws, closures of recreational facilities and cancellation of youth sports, increases in parents working from home, and social distancing recommendations, all of which may have impacted screen time among children.

“Our findings can help inform clinical guidelines that could aid parents and their children in re-establishing healthy media use habits,” said Dr. Hedderson. “Pediatricians can help parents reset family media use priorities and limits that may have relaxed during the early stages of the COVID-19 pandemic using tools like the American Academy of Pediatrics Family Media Plan.”

Prior studies have reported screen time levels during the pandemic but were unable to document changes in screen time because most lacked pre-pandemic assessments. This study is among a handful of ECHO COVID-19 studies to include pre-pandemic assessments of screen use in order to document changes during the pandemic.

More studies are needed to determine whether the increases in screen time among children during the pandemic impacted longer term obesity and mental health outcomes in children. Future studies can also clarify whether there were specific types of screen time that adversely impacted children’s health during the pandemic.

Read the research summary.

NIH Program Study Suggests Pregnant Women with Higher Levels of Oxidative Stress May Be More Likely to Deliver Preterm Babies

Posted on January 27, 2023August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

Elevated levels of oxidative stress during pregnancy might be linked to a higher risk of preterm birth, according to a new study funded by the Environmental influences on Child Health Outcomes Program at the National Institutes of Health.

Oxidative stress, a process that can trigger cell damage, may contribute to poor prenatal health outcomes. “Previous research on this topic has involved fairly small, primarily White populations, which is not reflective of diversity in the U.S.,” said Stephanie Eick, PhD, MPH, an ECHO Program investigator at Emory University’s School of Public Health.

This study examined data from 1,916 racially, ethnically, and demographically diverse pregnant women from four ECHO cohorts across the U.S. and Puerto Rico. Researchers used urine samples collected during the second and third trimesters of pregnancy to measure oxidative stress biomarkers and evaluate any links between those biomarkers and preterm birth.

The researchers found a strong association between higher levels of oxidative stress biomarkers and preterm birth, particularly for participants who experienced sudden, unexpected preterm birth or preterm birth that occurred prior to 34 weeks. Further research is needed to understand the chemical mechanisms behind this association and identify the risk factors that contribute to high oxidative stress during pregnancy.

Dr. Eick and Rachel Morello-Frosch, PhD, MPH an ECHO Program investigator at the University of California, Berkeley, led this collaborative research published in the American Journal of Obstetrics and Gynecology.

Eick, S. et al. A pooled analysis of four birth cohorts examining urinary oxidative stress biomarkers and preterm birth. American Journal of Obstetrics and Gynecology. DOI:10.1016/j.ajog.2022.11.1282.

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

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ECHO Researchers Investigate Whether Prenatal Chemical Exposures Affect the Development of Autism-related Traits in Children

Posted on January 26, 2023October 25, 2024 by Jodi Snare

Collaborative ECHO research led by Jennifer Ames, PhD of the Kaiser Permanente Northern California Division of Research and Ghassan Hamra, PhD of Johns Hopkins Bloomberg School of Public Health, investigates whether exposures to per- and polyfluoroalkyl substances (PFAS) during pregnancy were associated with the development of autism-related traits in children. The researchers looked at data from 1,224 mother-child pairs and found that prenatal exposure to one specific PFAS chemical, perfluorononanoic acid (PFNA), may be associated with an increase in autism-related traits in children. Prenatal exposure to the mixture of all PFAS chemicals combined was not associated with increased autism-related traits in children. This research, titled “Prenatal exposure to per- and polyfluoroalkyl substances and childhood autism-related outcomes,” is published in Epidemiology.

PFAS are widely used, long lasting chemicals, the components of which break down very slowly over time. Previous studies that have investigated the association between prenatal PFAS exposure and childhood autism spectrum disorder (ASD) have been inconsistent and mostly involved small sample sizes. This study leveraged the large, diverse ECHO-wide cohort to evaluate how prenatal PFAS exposure affects the development autism-related traits, even when a child does not receive a clinical ASD diagnosis.

This study included children born between 2011 and 2018 from 10 racially and ethnically diverse ECHO cohorts across the United States, including one cohort that enrolls children from families with an increased likelihood of ASD. The researchers measured the levels of eight different PFAS in blood samples collected from mothers during pregnancy. Later, when their children were aged 2.5 years or older, researchers asked caregivers to report on their child’s autism-related traits using a questionnaire called the Social Responsiveness Scale (SRS). The research team tracked the associations between these data to examine child SRS scores in relation to each individual PFAS as well as the combination of the PFAS.

“In the U.S. population, exposures to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) have dropped substantially since the industry voluntarily phased out these chemicals in the early 2000s,” said Dr. Ames. “However, other PFAS exposures have increased over time, including thousands with unknown toxicity. These so-called ‘forever chemicals’ continue to pose risks to health even after they are phased out because they persist in the environment and inside people’s bodies and don’t break down easily.”

These results underscore the need for more research on whether PFAS chemicals might have more significant effects on child neurodevelopment, and whether factors such as genetics, underlying health conditions, or nutritional status may change the effect of PFAS exposure on brain development.

Read the research summary.

New ECHO Study Investigates the Relationship Between a Mother’s Oxidative Stress Levels and Preterm Birth

Posted on January 26, 2023April 2, 2025 by Jodi Snare

A collaborative research study led by Stephanie Eick, PhD, MPH of Emory University’s Rollins School of Public Health and Rachel Morello-Frosch PhD, MPH of the University of California, Berkeley found an association between elevated levels of oxidative stress and higher risk of preterm birth. This study examined data from 1,916 racially, ethnically, and demographically diverse pregnant participants from four ECHO cohorts across the United States and Puerto Rico. This research titled, “A pooled analysis of four birth cohorts examining urinary oxidative stress biomarkers and preterm birth,” is published in the American Journal of Obstetrics and Gynecology.

Oxidative stress is a process that can trigger cell damage and may contribute to poor prenatal health outcomes. “This is the largest study to date looking at the relationship between oxidative stress and preterm birth,” said Dr. Eick. “Previous research on this topic has involved fairly small, primarily White populations, which is not reflective of diversity in the US.”

The researchers measured oxidative stress biomarkers in urine samples from participants collected during the second and third trimesters of pregnancy. Then, they calculated the association between the oxidative stress biomarkers concentration for each participant and all preterm births (delivery prior to 37 weeks).

Results from this study showed a strong association between higher levels of oxidative stress biomarkers and preterm birth. This association was particularly true for participants who experienced preterm birth that was sudden and unexpected or occurred prior to 34 weeks.

Future research will investigate how the chemicals involved in oxidative stress may lead to preterm birth and identify what risk factors lead to higher oxidative stress during pregnancy.

Read the research summary.

ECHO Study Suggests Prenatal Exposure to Perfluorononanoic Acid (PFNA) May Be Linked to Autism-Related Traits in Children

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ECHO Study Suggests Prenatal Exposure to Perfluorononanoic Acid (PFNA) May Be Linked to Autism-Related Traits in Children

Authors: Jennifer Ames, Ghassan Hamra, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

The researchers found that prenatal exposure to one specific PFAS chemical, perfluorononanoic acid (PFNA) may be associated with an increase in autism-related traits in children. Prenatal exposure to the mixture of all PFAS chemicals combined was not associated with increased autism-related traits in children.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study draws attention to the potential risks of PFAS chemicals on child neurodevelopment. In the U.S., exposures to some specific PFAS, such as PFOA and PFOS, have dropped substantially since the industry voluntarily phased these chemicals out in the early 2000s. However, other PFAS exposures have increased over time, including thousands of these substances with unknown toxicity. These so-called “forever chemicals” continue to pose risks to health even after they are phased out because they persist in the environment and inside people’s bodies and don’t break down easily. While the estimated effects of PFAS chemicals on child autism-related traits are relatively small in this study, future studies may investigate whether early childhood exposure to PFAS chemicals are associated with effects on other neurodevelopmental outcomes.

Why was this study needed?

Per- and polyfluoroalkyl substances (PFAS) are widely used, long lasting chemicals, the components of which break down very slowly over time. Previous studies looking at associations between prenatal PFAS exposure and childhood autism spectrum disorder (ASD) are inconsistent and mostly conducted in small sample sizes. The objective of this research was to determine whether blood concentrations of PFAS during pregnancy were linked to the development of autism-related traits in children. The researchers in this study were able to examine this question by continuously measuring the development of autism-related traits in a large number of children across the U.S, independently of whether a child received a clinical ASD diagnosis.

Who was involved?

The participants of this study included 1,224 mother-child pairs from ten cohorts across the United States. The participants were geographically, racially, and ethnically diverse, and one of the cohorts included families with an increased genetic likelihood of ASD. Most of the participating children were born between 2011 and 2018.

What happened during the study?

The researchers measured the levels of eight different PFAS in blood samples collected from mothers during pregnancy. Later, when their children were aged 2.5 years or older, researchers asked caregivers to report on the child’s autism-related traits using a questionnaire called the Social Responsiveness Scale (SRS). The research team tracked the relationship between child SRS scores and prenatal exposure to each individual PFAS as well as the combination of the eight PFAS.

What happens next?

Additional research is needed to continue studying the effect of early life exposure to PFAS on child neurodevelopment, including cognition, attention, and other neurobehaviors. Future studies can also investigate whether biological sex and other factors—such as genetics, underlying health conditions, and nutritional status—may change the effect of PFAS exposure on brain development.

Where can I learn more?

Access the full journal article, titled “Prenatal exposure to per- and polyfluoroalkyl substances and childhood autism-related outcomes,” in Epidemiology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published January 12, 2023

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ECHO Study Suggests Prenatal Exposure to Perfluorononanoic Acid (PFNA) May Be Linked to Autism-Related Traits in Children

ECHO Researchers Investigate How Changes in Family Situations Due to the COVID-19 Pandemic are Linked to Children’s Behaviors

Posted on December 30, 2022December 5, 2023 by Jodi Snare

Collaborative ECHO research led by Traci Bekelman, PhD, MPH and Katherine Sauder, PhD of the University of Colorado, Anschutz Medical Campus, investigates whether parents’ coping strategies, stress, and financial strain affected their children’s health behaviors during the first seven months of the COVID-19 pandemic. The researchers found that children with parents who were able to change their work schedules to care for their children during the pandemic had less screen time and slept longer at night, while children with parents who were unable to adjust their work schedules due to stress about money and access to food drank more sugary drinks, were less active, and slept less at night. This research, titled “Sociodemographic Variation in Children’s Health Behaviors During the COVID-19 Pandemic,” is published in Childhood Obesity.

This study included 3,315 children between 3 and 17 years old from 50 ECHO cohorts across the United States. Parents answered questions about their child’s diet, physical activity, screen time, and sleep during the first seven months of the COVID-19 pandemic. Additionally, the parents reported how they personally coped with the pandemic and what their largest sources of stress was.

The COVID-19 pandemic significantly changed many families’ routines and financial situations, causing an increase in parents’ stress and affecting children’s diet, physical activity, and sleep behaviors. “Parents stressed about money may need additional resources to help their children to eat healthier, increase their physical activity and sleep, and decrease their screen time,” said Dr. Bekelman. “Going forward, we will continue to look at how financial stress and parents’ work schedules affect children’s health behaviors to help guide the design of future interventions that can encourage healthy behaviors among children, especially during stressful times like a pandemic.”

Read the research summary.

NIH Program Study Finds Life Changes During the COVID-19 Pandemic Contribute to Mothers’ Traumatic Stress

Posted on December 16, 2022June 7, 2023 by Jodi Snare

FOR IMMEDIATE RELEASE

Mothers who experienced more life changes during the pandemic reported more symptoms of traumatic stress, according to a new study funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

Mothers with higher incomes and higher education tended to experience more changes and reported more symptoms of traumatic stress. Additionally, these mothers were more likely to report financial concerns as a cause of that stress.

“Our study found that mothers who had the most changes to their work, health, and social support systems also reported the highest amount of traumatic stress due to the pandemic,” said Tracy Bastain, PhD, MPH, an ECHO Program investigator from the University of Southern California.

This study included 11,473 mothers from 62 ECHO cohorts across the U.S. and Puerto Rico and investigated the potential impacts of the COVID-19 pandemic on maternal mental health from April 2020 through August 2021. ECHO researchers examined patterns of pandemic-associated changes in maternal health and health behaviors, healthcare visits, work and finances, and coping strategies. The researchers used cluster analysis to group the mothers based on their pandemic experiences and then examined whether these groups reported higher or lower symptoms of traumatic stress related to the pandemic.

Dr. Bastain and Amy Margolis, PhD, an ECHO Program investigator from Columbia University, led this collaborative research published in JAMA Network Open.

Bastain, T. et al. COVID-19 Pandemic Experiences and Symptoms of Pandemic-Associated Traumatic Stress Among Mothers in the US. JAMA Network Open. DOI:10.1001/jamanetworkopen.2022.47330

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.