COVID-19 Pandemic Altered Relationship Between Neighborhood Environment and Child Well-Being, ECHO Study Suggests

Authors: Xueying Zhang, et al.

Who sponsored this study?

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

Why was this study needed?

Understanding how neighborhood characteristics affect child well-being is important. Prior studies have found an association between neighborhood characteristics and children’s health and development. During the COVID-19 pandemic, stay-at-home policies limited people’s interactions with their neighborhood environment. However, researchers have not considered how the pandemic might have changed these effects. ECHO researchers wanted to address this gap by exploring how the pandemic, as a natural experiment, may have changed the relationship between neighborhood characteristics and child well-being. Additionally, since COVID-19 has impacted racial and ethnic groups differently, this study examined these differences to identify potential disparities.

What were the study results?

The study found that the relationship between neighborhood characteristics and child well-being changed during the COVID-19 pandemic. It also revealed racial disparities, showing that the pandemic's impact on child well-being varied across different racial and ethnic groups.

For non-Hispanic White children, the number of people who lived in their homes and the diversity of their neighborhood were linked to lower well-being. For children of other races and ethnicities, living in areas with higher percentages of Hispanic residents and more adults working as essential workers were associated with lower well-being.

What was the study's impact?

These findings highlight how neighborhood characteristics, the pandemic, and child well-being interact, emphasizing the importance of addressing disparities during unique events like the pandemic.

Who was involved?

The study involved 1,039 children, mostly between the ages of 11 and 19, from more than 10 ECHO Cohort Study Sites across the U.S.

What happened during the study?

Researchers conducted an analysis of children who completed a well-being questionnaire called the Patient-Reported Outcomes Measurement Information System (PROMIS) before (2019 to March 1, 2020) and during (March 1, 2020 to August 31, 2021) the pandemic. The PROMIS survey measures children's mental and physical health and peer and family relationships.

The researchers then matched U.S. Census tract data with a child’s residential address to examine the neighborhood characteristics. They looked at factors including the race, education, and occupation composition of residents, as well as house capacities and property features. They analyzed how these factors were associated with child well-being, considering the impacts of the pandemic, as well as differences across child racial groups.

Note: 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 happens next?

Future research could explore how specific aspects of neighborhoods affect children's well-being, especially when these factors interact.

Where can I learn more?

Access the full journal article, titled “Associations between neighborhood characteristics and child well-being before and during the COVID-19 pandemic: A repeated cross-sectional study in the Environmental influences on Child Health Outcomes (ECHO) program,” in Environmental Research.

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

Read the associated article.

Published July 1, 2024

Download this summary

COVID-19 Pandemic Altered Relationship Between Neighborhood Environment and Child Well-Being, ECHO Study Suggests

Harsh Parenting and High Socioeconomic Stress May Be Associated with Higher Internalizing Problems Like Anxiety in Children, ECHO Study Finds

<< Back to Research Summaries

Harsh Parenting and High Socioeconomic Stress May Be Associated with Higher Internalizing Problems Like Anxiety in Children, ECHO Study Finds

Authors: Lue Williams, Veronica Oro, Leslie Leve, et al.

Who sponsored this study?

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

Why was this study needed?

Internalizing problems in childhood such as chronic internal distress may be early indicators of problems associated with disorders such as depression and anxiety. Internalizing by children can be influenced by biological and environmental factors, including parent-child relationships and socioeconomic status.

This study examined the relationship between two early childhood stress factors, harsh parenting and socioeconomic stress, and children’s development from childhood through adolescence. For this study, the researchers characterized harsh parenting, or “parental hostility” as non-supportive and controlling parenting practices, displays of anger and disappointment in children, and discipline through punishment. Socioeconomic stress reflects disadvantages associated with factors like household income. Few studies have examined early childhood predictors of internalizing behavior development, so this research fills an important gap by examining the role of diverse risk factors in early life, between the ages of 18 months and 5 years, on patterns of internalizing symptoms later in childhood. The study design, which used data collected from participants over a long period, also allowed the research team to explore the long-range impact of early life influences across critical stages of children’s physical, social, and psychological development.

What were the study results?

Researchers observed that, within the study sample, children fell into three main groups based on the severity of their internalizing behaviors and how those behaviors progressed with age: low, moderate-increasing, and higher-increasing. Some of the internalizing behaviors reported include feeling anxious or depressed, being withdrawn, and complaining of aches and sickness. Parents who reported more negative interactions with children in early childhood had children who were more likely to be in the group with the highest internalizing behaviors. Children with more socioeconomic stress in their households were also most likely to be in the highest internalizing behaviors group, as compared with both the low- and moderate-internalizing symptoms groups.

Researchers also observed that household socioeconomic stress directly predicted children’s mental health. Study investigators did not find any significant relationship between child sex assigned at birth and how likely they would be to show internalizing behaviors.

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 this study's impact?

The findings from this study suggest that in addition to focusing on children’s symptoms when treating internalizing problems, health service providers may also wish to consider the broader context of caregiver behavior and access to resources for care.

Who was involved?

The study included two samples—a nationwide sample of 481 children who were adopted at birth and a sample of 1,053 children from six predominantly low-wealth, rural communities in eastern North Carolina and central Pennsylvania. Adopted children from the Early Growth and Development Study (EGDS) have lived in their adoptive homes since birth and were recruited into the study between 2003 and 2009. Children from the Family Life Project (FLP) were raised by their biological parents and were recruited into the study at birth, between September 2003 and 2004. Results may not be representative of the general population.

What happened during the study?

The researchers analyzed data collected from children and families that participated in the EGDS and FLP. EGDS children and families completed assessments approximately every nine months when adoptees were under the age of 3, and every one to two years after that. FLP participant families completed an initial home visit assessment when children were 2 months old and participated in annual assessments thereafter.

What happens next?

Future studies are needed to further support programming and research efforts by exploring mechanisms that underlie the relationship between socioeconomic stress, parenting styles, and children’s internalizing behaviors identified in the current study.

Where can I learn more?

Access the full journal article, titled “Influence of Early Childhood Parental Hostility and Socioeconomic Stress on Children’s Internalizing Symptom Trajectories from Childhood to Adolescence,” in Frontiers in Psychiatry.

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

Published April 16, 2024

Read the associated article.

Download this summary

Harsh Parenting and High Socioeconomic Stress May Be Associated with Higher Internalizing Problems Like Anxiety in Children, ECHO Study Finds

ECHO Study Shows Fish Consumption and Omega-3 Supplement Use Uncommon During Pregnancy

<< Back to Research Summaries

ECHO Study Shows Fish Consumption and Omega-3 Supplement Use Uncommon During Pregnancy

Authors: Emily Oken, Kristen Lyall, et al.

Who sponsored this study?

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

Why was this study needed?

Omega-3 fatty acids are essential nutrients for supporting positive health outcomes. Getting enough of these nutrients during pregnancy is vital for child health and neurodevelopment and may also improve other pregnancy outcomes. Prior research on the demographic characteristics associated with fish and supplement use during pregnancy has been limited, involving fewer participants and older data that may not represent current intake.

What were the study results?

During the study, about 25% of pregnant participants did not eat any fish or ate it less than once per month. Older participants were more likely to eat fish. Participants who were non-Hispanic Black, non-Hispanic Asian, or Hispanic ate less fish on average when compared to those who identified as non-Hispanic White. Participants categorized as overweight were also less likely to eat fish. Only about 1 in 6 pregnant participants reported taking omega-3 supplements. Supplement use was more common in participants who were older and had more education, had a lower body mass index (BMI), and ate fish.

What was the study's impact?

One-quarter of participants in this large, nationwide study rarely or never consumed fish during pregnancy, and omega-3 supplement use was uncommon, even among those who did not consume fish. Given the role of omega-3 fatty acids in preventing preterm birth and supporting child health and neurodevelopment, experts recommend pregnant women get at least 500 mg of omega-3 fatty acids per day through supplements or consuming fish that is low in mercury.

Learn more about the FDA’s and EPA’s current recommendations for eating fish during pregnancy here.

Who was involved?

This study included 10,800 pregnant participants enrolled in 23 ECHO research sites that collected information on fish consumption and 12,646 participants at 35 ECHO research sites that collected information on omega-3 supplement use. Information on fish consumption and omega-3 supplement use was collected from pregnant participants from 1999 to 2020.

What happened during the study?

The researchers collected information on fish intake during pregnancy and grouped participants based on the frequency of their fish consumption: never or less than once per month, once per month to less than once per week, one to two times per week, or more than twice per week. The researchers also collected information on participants’ omega-3 supplement intake. They then compared participant fish consumption and supplement use information across various demographic and lifestyle characteristics, including age, race, ethnicity, education, weight, and smoking status.

Note: 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 diet without first consulting your healthcare professional.

What happens next?

Future research may examine how fish consumption during pregnancy relates to childhood developmental outcomes such as autism-related traits.

Where can I learn more?

Access the full journal article titled “Demographic and health characteristics associated with fish and n-3 fatty acid supplement intake during pregnancy: results from pregnancy cohorts in the ECHO program” in Public Health Nutrition.

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

Published February 27, 2024

Read the associated article

Download this summary

ECHO Study Shows Fish Consumption and Omega-3 Supplement Use Uncommon During Pregnancy

ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

<< Back to Research Summaries

ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

Author: Santiago Morales

Who sponsored this study?

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

Why was this study needed?

Previous research has found a relationship between maternal education and children’s neurocognitive functions, but many of these studies have focused on early childhood. In addition, many previous studies have treated maternal education as something that doesn’t change over time. Few studies have explored whether a mother’s education level over the course of their child’s development might associate with neurocognitive function. ECHO researchers wanted to examine the relationship between changes in a mother’s education over time and their children’s later neurocognitive functioning, such as executive function and language skills.

What were the study results?

A mother’s education level during pregnancy and infancy was associated with children’s language and executive function. Increases in maternal education were related to improved language performance but were not associated with executive functioning performance.

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?

The study suggests that early maternal education is strongly associated with later child neurocognitive outcomes. In the study, changes in maternal education were also associated with some of these outcomes. These results suggest that further examining these associations can provide important insights that can help inform policies and interventions designed to foster neurocognitive development.

Who was involved?

The study included 2,688 children, adolescents, and young adults from 3 to 20 years of age at ECHO research sites in 42 states across the U.S.

What happened during the study?

Mothers reported their own education levels during pregnancy and their child’s infancy, and again, years later when their children’s neurocognitive functions were also assessed. For both periods, the study categorized the mother’s education level into one of five groups—less than high school; high school or GED equivalent degree; some college, associate degree or trade school; bachelor’s degree; and graduate degree. The same categories were used to measure maternal education during childhood. Maternal education and income are two commonly used indicators of socioeconomic status. However, missing income data in this study prevented investigators from fully assessing the impact of socioeconomic status and income on neurocognitive skills.

Researchers also measured child participants' cognitive abilities during childhood, adolescence, or young adulthood using the NIH Toolbox Cognition Battery. These tests assess aspects of cognition including language, memory, and problem solving. Test results created scores that reflected language skills, executive function, and overall brain function. The analysis included child participants who contributed at least one score.

What happens next?

While this study suggests an association between maternal education and a child’s neurocognitive function, this research doesn’t necessarily explain the factors or mechanisms involved in that association. Future studies might further explore these factors to provide additional insights.

Where can I learn more?

Access the full journal article, “Maternal Education Prospectively Predicts Child Neurocognitive Function: An ECHO Study,” in Developmental Psychology.

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

Published February 26, 2024

Access the associated article.

Download this summary

ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

Caregiver-Reported Measures of Childhood Behavior May be Biased by the Demographic Traits of Caregivers and Children

<< Back to Research Summaries

Caregiver-Reported Measures of Childhood Behavior May be Biased by the Demographic Traits of Caregivers and Children

Authors: Shuting Zheng, Maxwell Mansolf, Somer Bishop, et al.

Who sponsored this study?

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

Why was this study needed?

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 is critical for helping researchers and clinicians answer questions about the development of behavior problems in children from different backgrounds.

What were the study results?

Scores from the Child Behavior Checklist (CBCL) 1.5–5—a commonly used, caregiver-reported measure of internalizing (e.g., anxious) and externalizing (e.g., aggressive) behavior problems in children ages 1.5 to 5 years—may be biased by demographic factors such as the child’s age or the caregiver’s sex, education level, and primary language. Researchers found that caregiver responses for a number of questions on the CBCL were affected by caregiver or child demographic factors. 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 CBCL scores.

By determining the factors contributing to measurement bias, ECHO researchers identified a subset of questions on the CBCL that were less impacted by bias but still reliably captured childhood behavior problems.

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?

The results of this study highlight the need to carefully consider possible sources of bias when using caregiver-reported measures. This study was the first to use a large, diverse sample of families to examine how demographic factors influence the answers given for individual survey questions in the widely used CBCL. Developing surveys with less bias can help researchers and clinicians better measure and compare behavior problems across groups of children who differ in age and family background.

Who was involved?

The study included caregivers of 9,087 young children (ages 18 to 71 months) from 26 ECHO research sites across the United States.

What happened during the study?

The researchers used data from 26 ECHO research sites to evaluate how caregiver responses to the CBCL varied based on the characteristics (age, sex, race, bilingual status, and neurodevelopmental disorders) of the child and the characteristics (sex, education level, household income level, and depression diagnosis) of the caregiver. Researchers then selected the CBCL questions that showed the least amount of bias and compared how well this subset of questions worked for evaluating childhood behavior problems when compared to the full CBCL survey. Additionally, the researchers mapped the scores from the less biased question sets to the scores provided by the full item sets, allowing them to derive comparable scores to the original CBCL scale.

What happens next?

ECHO researchers plan to apply the newly identified subset of less biased CBCL survey questions, evaluating its reliability in identifying children with clinically significant behavior problems. The identification of question sets with little bias offers researchers and clinicians better alternatives for measuring and comparing behavior problems across groups of children who differ in age and family background.

Where can I learn more?

Access the full journal article, titled “Measurement Bias in Caregiver-Report of Early Childhood Behavior Problems across Demographic Factors in an ECHO-wide Diverse Sample,” in the Journal of Child Psychology & Psychiatry Advances.

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

Published September 29, 2023

Access the associated article.

Download this summary

Caregiver-Reported Measures of Childhood Behavior May be Biased by the Demographic Traits of Caregivers and Children

Education Levels and Child Age Shaped Caregivers’ Concerns Amid COVID-19, NIH Study Suggests

Posted on August 23, 2023August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

A caregiver’s education level and their child’s age played large roles in determining their primary sources of stress during the COVID-19 pandemic, researchers found in a recent study by NIH’s Environmental influences on Child Health Outcomes (ECHO) Program. Caregivers who had less than a high school education were less likely to work remotely and were more worried about finances, childcare, and access to necessities like food. Caregivers with a master’s degree or higher reported greater concern about social distancing and impacts on their work.

The social factors that influenced infection rates, disease severity, and financial burden among adults during the pandemic have been broadly documented. However, ECHO researchers wanted to understand the experiences of children and their caregivers.

“Understanding these experiences can help uncover social differences that could worsen conditions for some populations during future public health crises,” said Kaja Z. LeWinn, ScD of the University of California, San Francisco.

Conducting population-based studies during the pandemic was challenging, but by using existing ECHO Program research sites across the United States and COVID-19 questionnaires, researchers were able to see how social and economic factors were affecting families and children throughout the height of the pandemic. The study analyzed data from 14,646 ECHO children and 13,644 ECHO caregivers between April 2020 and March 2022.

Caregivers completed ECHO’s COVID-19 surveys about their child’s and their own experiences during the pandemic. Researchers measured how the pandemic affected caregivers based on three demographic characteristics—caregiver education, their child’s age, and whether they lived in urban or rural settings. Researchers documented different pandemic-related outcomes for children and caregivers and compared these outcomes across demographic groups. For children, researchers documented COVID-19 infection, availability of COVID-19 testing, healthcare changes, and disruptions to school and daycare. For caregivers, researchers asked questions about remote work, childcare challenges, and their personal ranking of pandemic-related stressors.

Education affected caregiver experiences

Researchers found that caregivers with less than a high school education were more likely to report difficulties getting COVID-19 tests for their children. Caregivers also cited financial concerns and access to necessities such as food as primary sources of stress. In contrast, caregivers with a master’s degree or higher were more likely to name social distancing as the top source of their pandemic-related stress.

The study's findings also indicate that caregivers with higher education were significantly more likely to have the option to work remotely. Caregivers with a high school or less education were less likely to be able to work remotely or change work schedules to care for their children compared to those with a master’s degree or greater. Even though those with a bachelor’s degree were less likely than those with a master’s degree to work remotely, they were still more likely than those with lower education to change their work schedule to care for children.

Interestingly, the opposite relationship existed for arranging childcare. Those with a master’s degree or higher reported more challenges finding childcare than those with less than a high school education. There is evidence suggesting greater rates of childcare center closures in areas where people had higher levels of education. Informal childcare arrangements among families with lower education levels may have been less affected by center closures.

Caregivers of young children faced more challenges

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.

“Our findings suggest that families with young children may need more support related to childcare and work flexibility, especially when school disruptions are involved,” Dr. LeWinn said.

Researchers observed few differences in the experiences of urban and rural residents.

Future research may investigate the long-term effects these pandemic challenges may have on children in the ECHO Program over time.

Dr. LeWinn and Lisa Jacobson, ScD of Johns Hopkins University led this collaborative research published in JAMA Network Open.

###

About ECHO: Launched in 2016, 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. 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.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

Connect With Us

Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on Twitter.

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

Posted on August 23, 2023August 29, 2023 by Jodi Snare

Collaborative ECHO 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 understanding 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 children in the ECHO Program over time.

Read the research summary.

Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

<< Back to Research Summaries

Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

Authors: Rachel L. Miller; Christine C. Johnson, 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.

Why was this study needed?

While the prevalence of asthma has been reported widely in the United States and elsewhere, studies on childhood asthma incidence rates within specific populations and across various types of asthma and age ranges have been relatively sparse. Describing the incidence rates of ARE across various pediatric populations is a critical first step for identifying potential risk factors and causes.

What were the study results?

In this study, investigators wanted to gather more information about factors that influence the rates of childhood asthma with recurrent exacerbations (ARE)—a subtype of asthma where children experience frequent, severe episodes of asthma.

ARE incidence rates were highest among children ages 2-4 years old, and among non-Hispanic Black and Hispanic Black children. ARE rates were also higher among children living in the Northeast and Midwest compared to those living in the West. Children with a parental history of asthma had ARE rates 2.9 times greater compared to those with no parental history.

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 impact?

Higher incidence rates of ARE among young children, non-Hispanic Black and Hispanic Black children, and children living in the Northeast and Midwest suggest that differential environmental exposures may play a significant role in the onset of recurring asthma issues in children. ARE rates are consistently higher among children with a parental history of asthma, especially for young children, which may be due to a combination of genetic, environmental, and family lifestyle factors.

Who was involved?

The research team leveraged data from 17,246 children born between 1990 and 2017 who were enrolled in 60 ECHO research sites in the U.S. and Puerto Rico. Child participants or their caregivers reported whether and when the child had an asthma diagnosis and any oral corticosteroids prescribed from a health care provider. Incidence rates of ARE were based on reports of systemic (not inhaled) corticosteroid use.

Of the 4,114 children diagnosed with asthma during this study, there were 2,061 children with at least one asthma episode when they used oral steroid medication; 734 of these children had 2 or more asthma episodes with steroid medication use and met the conditions for ARE.

What happened during the study?

The researchers calculated the incidence rates of ARE for the study population as a whole, along with the rates for subsets of the population defined by the year of ARE diagnosis, the decade they were born, their age and sex, their race and ethnicity, their residence at birth, and their parents’ history of asthma. The researchers followed the children from birth until they developed ARE, reached the age of 20 years or the study period ended. The study identified children who developed ARE based on at least two reports of systemic steroid medication use at any time during the entire follow-up period. Children who received asthma diagnoses before age 5 years were required to have confirmation after 5 years, either by a parent or caregiver, adolescent self-report of asthma symptoms, hospitalization, emergency department or urgent care visit for asthma, provider visits due to asthma, or asthma medication use.

What happens next?

ECHO researchers are planning new studies that examine key early environmental exposures that could contribute to ARE, including viral respiratory tract infections, indoor allergens, environmental tobacco smoke, air pollution, stress, socioeconomic status, and where children live.

Where can I learn more?

Access the full journal article, titled “Incidence Rates of Childhood Asthma with Recurrent Exacerbations in the U.S. Environmental influences on Child Health Outcomes (ECHO) Program,” in The Journal of Allergy and Clinical Immunology.

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

Published March 25, 2023

Access the associated article.

Download this summary

Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

ECHO Study Finds Associations Between Neighborhood Social Vulnerability at Birth With Higher Childhood Body Mass Index

<< Back to Research Summaries

ECHO Study Finds Associations Between Neighborhood Social Vulnerability at Birth With Higher Childhood Body Mass Index

Author(s): Izzuddin M. Aris, et al.

Who sponsored this study?

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

What were the study results?

The study found that children who lived in higher opportunity or less vulnerable neighborhoods early in life had lower average BMI and lower risk of obesity from childhood to adolescence. The neighborhoods children lived in at birth affected these health outcomes more than the neighborhoods they lived in later in childhood. These associations were not affected by individual and family sociodemographics or by prenatal risk factors for childhood obesity.

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 research focuses on how community resources can enhance children’s health outcomes. The Child Opportunity Index, Social Vulnerability Index, and other measures of neighborhood characteristics could help inform efforts to reduce neighborhood barriers and improve access to community resources so families can better support their children’s health and well-being.

Why was this study needed?

The physical and social characteristics of neighborhoods may influence how children grow and develop. Children’s body mass index (BMI)—an estimation of their overall body fat—and childhood obesity are significant risk factors for heart disease later in life. The associations between neighborhood characteristics and children’s BMI and risk of obesity remains understudied. This study compared neighborhood-level measures of opportunity and social vulnerability with BMI and obesity patterns in children from birth to adolescence.

Who was involved?

This study included 20,677 children from 54 ECHO cohorts located across the United States.

What happened during the study?

ECHO researchers collected each child’s home address and weight at birth, infancy (6 months‒1.5 years), early childhood (2‒5 years), and mid-childhood (5‒10 years). The researchers linked participants’ addresses throughout childhood to data from the Child Opportunity Index and Social Vulnerability Index. The Child Opportunity Index measures neighborhood conditions and resources that may affect child health outcomes including education, health and environment, and social and economic factors. The Social Vulnerability Index identifies communities with high numbers of public health emergencies and other stressors by looking at demographics, socioeconomic status, type of housing, access to transportation, and other factors.

The researchers used these data to examine links between children’s neighborhood-level opportunity and social vulnerability and their BMI and obesity over time.

What happens next?

More research is needed to determine how changes to specific aspects of neighborhood environments might influence weight gain and obesity in children.

Where can I learn more?

Access the full journal article, titled “Associations of Neighborhood Opportunity and Vulnerability with Trajectories of Child Body Mass Index and Obesity Among U.S. Children,” in JAMA Network Open.

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

Published: December 22, 2022

Access the associated article.

Download this summary

ECHO Study Finds Associations Between Neighborhood Social Vulnerability at Birth With Higher Childhood Body Mass Index

Pregnant Women Living in Worse Neighborhood Conditions Were More Likely to Have Shorter Pregnancies and Smaller Babies

<< Back to Research Summaries

Pregnant Women Living in Worse Neighborhood Conditions Were More Likely to Have Shorter Pregnancies and Smaller Babies

Author(s): Sheena Martenies, 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?

In this study, ECHO researchers found that pregnant participants living in neighborhoods with higher exposure index scores, which reflect worse neighborhood conditions, had shorter pregnancies and smaller babies. For Black pregnant participants, there was a higher risk of preterm birth linked to increased combined exposures during pregnancy compared to White pregnant participants. The researchers also found that pregnant women living in rural areas had shorter pregnancies and smaller babies compared to pregnant women living in urban areas who had similar scores on the combined exposure index.

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 provides additional support suggesting that neighborhood conditions can impact pregnancy and infant health. The effects of combined neighborhood-level exposures on childhood health can have notable effects on a national scale. Lower birthweight and shorter pregnancies are associated with health challenges later in life, including asthma and developmental delays.

Why was this study needed?

Previous studies have found that neighborhood conditions can influence pregnancy and infant health, but few have examined the effects of exposure to a combination of environmental and social stressors. It is important to look at multiple exposures simultaneously because this more closely mirrors real-world experiences on people’s health outcomes.

Existing tools for looking at combined exposures to environmental and social conditions in neighborhoods do not have national coverage or they do not extend across the time frames needed. To address this issue, researchers developed an exposure index to examine the relationship between combined environmental and social exposures at the neighborhood level and pregnancy and infant health in ECHO cohorts.

Who was involved?

This study included more than 13,000 infants born between 2010 and 2019. The participants were from 41 ECHO cohorts located throughout the United States.

What happened during the study?

ECHO researchers developed an exposure index that combined data on multiple environmental hazards and social circumstances into a single measure of neighborhood conditions. The index included factors such as air pollutants, vehicle traffic, poverty, and crowded housing. Pregnant participants were assigned an index score based on where they lived during their pregnancy. Then, the researchers looked at how this index score was associated with birthweight, length of pregnancy, and other pregnancy outcomes.

What happens next?

More research is needed to determine which of the exposures in the index are most important to child health outcomes. Some members of the research team are studying data from two ECHO cohorts to see how these neighborhood-level exposures might interact to influence obesity later in life.

Where can I learn more?

Access the full journal article, titled “Associations between combined exposure to environmental hazards and social stressors at the neighborhood level and individual perinatal outcomes in the ECHO-wide cohort,” in Health & Place.

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

Published July 21, 2022

Read the associated article.

Download this summary

Pregnant Women Living in Worse Neighborhood Conditions Were More Likely to Have Shorter Pregnancies and Smaller Babies