ECHO Study Finds Disparities across Racial, Ethnic Groups in Sleep Duration, Quality During Pregnancy

Author(s): Maristella Lucchini, 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?

Non-Hispanic Black/African American participants slept less and reported more sleep disturbances compared with non-Hispanic White participants. Hispanic participants slept longer, had better sleep quality, and fewer sleep disturbances compared with non-Hispanic White participants.

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 is the first to investigate and report differences in pregnant individuals’ sleep quality across racial and ethnic groups. If these results are replicated in other studies, they may suggest the need for targeted interventions to improve sleep health in pregnancy.

Why was this study needed?

Pregnant women from racial/ethnic minority groups are more likely to experience complications during pregnancy, and poor sleep during pregnancy is known to increase the risk of poor maternal health. People from racial/ethnic minority groups often experience worse sleep compared to non-Hispanic White people, but little is known about differences in sleep during pregnancy.

The objective of this study was to examine whether sleep differences during pregnancy among racial/ethnic groups was a factor that contributed to racial/ethnic disparities in overall maternal health outcomes.

Who was involved?

Researchers analyzed information from 2500 pregnant individuals from 14 ECHO cohorts across the United States who reported on their sleep habits during pregnancy. Participants self-reported race and ethnicity were grouped into Hispanic, non-Hispanic White, non-Hispanic Black/African American, and non-Hispanic Asian individuals.

What happened during the study?

Participants completed questionnaires during pregnancy to report on their sleep duration, quality, and disturbances. Other information collected included maternal education level, pre-pregnancy weight, height, and age.

The researchers evaluated the association between sleep duration, quality, and disturbances in each pregnancy trimester across racial/ethnic groups.

What happens next?

Future studies should research what factors contribute to these sleep disparities at a personal level, family level, and beyond. They should also explore to what extent differences in sleep duration, quality, and disturbances might contribute to disparities in maternal and child health outcomes across racial/ethnic groups.

Where can I learn more?

Access the full journal article, titled “Racial/ethnic disparities in subjective sleep duration, sleep quality and sleep disturbances during pregnancy: an ECHO study” in Sleep.

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

Published June 21, 2022

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ECHO Study Finds Disparities across Racial, Ethnic Groups in Sleep Duration, Quality During Pregnancy

ECHO Study Links Poor Neighborhood Conditions With Higher Risk of Asthma in Children

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ECHO Study Links Poor Neighborhood Conditions With Higher Risk of Asthma in Children

Author(s): Antonella Zanobetti, Patrick H. Ryan, 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?

Of the 5,809 children studied, 46% experienced wheezing in their first year of life, with 26% having wheezing through age 11. Diagnosis of asthma by age 11 varied by cohort, with an overall median prevalence of 25%. Children in neighborhoods with more people, and with more families with lower incomes, experienced more asthma and early and persistent wheezing. Black and Hispanic children remained at higher risk for asthma than White children, even in wealthier neighborhoods.

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 suggests that neighborhood characteristics at birth and race/ethnicity play a role in the development of childhood wheezing and asthma. This information can help inform strategies to reduce childhood asthma, including strategies that address the socioeconomic factors that create higher risks for Black and Hispanic children.

Why was this study needed?

In the United States, Black and Hispanic children have higher rates of asthma compared to White children and more often live in communities where households struggle to meet their basic needs. The objective of this study was to explore how much neighborhood-level socioeconomic factors, like income and education, contribute to differences in childhood wheezing and asthma between Black, White, and Hispanic children.

Who was involved?

Almost 6,000 children across the United States born between the 1980s and 2010s.

What happened during the study?

The team used questionnaires and interviews to collect information such as wheezing and asthma occurrence, medical history, and demographics. Each child’s home address was matched to U.S. Census data for the decade closest to their birth year. Researchers studied how children’s race/ethnicity and their mother’s education level and smoking habits, plus their neighborhood socioeconomic conditions, were related to wheezing – a symptom involving whistling breathing sounds due to narrowed airways – and asthma.

Where can I learn more?

Access the full journal article, titled “Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium” in JAMA Pediatrics.

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

Published May 23, 2022

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ECHO Study Links Poor Neighborhood Conditions With Higher Risk of Asthma in Children

ECHO Study Identifies Demographics of Pregnant Women Least Likely to Get the Nutrients They Need

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ECHO Study Identifies Demographics of Pregnant Women Least Likely to Get the Nutrients They Need

Author(s): Katherine Sauder, 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?

More than one in every five pregnant women did not eat enough of the vitamins D, E, K, and choline and the minerals magnesium and potassium, even when taking dietary supplements. The women most likely to not get enough vitamins and minerals were those aged 14-18 years, those who were Hispanic or Black, those who had less than a high school education, and those with obesity. Non-Hispanic women were the most likely to eat too much folic acid.

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 showed that many pregnant women are at a high risk of not getting enough nutrients from food alone, so it is important for pregnant women to improve their diet quality and take dietary supplements when needed. The risk of not getting enough vitamins or minerals for women of various ages, races/ethnicities, education levels, or weights is often a problem, even when using dietary supplements.

This study shows that the dietary supplements women use today do not help them get all the nutrients they need in the right amounts. Pregnant women need guidance specific to their bodies to manage the vitamins and supplements they need. Different combinations and formulas of dietary supplements taken before getting pregnant may also help this problem and make sure women do not receive too much folic acid, iron, and zinc.

Why was this study needed?

One in three pregnant women in the United States eats too little or too many key vitamins and minerals. Prior studies do not tell us what groups are at the most risk for poor nutrition during pregnancy. Knowing who is at risk for poor nutrition can make it easier for doctors and public health workers to help pregnant women manage their nutrition.

Who was involved?

The researchers studied 9,801 women aged 14-50 years living across the United States who were pregnant between 1999 and 2019.

What happened during the study?

Pregnant women reported their daily food and dietary supplement intake during pregnancy. Researchers compared their daily intake of 19 vitamins and minerals to the Institute of Medicine recommendations for pregnant women.

What happens next?

The researchers will study how much vitamins and minerals women are getting from foods and compare this amount to the amount pregnant women should get. They will identify dietary supplements that can give women the right amounts of the vitamins and minerals they need.

Where can I learn more?

Access the full journal article, titled “Disparities in risks of inadequate and excessive intake of micronutrients during pregnancy” in Journal of Nutrition.

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

Published September 7, 2021

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ECHO Study Identifies Demographics of Pregnant Women Least Likely to Get the Nutrients They Need

Nationwide ECHO Study Suggests Children in the Western and Southern U.S. May Have Lower Body Mass Index Than Children in the Northeast

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Nationwide ECHO Study Suggests Children in the Western and Southern U.S. May Have Lower Body Mass Index Than Children in the Northeast

Author(s): Dana Dabelea, Jody Ganiban, Traci Bekelman, 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?

BMI was lowest for children in the West and South compared to those in the Northeast. When demographic differences were accounted for, children in the Midwest had higher BMIs than those in the Northeast. Across all regions, BMI was highest in children who weighed more at birth and children with less educated mothers. In the Northeast, South, and Midwest, non-Hispanic Black children had higher BMIs on average compared to non-Hispanic white children. In the South and West, BMI was higher for Hispanic white children compared to non-Hispanic white children.

What was the study's impact?

This study revealed some of the regional and demographic factors influencing childhood obesity and overweight. The regional differences in children’s BMI suggest that their surroundings, cultures, and relationships affect the development of childhood obesity. These differences could potentially be linked to variations in food prices, fast food options, and opportunities to exercise.

Why was this study needed?

About 35% of US children are overweight or obese. Childhood obesity can have serious physical and mental health effects that can follow children into adulthood. Understanding the factors that affect children’s weight, can help us create ways to prevent obesity. This study looked at factors related to children’s weight where children live, how much they weighed at birth, and their ethnic background.

Who was involved?

This study included more than 14,000 children and teenagers from birth to age 15. The children lived in the West, South, Northeast, and Midwest regions of the United States. The study included children from different racial and ethnic backgrounds. About half of the children were girls.

Figure 1 This image shows the different regions of the Unites States where study participants lived.

What happened during the study?

Doctors measured children’s height and weight from 2000-2018. The research team used this information to calculate each child’s body mass index (BMI), which is an approximate measure of body fat based on height and weight. The team compared differences in average BMI based on region, mother’s level of education, and demographic factors, including birth weight, race, ethnicity, and sex.

What happens next?

More research is needed to understand exactly how regional environments and policies impact children’s BMI and how local policies contribute to differences in obesity risk based on demographics. Identifying the regional and social factors that result in increased obesity risk can help policymakers and public health officials create ways to prevent obesity.

Where can I learn more?

Access the full journal article, titled “Regional and Sociodemographic Differences in Average BMI Among U.S. Children in the ECHO Program” in Obesity.

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

Published: August 31, 2021

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Nationwide ECHO Study Suggests Children in the Western and Southern U.S. May Have Lower Body Mass Index Than Children in the Northeast

ECHO Study Identifies Demographics of Children Most Likely to Develop Asthma

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ECHO Study Identifies Demographics of Children Most Likely to Develop Asthma

Author(s): Christine Cole Johnson and Aruna Chandran

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 study found that children with at least one parent with a history of asthma had two to three times higher rates of asthma. This higher risk with family history of asthma mostly affected younger children, through four years old. The rates for boys went down with age, but rates for girls stayed about the same, so by the teenage years girls developed asthma more often than boys. Black children were diagnosed with asthma more than white children during preschool years, but less than white children after age 9-10 years.

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 helps us understand what groups of children are more likely to get asthma. The research shows that young Black children and young children whose parents had asthma develop asthma more often than other groups. Researchers can work to develop new asthma programs to help keep children at highest risk from getting asthma.

Why was this study needed?

Childhood asthma is a major cause of suffering, missed school for children, and missed work for parents. Researchers and doctors need to understand who is more likely to get asthma, not just focus on who already has it, as other studies have done. Knowing this information is a step to finding out why certain kids get asthma and preventing it. Using information from children from diverse backgrounds in the United States, this paper describes which children developed asthma from early childhood through adolescence.

Who was involved?

Children younger than 18 years old taking part in 31 studies within the ECHO program

What happened during the study?

The research team found out the ages when children learned from a doctor they had asthma, and the children’s race, sex, and what state they lived in. It was also important to collect information on whether their parents had asthma or not.

What happens next?

Researchers should work on asthma prevention programs for very young children, especially Black children and those whose parents have had asthma.

Where can I learn more?

If you would like to learn more about asthma in children, please visit the Centers for Disease Control and Prevention or the National Heart Lung and Blood Institute (NHLBI).

Access the full journal article, titled “Childhood Asthma Incidence Rate Patterns from the ECHO Consortium: Identifying High-Risk Groups for Primary Prevention.”

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

Published: May 17, 2021

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ECHO Study Identifies Demographics of Children Most Likely to Develop Asthma

ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

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ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

Author(s): Anne L. Dunlop, Alicynne Glazier-Essalmi, 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?

There were differences in how early the baby was born based on the mother’s race and ethnicity. Compared to non-Hispanic white women, women of all other races had a higher chance of PTB. For women overall, a bachelor’s degree or above was linked to less chances of PTB, and a high school education or less led to higher chances of PTB. This link between education level and PTB was mostly seen in non-Hispanic white women and those who lived in the South and Midwest regions of the US. This study also collected data on neighborhood factors; non-Hispanic white women living in a rural area had a higher chance of PTB delivery compared to women living in an urban area.

What was the study's impact?

This study explored an important gap in the field of children’s health. It gathered information on how factors such as the mother’s race/ethnicity, location, education level, and SES affect if a baby is born early. The results show that higher education among women could help decrease the chances of PTB in the US, especially in the South and Midwest regions.

Why was this study needed?

There are high rates of preterm birth (PTB) in the US. Previous studies show that the rates of PTB are different based on race and location, but there is not much information available on what causes these differences. This study also explored the link between the mother’s SES, race, and location and how they affect the baby’s age at birth. Socioeconomic status (SES) is a combination of factors such as education, income, and occupation.

Who was involved?

Women enrolled in the ECHO Program who delivered a baby were included in this study. They provided all of the required information about themselves and their infant. More than 20,000 mother-infant pairs participated.

What happened during the study?

Researchers studied a variety of information including the mother’s age at delivery, education, physical address or region, alcohol use, prenatal care, and the child’s birth sex and how many weeks they were at birth. They took this information and looked for patterns and connections between factors that affect PTB.

What happens next?

Non-Hispanic Black women, Native American, and Alaskan Native women have the highest rates of PTB. Future studies in these populations will help explore the causes for these differences and figure out ways to prevent PTB.

Where can I learn more?

View the full journal article, titled “Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts” in PLOS One.

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

Published: January 8, 2021

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ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level