Avera Health contributes to large study of child health, well-being

November 1, 2018



To deepen understanding of the effects of environmental exposures on children's health and well-being, the National Institutes of Health is gathering and pooling data from more than 80 ongoing studies of mothers and children, including work being done at Avera Health to improve child health.

The NIH program, called Environmental Influences on Child Health Outcomes, or ECHO, was launched in December 2015 and will run for seven years. Researchers will investigate how geographic, physical, chemical, social, behavioral and biological factors impact health in the womb, at birth and in early childhood. Researchers also will explore how environmental factors impact asthma and other conditions of the upper and lower airway, childhood obesity and neurodevelopment. The study includes analysis related to "positive health outcomes," a measure of healthy growth and development, according to posts on the NIH website about the program.

Amy Elliott, a principal investigator on the ECHO project, is a clinical psychologist and the chief clinical research officer with the Avera Research Institute Center for Pediatric and Community Research, a division of Sioux Falls, S.D.-based Avera Health. She described the research design as "large team science" in a recent interview with Catholic Health World.

What is the ECHO Program?
ECHO is a rebirth of the National Children's Study that was started 10 or 15 years ago. Many lessons were learned from that study that are being incorporated into ECHO. ECHO has recruited participation from numerous existing cohort studies and brought us together to design one comprehensive study to learn about how early environment influences later child health and development. Each participating cohort has data from when moms were pregnant, as well as extensive information from the first few years of a child's life. Some sites are also starting new pregnancy cohorts. In total, approximately 50,000 children and families will participate in ECHO.

ECHO allows us to stay in contact and follow each child's health and development. We will specifically be looking at health outcomes such as childhood obesity, asthma, allergies, autism. We're investigating what are early influences that may put kids at greater (health) risk.

Is well-being and satisfaction with life gauged through both the mom and the child?
Yes. We will be looking at all influences on child health, and parents play an important role. We are including important measures of maternal anxiety and depression, which we know affect child development.

Is anybody studying dads as part of this?
Yes. This is an area of much discussion as dads are often excluded in studies like this. Fathers play a critical role in a child's development and will play an important role in ECHO.

Is Avera Health specializing in a couple of areas of the research, or are you going to contribute across the board?
Each ECHO grantee is able to do both. We all will contribute to the large national study, but also have site-specific components that make each project unique and tailored to specific needs. Our site-specific elements focus on child sleep and the role it plays in development, as well as how allergen exposures throughout life affect asthma development and severity.

Our study participants were originally involved in a large study on the role of prenatal alcohol and smoking exposures on stillbirth and sudden infant death syndrome. This study was called the Safe Passage Study and it is currently in the final data analysis stages. The majority of participants gave permission for us to recontact them for future studies, and now many have the opportunity to also participate in ECHO. Prenatal exposures to alcohol and smoking are also an important part of ECHO. Although many women quit drinking and smoking after finding out they are pregnant, there is a lot of development that can occur prior to pregnancy awareness.

We also are focusing on neurodevelopmental outcomes, in particular autism and attention problems. We also will be collaborating with other researchers across the country on studies of childhood obesity and how to promote positive health.

What is positive health, and why is this project looking at that?
Positive health is not often included in pediatric studies like this. Positive health represents not just the absence of disease, but the presence of things like well-being and satisfaction with life.

Oftentimes we only study and report on aspects of poor health outcomes. For some, such as the American Indian populations in our region, these negative messages neglect to bring out all of the positive things going on that support and promote health. Having positive health as a main outcome of ECHO is a powerful component that will resonate well with many of our local communities.

What ECHO program work has been done so far?
The first couple of years were spent working with other study sites across the nation to create a common study protocol and infrastructure. Each research site had to meet certain milestones before moving on to the large-scale study implementation that we are in now. One of the major milestones was demonstrating you could re-engage with the cohort participants and show they were willing to participate in ECHO.

Through NIH leadership and collaboration across the numerous grantees, we are making tremendous progress. I think ECHO will become a model for how large team science can be efficient, successful, and most importantly, make a difference.

What are some of the things about early development that you think people are most excited about learning more about?
We all want answers to prevention of disease and adverse events. These findings can support a variety of public health initiatives and intervention projects.

Is there a time line for when findings may come out?
We currently have five more years of funding. In my opinion, if we do this right and demonstrate the value of team science, ECHO will continue for many years. To help demonstrate this value, we need to disseminate findings that make a difference early and consistently throughout the life of the project. I predict we will start seeing very real benefit and results very early.



Copyright © 2018 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3490.

Copyright © 2018 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.