Penn and CHOP Join National Study of Environmental Impacts on Children’s Health

University of Pennsylvania and CHOP researchers will enroll 2,500 families in an NIH-funded project that will track the effects of environmental exposures on child health and development.

By Lauren Ingeno

Air pollution, extreme heat, water quality, greenspace, and neighborhood walkability – environmental exposures can play a major role in children's health before and after birth.

And while climate change is a worldwide threat, communities of color are disproportionately victimized by environmental injustices. For example, Black people are 75 percent more likely than other groups to live near facilities that produce hazardous waste. In Philadelphia, Black and Hispanic children are hospitalized for asthma five times more often than their white counterparts.

Still, it has been historically difficult for researchers to measure the extent to which environmental exposures influence the health of specific populations.

To address that gap, the National Institutes of Health launched the Environmental Influences on Child Health Outcomes (ECHO) program in 2016. The program has brought together data from more than 107,000 child and parent participants from over 180 institutions throughout the United States.

Now, investigators from Children's Hospital of Philadelphia and the University of Pennsylvania are joining the next phase of the ECHO Program with a $50 million grant from the NIH. They are recruiting 2,500 pregnant Penn Medicine patients into the ECHO program, and their children will be followed at CHOP for the next seven years.

The principal investigators of Penn-CHOP ECHO include Heather Burris, MD, MPH, an attending neonatologist at CHOP Newborn Care; Sara DeMauro, MD, MSCE, an attending neonatologist at CHOP; and Sunni Mumford, PhD, a professor of Epidemiology in the Perelman School of Medicine at the University of Pennsylvania.

The goal of the Penn-CHOP ECHO team is to collect and contribute data to the broader ECHO program, so that a wide community of scientists will have the opportunity to answer research questions about the effects of early environmental exposures on child health and development.

The researchers individually have expertise in the macroenvironmental factors (like pollution, neighborhood violence, extreme temperatures) and the microenvironmental factors (diet, exercise, sleep) that impact reproduction and maternal-fetal health. The team plans to use that expertise to better investigate how the interplay between improving macro- and micro-environmental factors may worsen or reduce disparities through a child's lifespan.

"When people think about early childhood health disparities, they often focus on individual choices during pregnancy and early life, but the big, population-level differences in health outcomes are linked to environmental injustices and differences in population exposures," Dr. Burris said. "You can only study these big, macro-environmental factors if you have representation across large geographical areas and over large populations of humans."

The Penn-CHOP ECHO project will launch in January 2024. Any person who receives prenatal care at the Hospital of the University of Pennsylvania and Pennsylvania Hospital — where 77% of patients live within city limits — will be invited to participate in Penn-CHOP ECHO. During two prenatal care appointments, participants will answer questions related to their environmental exposures and undergo testing. Throughout the next seven years, the parents and children will attend yearly visits at CHOP, where further data will be collected. To standardize data analysis throughout the nearly 200 ECHO sites across the country, all biomedical specimens collected from participants will be sent to a central NIH lab.

"ECHO is overcoming a lot of the limitations of previous environmental health studies, both because we are going to have massive, geographically diverse representation, and because all of the data will be collected, stored, and analyzed in a uniform way," Dr. DeMauro said.

The NIH provides de-identified, centralized data from the ECHO program in its publicly available Data and Specimen Hub (DASH). This data, in addition to the new data that will be captured from the Penn-CHOP site, will be a valuable resource for researchers throughout the Philadelphia region and beyond, according to Dr. Burris.

"I think that society has underappreciated the extent to which the environment contributes to health disparities," Dr. Burris said. "The ECHO program is really going to enlighten us and identify potential interventions to improve child health."

For more information, see the CHOP news release.