Opportunities for evaluating chemical exposures and child health in the United States: the Environmental influences on Child Health Outcomes (ECHO) Program


The Environmental Influences on Child Health Outcomes (ECHO) Program will evaluate environmental factors affecting children’s health (perinatal, neurodevelopmental, obesity, respiratory, and positive health outcomes) by pooling cohorts composed of >50,000 children in the largest US study of its kind. Our objective was to identify opportunities for studying chemicals and child health using existing or future ECHO chemical exposure data. We described chemical-related information collected by ECHO cohorts and reviewed ECHO-relevant literature on exposure routes, sources, and environmental and human monitoring. Fifty-six ECHO cohorts have existing or planned chemical biomonitoring data for mothers or children. Environmental phenols/parabens, phthalates, metals/metalloids, and tobacco biomarkers are each being measured by ≥15 cohorts, predominantly during pregnancy and childhood, indicating ample opportunities to study child health outcomes. Cohorts are collecting questionnaire data on multiple exposure sources and conducting environmental monitoring including air, dust, and water sample collection that could be used for exposure assessment studies. To supplement existing chemical data, we recommend biomonitoring of emerging chemicals, nontargeted analysis to identify novel chemicals, and expanded measurement of chemicals in alternative biological matrices and dust samples. ECHO’s rich data and samples represent an unprecedented opportunity to accelerate environmental chemical research to improve the health of US children.

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Fig. 1: Existing or planned chemical assay data available for mothers or children by ECHO recruitment site.
Fig. 2: Number of 70 ECHO cohorts with chemical classes biomonitored in mothers or children. For mothers, we included any assay during preconception, prenatal, or delivery/infancy.


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The authors thank David Balshaw (National Institute of Environmental Health Sciences) for insightful contributions and Emma Alquist and Timothy Shields (ECHO Data Analysis Center, Johns Hopkins Bloomberg School of Public Health) for technical assistance.


Research reported in this publication was supported by the ECHO program, Office of The Director, NIH, under award numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center, JPB, GBH, EDP, MZ), UG3OD023305, UH3OD023305, UG3OD023271, UH3OD023271, and UG3OD023349, UH3OD023349 (ESB), UG3OD023282 (PIB), UG3OD023365, UH3OD023365 (DHB), UG3OD023316 (MSB), U2CES026544 (TRF), UG3OD023348, UH3OD023348 (RCF), U24OD023319-01 (Person-Reported Outcomes Core, WEF, RI), 3U2CES026533-01S1-3 (SSH), U2CES026542-01 (KK, PJP), UG3OD023275, UH3OD023275 (MPK, AJS-P), UG3OD023342, UH3OD023342 and 1U2COD023375-02 (KL), UG3OD023248, UH3OD023248 (APS), UG3OD023251, UH3OD023251 (DJW), UG3OD023272, UH3OD023272 (AW, TJW). This research was also supported by NIEHS P01ES022841 (TJW), NIEHS R01ES027051 (TJW), US EPA RD 83543301 (TJW), U2CES026542-01 (KK, PJP), P30 ES006694 (PIB), NIEHS P30 ES005022 (ESB), NIDDK R01DK076648 (APS), NIEHS R00ES025817 (APS), NIEHS P01ES022832 (MRK), and US EPA RD-83544201 (MRK). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Corresponding author

Correspondence to Jessie P. Buckley.

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Conflict of interest

WEF is a founding partner in EnMed MicroAnalytics, a company that provides heavy metal screening for newborns and children. MSB has worked for ICF International as a paid consultant on the US EPA “IRIS Draft Toxicological Review of PCBs: Effects Other Than Cancer.” All other authors declare they have no actual or potential competing financial interests.

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Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Members of the ECHO are listed in Appendix.

Supplementary information



The authors wish to thank our ECHO colleagues, the medical, nursing and program staff, as well as the children and families participating in the ECHO cohorts. We also acknowledge the contributions of the ECHO program collaborators.

ECHO components: Coordinating Center: Duke Clinical Research Institute, Durham, North Carolina: P. B. Smith, K. L. Newby, D. K. Benjamin. Data Analysis Center: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland: L. P. Jacobson; Research Triangle Institute, Durham, North Carolina: C. B. Parker. Person-Reported Outcomes Core: Northwestern University, Evanston, IL, USA: R. Gershon, D. Cella. Children’s Health and Exposure Analysis Resource: Icahn School of Medicine at Mount Sinai, New York City, NY, USA: S. L. Teitelbaum, R. O. Wright; Wadsworth Center, Albany, NY, USA: K. M. Aldous. RTI International, Research Triangle Park, NC, USA: T. Fennell; University of Minnesota, Minneapolis, MN, USA: S. S. Hecht, L. Peterson; Westat, Inc., Rockville, MD, USA: B. O’Brien. Idea States Pediatric Clinical Trials Network (ISPCTN): University of Arkansas for Medical Sciences, Little Rock, AR, USA: J. Y. Lee, J. Snowden. ISPCTN Data Coordinating and Operations Center: University of Arkansas for Medical Sciences, Little Rock, AR, USA. Pediatric Cohorts: See below under ECHO cohort awardees and cohort sites. ECHO Cohort Awardees

  • Albert Einstein College of Medicine, Bronx, NY, USA: J. L. Aschner

    • Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA: B. Poindexter

    • Icahn School of Medicine at Mount Sinai, New York, NY, USA: S. L. Teitelbaum, A. Stroustrup, C. Grennings, S. Andra, M. Arora

    • University of Buffalo, Buffalo, NY, USA: A. M. Reynolds

    • University of Florida, Gainesville, FL, USA: M. Hudak

    • University of Rochester, Rochester, NY, USA: G. Pryhuber

    • Vanderbilt University Medical Center, Nashville, TN, USA: P. Moore

    • Wake Forest University Health Sciences, Winston Salem, NC, USA: L. Washburn, J. Helderman

  • Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA: A. J. Elliott

    • The Trustees of Columbia University, New York, NY, USA: W. Fifer, J. Isler, M. Myers, M. Perzanowski, V. Rauh

  • Brigham & Women’s Hospital, Boston, MA, USA: A. A. Litonjua, S. T. Weiss

  • Columbia University, New York, NY, USA: F. P. Perer, J. B. Herbstman

  • Dartmouth College, Hanover, NH, USA: M. R. Karagas

  • Pennsylvania State University, State College, PA, USA: C. J. Newschaffer

    • Children’s Hospital of Philadelphia, Philadelphia, PA, USA: R. T. Schultz

    • Johns Hopkins University, Baltimore, MD, USA: H. E. Volk

    • Kaiser Permanente, Oakland, CA, USA: L. A. Croen

    • Kennedy Krieger Institute, Baltimore, MD, USA: R. J. Landa

    • University of California, Davis, Davis, CA, USA: R. J. Schmidt, S. Ozonoff

    • University of North Carolina, Chapel Hill, Chapel Hill, NC, USA: J. Piven

    • University of Washington, Seattle, WA, USA: S. R. Dager, D. Mayock

  • Emory University, Atlanta, GA, USA: A. L. Dunlop, P. A. Brennan, E. J. Corwin

  • Harvard Pilgrim Health Care, Boston, MA, USA: E. Oken, K. P. Kleinman

  • Icahn School of Medicine at Mount Sinai, Boston, MA, USA: R. J. Wright, R. O. Wright

    • Boston Children’s Hospital, Boston, MA, USA: M. B. Enlow

  • Kaiser Permanente, Oakland, CA, USA: A. Ferrara, L. A. Croen

  • Massachusetts General Hospital, Boston, MA, USA: C. A. Camargo

  • Michigan State University, East Lansing, MI, USA: N. Paneth, M. R. Elliott, P. McKane, J. M. Kerver, D. M. Ruden

    • Henry Ford Health System, Detroit, MI, USA: C. Barone

    • Wayne State University, Detroit, MI, USA: R. M. Douglas

  • Memorial Hospital of Rhode Island, Pawtucket, RI, USA: S. Deoni, V. A. D’Sa

    • Brown University, Providence, RI, USA: J. Braun

    • Johns Hopkins University School of Medicine, Baltimore, MD, USA: S. Carnell

    • The Translational Genomics Research Institute, Phoenix, AZ, USA: M. Huentelman

    • University of California, Davis, Davis, CA, USA: H. G. Mueller, J. L. Wang

    • University of Colorado Boulder, Boulder, CO, USA: M. LeBourgeois

    • Wellesley College, Wellesley, MA, USA: V. Klepac-Ceraj

    • Women & Infants Hospital, Providence, RI, USA: K. Matteson

  • New York State Psychiatric Institute at Columbia University, New York, NY, USA: C. S. Duarte, G. J. Canino, C. E. Monk, J. E. Posner

  • New York University, New York, NY, USA: C. B. Blair

  • New York University School of Medicine, New York, NY, USA: L. Trasande

  • Northeastern University, Boston, MA, USA: A. N. Alshawabkeh

  • Oregon Health & Science University, Portland, OR, USA: C. T. McEvoy, E. R. Spindel

  • University of California, Davis, CA, USA: I. Hertz-Picciotto, D. H. Bennett, J. B. Schweitzer

  • University of Colorado Anschutz Medical Campus, Aurora, CO, USA: D. Dabelea

  • University of Illinois, Urbana, Champaign, IL, USA: S. L. Schantz

    • University of California, San Francisco, CA, USA: T. Woodruff

  • University of New Mexico, Albuquerque, NM, USA: J. L. Lewis

  • University of North Carolina, Chapel Hill, Chapel Hill, NC, USA: M. O’Shea, R. Fry

  • University of Oregon, Eugene, OR, USA: L. D. Leve

    • George Washington University, Washington, DC, USA: J. M. Ganiban

    • Penn State, University Park, PA, USA: J. M. Neiderhiser

  • University of Pittsburgh, Pittsburgh, PA, USA: A. E. Hipwell, K. E. Keenan

  • University of Rochester, New York, NY, USA: T. G. O’Connor, C. Buss, R. K. Miller, P. D. Wadhwa

    • Magee-Women’s Hospital, University of Pittsburgh, Pittsburgh, PA, USA: H. N. Simhan

  • University of Southern California, Los Angeles, CA, USA: F. D. Gilliland, C. V. Breton

  • University of Utah, Salt Lake City, UT, USA: J. B. Stanford, E. B. Clark, C. Porucznik

  • University of Washington, Seattle, WA, USA: C. Karr, S. Sathyanarayana

    • University of California, San Francisco, CA, USA: K. Z. Lewinn, N. R. Bush

    • University of Tennessee Health Sciences Center, Memphis, TN, USA: F. A. Tylavsky

  • University of Wisconsin-Madison, Madison, WI, USA: J. Gern

    • Boston University, Boston, MA, USA: G. O’Connor

    • Brigham & Women’s Hospital, Boston, MA, USA: D. Gold

    • Columbia University, New York, NY, USA: R. Miller

    • Henry Ford Health System, Detroit, MI, USA: C. Johnson, D. Ownby, E. Zoratti

    • Johns Hopkins University, Baltimore, MD, USA: R. Wood

    • Marshfield Clinic Research Foundation, Marshfield, WI, USA: C. Bendixsen

    • University of Cincinnati, Cincinnati, OH, USA: G. K. Hershey

    • Vanderbilt University Medical Center, Nashville, TN, USA: T. Hartert

    • Washington University, St. Louis, MO, USA: L. Bacharier

  • Women & Infants Hospital of Rhode Island, Providence, RI, USA: B. Lester

    • Emory University, Atlanta, GA, USA: C. J. Marsit

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Buckley, J.P., Barrett, E.S., Beamer, P.I. et al. Opportunities for evaluating chemical exposures and child health in the United States: the Environmental influences on Child Health Outcomes (ECHO) Program. J Expo Sci Environ Epidemiol 30, 397–419 (2020). https://doi.org/10.1038/s41370-020-0211-9

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  • Environmental exposures
  • Chemicals
  • Children’s health
  • Environmental influences on child health outcomes

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