What affects a child’s growth? Is it more than DNA? These are just some of the questions being asked by the Avera Research Institute and the ECHO program. Amy Elliott, PhD, Chief Clinical Research Officer for the Avera Research Institute, explains how this study aims to better understand the role the environment has on child health outcomes.
What exactly is the ECHO program?
ECHO stands for Environmental Influences on Child Health Outcomes. When people think about environmental influences, they'll tend to think air pollution, soil quality, water, and it definitely includes all of those things; but it also includes exposures that people might not think of. Like if mom was depressed during pregnancy as an exposure or high blood pressure during that time or those sorts of things. Or it even could be in the first years of life, just those general things available to kids in their environment.
What questions or outcomes are you looking to address with this study?
There are five major outcomes: one being obesity, another being things that occur around the point of delivery or what we call our pre-perinatal time period. Next is airways, and so things like asthma and other pulmonary health issues. Fourth is neurodevelopment, which would include autism, ADHD, and we know those are extremely important topics today. Finally, we have positive health, which is kind of a nice add-on to ECHO because it includes not just disease type or problems, but also about when things are going right and what can lead to and facilitate growth and resilience.
What is asked of participants and what do return appointments look like?
There are a lot of surveys and a lot of questions so that we can find out all kinds of information and really learn stories from every participant. The participants actually, I think, set the whole tone for ECHO in the fact that it's their involvement. They're continuing to come back for appointments. They're filling out the surveys. They're really giving of themselves to help advance science so that we can be better. The mission of ECHO is to improve the health of children for generations to come. That's really what we're trying to achieve; , we know there are things that our kids are struggling with today or that maybe we've seen some improvements, but not enough. So how is it that we can be, what can we learn so that for the next generation and the next generation, we can just continue to improve health and opportunity.
How is this data used and why is this work important?
We have about 1,200 scientists across the country that work on this data set. Over 3,000 scientific publications have come out of ECHO in the past decade, which is an incredibly high number. Basically, if there's a recommendation out of the American Academy of Pediatrics or American College of Obstetrics and Gynecology, which is where our pediatricians and family practice and OB/GYNs get a lot of their guidance, chances are ECHO has touched those policies and helped influence them, which is amazing. Then when you learn that we're one of the largest sites in the country, it's really people here and needs of our region that are helping influence that at the national level.
The Avera Research Institute has been participating in the ECHO Study for the last two decades. In 2026, the very first baby enrolled in the study celebrated their 19th birthday. Avera clinics across the region help recruit participants, but any woman who is prior to 20 weeks gestation and wanting to enroll, can contact the Avera Research Institute and see if they meet eligibility.
Learn more about the ECHO Program
