Abstract The NIH Environmental influences on Child Health outcomes (ECHO) Program seeks to understand the impact of early environmental influences on child health and development – with a special emphasis on Pre-, Peri-, and Postnatal Health, Upper and Lower Airways, Neurodevelopment, Obesity, and Positive Health – and to enhance these areas of health and development. The Rochester-Magee award in the first phase of ECHO (UG3/UH3 OD023349) was a pregnancy cohort that followed children through age 4 years. In this proposal, which is responsive to RFA-OD-22-018 for the second phase of ECHO, we will recruit an additional pregnancy cohort of 375 pregnancies (across the first 5 years) and conduct a pediatric follow-up of our existing ECHO cohort (12601) and two Rochester-based ECHO cohorts that were part of other multi-site awards in first phase of ECHO: PROP/PRISM and TIDES-Rochester. Including these two additional cohorts in our pediatric follow- up plans increases the number of ECHO cohorts that are carried forward from the first to the second phase of ECHO and creates economies of scale and efficiencies for our pediatric follow-up. Collectively, we aim to follow 375 children across the three consolidated Rochester-based ECHO cohorts. In response to the RFA, we propose two areas of specialized outcomes, Neurodevelopment & Upper and Lower Airways/Asthma, and two areas of specialized exposures, Chemical exposure & Prenatal Immune Activation/Inflammation, that reflect expertise of the research team and measurement concentration and in- depth data related to the pregnancy and pediatric cohorts. Throughout the UG3 and UH3 phases of the second phase of the ECHO program we will institute practices to maximize retention of existing participants, ensure recruitment of diverse new pregnant/preconception participants, and implement the established ECHO Cohort Protocol with high fidelity. We will also lead novel and solution-oriented research that capitalizes on the data already on the ECHO platform and research that takes advantage of our specialized areas of expertise to understand how pre-conception, perinatal, and early postnatal exposures shape child health outcomes.

Project Narrative There is rapidly growing evidence that the health and development of the child and adult can be traced to early environmental influences, but fundamental questions remain about which specific early exposures confer risk and by what mechanisms. We pool three Rochester-based cohort studies and collect a new pregnancy cohort to add to and extend the NIH ECHO program into a second phase. We will institute practices to maximize retention of existing participants, ensure recruitment of diverse new pregnant/preconception participants, implement the ECHO Cohort Protocol with high fidelity, and lead analyses of novel and solution-oriented research that will yield robust recommendations for promoting child health outcomes.