FLP-ECHO: seeking to enhance the health of children for generations to come
Recognizing the underrepresentation in research studies of young children and families living in rural poverty, a group of scholars―including some at the UNC Frank Porter Graham Child Development Institute (FPG)―created the Family Life Project (FLP). This multidisciplinary longitudinal study used an epidemiologic sampling frame to recruit a representative sample of every baby born in one of six poor rural counties in North Carolina and Pennsylvania.
During the recruitment period from fall 2003 to fall 2004, researchers engaged infants and their families at the time of the child’s birth. For the first phase of the study, team members then followed the 1,292 children enrolled in the study from birth to 36 months of age, using a cumulative risk model, to examine the relation between social risk and children's executive functioning, language development, and behavioral competence at the age of 36 months. Subsequent phases of the study followed enrolled children and families through the pre-k and school transition, the early school years, and into adolescence and young adulthood; the child participants have all turned 18 across the last 12 months.
A collaboration between UNC and Penn State University, FLP was funded by a National Institutes of Child Health and Human Development (NICHD) program grant. A key element of this study was an oversampling of Black and poor participants who have traditionally been underrepresented in the literature. A second program grant enabled FLP to continue studying the subjects through the third grade. The study provided important insights into the development of young children growing up in rural poverty, family processes related to poverty, and the factors—including positive parenting—that mediate between risks and developmental domains in young children.
“Although there's a lot of risk and adversity that happens in these families, there is also a lot of strong support from churches, neighborhoods, and family members who live close by,” says FPG research scientist Margaret Swingler, PhD, who is the current UNC PI of the FLP-ECHO project. “That social support became a theme of resiliency for many of these families.”
In 2016, FLP joined the Environmental influences on Child Health Outcomes (ECHO) Program to become the FLP-ECHO project. ECHO is an NIH-supported research program designed to enhance the health of children for generations to come. The goal of the ECHO Program—which includes 72 cohorts throughout the country—is to understand the effects of a broad range of early environmental influences on child health and development.
The Family Life Project was included in and funded by ECHO as an existing cohort with longitudinal data alongside new cohorts that enrolled pregnant women. FLP was a natural partner for ECHO since the project focused from the beginning on investigating associations between early-life stress and neurodevelopment in a wide range of areas including self-regulation, child language development, school achievement, risk for psychopathology, and physical and mental health.
Having tens of thousands of children and families in the FLP-ECHO data set enables researchers to examine big questions that cannot be answered in smaller studies. The FPG team is exploring a wide range of issues including the impact of exposure to lead and cotinine, a biomarker for nicotine, on children’s cognitive development, executive functioning, school success, and academic readiness. There is also a focus on examining both the home environment and early exposures as potential predictors for children’s obesity, and the impact of COVID-19 on families, among other pressing issues. FPG research scientist Nissa Towe-Goodman, PhD—an investigator with FLP-ECHO who has been involved since FLP began in 2003—is leading a project looking at how the availability of nature in early development influences behavior problems and social emotional development.
Given ECHO’s interest in the developmental results of children’s exposures to various environmental and biological agents, the FPG team is collecting a battery of biological samples from the young adults still actively participating in the study, including saliva, urine, blood, and toenail clippings. “There may even be questions in the future that we don't grasp yet that this information can be used for,” says Swingler. “By creating this bio bank of these samples, researchers will be able to use these resources as new technologies, new techniques, and new questions arise.”
While the current FLP-ECHO funding ends in 2023, the FPG team is hopeful that the project will receive further funding. With the children in the original FLP cohort turning 18 and transitioning to adulthood, FPG researchers are interested in following them and their future children. Towe-Goodman says that given that the researchers know so much about their participants, the idea of an intergenerational study is exciting.
“Our sample population is unique since they were recruited at birth and are part of a historically under-studied population that makes up a large part of the United States,” says Swingler. “We have done a really nice job of collecting data and using the data for informing research but also for informing policy and educating the public about children growing up in these rural and low resource areas.”
ECHO disseminates findings to a broad array of stakeholders ranging from the Children’s Environmental Health Network to the American Academy of Pediatrics, with the goal of having research inform policy. “Historically, the factors that shape outcomes for children and families in rural communities have not been well understood”,” says Towe-Goodman. “Policies and programs designed to support children and families have to take into account the unique context of these areas.” She adds that while it is easy to think that poverty is always bad for children, FLP-ECHO research has shown that many families are resilient in the face of tremendous adversity, and are able to build strong, solid relationships that support young children’s development.