Understanding Risk Gradients from Environment on Native American Child Health Trajectories: Toxicants, Immunomodulation, Metabolic syndromes, & Metals Exposure

Project Summary: Available knowledge about how stress in the home environment influences child neurodevelopment points tothe importance of capturing time-sensitive data on major stressors, such as the COVID-19 pandemic, acrossthe many populations represented in ECHO. The collective ECHO data offers insight into an unfortunatenatural experiment on how such a major stress affects ECHO children and families. Understanding this willallow for better preparation to meet the needs of affected children as they re-enter school and community life,while helping to mitigate the impacts of similar stressors in future disasters affecting children. Minority andmarginalized populations are representative of US population prevalence in ECHO, but the total number of anygroup within the 55,000 ECHO children may still be relatively small. For example, most Native American ECHOparticipants are in 2 cohorts, and represent fewer than 1500 of the 55,000 children in ECHO. It is conceivablethat time-sensitive measures such as responses to ECHO will be captured in very few, or none, of the ECHOparticipants within marginalized populations most affected.This ECHO NOSI application examines the relative pandemic-induced stress across multiple cohorts differingwith respect to marginalization, COVID-19 population prevalence, and experience with historicaltrauma/systemic racism. At present, this comparison includes the Navajo Birth Cohort Study/ECHO(NBCS/ECHO) cohort, the PASS ECHO cohorts (Indigenous and non-Indigenous populations in SouthDakota), and the Atlanta ECHO cohort of urban Black participants. We propose three aims to address ouroverall hypothesis that pandemic-induced stress will be greatest in populations experiencing the greatest ratesof infection and mortality, but exacerbated by historical trauma in Indigenous and Black populations. Aim 1 willensure availability of time-sensitive data to test this hypothesis in the future; Aim 2 will expand theopportunities for remote and lay staff collection of neurodevelopmental data to ensure availability for testing thehypothesis, and Aim 3 will test and develop a reliable system for transfer of NBCS data to the DAC NBCSportal at greater frequency than is currently possible with infrastructure limits.This is the first study exploring the impact of increased stress across communities already affected by historicaltrauma and facing a disaster like COVID-19 to address whether collective stress affects long-term childneurodevelopment through changes in parenting and the home environment, and will ensure minority cohortsare represented in the time-sensitive datasets in sufficient numbers to evaluate and compare impacts todevelop mitigation interventions, rather than simply by population proportional representation.