Emily Knapp

Johns Hopkins University | JHU · Department of Epidemiology

Purpose The Environmental influences on Child Health Outcomes (ECHO) Cohort has enrolled over 60,000 children to examine how early environmental factors (broadly defined) are associated with key child health outcomes. The ECHO Cohort may be well‐positioned to contribute to our understanding of rural environments and contexts, which has implications...

Importance Being born either small for gestational age (SGA) or large for gestational age (LGA) and experiencing rapid or slow growth after birth are associated with later-life obesity. Understanding the associations of dietary quality during pregnancy with infant growth may inform obesity prevention strategies. Objective To evaluate the associati...

Using pooled vaginal microbiota data from pregnancy cohorts (N = 683 participants) in the Environmental influences on Child Health Outcomes (ECHO) Program, we analyzed 16S rRNA gene amplicon sequences to identify clinical and demographic host factors that associate with vaginal microbiota structure in pregnancy both within and across diverse cohort...

Purpose of Review Clearly defining and measuring neighborhood socioeconomic status (nSES) is a key first step in achieving environmental justice, as the disproportionate distribution of environmental hazards and access to resources is heavily influenced by socioeconomic factors. This scoping review explores the definition of neighborhoods, measurem...

Background Questionnaires for research that involve diverse populations require inclusive language. There are few guidelines to assist researchers in minimizing social and cultural biases in data collection materials; such biases can result in harm and negatively impact data integrity. Methods We describe an approach to evaluating language in data...

OBJECTIVES Breastfeeding practices may protect against offspring obesity, but this relationship is understudied among women with obesity. We describe the associations between breastfeeding practices and child BMI for age z-score (BMIz), stratified by maternal BMI. METHODS We analyzed 8134 dyads from 21 cohorts in the Environmental Influences on Ch...

Background: Drinking water is a common source of exposure to inorganic arsenic. In the US, the Safe Drinking Water Act (SDWA) was enacted to protect consumers from exposure to contaminants, including arsenic, in public water systems (PWS). The reproductive effects of preconception and prenatal arsenic exposure in regions with low to moderate arsen...

Objective: Single-substance exposure effects on neurodevelopmental outcomes, such as problem behavior and intelligence quotient (IQ), have been studied in children for decades. However, the long-term consequences of polysubstance exposure are poorly understood. Study design: Longitudinal neurodevelopmental data were gathered from cohorts across...

Objectives: To predict behavioral disruptions in middle childhood, we identified latent classes of prenatal substance use. Study design: As part of the Environmental influences on Child Health Outcomes (ECHO) Program, we harmonized prenatal substance use data and child behavior outcomes from 2,195 women and their 6- to 11-year-old children acros...

The Environmental influences on Child Health Outcomes (ECHO)-wide Cohort Study (EWC), a collaborative research design comprising 69 cohorts in 31 consortia, was funded by the National Institutes of Health (NIH) in 2016 to improve children's health in the United States. The EWC harmonizes extant data and collects new data using a standardized protoc...

Importance: The prevalence of obesity among youths 2 to 19 years of age in the US from 2017 to 2018 was 19.3%; previous studies suggested that school lunch consumption was associated with increased obesity. The Healthy, Hunger-Free Kids Act of 2010 (HHFKA) strengthened nutritional standards of school-based meals. Objective: To evaluate the assoc...

Importance: The COVID-19 pandemic led to widespread lockdowns and school closures that may have affected screen time among children. Although restrictions were strongest early in the pandemic, it is unclear how screen time changed as the pandemic progressed. Objective: To evaluate change in children's screen time from before the pandemic to duri...

Importance: The primary outcomes of the COVID-19 pandemic on the mental health of women with children remain largely unknown. Objectives: To identify and describe clusters of mothers of children participating in the Environmental influences on Child Health Outcomes (ECHO) Program that characterize pandemic-associated hardships, coping mechanisms...

Latent trait space can be leveraged to harmonize small data into big data when the constituent datasets measure the same underlying (latent) domains using a set of partially overlapping measurement instruments in each domain. The latent trait space then acts as a common metric space for each dataset, thus ensuring the same scale for the latent trai...

Introduction: Opioid use has disproportionally impacted pregnant people and their fetuses. Previous studies describing opioid use among pregnant people are limited by geographic location, type of medical coverage, and small sample size. We described characteristics of a large, diverse group of pregnant people who were enrolled in the Environmental...

Background: Sleep in childhood is affected by behavioral, environmental, and parental factors. We propose that these factors were altered during the COVID-19 pandemic. This study investigates sleep habit changes during the pandemic in 528 children 4-12 years old in the US, leveraging data from the Environmental Influences on Child Health Outcomes...

This longitudinal study compared children’s health behaviors before the COVID-19 pandemic versus during the pandemic. This analysis examined the association between individual-level characteristics and health behavior change. Four prospective cohort studies in the Environmental influences on Child Health Outcomes (ECHO) Program contributed data. Ch...

Background: Societal changes during the COVID-19 pandemic may affect children's health behaviors and exacerbate disparities. This study aimed to describe children's health behaviors during the COVID-19 pandemic, how they vary by sociodemographic characteristics, and the extent to which parent coping strategies mitigate the impact of pandemic-relate...

Background and objectives: Experts hypothesized increased weight gain in children associated with the COVID-19 pandemic, potentially due to closures of schools and recreational facilities with consequent reduction of physical activity and dietary changes. Our objective was to evaluate whether the rate of change of child BMI increased during the CO...

In the United States, racial/ethnic minoritized groups experience worse sleep than non-Hispanic Whites (nHW), but less is known about pregnant people. This is a key consideration since poor sleep during pregnancy is common and associated with increased risk of adverse perinatal outcomes. This study reports the prevalence of subjective sleep measure...

Introduction Poor sleep during pregnancy is common and associated with increased risk of adverse perinatal outcomes. Racial/ethnic minoritized groups in the United States experience worse sleep than non-Hispanic Whites (nHW), likely due to downstream effects of systemic and structural discrimination. Nonetheless, the extent of sleep disparities in...

Given the diversity of sex, gender identity, race, ethnicity, and socioeconomic position (SEP) in children across the United States, it is incumbent upon pediatric and epidemiologic researchers to conduct their work in ways that promote inclusivity, understanding and reduction in inequities. Current child health research often utilizes an approach...

Introduction: Children at highest obesity risk include those from certain racial/ethnic groups, from low-income families, with disabilities, or living in high-risk communities. However, a 2013 review of the National Collaborative for Childhood Obesity Research Measures Registry identified few measures focused on children at highest obesity risk. T...

Objective: This paper promotes rigorous methods and designs currently underutilized in obesity research, informed by a recent systematic review of the methods and risks of bias in studies of policies, programs, and built environment changes for obesity prevention and control. Methods: To determine the current state of the field, relevant databas...

Recent research has implicated economic insecurity in increasing midlife death rates and "deaths of despair," including suicide, chronic liver disease, and drug and alcohol poisoning. In this ecological longitudinal study, we evaluated the association between changes in economic insecurity and increases in deaths of despair and midlife all-cause mo...

Background Credit scores have been identified as a marker of disease burden. This study investigated credit scores’ association with chronic diseases and health behaviours that are associated with chronic diseases. Methods This cross-sectional analysis included data on 2083 residents of Philadelphia, Pennsylvania, USA in 2015. Nine-digit ZIP code...

Purpose: Credit scores may operate as a socioeconomic indicator of health: they represent cumulative financial history that directly influences ability to access financial and nonfinancial resources related to health. Yet, little is known about the relationship of credit score and health or to traditional measures of socioeconomic position (SEP)....

Background: Given the obesity pandemic, rigorous methodological approaches, including natural experiments, are needed. Purpose: To identify studies that report effects of programs, policies, or built environment changes on obesity prevention and control and to describe their methods. Data sources: PubMed, CINAHL, PsycINFO, and EconLit (January...

We compared two strategies for measuring built environment features in their associations with youth physical activity and sedentary behavior across heterogeneous geographies of Pennsylvania. Physical activity environments of communities representing a rural-to-urban gradient were characterized through direct observation and spatially referenced ar...

Understanding the effects of widespread disruption of the social fabric on public health outcomes can provide insight into the forces that drive major political realignment. Our objective was to estimate the association between increases in mortality in middle-aged non-Hispanic white adults from 1999-2005 to 2009-2015, health inequalities in life e...

There are currently no direct observation environmental audit tools that measure diverse aspects of the obesity-related environment efficiently and reliably in a variety of geographic settings. The goal was to develop a new instrument to reliably characterize the overall properties and features of rural, suburban, and urban settings along multiple...

Network methods have been applied to obesity to map connections between obesity-related genes, model biological feedback mechanisms and potential interventions, and to understand the spread of obesity through social networks. However, network methods have not been applied to understanding the obesogenic environment. Here, we created a network of 32...

Rationale: The Cystic Fibrosis Foundation Patient Registry (CFFPR) is an ongoing patient registry study that collects longitudinal demographic, clinical, and treatment information about persons with cystic fibrosis (CF) in the United States. CF is a life-shortening genetic disorder that occurs in approximately 1 in 3,500 births in the United State...

Monitoring potential changes in the epidemiology of cystic fibrosis (CF) pathogens furthers our understanding of the potential impact of interventions. We performed a retrospective analysis using data reported to the CF Foundation Patient Registry (CFFPR) from 2006-2012 to determine the annual percent changes in the prevalence and incidence of sele...

Background People with cystic fibrosis (CF) are managed differently in the USA and UK providing an opportunity to learn from differences in practice patterns. Objectives To compare cross-sectional demographics, practice patterns and clinical outcomes between US and UK CF patients. Methods This was a cross-sectional study using 2010 data from patien...

Background: Advances in treatments for cystic fibrosis (CF) continue to extend survival. An updated estimate of survival is needed for better prognostication and to anticipate evolving adult care needs. Objective: To characterize trends in CF survival between 2000 and 2010 and to project survival for children born and diagnosed with the disease...

Background Many patients with cystic fibrosis (CF) now reach adulthood, at which time the risk of cancer is increased. The aim of this study was to determine cancer risks in nontransplanted and transplanted CF patients.Methods From 1990 to 2009, we followed 41,188 patients who received care at one of the 250 CF care center programs in the United St...