Evidence map›Paper›PMID 39731317›Full record

ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2025

A descriptive examination of rurality in the Environmental influences on Child Health Outcomes Cohort: Implications, illustrations, and future directions.

Lacey A McCormack, Debra A MacKenzie, Arielle Deutsch, Daniel Beene, Christine W Hockett, Katherine Ziegler, Emily A Knapp, Amii M Kress, Zone R Li, Shivani Bakre and 30 more

Abstract read
In one paragraph

Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

40 authors.

Lacey A McCormackAvera Research Institute, Avera McKennan Hospital, Sioux Falls, South Dakota, USA.ORCID https://orcid.org/0000-0001-8872-2531
Debra A MacKenzieCommunity Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
Arielle DeutschAvera Research Institute, Avera McKennan Hospital, Sioux Falls, South Dakota, USA.
Daniel BeeneCommunity Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
Christine W HockettAvera Research Institute, Avera McKennan Hospital, Sioux Falls, South Dakota, USA.ORCID https://orcid.org/0000-0002-1665-6763
Katherine ZieglerAvera Research Institute, Avera McKennan Hospital, Sioux Falls, South Dakota, USA.
Emily A KnappJohns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Amii M KressJohns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Zone R LiJohns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Shivani BakreJohns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Rima HabreDepartment of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA.
Lisa JacobsonJohns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Margaret R KaragasDepartment of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Kaja LeWinnDepartment of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, California, USA.
Sara S NozadiCommunity Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
Akram AlshawabkehCollege of Engineering, Northeastern University, Boston, Massachusetts, USA.
Izzuddin M ArisDepartment of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Traci A BekelmanLifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Casper G BendixsenNational Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA.
Carlos CamargoDepartment of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Andrea E Cassidy-BushrowDepartment of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA.
Lisa CroenDivision of Research, Kaiser Permanente Northern California, Oakland, California, USA.
Ferrara AssiamiraDivision of Research, Kaiser Permanente Northern California, Oakland, California, USA.
Rebecca FryDepartment of Environmental Sciences and Engineering, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
Tebeb GebretsadikDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Tina HartertDivision of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Kelly A HirkoDepartment of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.
Catherine J KarrDepartment of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA.
Itai KloogDepartment of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Christine LoftusDepartment of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA.
Kelsey E MageeDepartment of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Cindy McEvoyDivision of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.
Jenae M NeiderhiserDepartment of Psychology, Penn State University, University Park, Pennsylvania, USA.
Thomas G O'ConnorDepartments of Psychiatry, Neuroscience, Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA.
Mike O'SheaDivision of Neonatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Jennifer K StraughenDivision of Research, Kaiser Permanente Northern California, Oakland, California, USA.
Audrey UrquhartDivision of Research, Kaiser Permanente Northern California, Oakland, California, USA.
Rosalind WrightDepartment of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Amy J ElliottAvera Research Institute, Avera McKennan Hospital, Sioux Falls, South Dakota, USA.
ECHO Cohort Consortium

Funding

Project-005U2COD023375 · OD · DUKE UNIVERSITY · PI Linda S Adair, Phillip Brian Smith · 2016 to 2026
$215.9M
ECHODAC (Environmental Influences on Child Health Outcomes Data Analysis Center)U24OD023382 · OD · JOHNS HOPKINS UNIVERSITY · PI Diane J Catellier, LISA P JACOBSON · 2016 to 2026
$148.4M
Wisconsin Infant Study Cohort (WISC) ECHO Pediatric Follow-UpUH3OD023282 · OD · UNIVERSITY OF WISCONSIN-MADISON · PI James E. Gern · 2018 to 2026
$64.8M
Mount Sinai ECHO site for Perinatal Environment and Development StudiesUH3OD023337 · OD · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI KECIA Nicole CARROLL, Robert O Wright · 2018 to 2026
$54.1M
The ECHO Measurement Core: A Framework and Resource for Assessing Environmental Exposure and Child HealthU24OD023319 · OD · NORTHWESTERN UNIVERSITY AT CHICAGO · PI Courtney K Blackwell, RICHARD GERSHON · 2016 to 2026
$43.7M
VISUAL INDICES OF NEUROTOXICITYP30ES001247 · NIEHS · UNIVERSITY OF ROCHESTER · PI Sally W Thurston · 1985 to 2026
$42.8M
XENOBIOTIC BIOTRANSFORMATION AND DISPOSITIONP30ES007033 · NIEHS · UNIVERSITY OF WASHINGTON · PI Sheela Sathyanarayana · 1995 to 2026
$42.5M
Prenatal and Early Childhood Pathways To Health:  An Integrated Model of Chemical and Social Exposures, Biological Mechanisms, and Sex-Specific Effects on Neurodevelopment and Respiratory OutcomesUH3OD023271 · OD · UNIVERSITY OF WASHINGTON · PI BUSH, NICOLE RENEE, KARR, CATHERINE J · 2018 to 2022
$37.3M
UNC-CH CENTER FOR ENVIRONMENTAL HEALTH &SUSCEPTIBILITYP30ES010126 · NIEHS · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Stephanie Engel · 2001 to 2026
$36.3M
ECHO Laboratory Core at Vanderbilt for Integrated Sample Biobanking and ProcessingU24OD035523 · OD · VANDERBILT UNIVERSITY MEDICAL CENTER · PI Suman Ranjan Das, NATASHA Bassam HALASA · 2023 to 2026
$32.8M
Environmental Influences on Childhood Outcomes in the Northern Plains Safe Passage Study CohortsUH3OD023279 · OD · AVERA MCKENNAN · PI Amy J Elliott, Christine W Hockett · 2018 to 2026
$31.7M
Lifecourse Approach to Developmental Repercussions of Environmental Agents on Metabolic and Respiratory Health (LA DREAMERs)UH3OD023287 · OD · UNIVERSITY OF SOUTHERN CALIFORNIA · PI BASTAIN, THERESA M, BRETON, CARRIE VAN DOREN · 2018 to 2022
$28.4M
Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director U24OD023319Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director U24OD023382Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director U2COD023375NIEHS NIH HHS P30 ES001247NIEHS NIH HHS P30 ES007033NIEHS NIH HHS P30 ES010126NIEHS NIH HHS P30 ES036084NIEHS NIH HHS U24 ES026539NIEHS NIH HHS U2C ES026533NIEHS NIH HHS U2C ES026542NIEHS NIH HHS U2C ES026555NIEHS NIH HHS U2C ES026561NIEHS NIH HHS U2C ES030851NIEHS NIH HHS U2C ES030857NIEHS NIH HHS U2C ES030859NIH HHS U24 OD023319NIH HHS U24 OD023382NIH HHS U24 OD035523NIH HHS U2C OD023375NIH HHS UG3 OD023251NIH HHS UG3 OD023271NIH HHS UG3 OD023279NIH HHS UG3 OD023282NIH HHS UG3 OD035508NIH HHS UG3 OD035509NIH HHS UG3 OD035513NIH HHS UG3 OD035516NIH HHS UG3 OD035517NIH HHS UG3 OD035518NIH HHS UG3 OD035519NIH HHS UG3 OD035521NIH HHS UG3 OD035526NIH HHS UG3 OD035527NIH HHS UG3 OD035528NIH HHS UG3 OD035529NIH HHS UG3 OD035532NIH HHS UG3 OD035533NIH HHS UG3 OD035536NIH HHS UG3 OD035537NIH HHS UG3 OD035540NIH HHS UG3 OD035542NIH HHS UG3 OD035543NIH HHS UG3 OD035544NIH HHS UG3 OD035546NIH HHS UG3 OD035550NIH HHS UH3 OD023251NIH HHS UH3 OD023253NIH HHS UH3 OD023268NIH HHS UH3 OD023271NIH HHS UH3 OD023279NIH HHS UH3 OD023282NIH HHS UH3 OD023286NIH HHS UH3 OD023287NIH HHS UH3 OD023318NIH HHS UH3 OD023320NIH HHS UH3 OD023328NIH HHS UH3 OD023332NIH HHS UH3 OD023337NIH HHS UH3 OD023347NIH HHS UH3 OD035509NIH HHS UH3 OD035516NIH HHS UH3 OD035543Office of Behavioral and Social Science Research ES0266542Office of Behavioral and Social Science Research U24ES026539Office of Behavioral and Social Science Research U24OD035523Office of Behavioral and Social Science Research U2CES026533Office of Behavioral and Social Science Research U2CES026542Office of Behavioral and Social Science Research U2CES026555Office of Behavioral and Social Science Research U2CES026561Office of Behavioral and Social Science Research U2CES030851Office of Behavioral and Social Science Research U2CES030857Office of Behavioral and Social Science Research U2CES030859Office of Behavioral and Social Science Research UG3OD035508Office of Behavioral and Social Science Research UG3OD035509Office of Behavioral and Social Science Research UG3OD035513Office of Behavioral and Social Science Research UG3OD035516Office of Behavioral and Social Science Research UG3OD035517Office of Behavioral and Social Science Research UG3OD035518Office of Behavioral and Social Science Research UG3OD035519Office of Behavioral and Social Science Research UG3OD035521Office of Behavioral and Social Science Research UG3OD035526Office of Behavioral and Social Science Research UG3OD035527Office of Behavioral and Social Science Research UG3OD035528Office of Behavioral and Social Science Research UG3OD035529Office of Behavioral and Social Science Research UG3OD035532Office of Behavioral and Social Science Research UG3OD035533Office of Behavioral and Social Science Research UG3OD035536Office of Behavioral and Social Science Research UG3OD035537Office of Behavioral and Social Science Research UG3OD035540Office of Behavioral and Social Science Research UG3OD035542Office of Behavioral and Social Science Research UG3OD035543Office of Behavioral and Social Science Research UG3OD035544Office of Behavioral and Social Science Research UG3OD035546Office of Behavioral and Social Science Research UG3OD035550Office of Behavioral and Social Science Research UG3/UH3OD023244Office of Behavioral and Social Science Research UG3/UH3OD023248Office of Behavioral and Social Science Research UG3/UH3OD023249Office of Behavioral and Social Science Research UG3/UH3OD023251Office of Behavioral and Social Science Research UG3/UH3OD023253Office of Behavioral and Social Science Research UG3/UH3OD023272Office of Behavioral and Social Science Research UG3/UH3OD023275Office of Behavioral and Social Science Research UG3/UH3OD023279Office of Behavioral and Social Science Research UG3/UH3OD023282Office of Behavioral and Social Science Research UG3/UH3OD023285Office of Behavioral and Social Science Research UG3/UH3OD023288Office of Behavioral and Social Science Research UG3/UH3OD023289Office of Behavioral and Social Science Research UG3/UH3OD023290Office of Behavioral and Social Science Research UG3/UH3OD023305Office of Behavioral and Social Science Research UG3/UH3OD023313Office of Behavioral and Social Science Research UG3/UH3OD023337Office of Behavioral and Social Science Research UG3/UH3OD023342Office of Behavioral and Social Science Research UG3/UH3OD023344Office of Behavioral and Social Science Research UG3/UH3OD023348Office of Behavioral and Social Science Research UG3/UH3OD023349Office of Behavioral and Social Science Research UG3/UH3OD023365Office of Behavioral and Social Science Research UG3/UH3OD023389Office of Behavioral and Social Science Research UH3OD023268Office of Behavioral and Social Science Research UH3OD023271Office of Behavioral and Social Science Research UH3OD023286Office of Behavioral and Social Science Research UH3OD023287Office of Behavioral and Social Science Research UH3OD023318Office of Behavioral and Social Science Research UH3OD023320Office of Behavioral and Social Science Research UH3OD023328Office of Behavioral and Social Science Research UH3OD023332Office of Behavioral and Social Science Research UH3OD023347
6 · The paper itself

Abstract

purposeThe 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 for rural health disparities research. The present study examined the outcome of child obesity to not only illustrate the suitability of ECHO Cohort data for these purposes but also determine how various definitions of rural and urban populations impact the presentation of findings and their interpretation.

methodsThis analysis uses data from children in the ECHO Cohort study who had residential address information between January 2010 and October 2023, including a subset who also had height and weight data. Several rural-urban classification schemes were examined with and without collapsing into binary rural/urban groupings (ie, the Rural-Urban Continuum Codes, 2010 Rural-Urban Commuting Area [RUCA] Codes, and Urban Influence Codes).

findingsVarious rural/urban definitions and classification schemes produce similar obesity prevalence (17%) when collapsed into binary categories (rural vs urban) and for urban participants in general. When all categories within a classification scheme are examined, however, the rural child obesity prevalence ranges from 5.8% to 24%.

conclusionsCollapsing rural-urban classification schemes into binary groupings erases nuance and context needed for interpreting findings, ultimately impacting health disparities research. Future work should leverage both individual- and community-level datasets to provide context, and all categories of classification schemes should be used when examining rural populations.

Indexed as

Child HealthRural PopulationChildChild, PreschoolCohort StudiesFemaleHumansMalePediatric Obesitychild obesityhealth disparitiesrural

Identifiers

PMID39731317
PMCPMC11702867

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.