Environmental Influences on Child Health Outcomes in Maine (ECHO-ME) - Maine is one of the most rural states in the nation, with over half of the pediatric population living in rural areas. About 25% of children in Maine have special healthcare needs, and it is estimated that one in three has a body weight designation of overweight or obese. As is typical in rural states, health care services are clustered in more densely populated southern parts of the state and along the coast, leaving large areas of Maine in the north and in the interior with less access to care. Rural Maine children have limited opportunities to participate in high-quality pediatric clinical trials. Through this application, “Environmental Influences on Child Health Outcomes in Maine (ECHO-ME),” MaineHealth seeks to join the IDeA States Pediatric Clinical Trials Network (ISPCTN) in the coming five-year funding cycle. To achieve the goals of the ECHO-ISPCTN, we propose the following aims: (1) Develop, conduct, and disseminate findings from multicenter clinical trials research, assuring the participation of children living in rural communities in Maine; (2) Build pediatric clinical trial research capacity in the MaineHealth system; and (3) Engage multiple interested parties across Maine such as community members, families with lived experience, nonprofit organizations, and professional societies to enhance ECHO-ISPCTN clinical trial impact, transferability, rigor, and feasibility. Participating in this network would build lasting capacity, infrastructure, and processes in Maine to design and conduct multisite clinical trials that answer questions of critical importance to pediatric health; increase the ability of rural children to participate in clinical research through MaineHealth (which serves about one-third of children in Maine); and allow the research team to participate fully in a dynamic, collaborative network of investigators committed to improving pediatric health outcomes for rural children across the country.