Over 25% of children suffer from mental health problems and/or develop obesity. Mental health problems
often emerge early through a broad range of symptoms before canalizing into disorders like depression, which
affects over 15% of adolescents in the U.S. Risk for obesity also increases with age from 13% in early
childhood to 22% in adolescence. Childhood diseases greatly impact adult health, and alarmingly, rates of
child mental health problems and obesity are increasing, particularly for youth of color. Myriad early life risk
and protective factors, often inequitably distributed and made more striking by the COVID-19 pandemic, have
been associated with these outcomes; however, without large national samples and systematic identification of
priority factors, clear targets for preventive interventions remain elusive. To address these critical issues, our
interdisciplinary team leverages the unique power of ECHO Cohort data to conduct environment-wide scans
for early life predictors of adolescent depression and obesity to identify and prioritize the most powerful targets
for prevention, with a focus on sex-specific associations and improving causal inference (Aim 1). We also take
a developmentally-informed, hypothesis-driven approach to understand the intergenerational relations between
maternal childhood and pregnancy stress with childhood psychopathology risk, and if associations are sex-
specific or buffered by family and community-level protective factors (Aim 2). To do this, we calculate a new,
specialized neurodevelopmental outcome, the p-factor, which draws on multiple indicators of behavior and
mental health to generate a single latent factor of general psychopathology in childhood and adolescence. This
parsimonious, transdiagnostic measure is ideally suited for population-based child development studies that
lack deep mental health phenotyping. Finally, we retain the socioeconomically and racially diverse CANDLE
cohort (64% African American, 30% White; 700 mother-child dyads in the ECHO Program (Aim 3). Our
success collecting ECHO Cohort data and contributions to diversity are self-evident: of the 69 ECHO cohorts,
CANDLE ranks #1 in African American participants and #3 in records contributed to ECHO’s REDCap Central.
Our team strongly contributes to collaborative science, leading multiple working groups, publishing and
disseminating ECHO Cohort findings, supporting measurement development and data harmonization, and co-
leading DEI efforts. Impact: We will generate robust evidence for prevention targets, including protective
factors, to mitigate the public health impact of child mental health problems and obesity. We examine sex-
specific associations and ensure that results are generalizable to youth of color, enhancing the potential of our
findings to improve health equity. A transdiagnostic measure of pediatric psychopathology (p-factor) will be
useful to many investigators and is well-suited to the examination of multiple exposures. The CANDLE study
notably contributes to the diversity of the ECHO Cohort, and our experienced team’s continued leadership and
partnerships during the next phase of ECHO will advance collaborative science to improve child health.
