Investing In The Bottom Line: The Value Case For Improving Human Experience In Healthcare, Jason A. Wolf, Vishal Bhalla, Brian Carlson, Jennifer Carron, Lanie Dixon, Julie K. Oehlert, Brant J. Oliver

Patient Experience Journal

Investment in human experience is imperative for healthcare organizations. It is a strategic focus that can lead to great benefits. Those that overlook experience, seeing it as “simply” about satisfaction or survey data, do so at great cost to their organization, team members, and most importantly those we serve – patients. A commitment to human experience – integrating the patient, workforce, and community experience – is essential for all healthcare organizations in realizing the goals they strive for and the impact they aspire to achieve. It leads to high-quality outcomes for those they care for. It creates a positive environment …

The Evolution Of Patient Experience: From Holistic Care To Human Experience, Corey Adams, Reema Harrison, Jason A. Wolf

Patient Experience Journal

Patient experience has evolved as a critical concept and outcome in health systems internationally. Evolving from consumer-led movements, coupled with shifts in the positioning of patients among clinical professions, the global focus on patient experience is now evident in nationally mandated measurement tools, the creation of dedicated institutional leadership roles, and outlets such as the Patient Experience Journal. By critically analysing the pivotal factors and milestones that have shaped its evolution throughout healthcare history, this review provides an in-depth exploration of the evolution of patient experience. In doing so, the review provides a critical analysis of the application of patient …

Looking Back To Move Forward: The Next Decade And Beyond For Human Experience, Jason A. Wolf

Patient Experience Journal

This issue comes out at an important moment for the experience conversation. It was ten years ago from the publication date of this issue on April 30, 2014, that the first issue of Patient Experience Journal (PXJ) was released. PXJ was intended to be a gathering place. A virtual town square for the experience movement where people could and would come together to share ideas and proven practice. This value of collaboration is at the foundation of our very efforts as a global community through The Beryl Institute. Experience is not some secret competitive ingredient in the world of healthcare. …

Maternal Care Utilization And Provision During The Covid-19 Pandemic: Voices From Minoritized Pregnant And Postpartum Women And Maternal Care Providers In Deep South, Ran Zhang, Tiffany Byrd, Shan Qiao Ph.D., Myriam E. Torres Phd, Msph, Xiaoming Li Ph.D., Jihong Liu Sc.D.

Faculty Publications

Background

The COVID-19 pandemic has significantly affected maternal care services especially for minoritized individuals, creating challenges for both service users (i.e., African American and Hispanic pregnant/postpartum women) and maternal care providers (MCPs). Guided by a socioecological framework, this study aims to investigate the experiences of African American and Hispanic pregnant and postpartum women, as well as MCPs, in accessing and providing maternal care services during the COVID-19 pandemic in the Deep South.

Methods

We conducted semi-structured interviews with 19 African American women, 20 Hispanic women, and 9 MCPs between January and August 2022. Participants were recruited from Obstetrics and Gynecology …

Preventive Strategies For Elder Abuse Within Hospice Care By Healthcare Professionals, Joshua Eason

Nursing | Student Research Posters

Background: Healthcare professionals providing hospice care need to have particular specialized abilities, empathy, and trust. Unfortunately, some of these medical professionals are unable to provide their patients the care they need, so they will instead abuse and ignore them. Elder abuse must be identified and addressed in hospice care settings if older patients are to have their rights and dignity upheld and a standardized, compassionate end-of-life care program is to be provided for each patient.

Purpose: The purpose of this study is to examine the effectiveness and preventative strategies for elder abuse, implemented by healthcare providers within the hospice care …

A Comparative Analysis Of Agile Vs. Traditional Project Management Methodologies In Healthcare App Development, Kruti Calcuttawala

Harrisburg University Dissertations and Theses

This study examined the effectiveness of Agile and traditional project management methodologies in developing healthcare apps. While traditional approaches like the waterfall model were commonly used in healthcare IT, their inflexibility could impede app development. Agile methodologies, with their iterative approach and collaborative nature, offer a potential solution. The study assessed both methodologies by comparing their project duration, budget, user satisfaction, and success rates and provided recommendations to optimize healthcare app development processes. It also identified the strengths and weaknesses of each methodology and their suitability for different scenarios. This study used a quantitative approach to analyze data by conducting …

Feasibility And Acceptability Of A Community Health Worker Administered Behavioral Activation Intervention For Postpartum Depression: A Single Arm Pilot Study From India, Amy Szajna, Bheemsain Tekkalaki, Veereshkumar Nandagaon, Gururaj Udapi, Manjunath Sogalad, Shweta Dandagi, Uma Kole, Sushma Patil, Sudha Raddi, Vanessa Short, Patricia Kelly

College of Nursing Faculty Papers & Presentations

INTRODUCTION: Women in India experience high rates of postpartum depression (PPD), with minimal availability of screening or treatment. India has an extensive network of community health workers, known as accredited social health activists (ASHAs). While they are knowledgeable about most maternal-child health problems, they have minimal knowledge about PPD. We trained ASHAs to deliver a simple home-based intervention, behavioral activation (BA), which involves individuals in activities that are sources of positive reinforcement to counter depression. The research questions guiding this study were as follows: 1) What are the feasibility and acceptability of ASHAs screening for and delivering a brief behavioral …

Educating Nurses On Frequent Oral Care For Mechanically Ventilated Patients: An Evidence-Based Practice Project Proposal, Grace Alford, Susan Butz, Ruth Chavez, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

The final scholarly project proposal is to implement oral care education for nurses in an intensive care unit (ICU). The proposal aims to create a guideline for an investigator to implement oral care recommendations for mechanically ventilated patients in order to reduce ventilator-associated pneumonia (VAP). The proposal consists of obtaining VAP data and oral care charting data for the unit studied, steps for providing oral care education, and analysis recommendations. Oral care involves swabbing the patient’s mouth every two hours with a swab and mouthwash. Oral care education would include handouts and direct teaching. The proposal aims to increase oral …

Association Of School Instructional Mode With Community Covid-19 Incidence During August–December 2020 In Cuyahoga County, Ohio, Pauline D. Terebuh, Jeffrey M. Albert, Jacqueline W. Curtis, Kurt C. Stange, Jill E. Miracle, Wail Yar, Prakash R. Ganesh, Heidi L. Gullett, Johnie Rose

Faculty Scholarship

Remote and hybrid modes of instruction were employed as alternatives to in-person instruction as part of early mitigation efforts in response to the COVID-19 pandemic. We investigated the impact of a public school district’s instructional mode on cumulative incidence and transmission in the surrounding community by employing a generalized estimating equations approach to estimate the association with weekly COVID-19 case counts by zip code in Cuyahoga County, Ohio, from August to December 2020. Remote instruction only (RI) was employed by 7 of 20 school districts; 13 used some non-remote instruction (NRI) (2–15 weeks). Weekly incidence increased in all zip codes …

An Expanded Chronic Care Management Approach To Multiple Chronic Conditions In Hispanics Using Community Health Workers As Community Extenders In The Rio Grande Valley Of Texas, Juliana Z Lopez, Minjae Lee, Soo K Park, Maria E Zolezzi, Lisa A Mitchell-Bennett, Paul G Yeh, Lubeth Perez, Natalia I Heredia, David D Mcpherson, Joseph B Mccormick, Belinda M Reininger

Faculty, Staff and Student Publications

INTRODUCTION: The synergistic negative effects of type 2 diabetes (T2DM) and hypertension increases all-cause mortality and the medical complexity of management, which disproportionately impact Hispanics who face barriers to healthcare access. The Salud y Vida intervention was delivered to Hispanic adults living along the Texas-Mexico Border with comorbid poorly controlled T2DM and hypertension. The Salud y Vida multicomponent intervention incorporated community health workers (CHWs) into an expanded chronic care management model to deliver home-based follow-up visits and provided community-based diabetes self-management education.

METHODS: We conducted multivariable longitudinal analysis to examine the longitudinal intervention effect on reducing systolic and diastolic blood …

Family Physicians And Menstrual Care: An Analysis Of Cera 2023, Allison Casola, Olivia Rea, Tiffany Ho

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Menstrual health is an important indicator of overall health and has large impacts on quality of life. Despite number and impact, discussion of menstruation remains largely taboo within health care. Patients and physicians are not engaging in regular, meaningful discussions on menstruation. Family physicians, as primary care providers, can facilitate these important conversations.

OBJECTIVES: We sought to understand the profile of menstrual care providing family physicians and assessed physician comfort, knowledge, training, and perceived importance regarding menstrual care.

DESIGN/METHODS: This is a cross-sectional analysis of the 2022 Council of Academic Family Medicine Educational Research Alliance survey. The survey included …

Dispelling The Malaria-Typhoid Co-Infection Myth In Nigeria. A Literature Review, Olawale Akinola

Dartmouth Library Staff Publications

Malaria and typhoid fever are public health concerns in Nigeria, with high prevalence rates. The perception of a widespread co-infection between these diseases may be misleading, due to limitations in diagnostic methods, particularly the Widal test for typhoid fever. This literature review examines the prevalence of malaria-typhoid co-infection in Nigeria and identifies factors contributing to misdiagnosis, including non-specific symptoms, limited diagnostic resources, and the diagnostic accuracy of tests employed. Additionally, the review discusses the implications of misdiagnosis, such as the overuse of broad-spectrum antibiotics leading to a rising incidence of antimicrobial resistance. Strategies to address this issue are explored, emphasizing …

Blastomas Of The Digestive System In Adults: A Review, Yu Liu, Tony El Jabbour, Jonathan Somma, Yukihiro Nakanishi, Saverio Ligato, Hwajeong Lee, Zhi-Yan Fu

School of Medicine Faculty Publications

Blastomas, characterized by a mixture of mesenchymal, epithelial, and undifferentiated blastematous components, are rare malignant neoplasms originating from precursor blast cells. This review focuses on digestive system blastomas in adult patients, including gastroblastoma, hepatoblastoma, and pancreatoblastoma. Gastroblastoma is a biphasic, epitheliomesenchymal tumor, with only sixteen cases reported to date. In addition to the characteristic histology, metastasis-associated lung adenocarcinoma transcript 1 - glioma-associated oncogene homolog 1 gene fusion is typical, although recently novel ewing sarcoma breakpoint region 1 - c-terminal binding protein 1 and patched 1 - glioma-associated oncogene homolog 2 fusions have been described. Hepatoblastoma is exceptionally rare in adults …

Investigating The Influence Of Prenatal Metals Exposures On Childhood Mitochondrial Biomarkers, Z'Dhanne Williams

Molloy Multidisciplinary Undergraduate Research Conference

Note: Z'Dhanne is a current Molloy student and conducted this research while studying at Columbia University - Mailman School of Public Health

Abstract

Background and Purpose: Mitochondrial health plays a vital role in the development of chronic health conditions, including neurodegenerative and cardiovascular diseases. Mitochondria have the unique ability to independently control replication of mitochondrial DNA (mtDNA) depending on conditions of cellular stress, including oxidative stress. Exposure to environmental metals affects a variety of health outcomes via oxidative stress pathways. Our objective was to determine the association between prenatal exposure to metals on two biomarkers of mtDNA in child blood: …

Comparing The Effects Of The Induction Of Anesthesia With Etomidate To The Induction Of Anesthesia With Midazolam On The Incidence Of In-Hospital Mortality: A Scoping Review, Madison Hayes Bsn, Rn, Ashley Lynch Bsn, Rn, Scott Jamison Bsn, Rn, Mary Joiner Bsn, Rn, Gray Seymour Bsn, Rn, Dwayne Accardo Dnp, Aprn, Crna, Tracy Mcclinton, Dnp, Aprn, Agacnp-Bc, Epb-C

Doctor of Nursing Practice Projects

Purpose/Background

The induction of anesthesia using hypnotic sedatives, such as etomidate and midazolam, is common practice. Etomidate and midazolam are commonly employed in the induction of anesthesia in the septic patient population, each with its unique advantages and drawbacks. This scoping review aims to synthesize evidence on the effects of anesthetic induction with etomidate versus midazolam in adult septic patients, focusing on the incidence of mortality and associated adverse effects during hospitalization. The purpose is to establish a standard of care for anesthetic induction in this population.

Methods

A literature review was conducted from September 2022 to March 2023 utilizing …

Investigating The Adherence Of Maternal Prenatal Vitamin Supplementation In Sarasota, Florida, Priya Darbhanga, Kaisha Mcmanus

BIO4960: Practicum in Biology I

Prenatal supplementation plays a critical role in supporting a healthy pregnancy and lowering the risk of developmental problems in children. Many expecting mothers do not consume the recommended amounts of such vitamins or any at all. This study aims to identify and understand the factors that contribute to prenatal vitamin adherence amongst women at the Sarasota Medical Pregnancy Center located in Sarasota, Florida. Paper-based questionnaires were administered to all willing participants to assess the current adherence of women to prenatal supplementation and discover the reasonings for such decisions. The primary contributors to adherence to prenatal vitamins were related to a …

Expanding Global Health Dermatology Leadership: Launching The Gloderm International Mentorship Program, Alexis G. Strahan, Olivia M. Davies, Lucía T. Fernández, Inena Wa Inena Gaylord, Yared Getachew Mekonnen, Marlous L. Grijsen, Jose E. Ollague, Doriane Sabushimike, Luisa Polo Silveira, Toby Maurer, Roni P. Dodiuk-Gad, Archana Singal, Henry W. Lim, Arpita Bhose, Janet E. Lubov, Shivani Jain, Morvarid Zehtab, Tom Allison, Maud Guerin, Wendemagegn Enbiale, Wingfield Rehmus, Karolyn A. Wanat, L Claire Fuller, Elizabeth Bailey, Esther E. Freeman

School of Medicine Faculty Publications

No abstract provided.

Prognostic Values Of Serum Lactate-To-Bicarbonate Ratio And Lactate For Predicting 28-Day In-Hospital Mortality In Children With Dengue Shock Syndrome, Thanh Nguyen Tat, Nhu Vo Hoang-Thien, Dat Nguyen Tat, Phuc Hoang Nguyen, Lien Thi Ho, Duong Hung Doan, Dung Tuan Phan, Yen Nguyen-Hoang Duong, Truc Huynh Nguyen, Tuyet Kim Nguyen, Ha Thi-Thu Dinh, Thuy Thi-Diem Dinh, Anh Thi-Mai Pham, Viet Do Chau, Tung Huu Trinh, Luan Vo Thanh

Faculty, Staff and Student Publications

This study aimed to assess the clinical utility of blood lactate-to-bicarbonate (L/B) ratio, as a prognostic factor for 28-day in-hospital mortality in children with dengue shock syndrome (DSS), admitted to the pediatric intensive care unit (PICU). This single-center retrospective study was conducted at a tertiary children hospital in southern Vietnam from 2013 to mid-2022. Prognostic models for DSS mortality were developed, using a predefined set of covariates in the first 24 hours of PICU admission. Area under the curves (AUCs), multivariable logistic and Least Absolute Shrinkage and Selection Operator (LASSO) regressions, bootstrapping and calibration slope were performed. A total of …

Results Of A Vosh Trip To Panama, Raelyn Ottenbreit Od, Aubrey Breithaupt Od, Allan Mccleary Od, Timothy Wingert Od, Emily Burnette Od

Optometric Clinical Practice

Background: Optometric services in many parts of the world are unavailable, or when available, limited to those individuals who have the resources and proximity to gain access to them. Recognizing this disparity in availability of eyecare services, teams from developed countries have been volunteering to provide eyecare in these areas with such a need for many years. Over time, these groups have also adopted a mission of enhancing the local infrastructure to create long-term improvement. Method: All records from a VOSH clinical trip to Panama were retrospectively analyzed to determine the prevalence of ocular conditions diagnosed. Results: As expected, the …

Addressing The Physical Demands Of Caregiving Or Children With Disabilities In Nicaragua: A Quality Improvement Collaboration With Fne International, Grace Price

Entry-Level Occupational Therapy Doctorate - Doctoral Capstone Symposium

Many caregivers of children with disabilities experience chronic pain and related symptoms of cumulative physical trauma. This type of phenomenon is particularly prevalent in developing, low-income countries where environmental accommodations may not be as accessible. A quality improvement program, was conducted as a doctoral capstone project to create resources addressing the physical needs of caregivers of children with disabilities in Nicaragua. Program participants included teachers at a school for children with disabilities and special needs in Nicaragua. The primary project deliverable consisted of conducting an in-person workshop to train the teachers with evidence-based methods for preventing chronic pain and other …

Targeting Idh2r140q And Other Neoantigens In Acute Myeloid Leukemia, Wingchi K Leung, Alejandro G Torres Chavez, Matthew French-Kim, Paul Shafer, Maksim Mamonkin, Laquisa C Hill, Manik Kuvalekar, Yovana Velazquez, Ayumi Watanabe, Norihiro Watanabe, Valentina Hoyos, Premal Lulla, Ann M Leen

Faculty, Staff and Students Publications

For patients with high-risk or relapsed/refractory acute myeloid leukemia (AML), allogeneic stem cell transplantation (allo-HSCT) and the graft-versus-leukemia effect mediated by donor T cells, offer the best chance of long-term remission. However, the concurrent transfer of alloreactive T cells can lead to graft-versus-host disease that is associated with transplant-related morbidity and mortality. Furthermore, ∼60% of patients will ultimately relapse after allo-HSCT, thus, underscoring the need for novel therapeutic strategies that are safe and effective. In this study, we explored the feasibility of immunotherapeutically targeting neoantigens, which arise from recurrent nonsynonymous mutations in AML and thus represent attractive targets because they …

Reproductive Justice In Mississippi: A Call For Reform And Acknowledgement, Andie Udziela

Honors Theses

In this thesis, I apply the values of the Reproductive Justice Movement to reproductive healthcare resources in Mississippi to advocate for reproductive policy reform. I begin by navigating the historic racial discrimination in gynecology and how it manifested in Mississippi. Dr Sim’s abusive experimentation on Anarcha, Betsy, and Lucy depict how Anti-Black racism took root in gynecology and obstetrics and was later expanded on by the eugenic goals of white supremacy and the feminist movement through Margaret Sanger and the Mississippi Appendectomy. Then I discuss the current availability of reproductive care in Mississippi to low-income individuals to emphasize socioeconomic and …

Confronting Cosmetic Carcinogens: A Proposal Regarding The Dangers Of Talcum Powder, Rachael Howell

Helm's School of Government Conference - 2021-2024

The Federal Government needs to stop the import, export, mining, and distribution of talcum powder in the United States. This is an issue that affects all Americans, especially active-duty military members.

Since 2013, there have been over 38,000 lawsuits against Johnson & Johnson, which allege that their talcum-based baby powder caused cancer. The plaintiffs in the very first talc case in the U.S. have died. All four of the plaintiffs from a 2019 suit have died. Yet, the 2019 case has been reversed and remanded. The FDA has redacted the names of scientist(s) that conduct “safety tests” on talc samples. …

Geographic Distribution Of Melanoma Cases In Maine: Identifying Vulnerable Counties For Targeted Intervention, Joshua R. Parbs, Madeline Prentiss, Calla Hladky, Henry Stoddard, Kathryn Stevens, Elizabeth V. Seiverling, Peggy Cyr

Journal of Maine Medical Center

Introduction: Maine has the twelfth highest incidence of melanoma in the United States. The purpose of this study was to determine which Maine counties were the most impacted by melanoma through the use of geographical methods. Identification of counties with the highest prevalence of melanoma will help in targeting future training and public health interventions.

Methods: All melanoma cases (n=5,340) reported to the Maine CDC Cancer Registry from 2013 to 2018 were sorted by pathologic T stage. Data were sorted by county and population-adjusted. Population data and provider data came from Area Health Resource Files. County and zip-code maps were …

Referral To In-Person Smoking Cessation Counseling As A Smoking Cessation Aid, Annie Mandrell Bsn, Rn, Matthew Keathley Bsn, Rn, Lewis Linden Bsn, Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Referral to In-Person Smoking Cessation Counseling as a Smoking Cessation Aid

Purpose/Background

Smoking increases an individual’s risk of acute and chronic disease morbidity and mortality, as well as creating a financial burden for the individual and healthcare system. In the United States, tobacco smoking is the leading cause of preventable death. There are an estimated 5 million tobacco-related deaths each year due to tobacco smoking. Additional healthcare costs are also seen due to the need for increased treatments, medical supplies, and staffing. Previous research for smoking cessation resources has primarily focused on traditional primary care offices. Research shows that in-person …

Fighting Fire And Fumes: Risk Awareness And Protective Practices Among Western Australian Firefighters, Kiam Padamsey, Ruth Wallace, Adelle Liebenberg, Martyn Cross, Jacques Oosthuizen

Research outputs 2022 to 2026

Background: In Western Australia, the issue of bushfires (wildfires) poses a persistent health risk to both volunteer and career forestry firefighters, populations that have been historically understudied. Aims: This descriptive qualitative study aimed to examine firefighters' level of understanding concerning hazardous exposures, their Personal Protective Equipment (PPE) protocols and their decontamination practices. Methods: Guided by the socioecological model, 23 semi-structured interviews were conducted with firefighters representing both volunteer and forestry sectors. Key results: Results indicate a gap in knowledge regarding the health risks associated with bushfire-generated smoke and contaminants among volunteer firefighters. Forestry firefighters, conversely, showed a greater awareness of …

Incidence And Seasonality Of Kawasaki Disease In Children In The Philippines, And Its Association With Ambient Air Temperature, Aden Kay Celis-Seposo, Lina Madaniyazi, Xerxes Seposo, Masahiro Hashizume, Lay Myint Yoshida, Michiko Toizumi

Ateneo School of Medicine and Public Health Publications

Background

Despite an unknown cause, Kawasaki disease (KD) is currently the primary leading cause of acquired heart disease in developed countries in children and has been increasing in recent years. Research efforts have explored environmental factors related to KD, but they are still unclear especially in the tropics. We aimed to describe the incidence of KD in children, assess its seasonality, and determine its association with ambient air temperature in the National Capital Region (NCR), Philippines from January 2009 to December 2019.

Methods

Monthly number of KD cases from the Philippine Pediatric Society (PPS) disease registry was collected to determine …

Maternal Depression And Phone Use Around Their Children: A Phone Tracking And Daily Survey Study, Brandon T. Mcdaniel Phd, Brooklyn Coleman, Victor P. Cornet Ms, Lauren Reining, Rebecca Tegiacchi, Zachary Kaiser

Health Services and Informatics Research

Previous research has connected phone use with mood and depressive symptoms but has typically relied on self-report measures of phone use. The current study examined the potential connection between objectively tracked phone use and self-reported depressive symptoms among 42 U.S. mothers with a young child (M age = 2.34 years). Their phone use was measured continuously for 5 days via an app installed on their smartphones, and mothers also completed a nightly survey each day. Mothers spent an average of 4.73 hours on their phone each day (SD = 2.87; Range = 0.70 - 13.59), and maternal phone use occurred …

Willingness And Preferences For Long-Acting Injectable Prep Among Us Men Who Have Sex With Men: A Discrete Choice Experiment, Sam Wilson Cole, Jennifer L. Glick, Nicola B. Campoamor, Travis H. Sanchez, Supriya Sarkar, Vani Vannappagari, Alex Rinehart, Keith Rawlings, Patrick S. Sullivan, John F.P. Bridges

School of Public Health Faculty Publications

Introduction Cabotegravir long-acting injectable HIV pre-exposure prophylaxis (LA-PrEP) was shown to be safe and effective in multiple clinical trials. Increasing uptake and persistence among populations with elevated risk for HIV acquisition, especially among men who have sex with men (MSM), is critical to HIV prevention. Objective This analysis aims to understand potential users' preferences for LA-PrEP, with audience segmentation. Design Willingness to use and preferences for LA-PrEP were measured in HIV-negative, sexually active MSM in the 2020 American Men's Internet Survey. Respondents answered a discrete choice experiment with paired profiles of hypothetical LA-PrEP characteristics with an opt-out option (no LA-PrEP). …

The Mental Health Impact Of Aortic Dissection, Elaine Symanski, Kristina W Whitworth, Hector Mendez-Figueroa, Kjersti M Aagaard, Iman Moussa, Juan Alvarez, Adrien Chardon Fabian, Kurunthachalam Kannan, Cheryl L Walker, Cristian Coarfa, Melissa A Suter, Hamisu M Salihu

Faculty, Staff and Student Publications

INTRODUCTION: The Maternal and Infant Environmental Health Riskscape (MIEHR) Center was established to address the interplay among chemical and non-chemical stressors in the biological, physical, social, and built environments that disproportionately impact perinatal health among Black pregnant people in a large and diverse urban area with documented disparities in the U.S.

METHODS: The MIEHR cohort is recruiting non-Hispanic Black and non-Hispanic white pregnant people who deliver their infants at major obstetric hospitals in Houston, Texas. At enrollment, all participants are asked to provide urine samples for chemical [metals, cotinine, and polycyclic aromatic hydrocarbons (PAHs)] analyses and blood samples. A subset …