Background/Objectives: The main goal of this study is to identify predictors associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) seropositivity in children, including demographics, history of coronavirus disease 2019 (COVID-19) infection of the child and the household members, prevention practices, and maternal vaccination. Methods: This retrospective cross-sectional study within the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH)/MeKiTamara cohort included 300 mother-child dyads recruited in Paramaribo and Nickerie, Suriname (February–April 2023). The total immunoglobulin G (IgG) anti-spike domain 1 (S1) and anti-nucleoprotein (NP) were quantified in dried blood spot (DBS) eluates from children using indirect enzyme-linked immunosorbent assays (ELISAs). Demographic information, COVID-19 prevention measures, history of viral infection of the child and the household members, and COVID-19 vaccination questionnaire data were recorded. Predictors of SARS-CoV-2 seroprevalence were determined using binary logistic regression. Results: Among 278 seropositive children in 2023, 73.4% were in the 5–6-year-old age group, 54.7% were female, 36.3% were of Asian descent, and 69.8% were recruited in Paramaribo. Seroprevalence increased from 33.8% in 2021–2022 to 93.3% in 2023, with a mean follow-up of 21.5 months. Of the 100 children previously tested by Polymerase Chain Reaction (PCR) or antigen test, 25 had confirmed COVID-19, as reported by mothers. Children from unvaccinated mothers were 6.11 times more likely to be seropositive (p = 0.022). Conclusions: This study shows a significant increase in SARS-CoV-2 seropositivity in Surinamese children aged 3–6 years between collection periods, indicating multiple exposures. Future public health interventions and policies should account for maternal vaccination status to reduce children’s exposure to COVID-19 during future outbreaks.

BACKGROUND:Per- and polyfluoroalkyl substances (PFAS) are a diverse group of organofluorine compounds used in industrial and consumer applications. The primary route of human exposure to PFAS is ingestion of contaminated food and drinking water, representing a significant and sometimes unavoidable exposure for many populations. Ecotoxicological and epidemiological studies have established associations between PFAS exposures and adverse health effects. Fetal and childhood development is a particularly susceptible window of exposure. OBJECTIVE:We characterized PFAS exposures for pregnant women in Suriname who identified as Indigenous or Tribal Peoples, and we examined regional variations in exposure patterns between urban, rural, and remote populations. METHODS:We measured 24 PFAS analytes in the blood serum of 100 pregnant Tribal and Indigenous women living in Suriname. Samples were collected from December 2016 to July 2019 and were purposively selected for laboratory analysis. We assessed differences in serum concentrations visually and statistically by location and ethnicity. RESULTS:Ten unique PFAS were detected in at least one sample. The median total PFAS across all participants was 1.05 ng/mL (IQR: 0.73-1.45 ng/mL). The most frequently detected PFAS were PFOS (DF = 100%, median concentration ( x ̃ ) = 0.59 ng/mL), PFOA (DF = 86%, x ̃  = 0.15 ng/mL), PFNA (DF = 84%, x ̃  = 0.09 ng/mL), PFUnDA (DF = 72%, x ̃  = 0.09 ng/mL), and PFHxS (DF = 71%, x ̃  = 0.06 ng/mL). Median total PFAS concentrations were highest for participants in the remote interior district, although differences among the districts were not statistically significant (p = 0.37) and should be interpreted cautiously due to limited statistical power. Indigenous Peoples tended to have higher total PFAS in their blood serum ( x ̃  = 1.25 ng/mL) compared to Tribal Peoples ( x ̃  = 0.84 ng/mL, p < 0.01), although we did not assess potential confounding variables. SIGNIFICANCE:Our analysis revealed mostly long-chain legacy PFAS with possibly different exposure risks for secluded interior communities compared to urban-coastal populations, indicating a need for contaminant source assessments. IMPACT:Our study adds to the growing literature around PFAS exposures for people living in remote areas. Suriname aims to reduce environmental contamination from persistent organic pollutants through the Stockholm Treaty. Our study provides data needed for policymakers and communities to make informed decisions about their environmental health.

We surveyed residents in Beaver County, Pennsylvania, to explore their perceptions on health in the months leading up to the November 2022 opening of a petrochemical plant (specifically, an ethylene cracker plant) in the county. An online survey collecting demographics, self-reported health habits, perceived community and personal health status, and attitudes toward environmental health was distributed from July 2022 through August 2023. Descriptive statistics were generated and chi-square tests of independence were calculated. A total of 436 adult residents of Beaver County completed the survey. Respondents indicated concerns about their current exposure to air pollution (76%) and unsafe drinking water (65%). Approximately 36% and 25% of survey respondents indicated that they felt their health had been harmed by air pollution or unsafe drinking water, respectively. Perceived health and specific health habits were associated with agreeing or disagreeing with the statements “My health has been harmed by unsafe drinking water” and “My health has been harmed by air pollution.” These data illustrate that there is high concern about current and future exposure to pollution in Beaver County. These findings can assist community leaders in addressing and advocating for participant concerns about exposure to air and water pollution. A follow-up survey will be conducted to determine if there have been changes in perceptions since plant operations began.

This study examined the relationship between infant birth weight and exposure during pregnancy to three nonessential trace metals, cadmium, lead, and mercury, and one essential trace metal, manganese. Small-scale gold mining has contaminated freshwater fish with mercury, a primary food resource, in interior regions of Suriname, South America. Whole blood samples from pregnant women collected in early pregnancy (late first trimester or early second trimester) were used to determine trace metal concentrations. Inductively-coupled plasma mass spectrometry was used to measure trace metal concentrations. Bayesian kernel machine regression was used to evaluate the association of trace metal exposures on infant birth weight and possible interactions among trace elements. Lead was negatively associated with birth weight. Mercury appeared to affect birth weight in a nonlinear fashion. Low birth weight was observed at low concentrations of blood mercury. Birth weight increased with increasing concentrations of mercury up to the higher concentrations of mercury where birth weight appeared to trend downward. Lead and mercury interacted such that high concentrations of lead and low concentrations of mercury were associated with low birth weight. Cadmium and manganese were not associated with birth weight in this study. Lead has been observed in previous studies to negatively influence birth weight as this study found. The association of mercury with birth weight in this study might reflect diet quality. With fish being a principal dietary source of mercury in this population and knowing that consumption of nutrient packed fish is beneficial for children's physical and neurological development, low concentrations of mercury may reflect the absence or low level of fish consumption in the maternal diet. The mechanistic and clinical health implications of these associations with birth weight require further investigation.

Exposure to mercury (Hg) and lead (Pb), in combination with liver and kidney impairment, may result in adverse birth outcomes. From 408 women in the age range of 16 to 46 years, living in rural and urban areas in the interior of Suriname, we looked at the association between adverse birth outcomes and exposure to Hg and Pb in combination with liver and kidney function. This group of women represented a subcohort of pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH)—Meki Tamara study. Liver function was assessed by measuring aspartate amino transferase (AST), alanine amino transferase (ALT), and gamma-glutamyl transferase (GGT). Kidney function was assessed by measuring creatinine, urea, and cystatin C. We defined preterm births as birth before 37 weeks of gestation, low birthweight as birthweight < 2500 g, and low Apgar score as a score < 7 at 5 min, and these were used as indicators for adverse birth outcomes. Small size for gestational age was defined as gestational age < −2SD weight for GA. We found significant statistical associations between biomarkers for liver and kidney functions and adverse birth outcomes Apgar score and gestational age. No significant association was found between heavy metals Hg and lead and adverse birth outcomes.

This study assessed a preventive intervention home visiting programme (Fussy Baby Network (FBN)) designed to support mothers struggling with infant crying, sleeping, or feeding concerns. Mothers were referred to the programme through local health- and social service providers and were eligible to participate in the study if they were age 18 or older and had a child <= 12 months of age. A mixed methods design quantitatively assessed pre- to post-test changes in maternal mental health, parenting confidence, and parent-infant bonding and qualitatively explored mothers' experiences of the programme. Statistically significant differences were found with effect sizes (Cohen's D) as follows: improved parenting self-efficacy (0.72) and confidence (0.44); reduced maternal anxiety (0.50), stress (0.44), mother-infant bonding difficulties (0.42), and depression (0.35). Qualitative findings revealed that Empathic Inquiry and Capacity Building, two core processes of the FBN model, emerged as the most salient themes of the programme.

In Suriname, 20% of pregnancies end in adverse birth outcomes. While prenatal exposure to metals may lead to adverse health outcomes, exposure assessments in Suriname are scant. Environmental contamination from mercury (Hg) used in artisanal goldmining in the Amazonian Interior, and the uncontrolled use of pesticides in suburban regions are of particular concern. This study assessed geographic differences in exposures to metals and essential elements in pregnant Surinamese women. This study is a subset (n = 400) of the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) cohort study. Sector-field inductively-coupled plasma mass spectrometry was used to determine concentrations of lead (Pb), Hg, selenium (Se), cadmium (Cd), manganese (Mn) and tin (Sn) in whole blood of the pregnant women. High vs. low exposures to Pb and Hg were determined and were based respectively on CDC (3.5 ug/dL) and USEPA (3.5 ug/L) action levels. Differences in geographic exposures were tested with the Mann-Whitney U-test, and differences between blood elemental concentrations and action levels for Pb and Hg with the Wilcoxon signed rank test. The association between demographics and high exposures of Pb and Hg was examined with multivariate logistic regression models. The median concentrations of Pb, Hg and Se (5.08 μg/dL, 7.87 μg/L, and 228.26 μg/L respectively) in Interior women, were higher than the Urban and Suburban regions (p < 0.001), and higher than internationally accepted action levels (p < 0.001). The median concentrations of Mn and Sn found in Suburban women (17.55 and 0.97 ug/L respectively) were higher than Urban and Interior regions (p < 0.02). Pregnant women living in Suriname's Amazonian Interior are exposed to Hg and Pb at levels of public health concern. Urgently needed is a comprehensive source characterization assessment and the development, implementation and monitoring of environmental health policies, specifically addressing the chemicals of concern. In a subset of participants enrolled in the CCREOH environmental epidemiology cohort study elevated levels of Hg and Pb were identified. This is the first comprehensive exposure assessment in the Surinamese population. Health concerns include adverse birth- and neurodevelopmental outcomes. Geographic differences require a tailored approach to health intervention and comprehensive source characterization. Future research should ascertain the role of Se as a potential protective factor. Environmental policy development, implementation and monitoring is pivotal to mitigate exposures to these neurotoxicants.

The primary aim of this prospective study was to examine the single and combined effect of prenatal exposure to perceived stress, probable depression, and lead on toddlers’ neurodevelopment using the Bayley Scales of Infant and Toddler Development, third edition. Data from 363 mother-toddler pairs enrolled in the Caribbean Consortium for Research in Environmental and Occupational Health prospective cohort study were analyzed. A prenatal lead exposure of ≥3.5 µg/dL was associated with significantly lower receptive (p = 0.008) and expressive (p = 0.006) communication scaled scores. Moderate and severe maternal prenatal probable depression scores were associated with significantly lower fine (p = 0.009) and gross (p = 0.009) motor scaled scores. However, a maternal report of prenatal stress was not associated with neurodevelopmental outcomes. After adjusting for maternal demographics, prenatal stress and lead exposure, prenatal probable depression remained predictive of the toddlers’ gross motor scaled scores (β −0.13, 95% CI [−0.24–−0.02]). Similarly, when adjusting for demographics, prenatal stress and probable depression, prenatal lead exposure remained a significant predictor of their receptive communication scaled scores (β −0.26, 95% CI [−0.49–−0.02]). An analysis testing combined exposure to perceived stress, probable depression, and lead exposure, measured using a cumulative risk index, significantly predicted the child fine motor scaled scores after adjusting for other covariates (β −0.74, 95% CI: [−1.41–−0.01]).

Prior research has shown that climate literacy is sparse among low- and middle-income countries. Additionally, no standardized questionnaire exists for researchers to measure climate literacy among general populations, particularly with regards to climate change effects on vector-borne diseases (VBDs). We developed a comprehensive literacy scale to assess current knowledge, attitudes, and behaviors towards climate change and VBD dynamics among women enrolled in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) cohort in Suriname. Items were generated by our research team and reviewed by a group of six external climate and health experts. After the expert review, a total of 31 climate change and 21 infectious disease items were retained. We estimated our sample size at a 10:1 ratio of participants to items for each scale. In total, 301 women were surveyed. We validated our scales through exploratory (n = 180) and confirmatory factor analyses (n = 121). An exploratory factor analysis for our general Climate Change Scale provided a four-construct solution of 11 items. Our chi-squared value (X2 = 74.32; p = 0.136) indicated that four factors were sufficient. A confirmatory factor analysis reinforced our findings, providing a good model fit (X2 = 39.03; p = 0.23; RMSEA = 0.015). Our Infectious Disease Scale gave a four-construct solution of nine items (X2 = 153.86; p = 0.094). A confirmatory factor analysis confirmed these results, with a chi-squared value of 19.16 (p = 0.575) and an RMSEA of 0.00. This research is vitally important for furthering climate and health education, especially with increases in VBDs spread by Aedes mosquitoes in the Caribbean, South America, and parts of the southern United States.

Behavioral benefits of the COVID lockdown have been suggested for patients with heart failure (HF) but little is known about the effects of the pandemic on the family and loved ones who care for these patients.The purpose of this study was to compare self-reported self-care neglect among HF caregivers in the months preceding the pandemic (August 2019 through March 2020) to the self-care neglect reported by HF caregivers in the early months of the pandemic (May 2020 through December 2020).Methods: Baseline data from an ongoing study with HF caregivers were used for this analysis.All potentially eligible caregivers are screened for self-care neglect; those who score 2 on the 10-item Health Self-Care Neglect scale (construct validity, a reliability .90)are eligible for study enrollment.Possible scores range from 0-10; lower is better.Baseline data before randomization were used for this analysis.Before the pandemic, 40 caregivers were enrolled.In the early months after the pandemic began, we enrolled another 55 caregivers.Participants' demographic and clinical characteristics were compared between groups.Regression analysis was used to identify group differences in self-care neglect, adjusting for group differences at baseline.Results: The sample of 95 HF caregivers was predominately White (64%), female (89.5%), spouses (66%), age 54.7 § 13.5 years, and caregiving 9.2 § 8 hours/day.Only sex differed significantly between the groups; pre-pandemic the sample was 97.5% female but during the early months of the pandemic it was 83.6% female.Health Self-Care Neglect scores were higher (worse) pre-pandemic compared to the early months of the pandemic after accounting for sex (5.3 § 0.5 vs. 4.3 § 0.4, p=0.04).When individual items on the scale were analyzed, only the proportion of caregivers who put off going to the doctor significantly differed between pre-pandemic (62.5%) and early-pandemic (40%, p=0.03) groups.Conclusions: Health Self-care Neglect was higher in HF caregivers before the pandemic began.It may be that the pandemic encouraged caregivers to focus on their health.

Climate literacy assesses general understanding of climate, climate change, and its effects on the environment as well as human health. Despite vast scientific evidence to support climate change and its associated consequences, particularly with regards to vector-borne diseases, climate change knowledge, attitudes, and behaviors among the general population is relatively poor. In this study, we conducted a thorough review of the current literature to evaluate the scope of global climate and health literacy studies and identify key areas for improvement. We found that very few climate and health literacy studies were based in low- and middle-income countries, and those that were did not make mention of significant regional climate change impacts and specifically those that increase mosquito-borne disease transmission in high-risk areas. We also noted that of the twenty-three studies included in our final review, most focused their assessments on general climate and climate change knowledge, and not on literacy of the relationships between climate change and environmental impacts or subsequent health outcomes. Our findings make it clear that moving forward, there is a major need for climate and health literacy research to expand upon existing climate literature to include additional assessments of the relationships between certain climate change impacts and infectious diseases in particular, as well as to make available a more comprehensive overview of climate and health information to the public in the future.

The disparate measurement protocols used to collect study data are an intrinsic barrier to combining information from environmental health studies. Using standardized measurement protocols and data standards for environmental exposures addresses this gap by improving data collection quality and consistency. To assess the prevalence of environmental exposures in National Institutes of Health (NIH) public data repositories and resources and to assess the commonality of the data elements, we analyzed clinical measures and exposure assays by comparing the Caribbean Consortium for Research in Environmental and Occupational Health study with selected NIH environmental health resources and studies. Our assessment revealed that (1) environmental assessments are widely collected in these resources, (2) biological assessments are less prevalent, and (3) NIH resources can help identify common data for meta-analysis. We highlight resources to help link environmental exposure data across studies to support data sharing. Including NIH data standards in environmental health research facilitates comparing and combining study data, and the use of NIH resources and adoption of standard measures will allow integration of multiple studies and increase the scientific impact of individual studies.

Anthropogenic climate change adversely impacts human health. In this perspective, we examine the impact of climate change on respiratory health risk. We describe five respiratory health threats—heat, wildfires, pollen, extreme weather events, and viruses—and discuss their impact on health outcomes in a warming climate. The risk of experiencing an adverse health outcome occurs at the intersection of exposure and vulnerability, consisting of sensitivity and adaptive capacity. Exposed individuals and communities most at risk are those with high sensitivity and low adaptive capacity, as influenced by the social determinants of health. We call for the implementation of a transdisciplinary strategy for accelerating respiratory health research, practice, and policy in the context of climate change.

Prenatal exposure to pesticides and the association with adverse health outcomes have been examined in several studies. However, the characterization of pesticide exposure among Surinamese women during pregnancy has not been assessed. As part of the Caribbean Consortium of Research in Environmental and Occupational Health research program, 214 urine samples were collected from pregnant women living in three regions in Suriname with different agricultural practices: capital Paramaribo, the rice producing district Nickerie, and the tropical rainforest, the Interior. We used isotope dilution tandem mass spectrometry to quantify urinary concentrations of biomarkers of three pesticide classes, including phenoxy acid herbicides and organophosphate and pyrethroid insecticides, all of which are commonly used in agricultural and residential settings in Suriname. We observed that participants residing in Nickerie had the highest urinary metabolite concentrations of 2,4-dichlorophenoxyacetic acid and pyrethroids compared to those from Paramaribo or the Interior. Paramaribo had the highest concentrations of organophosphate metabolites, specifically dialkyl phosphate metabolites. Para-nitrophenol was detected in samples from Paramaribo and the Interior. Samples from Nickerie had higher median urinary pesticide concentrations of 2,4-dichlorophenoxyacetic acid (1.06 μg/L), and the following metabolites, 3,5,6-trichloro-2-pyridinol (1.26 μg/L), 2-isopropyl-4-methyl-6-hydroxypyrimidine (0.60 μg/L), and 3-phenoxybenzoic acid (1.34 μg/L), possibly due to residential use and heavy rice production.

Screening for prenatal stress is not routine in Suriname, despite its significant impact on maternal and newborn health. This study assessed the prevalence of high perceived prenatal stress and its sociodemographic predictors in three geographic areas in Suriname. In this cross-sectional study, data from 1190 participants of the Caribbean Consortium for Research in Environmental and Occupational Health cohort study were analyzed. Cohen’s Perceived Stress Scale was completed during pregnancy to ascertain high perceived stress (cut-off score 20). The association between maternal sociodemographic factors and high perceived stress was examined using the chi-square test and logistic regression models; 27.5% of all participants had high perceived stress with statistically significant lower rates in Nickerie (18.8%) compared with Paramaribo (29.8%; p = 0.001) and the Interior (28.6%; p = 0.019). Maternal sociodemographic factors moderated the difference between the Interior and Nickerie. Participants from Paramaribo had statistically significant higher odds of high perceived stress compared to those from Nickerie, independent of their age and educational level (adjusted OR = 1.94; 95% confidence interval 1.32–2.86). Perceived stress during pregnancy is predicted by sociodemographic factors. These findings identified target groups for interventions in Suriname. Policy makers should consider integrating perceived stress assessment as a routine part of prenatal care.

In AJPH and elsewhere, a steady stream of research articles, blogs, and opinion pieces have been published supporting the expansion of the community health worker (CHW) workforce.1 As frontline public health workers, CHWs have played an important role in COVID-19 response and prevention.2 Moreover, there is ever-increasing evidence of their effectiveness in promoting access to primary and preventive care, building bridges between communities and health care systems, and improving health outcomes for chronic conditions, particularly in underserved communities.3 Workforce growth is predicated upon sustainable, dedicated financing mechanisms. In the United States, CHW employment often relies on grants and other short-term resources.1,4 Long-term flexible funding models are important for both workforce development and program continuity.5 Medicaid coverage for CHW services has been identified as a potential solution for the constraints to CHW program sustainability.4 Similarly, occupational certification for CHWs provides a pathway for career development and higher earning potential while encouraging workforce growth and integration.6 Although Medicaid coverage and certification are commonly touted as enablers of workforce growth, we actually know very little about how these two policies affect the CHW labor force. Jones et al. state that low wages are the main predictor of resignations among frontline health workers, but they did not examine how wages affect turnover. Because of data limitations, turnover in this study was narrowly defined as leaving the CHW workforce altogether;job transitions within the field were not captured.

Context: It is critical to evaluate community health worker (CHW) programs to maximize effectiveness. However, there is little consensus, and structure, for how to evaluate such programs. Objective: The purpose of this study was to develop a flexible framework for evaluating components of CHW programs in community and clinical settings. Design: Semistructured interviews were conducted with CHWs and their supervisors to determine evaluation categories for the framework. A survey was then administered to pilot the framework at federally qualified health centers and community-based organizations with existing CHW programs. Setting: Eighteen federally qualified health centers and community-based organizations in Louisiana, Mississippi, Alabama, and Florida. Participants: Participants consisted of 23 CHWs and 19 CHW supervisors. Results: Interview participants directly informed the development of an evaluation framework for CHW programs. The framework consists of 7 evaluation categories: client relations, intraorganizational relations, interorganizational relations, capacity development, program effectiveness, cost-efficiency, and sustainability. Survey respondents specified best practices for program implementation for each evaluation category. Recommendations for CHW program evaluation include tailoring evaluation efforts and data collection methods to program context, using mixed-methods approaches for collecting evaluation data, and streamlining evaluation efforts with an organization's existing evaluation systems. Conclusions: The evaluation framework is a flexible and practical model for collecting information needed for monitoring and evaluating CHW programs. By relying on practitioners' perspectives, this study contributes to an evidence base for implementing and evaluating CHW programs.

Exposure to mercury (Hg) and lead (Pb) may have an effect on pregnant women. We assessed the effect of exposure to mercury and lead on liver and kidney functions in a subcohort of pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH)—Meki Tamara, study. From 400 women aged 16–46 living in rural, urban, and interior regions of Suriname, we measured blood mercury and blood lead levels. Creatinine, urea, and cystatin C were measured to assess kidney function, and aspartate amino transferase (AST), alanine amino transferase (ALT), and gamma-glutamyl transferase (GGT) were measured to assess liver function. Education, region, and ethnicity showed significant differences for both blood mercury and lead levels, which all had p-values < 0.001. Creatinine and urea were elevated with higher mercury blood levels. Our findings also suggest a relationship between high mercury blood levels and potential harmful effects on liver and kidney function.

Caribbean small island developing states are highly exposed to climate change impacts. Incorporating weather and climate information into public health decisions can promote resilience to climate change’s adverse health effects, but regionally it is not common practice. We implemented a project to enhance dialogue between climate and public health specialists in Puerto Rico and Dominica. First, we conducted environmental scans of public health vulnerability in the context of weather and climate for both islands. Then, we convened stakeholders to discuss the scan results and identify priorities for climate and health. A shared priority was increasing climate and health knowledge; thus, we developed several educational initiatives. In this viewpoint, we discuss our process for conducting environmental scans, building capacity and partnerships, and translating knowledge-to-action around climate and health.

Information regarding adverse birth outcomes (ABO) of Indigenous and Tribal women living in the remote tropical rainforest of Suriname, where mercury (Hg) use is abundant in artisanal gold mining, is not available. In the context of a health system analysis, we examined the association between Hg exposure, maternal sociodemographics on the ABO of Indigenous and Tribal women living in Suriname’s interior and its capital, Paramaribo. ABO were determined in pregnant women enrolled from December 2016 to July 2019 in the Caribbean Consortium for Environmental and Occupational Health prospective environmental epidemiologic cohort study. Associations were explored using Pearson’s χ2-test and the Mann–Whitney U-test. Among 351 singleton participants, 32% were Indigenous, residing mainly in the interior (86.8%), and 23.1% had ABO. Indigenous participants had higher rates of ABO (29.8% vs. 19.8%) and preterm birth (PTB) (21.2% vs. 12.4%), higher Hg levels, delivered at a younger age, were less educated, and had lower household income compared to Tribal participants. Multivariate logistic regression models revealed that Indigenous participants had higher odds of ABO (OR = 3.60; 95% CI 1.70–7.63) and PTB (OR = 3.43; 95% CI 1.48–7.96) compared with Tribal participants, independent of Hg exposure and age at delivery. These results highlight the importance of effective risk reduction measures in support of Indigenous mothers, families, and communities.