Click here if interested in participating!
The Navajo Birth Cohort Study (NBCS) is assessing the relationship among exposures to uranium waste, birth outcomes, and child development on Navajo Nation where more than 500 abandoned uranium mines (AUMs) and 1100 associated waste features remain. Exposure is extensively characterized by a combination of survey data, environmental home assessments, and biosamples.
The primary goal of this study is to better understand the relationship between uranium and environmental metal exposures with birth outcomes and children’s development on Navajo Nation.
The NIH (National Institutes of Health) ECHO ( E nvironmental influences on C hild H ealth O utcomes) program brings separate research groups, or cohorts, from across the country together in order to better understand how early life exposures and experiences can affect child health and development. The ECHO program aims to enroll over 55,000 children across the U.S. with the mission to enhance the health of children for generations to come.
The Navajo Birth Cohort Study (NBCS), now part of the ECHO program, is called NBCS/ECHO+ and will represent more than half of all Native American children enrolled in the national study. While the NBCS continues to focus on the impacts of early life exposure to toxic metals in the environment, such as uranium and arsenic, participation in the ECHO program allows NBCS to study a broader set of health outcomes that include obesity, upper and lower airway function, birth outcomes, neurodevelopment and overall health.
ECHO-supported studies share standardized data collection methods in these five key outcome domains:
NBCS/ECHO+ is currently recruiting!
Ashley Wegele, MPH
AWegele@salud.unm.edu
Carolyn Roman, PhD
cwroman@salud.unm.edu
For more information, call 1-877-545-6775
Cho YJ, Leventhal BL, Rennie BJ, Geib EF, Krapf HD, Nozadi SS, Leckie AL, Ankenman K, Salzman E, Ence W, Burnette C. Examining the Child Behavior Checklist (CBCL) Utility in a Native American Population. JAACAP Open. 2026 May. doi:10.1016/j.jaacop.2026.05.001.
Beene D, Lin Y, Hoover JH, Shi X. Deconstructing rurality to better “place” health data. Int J Geogr Inf Sci. 2026;40(8):2594-2621. Epub 2025 Mar 31. doi:10.1080/13658816.2025.2482718.
Du R, Chu X, Jin J, Luo L, Lee J, Hudson LG, MacKenzie D, Lewis JL. A data-driven single substitution to overcome bias from conventional single substitution for LOD missingness in covariates in least squares regression. J Appl Stat. 2026.
Levin R, Villanueva CM, Beene D, Cradock AL, Donat-Vargas C, Lewis J, Martinez-Morata I, Minovi D, Nigra AE, Olson ED, Schaider LA. US drinking water quality: exposure risk profiles for seven legacy and emerging contaminants. J Expo Sci Environ Epidemiol. 2024 Jan;34(1):3-22. Epub 2023 Sep 22. doi:10.1038/s41370-023-00597-z.
Hoover JH, Coker ES, Erdei E, Luo L, Begay D, MacKenzie D, NBCS Study Team, Lewis J. Preterm Birth and Metal Mixture Exposure among Pregnant Women from the Navajo Birth Cohort Study. Environ Health Perspect. 2023 Dec 18;131(12):127014. doi:10.1289/EHP10361.
Rennie BJ, Bishop S, Leventhal BL, Zheng S, Geib EF, Kim YS, Burnette C, Salzman E, Nozadi SS, Kim H, Ence W. Neurodevelopmental profiles of 4-year-olds in the Navajo Birth Cohort Study. JAACAP Open. 2023 Nov;1(3):184-195. doi:10.1016/j.jaacop.2023.06.003.
Du R, Luo L, Hudson LG, Nozadi S, Lewis J. An adjusted partial least squares regression framework to utilize additional exposure information in environmental mixture data analysis. J Appl Stat. 2023;50(8):1790-1811. doi:10.1080/02664763.2022.2043254.
Erdei E, Qeadan F, Miller C, Kanda D, Luo L, Gonzales M, Lewis J, MacKenzie D. Environmental uranium exposures and cytokine profiles among mother-newborn baby pairs from the Navajo Birth Cohort Study. Toxicol Appl Pharmacol. 2022 Dec 1;456:116292. Epub 2022 Oct 19. PMID: 36270330; doi:10.1016/j.taap.2022.116292.
Thompson González N, Ong J, Luo L, MacKenzie D. Chronic Community Exposure to Environmental Metal Mixtures Is Associated with Selected Cytokines in the Navajo Birth Cohort Study (NBCS). Int J Environ Res Public Health. 2022 Nov 13;19(22):14939. doi:10.3390/ijerph192214939.
Nozadi SS, Li L, Luo L, MacKenzie D, Erdei E, Du R, Roman C, Hoover J, O’Donald E, Burnette C, Lewis J. Prenatal metal exposures and infants’ developmental outcomes in a Navajo population. Int J Environ Res Public Health. 2022 Jan;19(1):425.
Beene D, Collender P, Cardenas A, Harvey C, Huhmann L, Lin Y, Lewis J, LoIacono N, Navas-Acien A, Nigra A, Steinmaus C. A mass-balance approach to evaluate arsenic intake and excretion in different populations. Environ Int. 2022;166:107371. PMID: 35809487.
Miller C. Marginal probabilities and point estimation for conditionally specified logistic regression. Commun Stat Simul Comput. 2021 Dec 2;50(12):4338-4363.
Shaw JL, Semmens E, Okihiro M, Lewis JL, Hirschfeld M, VanWagoner TM, Stephens L, Easa D, Ross JL, Graham N, Watson SE. Best Practices for Conducting Clinical Trials With Indigenous Children in the United States. Am J Public Health. 2021 Sep;111(9):1645-1653. doi:10.2105/AJPH.2021.306372.
Walker ES, Noonan CW, Semmens EO, Ware D, Smith P, Boyer BB, Erdei E, Hopkins SE, Lewis J, Belcourt A, Ward TJ. Indoor fine particulate matter and demographic, household, and wood stove characteristics among rural US homes heated with wood fuel. Indoor Air. 2021 Jul;31(4):1109-1124. doi:10.1111/ina.12808.
Hoover JH, Erdei E, Begay D, Gonzales M, Jarrett JM, Cheng PY, Lewis J. Exposure to uranium and co-occurring metals among pregnant Navajo women. Environ Res. 2020;190:109943.
Scammell MK, Sennett C, Laws RL, Rubin RL, Brooks DR, Amador JJ, López-Pilarte D, Ramirez-Rubio O, Friedman DJ, McClean MD, Navajo Birth Cohort Study Team. Urinary metals concentrations and biomarkers of autoimmunity among Navajo and Nicaraguan men. Int J Environ Res Public Health. 2020 Aug;17(15):5263. PMCID: PMC7432079.
Hipwell AE, Tung I, Palmore M … McGrath M; ECHO Cohort Consortium. Does gestational vitamin D attenuate the negative effects of prenatal depression on offspring emotional and behavioral problems? Findings from the ECHO Cohort. Psychological Medicine. 2026. PMID: 42299714.
Beene D, MacKenzie D, Camargo CA … Kress AM; ECHO Cohort Consortium. Challenges associated with rural-urban stratification for generalizing birth outcomes: Insights from the ECHO Cohort. Journal of Rural Health. 2026. PMID: 42117321.
Kahn LG, Hipwell AE, Stanford J … MacKenzie DA … Ghassabian A; program collaborators for Environmental influences on Child Health Outcomes. Associations of subfecundity and infertility treatment with child neurodevelopment in ECHO. JAMA Network Open. 2026. PMID: 42258210.
Marceau K, Law A, Derefinko KJ … Nozadi SS … Neiderhiser JM; ECHO Cohort Consortium. Prenatal Smoking and Child Psychopathology Associations by Age and Sex in the ECHO Cohort. Development and Psychopathology. 2026. PMID: 41936434.
Margolis AE, Law A, Knapp E … Lewis J … Bastain TM. Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis. Journal of Clinical Child & Adolescent Psychology. 2025. PMID: 41105920.
Melough MM, McGrath M, Palmore M … Sathyanarayana S; program collaborators for Environmental influences on Child Health Outcomes. Gestational vitamin D concentration and child cognitive development: A longitudinal cohort study in the ECHO Program. American Journal of Clinical Nutrition. 2025. PMID: 40562362.
Blackwell CK, Bekelman T, Bakre S, Jacobson LP, Towe-Goodman NR, Lewis J, MacKenzie DA, Anderson Q, Watts DJ, LeWinn KZ. Sociodemographic differences in parental hesitancy to the COVID-19 vaccine. Vaccine. 2025 May 10;55:127041. PMID: 40132320; PMCID: PMC12078000; doi:10.1016/j.vaccine.2025.127041.
Nigra AE, Bloomquist TR, Rajeev T … Lewis J, MacKenzie D, Beene D … Kress AM; ECHO Cohort Consortium. Public water arsenic and birth outcomes in the Environmental influences on Child Health Outcomes Cohort. JAMA Network Open. 2025. PMID: 40522663.
McCormack LA, MacKenzie DA, Deutsch A, Beene D, Hockett CW, Ziegler K, Knapp EA, Kress AM, Li ZR, Bakre S, Habre R. A descriptive examination of rurality in the Environmental influences on Child Health Outcomes Cohort: Implications, illustrations, and future directions. J Rural Health. 2025 Jan;41(1):e12908. doi:10.1111/jrh.12908.
Brennan PA, Nozadi SS, McGrath M, Churchill ML, Dunlop AL, Elliott AJ, MacKenzie D, Margolis AE, Ghassabian A, McEvoy CT, Fry RC, Bekelman TA, Ganiban JM, Williams L, Wilson CL, Lewis J; program collaborators for Environmental influences on Child Health Outcomes. COVID-19 Stress and Child Behavior: Examining Discrimination and Social Support in Racially Diverse ECHO Cohorts. J Am Acad Child Adolesc Psychiatry. 2024 May;63(5):528-538. PMID: 37544643; doi:10.1016/j.jaac.2023.07.996.
Zheng S, Mansolf M, McGrath M, Churchill ML, Bekelman TA, Brennan PA, Margolis AE, Nozadi SS, Bastain TM, Elliott AJ, LeWinn KZ. Measurement bias in caregiver-report of early childhood behavior problems across demographic factors in an ECHO-wide diverse sample. JCPP Adv. 2024 Mar;4(1):e12198. doi:10.1002/jcv2.12198.
Bragg MG, Westlake M, Alshawabkeh AN, Bekelman TA, Camargo CA Jr, Catellier DJ, Comstock SS, Dabelea D, Dunlop AL, Hedderson MM, Hockett CW, Karagas MR, Keenan K, Kelly NR, Kerver JM, MacKenzie D, Mahabir S, Maldonado LE, McCormack LA, Melough MM, Mueller NT, Nelson ME, O’Connor TG, Oken E, O’Shea TM, Switkowski KM, Sauder KA, Wright RJ, Wright RO, Zhang X, Zhu Y, Lyall K; program collaborators for Environmental influences on Child Health Outcomes. Opportunities for Examining Child Health Impacts of Early-Life Nutrition in the ECHO Program: Maternal and Child Dietary Intake Data from Pregnancy to Adolescence. Curr Dev Nutr. 2023 Oct 23;7(11):102019. PMID: 38035205; PMCID: PMC10681943; doi:10.1016/j.cdnut.2023.102019.
Nozadi SS, Aguiar A, Du R, Enright E, Schantz S, Miller C, Rennie B, Quetawki M, MacKenzie D, Lewis J. Cross-cultural applicability of eye-tracking in assessing attention to emotional faces in preschool-aged children. Emotion. 2023 Aug;23(5):1385-1399. doi:10.1037/emo0001124.
Knapp EA, Kress AM, Parker CB, Page GP, McArthur K, Gachigi KK, Alshawabkeh AN, Aschner JL, Bastain TM, Breton CV, Bendixsen CG … Leventhal B … Lewis J … Jacobson L. The Environmental Influences on Child Health Outcomes (ECHO)-Wide Cohort. Am J Epidemiol. 2023 Aug 4;192(8):1249-1263. PMID: 36963379; doi:10.1093/aje/kwad071.
Nozadi SS, Li X, Kong X, Rennie B, Kanda D, MacKenzie D, Luo L, Posner J, Blackwell CK, Croen LA, Ferrara A. Effects of COVID-19 Financial and Social Hardships on Infants’ and Toddlers’ Development in the ECHO Program. Int J Environ Res Public Health. 2023 Jan 5;20(2):1013. doi:10.3390/ijerph20021013.
Bastain TM, Knapp EA, Law A, Algermissen M, Avalos LA, Birnhak Z, Blackwell C, Breton CV, Duarte C, Frazier J, Ganiban J, Greenwood P, Herbstman J, Hernandez-Castro I, Lewis J, et al. COVID-19 Pandemic Experiences and Symptoms of Pandemic-Related Traumatic Stress Among Mothers in the United States. JAMA Netw Open. 2022 Dec 1;5(12):e2247330. doi:10.1001/jamanetworkopen.2022.47330.
Xu X, Shuffrey LC, Bastain TM, Liu C, Wright RJ, Bosquet Enlow M, Hernandez A, Ganiban J, Nozadi SS, Margolis AE, Elliott AJ, Morales S. The role of negative affectivity in the developmental pathway linking perinatal complications to behavioral and emotional problems in children. Dev Psychopathol. 2026 Aug;38(3):1322-1332. PMID: 41693363; PMCID: PMC12994220; doi:10.1017/S0954579426101175.
Shuffrey LC, Rennie B, Li X, Galai N, Pini N, Akbaryan A, Alshawabkeh A, Aschner J, et al.; Margolis AE. Combining developmental and sleep health measures for autism spectrum disorder screening: an ECHO study. Pediatr Res. 2025;97(1):411-421. doi:10.1038/s41390-024-03306-0.
Blackwell CK, Wu G, Chandran A, Arizaga J, Bosquet Enlow M, Brennan PA, Burton P, Bush NR, Cella D, Cummins C, D’Sa VA, Frazier JA, Ganiban JM, Gershon R, Koinis-Mitchell D, Leve LD, Loftus CT, Lukankina N, Margolis A, Nozadi SS, Wright RJ, Wright RO, Zhao Q, LeWinn KZ. Longitudinal Changes in Youth Mental Health From Before to During the COVID-19 Pandemic. JAMA Netw Open. 2024 Aug 1;7(8):e2430198. PMID: 39186267; PMCID: PMC11856357; doi:10.1001/jamanetworkopen.2024.30198.
Morales S, Bowers ME, Shuffrey L, Ziegler K, Troller-Renfree S, Hernandez A, Leach SC, McGrath M, Ola C, Leve LD, Nozadi SS, Swingler MM, Lai JS, Schweitzer JB, Fifer W, Camargo CA, Khurana Hershey GK, Shapiro ALB, Keating DP, Hartert TV, Deoni S, Ferrara A, Elliott AJ. Maternal education prospectively predicts child neurocognitive function: An environmental influences on child health outcomes study. Dev Psychol. 2024 Jun;60(6):1028-1040. PMID: 38407105; PMCID: PMC11164632; doi:10.1037/dev0001642.
Lewis JV, Knapp EA, Bakre S, Dickerson AS, Bastain TM, Bendixsen C, Bennett DH, Camargo CA, Cassidy-Bushrow AE, Colicino E, D’Sa V … MacKenzie D … Kress AM. Associations between area-level arsenic exposure and adverse birth outcomes: An ECHO-wide cohort analysis. Environ Res. 2023 Nov 1;236:116772. doi:10.1016/j.envres.2023.116772.
Melough MM, Li M, Hamra G, Palmore M, Sauder KA, Dunlop AL, LeWinn KZ, Zhao Q, Kelly RS, Switkowski KM, Hipwell AE, Korrick SA, Collett BR, MacKenzie D, Nozadi SS, Kerver JM, Schmidt RJ, McGrath M, Sathyanarayana S; program collaborators for Environmental influences on Child Health Outcomes. Greater Gestational Vitamin D Status is Associated with Reduced Childhood Behavioral Problems in the Environmental Influences on Child Health Outcomes Program. J Nutr. 2023 May;153(5):1502-1511. PMID: 37147034; doi:10.1016/j.tjnut.2023.03.005.
Brennan PA, Dunlop AL, Croen LA, Avalos LA, Salisbury AL, Hipwell AE, Nozadi SS, Sathyanarayana S, Crum RM, Musci R, Li M, Li X, Mansolf M, O’Connor TG, Elliott AJ, Ghildayal N, Lin PD, Sprowles JLN, Stanford JB, Bendixsen C, Ozonoff S, Lester BM, Shuster CL, Huddleston KC, Posner J, Paneth N. Prenatal Antidepressant Exposures and Autism Spectrum Disorder or Traits: A Retrospective, Multi-Cohort Study. Res Child Adolesc Psychopathol. 2023 Apr;51(4):513-527. PMID: 36417100; PMCID: PMC10150657; doi:10.1007/s10802-022-01000-5.
Howe CG, Nozadi SS, Garcia E, O’Connor TG, Starling AP, Farzan SF, Jackson BP, Madan JC, Alshawabkeh AN, Cordero JF, Bastain TM. Prenatal metal(loid) mixtures and birth weight for gestational age: A pooled analysis of three cohorts participating in the ECHO program. Environ Int. 2022 Mar 1;161:107102.
Sauder KA, Harte RN, Ringham BM, Guenther PM, Bailey RL, Alshawabkeh A, Cordero JF, Dunlop AL, Ferranti EP, Elliott AJ, Mitchell DC … Hoover J, MacKenzie D. Disparities in risks of inadequate and excessive intake of micronutrients during pregnancy. J Nutr. 2021 Nov 2;151(11):3555-3569.
Faro EZ, Sauder KA, Anderson AL, Dunlop AL, Kerver JM, McGrath M, Roary M, Roman CW, Weidinger C, Huddleston KC. Characteristics of Environmental influences on Child Health Outcomes (ECHO) Cohorts Recruited During Pregnancy. MCN Am J Matern Child Nurs. 2021;46(4):230-235. doi:10.1097/NMC.0000000000000725.
Schantz SL, Eskenazi B, Buckley JP, Braun JM, Sprowles JN, Bennett DH, Cordero J, Frazier JA, Lewis J, Hertz-Picciotto I, Lyall K, Nozadi SS … Watkins DJ. A framework for assessing the impact of chemical exposures on neurodevelopment in ECHO: Opportunities and challenges. Environ Res. 2020;188:109709.
Bush NR, Wakschlag LS, LeWinn KZ, Hertz-Picciotto I, Nozadi SS, Pieper S, Lewis J, Biezonski D, Blair C, Deardorff J, Neiderhiser JM. Family environment, neurodevelopmental risk, and the Environmental influences on Child Health Outcomes (ECHO) initiative: Looking back and moving forward. Front Psychiatry. 2020;11:547.