About

Patrick Tyjuan Smith is an Associate Research Professor of Theological Ethics and Bioethics at the Divinity School, where he has been serving since 2018. He is also the Co-Director in the Trent Center for Bioethics, Humanities & History of Medicine since 2021, and the Director of the Capacious Minds Initiative at the Kenan Institute for Ethics since 2025. Additionally, he holds a position as an Associate Professor in Population Health Sciences within the Basic Science Departments since 2021. His research focuses on addressing ethical challenges in health equity, racial inequalities in healthcare, and the promotion of diversity, equity, and inclusion within bioethics. Smith has contributed to the field through publications that advocate for pushing back against assaults on diversity and addressing racism in bioethics. His work includes exploring strategies to promote health equity, particularly in perioperative health and ICU prognostication, supported by grants from institutions such as the National Institutes of Health and the John and Wauna Harman Foundation.

Research topics

• Medicine
• Internal medicine
• Biology
• Environmental health
• Intensive care medicine
• Microbiology
• Bioinformatics
• Anesthesia
• Genetics
• Dermatology
• Demography
• Physiology
• Pediatrics
• Emergency medicine
• Endocrinology

Selected publications

• Early-Life Factors and Body Mass Index Trajectories Among Children in the ECHO Cohort

  JAMA Network Open · 2025-05-22 · 9 citations

  articleOpen access

  Importance: Identifying atypical body mass index (BMI) trajectories in children and understanding associated, modifiable early-life factors may help prevent childhood obesity. Objective: To characterize multiphase BMI trajectories in children and identify associated modifiable early-life factors. Design, Setting, and Participants: This cohort study included longitudinal data obtained from January 1997 to June 2024, from the Environmental influences on Child Health Outcomes (ECHO) cohort, which included children aged 1 to 9 years with 4 or more weight and height assessments. Analyses were conducted from January to June 2024. Exposures: Prenatal exposure to substances and stress (smoking, alcohol, depression, anxiety), maternal characteristics (prepregnancy BMI, gestational weight gain), child characteristics (preterm birth, birth weight, breastfeeding), and demographic covariates. Main Outcomes and Measures: BMI (calculated as weight in kilograms divided by length in meters squared for children aged 1 and 2 years and as weight in kilograms divided by height in meters squared for children older than 2 years) obtained using medical records, staff measurements, caregiver reports, or remote study measures. The analysis was conducted using a multiphase latent growth mixture model. Results: This study included 9483 children (4925 boys [51.9%]). Two distinct 2-phase BMI patterns were identified: typical and atypical. The typical group (n = 8477 [89.4%]) showed linear decreases in BMI (b2, -0.23 [95% CI, -0.24 to -0.22]), with the lowest BMI at age 6 years (95% CI, 5.94-6.11), followed by linear increases from 6 to 9 years (slope difference [b4 - b2], 0.81 [95% CI, 0.76-0.86]; mean BMI at 9 years: 17.33). The atypical group (n = 1006 [10.6%]) showed a stable BMI from ages 1 to 3.5 years (b6, 0.06 [95% CI, -0.04 to 0.15]), followed by rapid linear increases from ages 3.5 to 9 years (slope difference [b8 - b6], 1.44 [95% CI, 1.34-1.55]). At age 9 years, this group reached a mean BMI (26.2) that exceeded the 99th percentile. Prenatal smoking, high prepregnancy BMI, high gestational weight gain, and high birth weight were key risk factors for the atypical trajectory. Conclusions and Relevance: In this cohort study of children in the ECHO cohort, analyses identified children on the path to obesity as early as age 3.5 years. Modifiable factors could be targeted for early prevention and intervention programs aimed at reducing childhood obesity.

  PublisherOA PDFDOI

• Racial and ethnic disparities in environmental chemical exposures and hypertensive disorders of pregnancy: The ECHO-wide cohort study

  Environmental Pollution · 2025-12-02 · 1 citations

  article
  PublisherDOI

• SARS-CoV-2 N protein and anti-spike serologies: insights into COVID-19 disease severity and mortality—a secondary analysis of the ACTIV-1 trial

  UNC Libraries · 2025-05-01

  articleOpen access

  Background: Understanding factors that predict progression to severe COVID-19 is critical. Antibodies targeting SARS-CoV-2 spike protein confer protection, while the N protein of SARS-CoV-2 plays roles in viral replication and immune dysfunction. This study explores the significance of N protein and anti-spike antibodies on disease severity, progression, and mortality. Objectives: To evaluate the relationship between SARS-CoV-2 N protein and anti-spike antibody levels with disease severity, clinical outcomes, and mortality in hospitalized patients with COVID-19. Design: A secondary analysis of serologic data from participants in the ACTIV-1 randomized clinical trial, which evaluated immunomodulators for the treatment of hospitalized patients with COVID-19. Methods: A subanalysis of the ACTIV-1 immune modulator trial was conducted. Samples collected at randomization were tested for N protein levels and anti-spike antibodies. Logistic regression and linear models were employed to examine the association between serological measures and clinical outcomes, including 28-day mortality as well as progression to high-flow nasal cannula (HFNC) and invasive mechanical ventilation (MV). Results: Among the 496 participants with detectable serum N protein, the median was 1143 ng/dL, and levels decreased from 2559 ng/dL in participants randomized at 6 days of symptom onset to 477.6 ng/dL at 11 days. Higher anti-spike antibody levels were seen as the days from symptom onset progressed or disease severity increased. Greater disease severity at randomization was associated with 28-day mortality, prolonged days of oxygenation, ventilation, hospitalization, and risk of new non-invasive ventilation, HFNC, MV, or extracorporeal membrane oxygenation use. N protein levels were associated with a higher risk of new non-invasive ventilation or HFNC use, longer oxygenation duration, and extended hospitalization. Anti-spike antibody serologies were not associated with clinical outcomes. Conclusion: N protein levels could provide insights into COVID-19 disease progression and prognosis. Further research is needed to explore the clinical implications of these findings to optimize patient care and enhance outcomes. Plain language summary Understanding COVID-19 severity: the role of viral proteins and antibodies COVID-19 severity can vary widely, and predicting who will develop severe disease is crucial for effective treatment. This study looks at two key components of the virus: the N protein, which helps the virus replicate, and anti-spike antibodies, which help the body fight off the virus. We studied blood samples from participants in a clinical trial to see how levels of these two components related to disease severity and outcomes, such as the need for advanced respiratory support or death. The study found that higher levels of the N protein were associated with more severe disease and worse outcomes, including a higher risk of requiring advanced respiratory support and longer hospital stays. On the other hand, anti-spike antibodies, which are typically seen as protective, did not show a clear relationship with the severity of illness or outcomes in this study. These findings suggest that the N protein might be a useful indicator for predicting how severe a person's COVID-19 illness might become, which could help doctors better manage and treat the disease. However, more research is needed to fully understand the role of these viral components in COVID-19 and how they can be used to improve patient care.

  PublisherDOI

• Abatacept, Cenicriviroc, or Infliximab for Treatment of Adults Hospitalized With COVID-19 Pneumonia

  UNC Libraries · 2025-03-18

  articleOpen access

  Importance: Immune dysregulation contributes to poorer outcomes in COVID-19. Objective: To investigate whether abatacept, cenicriviroc, or infliximab provides benefit when added to standard care for COVID-19 pneumonia. Design, Setting, and Participants: Randomized, double-masked, placebo-controlled clinical trial using a master protocol to investigate immunomodulators added to standard care for treatment of participants hospitalized with COVID-19 pneumonia. The results of 3 substudies are reported from 95 hospitals at 85 clinical research sites in the US and Latin America. Hospitalized patients 18 years or older with confirmed SARS-CoV-2 infection within 14 days and evidence of pulmonary involvement underwent randomization between October 2020 and December 2021. Interventions: Single infusion of abatacept (10 mg/kg; maximum dose, 1000 mg) or infliximab (5 mg/kg) or a 28-day oral course of cenicriviroc (300-mg loading dose followed by 150 mg twice per day). Main Outcomes and Measures: The primary outcome was time to recovery by day 28 evaluated using an 8-point ordinal scale (higher scores indicate better health). Recovery was defined as the first day the participant scored at least 6 on the ordinal scale. Results: Of the 1971 participants randomized across the 3 substudies, the mean (SD) age was 54.8 (14.6) years and 1218 (61.8%) were men. The primary end point of time to recovery from COVID-19 pneumonia was not significantly different for abatacept (recovery rate ratio [RRR], 1.12 [95% CI, 0.98-1.28]; P = .09), cenicriviroc (RRR, 1.01 [95% CI, 0.86-1.18]; P = .94), or infliximab (RRR, 1.12 [95% CI, 0.99-1.28]; P = .08) compared with placebo. All-cause 28-day mortality was 11.0% for abatacept vs 15.1% for placebo (odds ratio [OR], 0.62 [95% CI, 0.41-0.94]), 13.8% for cenicriviroc vs 11.9% for placebo (OR, 1.18 [95% CI 0.72-1.94]), and 10.1% for infliximab vs 14.5% for placebo (OR, 0.59 [95% CI, 0.39-0.90]). Safety outcomes were comparable between active treatment and placebo, including secondary infections, in all 3 substudies. Conclusions and Relevance: Time to recovery from COVID-19 pneumonia among hospitalized participants was not significantly different for abatacept, cenicriviroc, or infliximab vs placebo. Trial Registration: ClinicalTrials.gov Identifier: NCT04593940.

  PublisherDOI

• SARS-CoV-2 N protein and anti-spike serologies: insights into COVID-19 disease severity and mortality—a secondary analysis of the ACTIV-1 trial

  Therapeutic Advances in Infectious Disease · 2025-04-22

  articleOpen access

  Background: Understanding factors that predict progression to severe COVID-19 is critical. Antibodies targeting SARS-CoV-2 spike protein confer protection, while the N protein of SARS-CoV-2 plays roles in viral replication and immune dysfunction. This study explores the significance of N protein and anti-spike antibodies on disease severity, progression, and mortality. Objectives: To evaluate the relationship between SARS-CoV-2 N protein and anti-spike antibody levels with disease severity, clinical outcomes, and mortality in hospitalized patients with COVID-19. Design: A secondary analysis of serologic data from participants in the ACTIV-1 randomized clinical trial, which evaluated immunomodulators for the treatment of hospitalized patients with COVID-19. Methods: A subanalysis of the ACTIV-1 immune modulator trial was conducted. Samples collected at randomization were tested for N protein levels and anti-spike antibodies. Logistic regression and linear models were employed to examine the association between serological measures and clinical outcomes, including 28-day mortality as well as progression to high-flow nasal cannula (HFNC) and invasive mechanical ventilation (MV). Results: Among the 496 participants with detectable serum N protein, the median was 1143 ng/dL, and levels decreased from 2559 ng/dL in participants randomized at 6 days of symptom onset to 477.6 ng/dL at 11 days. Higher anti-spike antibody levels were seen as the days from symptom onset progressed or disease severity increased. Greater disease severity at randomization was associated with 28-day mortality, prolonged days of oxygenation, ventilation, hospitalization, and risk of new non-invasive ventilation, HFNC, MV, or extracorporeal membrane oxygenation use. N protein levels were associated with a higher risk of new non-invasive ventilation or HFNC use, longer oxygenation duration, and extended hospitalization. Anti-spike antibody serologies were not associated with clinical outcomes. Conclusion: N protein levels could provide insights into COVID-19 disease progression and prognosis. Further research is needed to explore the clinical implications of these findings to optimize patient care and enhance outcomes.

  PublisherDOI

• Children’s executive functioning and health behaviors across pediatric life stages and ecological contexts

  Journal of Behavioral Medicine · 2025-01-09

  articleOpen access
  PublisherOA PDFDOI

• Racial and ethnic differences in prenatal exposure to environmental phenols and parabens in the ECHO Cohort

  Journal of Exposure Science & Environmental Epidemiology · 2025-02-15 · 3 citations

  articleOpen access

  BACKGROUND: Research suggests racial/ethnic disparities in prenatal exposure to endocrine disrupting environmental phenols (EPs) in limited populations. However, no studies have investigated racial/ethnic disparities in prenatal EP exposure across the U.S. OBJECTIVES: To estimate demographic differences in prenatal urinary EPs among participants in the Environmental influences on Child Health Outcomes (ECHO) Cohort. METHODS: An analysis of 4006 pregnant ECHO participants was performed, with 7854 specimens collected from 1999-2020. Racial/ethnic identity was self-reported. Urinary levels of 2,4-dichlorophenol (2,4-DCP), 2,5-dichlorophenol (2,5-DCP), benzophenone-3 (BP-3), bisphenols A (BPA), F (BPF), and S (BPS), and methyl- (MePb), ethyl- (EtPb), propyl- (PrPb), and butyl- (BuPb) parabens were measured at one or more time points during pregnancy. Effect estimates were adjusted for age, pre-pregnancy body mass index, educational level, gestational age and season at urine collection, and ECHO cohort. RESULTS: Participants were classified as Hispanic of any race (n = 1658), non-Hispanic White (n = 1478), non-Hispanic Black (n = 490), and non-Hispanic Other (n = 362), which included individuals of multiple races. Urinary 2,4-DCP and 2,5-DCP concentrations were 2- to 4-fold higher among Hispanic, non-Hispanic Black, and non-Hispanic Other participants relative to non-Hispanic White participants. MePb was ~2-fold higher among non-Hispanic Black (95% confidence interval (CI): 1.7-3.1) and non-Hispanic Other (95% CI: 1.5-2.8) participants. PrPb was similarly higher among non-Hispanic Black (95% CI: 1.7-3.7) and non-Hispanic Other (95% CI: 1.3-3.1) participants. EtPb was higher among non-Hispanic Black participants (3.1-fold; 95% CI 1.7-5.8). BP-3 was lower in Hispanic (0.7-fold; 95% CI: 0.5-0.9), non-Hispanic Black (0.4-fold; 95% CI: 0.3-0.5), and non-Hispanic Other (0.5-fold; 95% CI: 0.4-0.7) participants. Urinary BuPb, BPA, BPF, and BPS were similar across groups. IMPACT STATEMENT: This multisite, observational cohort study investigated whether there are racial and ethnic differences in prenatal exposure to endocrine disrupting environmental phenols and parabens. Among 4006 participants from multiple U.S. cohorts who provided urine specimens during pregnancy, those who self-reported a racial and ethnic identity other than non-Hispanic White had higher urinary concentrations of 2,4-dichlorophenol, 2,5-dichlorophenol, methyl paraben, ethyl paraben, and propyl paraben and lower urinary concentrations of benzophenone-3 than those reporting as non-Hispanic White. These data show differences in prenatal concentrations of endocrine disrupting environmental phenols and parabens by racial and ethnic identity.

  PublisherOA PDFDOI

• Influence of Eat, Sleep, and Console on Infants Pharmacologically Treated for Opioid Withdrawal

  JAMA Pediatrics · 2024-04-15 · 20 citations

  articleOpen access

  Importance: The function-based eat, sleep, console (ESC) care approach substantially reduces the proportion of infants who receive pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS). This reduction has led to concerns for increased postnatal opioid exposure in infants who receive pharmacologic treatment. However, the effect of the ESC care approach on hospital outcomes for infants pharmacologically treated for NOWS is currently unknown. Objective: To evaluate differences in opioid exposure and total length of hospital stay (LOS) for pharmacologically treated infants managed with the ESC care approach vs usual care with the Finnegan tool. Design, Setting, and Participants: This post hoc subgroup analysis involved infants pharmacologically treated in ESC-NOW, a stepped-wedge cluster randomized clinical trial conducted at 26 US hospitals. Hospitals maintained pretrial practices for pharmacologic treatment, including opioid type, scheduled opioid dosing, and use of adjuvant medications. Infants were born at 36 weeks' gestation or later, had evidence of antenatal opioid exposure, and received opioid treatment for NOWS between September 2020 and March 2022. Data were analyzed from November 2022 to January 2024. Exposure: Opioid treatment for NOWS and the ESC care approach. Main Outcomes and Measures: For each outcome (total opioid exposure, peak opioid dose, time from birth to initiation of first opioid dose, length of opioid treatment, and LOS), we used generalized linear mixed models to adjust for the stepped-wedge design and maternal and infant characteristics. Results: In the ESC-NOW trial, 463 of 1305 infants were pharmacologically treated (143/603 [23.7%] in the ESC care approach group and 320/702 [45.6%] in the usual care group). Mean total opioid exposure was lower in the ESC care approach group with an absolute difference of 4.1 morphine milligram equivalents per kilogram (MME/kg) (95% CI, 1.3-7.0) when compared with usual care (4.8 MME/kg vs 8.9 MME/kg, respectively; P = .001). Mean time from birth to initiation of pharmacologic treatment was 22.4 hours (95% CI, 7.1-37.7) longer with the ESC care approach vs usual care (75.4 vs 53.0 hours, respectively; P = .002). No significant difference in mean peak opioid dose was observed between groups (ESC care approach, 0.147 MME/kg, vs usual care, 0.126 MME/kg). The mean length of treatment was 6.3 days shorter (95% CI, 3.0-9.6) in the ESC care approach group vs usual care group (11.8 vs 18.1 days, respectively; P < .001), and mean LOS was 6.2 days shorter (95% CI, 3.0-9.4) with the ESC care approach than with usual care (16.7 vs 22.9 days, respectively; P < .001). Conclusion and Relevance: When compared with usual care, the ESC care approach was associated with less opioid exposure and shorter LOS for infants pharmacologically treated for NOWS. The ESC care approach was not associated with a higher peak opioid dose, although pharmacologic treatment was typically initiated later. Trial Registration: ClinicalTrials.gov Identifier: NCT04057820.

  PublisherOA PDFDOI

• Infant Feeding and Weight Trajectories in the Eat, Sleep, Console Trial

  JAMA Pediatrics · 2024-08-12 · 7 citations

  articleOpen access

  Importance: Infants with neonatal opioid withdrawal syndrome (NOWS) cared for with the Eat, Sleep, Console (ESC) care approach receive less pharmacologic treatment and have shorter hospital stays compared to usual care with the Finnegan Neonatal Abstinence Scoring Tool, but the effects of these approaches on feeding and weight are unknown. Objective: To evaluate feeding practices and weight trajectories in infants cared for with ESC vs usual care. Design, Setting, and Participants: ESC-NOW is a cluster randomized trial of infants with NOWS born at 36 weeks' gestation or later at 26 US hospitals from September 2020 to March 2022. Each site transitioned from usual care to ESC (the study intervention) at a randomized time. Feeding was per site practice and not specified by the intervention. Feeding and weight outcomes were assessed at hospital discharge. Intervention: ESC vs usual care. Main Outcomes and Measures: Outcomes include prospectively identified secondary end points related to feeding and weight. z Scores were used for growth to account for corrected gestational age at the time of measurement. All analyses were intention to treat and adjusted for study design. Maternal/infant characteristics were included in adjusted models. Results: The analyses included 1305 infants (702 in usual care and 603 in ESC; mean [SD] gestational age, 38.6 [1.3] weeks; 655 [50.2%] male and 650 [49.8%] female). Baseline demographic characteristics were similar between groups. The proportion of breastfed infants was higher in the ESC group (52.7% vs 41.7%; absolute difference, 11%; 95% CI, 1.0-20.9). A higher proportion of infants cared for with ESC received exclusive breast milk (15.1% vs 6.7%; absolute difference, 8.4%; 95% CI, 0.9-5.8) or any breast milk (38.8% vs 27.4%; absolute difference, 11.4%; 95% CI, 0.2-23.1) and were directly breastfeeding at discharge (35.2% vs 19.5%; absolute difference, 15.7%; 95% CI, 4.1-27.3). There was no difference in proportion of infants with weight loss greater than 10% or maximum percentage weight loss, although infants cared for with ESC had a lower weight z score on day of life 3 (-1.08 vs -1.01; absolute difference, 0.07; 95% CI, 0.02-0.12). When pharmacologic treatment was added into the model, no breastfeeding outcomes were statistically significant. Conclusions and Relevance: In this study, infants cared for with ESC were more likely to initiate and continue breastfeeding and had no difference in percentage weight loss. The improvement in breastfeeding with ESC may be driven by reduction in pharmacologic treatment and provision of effective nonpharmacologic care. Trial Registration: ClinicalTrials.gov Identifier: NCT04057820.

  PublisherOA PDFDOI

• Approaches to protocol standardization and data harmonization in the ECHO-wide cohort study

  Pediatric Research · 2024-02-16 · 17 citations

  reviewOpen access

  The United States (U.S.) National Institutes of Health-funded Environmental influences on Child Health Outcomes (ECHO)-wide Cohort was established to conduct high impact, transdisciplinary science to improve child health and development. The cohort is a collaborative research design in which both extant and new data are contributed by over 57,000 children across 69 cohorts. In this review article, we focus on two key challenging issues in the ECHO-wide Cohort: data collection standardization and data harmonization. Data standardization using a Common Data Model and derived analytical variables based on a team science approach should facilitate timely analyses and reduce errors due to data misuse. However, given the complexity of collaborative research designs, such as the ECHO-wide Cohort, dedicated time is needed for harmonization and derivation of analytic variables. These activities need to be done methodically and with transparency to enhance research reproducibility. IMPACT: Many collaborative research studies require data harmonization either prior to analyses or in the analyses of compiled data. The Environmental influences on Child Health Outcomes (ECHO) Cohort pools extant data with new data collection from over 57,000 children in 69 cohorts to conduct high-impact, transdisciplinary science to improve child health and development, and to provide a national database and biorepository for use by the scientific community at-large. We describe the tools, systems, and approaches we employed to facilitate harmonized data for impactful analyses of child health outcomes.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R21HD08060601A1

  NIH · $259k · 2017

• NIH Grant K23HD060040

  NIH · $320k · 2013

• NIH Grant R01FD005101

  NIH · $1.1M · 2020

• NIH Grant R21HD080606

  NIH · $197k · 2018

• NIH Grant K23HD06004001

  NIH · $124k · 2013

Frequent coauthors

• Daniel K. Benjamin

  Duke University

  701 shared

• C. Michael Cotten

  Duke University

  484 shared

• Rosemary D. Higgins

  Eunice Kennedy Shriver National Institute of Child Health and Human Development

  378 shared

• Christoph P. Hornik

  Clinical Research Institute

  342 shared

• Michael Cohen‐Wolkowiez

  Clinical Research Institute

  327 shared

• Abhik Das

  RTI International

  315 shared

• Edward F. Bell

  University of Iowa

  313 shared

• Betty R. Vohr

  Brown University

  288 shared