Breadcrumb
Plugged in to Public Health: The impacts of relaxed staff training and licensing requirements on nursing homes
Published on July 10, 2025
Lauren welcomes Gulrukh Mehboob for a discussion about the impacts of relaxed staff training and licensing requirements on nursing homes during the COVID-19 pandemic. Gul is a Fulbright PhD scholar at the University of Iowa College of Public Health, studying health workforce policy, particularly in long-term care settings.
The views and opinions expressed in this podcast are solely those of the student hosts, guests, and contributors, and do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health.
Lauren Lavin:
Hello everybody and welcome back to Plugged Into Public Health. Today we’re diving into workforce shortages in nursing homes during the COVID-19 pandemic and what happens when regulations are loosened in an effort to fix this problem, we’re joined by Gulrukh Mehboob, Fulbright PhD Scholar at the University of Iowa College of Public Health in the Department of Health Management policy whose research focuses on health workforce policy, particularly in long-term care settings. In this episode, you’ll hear about the lessons learned from a natural policy experiment during the pandemic, when 19 states reduced CNA training and licensee requirements, did these emergency changes solve the staffing crisis? What can policymakers learn from this period of disruption? And what might actually work if we want to build a stronger long-term care workforce? I’m Lauren Lavin, and if it’s your first time with us, welcome. We’re a student-run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and outside the field of public health.
Now let’s get plugged into public health. Plugged into public health is produced and edited by the students of the University of Iowa College of Public Health and the views and opinions expressed in this podcast are solely those of the student hosts, guests, and contributors. They do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health.
Well, welcome to the podcast today, Gul. I would love it if you could just introduce yourself for our listeners, so just who you are, what you do, that type of thing. Just some background.
Gulrukh Mehboob:
Well, first of all, thank you so much for inviting me over to talk about my study and this very important topic. So like you introduced, my name is Gulrukh, and I’m originally from Peshawar, Pakistan. In August 2021, I joined the University of Iowa College of Public Health as a Fulbright PhD scholar, and I study health services and research, and within that I focus on health management and policy.
Lauren Lavin:
Do you have a specific area within health management and policy you’re most interested in?
Gulrukh Mehboob:
Yes. So my work focuses on workforce shortages, and then when we talk about workforce shortages, we specifically talk about the nursing home industry and the older adults.
Lauren Lavin:
And I think, well, if you didn’t say you’re going into your fifth year, do you know what you want to do when you’re done?
Gulrukh Mehboob:
I would definitely would like to stick with academia because that’s where I was before I came here. I was working as a research consultant with different development organizations back home, and I was also into teaching positions, and that is the kind of blend I would like to carry on. So I think one reason for coming for this PhD here was just equipped myself more with the skills that I need, especially in the consultancy role that I would like to resume. But yes, I’m very passionate about teaching and research and I would see myself what I’m doing, let’s say more of that, but also along with it, just helping policymakers making better or informed decisions with what they’re doing.
Lauren Lavin:
Yeah. And how did you decide on Iowa when you decided to come and get a PhD?
Gulrukh Mehboob:
Right. I was just looking for a good program fit. So I was back home working with the Minister of Health and the federal and provisional governments to scale up the social health protection or the universal health coverage program back in Pakistan. And since Pakistan, healthcare systems are not made for insurance, that’s not how the system worked there. It was a pretty new thing. And I think a lot of skills were required for people who know something about a system that runs an insurance. And I think while the US healthcare system is pretty complex, but I think we have all sorts of flavor here. It’s like publicly mandated programs or private insurance and other forms of programs. So I was just looking around for a better fit and I came across a program in Iowa and I thought, “Well, this looks interesting.” So I went through what kind of research they do and what they teach, and I was like, “Well, this is something that I would like to come across and maybe potentially learn more from.” So yeah, I think that was the reason I landed here.
Lauren Lavin:
Yeah. Well, as someone who’s in your department, you’ve been obviously a great addition and we’re so grateful to have, you are such a great teacher and you’ve given back to the students, so I appreciate that as someone who’s younger than you. Today, we’re going to be talking about the paper that you published. When was it published?
Gulrukh Mehboob:
It got published in February 2025.
Lauren Lavin:
Okay, so really recently. And what was the title of the paper?
Gulrukh Mehboob:
Yeah, so the title of the paper was, it was basically a question which says that, “Do the relaxation of the training and licensing requirements of nurse aides. So do those policies improve the nurse aid levels in nursing homes?” It’s more like a question mark rather than a very straight ahead title. And the reason for that is that this was the question that the scholars and researchers, they always talked about. What happens if you relax the training and licensing requirements, because some of them argued that they are pretty strict. So we leave the title as is a big question mark.
Lauren Lavin:
Yeah, it draws the reader in. What pulled you to this topic of CNA staffing and regulation, especially during the pandemic timeframe?
Gulrukh Mehboob:
Yeah, I think that’s a very good question. So when I came here in 2021, the pandemic was still going on. The public health emergency was still there. We had cases, and I think the experience of pandemic for all of us has been very hands-on. We have navigated it at a personal level, but also as a student of public health, I think there was this natural curiosity. When I was going through this pandemic, I was like, “Okay.” I was very curious and I think I was paying a lot of attention to how the pandemic is impacting the healthcare systems. I would say that this was more of a natural inclination just to explore more about the pandemic and how it has exposed the cracks that exists in the healthcare systems because the healthcare systems were not challenged like that before. And when it received that challenge, we could see what was not working, what were the cracks in the system, which actually got very prominent with that pandemic.
So I think that working on the pandemic part was a natural curiosity for me as a person who had lived through the pandemic and then also as a public health student. The second part of the question, like the nursing homes and the CNAs, that was not something that came to me naturally. I think that’s where I had to do a lot of homework. I did a lot of exploration, understanding, tons of tons of readings. When we talk about healthcare systems, we know we are talking about so many things. There’s so many components to it. And when we talk about the impact of a public health emergency, again, there are so many vulnerabilities that we talk about. And the reason I kept on reading about it was I was trying to see where exactly the most, where is the most vulnerable population or where are the worst impacts of this pandemic?
The more I read about it, the more I realized that it’s definitely the older adults and it is the nursing homes. At the same time, I realized, well, who’s talking about it? Who is paying attention to the older adults? I mean, when we talk about vulnerable populations, we talk about different people. When we talk about healthcare systems, we talk about so many other components, but I realized that hardly people talk about nursing homes, they hardly talk about older adults. And the truth is that when the pandemic hit, that’s where the worst impact was because the older adults is where most of mortality and morbidity was reported. Again, the worst hit was the nursing home industry because it was already struggling with so many challenges.
When we talk about the nursing home industry, we’re talking about 4.7 million direct care workers. It’s not a small number. And when we talk about the people who receive care, and that’s again in millions, like 1.2 million residents. It’s a lot of people. And then again, the older age population is growing. The nursing home industry, the demand for long-term care is also growing and we know that this was not the only public health emergency the world faced, there are climatic changes and other things. More will be coming up and it’s important that we prepare the most vulnerable populations that we have and also the industries which can be the worst hits of the public health emergency.
Lauren Lavin:
And what do you think happened specifically during COVID that made staffing such a critical issue in nursing homes? Were people leaving or was it just exacerbating a problem that was already there because now they had to work more and there was just less people already?
Gulrukh Mehboob:
Yeah, you’re right. The nursing home industry has historically been challenged by the workforce shortages. It is not something that COVID, because of COVID, it did not happen because of COVID. For example, 47% of the nursing home providers were not able to maintain the adequate levels of the staffing, the recommended adequate levels of the staff.
Lauren Lavin:
It’s almost half.
Gulrukh Mehboob:
Yeah, even before the pandemic and there are many reasons for that. I would like to highlight three main reasons where I would say that, why was already the industry facing shortages and then what happened during the pandemic that it just got worse? So the first thing is that the kind of care that is provided in nursing homes, it’s extremely challenging. It’s physically draining, but it’s also emotionally distressing. The burnout is really high. Job dissatisfaction is definitely there. And then on top of it, you add the low wages and then the low benefits that the staff receives in nursing homes and especially nurse aids. So my paper focuses on the nurse aid levels. I would like to focus on the nurse aids because 80% of the care in nursing homes is provided by the nurse aids, and their job is very demanding because they assess the older adults with activities of daily living, and it’s like kind of a 24-7 kind of assistance that they provide to that vulnerable population, which is already sick and has multiple comorbidities.
So now imagine that you are in a job where you’re providing this care and then a pandemic hit, you cannot protect yourself from getting infected because you are on the front line, but it’s a kind of front line where the social distancing is impossible and you cannot protect yourself with any kind of the protective equipment or other things that were provided. And then when that particular vulnerable population gets sick, it’s even more hard for you to provide care. The second element is that you are in, your job is so difficult, and on top of it, if you get infected, you don’t get a paid sick leave, you don’t have health insurance. So majority of the nurses that works in those industries, they don’t have any benefits when it comes to health insurance, when it comes to paid sick leave, when it comes to any hazard bonus pay.
So now add a third element on that. 90% of the nurse aides that work in the nursing homes are women. And we know that women have many other caregiving roles. They have other people at home that they look after, including children. So most of them are women with young children. And it is interesting that literature is now talking about it. There are some recent papers that came out, and I’m happy that people are also focusing on this gender element here. In counties where the pandemic hit was the worst, where there was stricter lockdowns, where the daycares were closed, the schools were closed, they found that there was more heightened over of nursing aid. People were just, these women were just leaving the job market because they did not know what to do with their children. There was no childcare for them, and they had to just be at home and provide that care to their children.
So there are many aspects, but when you add all of them together, you would understand that why within the nursing homes, we were witnessing a very severe shortage, especially of nurse aides where they were exposed, their job is becoming difficult, they have low wages, no insurance, no benefit, they have other caregiving roles. Just to end that argument, on a very simple example, in most of the states, a nurse aide would make a similar wage if they work in let’s say a fast food industry. So if you’re given a choice, this is what you’re getting, and there is a pandemic, you would go and work in a fast food industry rather than working in a nursing home. So this was some of the reasons because of which the whole situation just got worse.
Lauren Lavin:
That is excellent background. Just in case people are listening and don’t know what a nurse aide is, could you describe what their training and what their role looks like in comparison to a nurse which we’re more familiar with?
Gulrukh Mehboob:
So in nursing homes, we have three types of nursing staff who are on the front line, we would say, or provide direct care to the residents. So a registered nurse is more in a supervisory role. Then we have the licensed practical nurses who work closely with the registered nurse. As far as the CNA is concerned, or nurse aide is concerned, the nurse aide is a person who would receive, according to federal requirement, 75 hours of training and part of it is the clinical training where they are trained on how to help older adults with assisting them with activities of daily living, which is like eating, bathing, clothing, transfer from one bed to another or use of the toilet and all those kinds of activities that they cannot do themselves.
So a nurse aide has more hands-on job and they have to be engaged with the residents, almost like 24-7 and then they are under the supervision of either the RN or the LPN, whatever they can be substituted. And most of these, like I said, the CNAs are, 90% of them are women, and they would have education equaling to high school, most of them. And this is the minimum training requirements, is 75 hours, that they have to complete. They also pass a certification exam in order to become a certified nursing aid which is called the CNA.
Lauren Lavin:
Great. That’s helpful. I think it is just important to know those distinctions, especially when we’re talking about some of the regulations around them. So the overall question for your study was, “How does relaxing CNA training and licensing impact staffing levels?” Right? Okay.
Gulrukh Mehboob:
Yes.
Lauren Lavin:
So how did you go about answering that question? What was the thought process behind that?
Gulrukh Mehboob:
Right. So what happened was that during the peak of pandemic, and I explained how the nursing home industry was struggling, the state authorities were thinking of various ways just somehow to boost that industry and to improve the nurse aid levels. So like I said, that the minimum requirement, the federal minimum requirement is 75 hours of training. However, many states go beyond that. There are states where the CNA has to go around one 20 hours of training and then a certification exam to become a CNA. In some states, it’s even beyond that. When it comes to the licensing requirements, some states have stricter requirements on top of the minimum what the federal authorities say. So states have those varying forms of requirements, and the scholars argued that in states where these requirements are stricter, it’s kind of a hindrance for the nurse aides to enter the labor market because then the training hours are very high or the licensing requirements are very tough.
These changes with the CNA licensing and training requirements, they have never been changed, at least in the last two decades. Pandemic was a time when certain states started thinking on those lines and they were like, “Why don’t we reduce these requirements, relax some of these restrictions, and then see if it would boost up the supply of nurse aides into the nursing home.” So that was a thought process from the states on that. And between March 2020 and September 2021, 19 out of 50 states came up with such policies, which would either reduce the training hours or relax the licensing requirements. There were some states that also tried to experiment with making personal care attendants, CNAs with limited training and somehow boosting up the CNA supply in nursing homes through that strategy.
So it is kind of like states being the experimental labs where they’re trying to experiment with these policies. And for researcher like us, it’s a great opportunity where we’re like, “Oh my God, this is happening and this thing has never happened before. People have not tested it or experimented with it, but this is the time.” So yes, they have done it, and why don’t we just grab that opportunity and see if it actually worked? And we try to answer this longstanding question. So I think that was a little bit background, we landed up there.
Lauren Lavin:
For those listening, this kind of the best case scenario when some states adopt some level of policy or what we would call treatment, and then some states don’t, which we call the control and so it allows us to compare the treated group to a control group. And of course there are lots of considerations that I’m sure you went into to make sure that the states that did adopt new policies compared to the states that didn’t. Did you guys control for things like that or did you find that certain states were more likely to adopt new policy? And if so, how’d you handle that?
Gulrukh Mehboob:
That’s a good question, and there are two aspects to it. I think our biggest challenge when we were working this question was to very carefully isolate the treatment group from the control group. Because the nursing home industry is very heavily regulated. There are so many policies, especially related to workforce shortages that keep on happening. There’s so many requirements and so many interventions that keep on happening. During the pandemic, a lot of states were experimenting were a lot of things. So for us, the first challenge was to very carefully isolate the treatment group from the control group, which means that we had to be very careful that if the treatment group is adopting the policies related to relaxing training and licensing requirements, we do control for other policies if they have adopted at the same time.
When we talk about the control group, again, we were very careful to exclude states from the control groups that have similar policies, which could impact staffing levels. And those policies can be like wage benefit, improve or sick leave policies and those things were also happening during pandemic. So that was the first part where we had to be very careful in isolating our treatment group and then our control group. In the second part, we do tons of robustness checks and sensitivity analysis just to make sure that our final conclusion remains the same no matter what we do and no matter how many times we analyze it.
The third component of this is that we were also very carefully looking at the kind of interventions the states were doing. So all the 19 states did not adopt these policies just the same. They were not similar, they were not standard. So they were variations. And in our analysis, we not only analyze the 19 states together, but we also group them based on the kind of variation they adopt and then analyze them separately. So in simple words, I would say that we had to apply the latest methodologies just to control for all those factors. But at the same time, we also had to do tons of other analysis just to make sure that our main finding remains the same.
Lauren Lavin:
I think it just shows how much thought and preparation goes into even creating the basis of the research study, that it’s not just that you just look at what’s happening, that there’s a lot of control that happens so you can get reliable and credible results. And another thing that came to my mind was, so you talk about the state policies that are changing. Was there anything federally happening or is there no federal regulation over CNA training and licensing?
Gulrukh Mehboob:
Right. The federal regulation remains the same. That is the 75 hours of minimum training. And like I mentioned, that those were not changed at least in the last two decades based on the literature. So it was up to states and the states were taking those decisions that depended on the already existing shortages of staffing, the intensity of the COVID-19 pandemic, the state level regulatory and workforce differences, and then the opportunities that states took to change those policies around. So the federal requirements were there in its place, but it was the states that were making those decisions based on how the pandemic and the shortages looked in their own settings.
Lauren Lavin:
All of that background aside, what did you guys find? Did loosening these regulations actually improve staffing levels?
Gulrukh Mehboob:
What we found was that loosening these regulations do not improve staffing levels in nursing homes. Now, having said that, I know that people get very excited when they find something about a policy that is working. What we found is that policies are not working. And if you think about it, I would say that a conclusion, a study that says, well, a certain policy is not working, is equally important to a study that says a certain policy works. Because when states come up with these policies and they implement it, a lot of energy, a lot of resource, a lot of time goes into it, and these policies have real consequences.
So the policy might say that it did not improve the outcome it aimed to improve, but there will be consequences in so many other aspects. So yeah, our main conclusion was that the states adopting these relaxation training and licensing relaxation policies did not improve the staffing levels in nursing homes. And no matter how many ways we see it, whether we see them collectively or we look at the groups of states that adopted three different variations of the same policy, we see that they do not improve the staffing levels in nursing homes.
Lauren Lavin:
And why do you think that is? Why didn’t they have the intended impact?
Gulrukh Mehboob:
That’s a very interesting question, and the thing is that I think we have to very carefully conclude this. So if I’m asked that, “Do you think that relaxing the training and licensing requirements would work in the nursing home industry?” Because like I mentioned, this was a question that scholars argued that maybe that’s why it’s one of the factor that is discouraging people to enter the labor market. What we found is that no, it does not. However, we should be mindful of the fact that our study was conducted during the COVID-19 pandemic, and we apply all the latest methodologies and indeed, do the tons of robustness checks just to make sure that we control for all the factors that you would need to control for during a pandemic, but it’s still a public health emergency.
So I would say that if somebody asked me, “Do these policies work during a public health emergency?” I can say with confidence that they do not. So if there is a public health emergency due to any reason, and if the states are trying to reduce licensing and training requirements, it is not going to help improve the levels. Would this conclusion be the same under normal circumstances? It may be, it may not be. So we have to be a little mindful when we conclude this. However, I would definitely say that there are other factors that you need to consider when it comes to encouraging CNAs to remain in their jobs or to encourage them to join the industry. And they include better wages. They include having sick leave policies, paid, sick leave policies, benefits like health insurance, reducing the burnout on them and making their work more easy for them, giving them better training. And the literature has established that these factors really work when it comes to especially CNAs.
They are more responsive, that their wages are more… Their retention rates and joining the industry, all those things are more elastic when it comes to changes in the wages in comparison to the training requirements and the other requirements. So the thing is that it’s a holistic approach. If you are keeping other factors constant and only reducing the training and licensing requirements, it might not work. But at the same time, if you’re also improving their benefits and making their work more easy on them and improving other circumstances for them, it for sure will work.
Lauren Lavin:
So it sounds like it’s a multitude of factors that need to align in order to see a workforce increase or at least not a workforce shortage.
Gulrukh Mehboob:
Correct.
Lauren Lavin:
Were there any states or strategies that stood out as exceptions that did impact workforce levels, or were the findings pretty consistent that it was not beneficial across the board?
Gulrukh Mehboob:
Yeah, I think one of the interesting findings, were kind of surprising as well, that the finding was just consistent across board. So we looked at states that only reduced the training hours requirements. We did not see any impact there. Then we separately analyzed the states that relaxed the licensing requirements and we see there’s no impact there. The third group was the states that thought that they can use the personal care attendance with short-term training. And again, we don’t see any impact there. So whether we analyze them collectively or separately, it was pretty surprising that no matter what way the state did it, it just did not result in improving the nurse aid levels in nursing homes.
Lauren Lavin:
Sometimes that makes your conclusion a little bit easier if it’s consistent.
Gulrukh Mehboob:
Yeah, it’s consistent. I think it’s easier. It’s also interesting. But we should, like I mentioned before, so when we do a study, we have, it’s a policy evaluation, so our focus is on whether the policy is working or not. But like I said, there are so many other consequences, especially for, people should definitely be raising this question and talking about that, okay, you relaxed the training requirements and the licensing requirements and it does not improve the nurse aid levels, but what happens to the quality of the staffing in nursing homes because they’re less trained now or you have reduced other requirements for them? And then what is the outcome in terms of the residents in the nursing homes, what healthcare outcomes are there for them? Because now you are working with a staff that is less trained, so there can be other consequences of these policies. And that’s why I said that when you figure out that a policy is working, it’s a good finding, but if you find that a policy is not working, it is as important as the first one.
Lauren Lavin:
Yeah, say it louder for the people in the back. That can be a daunting part of starting research is that you’re not sure what you’re going to find, and there can be a bias towards wanting to publish positive results like, “This policy is working.” But like you said, it’s just as impactful because there are so many resources sunk in to policy formation even if they don’t work, and someone needs to be able to identify whether or not they’re working. So with that in mind, what kind of policies or strategies, and you kind of touched on this earlier, would you recommend to policymakers if they want to improve CNA staffing in nursing homes?
Gulrukh Mehboob:
It would definitely be around incentives and improving the benefit package for them. The example that I gave earlier is that if a nurse aide can earn the same minimum wage as they earn in a fast food industry and then add a pandemic on top of it, how would you encourage them actually to be there and do their job? So all those elements that are associated with the fact that they are working on low wages or they have less benefits, and recently the states have, some of the states have kind of experimented with those policies as well. So there has to be a holistic approach based on evidence, what the literature says is incentive based policies, they do work.
In comparison to registered nurses and licensed practical nurses, the nurse aids, their response towards improvement in wages is actually better, and this is something that the global literature establishes. Also, the findings that we have from the US suggests that incentive based policies work. Just to add to that, there were a number of states that also offered, basically, policies to the staffing, and then also were trying to offer a hazard bonus for people who were working on the front line. It’ll be very interesting to evaluate that and see if that was something that made a difference.
Lauren Lavin:
We kind of wrap up this conversation. What do you think the big takeaway from the study is for our listeners? What would you say is, if you just sum it up?
Gulrukh Mehboob:
To sum it up, I would say that first of all, this argument that this higher requirements act as a barrier for the nurse aids to enter the market. Our findings suggest that it does not act as a barrier, especially during public health emergencies. And the second big takeaway is that when you’re trying to improve the staffing levels within the industry, it’s a holistic approach and you have to also consider other aspects of it, whether it’s wages or incentives or benefits along with the training requirements. And again, I think there has to be a fine balance between what a well-trained staff is, where are these requirements way too high and then where are those requirements way too low.
Like I said, that our study does not look into it, but it’s an important question to evaluate because literature also establish that a well-trained staff also reduces the turnover in nursing homes because the nurse aids or the staff, they’re very well-equipped or well-trained to take that load and to deal with a high demanding job. So a good training itself is good for the retention rates and also for better health outcomes for the residents who are receiving care in nursing homes.
Lauren Lavin:
What’s next for the research? Are you planning to explore the impact of other types of workforce shortages? Are you looking at the quality of care, what’s next?
Gulrukh Mehboob:
Absolutely. Yeah. Within the PhD, so when I was exploring this topic, it’s definitely, so the focus is on the workforce shortages within nursing homes, and the next research question that I’m trying to answer is to see whether the states that adopted the incentive-based policies during the pandemic, did those work or not. So now I’m looking at those states, and again, they adopted the policy with variation. So some of them offered basic leave to the staffing. Some of them offered a one-time hazard pay bonus, and there is a group of state that just improved or increased per hour wage for the staffing levels. So that’s what I’m trying to analyze in the next part.
And I’m also trying to analyze some states that they have adopted the incentive-based policies, they’re trying to improve the wages of nurse aides and the registered nurses and the LPNs through direct care quotient policy. So that is when you are kind of improving those wages through by assigning a specific amount from the Medicaid payment, the reimbursement a part of it, a portion of it goes towards improving the wages of the staffing, and if you don’t do that, you have to pay a penalty. This is something which is very new and there are three states right now which are experimenting with this. That’s something, again, related to incentive-based policy, but through a very different channel. So I’m kind of evaluating that as well. Then way beyond that, I would definitely like to explore how all of this is resulting when we talk about the residents who are receiving care in the nursing homes.
Lauren Lavin:
Well, that is a big task list to fill, but I’m really looking forward especially to that next paper. That would be a great follow-up to this conversation that we have. So once that gets published, we’ll have to invite you back on to talk about that.
Gulrukh Mehboob:
Let’s see.
Lauren Lavin:
Well, thank you so much for chatting with me today. This was really informative, and this is definitely a more in-depth episode on a particular paper, which I think is a fun change up for our audience. So I really appreciate you bringing your expertise and sharing that with us today.
Gulrukh Mehboob:
Thank you so much for inviting. I really enjoyed chatting with you, and I hope the audience find it interesting as well.
Lauren Lavin:
That’s it for our episode this week. A big thank you to Gulrukh for joining us and sharing her expertise on workforce shortages in nursing homes and the real-world impact of [inaudible 00:34:48]. That’s it for our episode this week. A big thank you to Gulrukh for joining us and sharing her expertise on workforce shortages in nursing homes and the real world impact of policy decisions made in a crisis. This episode was hosted and written by Lauren Lavin and edited and produced by Lauren Lavin. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health. Have a suggestion for our team? You can reach us at CPH-GradAmbassador@Uiowa.edu. This episode is brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care.