Digital Commons Network^™

The Effect Of Social Exclusion On Trust Among Youth Orphaned By Hiv/Aids: Evidence From An Event-Related Potentials Study, Jiaojiao Wan, Qi Zhao, Yafei Zhang, Lili Ji, Junfeng Zhao, Shan Qiao Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Grounded in a follow-up study among children who lost one or both parents to HIV in central China in the early 2000s, we conducted an event-related potentials (ERPs) experiment to explore the effect of social exclusion on trust and the corresponding neurophysiological mechanism among youth orphaned by HIV/AIDS (“AIDS orphans”). A sample of 31 AIDS orphans (26.16 ± 3.34 years old; 15 female) and 32 age and development status matched controls (25.02 ± 3.45 years old; 14 female) participated in the study. They were all assigned to play Cyberball, a virtual ball-tossing game that reliably induced social exclusion (15 orphans, …

Correlates Of Zero-Dose Vaccination Status Among Children Aged 12-59 Months In Sub-Saharan Africa: A Multilevel Analysis Of Individual And Contextual Factors, Chamberline Ozigbu, Bankole Olatosi, Zhenlong Li, James W. Hardin, Nicole L. Hair

Faculty Publications

Despite ongoing efforts to improve childhood vaccination coverage, including in hard-to-reach and hard-to-vaccinate communities, many children in sub-Saharan Africa (SSA) remain unvaccinated. Considering recent goals set by the Immunization Agenda 2030 (IA2030), including reducing the number of zero-dose children by half, research that goes beyond coverage to identify populations and groups at greater risk of being unvaccinated is urgently needed. This is a pooled cross-sectional study of individual- and country-level data obtained from Demographic and Health Surveys Program and two open data repositories. The sample includes 43,131 children aged 12–59 months sampled between 2010 and 2020 in 33 SSA countries. …

“Where The Truth Really Lies”: Listening To Voices From African American Communities In The Southern States About Covid-19 Vaccine Information And Communication, Ran Zhang, Shan Qiao, Brooke Mckeever, Bankole Olatosi, Xiaoming Li

Faculty Publications

The high uptake of COVID-19 vaccines is one of the most promising measures to control the pandemic. However, some African American (AA) communities exhibit vaccination hesitancy due to mis- or disinformation. It is important to understand the challenges in accessing reliable COVID-19 vaccine information and to develop feasible health communication interventions based on voices from AA communities. We conducted 2 focus group discussions (FGDs) among 18 community stakeholders recruited from 3 counties in South Carolina on 8 October and 29 October 2021. The FGDs were conducted online via Zoom meetings. The FGD data were managed and thematically analyzed using NVivo …

Listening To Voices From African American Communities In The Southern States About Covid-19 Vaccine Information And Communication: A Qualitative Study, Ran Zhang, Shan Qiao, Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

The high uptake of COVID-19 vaccines is one of the most promising measures to control the pandemic. However, some African American (AA) communities exhibit vaccination hesitancy due to mis- or disinformation. It is important to understand the challenges in accessing reliable COVID-19 vaccine information and to develop feasible health communication interventions based on voices from AA communities. We conducted 2 focus group discussions (FGDs) among 18 community stakeholders recruited from 3 counties in South Carolina on 8 October and 29 October 2021. The FGDs were conducted online via Zoom meetings. The FGD data were managed and thematically analyzed using NVivo …

Association Between The Dietary Inflammatory Index And Gastric Disease Risk: Findings From A Korean Population-Based Cohort Study, Sundara Raj Sreeja, Trong-Dat Le, Bang Wool Eom, Seung Hyun Oh, Nitin Shivappa Mbbs, Mph, Ph.D., James R. Hébert Scd, Mi Kyung Kim

Faculty Publications

Evidence suggests that diets with high pro-inflammatory potential may play a substantial role in the origin of gastric inflammation. This study aimed to examine the association between the energy-adjusted dietary inflammatory index (E-DIITM) and gastric diseases at baseline and after a mean follow-up of 7.4 years in a Korean population. A total of 144,196 participants from the Korean Genome and Epidemiology Study_Health Examination (KoGES_HEXA) cohort were included. E-DII scores were computed using a validated semi-quantitative food frequency questionnaire. Multivariate logistic regression and Cox proportional hazards regression were used to assess the association between the E-DII and gastric disease risk. In …

Inhibitory Control Of Emotional Interference In Deaf Children: Evidence From Event-Related Potentials And Event-Related Spectral Perturbation Analysis, Qiong Chen, Junfeng Zhao, Huang Gu, Xiaoming Li Ph.D.

Faculty Publications

Background: Impairment of interference control ability may reflect a more general deficit in executive functioning, and lead to an increase in internal-externalized problems such as impulsivity, which has been reported in deaf children. However, few researches have examined the neural mechanism of this impairment.

Methods: This study applied the electroencephalogram (EEG) technique to investigate the interference control ability in 31 deaf children and 28 hearing controls with emotional face-word stroop task.

Results: Results from behavioral task showed that deaf children exhibited lower accuracy compared to hearing controls. As for EEG analysis, reduced activation of ERP components in N1 and enhanced …

Does Hiv-Related Stigma Depress Social Well-Being Of Youths Affected By Parental Hiv/Aids?, Yafei Zhao, Jiaojiao Wan, Lili Ji, Giagai Lui, Yixin Shi, Junfeng Zhao, Xiaoming Li Ph.D.

Faculty Publications

Parental illness or death due to HIV/AIDS has long-term impacts on children’s social well-being, potentially challenging the children’s basic developmental needs and future. Based on the theoretical model of social well-being, the present study tested a moderated mediation model that HIV-related stigma moderated the mediating role of social trust on the relationship between perceived social support (PSS) and social well-being. A sample of 297 youths aged 20–30 years affected by parental HIV/AIDS (57.2% male), including 129 (43.40%) AIDS orphans and 168 vulnerable youths (56.60%) completed questionnaires of perceived social support, social well-being, social trust, and HIV-related stigma. IBM SPSS 25.0 …

How Different Pre-Existing Mental Disorders And Their Co-Occurrence Affects Covid-19 Clinical Outcomes? A Real-World Data Study In The Southern United States, Shan Qiao Ph.D., Jiajia Zhang Ph.D., Shujie Chen, Bankole Olatosi Ph.D., Suzanne Hardeman, Meera Narasimhan, Larisa Bruner, Abdoulaye Diedhiou, Cheryl Scott, Ali Mansaray, Sharon Weissman, Xiaoming Li Ph.D.

Faculty Publications

Background: Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes.

Methods: Using a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data …

How Different Pre-Existing Mental Disorders And Their Co-Occurrence Affects Covid-19 Clinical Outcomes? A Real-World Data Study In The Southern United States, Shan Qiao Ph.D., Jiajia Zhang Ph.D., Shujie Chen, Bankole Olatosi Ph.D., Suzanne Hardeman, Meera Narasimhan, Larisa Bruner, Abdoulaye Diedhiuo, Cheryl Scott, Ali Mansaray, Sharon Weissman, Xiaoming Li Ph.D.

Faculty Publications

Background: Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes. Methods: Using a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data …

Treatment Pearls: Management Of Physical Healthcare Needs In Patients With Mental Illness, Leslie W. Miles, Brandon Thatcher, Michael C. Thomas, Blaine Winters

Faculty Publications

Clinicians caring for persons with mental illness should be aware of increased mortality, physical problems, and health disparities in this population. This article provides a brief overview of physical health problems in the context of mental illness as well as those related to psychotropic medications, and discusses strategies to manage treatment effectively.

Covid-19 And Transition To Distance Learning: Perspectives Of Postsecondary Teachers In Kenya, James Ogechi Kereri, Grace Moraa Kennedy, Dovison Kereri

Faculty Publications

Several countries have transitioned to online and/or virtual learning to minimize the impact of Covid-19 on education. In Kenya, schools were closed for the better part of 2020 and reopened back on relying on an online mode and/or virtual learning. However, very little is known about the impact of such transition on postsecondary educators. Therefore, this research aims to bridge this gap by investigating the impact of online and/or virtual learning transition on postsecondary educators based on age, gender, location, and academic rank. Using a nationally distributed web-based survey, the study utilized data from 117 educators across Kenya who participated …

Examining Social Determinants Of Health During A Pandemic: Clinical Application Of Z Codes Before And During Covid-19, Xueying Yang Ph.D., Brooks Yelton, Shujie Chen, Jiajia Zhang Ph.D., Bankole Olatosi Ph.D., Shan Qiao Ph.D., Xiaoming Li Ph.D., Daniela B. Friedman Ph.D.

Faculty Publications

Recognition of the impact of social determinants of health (SDoH) on healthcare outcomes, healthcare service utilization, and population health has prompted a global shift in focus to patient social needs and lived experiences in assessment and treatment. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) provides a list of non-billable “Z codes” specific to SDoH for use in electronic health records. Using population-level analysis, this study aims to examine clinical application of Z codes in South Carolina before and during the COVID-19 pandemic. The study population consists of South Carolina residents who had a healthcare visit and had …

Analysis Of Firearm Violence During The Covid-19 Pandemic In The Us, Shengzhi Sun, Wangnan Cao, Yang Ge

Faculty Publications

Importance In the US, the COVID-19 pandemic intensified some conditions that may contribute to firearm violence, and a recent surge in firearm sales during the pandemic has been reported. However, patterns of change in firearm violence in the first year of the COVID-19 pandemic in the US remain unclear.

Objective To quantify the changes in interpersonal firearm violence associated with the pandemic across all 50 US states and the District of Columbia.

Design, Setting, and Participants This population-based cross-sectional study examined 50 US states and the District of Columbia from January 1, 2016, to February 28, 2021. The COVID-19 pandemic …

Do We Trust The Government? Attributes Of Covid-19 Vaccine Hesitancy And Acceptance In Nigeria, Osmond C. Ekwebelem, Helen Onyeaka, Ismaeel Yunusa Ph. D., Taghi Miri, Yahwedalu M. Onwuneme, Ayeni T. Eunice, Amara Anyogu, Bright Obi, Ngwogu Ada Carol

Faculty Publications

Objectives:

A significant percentage of the population must be vaccinated to achieve herd immunity. Therefore the success of a vaccination program relies on the level of acceptance. This present study seeks to understand COVID-19 vaccine acceptance and hesitancy in Nigeria by assessing the public's willingness to get vaccinated.

Study design:

This is a population-based cross-sectional study. Data were derived through a structured online survey.

Methods:

A cross-sectional study was conducted among adult residents in Nigeria in March 2021 using a structured online questionnaire. The questionnaire surveyed participants' demographic characteristics and perception of COVID-19 and the COVID-19 vaccine. Descriptive statistics and …

Social Capital, Urbanization Level, And Covid-19 Vaccination Uptake In The United States: A National Level Analysis, Shan Qiao, Zhenlong Li, Jiajia Zhang, Xiaowen Sun, Camryn Garrett, Xiaoming Li

Faculty Publications

Vaccination remains the most promising mitigation strategy for the COVID-19 pandemic. However, existing literature shows significant disparities in vaccination uptake in the United States. Using publicly available national-level data, we aimed to explore if county-level social capital can further explain disparities in vaccination uptake rates when adjusting for demographic and social determinants of health (SDOH) variables, and if association between social capital and vaccination uptake may vary by urbanization level. Bivariate analyses and a hierarchical multivariable quasi-binomial regression analysis were conducted, where the regression analysis was stratified by urban–rural status. The current study suggests that social capital contributes significantly to …

Social Capital, Urbanization Level, And Covid-19 Vaccination Uptake In The United States: A National Level Analysis, Shan Qiao Ph.D., Zhenlong Li, Jiajia Zhang Ph.D., Xiaowen Sun, Camryn Garrett, Xiaoming Li Ph.D.

Faculty Publications

Vaccination remains the most promising mitigation strategy for the COVID-19 pandemic. However, existing literature shows significant disparities in vaccination uptake in the United States. Using publicly available national-level data, we aimed to explore if county-level social capital can further explain disparities in vaccination uptake rates when adjusting for demographic and social determinants of health (SDOH) variables, and if association between social capital and vaccination uptake may vary by urbanization level. Bivariate analyses and a hierarchical multivariable quasi-binomial regression analysis were conducted, where the regression analysis was stratified by urban–rural status. The current study suggests that social capital contributes significantly to …

Pro-Inflammatory Diet Pictured In Children With Atopic Dermatitis Or Food Allergy: Nutritional Data Of The Lina Cohort, Olivia Schütte, Larissa Bachmann, Nitin Shivappa Mbbs, Mph, Ph.D., James R. Hébert Scd, Janine F. Felix, Stefan Röder, Ulrich Sack, Michaek Borte, Wieland Kiess, Ana C. Zenclussen, Gabriele I. Stangl

Faculty Publications

Background: Lifestyle and environmental factors are known to contribute to allergic disease development, especially very early in life. However, the link between diet composition and allergic outcomes remains unclear. Methods: In the present population-based cohort study we evaluated the dietary intake of 10-year-old children and analyses were performed with particular focus on atopic dermatitis or food allergy, allergic diseases known to be affected by dietary allergens. Dietary intake was assessed via semi-quantitative food frequency questionnaires. Based on these data, individual nutrient intake as well as children’s Dietary Inflammatory Index (C-DII™) scores were calculated. Information about atopic manifestations during the first …

A Resilience-Based Intervention To Mitigate The Effect Of Hiv-Related Stigma: Protocol For A Stepped Wedge Cluster Randomized Trial, Xiaoming Li Ph.D., Shan Qiao Ph.D., Xueying Yang, Sayward E. Harrison, Cheuk Chi Tam, Zhiyong Shen, Yuejiao Zhou

Faculty Publications

Background: Despite decades of global efforts to tackle HIV-related stigma, previous interventions designed to reduce stigma have had limited effects that were typically in the small- to-moderate range. The knowledge gaps and challenges for combating HIV-related stigma are rooted both in the complexity of the stigma and in the limitations of current conceptualizations of stigma reduction efforts. Recent research has shown the promise of resilience-based approaches that focus on the development of strengths, competencies, resources, and capacities of people living with HIV (PLWH) and their key supporting systems (e.g., family members and healthcare providers) to prevent, reduce, and mitigate the …

Hiv-Related Stigma, Sexual Identity, And Depressive Symptoms Among Msm Living With Hiv: A Moderated Mediation Modeling Analysis, Tianyue Mi, Guanghua Lan, Xueying Yang Ph.D., Xiaoming Li Ph.D., Shan Qiao Ph.D., Zhiyong Shen, Yuejiao Zhou

Faculty Publications

Depression is one of the biggest health issues among men who have sex with men (MSM) living with HIV, where sexual identity might play an intricate role. Yet, findings of the relationship between sexual identity and depression were mixed and few studies explored its underlying mechanisms. This study aimed to examine the association between sexual identity and depression, and the potential mediating role of HIV-related stigma and moderating role of age. A cross-sectional survey was conducted among 203 MSM living with HIV in Guangxi, China. Participants provided information on sexual identity, depression, HIV-related stigma, and background information. Descriptive statistics, bivariate …

Accountability As A Key Virtue In Mental Health And Human Flourishing, John R. Peteet, Charlotte Vanoyen-Witvliet, C. Stephen Evans

Faculty Publications

We propose that accountability plays an implicit, important, and relatively unexamined role in psychiatry. People generally think of accountability as a relation in which one party is held accountable by another. In this paper, we examine accountability as a virtue, drawing on philosophy, psychiatry, and psychology to examine what it means to welcome being accountable in an excellent way that promotes flourishing. When people manifest accountability as a virtue, they are both responsive to others they owe a response, and they are responsible for their attitudes and actions in light of these relationships. Psychiatric treatment often aims to correct disordered …

Mindfulness, Psychological Distress, And Somatic Symptoms Among Women Engaged In Sex Work In China, Cheuk Chi Tam, Yuejiao Zhou, Shan Qiao, Xiaoming Li Ph.D., Zhiyong Shen

Faculty Publications

Women engaged in sex work (WSW) in China encounter numerous disadvantages (e.g., exposure to violence) and have substantial risk for psychological distress and somatic symptoms. Intervention literature has attended to mindfulness, which is a protective factor for psychological outcomes, and its influences can further improve physical health. However, mindfulness has not been well studied in WSW. We aimed to examine the association among mindfulness, psychological distress, and somatic symptoms among Chinese WSW. Data were collected from 410 WSW in Guangxi, China, using an anonymous, self-administered survey evaluating demographics, mindfulness, psychological distress (i.e., depression, loneliness, and perceived stress), and somatic symptoms …

Impacts Of Climate Change And Heat Stress On Farmworkers' Health: A Scoping Review, Moussa El Khayat, Dana A. Halwani, Layal Hneiny, Ibrahim Alameddine, Mustapha A. Haidar, Rima R. Habib

Faculty Publications

Due to the continuous rise of global temperatures and heatwaves worldwide as a result of climate change, concerns for the health and safety of working populations have increased. Workers in the food production chain, particularly farmworkers, are especially vulnerable to heat stress due to the strenuous nature of their work, which is performed primarily outdoors under poor working conditions. At the cross-section of climate change and farmworkers' health, a scoping review was undertaken to summarize the existing knowledge regarding the health impacts associated with climate change and heat stress, guide future research toward better understanding current and future climate change …

Effects Of Positive And Negative Emotion On Picture Naming For People With Mild To Moderate Aphasia: A Preliminary Investigation, Tyson G. Harmon, Courtney Nielsen, Corinne Loveridge, Camille Williams

Faculty Publications

Purpose: To investigate how emotional arousal and valence affect confrontational naming accuracy and response time in people with mild to moderate aphasia compared with adults without aphasia. We hypothesized that negative and positive emotions would facilitate naming for people with aphasia but lead to slower responses for adults with no aphasia.

Method: Eight participants with mild to moderate aphasia, 15 older adults, and 17 young adults completed a confrontational naming task across three conditions (positive, negative, neutral) in an ABA case series design. Immediately following each naming condition, participants self-reported their perceived arousal and pleasure. Accuracy and response time were …

Diet Quality And Dietary Inflammatory Index Score Among Women’S Cancer Survivors, Sibylle Kranz, Faten Hasan, Erin Kennedy, Jamie Zoellner, Kristin A. Guertin, Nitin Shivappa Mbbs, Mph, Ph.D., James R. Hébert, Roger Anderson, Wendy Cohn

Faculty Publications

The purpose of this study was to investigate Healthy Eating Index 2015 (HEI-2015) and Energy-Adjusted Dietary Inflammatory Index (E-DIITM) scores in women's cancer survivors and to examine socio-economic (SES) characteristics associated with these two diet indices. In this cross-sectional study, survivors of women's cancers completed a demographic questionnaire and up to three 24-h dietary recalls. HEI-2015 and E-DII scores were calculated from average intakes. One-way ANOVA was used to examine the association of various demographic factors on HEI-2015 and E-DII scores. Pearson Correlation was used to calculate the correlation between the two scores. The average HEI-2015 score was 55.0 +/- …

A Bayesian Phase I/Ii Biomarker-Based Design For Identifying Subgroup-Specific Optimal Dose For Immunotherapy, Beibei Guo, Yong Zang

Faculty Publications

Immunotherapy is an innovative treatment that enlists the patient's immune system to battle tumors. The optimal dose for treating patients with an immunotherapeutic agent may differ according to their biomarker status. In this article, we propose a biomarker-based phase I/II dose-finding design for identifying subgroup-specific optimal dose for immunotherapy (BSOI) that jointly models the immune response, toxicity, and efficacy outcomes. We propose parsimonious yet flexible models to borrow information across different types of outcomes and subgroups. We quantify the desirability of the dose using a utility function and adopt a two-stage dose-finding algorithm to find the optimal dose for each …

Global, Regional, And National Sex Differences In The Global Burden Of Tuberculosis By Hiv Status, 1990-2019: Results From The Global Burden Of Disease Study 2019, Jorge R. Ledesma, Jianing Ma, Avina Vongpradith, Emilie R. Maddison, Amanda Novotney, Ismaeel Yunusa

Faculty Publications

Background Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019.

Methods We used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21505 siteyears of vital registration …

The Mediating Effect Of Depression On The Relation Between Interpersonal Needs And Suicidal Ideation Among Chinese Transgender Women, Ruijie Chang, Chengbo Zeng, Shan Qiao Ph.D., Huwen Wang, Chen Xu, Xiaoyue Yu, Tiecheng Ma, Ying Wang, Xiaoming Li Ph.D., Yong Cai

Faculty Publications

Background: Transgender women are at high risk of depression and suicidal ideation. The interpersonal theory of suicide proposes that suicidal ideation could be a consequence of high interpersonal needs (thwarted belongingness and perceived burdensomeness). The current study tests this theory and investigates whether depression could mediate the relationship between interpersonal needs and suicidal ideation among transgender women in Shenyang, China.

Methods: A total of 198 transgender women were recruited by snowball sampling. A cross-sectional study was conducted through a structured questionnaire. Suicidal ideation, depression, and interpersonal needs were assessed. Path analysis was used to carry out the research goals and …

Scanner: A Web Platform For Annotation, Visualization And Sharing Of Single Cell Rna-Seq Data, Guoshuai Cai, Xuanxuan Yu, Choonhan Youn, Jun Zhou, Feifei Xiao

Faculty Publications

In recent years, efficient scRNA-seq methods have been developed, enabling the transcriptome profiling of single cells massively in parallel. Meanwhile, its high dimensionality and complexity bring challenges to the data analysis and require extensive collaborations between biologists and bioinformaticians and/or biostatisticians. The communication between these two units demands a platform for easy data sharing and exploration. Here we developed Single-Cell Transcriptomics Annotated Viewer (SCANNER), as a public web resource for the scientific community, for sharing and analyzing scRNA-seq data in a collaborative manner. It is easy-to-use without requiring special software or extensive coding skills. Moreover, it equipped a real-time database …

The Isocaloric Substitution Of Plant-Based And Animal-Based Protein In Relation To Aging-Related Health Outcomes: A Systematic Review, Jiali Zheng, Tianren Zhu, Guanghuan Yang, Longgang Zhao, Fangyu Li, Yong-Moon Park, Fred K. Tabung, Susan E. Steck Phd, Mph, Rd, Xiaoguang Li, Hui Wang

Faculty Publications

Plant-based and animal-based protein intake have differential effects on various aging-related health outcomes, but less is known about the health effect of isocaloric substitution of plant-based and animal-based protein. This systematic review summarized current evidence of the isocaloric substitutional effect of plant-based and animal-based protein on aging-related health outcomes. PubMed and Embase databases were searched for epidemiologic observational studies published in English up to 15 March 2021. Studies that included adults ≥18 years old; use of a nutritional substitution model to define isocaloric substitution of plant protein and animal protein; health outcomes covering mortality, aging-related diseases or indices; and reported …

Future Orientation Among Children Affected By Parental Hiv In China: An Exploratory Analysis Of Complex Interactions, Heather L. Mcdaniel, Sayward E. Harrison, Amanda J. Fairchild, Xiaoming Li Ph.D.

Faculty Publications

We utilized an exploratory analytic approach to examine predictors of children's future beliefs, an internal asset associated with resilience among children affected by HIV, with emphasis on complex interactions among multisystem factors. Children (N = 1221) affected by parental HIV in China reported on psychosocial functioning, as well as internal, familial, and community resilience assets. Exploratory data analysis was conducted using a binary segmentation program. Six binary splits on predictors accounted for 22.78% of the variance in future expectation, suggesting interactions between children's perceived control of their future, loneliness, caregiver trust, and social support. Four binary splits accounted for …