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Identifying Barriers To Dental Care Among Hispanics In Southwest Minnesota, Lissette Garza Jan 2023

Identifying Barriers To Dental Care Among Hispanics In Southwest Minnesota, Lissette Garza

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this study was to assess the different barriers for dental health care among the Hispanic population in a rural, southwestern community in Minnesota. To collect data, an adaptation of the survey written by Vazquez and Swan (2003) was distributed to Hispanic individuals at an agricultural facility, religious organization, and an early childhood organization. The findings for the research question are presented in the cross-sectional study utilizing descriptive statistics in the form of frequencies and percentages. The results of this study indicate that not having a dental provider of the same cultural background, having a language barrier, and …


Perceptions Of Individual Burnout, Team Burnout, And Coping Resiliency Among Elite Pre-Professional Female Soccer Athletes, Kathleen Stapleton Jan 2023

Perceptions Of Individual Burnout, Team Burnout, And Coping Resiliency Among Elite Pre-Professional Female Soccer Athletes, Kathleen Stapleton

All Graduate Theses, Dissertations, and Other Capstone Projects

Mental illness is a significant contributor to physical illness and disease worldwide and is more prevalent in young adult females. Stress and burnout are both inputs and outputs affecting mental and physical health. Elite athletes are particularly susceptible to stress and burnout due to the added pressures of achieving champion status in their respective sports. Previous studies focused on individual perceptions of athlete burnout, but research is increasingly showcasing the need to understand the social aspect of team sport environments. This study used a cross-sectional survey to assess the levels of perceived burnout in a convenience sample of elite female …


Understanding The Implications Of Hpv Infection: Does Parental Education Impact Hpv Vaccination Completion Rates?, Heather A. Pederson Jan 2021

Understanding The Implications Of Hpv Infection: Does Parental Education Impact Hpv Vaccination Completion Rates?, Heather A. Pederson

All Graduate Theses, Dissertations, and Other Capstone Projects

Up to 80% of United States (U.S.) citizens will contract the human papillomavirus (HPV) at some point in their lives. HPV has the ability to cause multiple types of cancer, including cervical, vulvar, vaginal, penile, anal, and oropharyngeal. The most recent HPV vaccine is effective against nine strains of the virus, which account for most cases of cancer and genital warts caused by HPV. Parents are a key component in reaching Healthy People 2030’s goal to have 80% of all adolescents in the U.S. completely vaccinated against HPV. Objective: The purpose of this systematic review was to determine if …


The Difference In Barriers To Colorectal Cancer Screening Between Men And Women In The 45-55-Year Age Group, Maren Christina Davis Jan 2020

The Difference In Barriers To Colorectal Cancer Screening Between Men And Women In The 45-55-Year Age Group, Maren Christina Davis

All Graduate Theses, Dissertations, and Other Capstone Projects

Statement of the Problem: Adults, 50 years or older, should have a screening colonoscopy every ten years and fecal immunochemical test (FIT) every year. However, close to 22 million adults between the ages of 50-75 in the U.S. have never been screened for colorectal cancer, which delays treatment and can be fatal if the cancer is not found in time.

Procedure: This study used a descriptive, cross-sectional, survey-based design and a convenience sample of men and women between 45 and 55 years old to assess colorectal screening practices, barriers to screening, and knowledge levels about colorectal cancer screening.

Findings: A …


Human Papillomavirus (Hpv) Infection And Vaccine Knowledge And Attitudes Among University Students, Mckenzie Schmitz Jan 2020

Human Papillomavirus (Hpv) Infection And Vaccine Knowledge And Attitudes Among University Students, Mckenzie Schmitz

All Graduate Theses, Dissertations, and Other Capstone Projects

HPV is the “most common sexually transmitted infection,” with approximately four out of five sexually active individuals getting infected at some point in their lives (Planned Parenthood, n.d.b, para.1). Cancers of the throat, mouth, cervix, anus, penis, and vagina have all been linked to HPV infections. In addition to being tested for HPV, the utilization of barrier methods and reduction of risky sexual risk behaviors, are the best ways to prevent and treat sexually transmitted infections. This study contributes to existing literature on university students’ knowledge and attitudes about HPV infections and the vaccination. This study was conducted using descriptive, …


Screens, School District Employees, And Sleep: Is There A Relationship?, Mary Kay L. Bruihler Jan 2020

Screens, School District Employees, And Sleep: Is There A Relationship?, Mary Kay L. Bruihler

All Graduate Theses, Dissertations, and Other Capstone Projects

Statement of the Problem

Working in a school can be stressful and about half of educators in a national survey reported less than the recommended minimum of seven hours of sleep. Smartphones and other screened devices can cause sleep loss and are becoming more prevalent. Is there a relationship between the use of screened devices and sleep among the employees of a school district?

Procedures

Employees (n=36) of a small southern Minnesota school district were given an online survey regarding their sleep habits utilizing the Pittsburg Sleep Quality Index (PSQI), their screen time use, utilizing the Screen Time Questionnaire (STQ), …


Perceptions, Attitudes, Self-Efficacy, And Behaviors Of Mouthguard Use Among Collegiate Athletes, Heather Prosser Jan 2020

Perceptions, Attitudes, Self-Efficacy, And Behaviors Of Mouthguard Use Among Collegiate Athletes, Heather Prosser

All Graduate Theses, Dissertations, and Other Capstone Projects

With the high risk of dental trauma in contact sports, it is important that all athletes have a strong foundation of how to prevent such injuries. Properly fitted mouthguards are the best available protective equipment to prevent orofacial trauma; however, previous research has found them underutilized, with the need for evidence-based interventions to promote mouthguard use among athletes. This study used a descriptive, cross-sectional, correlational research design, focusing on studying collegiate athletes at one large, Midwestern university, to determine their current attitudes, perceptions, self-efficacy, and behaviors of mouthguard use during participation in a contact sport. A convenience sampling technique was …


Incentive-Use In Worksite Wellness Programs In Mn Government Agencies, Sandra Bromley Jan 2019

Incentive-Use In Worksite Wellness Programs In Mn Government Agencies, Sandra Bromley

All Graduate Theses, Dissertations, and Other Capstone Projects

We used a digital email-based survey to collect information on WWP in government agencies in Minnesota. In terms of associations between incentive-use and success rates, results were inconclusive. Due to limitations in responses on the survey we are unable to draw a correlation between incentive-use and cost savings outcomes for agencies surveyed. Survey results did provide other information that can be useful by health educators to improve and grow WWP. Results showed that compared to national rates, government agencies in Minnesota may not be utilizing additional funding resources for WWP. Future research on the use of grant and insurance company …


Sugar-Sweetened Beverages: A Survey To Assess Adults Knowledge, Attitudes, And Consumption Patterns Of Sugar-Sweetened Beverages, Jeff Schafer Jan 2019

Sugar-Sweetened Beverages: A Survey To Assess Adults Knowledge, Attitudes, And Consumption Patterns Of Sugar-Sweetened Beverages, Jeff Schafer

All Graduate Theses, Dissertations, and Other Capstone Projects

Sugar-sweetened beverages (SSBs) have a direct impact on the general health of the country when looking at the rising obesity levels (CDC, 2017a). The USDA’s dietary guidelines suggest that the daily intake of added sugar should be limited to 6 teaspoons for women and 9 teaspoons for men (Hughes, 2017). However, the average American consumes 20 teaspoons of sugar daily (Hughes, 2017). These extra calories are converted into fat and stored in the body. Data collected throughout the years indicates a rise in the number of Americans living with a weight above healthy recommendations, which is termed, obese. Obesity is …


Using The Health Belief Model To Assess Undergraduate College Students Knowledge And Perceptions Of Human Papillomavirus In Order To Better Understand Vaccine Intentions, Kelly Mcmahon Jan 2018

Using The Health Belief Model To Assess Undergraduate College Students Knowledge And Perceptions Of Human Papillomavirus In Order To Better Understand Vaccine Intentions, Kelly Mcmahon

All Graduate Theses, Dissertations, and Other Capstone Projects

According to the Centers for Disease control and Prevention (CDC)(2016b), Human Papillomavirus (HPV) is the most commonly sexually transmitted infection in the United States. HPV is so prevalent that nearly all sexually active people will obtain a strain of HPV at some point in their lives (CDC, 2016d). Approximately one in four Americans are currently infected in the United States with HPV, and approximately 14 million new infections of HPV spread each year in the United States (CDC, 2016b).

Ultimately the HPV vaccination is a form of cancer prevention. With the vaccination uptake, the burden of HPV related health problems …


Screen Time And Sleep Condition Among Selected College Students, Angela Lynn Sargent Jan 2017

Screen Time And Sleep Condition Among Selected College Students, Angela Lynn Sargent

All Graduate Theses, Dissertations, and Other Capstone Projects

College students underestimate the value of adequate sleep. The purpose of this research was to measure the relationship between students’ sleep condition and screen time usage one hour prior to bed. The participants in this study were undergraduate students, from ages 18 to 25 years of age, enrolled in spring semester 2017 at a Midwestern University. A 15-item paper survey was distributed to participants for this research (55.7% female; 42.8% male). This research found that sampled undergraduate students’ amount of sleep each night ranged from 4 to 10 hours and averaged 6.9 hours of adequate sleep each night. This finding …


Preconception Health Knowledge Among Undergraduate Women, Ashley Mae Paulsen Jan 2017

Preconception Health Knowledge Among Undergraduate Women, Ashley Mae Paulsen

All Graduate Theses, Dissertations, and Other Capstone Projects

Preconception health is a woman’s health before she becomes pregnant. It means knowing and understanding how preexisting health conditions and risk factors could affect a woman or her unborn child if she becomes pregnant (Office on Women’s Health, 2010). This study examined undergraduate students’ knowledge of recommended preconception health practices. A paper survey was distributed to general education classes in health, sociology, and family consumer science. This 33-item survey assessed demographics, barriers to practicing recommended preconception health behaviors, and knowledge of preconception health practices. Analyses included frequencies, independent t-test, and ANOVA. Respondents had a mean score of 42.85 (2.68) on …


Workplace Management Knowledge And Support For Employee Breastfeeding Practices, Elizabeth Heimer Jan 2017

Workplace Management Knowledge And Support For Employee Breastfeeding Practices, Elizabeth Heimer

All Graduate Theses, Dissertations, and Other Capstone Projects

Breastfeeding has many benefits to both mother and child. It also happens to have benefits to workplaces who support breastfeeding. Research shows that lack of environmental support of breastfeeding at the workplace may discourage women from exclusively breastfeeding the recommended amount of time of SIX months (American Academy of Pediatrics, 2012). To investigate the management knowledge and workplace breastfeeding support services, an online survey was sent out employees in management positions at selected workplaces in Faribault, Martin and Watonwan counties in Minnesota. Of the 98 selected participants, only 16 participants completed the survey. The study aimed to discover whether there …


Complementary And Alternative Medicine: Current Mind-Body Practices And Perceptions Of Undergraduate Students, Julia Ann Marie Putz Jan 2017

Complementary And Alternative Medicine: Current Mind-Body Practices And Perceptions Of Undergraduate Students, Julia Ann Marie Putz

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this study was to evaluate the practices and perceptions undergraduate students have of complementary and alternative medicine. This study also analyzed the purpose in which students use complementary and alternative medicine. A survey was distributed to 450 students attending undergraduate classes at a large Midwestern university. The survey was developed using A Complementary Alternative Medicine Questionnaire for Young Adults by Patterson and Arthur (2009). This survey consisted of 48 questions addressing demographic information, uses of complementary and alternative medicine, mind-body practices and beliefs of complementary and alternative medicine. There was a total of 307 responses; however,14 were …


Avian And Pandemic Influenza Knowledge And Risk Perception In Southern Minnesota, Holly Munch Jan 2017

Avian And Pandemic Influenza Knowledge And Risk Perception In Southern Minnesota, Holly Munch

All Graduate Theses, Dissertations, and Other Capstone Projects

Avian influenza is an important public health issue because such viruses have the potential to mutate into a pandemic influenza virus with widespread, even global, morbidity and mortality. Studies have indicated that knowledge about avian and pandemic influenza and perception of pandemic risk are low among the public and even in the health professions. This study was undertaken to evaluate the level of avian and pandemic influenza knowledge and risk perception among adults in southern Minnesota with a view to preparing effective educational interventions and improving preparedness for an influenza pandemic. An 18-question electronic survey was administered to 99 people …


Patient Empathy & Effects On Health Outcomes, Erin Elizabeth Schliesman Jan 2016

Patient Empathy & Effects On Health Outcomes, Erin Elizabeth Schliesman

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this paper is to examine the relationship between physician empathy and healthcare outcomes for patients. The main points of focus will be how empathy is defined in a healthcare setting, the effects empathy has on health and healing of patients, particularly the empathetic relationship between the physicians and patients and finally how empathy can be better incorporated into healthcare settings.


An Analysis Of Western Medicine Mistrust Among Selected African Immigrant Women In Minnesota, Wanjiru Julie Gicheru Jan 2016

An Analysis Of Western Medicine Mistrust Among Selected African Immigrant Women In Minnesota, Wanjiru Julie Gicheru

All Graduate Theses, Dissertations, and Other Capstone Projects

Mistrust in Western medicine contributes to many individuals noncompliance, avoidance of treatment, or seeking other outlets or alternative treatments. As a result, health outcomes are poorer for those individuals who proactively avoid treatment from health care professionals. Factors that contribute to racial and ethnic health disparities have been accounted for in research and literature; however, immigrant health disparities have not been well studied. The primary purpose of this study was to analyze factors that contributed to Western medicine mistrust among selected African immigrant women in Minnesota. Participants were recruited from community centers, churches, and by snowball sampling within the Minneapolis-Saint …


Health Literacy Proficiency, Sources Of Health Information, And Perceived Barriers To Health Literacy Among Selected Members Of The Hmong Community In Minnesota, Amanda Vang Jan 2015

Health Literacy Proficiency, Sources Of Health Information, And Perceived Barriers To Health Literacy Among Selected Members Of The Hmong Community In Minnesota, Amanda Vang

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this study was to determine health literacy proficiency, sources of health information, and perceived barriers to health literacy among selected members of the Hmong community in Minnesota. Data for this cross-sectional study were collected using the Short Assessment on Health Literacy-English (SAHL-E) screening tool and a questionnaire. The SAHL-E screening tool and a questionnaire were distributed to 40 Hmong residents in the St. Paul/Minneapolis in Minnesota. When combining the numbers of health literacy scores, a mean of 15.5 was reported. The overall findings of this research assessed that the Hmong community in Minnesota has adequate health literacy …


Plan B Emergency Contraception: Sampled University Students' Knowledge, Attitudes, And Behaviors, Natalie Hazel Jan 2014

Plan B Emergency Contraception: Sampled University Students' Knowledge, Attitudes, And Behaviors, Natalie Hazel

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this research was to assess and evaluate sampled university students' knowledge, attitudes, perceptions, and behaviors related to the Plan B emergency contraceptive. To collect data, a 29 item survey was developed and administered to students in sampled classrooms at Minnesota State University, Mankato campus regarding their knowledge, attitudes, perceptions, and behaviors related to the Plan B emergency contraceptive; as well as demographic information. The findings of the study indicated there were some participants who have much knowledge about the Plan B emergency contraceptive. However, findings also showed that there were a number of participants who lacked knowledge …


Physical Environment And Women's Physical Activity Behaviors, Beth Ann Brisky Jan 2014

Physical Environment And Women's Physical Activity Behaviors, Beth Ann Brisky

All Graduate Theses, Dissertations, and Other Capstone Projects

This study was developed using the Ecological Model (Stokols, 1992). The purpose of this study was to determine women's perceptions of the physical environment and the relationship between perceptions and physical activity behaviors. The study also analyzed women's non-motorized transportation behaviors, including walking and cycling to get from place to place. An email was sent to 526 female Minnesota State University, Mankato employees to ask them to participate in an electronic survey. The survey was developed using two of Sallis's (2013a, 2013b) instruments, Neighborhood Quality of Life Study survey and Neighborhood Environment Walkability Scale-Confirmatory Factor Analysis survey. The survey consisted …


Knowledge Of Hpv, Perception Of Risk, And Intent To Obtain Hpv Vaccination Among Sampled Male University Students At Minnesota State University, Mankato, Lia Lambert Jan 2014

Knowledge Of Hpv, Perception Of Risk, And Intent To Obtain Hpv Vaccination Among Sampled Male University Students At Minnesota State University, Mankato, Lia Lambert

All Graduate Theses, Dissertations, and Other Capstone Projects

Human papilloma virus (HPV) is the most common sexually transmitted infection (STI) in the U.S. HPV is known to cause many types of cancers such as cervical, vulvar, vaginal, penile, anal, and oropharyngeal cancers. A preventative measure, the HPV vaccine, is recommended by the Centers for Disease Control for both boys and girls. Since past prevention efforts primarily focused on female vaccination it is uncertain if males are aware of HPV, its effects and preventative measures. The purpose of this study was to determine the knowledge level of HPV, perceived risk of HPV and intent to obtain HPV vaccination among …


Recognition Of And Attitudes Toward, Intimate Partner Violence Among Sampled University Students, Samantha Maureen Wobschall Jan 2014

Recognition Of And Attitudes Toward, Intimate Partner Violence Among Sampled University Students, Samantha Maureen Wobschall

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this research was to further explore university students' recognition of instances of intimate partner violence and their attitudes toward this issue. A total of 382 male and female university students from a mid-sized public university participated in the survey. Findings show that 97% of participants were able to accurately identify the scenario that did not depict intimate partner violence, however rates of recognition ranged from 51% to 90% for scenarios that did depict IPV. Through an independent t-test, this research found that there was a significant difference when comparing male and female students' ability to accurately recognize …


Breastfeeding Knowledge, Practice, Attitudes, And Influencing Factors: Findings From A Selected Sample Of Breastfeeding Mothers In Bemidji, Minnesota, Hadeel Adnan Tanash Jan 2014

Breastfeeding Knowledge, Practice, Attitudes, And Influencing Factors: Findings From A Selected Sample Of Breastfeeding Mothers In Bemidji, Minnesota, Hadeel Adnan Tanash

All Graduate Theses, Dissertations, and Other Capstone Projects

Breastfeeding is generally considered by health professionals as the ideal feeding practice for infants. It is the first communication pathway between the mother and her infant. This study was designed to describe breastfeeding knowledge, attitudes, practice and influencing factors among breastfeeding mothers in Bemidji, MN. This cross-sectional study allowed the researcher to determine trends and other information about the sample in the Bemidji area. The participants for this study were breastfeeding mothers who gave a birth at Sanford Health located in Bemidji, MN. A written data collection instrument containing forty nine questions was used to collect data. The findings of …


Sex Education Background Of Students At Msu, Mankato Prior To Enrollment At The University, Natalie Mcconkey Jan 2014

Sex Education Background Of Students At Msu, Mankato Prior To Enrollment At The University, Natalie Mcconkey

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this study was to determine what key concepts were recalled in high school sex education curricula by students at MSU. The participants in this study were MSU, students enrolled in 2013 spring semester Health and the Environment course. An electronic survey consisting of 43 questions was distributed though the survey program SurveyMonkey. The survey was sent out to 596 MSU students, and data was collected from 39 MSU, M students. Roughly, 73% of the participants reported receiving comprehensive sex education compared to 19% of participants reporting abstinence-only education in high school. The key concepts that received major …


Risk Perceptions Of Cardiovascular Disease In College Students, Antonia Kolas Jan 2014

Risk Perceptions Of Cardiovascular Disease In College Students, Antonia Kolas

All Graduate Theses, Dissertations, and Other Capstone Projects

College students oftentimes underestimate their risk perception of cardiovascular disease (CVD). This study examined undergraduate students' perception of efficacy and perception of threat of cardiovascular disease. A paper survey was distributed to three undergraduate student classes (n = 127; 66.9% female; 33.1% male; 83.5% White/Caucasian; M age = 20.00). This 17-item survey assessed demographics, perception of general health, perception of efficacy of cardiovascular disease, and perception of threat of cardiovascular disease. Analyses included Cronbach's alpha, descriptive, frequencies, and independent sample t-test. College students have a higher perception of efficacy (M = 24.45 out of 30.00; SD = 4.35) and a …


Sampled University Students' Perceived Risk Of Diabetes & Self-Reported Diabetes Risk Factors, Ajibike R. Shodunke Jan 2014

Sampled University Students' Perceived Risk Of Diabetes & Self-Reported Diabetes Risk Factors, Ajibike R. Shodunke

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this research was to measure university students' perceived risk of diabetes and self-reported diabetes risk factors. Informed consent forms and survey questionnaires were distributed to students in randomly sampled courses (n=357), with students aged 18 to 24. Out of the 357 surveys completed, 325 surveys were used for analysis of this study. Forty-eight percent of participants between ages 18 to 24 perceived themselves at minimal risk for developing type II diabetes. Sampled participants reported a mean of 2.25 (type II) diabetes risk factors out of 18 diabetes risk factors. Additionally, there were significant differences ( …


University Students' Perceptions Of The Severity Of Binge Drinking, Lauren Eleanore Stone Jan 2014

University Students' Perceptions Of The Severity Of Binge Drinking, Lauren Eleanore Stone

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this research was to assess university students' perceptions of the severity of binge drinking. To assess university students' perceptions, a survey questionnaire was used. The survey looked at reported binge drinking behaviors by sampled college students and how serious they perceived consequences of binge drinking. A total of 270 students at Minnesota State University, Mankato participated in the research regarding binge drinking during spring semester 2014. The mean age was 19.8 years old, with a majority (70%) being freshmen and sophomores. Around 60% of females reported binge drinking within the last two-weeks of taking the survey, while …


Access To Ems Services And Training, Knowledge, And Perceptions Related To First Aid And Cardiopulmonary Resuscitation (Cpr) Skills Among College Students, Feifei Sun Jan 2013

Access To Ems Services And Training, Knowledge, And Perceptions Related To First Aid And Cardiopulmonary Resuscitation (Cpr) Skills Among College Students, Feifei Sun

All Graduate Theses, Dissertations, and Other Capstone Projects

This study included two purposes. The first purpose of this study was to compare undergraduate students' knowledge and perceptions related to first aid and cardiopulmonary resuscitation (CPR) according to their level of first aid and CPR training. The second purpose of this study was to compare the students' perceptions of access to emergency medical services (EMS) by the geographic location of their hometown. A quantitative survey was distributed to students enrolled in three HLTH 101: Health and Environment classes in Spring, 2013. The survey included questions related to the participants' demographic characteristics, perceptions of the time needed for EMS services …


The Relationship Between Emotional Intelligence And Alcohol Use Among Students At Minnesota State University - Mankato, Ganisher Davlyatov Jan 2013

The Relationship Between Emotional Intelligence And Alcohol Use Among Students At Minnesota State University - Mankato, Ganisher Davlyatov

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this study was to examine the role of emotional intelligence, gender, fraternity/sorority membership, and residence on alcohol use among undergraduate students enrolled in spring semester, 2013 at Minnesota State University, Mankato. The relationship between emotional intelligence and alcohol use was studied. Moreover, the effect of gender, fraternity/sorority membership, and residence on alcohol use was determined. Participants were 390 students of Minnesota State University, Mankato. A quantitative cross-sectional online survey was conducted to collect data regarding students' emotional intelligence status and alcohol use through Schutte Self Report Intentory (SSRI) for emotional intelligence (Schutte, Malouff, Hall, Haggerty, Cooper, Golden, …


Selected College Students' Perceptions, Knowledge And Awareness Of Sexual Abuse Of Children, Farhiya A. Muse Jan 2013

Selected College Students' Perceptions, Knowledge And Awareness Of Sexual Abuse Of Children, Farhiya A. Muse

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this research was to assess and evaluate selected college students' perception of and knowledge and awareness about sexual abuse of children. In order to collect data a 29-item survey was developed and administered to students in selected classrooms in Minnesota State University, Mankato campus regarding their perception, knowledge, awareness, and prevention strategies of sexual abuse of children; as well as demographic information. The findings from the quantitative analysis for each research question are presented in this study. The findings of the study indicated there were college students who do have much knowledge and awareness about sexual abuse …