Digital Commons Network^™

Fruit And Vegetable Intake, Food Security, Barriers To Healthy Eating, And Empowerment Among Dietetic Interns And Physician Assistant Interns: A Cross-Sectional Pilot Study, Alison Campbell, Maren Stirling, Natalie Keele, Alisse Larkin, Rachel Crandall, Aubree N. Wilcox, Meghan Adair, Cloie Malan, Jaidyn Thomson, Alexis Bennett, Heather Jensen, Hadyn Flygare, Lacie Peterson, Holly Hopkins, Nikki Kendrick, Maria Givler, Rebecca Charlton, Katie N. Kraus

Nutrition, Dietetics, and Food Sciences Faculty Publications

Students are required to complete supervised practice hours prior to becoming Registered Dietitians and Physician Assistants. Research suggests that environmental and social factors affect dietetic interns’ diets during their internship, although these factors have not been studied among physician assistant interns. This cross-sectional study utilized an online survey to compare dietetic interns’ (n = 81) and physician assistant interns’ (n = 79) fruit and vegetable intake, food security, barriers to healthy eating, and empowerment for making healthy dietary choices during an internship. Differences were assessed via independent t-tests and chi-square distributions. The significance was set at p …

Promoting Nutrition Literacy In Children: A Case Study Of A Community Partnership Between A University And An Elementary School, Candise Branum

Foley Library Scholarship

Background: Health literacy outreach is commonplace within public and hospital libraries but less so in academic libraries, where it is often viewed as not integral. Academic health science libraries may collaborate with public libraries to provide public health information literacy programming or “train the trainer” sessions, but examples of academic health science librarians leading community health initiatives are still limited.

Case Presentation: This case report discusses a collaborative project between Gonzaga’s Foley Center Library, the School of Nursing and Human Physiology, and a local elementary school to promote health literacy for students and their families, led by an Academic Health …

Urban-Rural Differences In School Districts' Local Wellness Policies And Policy Implementation Environments, Swati Iyer, Timothy J Walker, Alexandra L Macmillan Uribe, Chad D Rethorst, Rebecca A Seguin-Fowler, Jacob Szeszulski

Student and Faculty Publications

Higher rates of obesity in rural compared to urban districts suggest environmental differences that affect student health. This study examined urban-rural differences in districts' local wellness policies (LWPs) and LWP implementation environments. Cross-sectional data from two assessments in Texas were analyzed. In assessment one, each district's LWP was reviewed to see if 16 goals were included. In assessment two, an audit was conducted to identify the presence of a wellness plan (a document with recommendations for implementing LWPs), triennial LWP assessment, and school health advisory councils (SHACs) on the district website. Rural districts' LWPs had a smaller number of total …

Development Of A Culinary Medicine Toolkit To Improve Implementation Of Virtual Cooking Classes For Low-Income Adults With Type 2 Diabetes, David Ai, Natalia I Heredia, Vanessa Cruz, Diana C Guevara, Shreela V Sharma, Dolores Woods, Melisa Danho, John Wesley Mcwhorter

Student and Faculty Publications

Culinary medicine (CM) addresses diseases through nutrition and culinary education. To promote access to educational material for people with diabetes and engagement in virtual classes, we created a virtual culinary medicine toolkit (VCMT) sensitive to literacy levels and language preferences. The VCMT was developed to accompany existing virtual CM programs and help improve participant interaction and retention, offering educational materials for providers and participants. The provider VCMT offers level-setting education to reduce mixed nutrition messaging, including educational resources discussing inclusive nutrition and mindful eating topics. Each handout has a QR code and link to engaging, animated videos that provide further …

Development Of A Culinary Medicine Toolkit To Improve Implementation Of Virtual Cooking Classes For Low-Income Adults With Type 2 Diabetes, David Ai, Natalia I Heredia, Vanessa Cruz, Diana C Guevara, Shreela V Sharma, Dolores Woods, Melisa Danho, John Wesley Mcwhorter

Student and Faculty Publications

Culinary medicine (CM) addresses diseases through nutrition and culinary education. to promote access to educational material for people with diabetes and engagement in virtual classes, we created a virtual culinary medicine toolkit (VCMT) sensitive to literacy levels and language preferences. The VCMT was developed to accompany existing virtual CM programs and help improve participant interaction and retention, offering educational materials for providers and participants. The provider VCMT offers level-setting education to reduce mixed nutrition messaging, including educational resources discussing inclusive nutrition and mindful eating topics. Each handout has a QR code and link to engaging, animated videos that provide further …

Electronic Nicotine Delivery Systems Use And Periodontal Health—Findings From The Population Assessment Of Tobacco And Health Study, Amir Mohajeri, Martin S. Lipsky, Rachana Hegde, Jody Chiang, Man Hung

Institute on Aging Publications

Background: Electronic nicotine delivery systems (ENDSs) are rapidly increasing in the U.S., however, information about their long-term risks and benefits remains limited. This study examined the relationship between ENDS use and periodontal health among U.S. adults. (2) Methods: Data came from 33,822 adults who participated in the 2016–2018 wave of the Population Assessment of Tobacco and Health (PATH) study. Inclusion criteria were adults without a history of cigarette smoking or diabetes. Logistic regression analysis was performed to estimate the associations between ENDS use and a history of periodontal disease, with multivariable logistic regression adjusting for factors associated with poor oral …

Implementation Of Nutritional Screening In Adults (Ages 19-65) With Major Depressive Disorder: An Integrative Review, Laurie S. Stephens

Doctoral Dissertations and Projects

The World Health Organization estimates the total percentage of depression at 3.8% and projects it to be the leading cause of global disability by 2030 (WHO, 2023). The economic burden for adults with major depressive disorder in the United States is estimated at a staggering annual cost of 236 billion dollars (Greenberg et al., 2018). Nutritional psychiatry is a growing subspecialty focused upon how diet can improve mental health outcomes. The evidence shows a correlation between diet and depression, influencing questions on how this translates to current dietary recommendations and treatment. An integrative review of current literature was performed to …

Nutritional Knowledge, Attitudes, And Practices Among Family Physician Practitioners In Gulf Countries (Bahrain, Kuwait, Saudi Arabia, And Uae), Abeer S. Alzaben, Abeer A. Aljahdali, Lulua F. Alasousi, Ghadeer Alzaben, Lynne Kennedy, Anwar Alhashem

All Works

Family physicians serve as pivotal points of contact within global healthcare systems. Nutrition plays a significant role in lifestyle and preventive medicine. With the rise of chronic and non-communicable diseases in Gulf Cooperation Council (GCC) countries, these physicians advise patients and the public on diet-related conditions. This descriptive cross-sectional study assessed the nutritional knowledge and practices across the GCC. Combining survey data from multiple GCC sites, a sample of family physicians was generated. Registered GCC family physicians received email invitations containing participant information, informed consent forms, and a self-administered online questionnaire. Analysis of data from four GCC countries involving 8751 …

Dietary Patterns Of Children From The Amazon Region Of Ecuador: A Descriptive, Qualitative Investigation, Kristin N. Murphy, Lisa Boyce, Eduardo Ortiz, Marcela Santos, Gloria Balseca

Human Development and Family Studies Faculty Publications

Many young children in Ecuador suffer from high rates of malnutrition and stunting that affect their long-term growth and development. Little is known about the dietary patterns of children from the Amazon region who experience some of the highest rates of stunting (height-for-age) within Ecuador. Semi-structured interviews were conducted with 50 mothers of young children living in the Ecuadorian Amazon. In addition to descriptions of overall dietary patterns, three themes emerged from the interviews relating to strengths mothers have in feeding their children healthy diets: knowledge, autonomous and independent children, and supportive and responsive parenting. Five themes were found relating …

Improving Knowledge Of Parents In Dietary Management For Children With Diabetes And Hyperlipidemia: A Quality Improvement Project, Jorge L. Valdes, Charles Buschemi

Nicole Wertheim College of Nursing Student Projects

Abstract: There is evidence that the number of cases of hyperlipidemia and diabetes in children is increasing along with the prevalence of childhood obesity in low- and high-income countries. Several factors may influence the dietary management of chronic conditions in children and adolescents, including the perceptions and beliefs of parents and caregivers about the conditions and their role in treating them. Shifting the focus of obesity, hyperlipidemia, and diabetes prevention interventions to the early education of parents has the potential to change children’s dietary habits significantly and decrease their risk of suffering from these chronic conditions. Ab important goal of …

Nutrition In Times Of Crisis: A Qualitative Study In Siargao Island, Philippines, During The Covid-19 Pandemic, Gideon Lasco, Vincen Gregory Yu, Julie Madelo Compra, Phetdavanh Leuangvilay, Rapeepong Suphanchaimat, Yunting Zhang, Charina Javier

Development Studies Faculty Publications

Objectives

Despite the public-health significance of both malnutrition and crises, little has been done to explore the convergence of the two domains and develop ways to improve policies and practices, especially in rural communities. This article remedies that knowledge gap by focusing on nutrition-related changes, responses, and practices during crisis situations in Siargao Island, Philippines, using the COVID-19 pandemic as a backdrop.

Methods

Forty-six (46) semi-structured interviews were conducted among parents, caregivers, local health workers, and local officials of Del Carmen, Siargao Island. Principles of thematic analysis were applied to data analysis using NVivo 12. Afterwards, the preliminary data were …

Vitamin D In The Prevention And Treatment Of Oral Cancer: A Scoping Review, Man Hung, Konstantinia Almpani, Bao Thao, Kaili Sudweeks, Martin S. Lipsky

Institute on Aging Publications

Introduction: Oral cancer is a serious health problem with an increasing incidence worldwide. Researchers have studied the potential anti-cancerous action of vitamin D and its association with several cancers including oral cancer. The purpose of this scoping review is to synthesize the existing literature on the role of vitamin D on oral cancer. Methods: A scoping review of the literature was conducted using the framework developed by Arkey and O’Malley and the PRISMA-ScR guidelines. Nine databases were searched for peer-reviewed human studies published in English that either investigated the association of vitamin D with, or its impact on either the …

The Association Between College Age Students' Nutrition Intake And Depression, Mackenzie Allen

Honors Projects

The research performed was to determine a correlation between depression and nutrient intake in college age students. This study used NHANES publicily available data and IBM's SPSS statistical software to analyze a correlation between depression and nutrition/lifestyle variables: vitamin D, vitamin B12, saturated fatty acids, unsaturated fatty acids, fiber, and exercise. The study found that fiber and unsaturated fatty acid intake had a negative correlation with depression, meaning that as the intake of these nutrients increased, depression decreased. This research reveals key factors to improve the nutritional status of college age students, along with their emotional wellbeing.

International Society Of Sports Nutrition Position Stand: Nutritional Concerns Of The Female Athlete, Stacy T. Sims, Chad M. Kerksick, Abbie E. Smith-Ryan, Xanne A.K. Janse De Jonge, Katie R. Hirsch, Shawn M. Arent, Susan Joyce Hewlings, Susan M. Kleiner, Erik Bustillo, Jaime Tartar, Valerie Starratt, Richard B. Kreider, Casey Greenwalt, Liliana I. Rentería, Michael J. Ormsbee, Trisha Vandusseldorp, Bill I. Campbell, Douglas S. Kalman, Jose Antonio

HPD Articles

Based on a comprehensive review and critical analysis of the literature regarding the nutritional concerns of female athletes, conducted by experts in the field and selected members of the International Society of Sports Nutrition (ISSN), the following conclusions represent the official Position of the Society: 1. Female athletes have unique and unpredictable hormone profiles, which influence their physiology and nutritional needs across their lifespan. To understand how perturbations in these hormones affect the individual, we recommend that female athletes of reproductive age should track their hormonal status (natural, hormone driven) against training and recovery to determine their individual patterns and …

Encouraging Or Guilt-Inducing? An Analysis Of Fitspiration Content And Its Effect On Body Image And Lifestyle Changes, Brenna Mazour

Honors Theses

More people are acquiring their nutrition and exercise information from social media accounts called fitspiration. Analyses of fitspiration content have found the focus to be on restrictive diets and excessive exercise that’s appearance driven. Although its intent is to inspire its consumers to change their lifestyle, many speculate that it brings upon negative body image and induces guilt. The Theory of Planned Behavior (TPB) has been used to determine why people take part in certain health behaviors, such as diets or exercise regimens posted on fitspiration. TPB shows how the characteristics of social media discourage people to use fitspiration as …

Examination Of The Cumulative Risk Assessment And Nutritional Profiles Among College Ballet Dancers, Kenya Moore, Nancy A. Uriegas, Jessica Pia, Dawn M. Emerson, Kelly Pritchett, Toni M. Torres-Mcgehee

All Faculty Scholarship for the College of Education and Professional Studies

This study examined female collegiate ballet dancers’ (n = 28) Female Athlete Triad (Triad) risk via the Cumulative Risk Assessment (CRA) and nutritional profiles (macro- and micronutrients; n = 26). The CRA identified Triad return to play criteria (RTP: Full Clearance, Provisional Clearance, or Restricted/Medical Disqualified) by assessing eating disorder risk, low energy availability, menstrual cycle dysfunction, and low bone mineral density. Seven-day dietary assessments identified any energy imbalances of macro- and micronutrients. Ballet dancers were identified as low, within normal, or high for each of the 19 nutrients assessed. Basic descriptive statistics assessed CRA risk classification and dietary macro- …

Examination Of The Cumulative Risk Assessment And Nutritional Profiles Among College Ballet Dancers, Kenya Moore, Nancy A. Uriegas, Jessica Pia, Dawn M. Emerson, Kelly Pritchett, Toni M. Torres-Mcgehee

Faculty Publications

This study examined female collegiate ballet dancers' ( = 28) Female Athlete Triad (Triad) risk via the Cumulative Risk Assessment (CRA) and nutritional profiles (macro- and micronutrients; = 26). The CRA identified Triad return to play criteria (RTP: Full Clearance, Provisional Clearance, or Restricted/Medical Disqualified) by assessing eating disorder risk, low energy availability, menstrual cycle dysfunction, and low bone mineral density. Seven-day dietary assessments identified any energy imbalances of macro- and micronutrients. Ballet dancers were identified as low, within normal, or high for each of the 19 nutrients assessed. Basic descriptive statistics assessed CRA risk classification and dietary macro- and …

Rabbit Meat—Production, Consumption And Consumers’ Attitudes And Behavior, Shahida Anusha Siddiqui, Francesca Gerini, Ali Ikram, Farhan Saeed, Xi Feng, Yanping Chen

Faculty Research, Scholarly, and Creative Activity

Rabbit meat could play an important role in health, the rural economy, and sustainable development. Rabbit meat has excellent nutritional features, such as high protein content, low-fat content, and a high percentage of unsaturated fatty acids, low cholesterol and sodium levels. In addition, rabbit meat production contributes to maintaining economic activities in rural marginal areas. However, the consumption of rabbit meat is still limited due to several factors such as the higher cost of commercial food that is slowing down rabbits’ breeding. Socio-demographic characteristics, attitudes, and nationality of consumers influence the demand and consumption of rabbit meat. The social and …

Higher Dietary Vitamin K Intake Is Associated With Better Physical Function And Lower Long-Term Injurious Falls Risk In Community-Dwelling Older Women, Marc Sim, C. Smith, Nicky P. Bondonno, Simone Radavelli-Bagatini, Lauren C. Blekkenhorst, Jack Dalla Via, R. Mccormick, K. Zhu, Jonathan M. Hodgson, R. L. Prince, Joshua R. Lewis

Research outputs 2022 to 2026

Background: In recent years, a potential beneficial role of Vitamin K in neuromuscular function has been recognised. However, the optimal dietary intake of Vitamin K to support muscle function in the context of falls prevention remains unknown. Objective: To examine the relationship of dietary Vitamin K1 and K2 with muscle function and long-term injurious fall-related hospitalisations in older women. Design: Cohort study. Participants: 1347 community-dwelling older Australian women ≥ 70 years. Measurements: A new Australian Vitamin K nutrient database, supplemented with published data, was used to calculate Vitamin K1 and K2 intake from a validated food frequency questionnaire at baseline …

Associations Between Daily Wellness Behaviors And Outcomes Among Medical Students, Ankrish Milne, Alexandra Novelli, Carly Watson, Hakeem Yousef, William Copeland, Leigh Ann Holterman, Lee Rosen, Yang Bai, Azilee Curl, Samuel Pasqualoni, Stephen Kirby, Xixi Halvorson-Phelan, James Hudziak

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

Objective: Explore which wellness behaviors have the greatest impact on wellbeing outcomes in medical students.

Methods: A total of 213 medical students were enrolled in this study between June and September 2021. Participants completed a battery of online surveys, including demographic information, and 60-second nightly surveys on the WE-MD smartphone app, which assessed wellness-related indicators (exercise duration, sleep quality, nutrition quality, etc.) and wellbeing outcomes (mood, focus, stress, etc.).

Results: 116 participants completed >50% of nightly surveys between September 2021 and November 2021 and were included in the analysis. All wellness indicators were significantly associated with at least one wellness …

The Most Environmentally Sustainable Diet For Adolescents In Terms Of Land Use, Food Waste, And Greenhouse Gas Emissions., Lina Elsehelly

Papers, Posters, and Presentations

The current food system is directly responsible for much environmental damage including severe climate change, biodiversity loss, and land scarcity. This research aims to find some strategies to mitigate these damages through diet by specifically targeting adolescents because they are potential problem-solvers. This period is also when personality and habits are articulated. By focusing on reducing greenhouse gas emissions, land use, and food waste, a more environmentally sustainable diet can be formulated. The key findings of the research can be summarized by reducing ultra-processed foods, choosing sustainably produced food, generally reducing meat consumption from the current rate, substituting red and …

Effects Of A Residential Lifestyle Intervention Program On Selected Lipid Measures And Nutritional Choices, Delores M. Rugless

DNP Research Projects

Abstract

Objective: Cardiovascular disease has been the leading cause of death since the early 1920s. As with other chronic diseases, cardiovascular disease is primarily influenced by behaviors and the environment, with poor nutrition being a major contributing factor. Despite knowing the importance of lifestyle modification to manage cardiovascular disease effectively, many individuals have difficulty adhering to lifestyle modification principles. Residential lifestyle modification centers provide the education and support necessary to assist individuals with implementing behavioral changes. This DNP project aimed to demonstrate the value of diet modification implemented at a residential lifestyle center to decrease specific cardiovascular risk factors. Method: …

A Lifestyle Management Coaching Intervention For Fear Of Cancer Recurrence In Young Breast Cancer Survivors, Lisa R. Murphy

DNP Research Projects

Abstract

Objective: A significant challenge facing young breast cancer (BC) survivors is learning how to manage fear of cancer recurrence (FCR) during survivorship. Limited tailored FCR interventions and age-appropriate support exist. This Doctor of Nursing (DNP) project, based upon best practice guidelines, aimed to evaluate how a Lifestyle Management Coaching Intervention (LMCI) could help young female BC survivors learn how to decrease and manage their FCR more effectively and experience improved health outcomes.

Method: Eligible participants were female BC survivors aged 18-59 with Stage I-III BC demonstrating elevated baseline FCR screening scores during the extended survival period recruited from the …

Protecting Low-Income Consumers In The Era Of Digital Grocery Shopping: Implications For Wic Online Ordering, Qi Zhang, Priyanka Patel, Caitlin M. Lowery

Community & Environmental Health Faculty Publications

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is now expected to allow participants to redeem their food benefits online, i.e., via online ordering, rather than only in-store. However, it is unclear how this new benefit redemption model may impact participants’ welfare since vendors may have an asymmetric information advantage compared with WIC customers. The WIC online ordering environment may also change the landscape for WIC vendors, which will eventually affect WIC participants. To protect WIC consumers’ rights in the new online ordering model, policymakers need an appropriate legal and regulatory framework. This narrative review provides that …

Investigating Pre-Professional Dancer Health Status And Preventative Health Knowledge, Joanna Nicholas, Sara Grafenauer

Research outputs 2022 to 2026

Introduction: Dance is a highly demanding physical pursuit coupled with pressure to conform to aesthetic ideals. Assessment of health status and preventative health knowledge of pre-professional dancers may help inform educational strategies promoting dancers’ health and career longevity. The aim of this research was to establish a baseline understanding of dance students at a single pre-professional institution based on metrics focused on current health, nutrition, lifestyle, and wellbeing while also gauging knowledge of longer-term health implications. Methods: Adopting a cross-sectional study design, the Dance-Specific Energy Availability Questionnaire was tailored for Australian participants and administered online. Results: The response rate was …

Lifestyle Tools For Men’S Health And Disease Prevention: Well-Being Through Nutrition, Physical Activity, Stress Management, And Connection, Leigh A. Frame

Clinical Research and Leadership Faculty Publications

Mental health is an often-overlooked aspect of overall health and wellness (well-being). Mental illness is increasingly common with 1 in 5 American adults experiencing it annually, and 1 in 20 suffering from a serious mental illness each year [1]. Treatment rates for mental illness are lower in men (37.4%) compared to women (51.2%) [1]. Globally, treatment rates are similar with an estimated cost to the global economy of $1 trillion annually, yet less than 2% of government health expenditure is for mental health worldwide [2]. Despite this, only nine studies have been published specifically targeting men’s mental health through lifestyle …

Association Between The Health Belief Model, Exercise, And Nutrition Behaviors During The Covid-19 Pandemic, Keagan Kiely, Bill Mase, Andrew R. Hansen, Jessica S. Schwind

Department of Biostatistics, Epidemiology, and Environmental Health Sciences Faculty Publications

Introduction: The COVID-19 pandemic has affected our nation’s health further than the infection it causes. Physical activity levels and dietary intake have suffered while individuals grapple with the changes in behavior to reduce viral transmission. With unique nuances regarding the access to physical activity and nutrition during the pandemic, the constructs of Health Belief Model (HBM) may present themselves differently in nutrition and exercise behaviors compared to precautions implemented to reduce viral transmission studied in previous research. The purpose of this study was to investigate the extent of exercise and nutritional behavior change during the COVID-19 pandemic and explain the …

Covid-19, Nutrition, And Gender: An Evidence-Informed Approach To Gender-Responsive Policies And Programs, Anna Kalbarczyk, Noora-Lisa Aberman, Bregje S M Van Asperen, Rosemary Morgan, Zulfiqar Ahmed Bhutta, Bianca Carducci, Rebecca Heidkamp, Saskia Osendarp, Neha Kumar, Anna Lartey

Department of Paediatrics and Child Health

In addition to the direct health impacts of COVID-19, government and household mitigation measures have triggered negative indirect economic, educational, and food and health system impacts, hitting low-and middle-income countries the hardest and disproportionately affecting women and girls. We conducted a gender focused analysis on five critical and interwoven crises that have emerged because of the COVID-19 crisis and exacerbated malnutrition and food insecurity. These include restricted mobility and isolation; reduced income; food insecurity; reduced access to essential health and nutrition services; and school closures. Our approach included a theoretical gender analysis, targeted review of the literature, and a visual …

Processed Food As A Risk Factor For The Development And Perpetuation Of Crohn's Disease-The Enigma Study, Gina L. Trakman, Winnie Y.Y. Lin, Amy L. Hamilton, Amy L. Wilson-O'Brien, Annalise Stanley, Jessica Y. Ching, Jun Yu, Joyce W.Y. Mak, Yang Sun, Junkin Niu, Yinglei Miao, Xiaoqing Lin, Rui Feng, Minhu Chen, Nitin Shivappa Mbbs, Mph, Ph.D., James R. Hébert Scd, Mark Morrison, Siew C, Ng, Michael A. Kamm

Faculty Publications

(1) Background: Developing countries have experienced a rapid recent rise in Inflammatory Bowel Disease (IBD) incidence and emerging evidence suggests processed foods and food additives may predispose one to the development and perpetuation of Crohn’s disease (CD). The aim of this study was to evaluate processed food and food additive intake in CD patients and controls, in Australia (high CD incidence), Hong Kong (intermediate incidence) and mainland China (emerging incidence). (2) Methods: In 274 CD patients (CD), 82 first-degree relatives (FDR), 83 household members (HM) and 92 healthy unrelated controls (HC) from Australia (n = 180), Hong Kong (HK) (n …

Food Insecurity Among Low-Income Households With Children Participating In A School-Based Fruit And Vegetable Co-Op, Allison N Marshall, Ru-Jye Chuang, Joanne Chow, Nalini Ranjit, Jayna M Dave, Mallika Mathur, Christine Markham, Shreela V Sharma

Student and Faculty Publications

The purpose of this study was to evaluate the impact of a nutrition intervention on food insecurity among low-income households with children. Data were collected from 371 parent−child dyads in a quasi-experimental evaluation study of a 1-year intervention (n = 6 intervention schools receiving Brighter Bites, n = 6 wait-list control schools), and longitudinal follow-up of the intervention group 2 years post-intervention in Houston, Texas. Data were collected at three timepoints: at baseline and 1 year for all participants, and at 2 year follow-up for the intervention group (the wait-list control group received the intervention during that time). At baseline, …