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Full-Text Articles in Medicine and Health Sciences

Program Curricula For Preparing Medical Professionals On Early Childhood Mental Health, Socio-Emotional Development, And Adverse Childhood Experiences In Primary Care Settings: A Phenomenological Study, Jesutomilola O. Olayemi May 2024

Program Curricula For Preparing Medical Professionals On Early Childhood Mental Health, Socio-Emotional Development, And Adverse Childhood Experiences In Primary Care Settings: A Phenomenological Study, Jesutomilola O. Olayemi

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Primary care settings serve as the frontline for addressing the holistic well-being of individuals and particularly for children, they play a pivotal role in shaping early childhood experiences. Pediatric primary care physicians are pivotal in addressing the scarcity of mental health resources for children aged zero to five. There is limited knowledge regarding the competence of pediatric primary care providers in providing developmentally appropriate mental health care in early childhood. Therefore, this phenomenological study examined how early childhood mental health, social-emotional development, and adverse childhood experiences and their related screening practices were integrated into the curricula for preparing prospective pediatric …


Navigating New Normals: Student Perceptions, Experiences, And Mental Health Service Utilization In Post-Pandemic Academia, Hadiza Galadima, Anne Dumadag, Cara Tonn Jan 2024

Navigating New Normals: Student Perceptions, Experiences, And Mental Health Service Utilization In Post-Pandemic Academia, Hadiza Galadima, Anne Dumadag, Cara Tonn

Community & Environmental Health Faculty Publications

This study explores the profound impacts of the COVID-19 pandemic on higher education, focusing on shifts in learning experiences and students’ intentions to utilize mental health services post-pandemic. Utilizing Andersen’s Behavioral Model of Health Services Use, this study assesses perceptions from a stratified random sample of college students on post-pandemic learning experiences and mental health service utilization intentions. Findings reveal a positive reception to university initiatives and a preference for ongoing virtual classes. There is an evident increase in, and varying intentions for, using mental health services, shaped by demographics, employment, and prior service utilization. Younger and female students showed …


Identifying Youth Appeals In Alcohol Alternative Social Media Content Through Framing, Melina Oneal Jan 2024

Identifying Youth Appeals In Alcohol Alternative Social Media Content Through Framing, Melina Oneal

West Chester University Master’s Theses

Proposed regulations for alcohol advertising prevent beverage companies from targeting people under the legal drinking age. However, similar regulations for alcohol alternative beverages are less explored, which could allow alcohol alternative products to create awareness for alcoholic beverages among youth. Alcohol alternatives beverages, including no-alcohol and low-alcohol products, are increasing in popularity and can function as compliments to alcoholic products to decrease the total alcohol volume consumed or as substitutes for alcoholic products. Framing theory can be operationalized through the Content Appealing to Youth Index, an index of content elements found in research literature to be appealing to youth, to …


The Impact Of Sitting And Crawling On The Acquisition Of Object Permanence In Infants With Motor Delays And Infants With Typical Development, Karl Jancart Dec 2023

The Impact Of Sitting And Crawling On The Acquisition Of Object Permanence In Infants With Motor Delays And Infants With Typical Development, Karl Jancart

Electronic Theses and Dissertations

Object permanence (OP) is the ability to understand that objects continue to exist even when they cannot be perceived. During play, infants with an understanding of OP will continue searching for toys when the toys have been obscured by other items. Searching requires movement. The theory of embodied cognition maintains that the form and function of an organism’s body influence how the organism learns; Therefore, if a child has difficulties with movement, as demonstrated by children with motor delays, they will likely have difficulty engaging in play, the modality by which children learn about their world. The current research is …


Mixed Method Approach Towards The Life Of University Students During The Covid-19 Pandemic, Raihan Khan, Andrew White, Tony Jehi Sep 2023

Mixed Method Approach Towards The Life Of University Students During The Covid-19 Pandemic, Raihan Khan, Andrew White, Tony Jehi

Department of Health Sciences - Faculty Scholarship

Background

The COVID-19 pandemic negatively impacted the higher education system. This mixed-methods study aimed to assess COVID-19 fear, anxiety, and stress among Shenandoah Valley college students.

Methods

An online survey was fielded and completed by n=680 students. Qualitative semi-structured interviews were conducted with 20 students.

Results

The mean participant age was 22.14±5.48 years, and primarily White (81.9%), women (80.4%), and undergraduate (78.0%) students. Approximately 41% were enrolled in health-related majors (41.4%). Women students had significantly higher anxiety, depression, and fear of contracting COVID-19 than men. Undergraduate students had significantly higher depression than graduate students. Qualitative analysis revealed several major themes: …


A Post Pandemic Analysis Of Covid-19 And The Impact On Mental Health Of High School Student-Athletes—Today, More Than Ever Minds Matter, Pastora Hernandez Barbee Aug 2023

A Post Pandemic Analysis Of Covid-19 And The Impact On Mental Health Of High School Student-Athletes—Today, More Than Ever Minds Matter, Pastora Hernandez Barbee

Ed.D. Dissertations in Practice

The cancellation of sporting opportunities during the COVID-19 pandemic caused many student-athletes to feel deprived of the only outlet they had, which held a significant component of their personal and athletic identities (Grubic et al. 2021). This study aimed to answer the following research question: What are the experiences of high school student-athletes in a Pacific Northwest school district with access and support for holistic wellness in a post-pandemic COVID-19 school environment? The research methodology used was the wellness theory framework (Adams, Bezner, & Steinhardt, 1997). A total of seven student-athletes participated in the study through in-depth interviews. From the …


Identifying Associations Between The Family Environment And Anxiety And Depression Among Children Ages 0-17 In The United States, Reagan A. Richardson, Nicole M. Holt Aug 2023

Identifying Associations Between The Family Environment And Anxiety And Depression Among Children Ages 0-17 In The United States, Reagan A. Richardson, Nicole M. Holt

OUR Journal: ODU Undergraduate Research Journal

This study analyzes whether physical, emotional & neurological, family environment, or community-related factors display the strongest association with anxiety and depression among children ages 0-17 in the United States.

Using IBM SPSS v. 27, we conducted a univariate and multivariate logistic regression analysis on data from the 2017 National Survey of Children’s Health (NSCH) with a sample size of 21,599. Our independent variables included 30 questions from the NSCH which were compared to a mental health index score.

Our study shows that about 10.6% of children suffer from either anxiety, depression, or both, and the univariate model found that 19 …


My Path To Advanced Practice, Hannah Oiselle Knisley May 2023

My Path To Advanced Practice, Hannah Oiselle Knisley

Graduate Student Portfolios, Professional Papers, and Capstone Projects

No abstract provided.


School Psychologists’ Knowledge And Perceived Competence Regarding Concussion Management In Schools, Braelyn Tracy May 2023

School Psychologists’ Knowledge And Perceived Competence Regarding Concussion Management In Schools, Braelyn Tracy

Electronic Theses and Dissertations

A concussion is a type of traumatic brain injury that can have a serious effect on a young, developing brain. Following a concussion, it is common for children and adolescents to experience difficulties in the school setting. Schools may be the ideal setting to address some of the problems children experience as schools employ some personnel with expertise and experience in assessment and intervention. If return to learn is put to the side, students experiencing concussion signs and symptoms could potentially have long-term cognitive problems. School psychologists play a key role in the prevention and assessment of, and intervention for …


On Versus Off-Campus Living: An Exploration Of College Students' Mental Well-Being, Sameer Siddiqui May 2023

On Versus Off-Campus Living: An Exploration Of College Students' Mental Well-Being, Sameer Siddiqui

Theses/Capstones/Creative Projects

The World Health Organization defines mental health as “a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community” (“Mental Health,” 2022). Risk and protective factors can be used to predict mental health outcomes. Both positive and negative outcomes can be predicted, respectively. The categories of these include individual, relationship, community, and societal. When examining college students, it is most reasonable to study the relationship and community factors. This study examined whether living on or off campus impacts predicted mental health outcomes in …


Teaching As Accommodation: The Benefits Of Teaching All Children Through A Trauma-Informed Lens, Megan Retzloff May 2023

Teaching As Accommodation: The Benefits Of Teaching All Children Through A Trauma-Informed Lens, Megan Retzloff

Art of Teaching Thesis - Written

Adverse Childhood Experiences (ACEs) are an epidemic in our society. In 2021 alone, an estimated 600,000 children in the United States experienced abuse or neglect, with 90.6% of all reported cases documenting one or both parents as the perpetrator (HHS, 2023). As educators, we play an important role in preventing and mitigating the effects of ACEs in our students. When a child’s home life is unstable, schools and teachers are the next line of defense. Throughout the United States, schools are the constant; they are a universal provider even in areas that otherwise have limited access to support. Schools are …


Targeting The Gap In Mental Health Advocacy For First-Year College Students, Hailey Kurtz Apr 2023

Targeting The Gap In Mental Health Advocacy For First-Year College Students, Hailey Kurtz

Honors Projects

The transition from high school to attending a university has been shown to have an impact on the mental health and well-being of first-year university students. First-year students struggle with anxiety and depression in relation to being in a new environment, feeling lonely, fitting in, and taking more academically rigorous coursework. Current students have an awareness of what mental health and well-being resources on their campus are available to them, but such resources are not widely used, though a majority of students indicate that they do or have struggled with their mental health. This indicates that though students are struggling …


An Exploration Of The Social And Economic Factors That Influence The Mental Health Of Lgbtq College Students, Alexandria Mh Fossum Apr 2023

An Exploration Of The Social And Economic Factors That Influence The Mental Health Of Lgbtq College Students, Alexandria Mh Fossum

Senior Theses

LGBTQ individuals face a much higher prevalence of psychiatric disorders and mental health issues than their heterosexual, cisgender counterparts. The added academic pressures of college introduce a unique set of challenges that LGBTQ students face. This thesis includes a review of academic literature and data examining the intersections between social isolation, institutional discrimination, and financial insecurity and the effects they have on the mental health outcomes of LGBTQ college students. The paper is accompanied by a documentary consisting of a set of interviews of LGBTQ college students, giving a more personal insight into the multitude of factors that affect their …


The International Student Social Experience At A Predominantly White Institution, Arianna Patel Apr 2023

The International Student Social Experience At A Predominantly White Institution, Arianna Patel

Senior Theses and Projects

Past research has shown widespread disparities in the way domestic students adjust to this transition versus the way international students adjust to the transition of moving into university; especially at predominantly white institutions (PWI) within The United States of America. In many studies, international students have been found to attain elevated levels of anxiety, and experience more difficulty in finding a sense of belonging. Therefore, the present study sought to examine these concerns more carefully. 49 students from all academic years at Trinity College, a PWI, were administered two surveys in order to objectively gauge their levels of anxiety and …


Paths To Equity: Parents In Partnership With Ucedds Fostering Black Family Advocacy For Children On The Autism Spectrum, Elizabeth H. Morgan, Benita D. Shaw, Ida Winters, Chiffon King, Jazmin Burns, Aubyn Stahmer, Gail Chodron Feb 2023

Paths To Equity: Parents In Partnership With Ucedds Fostering Black Family Advocacy For Children On The Autism Spectrum, Elizabeth H. Morgan, Benita D. Shaw, Ida Winters, Chiffon King, Jazmin Burns, Aubyn Stahmer, Gail Chodron

Developmental Disabilities Network Journal

Racism and ableism have doubly affected Black families of children with developmental disabilities in their interactions with disability systems of supports and services (e.g., early intervention, mental health, education, medical systems). On average, Black autistic children are diagnosed three years later and are up to three times more likely to be misdiagnosed than their non-Hispanic White peers. Qualitative research provides evidence that systemic oppression, often attributed to intersectionality, can cause circumstances where Black disabled youth are doubly marginalized by policy and practice that perpetuates inequality. School discipline policies that criminalize Black students and inadequate medical assessments that improperly support Black …


State Level Mental Health Education Compared To Suicide-Related Behavior In Adolescents, 2019, Sonia Rao Jan 2023

State Level Mental Health Education Compared To Suicide-Related Behavior In Adolescents, 2019, Sonia Rao

Honors Theses

Objective: Determining correlations between state level mental and emotional health (M&E) education and suicide prevention (SP) education to suicide-related behaviors (I.e. feeling sad or hopeless, suicide ideation, making a suicide plan, suicide attempt, suicide attempt treated by medical personnel, and death by suicide) within high school adolescents aged 15-19 within the United States in 2019.

Methods: State level education policies, M&E and SP, were retrieved from the National Association of State Boards of Education (NASBE). Self-reported adolescent suicide related behaviors were retrieved from the 2019 Youth Risk Behavior Surveillance System (YRBSS). Data on deaths by suicide of youth aged 15-19 …


Assessing 4-H And Its Circle Of Courage In A Psychiatric Residential Treatment Facility: A Case Study, Elizabeth Steering Jan 2023

Assessing 4-H And Its Circle Of Courage In A Psychiatric Residential Treatment Facility: A Case Study, Elizabeth Steering

Theses and Dissertations--Family Sciences

This 4-H case study takes place in a psychiatric residential treatment facility (PRTF) in Kentucky. The PRTF provides clinical services to youth that are not able to be safely maintained in their homes due to having demonstrated unsafe or harmful behaviors. Youth admitted to the PRTF stay for an average of three to six months while they receive intensive therapeutic and psychiatric care as well as medical treatment and public schooling. The current case study incorporates programming from 4-H, which is the youth development program of the Cooperative Extension System (CES) and the National Institute of Food and Agriculture (NIFA), …


Propuesta De Abordaje De La Salud Mental Positiva En Contextos Escolarizados. Experiencia Con Adolescentes Migrantes Venezolanos De La Institución Educativa San José En Cúcuta - Colombia, Jesús Andrés Sánchez Suárez Jan 2023

Propuesta De Abordaje De La Salud Mental Positiva En Contextos Escolarizados. Experiencia Con Adolescentes Migrantes Venezolanos De La Institución Educativa San José En Cúcuta - Colombia, Jesús Andrés Sánchez Suárez

Doctorado en Educación y Sociedad

La promoción de la salud mental positiva -SMP- en adolescentes es una herramienta fundamental para facilitar procesos de bienestar no solo individuales sino comunitarios. Estudiar esta categoría en la población migrante se constituye en reto y a la vez oportunidad para generar acciones que promuevan el bienestar en este grupo poblacional que vive en condiciones particulares de vulnerabilidad de tipo social, económico, político, cultural y personal, entre otros. Así, esta investigación, que está inscrita en el subsistema de éticas, políticas públicas y ciudadanías, tuvo como objetivo diseñar una propuesta de abordaje de la salud mental positiva para adolescentes escolarizados que …


Improving Caregiver Implementation Of Communication Supports For Young Children With Autism, Heather Coleman, Selena J. Layden, Lynda Gayle Horner Jan 2023

Improving Caregiver Implementation Of Communication Supports For Young Children With Autism, Heather Coleman, Selena J. Layden, Lynda Gayle Horner

Communication Disorders & Special Education Faculty Publications

The use of evidence-based practices (EBPs) in the child's natural setting is critical for young children with autism spectrum disorder (ASD) to improve communication skills and promote generalization. Yet, to implement EBPs effectively, caregivers often require training. The purpose of this study is to explore the efficacy of behavior skills training (BST) to teach a caregiver to implement a parent-implemented discrete trial training (DTT) intervention in their home. Using a multiple baseline design, one caregiver was taught to implement the intervention focused on three verbal behavior operants. Results demonstrated a functional relation between the BST and caregiver implementation. This study …


Mental Health Help-Seeking Behaviors Of First-Year University Students, Kylie A. Roberts Jan 2023

Mental Health Help-Seeking Behaviors Of First-Year University Students, Kylie A. Roberts

Electronic Theses and Dissertations

The early college years represent a specific period in a student’s life that is crucial for their development. Approximately one in three college students meet the criteria for a mental health problem (Eisenberg et al., 2013). Universities have unique opportunities for identifying risk and delivering prevention or intervention strategies to students in need. The purpose of this study was to investigate factors associated with First-Year University students’ help-seeking behaviors for university-based mental health services. H1: There will be group differences between gender and race/ethnicity on help-seeking behaviors, knowledge barriers of services or providers and perceived stigma. H2 …


Moderating Factors In The Relationship Between Bully Victimization And Psychosomatic Symptoms, Tonya Paulson Oct 2022

Moderating Factors In The Relationship Between Bully Victimization And Psychosomatic Symptoms, Tonya Paulson

Theses and Graduate Projects

The purpose of this study was to investigate the relationship between bully victimization and psychosomatic symptoms, and to examine the protective influence of perceived parent and peer support across developmental age groups. Bully victimization frequency, somatic symptom severity, perceived parent support, and perceived peer support were assessed using archival data from 7,304 youth who participated in the 2009-2010 Health Behavior in School-Aged Children (HBSC) U.S. survey, excluding perpetrators of bullying. Bully victimization and somatic symptoms were significantly positively correlated. Older adolescents consistently reported more severe somatic symptoms, but age did not moderate the relationship between bullying and somatic symptoms. Higher …


“Living In Trauma 24/7”: A Qualitative Exploration Of Factors Contributing To Secondary Traumatic Stress And Burnout Among Student Services Professionals Working With Marginalized Student Populations, Delia Sanchez, Portia A. Jackson Preston, Christine Vu, Lucia Alcala Oct 2022

“Living In Trauma 24/7”: A Qualitative Exploration Of Factors Contributing To Secondary Traumatic Stress And Burnout Among Student Services Professionals Working With Marginalized Student Populations, Delia Sanchez, Portia A. Jackson Preston, Christine Vu, Lucia Alcala

Journal of Human Services: Training, Research, and Practice

Higher education professionals are at risk of secondary traumatic stress (STS) as a result of supporting students experiencing trauma, while overwhelming workload, inadequate resources, and unclear role responsibilities may lead to burnout. This study explored contributing factors to STS and burnout and coping efforts among faculty, students, and staff working in a capacity in which they provide non-instructional support to programs or centers focusing on marginalized student populations. Participants (N=56) represented twenty-two U.S. regional universities, and were a subset of respondents to a larger mixed-methods study (n=559). Qualitative responses to three open-ended questions on challenges and coping efforts were analyzed …


Emergency Care For Youth Who Experience Suicidality And Identify As Lesbian Gay Bisexual Transgender Queer/Questioning (Lgbtq+): An Interpretive Phenomenology, Theresa Schultz Aug 2022

Emergency Care For Youth Who Experience Suicidality And Identify As Lesbian Gay Bisexual Transgender Queer/Questioning (Lgbtq+): An Interpretive Phenomenology, Theresa Schultz

Electronic Theses and Dissertations

Purpose: Suicide is a leading cause of death in children; youth who identify as LGBTQ+ are at an exponentially higher risk of suicide. The purpose of this study was to explore the lived experiences of young adults who identify as LGBTQ+ and sought emergency care for suicidality when they were adolescents.

Methods: Heideggerian hermeneutics phenomenology is the research method used in this study. Youth, ages 18-25 years, who identify as LGBTQ+ and sought emergency treatment for suicidality when they were adolescents (13-17 years) were recruited to participate;fifteen youth enrolled. Individuals ranged in age from 20 to 25 years. Participants described …


Covid-19 & Mental Health: The Impact On The Future Of Younger Generations, Greyson A. Fox Tran Apr 2022

Covid-19 & Mental Health: The Impact On The Future Of Younger Generations, Greyson A. Fox Tran

Senior Theses

The aim of this research is to identify any existing correlations between the COVID-19 pandemic and negative mental health outcomes in younger populations. This paper examines the impact of the COVID-19 pandemic on the mental health of those younger than 25 years of age, specifically focusing on students. It will investigate how various factors of the pandemic have affected people and how they have coped with psychological distress induced by the pandemic. Through a review of scientific data and scholarly literature, the impacts of the pandemic on mental health will be assessed. Coping mechanisms and the effects of physical activity …


Trauma-Informed Teaching: Professional Development For School Staff, Heather Roesinger, Chelsea Williams, Tammy L. Hughes Mar 2022

Trauma-Informed Teaching: Professional Development For School Staff, Heather Roesinger, Chelsea Williams, Tammy L. Hughes

Graduate Student Research Symposium

Trauma is defined as a response to a negative event that includes both an emotional and physiological component. Two thirds of children experience some form of a traumatic event by the age of 16 (Cavanaugh, 2016). Many youth with disabilities, particularly emotional and behavioral, have experienced trauma and show visible signs of difficulty in the classroom (Cavanaugh, 2016). Trauma-informed schools take a strengths-based approach and focus on building safe, positive environments and relationships. Research has provided evidence that a trauma-informed approach can be instrumental in supporting positive outcomes of children exposed to trauma, but school staff feel ill-equipped to support …


Exploring The Potential For Therapeutic Art-Making In School Psychology Practice: A Single Case Study Of A Training Experience, Alexandra G. Manion Jan 2022

Exploring The Potential For Therapeutic Art-Making In School Psychology Practice: A Single Case Study Of A Training Experience, Alexandra G. Manion

Electronic Theses and Dissertations

The purpose of this study was to investigate the impact of a training experience on the use of therapeutic art-making for school psychologists, with a focus on how to incorporate these concepts into their school-based mental health practice. Therapeutic artmaking includes the use of visual art activities (drawing, painting, clay, and collage) with specific therapeutic intent. Although there are examples of art therapists providing inschool therapeutic art-making services to support the mental health needs of students, there is far less information regarding the use of therapeutic art-making by school-based mental health providers, including school psychologists. This single case study explored …


Examining Emailed Feedback As Boosters After A College Drinking Intervention Among Fraternities And Sororities: Rationale And Protocol For A Remote Controlled Trial (Project Greek), Abby L. Braitman, Jennifer L. Shipley, Megan Strowger, Rachel Ayala Guzman, Alina Whiteside, Adrian J. Bravo, Kate B. Carey Jan 2022

Examining Emailed Feedback As Boosters After A College Drinking Intervention Among Fraternities And Sororities: Rationale And Protocol For A Remote Controlled Trial (Project Greek), Abby L. Braitman, Jennifer L. Shipley, Megan Strowger, Rachel Ayala Guzman, Alina Whiteside, Adrian J. Bravo, Kate B. Carey

Psychology Faculty Publications

BACKGROUND: College students involved in Greek life (ie, members of fraternities and sororities) tend to engage in more high-risk alcohol use and experience more negative consequences than those not involved in Greek life. Web-based alcohol interventions, such as Alcohol eCHECKUP TO GO, have been successful in reducing alcohol use and consequences among the general college student population, but interventions targeting alcohol reduction among those involved in Greek life have had limited success. Booster emails including personalized feedback regarding descriptive norms and protective behavioral strategies have shown potential in increasing the effectiveness of web-based interventions among college drinkers. Studies are needed …


Mental Health, Bullying, And Victimization Among Chinese Adolescents, Yang Wen, Xihe Zhu, Justin A. Haegele, Fangliang Yu Jan 2022

Mental Health, Bullying, And Victimization Among Chinese Adolescents, Yang Wen, Xihe Zhu, Justin A. Haegele, Fangliang Yu

Human Movement Sciences & Special Education Faculty Publications

The purpose of this study was to examine if adolescents who experience anxiety or depression have higher levels of reported bullying victimization or perpetration than those who do not. Based on the existing research, we hypothesized that those who experienced moderate or severe depression and anxiety would have higher rates of bullying victimization and perpetration when compared to those who experienced mild or no depression. This study used an observational design, and data were collected from a convenience sample of adolescents in a large regional high school in an Eastern province of China. The final sample included 1481 adolescents aged …


Peer-Led Building Resilience And Enhancing Social-Emotional Skills Program, Danielle K. Enrico Dec 2021

Peer-Led Building Resilience And Enhancing Social-Emotional Skills Program, Danielle K. Enrico

Department of Occupational Therapy Entry-Level Capstone Projects

The purpose of the Capstone experience was to develop and implement a five-week peer-led building resilience and social-emotional skills training program at a public high school. This program addressed high school students' knowledge, skills, and attitudes regarding resources, social-emotional skills, and resilience. A questionnaire was administered pre and post-program to measure effectiveness. The results indicated an increase in scores, demonstrating a clearer understanding in all three areas.


Social Anxiety Screening And Associated Factors Among University Students, Kathleen Prendergast Oct 2021

Social Anxiety Screening And Associated Factors Among University Students, Kathleen Prendergast

Seton Hall University Dissertations and Theses (ETDs)

Social anxiety is a type of anxiety triggered by social situations whereby the individual feels scrutinized by others, and which may contribute to avoidance of certain situations. This avoidance can interfere with personal, academic, and career endeavors. Cognitive behavioral therapy can help manage social anxiety. However, social anxiety is often underrecognized and
under treated. A survey with the Liebowitz Social Anxiety Scale (LSAS) was disseminated to identify and address this need among students in a large Northeastern university in the United States. The study is valuable as a pilot study. There was a small response rate for participation in the …