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2019

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Articles 1 - 25 of 25

Full-Text Articles in Public Health

Quality Evaluation Tool For Clinician Online Continuing Medical Education, Brittany Rosen, Gary Kreps, James M. Bishop Mr., Skye L. Mcdonald Dec 2019

Quality Evaluation Tool For Clinician Online Continuing Medical Education, Brittany Rosen, Gary Kreps, James M. Bishop Mr., Skye L. Mcdonald

Health Behavior Research

The purpose of this study was to develop and assess an instrument evaluating the quality of online continuing medical education interventions for clinicians. A review of seminal literature for evaluating health-related websites was conducted to incorporate best practices from health education, health communication, and web-based design principles. After reviewing the literature, 12 preliminary quality indicators were developed. Two independent coders used the preliminary quality indicators to code continuing medical education interventions. Internal reliability of the preliminary indicators was calculated using the Krippendorff’s alpha coefficient. After completing the reliability testing and revising the tool, the quality evaluation framework consisted of six …


Exposure To Violence And Sleep Inadequacies Among Men And Women Living In A Shelter Setting, Pooja Agrawal, Julie Neisler, Michael S. Businelle Phd, Darla E. Kendzor Phd, Daphne C. Hernandez, Chisom Odoh, Lorraine R. Reitzel Dec 2019

Exposure To Violence And Sleep Inadequacies Among Men And Women Living In A Shelter Setting, Pooja Agrawal, Julie Neisler, Michael S. Businelle Phd, Darla E. Kendzor Phd, Daphne C. Hernandez, Chisom Odoh, Lorraine R. Reitzel

Health Behavior Research

Exposure to violence may explain sleep inadequacies reported by homeless adults, with women being potentially more susceptible to violence and sleep disturbances than men. This study examined the association between violence and sleep inadequacies among homeless adults and explored differences by sex. Adult participants were recruited from a shelter (n = 194; 71.1% men, Mage = 43.8+12.2). Participants self-reported victimization and/or witnessing violence (mugging, fight, and/or sexual assault) at the shelter, sleep duration (over an average 24 hours), insufficient sleep (days without sufficient rest/sleep), and unintentional daytime sleep (days with unintentional sleep) in the past month. Linear regressions …


Diet Quality As A Mediator Of The Relation Between Income-To-Poverty Ratio And Overweight/Obesity Among Adults: Moderating Effect Of Sex, Sajeevika S. Daundasekara, Nipa P. Kamdar, Ashley Dao, Anna Greer, E. Lisako J. Mckyer, Daphne C. Hernandez Dec 2019

Diet Quality As A Mediator Of The Relation Between Income-To-Poverty Ratio And Overweight/Obesity Among Adults: Moderating Effect Of Sex, Sajeevika S. Daundasekara, Nipa P. Kamdar, Ashley Dao, Anna Greer, E. Lisako J. Mckyer, Daphne C. Hernandez

Health Behavior Research

Poverty status influences obesity and dietary quality, and dietary quality influences obesity. How these relationships differ by sex is unclear. The current study aims were to 1) determine whether dietary quality mediates the relation between income-to-poverty ratio (IPR) and overweight/obesity (OV/OB) among men and women, separately, and 2) determine whether either of the mediated paths differs by sex. Four cycles of NHANES (2007-2014) were merged to obtain an unweighted study sample of 12,768 adults with complete data. Exposure variables included self-reported measures of IPR, Healthy Eating index (HEI) total score to measure diet quality, and sex. Direct assessment of …


Adult Food Insecurity Is Associated With Heavier Weight Preferences Among Black Women, Layton Reesor-Oyer, Nadia Garcia Marroquin, Daphne C. Hernandez Dec 2019

Adult Food Insecurity Is Associated With Heavier Weight Preferences Among Black Women, Layton Reesor-Oyer, Nadia Garcia Marroquin, Daphne C. Hernandez

Health Behavior Research

Food insecurity is related to overweight/obesity among women. However, it is unknown whether food insecurity impacts individuals’ desired body composition, and whether this relationship differs by race/ethnicity similar to perceived ideal weight status. This study aims to evaluate whether food insecurity is related to elevated preferred weight status (e.g., overweight/obese versus normal weight) among black, white, and Hispanic women classified as overweight/obese. Four waves of NHANES data (2007–2014) were merged and yielded a total of 907 black, 1,271 white, and 1,005 Hispanic non-pregnant adult (age 20 to 59) women classified as overweight/obese. Participants self-reported their preferred weight status, adult-level food …


Consistency Of Reported Barriers For Colorectal Cancer Screening Among Adults Who Have Never Been Screened, Cherie Conley, Amanda J. Dillard, Constance M. Johnson, John A. Updegraff, Wei Pan, Alyssa Langenberg, Isaac Lipkus Dec 2019

Consistency Of Reported Barriers For Colorectal Cancer Screening Among Adults Who Have Never Been Screened, Cherie Conley, Amanda J. Dillard, Constance M. Johnson, John A. Updegraff, Wei Pan, Alyssa Langenberg, Isaac Lipkus

Health Behavior Research

Morbidity and mortality from colorectal cancer can be decreased by addressing patient barriers to colorectal cancer screening; especially among adults who have never been screened. Assessing changes in barriers over time may help practitioners better tailor interventions to address patient barriers. We assessed among adults ages 50 -75 who have never been screened for colorectal cancer (CRC) which barriers predict prospective screening. A sample of 560 adults who had never been screened, recruited from Growth for Knowledge’s online panel, completed a baseline and a six-month follow-up survey. Both surveys assessed screening barriers after an online intervention that involved conveying tailored …


Cross-Sectional Associations Of Opiate Misuse/Opioid Use Disorder Among Adults Experiencing Homelessness, Valentina Maza, Daphne C. Hernandez, Phd, Msed, Faahb, Darla E. Kendzor Phd, Michael S. Businelle Phd Dec 2019

Cross-Sectional Associations Of Opiate Misuse/Opioid Use Disorder Among Adults Experiencing Homelessness, Valentina Maza, Daphne C. Hernandez, Phd, Msed, Faahb, Darla E. Kendzor Phd, Michael S. Businelle Phd

Health Behavior Research

The purpose of this manuscript is to determine the prevalence of opioid misuse/opioid use disorder (OUD) among adults experiencing homelessness and describe characteristics that account for significant variance in relation to opioid misuse in those who misuse and do not misuse opioids. From six homeless shelters in Oklahoma City, adults participated in a survey about their demographics, substance use, mental health, and physical health from July to August of 2016 (n = 569). For assessing substance use, participants responded about their opioid misuse and diagnosis of OUD, current smoking status, arrests due to drug possession or driving while intoxicated, …


Health Literacy And Self-Rated Health Among Homeless Adults, Chisom Odoh Phd, Jennifer I. Vidrine Phd, Michael S. Businelle Phd, Darla E. Kendzor Phd, Pooja Agrawal, Lorraine R. Reitzel Phd Dec 2019

Health Literacy And Self-Rated Health Among Homeless Adults, Chisom Odoh Phd, Jennifer I. Vidrine Phd, Michael S. Businelle Phd, Darla E. Kendzor Phd, Pooja Agrawal, Lorraine R. Reitzel Phd

Health Behavior Research

Poor health literacy reduces the efficacy of behavior change interventions, hampers management of health conditions, and attenuates understanding of the prevention and treatment of diseases. Poor health literacy has also been linked to fair/poor self-rated health in domiciled samples; however, there is a paucity of studies on the relation amongst homeless adults, who bear a disproportionate burden of disease and disability and require a high level of care and access to health services. Here, we examined the association between health literacy and self-rated health among a convenience sample of homeless adults. Participants were recruited from six homeless-serving agencies in Oklahoma …


What Determines Young Adults’ Attitudes, Perceived Norms, And Perceived Behavioral Control Towards Healthy Sleep Behaviors? A Reasoned Action Approach, Paul Branscum, Katie Qualls Fay Dec 2019

What Determines Young Adults’ Attitudes, Perceived Norms, And Perceived Behavioral Control Towards Healthy Sleep Behaviors? A Reasoned Action Approach, Paul Branscum, Katie Qualls Fay

Health Behavior Research

A common limitation to the design of public health sleep interventions is the overall lack of using theory. Previous researchers have utilized the theory of planned behavior and the reasoned action approach (RAA) to predict healthy sleep behaviors, however much of this research was done using reflective (or generalized) measures, which alone is likely inadequate to equip health practitioners with tangible information they can use to translate theory into practice. Therefore, the purpose of this study was to use formative (or belief-based) measures of the RAA to evaluate the determinants of attitudes, perceived norms, and perceived behavioral control (PBC) of …


Food Insecurity As A Predictor Of Hurricane Exposure Among Underserved Adolescents, Katherine R. Arlinghaus, Daphne C. Hernandez, Craig Johnston Dec 2019

Food Insecurity As A Predictor Of Hurricane Exposure Among Underserved Adolescents, Katherine R. Arlinghaus, Daphne C. Hernandez, Craig Johnston

Health Behavior Research

Low-income populations are at increased risk for experiencing negative hurricane exposures and food insecurity. However, little is known regarding how pre-hurricane food insecurity experiences are related to youth hurricane exposure. This study examined the types of hurricane disaster exposures low-income, ethnic minority adolescents experienced during Hurricane Harvey and examined the association between food insecurity and hurricane exposure. Low-income adolescents (n = 185) were recruited from a Houston-area school district. Two days before the hurricane, food insecurity was assessed. Adolescents with at least one affirmative answer on the 9-item USDA Child Food Security Survey Module were classified as food insecure. …


Negative School Experiences And Pain Reliever Misuse Among A National Adolescent Sample, Kelsi J. Wood, Keith A. King, Rebecca A. Vidourek, Ashley L. Merianos Dec 2019

Negative School Experiences And Pain Reliever Misuse Among A National Adolescent Sample, Kelsi J. Wood, Keith A. King, Rebecca A. Vidourek, Ashley L. Merianos

Health Behavior Research

A recent public health concern is the nonmedical use of prescription drugs among U.S. adolescents. The purpose of this study was to determine the relationship between negative school experiences and lifetime and past year pain reliever misuse among adolescents enrolled in high school nationwide. A secondary analysis was performed using the National Survey on Drug Use and Health 2017 data. Participants included 8,337 adolescents enrolled in 9th -12th grades. A total of 6.0% of high school students reported they had misused pain relievers in their lifetime, and 3.9% reported they had misused pain relievers during the past year. …


Using The Theory Of Triadic Influence To Examine Correlates Of Positive Drug Expectancies Among Hispanic Adolescents, Wura Jacobs, Lauren Bartoszek, Jennifer Unger Dec 2019

Using The Theory Of Triadic Influence To Examine Correlates Of Positive Drug Expectancies Among Hispanic Adolescents, Wura Jacobs, Lauren Bartoszek, Jennifer Unger

Health Behavior Research

This study employs the Theory of Triadic Influence (TTI) which articulates the different variables that influence health-related behaviors into streams of influence—intrapersonal, social, and cultural—to better understand factors that influence positive drug use expectancies (PDE) among Hispanic adolescents. Data for the study came from Project RED, which included 1,963 high school students in Southern California. The relationships between participants’ drug expectancies and different streams of influence were examined using regression analysis. Participants were mostly females (54.2%); with a mean age of 17.13 years. Controlling for other covariates, there were no cultural stream variables associated with PDE (Model 1). Model 2, …


The Spread And Utility Of Social Network Analysis Across A Group Of Health Behavior Researchers, Megan S. Patterson, Tyler Prochnow Med, Patricia Goodson Dec 2019

The Spread And Utility Of Social Network Analysis Across A Group Of Health Behavior Researchers, Megan S. Patterson, Tyler Prochnow Med, Patricia Goodson

Health Behavior Research

Social network analysis (SNA), both as theory and methodology, is a powerful framework for delimiting and studying health behaviors. Using SNA allows scholars to answer new research questions, innovatively investigate the social and systemic contexts of health and behavior, and collaborate on multi- or inter-disciplinary projects. As a result, SNA is growing in popularity within health behavior research and practice. Despite SNA’s contribution and appeal, few health behavior researchers and practitioners have access to formal SNA education; much of the current training efforts occur outside degree-granting curricula. Therefore, the aims of this paper were to: 1) assess the diffusion of …


Mentoring The Next Generation Of Health Professionals: A Mentor-The-Mentor Approach, Andrea L. Demaria, Stephanie Meier, Jaziel L. Ramos-Ortiz Dec 2019

Mentoring The Next Generation Of Health Professionals: A Mentor-The-Mentor Approach, Andrea L. Demaria, Stephanie Meier, Jaziel L. Ramos-Ortiz

Health Behavior Research

The purpose of this commentary is to share team-based mentoring strategies used for successful interdisciplinary research team productivity and sustainability. This commentary lists and describes the top ten considerations for building a productive mentor-the-mentor approach, inspired by the train-the-trainer method. The approach promotes reciprocal training and individualized experiences, while producing positive professional and personal outcomes. We pinpoint how relationship-building rooted in passion and clear communication, explicit expectations and regular celebrations, and routine paired with a bit of play enhances productivity and encourages future health professionals to emerge as leaders in the field.


Strategies For Successful Long-Distance Mentoring, Annie Nguyen, Scott Rhodes Dec 2019

Strategies For Successful Long-Distance Mentoring, Annie Nguyen, Scott Rhodes

Health Behavior Research

Mentorship offers benefits to both the mentee and mentor in terms of professional development and productivity. It can take many forms and is not limited to mentee-mentor pairs that are employed at the same institution. Mentoring relationships that span institutions offer an avenue for expanding one’s professional network beyond the local environment. We refer to this type of mentorship as “long-distance mentoring.” We offer four critical strategies and reflections for successful long-distance mentoring based on our experience in the AAHB Research Scholars Mentorship Program.


The Mechanism Of Theory-Based Hiv Behavioral Intervention On Condom Use Among Rural-To-Urban Migrants In China: The Mediating Roles Of Hiv Knowledge And Condom Use Self-Efficacy, Chengbo Zeng, Xiaoming Li, Hongfei Du, Danhua Lin Oct 2019

The Mechanism Of Theory-Based Hiv Behavioral Intervention On Condom Use Among Rural-To-Urban Migrants In China: The Mediating Roles Of Hiv Knowledge And Condom Use Self-Efficacy, Chengbo Zeng, Xiaoming Li, Hongfei Du, Danhua Lin

Health Behavior Research

Previous studies have suggested HIV knowledge and self-efficacy are important cognitive factors that might influence condom use behaviors. However, data were limited regarding their mediating effects on condom use during behavioral interventions. This study examined the mechanistic roles of these two factors on the effect of a community-based intervention aiming to increase condom use behaviors and intention among young rural-to-urban migrants in China. Data were derived from a community-based HIV behavioral intervention trial among 639 young sexually active rural-to-urban migrants in Beijing, China. Path analyses were used to examine the direct and indirect effects of the intervention program on condom …


Barriers To Hiv Testing Within A Sample Of Spanish-Speaking Latinx Gay, Bisexual, And Other Men Who Have Sex With Men: Implications For Hiv Prevention And Care, Danielle N. Horridge, Timothy S. Oh, Jorge Alonzo, Lilli Mann-Jackson, Amanda E. Tanner, Eunyoung Y. Song, Benjamin D. Smart, Cornelius N. Van Dam, Logan S. Baker, Scott D. Rhodes Oct 2019

Barriers To Hiv Testing Within A Sample Of Spanish-Speaking Latinx Gay, Bisexual, And Other Men Who Have Sex With Men: Implications For Hiv Prevention And Care, Danielle N. Horridge, Timothy S. Oh, Jorge Alonzo, Lilli Mann-Jackson, Amanda E. Tanner, Eunyoung Y. Song, Benjamin D. Smart, Cornelius N. Van Dam, Logan S. Baker, Scott D. Rhodes

Health Behavior Research

Gay, bisexual, and other men who have sex with men (GBMSM) have higher rates of HIV infection compared to the general population in the United States, and the infection rate is growing among Latinx GBMSM, compared to a decline in most other demographic subgroups. Uptake of pre-exposure prophylaxis (PrEP), a biomedical strategy designed to reduce HIV transmission, is very low among Latinx GBMSM. HIV testing is a critical first step in the HIV prevention and care continua. We analyzed data from a community-based sample of Latinx GBMSM in the southeastern United States to identify the most common HIV testing barriers …


Using Complex, Multi-Sectoral Data In A Needs Assessment To Inform Future Strategies In Childhood Asthma Management, Loren Raun, David Persse, Gwendolyn Johnson, Katherine Ensor, Elizabeth Stevenson, Melissa A. Valerio, Erin K. Caton, Laura Campos, Harold J. Farber Oct 2019

Using Complex, Multi-Sectoral Data In A Needs Assessment To Inform Future Strategies In Childhood Asthma Management, Loren Raun, David Persse, Gwendolyn Johnson, Katherine Ensor, Elizabeth Stevenson, Melissa A. Valerio, Erin K. Caton, Laura Campos, Harold J. Farber

Health Behavior Research

The purpose of this needs assessment was to study the current state of asthma management in high-risk children in Houston, Texas to inform a theory-based approach to improving asthma management. The mixed-method assessment included multi-sectoral survey, quantitative, and geospatial data that address a range of social and community factors in family, community, home, and medical contexts. Houston Emergency Medical Services (EMS) provided ambulance-treated asthma data mapped by geographic area to identify where childhood asthma management was weakest. Texas Children’s Health Plan (TCHP) provided medication compliance rates and counts of children by zip code that TCHP considered high-risk according to claims …


The American Academy Of Health Behavior 2019 Annual Scientific Meeting: "Theory And Applications Of Multiple Health Behavior Change", Mark Reed Jul 2019

The American Academy Of Health Behavior 2019 Annual Scientific Meeting: "Theory And Applications Of Multiple Health Behavior Change", Mark Reed

Health Behavior Research

The American Academy of Health Behavior (AAHB) hosted it's 19th Annual Scientific Meeting at the Westin Poinsett in Greenville, SC March 10-13, 2019. The meeting's theme was "Theory and Applications of Multiple Health Behavior Change." This publication describes the meeting theme and includes the refereed abstracts presented at the 2019 Annual Scientific Meeting.


The Ecological Paradox: Can Human Prosperity And Planetary Health Co-Exist?, Jay E. Maddock Jul 2019

The Ecological Paradox: Can Human Prosperity And Planetary Health Co-Exist?, Jay E. Maddock

Health Behavior Research

Over the past century, advances in public health have led to longer, healthier, and more prosperous lives. However, this rising prosperity has led to increases in consumption contributing to loss of biodiversity, climate change, air pollution, ocean acidification, and deforestation. In his new book entitled, “Survival: One Health, One Planet, One Future,” George Lueddeke examines this paradox and what can be done to ensure a sustainable planet as well as healthy human and animal populations.


Examining Multiple Health Behaviors, Julie M. Croff, Ashleigh L. Chiaf, Erica K. Crockett Jul 2019

Examining Multiple Health Behaviors, Julie M. Croff, Ashleigh L. Chiaf, Erica K. Crockett

Health Behavior Research

Health behaviors have been extensively studied as predictors of disease; however, these behaviors may interact and intersect to amplify or ameliorate risks of predicted disease outcomes. Breadth of study is needed to examine how single antecedents may act to influence multiple health behaviors, and how multiple health behaviors may predict other behaviors and/or interact to influence the occurrence of disease outcomes. Better understanding of how behaviors interact and impact health is necessary to identify the appropriate leverage points for the evolution of health behavior theory, and the promotion of multiple health behavior change.


Heme Expression From Caulobacter Crescentus In E. Coli, Gloriana Tokgozoglu Apr 2019

Heme Expression From Caulobacter Crescentus In E. Coli, Gloriana Tokgozoglu

Kansas State University Undergraduate Research Conference

The focus of my research is to create a clone of a Heme transporter from Caulobacter crescentus and transformed into E. coli OKN359 and fluorescently label it so that it can detect Heme in the environment. This sensor will be combined with others in a fluorescence assay to analyze pathogenic bacteria and identify drugs that are the most effective in inhibiting their iron transport. To do so, I used Gibson cloning and made a hybrid gene, pITS27, that contains a small initial portion of an E.coli gene fepA followed by the full Caulobacter crescentus gene hutA. The initial portion of …


Evaluation Of A Peer-To-Peer Approach To Improve The Reach Of Farmers’ Markets Among Low-Income Populations, Darcy Freedman, Eunlye Lee, Susan Flocke, Rachael Sommer, Erika S. Trapl, Amanda Osborne, Elaine Borawski Mar 2019

Evaluation Of A Peer-To-Peer Approach To Improve The Reach Of Farmers’ Markets Among Low-Income Populations, Darcy Freedman, Eunlye Lee, Susan Flocke, Rachael Sommer, Erika S. Trapl, Amanda Osborne, Elaine Borawski

Health Behavior Research

Farmers’ markets have been implemented to improve access to nutritious foods, yet use is low among people receiving Supplemental Nutrition Assistance Program (SNAP) benefits. This study’s objectives were to assess the feasibility of implementing the FreshLink Ambassador intervention to promote use of farmers’ markets located in high SNAP neighborhoods, describe information dissemination by Ambassadors, and evaluate intervention impact on SNAP use. The theory-based and data-driven intervention trained nine community residents as FreshLink Ambassadors in 2017; eight completed the study. Ambassadors conducted weekly outreach disseminating coupons to promote use of three intervention markets. Four comparison markets were selected to evaluate impact …


Cumulative Risk Factors Associated With Food Insecurity Among Adults Who Experience Homelessness, Daphne C. Hernandez, Sajeevika S. Daundasekara, Katherine R. Arlinghaus, Nubia Tobar, Lorraine R. Reitzel, Darla E. Kendzor, Michael S. Businelle Mar 2019

Cumulative Risk Factors Associated With Food Insecurity Among Adults Who Experience Homelessness, Daphne C. Hernandez, Sajeevika S. Daundasekara, Katherine R. Arlinghaus, Nubia Tobar, Lorraine R. Reitzel, Darla E. Kendzor, Michael S. Businelle

Health Behavior Research

There is a dearth of research on the determinants of food insecurity among adults who experience homelessness. According to cumulative risk theory, it is the accumulation of risk factors that places individuals in jeopardy for negative health consequences. Building on the cumulative risk theory, domain specific indices were created to examine the relationship between four cumulative risk factors and food insecurity among adults who experience homelessness. Adult participants were recruited from six area shelters in Oklahoma City (N = 565) during July – August of 2016. Participants who affirmatively responded to two to six items of the six-item USDA …


The Role Of Acculturation And Training In Personal Protective Equipment (Ppe) Use Among Hispanic Farmworkers: A Follow-Up From The ¡Protejase! Study., Shedra A. Snipes, Angela G. Campbell, Patricia Y. Miranda Mar 2019

The Role Of Acculturation And Training In Personal Protective Equipment (Ppe) Use Among Hispanic Farmworkers: A Follow-Up From The ¡Protejase! Study., Shedra A. Snipes, Angela G. Campbell, Patricia Y. Miranda

Health Behavior Research

Hispanic farmworkers are at disproportionate risk of pesticide exposure. Moreover, new immigrant, Spanish-speaking farmworkers are least likely to receive safety training and protection from pesticides in the form of personal protective equipment (PPE). Provision is known to increase PPE use among farmworkers, but it is unclear whether provision helps new immigrant Hispanic farmworkers. Thus, this study examined the extent to which provision increases Hispanic farmworkers’ use of PPE. Additionally, we examined associations with English language acculturation since language barriers might influence training and use of PPE in a largely new immigrant, Spanish-speaking workforce. Farmworkers were provided three types of PPE …


A Culturally Adapted Diabetes Prevention Intervention In The New York City Sikh Asian Indian Community Leads To Improvements In Health Behaviors And Outcomes, Sahnah Lim, Laura Wyatt, Harmanpreet Chauhan, Jennifer M. Zanowiak, Rucha Kavathe, Hardayal Singh, Simona Kwon, Chau Trinh-Shevrin, Nadia S. Islam Mar 2019

A Culturally Adapted Diabetes Prevention Intervention In The New York City Sikh Asian Indian Community Leads To Improvements In Health Behaviors And Outcomes, Sahnah Lim, Laura Wyatt, Harmanpreet Chauhan, Jennifer M. Zanowiak, Rucha Kavathe, Hardayal Singh, Simona Kwon, Chau Trinh-Shevrin, Nadia S. Islam

Health Behavior Research

Sikh Asian Indians are an underserved, minority group demonstrating high rates of diabetes. Community health workers (CHWs) are effective in addressing health disparities by reaching socially and linguistically isolated populations. There are no culturally adapted programs for diabetes prevention among Sikh Asian Indians, thus, this study tests the efficacy of a culturally tailored CHW intervention to improve diabetes prevention-related outcomes among Sikh Asian Indians at risk for diabetes. A quasi-experimental two-arm intervention among Sikh Asian Indian adults at risk for diabetes and living in New York City (n = 160) was conducted in 2013-2014. The treatment group received six …