Digital Commons Network^™

Dental Utilization Pre- And Post-Covid-19 Pandemic Shutdown Across Different Birth Cohorts, Anirudh Agaram, Jeff Johnston Dds, Ms, Stephen A. Eklund Drph, Dds, Mhsa

The Journal of the Michigan Dental Association

Given the disruptions to dental practice because of COVID-19 in 2020, the question arose as to how dental patients would return to dental care in the following years, and if treatment patterns would be different, or would return to the previous patterns. Further, it was desired to understand whether patients of different ages would return to dental practices and use dental services differently. In order to assess these questions, utilization patterns among commercial enrollees within Delta Dental of Michigan, Ohio, and Indiana were explored. The analysis, spanning from 2018 to 2023, focused on diagnostic, preventative, and restorative procedures across diverse …

The Wellness Connection May 2025, Roger Williams University School Of Law

Life of the Law School (1993- )

No abstract provided.

Stereotypic Behaviors And Physiological Indicators Of Stress Occur In Horses With Restricted Durations Of Turnout, Elizabeth E. Rodgers

Department of Animal Science: Dissertations, Theses, and Student Research

The confinement of horses to stalls with limited or no turnout time restricts their natural roaming behaviors, which potentially increases stress and behavioral stereotypies. This study investigated the impact of turnout duration on behavioral and physiological stress indicators in healthy horses. Adult horses (n = 11) were enrolled in a 3 treatment (0-, 15-, and 60-minute turnout/day) Latin square design, including 3 12 d experimental periods over 6 weeks. Horses were acclimated to turnout (24.38 x 64.01m indoor arena) and stalls (2.74 x 4.87m - 3.66 x 3.66m) stalls prior to data collection on day 1. Experienced handlers managed …

Digestibility, Palatability, And Nutrient Composition Of Three Species Of Whole Prey In Three Species Of Snakes, Morgan R. Kienzle

Department of Animal Science: Dissertations, Theses, and Student Research

Snakes in human care often lack diversity in the diet. Rodents account for the majority of meals, while wild snakes are consuming a varied diet composed of multiple different whole prey species. By feeding only one species of prey, the chance of nutrient deficiencies and other health concerns increases. To promote variety in the managed diet, two commercially available whole prey species (mice (Mus musculus) and chicks (Gallus spp.)) and one novel species (Seba’s short-tailed bats (Carollia perspicillata)), were analyzed for their dry matter (DM), organic matter (OM), crude protein (CP), crude fat …

Methane Mitigation And Its Effects On Energy Utilization In Lactating Dairy Cattle, Shan C. Sherwood

Department of Animal Science: Dissertations, Theses, and Student Research

Improved methane (CH₄) mitigation strategies are needed to achieve the greenhouse gas emission goals of the dairy industry. The first experiment was conducted to evaluate the effects of feeding black cumin (Nigella sativa) seed oil and acetate (BCA) on CH₄ production and whole-animal energy utilization. Twelve dry Jersey cows were used in a 2-period crossover design study with 28d periods. The BCA treatment was compared to a control diet with corn oil. Both BCA and corn oil were added to the base diet as a top dress. Results from this study did not show any …

Improving Nutrition Outcomes Through Enhanced Allocative Efficiency Of Investments In 24 High Risk Counties In Kenya: An Optima Nutrition Modelling Study, Morris Ogero, Nick Scott, Veronica Kirogo, Anthony Ngugi

Population Health, East Africa

Introduction ;Undernutrition remains a significant global challenge, severely impacting children’s development and growth. To address this, the Sustainable Development Goals target a substantial reduction in stunting and wasting by 2025. Achieving these goals requires scaling up evidence-based nutritional interventions; however, limited budgets pose challenges in funding all necessary programs. To assist policymakers in making informed decisions, the World Bank developed the Optima Nutrition Modelling tool, which optimizes the allocation of nutrition investments. Kenya, with its high prevalence of stunting, was the focus of this study. Using the Optima Nutrition model, we aimed to (1) assess the impact of scaling up …

Evolution And Strengths Of School Lunch Programs In The United States And Japan, Sarah Ritterling

Honors Program: Senior Projects (Public)

School lunches around the world perform a vital role in children’s nutritional needs and overall health. These nutritional programs provide a chance for children to learn how to create a balanced meal and about the production and serving of food. However, many countries, including the United States and Japan, have taken different approaches to meet these goals, influenced by the needs of children and communities over time. The United States provides support, funding, and nutritional standards through the National School Lunch Program. Japan promotes the Basic Act of Shokuiku (food and nutrition education) within society and outlines goals for schools …

Gut Feeling: A Holistic Digital Tool For Managing Irritable Bowel Syndrome And Food Sensitivities, Hailey M. Olberding

Honors Program: Senior Projects (Public)

Irritable Bowel Syndrome (IBS) and food intolerances are increasingly prevalent chronic gastrointestinal (GI) conditions that significantly impair quality of life. While the low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAP) diet has demonstrated success in symptom management, current digital tools fail to offer integrated, user-friendly platforms that holistically track contributing health factors. Gut Feeling is a mobile app (Appendix 1) and complementary website (Appendix 2) developed to fill this gap. By incorporating symptom logging, food intake tracking and complementary database, stress and sleep monitoring, and trend analysis, this platform empowers users to better understand their bodies and manage GI symptoms proactively. …

Circulating Epstein-Barr Virus Antibody Levels As A Biomarker Of Socioecological Adversity In Amazonian Ecuador, Tyler M Barrett, Melissa A Liebert, Geeta N Eick, Julia G Ridgeway-Diaz, Felicia C Madimenos, Aaron D Blackwell, Tara J Cepon-Robins, Samuel S Urlacher, Lawrence S Sugiyama, J Josh Snodgrass

Faculty, Staff and Students Publications

Objectives: Circulating Epstein-Barr virus antibodies (EBV-Ab) are used as a biomarker of chronic stress in high-income settings, but their relevance in environments with a high burden of infectious disease, nutritional constraints, and limited resources is less clear. We investigated EBV-Ab as a biomarker of adversity in a setting where local ecology and economy may affect immune development differently than in wealthy countries.

Methods: We measured EBV-Ab in finger-prick dried blood spots collected from Indigenous Shuar (n = 433) and non-Indigenous Colonos (n = 84) ranging from < 1 to 87 years old in Amazonian Ecuador. For a subset of adults (≥ 15 years, n = 210), we collected socioeconomic information (income, education, and occupation) and assessed household-level market integration. We determined the most important predictors of EBV-Ab for adults and children using multi-model averaging of linear regression models.

Results: Male children (< 15 years) had lower EBV-Ab than female children (model averaged β [SE]: -0.238 [0.066]). For adults, Shuar had higher EBV-Ab than Colonos (model averaged β [SE]: 0.235 [0.113]), and high systolic blood pressure was an important predictor of elevated EBV-Ab (model averaged β [SE]: 0.088 [0.047]). Individuals who reported unpaid domestic work as their primary occupation had higher EBV-Ab than agricultural workers (model averaged β [SE]: 0.302 [0.113]). Individuals living in houses with more market-sourced infrastructure had lower EBV-Ab (model averaged β [SE]: -0.088 [0.068]).

Conclusions: Circulating EBV-Ab may capture context-specific aspects of socioecological adversity …

Spaceflight Associated Neuro-Ocular Syndrome (Sans) And Its Countermeasures, Tuan Nguyen, Joshua Ong, Tyson Brunstetter, C Robert Gibson, Brandon R Macias, Steven Laurie, Thomas Mader, Alan Hargens, Jay C Buckey, Mimi Lan, Peter Wostyn, Cihan Kadipasaoglu, Scott M Smith, Sara R Zwart, Benjamin J Frankfort, Sarah Aman, Jessica M Scott, Ethan Waisberg, Mouayad Masalkhi, Andrew G Lee

Faculty, Staff and Students Publications

Astronauts can develop a distinct collection of neuro-ophthalmic findings during long duration spaceflight, collectively known as Spaceflight Associated Neuro-ocular Syndrome (SANS). These clinical characteristics include optic disc edema, hyperopic refractive shifts, globe flattening, and chorioretinal folds, which may pose a health risk for future space exploration. Obtaining knowledge of SANS and countermeasures for its prevention is crucial for upcoming crewed space missions and warrants a multidisciplinary approach. This review examines the potential causes and countermeasures of SANS, including space anticipation glasses, lower body negative pressure, venoconstrictive thigh cuffs, impedance threshold devices, translaminar pressure gradient modulation, centrifugation, artificial gravity, pharmaceuticals, and …

Participant Personal Characteristics And Adherence To Oral Capsules: A Secondary Analysis Of A Randomized Placebo-Controlled Trial Of Antenatal Probiotics, Lisa Hanson, Kathlyn Albert, Emily Malloy, Maharaj Singh, Mikala Kallay, Ava Brandt, Courtney Morris, Diana Kleber, Marie Forgie

College of Nursing Faculty Research and Publications

Background

Adherence to study interventions is critical to the conduct of randomized controlled trials (RCTs). The relationships between participant characteristics and intervention adherence are understudied in pregnant populations. The purpose of this study was to conduct a secondary analysis of adherence to study capsules in a double-masked, placebo-controlled RCT of a probiotic intervention to reduce antenatal Group B Streptococcus colonization, in relationship to participant characteristics.

Methods

We analyzed the relationship between capsule adherence rates and demographic characteristics among 81 RCT participants. Categorical variables were reported using counts and percentages, and continuous variables were expressed as means along with their standard …

Lefitolimod In Combination With Ipilimumab In Patients With Advanced Solid Tumors: A Phase I Trial, Mirella Nardo, Mohamed A Gouda, Matthew J Reilley, Amadeo B Biter, Joann Lim, Stacie A Bean, Ly M Nguyen, Priya R Bhosale, Casey R Ager, Coline A Couillault, Sarina A Piha-Paul, Siqing Fu, Apostolia M Tsimberidou, Timothy A Yap, Aung Naing, Jordi Rodon, Vivek Subbiah, Daniel D Karp, Michael A Curran, David S Hong

Faculty, Staff and Student Publications

Introduction: TLR9 agonists are immunomodulators that have been of interest for combined use with cancer immunotherapy. TLR9 agonists, such as lefitolimod (MGN1703), significantly increased Th1 response in preclinical models and have demonstrated efficacy in early clinical trials. This trial assessed the safety and preliminary efficacy of the combination of lefitolimod and ipilimumab in patients with advanced solid tumors.

Methods: This was a single-center, open-label, investigator-initiated phase I trial conducted at The University of Texas MD Anderson Cancer Center. Patients received leftolimod either subcutaneously (at escalating doses of 15-120 mg) or intratumorally (at the maximum feasible dose) in combination with ipilimumab …

Trends In The Prevalence Of Orofacial Clefts Among Hispanic Infants In The Rio Grande Valley Of Texas (1997-2018), Yossef Alsabawi, Aaron Dadzie, Kelsey Baker

School of Medicine Publications

Background Orofacial clefts (OFCs), including the cleft lip with or without cleft palate (CLP) and cleft palate alone (CP), represent significant congenital anomalies with implications for feeding, speech, and psychosocial development. The Rio Grande Valley (RGV) of Texas, a predominantly Hispanic region that faces socioeconomic and healthcare challenges, may have a distinct OFC profile compared to non-border counties (NBCs) of Texas. Methods Prevalence data with 95% confidence intervals for OFCs from 1997 to 2018 were obtained from the Texas Department of State Health Services (DSHS). Definitions provided by the DSHS were adhered to, including only definite diagnoses. Given the large …

Gonadotropin-Releasing Hormone Ii And Its Receptor: Novel Regulators Of Semen Quality And Follicular Function In Swine, Caitlin Elizabeth Ross

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

Pigs are the only mammalian livestock species encoding functional proteins for the second form of gonadotropin-releasing hormone (GnRH-II) and its receptor (GnRHR-II). In the first study, GnRHR-II localized to developing germ cells and the connecting piece of ejaculated spermatozoa. Concurrently, GnRH-II was most abundantly produced in the testis compared with other reproductive tract organs and was present within seminal plasma. Moreover, treatment of extended semen with GnRHR-II analogues altered sperm motility, morphology, and kinematics. For remaining studies, we utilized a swine line with ubiquitous knockdown of GnRHR-II (GnRHR-II KD) developed in our laboratory. The second study demonstrated that circulating GnRH-II …

Racial Disparity And Environmental Influences On Perinatal Health In Jefferson County, Kentucky., Felicia A Pugh

Electronic Theses and Dissertations

Background: Severe maternal morbidity (SMM) risk has tripled over the past 30 years. Adverse infant birth outcomes in the U.S. have also increased with substantial Black-White disparities. Objectives: This work compares the frequency of adverse maternal and infant birth outcomes by maternal race (Black vs White) and examines associations between maternal ambient heavy metal exposures and birth outcomes in Jefferson County, Kentucky, 2017-2022. Methods: Jefferson County inpatient hospital delivery and birth certificate records of self-identified Black or White birthing parents were used. Incidence of SMM, stillbirth, preterm birth (PTB), and small for gestational age (SGA) with 95% confidence intervals (CI) …

Targeting Discrepancies In Linear Growth Measurements In The Neonatal Intensive Care Unit Through Nursing Interventions: A Quality Improvement Initiative, Gail Snyder, Rebekah Wilkinson, Raina Evans, Meagan Owen, Akram Yazdani, Covi Tibe, Catherine Perez, Lindsay F Holzapfel

Faculty, Staff and Student Publications

Objective: Accurate length measurements are essential for infants to identify growth deficiencies and adjust nutrition accordingly. The gold standard for length measurement in infants is using a length board with two people to obtain an accurate clinical assessment. We aimed to improve the number of measurements with the desired minimal difference, defined as a discrepancy ≤1 cm between nurse and audit measurements, in our center. Our secondary aim was to increase and maintain the number of length boards available.

Methods: This quality improvement (QI) study used a before-and-after intervention comparison design in a single-level IV neonatal intensive care unit between …

Enteral Nutritional Practices In Extremely Preterm Infants: A Survey Of U.S. Nicus, Mar Romero-Lopez, Mamta Naik, Lindsay F Holzapfel, Jon E Tyson, Claudia Pedroza, Kaashif A Ahmad, Matthew A Rysavy, Waldemar A Carlo, Yuxin Zhang, Covi Tibe, Ariel A Salas

Faculty, Staff and Student Publications

No abstract provided.

First Step To Environmentally Sustainable Endoscopy Practice: A Prospective Study Of Minimizing Multiple Device Use During Screening Colonoscopy At A Large Tertiary Center, Prateek S Harne, Vaishali Harne, Asad Rehman, Nirav Thosani, Madhav Desai

Faculty, Staff and Student Publications

The healthcare sector generates 8% of greenhouse gas emissions in the USA, of which gastrointestinal (GI) endoscopy is the third largest contributor. Single-use tools are a major contributor to modifiable waste generation during GI endoscopy. Through a quality improvement initiative, we aimed to reduce endoscopy waste by urging gastroenterologists to be mindful of tools used during polypectomies by avoiding using multiple tools.We discussed green endoscopy initiatives in monthly journal club and business meetings. Over 14 weeks, 210 patients were included in the pre-intervention group and 112 in the post-intervention group.At baseline, 34% of colonoscopies required no intervention, 32% required one …

Comparing The Efficacy And Safety Of Glp-1 Receptor Agonists Versus Gastric Bypass Surgery In The Treatment Of Obesity And Type 2 Diabetes, Abir Oliver

Physician Assistant Scholarly Project Papers

Obesity and type 2 diabetes are interconnected global health challenges, contributing significantly to morbidity, mortality, and healthcare costs. This literature review compares the efficacy, safety, and applicability of glucagon-like peptide-1 (GLP-1) receptor agonists and bariatric surgery as treatment options. A literature search with defined inclusion and exclusion criteria was conducted using PubMed and EBSCOhost from May to July 2024, resulting in 14 randomized controlled trials for evaluation. This literature review supports the efficacy of both GLP-1 receptor agonists, particularly semaglutide, and bariatric surgery as effective interventions for weight loss and glycemic control in patients with obesity and type 2 diabetes. …

Risk Analysis Index For Estimation Of 30-Day Postoperative Mortality In Hip Fractures., Nithin K Gupta, Hikmat R Chmait, Vikram Gill, Morgan Turnow, Taylor Manes, Benjamin C Taylor, Jack W Weick, Christian Bowers

Surgery Articles

IMPORTANCE: Hip fractures present a substantial public health challenge, with projections of more than 500 000 per year by 2040. As such, frailty indices such as the Revised Risk Analysis Index (RAI) and the Modified Five-Item Frailty Index (mFI-5) have been recently investigated as metrics for preoperative risk stratification for these patients.

OBJECTIVE: To understand the accuracy of frailty, as measured by the RAI and the mFI-5, for estimating 30-day mortality following surgically managed hip fractures.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional analysis used the American College of Surgeons' National Surgical Quality Improvement database. Patients aged 65 years old …

Refractive Error And Axial Length (Real) Study: Feasibility Of A Population Study In The United States, Sarah E. Singh Dr, Lisa A. Ostrin, Kristen Kerber Dr, Concepcion Cayle, Celia Gong Dr, Lal Barsha Dr, Ian Flitcroft, Síofra Harrington, James Loughman, Kathryn Saunders Prof, Fuensanta Vera-Diaz Dr

Articles

Myopia is the most common eye disease and a leading cause of blindness. A contemporary, large, and ethnically and geographically diverse study of ocular biometry and refractive error in children in the United States is needed to help better describe differences between myopic and nonmyopic eyes.

This is an initial cross-sectional report from the Refractive Error and Axial Length Growth Curve Study that includes ocular component data as a function of age, gender, and geographic location. This feasibility report will inform a planned larger longitudinal ocular growth study in children in the United States.

Cross-sectional data on children, ages 3 …

Nitrate And Nitrite Food Composition Database: An Update And Extensive Deep Dive, Liezhou Zhong, Jonathan M. Hodgson, Joshua R. Lewis, Lauren C. Blekkenhorst, Nicola P. Bondonno, Marc Sim, Richard J. Woodman, Catherine P. Bondonno

Research outputs 2022 to 2026

Background: Growing evidence suggests that health outcomes of dietary nitrate and nitrite intake are food source dependent. Robust evaluations in dietary studies necessitate a comprehensive and current food composition database of nitrate/nitrite content, along with variation based on country or region of origin, calendar year, growing season, and cooking method. Objectives: The objectives of this study were to update the previous animal- and plant-based food nitrate/nitrite databases and investigate effects of cooking methods, seasonal and geographic variations, and longitudinal changes on nitrate and nitrite content to guide application of the database in observational and clinical studies. Methods: Food nitrate/nitrite composition …

In Competitive Athletes, Does Adding Psychological Rest Compared To Regular Training Reduce Burnout: A Critically Appraised Topic, Amy A. Umutoni

All Student Scholarship

Burnout among competitive athletes is a multifaceted syndrome characterized by emotional and physical exhaustion, a diminished sense of accomplishment, and sport devaluation. 1 The rigorous demands of training and competition can lead to chronic stress, potentially culminating in burnout. While physical rest is a well-established component of athletic recovery, the role of psychological rest in mitigating burnout is gaining attention. 2 Psychological rest encompasses mental breaks and activities that promote cognitive relaxation, potentially aiding in recovery and performance. Emerging evidence also suggests that structured psychological interventions can enhance emotional well-being and resilience among athletes, particularly those coping with injuries. In …

Small But Mighty: Strengthening The Value Of Local Pocket Parks, Makana Sm Higa

Capstone Projects and Master's Theses

In Monterey County, youth obesity rates are climbing at an alarming rate. Ventana Wildlife Society, and Wellness Through Nature program seek to help lower these rates. Ventana looks to achieve this through outdoor education and family trips with migrant farm working families in the cities of Soledad and Salinas. These trips attempt to increase environmental stewardship and improve community health. The project aims to evaluate the effectiveness and community engagement in regards to pocket parks. The parks visited were Bataan Memorial Park, Harden Neighborhood Park, Cesar Chavez Park, Joe Ledesma Park and San Antonio Park. The research seeks to increase …

Healthy Food, Healthy Future: Equitable Nutrition Access, Daisy Paredes

Capstone Projects and Master's Theses

While homelessness is a major global health issue, those without a place to live should have easy access to nutritional foods and medical care; otherwise, they risk developing long-term physical and mental health effects caused by circumstances beyond their control. The Community Action Board of Santa Cruz builds bridges to ensure everyone has access to resources and opportunities, regardless of race, ethnicity, gender, identity, immigration status, and other aspects of one’s identity. The capstone project enhances physical health by coordinating a weekly food distribution event for unhoused individuals in partnership with Second Harvest Food Bank. This allows us to reduce …

Pembrolizumab In Patients With Advanced Miscellaneous Rare Cancers: Results From A Phase 2 Basket Trial, Mirella Nardo, Camila Braganca Xavier, Bettzy Stephen, Jeffrey A How, Justin Moyers, Vivek Subbiah, David S Hong, Aung Naing

Faculty, Staff and Student Publications

Introduction: Rare solid tumors account for one-quarter of cancers among adults in the United States, but few resources have been devoted to their treatment. We evaluated the efficacy of pembrolizumab, a programmed cell death-1 inhibitor, in patients with rare solid tumors.

Methods: We conducted a phase 2 basket trial that included patients with rare, advanced tumors. Patients were enrolled in the study in nine tumor-specific and a 10th cohort of miscellaneous rare histologies. Patients received pembrolizumab 200 mg intravenously every 21 days. The primary endpoint was the non-progression rate at 27 weeks per immune-related Response Evaluation Criteria in Solid Tumors …

Multiparametric Mri Scoring System Of The Pancreas For The Diagnosis Of Chronic Pancreatitis, Temel Tirkes, Dhiraj Yadav, Darwin L Conwell, Xuandong Zhao, Anil K Dasyam, Vivek Gowdra Halappa, Aashish Patel, Zarine K Shah, Jordan Swensson, Naoki Takahashi, Sudhakar Venkatesh, Ashley Wachsman, Liang Li, Kristofer Jennings, Yunlong Yang, Phil A Hart, Stephen J Pandol, Walter G Park, Santhi Swaroop Vege, Mark Topazian, Paul R Territo, Scott A Persohn, Dana K Andersen, Evan L Fogel, Consortium For The Study Of Chronic Pancreatitis, Diabetes, And Pancreatic Cancer (Cpdpc)

Faculty, Staff and Student Publications

Background: Ductal features alone may not offer high diagnostic sensitivity or most accurate disease severity of chronic pancreatitis (CP).

Purpose: Diagnose CP based on multiparametric MRI and MRCP features.

Study type: Prospective.

Population: Between February 2019 and May 2021, 46 control (23 males, 49.3 ± 14.1 years), 45 suspected (20 males, 48.7 ± 12.5 years), and 46 definite (20 males, 53.7 ± 14.6 years) CP patients were enrolled at seven hospitals enrolled in the MINIMAP study. CP classification was based on imaging findings and clinical presentation.

Field strength and sequences: 1.5 T. T1-weighted (T1W) spoiled gradient echo, T1 map with …

Labour Companionship And Respectful Treatment Of Women During Childbirth: A Cross-Sectional Study Across 16 Hospitals In Benin, Malawi, Tanzania And Uganda, Soha El-Halabi, Kristi Sidney Annerstedt, Christian Agossou, Fadhlun Al-Beity, Andrea B. Pembe, Phillip Wanduru, Bianca Kandeya, Jean-Paul Dossou, Helle Molsted-Alvesson, Claudia Hanson

Centre of Excellence in Women and Child Health

Introduction: Evidence suggests that women value and benefit from having a labour companion during childbirth. However, the applicability of the evidence to low-income and lower-middle-income countries is limited and varies. Thus, we assessed the association between the presence of labour companions and mistreatment in 16 hospitals of Benin, Malawi, Tanzania and Uganda.

Methods: We conducted a cross-sectional survey using a validated questionnaire administered to women at discharge after birth between December 2021 and March 2024. The main outcomes were factor-weighted respectful treatment score and its subscores on maintained respect and dignity, privacy and maintained confidentiality and no physical and verbal …

Local Systems Change: Applied Research Methods For Sustainable Communities, Taylor Barrett Hill

Graduate Student Portfolios, Professional Papers, and Capstone Projects

No abstract provided.

Analyzing The Association Of Competitive Food Policy On Competitive Food Content In U.S. Schools., Mary E. Curnutte

Electronic Theses and Dissertations

OBJECTIVES: School food can have a profound effect on the population’s health. Thirty million children receive food at school and consume half their daily calorie intake at school. Competitive foods are foods sold outside of school breakfast and lunch, such as those sold in vending machines. A new ruling for Smart Snacks Standards, a set of competitive food guidelines, started in the school year 2014-2015. It is known that competitive foods undermine school lunch participation, and a decrease in school lunch consumption is associated with poorer student health. Additionally, an increase in competitive foods tends to be of nutrient-poor …