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International Society Of Sports Nutrition Position Stand: Long-Chain Omega-3 Polyunsaturated Fatty Acids, Ralf Jäger, Jeffrey L. Heilson, Sidney Abou Sawan, Broderick L. Dickerson, Megan Leonard, Richard B. Kreider, Chad M. Kerksick, Stephen M. Cornish, Darren G. Candow, Dean M. Cordingley, Scott C. Forbes, Grant M. Tinsley, Tindaro Bongiovanni, Roberto Cannataro, Bill I. Campbell, Shawn M. Arent, Jeffrey R. Stout, Douglas S. Kalman, Jose Antonio

Faculty Scholarship

Position Statement: The International Society of Sports Nutrition (ISSN) presents this position based on a critical examination of the literature surrounding the effects of long-chain omega-3 polyunsaturated fatty acid (ω-3 PUFA) supplementation on exercise performance, recovery, and brain health. This position stand is intended to provide a scientific foundation for athletes, dietitians, trainers, and other practitioners regarding the effects of supplemental ω-3 PUFA in healthy and athletic populations. The following conclusions represent the official position of the ISSN:

1. Athletes may be at a higher risk for ω-3 PUFA insufficiency.

2. Diets rich in ω-3 PUFA, including supplements, are effective strategies …

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The United States Healthcare System: From Medicare To Post-Pandemic Health Policy, William M. Sage

Faculty Scholarship

My purpose in this essay is to comment on national health policy in the United States over the past sixty years.  My conclusions are less optimistic than what I had hoped when I began my teaching and research career in the 1990s to be able to say in 2025.  In particular, the successful expansion of publicly supported health coverage via the passage of the Affordable Care Act (“ACA” or “Obamacare”) in 2010 seems to have triggered -- though I hesitate to say that it caused – a backsliding from broader commitments to clinical performance, population health, and social solidarity that …

Border Decriminalization As A State Project: Lessons From Marijuana And Assisted Suicide Legalization Across The United States, Victor C. Romero

Faculty Scholarship

My prior work argued for the decriminalization of border crossings without proof of specific intent to violate another law (like drug trafficking), which is even less likely to happen now than it was when the piece was published, given the current presidential administration’s zealous deportation strategy and Congress’s seeming acquiescence. As such, I advocate for a second-best solution involving federal-state cooperative agreements wherein border states abutting both Mexico and Canada are given the option by the federal government to pass local legislation decriminalizing border crossings into their states as their communities desire. To the extent that the current presidential administration …

Birth On Mother Earth: Mitigating The Maternal Health Crisis, Jill C. Engle

Faculty Scholarship

Maternal health outcomes in the U.S. are remarkably poor, especially when compared to those in other industrialized countries. For example, our maternal death rate is more than twice that of Canada’s. Women of color in the U.S. suffer maternal morbidity and mortality at rates considerably higher than white women. Indigenous women experience the worst maternal health outcomes of all. Yet, most maternal deaths and injuries are preventable. Furthermore, rates of maternal harm, including death, are lower when midwives and similar birthing attendants are involved. This Article is the first to fully explore the unique skillset of traditional birth attendants (TBAs). …

Interplanetary Risk Regulation, Jonathan B. Wiener, Charles (Chase) Hamilton

Faculty Scholarship

Space exploration promises new opportunities but also new risks. After centuries of national settlements and international conflicts on Earth, and the Cold War era of two great power states racing to the Moon, today we see a rapidly proliferating arena of actors, both governmental and non-governmental, undertaking bold new ventures off-Earth while posing an array of new risks. These multiple activities, actors, and risks raise the prospects of regulatory gaps, costs, conflicts, and complexities that warrant reconsideration and renovation of legacy legal regimes such as the international space law agreements. New approaches are needed, beyond current national and international law, …

Response: Work And Home, Katharine B. Silbaugh

Faculty Scholarship

The idea of work, as it pertains to a place called home, as distinct from the market, has engaged and perplexed scholars for generations. Work in the home raises complicated issues that have accordingly drawn the focus of generations of scholars, from Charlotte Perkins Gilman and the material feminists of the late nineteenth century¹ to historians of labor such as Eileen Boris² and of law like Reva Siegel,³ from legal scholars like Fran Olson, Dorothy Roberts, and Robert Ellickson⁴ to social theorists like Friedrick Engels⁵ and architectural historians like Dolores Hayden,⁶ to name just …

The Hidden Cost Of Venture Capital, Emilie Aguirre

Faculty Scholarship

Founders, employees, consumers, and even funders increasingly expect businesses to pursue social goals alongside financial performance. Yet even the most committed firms have found it difficult to maintain social performance over time. Scholars in economics, management, and law have put forth several explanations for this “mission drift,” including inappropriate governance, poor management, lack of genuine commitment, and threat of takeovers. Puzzlingly, research to date primarily focuses on later-stage firms, even though the events and decisions that take place in a firm’s early stages can critically impact retention of its social performance.

Drawing from over five years of qualitative field research …

Incremental Innovation, George Horvath

Faculty Scholarship

Transformative innovations—the ones that use new technologies to disrupt the world—command our attention. But most new products are the result of a more mundane process of incremental iterative innovation, evolving through a long series of small modifications of existing technologies. Although both kinds of innovation can result in improved safety and utility, both can also create new dangers. We tend to be more aware of this in transformative innovations (as current worries over artificial intelligence show); by contrast, dangers created by incremental iterative innovation often go unrecognized, because the process itself is easy to overlook. Policymakers and regulators need to …

The Savings Mirage, Sara Sternberg Greene

Faculty Scholarship

In the past, we did not worry much about elderly poverty because retirement was short for most Americans – a brief jaunt of post-work life was soon met with death. But with the 100-year life becoming a reality for more Americans, an elderly poverty crisis looms. The American dream of abundant retirement savings remains elusive for many, particularly low-wage workers. While government initiatives emphasize individual responsibility and financial education as a way toward retirement success, the reality is that governmental policies are barriers, including asset limitations that prevent those who receive public benefits from saving. This chapter urges reform in …

Acute Alpha-Glycerylphosphorylcholine Supplementation Enhances Cognitive Performance In Healthy Men, Chad M. Kerksick

Faculty Scholarship

Background: Choline is an essential nutrient required for proper cell functioning. Due to its status as a precursor to acetylcholine, an important neurotransmitter connected to cognition and neuromuscular function, maintaining or enhancing choline levels is of interest. Supplementation with alpha-glycerylphosphorycholine (A-GPC) can maintain choline levels, but its ability to offer support towards cognition remains an area of ongoing research. Methods: Using a randomized, double-blind, placebo-controlled, crossover approach, 20 resistance-trained males (31.3 ± 11.0 years, 178.6 ± 7.3 cm, 84.6 ± 11.4 kg, 15.4 ± 5.6% body fat) consumed either a placebo (PL), 630 mg A-GPC (HD), or 315 mg (LD) …

Effects Of Acacia Catechu And Scutellaria Baicalensis Extract On Cognitive Function In A Healthy Adult Population: A Double-Blind, Randomized, Placebo-Controlled Trial, Anthony M. Hagele, Petey Mumford, Diego De Gregorio, Connor J. Gaige, Ethan R. Hoffman, Kristen N. Gross, Kevin F. Holley, Leah E. Allen, Chad M. Kerksick

Faculty Scholarship

Flavonoids, known for their neuroprotective properties, are abundant in Acacia catechu and Scutellaria baicalensis. Yet, human studies on their combined effects are limited.

Objective

This study evaluated the cognitive effects of combined Acacia catechu and Scutellaria baicalensis supplementation in healthy adults.

Methods

In a randomized, double-blind, placebo-controlled trial, 26 males and 59 females (N = 85; 43 ± 8 yrs) consumed the test product (TP) containing 240 mg stem extract of Scutellaria baicalensis and 51 mg heartwood extract of Acacia catechu (UP326, Unigen, Tacoma, WA USA) or placebo (PLA) for four weeks. Cognitive function and biomarkers were assessed throughout …

International Society Of Sports Nutrition Position Stand: Β-Hydroxy-Β-Methylbutyrate (Hmb), John A. Rathmacher, Lisa M. Pitchford, Jeffrey R. Stout, Jeremy R. Townsend, Ralf Jägerg, Richard B. Kreider, Bill I. Campbell, Chad M. Kerksick, Patrick S. Harty, Darren G. Candow, Brandon M. Roberts, Shawn M. Arent, Douglas S. Kalman, Jose Antonio

Faculty Scholarship

Position Statement: The International Society of Sports Nutrition (ISSN) bases the following position stand on an analysis of the literature regarding the effects of β-Hydroxy-β-Methylbutyrate (HMB). The following 12 points have been approved by the Research Committee of the Society: 1. HMB is a metabolite of the amino acid leucine that is naturally produced in both humans and other animals. Two forms of HMB have been studied: Calcium HMB (HMB-Ca) and a free acid form of HMB (HMB-FA). HMB-FA appears to lead to increased appearance of HMB in the bloodstream when compared to HMB-Ca, though recent results are mixed. 2. …

Dileucine Ingestion, But Not Leucine, Increases Lower Body Strength And Performance Following Resistance Training: A Double-Blind, Randomized, Placebo-Controlled Trial, Anthony M. Hagele, Joesi M. Krieger, Connor J. Gaige, Kevin F. Holley, Kristen N. Gross, Joshua M. Ianotti, Leah E. Allen, Paige J. Sutton, Logan S. Orr, Petey W. Mumford, Martin Pupura, Ralf Jager, Chad M. Kerksick

Faculty Scholarship

Background

The essential amino acid leucine (LEU) plays a crucial role in promoting resistance-training adaptations. Dileucine (DILEU), a LEU-LEU dipeptide, increases MPS rates, however its impact on resistance training outcomes remains unexplored. This study assessed the effects of DILEU supplementation on resistance training adaptations.

Methods

Using a randomized, double-blind, placebo-controlled approach, 34 resistance-trained males (age: 28.3 ± 5.9 years) consumed 2 grams of either DILEU monohydrate (RAMPS™, Ingenious Ingredients, L.P.), LEU, or placebo (PLA) while following a 4-day per week resistance training program for 10 weeks. Changes in body composition, 1-repetition maximum (1RM) and repetitions to failure (RTF) for leg …

Part Ii. Common Questions And Misconceptions About Creatine Supplementation: What Does The Scientific Evidence Really Show?, Jose Antonio, Ann F. Brown, Darren G. Candow, Philip D. Chilibeck, Stacey J. Ellery, Scott C. Forbes, Bruno Gualano, Andrew R. Jagim, Chad Kerksick, Richard B. Kreider, Sergej M. Ostojic, Eric S. Rawson, Michael D. Roberts, Hamilton Roschel, Abbie E. Smith-Ryan, Jeffrey R. Stout, Mark A. Tarnopolsky, Trisha A. Vandusseldorp, Darryn S. Willoughby, Tim N. Ziegenfuss

Faculty Scholarship

Creatine monohydrate supplementation (CrM) is a safe and effective intervention for improving certain aspects of sport, exercise performance, and health across the lifespan. Despite its evidence-based pedigree, several questions and misconceptions about CrM remain. To initially address some of these concerns, our group published a narrative review in 2021 discussing the scientific evidence as to whether CrM leads to water retention and fat accumulation, is a steroid, causes hair loss, dehydration or muscle cramping, adversely affects renal and liver function, and if CrM is safe and/or effective for children, adolescents, biological females, and older adults. As a follow-up, the purpose …

Common Questions And Misconceptions About Energy Drinks: What Does The Scientific Evidence Really Show?, Jose Antonio, Brandi Antonio, Shawn M. Arent, Darren G. Candow, Guillermo Escalante, Cassandra Evans, Scott Forbes, David Fukuda, Maureen Gibbons, Patrick Harty, Andrew R. Jagim, Douglas S. Kalman, Chad Kerksick, Jennifer A. Kurtz, Joseph Lillis, Lonnie Lowery, Gianna F. Mastrofini, Scotty Mills, Michael Nelson, Flavia Pereira, Justin Roberts, Michael Sagner, Jeffrey Stout, Jaime Tartar, Adam Wells

Faculty Scholarship

Energy drinks are a commonly consumed beverage, and studies suggest a possible performance-enhancing effect. A Google Scholar search using the keywords “energy drinks” and “exercise” yields numerous results, underscoring the voluminous research on this topic. However, there are questions regarding the effectiveness and safety of energy drinks. These questions include, but are not limited to: (1) What are the main active ingredients in energy drinks? (2) Do energy drinks assist in weight management? (3) Do energy drinks enhance aerobic performance? (4) Do energy drinks enhance athletic speed? (5) Do energy drinks improve reaction time? (6) Do energy drinks enhance lean …

The Association Of Zero Walking Cadence Minutes With Sleep Quality In Adults 18 – 65, Trent A. Hargens, Matthew C. Scott, Meghan Peterson, Kimberly C. Bennett, Timothy Thome, Elizabeth S. Edwards

Faculty Scholarship

Purpose Physical activity (PA) guidelines suggest a link between PA, sedentary time, and sleep quality (SQ). Step cadence is an emerging proxy for PA intensity, with zero cadence (ZC) indicating sedentary time. No research has explored the relationship between ZC and SQ. This study examines the relationship between ZC and SC, compared to traditional PA and sedentary metrics, all measured via accelerometry. Methods Sleep and PA was assessed in 138 adults (53 male, 85 female, age = 23.5 ± 8.0 year.) via accelerometry. Sedentary, light, moderate, vigorous intensity PA, and ZC minutes per day were measured. SQ variables included sleep …

Administration Patterns Of Magnesium Sulphate For Women With Preeclampsia And Immediate Newborn Outcomes In Kawempe National Referral Hospital-Uganda: A Cohort Study, Christopher J. Burant, Shirley Moore, Carol Blixen, Martha Sajatovic

Faculty Scholarship

Background: Preeclampsia is the second leading cause of maternal death in Uganda. WHO recommends using magnesium sulphate (MgSO4) to prevent and treat preeclampsia with severe features (PEC) and eclampsia. MgSO4 is used to prevent eclampsia and treat women who experience an eclamptic convulsion to avoid severe maternal/infant illnesses and death. We set out to assess MgSO4 administration patterns in women with PEC or eclampsia and the immediate newborn outcomes of neonates. Methods: This was an analytical observational cohort study at Kawempe National Referral Hospital in Uganda. Two hundred ten pregnant mothers with PEC or eclampsia were recruited in the study …

Nanobubble Contrast Enhanced Ultrasound Imaging: A Review, Pinunta Nittayacharn, Felipe M. Berg, Dorian Durig, Agata A. Exner

Faculty Scholarship

Contrast-enhanced ultrasound is currently used worldwide with clinical indications in cardiology and radiology, and it continues to evolve and develop through innovative technological advancements. Clinically utilized contrast agents for ultrasound consist of hydrophobic gas microbubbles stabilized with a biocompatible shell. These agents are used commonly in echocardiography, with emerging applications in cancer diagnosis and therapy. Microbubbles are a blood pool agent with diameters between 1 and 10 μm, which precludes their use in other extravascular applications. To expand the potential use of contrast-enhanced ultrasound beyond intravascular applications, sub-micron agents, often called nanobubbles or ultra-fine bubbles, have recently emerged as a …

Self-Monitoring With Coping Skills And Lifestyle Education For Hypertension Control In Primary Care, Sonal J. Patil, Eno Obong Udoh

Faculty Scholarship

Self-monitoring with support, lifestyle modifications, and emotion management improves blood pressure (BP). Patients with hypertension need continual support to modify behaviors, but time pressures limit lifestyle education in primary care settings. Using mixed methods, we aimed to study the feasibility and acceptability of an innovative 6-week program that combined self-monitoring with coping skills and lifestyle education for patients with uncontrolled hypertension. Patients with uncontrolled hypertension interested in lifestyle modifications before intensifying medications were enrolled from primary care clinics. Patients self-monitored emotions, behaviors, and BPs and received education from medical providers and mind-body therapists through shared medical appointments (SMAs) with an …

Proceedings Of The 2022 “Lifestyle Intervention For Epilepsy (Life)” Symposium Hosted By Cleveland Clinic, Martha Sajatovic

Faculty Scholarship

Lifestyle interventions are strategies used to self-manage medical conditions, such as epilepsy, and often complement traditional pharmacologic and surgical therapies. The need for integrating evidence-based lifestyle interventions into mainstream medicine for the treatment of epilepsy is evident given that despite the availability of a multitude of treatments with medications and surgical techniques, a significant proportion of patients have refractory seizures, and even those who are seizure-free report significant adverse effects with current treatments. Although the evidence base for complementary medicine is less robust than it is for traditional forms of medicine, the evidence to date suggests that several forms of …

A Sex Comparison Of The Physical And Physiological Demands Of United States Marine Corps Recruit Training, Bridget A. Mcfadden, Harry P. Cintineo, Alexa J. Chandler, Gianna F, Mastrofini, Caroline Vicenty, Patrick Peterson, Mita Lovalekar, Bradley Nindl, Shawn M. Arent

Faculty Scholarship

PURPOSE: to monitor USMC recruits throughout training to comparatively assess workload, sleep, stress, and performance responses in men and women.

METHODS: 278 recruits (M = 180 & W = 98; Age = 19 ± 2y) were monitored and tested. Workload, sleep, and stress assessments occurred at weeks 2, 7/8, and 11 of training. Workload (energy expenditure per kg body mass [EE], distance [DIS], steps) and sleep (continuity & duration) were tracked over 72-hour periods using wearable accelerometry and heart rate devices. Stress was determined through salivary cortisol. Performance testing (vertical jump [CMJ] and isometric mid-thigh pull [IMTP]), occurred …

Impact Of Body Mass Index And Vo2 Max On Symptoms, Physical Activity, And Physical Function In A Multinational Sample Of People With Hiv, Christine Horvat Davey, Deepesh Duwadi

Faculty Scholarship

People with HIV (PWH) are at increased risk for metabolic disorders affecting body mass index (BMI), chronic symptoms, and impaired physical function and capacity. Although physical activity improves health and well-being, PWH often do not meet activity recommendations necessary to achieve these benefits. Despite the known impact of symptoms, physical activity, and physical function on health, little is known about the relationships and interactions between these variables and BMI and maximum oxygen consumption during exercise (VO2 max) in a multinational population of PWH. We examined the relationship of BMI with PROMIS-29 measures, physical activity, strength, flexibility, and VO2 max in …

Global Trends In Type 1 Diabetes In Adolescents And Young Adults (1990–2019), Jessy Louisa Silfer, Ksenia N. Tonyushkina

Faculty Scholarship

The study by Gong et al. examines the increases in the incidence, prevalence, and burden trends of type 1 diabetes (T1D) in adolescents and young adults over a 30-year span (1990 – 2019) by age, sex, and geographical regions based on the data from the 204 countries and territories included in the Global Burden of Disease (GBD) collaborative.1 Burden is defined as a combination of mortality rates and disability adjusted life year (DALY) indexes. The results of this 3-decade study should be interpreted within the milieu of improvements in the diagnosis and treatment of T1D over this period as well …

Barriers And Facilitators To Incorporating An Integrative Mind–Body Intervention In Youth With Type 2 Diabetes, Irina Bransteter, Molly Mcvoy, David W. Miller, Rose A. Gubitosi-Klug, Martha Sajatovic

Faculty Scholarship

Objective: There has been little to no qualitative research done with adolescents and young adults (AYA) with type 2 diabetes (T2D) that can guide creation of interventions for this demographic. Using qualitative research methods, a novel mind–body intervention called Intervention for Early Onset Type 2 Diabetes (INTEND) has been developed for AYA aged 15 to 20 years, with the goal of improving self-management and coping skills, by enhancing routine care with augmented education coupled with mind–body skills. Method: Qualitative interviews with AYA 15 to 20 years of age with T2D, their parents, and professionals caring specifically for this population were …

The Limits Of Immigrant Resilience, Huyen Pham, Natalie C. Cook, Ernesto Amaral, Raymond Robertson, Suojin Wang

Faculty Scholarship

Economists have identified important adaptations that immigrant workers have made to weather economic crises. During times of economic contraction, immigrant workers have moved across industries or geographical locations, downshifted to part-time work, and accepted lower wages to stay employed. Evidence from the Great Recession (2007–2009) shows the benefits of that economic resilience: immigrant workers were more likely than native-born workers to remain continuously employed, to have shorter periods of unemployment when they lost their jobs, and to regain jobs more quickly in the recovery period. Of course, these adaptations had significant personal costs for immigrant workers and their families, but …

Why Mlp Legal Care Should Be Financed As Health Care, William M. Sage, Keegan D. Warren

Faculty Scholarship

Medical-legal partnership (MLP) integrates the unique expertise of lawyers into collaborative clinical environments. MLP teams meet the needs of individual patients while also detecting structural problems at the root of health inequities and advancing solutions at the institutional, community, and system levels. Yet MLPs today operate in limited settings and survive on scant budgets. Expanding their impact requires secure funding. Financing MLPs as health care can do the following: (1) help address inequity at the point of care; (2) enable expert diagnosis and treatment of nonmedical drivers of health; (3) enhance team-based practice in health care organizations; (4) offer another …

Using Latent Variables To Improve The Management Of Depression Among Hemodialysis Patients, Douglas D. Gunzler, Martha Sajatovic, Ashwini R. Sehgal

Faculty Scholarship

Background: Screening for depression can be challenging among hemodialysis patients due to the overlap of depressive symptoms with dialysis or kidney disease related symptoms. The aim of this study was to understand these overlapping symptoms and develop a depression screening tool for better clinical assessment of depressive symptoms in dialysis patients. Methods: We surveyed 1,085 dialysis patients between March 1, 2018 and February 28, 2023 at 15 dialysis facilities in Northeast Ohio with the 9-item patient health questionnaire (PHQ-9) and kidney disease quality of life (KDQOL) instrument. To evaluate overlap across questionnaire items, we used structural equation modeling (SEM). We …

Diagnosis And Management Of Hypertension In Adolescents With Obesity, Shradha M. Chhabria, Sarah D. Ronis, Courtney E. Batt

Faculty Scholarship

Purpose of Review: Hypertension (HTN) and obesity are increasing in prevalence and severity in adolescents and have significant implications for long term morbidity and mortality. This review focuses on the diagnosis and management of HTN in adolescents with obesity with an emphasis on co-management of the two conditions. Recent Findings: Recent studies affirm the increasing prevalence of abnormal blood pressures and diagnoses of HTN associated with increased adiposity. Current guidelines recommend routine screening with proper technique for HTN in patients with obesity. Additionally, obesity and HTN related co-occurring medical conditions should be evaluated as there is frequently a bidirectional impact …

Alpha Angle And Anterior Femoral Neck Offset Identify Different Cohorts Of Cam Morphology: An Osteologic Study, Grigory A. Manyak

Faculty Scholarship

Purpose: To explore differences in cam morphology defined by alpha angle (AA) and anterior femoral neck offset (AFNO) in the context of other anthropometric parameters in an osteologic collection to further elucidate whether each measurement tool is identifying the same underlying pathology. Methods: Anthropometric measurements of 992 cadaveric hips from the Hamann-Todd Osteological Collection were analyzed. Femurs with cam morphology were identified by AA >55° or AFNO <7 mm. Anthropometric parameters stratified by cam morphology were assessed with Wilcoxon rank-sum and Pearson χ2 tests. Multivariate logistic regressions were performed on significant variables in univariate analysis to examine the predictive ability of anthropometric variables to cam morphology. Results: Cam morphology was identified in 242 hips via AA, 344 hips via AFNO, and 123 hips via both measures. Multivariate logarithmic regression analysis demonstrated that sex negatively predicted AA (females with less pathology, β = –0.14, P = .04), race negatively predicted AA (Blacks with less pathology, β = –0.21, P < .01), and proximal femoral osteoarthritis was positively associated with AA (β = 0.16, P = .02), while none of these were associated with AFNO. On the other hand, right-side specimens were associated with AA (β = 0.15, P = .02) and AFNO (β = 0.25, P < .01), whereas the combined version was unassociated with both measures. Conclusions: In conclusion, cam morphology was identified in a modest percentage of osteologic specimens by both AA and AFNO in our study. Further, associations of multiple demographic, anthropometric, and anatomical parameters to AA and AFNO suggest they may identify different subsets of cam morphology. Clinical Relevance: Cam morphology identified by AA versus AFNO may represent 2 different pathologic entities. Future studies should assess differences between these measures in a clinical cohort and determine whether these 2 definitions of cam morphology identify different clinical populations.

Parental Political Engagement And Self-Efficacy: An Exploratory Study, Christina Randolph, Robert Needlman, Ellen Hutchinson

Faculty Scholarship

Political engagement (PE) is associated with a sense of empowerment. PE by parents affects children's lives. This study explored parents' attitudes about inclusion of political engagement discussion in well-child care. Because voting is an expression of empowerment, we hypothesized that voting would be related to higher parenting self-efficacy. We administered a brief questionnaire to a convenience sample of parents/guardians at well-child visits at an urban hospital. The questionnaire included 10 Likert scale questions touching on parenting efficacy; beliefs about political engagement; voting behaviors; and demographics. Analysis included descriptive statistics, correlations, and factor analysis. Among the 70 respondents 84% were mothers; …