Digital Commons Network^™

Social Determinants Of Occupational Injuries Among Us-Based Commercial Fishermen: A Systematic Review, Shannon Guillot-Wright, Leonard Kuan-Pei Wang, Bibiana Toro Figueira, Mary Overcash Jones, Ruhi Maredia, Nikhita Kichili

Faculty, Staff and Student Publications

BACKGROUND: Commercial fishing is a multibillion-dollar industry that supports job growth, small- to large- businesses, and port and city revenue. The commercial fishing industry continues to be one of the most dangerous in the US, with a fatality rate nearly 40 times higher than the national average. Dangers of the fishing industry are multi-faceted and include hazardous working conditions, strenuous labor, long work hours, and harsh weather. Moreover, a vast majority of fishermen suffer from economic insecurity, including safe and affordable housing and food insecurity.

METHODS: We followed the recommendations and standards set by the Campbell and Cochrane Equity Methods …

Ypfs Lessons Learned Oral History Project: An Interview With Anthony Dowd, Anthony Dowd, Rosalind Z. Wiggins, Mercedes Cardona

Documents

No abstract provided.

Dna Methylation Profiling At Base-Pair Resolution Reveals Unique Epigenetic Features Of Early-Onset Colorectal Cancer In Underrepresented Populations, Jason Sheng Li, Karen Riggins, Li Yang, Chaorong Chen, Patricia Castro, Wedad Alfarkh, Neda Zarrin-Khameh, Michael E Scheurer, Chad J Creighton, Benjamin Musher, Wei Li, Lanlan Shen

Faculty, Staff and Students Publications

BACKGROUND: The incidence of early-onset colorectal cancer (EOCRC) has been rising at an alarming rate in the USA, and EOCRC disproportionately affects racial/ethnic minorities. Here, we construct comprehensive profiles of EOCRC DNA methylomes at base-pair resolution for a cohort of Hispanic and African American patients.

RESULTS: We show the epigenetic landscape of these EOCRC patients differs from that of late-onset colorectal cancer patients, and methylation canyons in EOCRC tumor tissue preferentially overlapped genes in cancer-related pathways. Furthermore, we identify epigenetic alterations in metabolic genes that are specific to our racial/ethnic minority EOCRC cohort but not Caucasian patients from TCGA. Top …

Priority Competencies For Designated Education Officers In The Veterans Health Administration, Duane R. Bidwell, Anita Samuel, Ronald M. Cervero, Steven J. Durning, Sherri L. Stephan, Erin L. Patel, Marjorie A. Bowman, Holly S. Meyer

Population and Public Health Sciences Faculty Publications

Designated Education Officers (DEOs) at Veteran Health Administration (VHA) hospitals are senior educational leaders tasked with oversight of all clinical training at a particular facility. They prioritize dozens of tasks and responsibilities each day, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Clarifying priority competencies for the role can help executives recruit, appoint, and evaluate capable personnel and promote effective, efficient performance. Using a federally developed method of competency analysis, researchers consulted a panel of subject-matter experts to identify priority competencies for DEOs, using data from a 2013 study that …

Associations Between Deficit Accumulation Frailty And Baseline Markers Of Lifestyle In The Us Pointer Trial, Mark A Espeland, Yitbarek N Demesie, Kayloni Olson, Samuel N Lockhart, Sarah E Tomaszewski Farias, Maryjo L Cleveland, Christy C Tangney, Lucia Crivelli, Heather M Snyder, Michele K York, Laura D Baker, Rachel A Whitmer, Rena R Wing, Katelyn R Garcia, Kathryn E Callahan

Faculty, Staff and Students Publications

BACKGROUND: Multidomain lifestyle interventions may have the potential to slow biological aging as captured by deficit accumulation frailty indices. We describe the distribution and composition of the 49-component frailty index developed by the U.S. POINTER clinical trial team of investigators and assess its cross-sectional associations with sociodemographic factors and markers chosen to be representative of behaviors targeted by the trial's multidomain interventions.

METHODS: We draw baseline data from the 2 111 volunteers enrolled in U.S. POINTER who were ages 60-79 years and at increased risk for cognitive decline. Frailty components were grouped into 9 domains. Associations that frailty index scores …

Cannabis Use Characteristics And Associations With Problematic Use Outcomes, Quitting-Related Factors, And Mental Health Among Us Young Adults, Carla J Berg, Cassidy R Loparco, Katelyn F Romm, Yuxian Cui, Darcey M Mccready, Yan Wang, Y Tony Yang, Hannah S Szlyk, Erin Kasson, Rishika Chakraborty, Patricia A Cavazos-Rehg

2020-Current year OA Pubs

OBJECTIVE: Given the changes in trends of cannabis use (e.g., product types), this study examined latent classes of young adult use and associations with use-related outcomes.

METHODS: We analyzed 2023 survey data among 4,031 US young adults (M

RESULTS: LCA identified 4 classes of cannabis use frequency and types used: 'infrequent-herb/edibles' (41.4%), 'frequent-herb' (16.8%), 'moderate-herb' (28.0%), and 'moderate-oil/other' (13.8%). In multivariable analyses (referent group: 'moderate-herb' class), 'frequent-herb' reported less problematic use (B=-0.18, 95%CI=-0.30, -0.07), while 'moderate-oil/other' reported greater (B = 0.39, 95%CI = 0.27, 0.51). 'Infrequent-herb/edibles' had lower odds of driving post-use of cannabis (aOR = 0.28, 95%CI = 0.22, …

Cancer-Related Health Behaviors During The Covid 19 Pandemic In Geographically Diverse Samples Across The Us, Breanna B Greteman, Bettina F Drake, Kia L Davis, Et Al.

2020-Current year OA Pubs

BACKGROUND: The COVID-19 pandemic involved business closures (e.g., gyms), social distancing policies, and prolonged stressful situations that may have impacted engagement in health behaviors. Our study assessed changes in cancer-related health behaviors during the pandemic, specifically physical activity, fruit/vegetable intake, smoking/tobacco use, and alcohol consumption.

METHODS: Eight cancer centers administered mailed/web-based/telephone surveys between June 2020 and March 2021. Surveys assessed demographics, perceptions on social distancing, and self-reported changes of behaviors (less/same/more) associated with cancer prevention or risk, e.g., physical activity, fruit/vegetable intake, tobacco/smoking use, and alcohol consumption. Descriptive analyses and logistic regression models assessed association of variables with behavior change. …

Buprenorphine And Postpartum Contraception Utilization Among People With Opioid Use Disorder: A Multi-State Analysis, Kevin Y Xu, Jennifer K Bello, Joanna Buss, Hendrée E Jones, Laura J Bierut, Dustin Stwalley, Hannah S Szlyk, Caitlin E Martin, Jeannie C Kelly, Ebony B Carter, Elizabeth E Krans, Richard A Grucza

2020-Current year OA Pubs

BACKGROUND: The postpartum period provides an opportunity for birthing people with opioid use disorder (OUD) to consider their future reproductive health goals. However, the relationship between the use of medication for opioid use disorder (MOUD) and contraception utilization is not well understood. We used multistate administrative claims data to compare contraception utilization rates among postpartum people with OUD initiating buprenorphine (BUP) versus no medication (psychosocial services receipt without MOUD (PSY)) in the United States (US).

METHODS: In this retrospective cohort study, we analyzed data from the Merative™ MarketScan

RESULTS: Our sample consisted of 11,118 postpartum people with OUD. Among those, …

Us Military Veterans’ Perceived Concordance With Their Providers Regarding Persistent Physical Symptoms Prospectively Predicts Satisfaction With Care And Adherence To Care Plans, L Alison Phillips, Laura M Lesnewich, Katharine Bloeser, Yong Lin, Rachel L Boska, Justeen K Hyde, Peter J Bayley, Helena K Chandler, Matthew J Reinhard, Susan L Santos, Rachel Stewart, Drew A Helmer, Lisa M Mcandrew

Center for Medical Ethics and Health Policy Staff Publications

Background: Medically unexplained, persistent physical symptoms and syndromes are commonly seen in primary care. These are debilitating for patients and difficult to treat, causing frustration for patients and providers.

Purpose: This study investigates how well US military veterans with multiple persistent physical symptoms (PPS), called Gulf War illness (GWI), agree with their healthcare providers about their illness. This agreement, called perceived concordance, is hypothesized to influence veterans' satisfaction with care, adherence to care plans, and disability levels.

Methods: Participants were 230 veterans with GWI deployed to the 1990-1991 Gulf War who were recruited from Veteran Affairs primary care and War …

Covid-19 Pandemic And Racial And Ethnic Disparities In Long-Term Nursing Home Stay Or Death Following Hospital Discharge, Laurent G Glance, Karen E Joynt Maddox, Patricia W Stone, Jingjing Shang, E Yoko Furuya, Ashley M Chastain, Ji Won Lee, Bridget Morse-Karzen, Andrew W Dick

2020-Current year OA Pubs

IMPORTANCE: Long-term nursing home stay or death (long-term NH stay or death), defined as new long-term residence in a nursing home or death following hospital discharge, is an important patient-centered outcome.

OBJECTIVE: To examine whether the COVID-19 pandemic was associated with changes in long-term NH stay or death among older adults with sepsis, and whether these changes were greater in individuals from racial and ethnic minoritized groups.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used patient-level data from the Medicare Provider Analysis and Review File, the Master Beneficiary Summary File, and the Minimum Data Set. Community-dwelling individuals aged at least …

Covid-19 Vaccine Hesitancy Among Black Women In The Us, Brittany C Slatton, Farrah G Cambrice, Serwaa S Omowale

Faculty, Staff and Student Publications

IMPORTANCE: COVID-19 vaccine hesitancy among Black women is a critical public health concern, potentially exacerbating existing health disparities and impacting community-wide vaccination efforts.

OBJECTIVE: To explore the factors associated with COVID-19 vaccine hesitancy among Black women in the US and identify the specific concerns and experiences shaping hesitant attitudes toward vaccination.

DESIGN, SETTING, AND PARTICIPANTS: Qualitative study using in-depth, semistructured interviews conducted virtually between June and November 2021. Thematic analysis was used to identify key themes from the interview data. Participants were recruited through social media platforms and word-of-mouth referrals from various regions of the US. Interviews were conducted remotely …

Adverse Prehospital Events And Outcomes After Traumatic Brain Injury, Amelia W Maiga, Hsing-Hua Sylvia Lin, Stephen R Wisniewski, Joshua B Brown, Ernest E Moore, Martin A Schreiber, Bellal Joseph, Chad T Wilson, Bryan A Cotton, Daniel G Ostermayer, Brian G Harbrecht, Mayur B Patel, Jason L Sperry, Francis X Guyette, Henry E Wang

Faculty, Staff and Student Publications

Importance: While national guidelines recommend avoidance of hypoxia, hypotension, and hypocarbia in the prehospital care of traumatic brain injury (TBI), limited data validate the association of these adverse physiologic events with TBI outcomes.

Objective: To validate the associations of prehospital hypoxia, hypotension, and hypocarbia with TBI outcomes in a US national trauma network.

Design, setting, and participants: This cohort study examined data from 8 level I trauma centers and their affiliated ground and air emergency medical services (EMS) agencies in the Linking Investigations in Trauma and Emergency Services (LITES) Network from January 1, 2017, to June 30, 2021. Adult patients …

Cardiovascular Disease And Breast Cancer Stage At Diagnosi\S, Ivan Angelov, Allen M Haas, Elizabeth Brock, Lingfeng Luo, Jing Zhao, Benjamin D Smith, Sharon H Giordano, Nicholas J Leeper, Kevin T Nead

Faculty, Staff and Student Publications

Importance: Cardiovascular disease (CVD) and cancer are the leading causes of mortality in the US. Large-scale population-based and mechanistic studies support a direct effect of CVD on accelerated tumor growth and spread, specifically in breast cancer.

Objective: To assess whether individuals presenting with advanced breast cancers are more likely to have prevalent CVD compared with those with early-stage breast cancers at the time of diagnosis.

Design, setting, and participants: This population-based case-control study used data from the Surveillance, Epidemiology, and End Results-Medicare linked databases from 2009 to 2020. The analysis was completed from May 2023 to August 2024. Participants were …

Utility Of Candidate Genes From An Algorithm Designed To Predict Genetic Risk For Opioid Use Disorder, Christal N Davis, Alexander S Hatoum, Arpana Agrawal, Et Al.

2020-Current year OA Pubs

IMPORTANCE: Recently, the US Food and Drug Administration gave premarketing approval to an algorithm based on its purported ability to identify individuals at genetic risk for opioid use disorder (OUD). However, the clinical utility of the candidate genetic variants included in the algorithm has not been independently demonstrated.

OBJECTIVE: To assess the utility of 15 genetic variants from an algorithm intended to predict OUD risk.

DESIGN, SETTING, AND PARTICIPANTS: This case-control study examined the association of 15 candidate genetic variants with risk of OUD using electronic health record data from December 20, 1992, to September 30, 2022. Electronic health record …

Factors Impacting Undergraduate Student Use Of Mental Health Care In The U.S. And France, Samantha Lamontagne

CISLA Senior Integrative Projects

No abstract provided.

Part 5: Silver Tsunami For The Third Sector, Dragas Center For Economic Analysis And Policy, Old Dominion University

State of the Region Reports: Hampton Roads

Affordable housing is only one of several societal stressors predicted to have nationwide impacts in conjunction with what has been dubbed the “Silver Tsunami,” a significant demographic shift occurring in the United States. According to Pew Research, every day, 10,000 members of the baby boomer generation—born between 1946 and 1964—reach retirement age. The implications of this demographic shift will impact every facet of life in Hampton Roads. This chapter explores how an aging population impacts nonprofits in Hampton Roads.

Lower Electronic Health Record Adoption And Interoperability In Rural Versus Urban Physician Participants: A Cross-Sectional Analysis From The Cms Quality Payment Program, Alfred J. Anzalone, Carol R. Geary, Ran Dai, Shinobu Watanabe-Galloway, James C. Mcclay, James Campbell

Journal Articles: Epidemiology

BACKGROUND: The Health Information Technology for Economic and Clinical Health Act of 2009 introduced the Meaningful Use program to incentivize the adoption of electronic health records (EHRs) in the U.S. This study investigates the disparities in EHR adoption and interoperability between rural and urban physicians in the context of federal programs like the Medicare Access and CHIP Reauthorization Act of 2015 and the 21st Century Cures Act.

METHODS: A cross-sectional analysis was conducted using the 2021 Quality Payment Program Experience Report Public Use File to compare EHR adoption and Promoting Interoperability scores (PISs) between urban and rural physician participants. Data …

Representing Climate Wreckers, Camila Bustos

Elisabeth Haub School of Law Faculty Publications

In recent years, lawyers have become increasingly aware of the implications of the climate crisis for legal practice. Amidst this context, United Nations Secretary General Ant6nio Guterres has urged recent graduates to decline work on behalf of "climate wreckers." This Article examines how professional responsibility rules and principles in the United States should be interpreted on a warming planet, particularly in the context of attorneys representing so-called "climate wreckers" in civil matters. I use the term "climate wrecker" to refer to fossil fuel corporations and trade associations that have engaged in public disinformation campaigns to stall climate action and sow …

Abundance And Other Food Fixations, Margot J. Pollans

Elisabeth Haub School of Law Faculty Publications

Although most people in the United States no longer devote the majority of their time to food production, processing, and distribution, food remains a daily fixation. This Article explores three driving food fixations--abundance, thinness, and health--and situates each against an inverse fear--scarcity, fatness, and illness, respectively. Mapping these threats onto U.S. food policy, this Article examines, among other policy arenas, food waste policy, nutrition and health claim labeling law, and food additive regulations. Across food policy, these fixations feed what this Article calls the “politics of abundance.” This politics helps to insulate the food industry from deeper systemic reform aimed …

Cronyism In Creating Chronic Disease—A Path To Food Justice, Martha Leonard

St. Thomas Law Review

Central to this discussion is a quote often attributed to the ancient Greek physician Hippocrates: “Let food be thy medicine, and medicine be thy food.” Today, physicians recognize the crucial role of diet in maintaining good health and preventing chronic disease, but U.S. laws fail to reflect this understanding. The health field has seen significant progress in scientific research on pathology; however, nutritional research presents a challenging and contradictory landscape. Corporate influence in scientific research leads to a lack of consensus on the most optimal diet for promoting general health, presenting a challenge for policymaking. The dark reality is that …

The New World's Pandemic: Sexual Exploitation In The Digital Age, Rocio Iglesias Gonzalez

St. Thomas Law Review

Mary is a fifteen-year-old who is excited about starting her sophomore year of high school. Unbeknownst to Mary, George, a classmate whose romantic advances Mary had rejected, created a sexually explicit image generated by artificial intelligence, most commonly known as a deepfake, of Mary and started sending it to other classmates. Once Mary discovered the deepfaked pictures, she and her parents sought legal advice on available remedies. Unfortunately, Mary lives in Nevada, a state that has no legislation addressing the issue of nonconsensual sexually explicit deepfakes. Similarly, at the federal level, Mary has no course of action against her offender. …

No Remedy For Colonization, Sigrid Vendrell-Polanco

Faculty Articles

The United States purports to maintain a democratic relationship with its inhabited territories, yet the Supreme Court continues to uphold twentieth century laws that affirm rather than abrogate colonial policies. The gap between how the United States idealizes democracy and its real world application, especially in its five colonized territories (Puerto Rico, American Samoa, Guam, the Northern Mariana Islands, the United States Virgin Islands, and American Samoa), is not just growing—it is becoming a chasm. These colonies are currently referred to as United States territories. In 2023, the U.S. territory of Puerto Rico experienced a controversial sovereignty challenge surrounding the …

The Role Of Mentoring In Combating Racism And Sexism In Higher Education As A Blueprint For Other Historical Institutions In The United States, Michelle R. Gherardi

West Chester University Doctoral Projects

Racism and sexism create a bottleneck to advancement for women in higher education.

This qualitative study and dissertation investigate the role of mentoring in combating racism and sexism in higher education in the United States as a blueprint for other historical institutions. Twenty-six women of color in four categories (presidents/provosts/chancellors, deans of law and medical schools, vice presidents of diversity, equity, and inclusion/student affairs, and graduate students) of higher education were interviewed to explore their experiences with racism, sexism, and mentor relationships. Findings demonstrate all but one participant (96%) disclosed racial victimization in higher education, all participants (100%) disclosed sexist …

Regional Variation And Correlation Of Big Five Personality Traits With Rates Of Insufficient Sleep And Diabetes In The United States, Isabella Chirakos, Brennan Schroeder

Scholarship in Medicine - All Papers

Background: Diabetes and insufficient sleep are prevalent health concerns, and determining potential contributing factors could help decrease the incidence of these issues. This study aims to explore potential associations between insufficient sleep and diabetes mellitus, examining whether these negative health outcomes can be linked geographically and by personality traits. Results could help create more effective programs to combat diabetes and insufficient sleep.
Materials and Methods: The study utilized longitudinal health data and roadmaps from 2016 and 2023 for each state, categorizing the data into four regions: Northeast, Midwest, South, and West. We incorporated personality data from the Synthetic Aperture Personality …

Food Waste Crisis In The United States Of America: The Known, The Overlooked And The Undisclosed, Sagarika Srivastava, David J. Tonjes

Technology & Society Faculty Publications

With a loss of 1,250 calories per day per person or 140 kg/p/yr, the United States (U.S.) has a large problem with food waste. The later a product is wasted in the supply chain, the greater its environmental cost. Many food waste mitigation efforts focus on the retail and consumer stages, but there is also considerable food waste in the production phase, which includes growing, harvesting, transportation, storage and processing. The study is conducted in two steps: a bibliometric analysis of 218 articles on food waste in the U.S., followed by an investigation of options to meet food waste recovery …

Part 4: Is It Better To Give Than Receive? Exploring The Distributional Dimension Of Virginia's Budget, Dragas Center For Economic Analysis And Policy, Old Dominion University

State of the Commonwealth Reports

This chapter focuses on the distribution of intergovernmental finances in Virginia. Specifically, it analyzes the distribution of state-level public resources in the Commonwealth of Virginia that takes place as a result of state-to-local intergovernmental transfers. The analysis suggests that, as a result of the manner in which state revenues are collected and allocated back to localities, some Virginians contribute significantly more to the Commonwealth budget in taxes than they receive back in local benefits, while other state residents receive more in benefits than they pay in taxes.

Columbus State University Honors College: Senior Theses, Fall 2024/Spring 2025, Mary Claire Bucanan, Amanda Byars, Marcos Falck, Celeste Grantham, Jarrett Huckaby, Kangjin Joo, Lauren Katzfey, Samual Kimball, Apoorva Kollaram, Ma'lon Lane, Yesmin Mezeyek, Collin Miller, Elizabeth Williams, Matthew Woods

Senior Theses from the Honors College

This is a collection of senior theses written by honors students at Columbus State University during the Fall 2024 and Spring 2025 semesters.

Titles:

- "Listening, Looking, and Learning: An Exploration of Musical Influence on the Narratives and Characters of Call the Midwife" , by Mary Bucanan

- "Stop Suffering for Your Art" , by Amanda Byars

- "Cross-Cultural Narratives: A Comparative Analysis of "Yo Soy Betty La Fea" and "Ugly Betty" " , by Marcos Falck

-"Innovative Teaching Strategies and Lesson Plans to Support Students and ADHD" , by Celeste Grantham

-"Inquiry Based Eighth Grade Math and Science Lessons" …

An Evaluation Of The Decline In Primary Care Physician Visits, 2010 To 2021, Anuradha Jetty, Marie Ezran, Alison Huffstetler, Yalda Jabbarpour

Department of Family & Community Medicine Faculty Papers

INTRODUCTION: Primary care is the backbone of the United States healthcare system, yet it continues to be underfunded and inaccessible to many. Previous studies explored primary care visit patterns until 2016, leaving gaps in our understanding of how recent factors like state Medicaid expansions, the Coronavirus Disease 2019 (COVID-19) pandemic, and population growth have influenced these patterns. Hence, the objective of the current study was to analyze the trends in primary care visits provided by outpatient clinicians over time and by visit type and contextualize study findings within the changing healthcare landscape.

METHODS: The Medical Expenditure Panel Survey data (2010-2021) …

Letter Of Concern From The Association Of Academic Chairs Of Emergency Medicine Regarding Acgme Proposed Changes, Richard J. Hamilton, Lance B. Becker, Richard E. Wolfe, D. Adam Algren, Arnold Thomas, Michael Baumann, Ross P. Berkeley, Terrell S. Caffery, Chad Cannon, Theodore J. Corbin, Michael E. Chansky, Harinder S. Dhindsa, Charles L. Emerman, David A. Farcy, Chris Fox, Michael A. Gibbs, Christopher S. Goode, Steven "Andy" Godwin, Dietrich Jehle, David Johnson, Samuel M. Keim, Babak Khazaeni, Barry J. Knapp, Clint Hawthorne, John D. Hoyle Jr., Michael Christopher Kurz, Evan Leibner, Robert Mcnamara, Robert F. Mccormack, Edward A. Michelson, Chadwick Miller, Ashley Norse, Andrew Nugent, Brian J. O'Neil, David T. Overton, Edward A. Panacek, William F. Paolo, Denis R. Pauzé, Amanda L. Perez, Ralph J. Riviello, Scott W. Rodi, Peter S. Pang, Juan A. Gonzalez Sanchez, David P. Sklar, Ben C. Smith, Jeffrey R. Stowell, Marc D. Squillante, J. Jeremy Thomas, Terry Vanden Hoek, Gregory A. Volturo, E. Lea Walters, Thomas E. Wyatt, Donald M. Yealy

Department of Emergency Medicine Faculty Publications

This letter, signed by over 50 academic chairs of emergency medicine, urges the ACGME to reconsider a proposed mandate requiring all emergency medicine residency programs to adopt a four-year training model. The authors argue that current three-year programs are supported by data demonstrating equivalent educational and clinical outcomes compared to four-year formats. They criticize the flawed survey methodology underpinning the proposal, note the loss of milestone-based training flexibility, and highlight the lack of added scholarly or clinical value in the fourth year. The letter also outlines negative consequences for fellowship participation, workforce development, trainee debt, and diversity. The signatories advocate …

Exploring Psychological Impacts, Coping, And Conflict Resolution Of Transnationalism On Parent-Child Relationships, Sally Sanchez

PCOM Psychology Dissertations

The number of immigrants migrating to the United States has increased over the past 30 years. Many of these immigrants leave behind their spouses and children, creating transnational families. Researchers have focused on the experiences of transnational families, but there is a need for continued research to further explore the psychological impact of separation and reunification. The purpose of this study was to identify the possible psychological impact of the separation and reunification process experienced by transnational families, and the coping strategies used during the process. This study used a qualitative design to explore the experiences of transnational families who …