Open Access. Powered by Scholars. Published by Universities.®

Medicine and Health Sciences Commons

Open Access. Powered by Scholars. Published by Universities.®

Theses/Dissertations

Social and Behavioral Sciences

2019

Institution
Keyword
Publication
File Type

Articles 1 - 30 of 671

Full-Text Articles in Medicine and Health Sciences

To Disclose Or Not To Disclose? Self-Disclosure Of Mental Health In The Workplace, Samantha Margaret Reynolds Dec 2019

To Disclose Or Not To Disclose? Self-Disclosure Of Mental Health In The Workplace, Samantha Margaret Reynolds

Dissertations and Theses

When making the decision to disclose a mental illness, individuals may be met with a number of factors that impact disclosure. This study examines the relationship between self-stigma, psychological safety, social support and self-disclosure of mental illness in the workplace. The present study surveyed 756 participants and found a positive relationship between stigma and self-disclosure as well as a positive relationship between social support and self-disclosure. For work outcomes, there was a negative relationship between both job satisfaction and productivity in relation to self-disclosure. This study potentiates the antecedents and consequences of self-disclosure of mental illness and how it impacts …


The Ethical Justification Of Increasing Awareness Of Preventive Medicine Among Healthcare Professionals, Patients And The General Public In The United States, Karishma Ether Moazzam Dec 2019

The Ethical Justification Of Increasing Awareness Of Preventive Medicine Among Healthcare Professionals, Patients And The General Public In The United States, Karishma Ether Moazzam

Electronic Theses and Dissertations

While practiced for centuries, preventive medicine has received increased attention during the recent times. Preventive medicine has a distinct mission to protect, promote, and maintain health as well as to prevent diseases, disabilities, and premature deaths. It aims to fulfill its mission through the combined form of clinical intervention and health promotion. In the recent years, preventive medicine has begun to lean more towards the clinical interventions, taking away from the health promotion. This imbalance has caused preventive medicine to lose its effectiveness in fulfilling its mission. One of the leading causes for such imbalance is the lack of proper …


More Than A Century After Problem Emerged, Manhole Explosions Still Injuring Dozens In New York City, Gaspard Le Dem, Gabriel Sandoval Dec 2019

More Than A Century After Problem Emerged, Manhole Explosions Still Injuring Dozens In New York City, Gaspard Le Dem, Gabriel Sandoval

Capstones

Since the early days of electrification, New York City has been rattled by manhole explosions –– underground blasts that injure residents, damage buildings, force evacuations, cause power outages and traffic disruptions.

Consolidated Edison, the city's largest electric provider, has for decades blamed manhole issues on bad weather and road salt that erodes underground wires. But some experts and former utility workers say lack of maintenance is at the root of the problem.

Meanwhile, city and state officials have failed to rein in the problem through weak laws and loose oversight. As a result, unsuspecting drivers and pedestrians continue to be …


Visual Attention And Emotion Regulation In Schizophrenia, Bern Lee Dec 2019

Visual Attention And Emotion Regulation In Schizophrenia, Bern Lee

UNLV Theses, Dissertations, Professional Papers, and Capstones

Emotion regulation and emotion processing deficits cut across the varying symptom presentations of schizophrenia. Emotion processing deficits are inadequately treated by pharmacologic interventions and are related to real-world functional impact and disability. This study investigated behavioral and psychophysiological responses to a series of emotion regulation tasks while concurrently collecting eye tracking data as an index of visual attention. A brief neurocognitive assessment was also completed in order to examine potential cognitive determinants of emotion. Participants completed tasks designed to assess cognitive change and directed attention strategies for down-regulation of unpleasant and pleasant emotion. For each of our two unpleasant emotion …


A Community Of Care: Patterns Of Pathology And Trauma With A Focus On The Bioarchaeology Of Care At Carrier Mills, Il (10,000 – 1000 Bp), Alecia Schrenk Dec 2019

A Community Of Care: Patterns Of Pathology And Trauma With A Focus On The Bioarchaeology Of Care At Carrier Mills, Il (10,000 – 1000 Bp), Alecia Schrenk

UNLV Theses, Dissertations, Professional Papers, and Capstones

Illness and injury are universal human experiences which are endowed with cultural meaning. Bioarchaeology has only recently begun to engage with the socioeconomic impacts of illness, injury, impairment, and healthcare provisioning in the past. This study examines how the Middle Archaic (6000 – 300 BC) and Early Woodland (1000 – 200 BC) hunter-gatherer community of Carrier Mills, Illinois was affected by and managed the socioeconomic burdens of poor health. The data presented in this study used bioarchaeological analyses to reveal patterns of poor health and healthcare provisioning within the Carrier Mills community. Bioarchaeology is ideally situated for such investigations since …


Early Child Development Amid The Pandemic, Zain Saeed Siddiqui Dec 2019

Early Child Development Amid The Pandemic, Zain Saeed Siddiqui

MSJ Capstone Projects

I would like to bring to notice the importance of early child development because the early years are crucial for the development especially the skills that are going to help children succeed in life. Basically, I would like to focus on the natural development of the human being from birth to maturity, enabling children to become the transforming elements of society, leading to a harmonious and peaceful world.

Emotional well-being and social competence provide a strong foundation for emerging cognitive abilities, and together they are the bricks and mortar that comprise the foundation of human development.

Generally, development happens in …


Structural And Tissue-Level Adaptations Of Lumbar Intervertebral Discs In Humans With Inducible Low Back Pain Symptoms, Christian Isaiah Weber Dec 2019

Structural And Tissue-Level Adaptations Of Lumbar Intervertebral Discs In Humans With Inducible Low Back Pain Symptoms, Christian Isaiah Weber

McKelvey School of Engineering Theses & Dissertations

Low back pain (LBP) is a devastating musculoskeletal ailment that impacts majority of the global population. Up to 95% of cases are considered nonspecific where the origin is unclear. Although there is a diagnosis with these cases, there lacks specificity that would help individuals with treatment and pain management. Imaging techniques such as magnetic resonance imaging (MRI) are primarily utilized in the diagnosis of LBP as it illuminates internal structures of the spine. One important structure clearly identified with MRI is the intervertebral disc (IVD) that is susceptible to injury and disease. Further, diagnostic imaging is performed lying down where …


Increasing Utilization Of Motivational Interviewing To Promote Pediatric Oral Health, Ulyses Reamico Dec 2019

Increasing Utilization Of Motivational Interviewing To Promote Pediatric Oral Health, Ulyses Reamico

Doctor of Nursing Practice (DNP) Projects

Prevalence of early childhood caries (ECC) remains high even in developed countries such as the United States. An interprofessional education (IPE) project between University of San Francisco (USF) School of Nursing and Health Professions and the University of the Pacific (UoP), Arthur A. Dugoni School of Dentistry was initiated four years ago to enhance nurse practitioner (NP) and dental students’ pediatric oral-systemic health assessment and health promotion communication skills. Since then, USF NP students received pediatric oral health assessment training and spent clinical rotations at UoP to provide pediatric oral care alongside dental students. This doctor of nursing (DNP) project …


Acceptability Of A Vaginal Ring To Prevent Hiv And Pregnancy: Integrating Multiple Qualitative Methods, Dana Watnick Dec 2019

Acceptability Of A Vaginal Ring To Prevent Hiv And Pregnancy: Integrating Multiple Qualitative Methods, Dana Watnick

Dissertations and Theses

Heterosexual vaginal sex can simultaneously put women at risk for unintended pregnancy and sexually transmitted infections, such as HIV, disproportionately impacting poor women around the world. Both unintended pregnancy and HIV are persistent public health concerns associated with negative outcomes for mothers, families and communities. The current mix of prevention tools available to women to protect against unintended pregnancy and HIV is limited. Multipurpose Prevention Technologies (MPTs) are innovative products that simultaneously offer protection against pregnancy and HIV. However, MPTs will only be effective in reducing unintended pregnancy and incident HIV if women are willing to use them. With an …


Coaching Nurse Leaders In Conflict Management And Team Building To Improve Retention, Jeanette Black Dec 2019

Coaching Nurse Leaders In Conflict Management And Team Building To Improve Retention, Jeanette Black

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Retention of assistant nurse managers (ANMs) was identified as a concern from interviews with executive leadership and ANMs employed at a large hospital within a Northern California integrated health system. The nurse leader orientation training was reviewed, with gaps identified in conflict management and team building.

Context: The attrition rate of U.S. nurse managers in 2010 was 8.3%, higher than executive nurse leaders, with replacement costs equal to 75% - 125% of a nurse manager’s salary (Loveridge, 2017). Employee turnover and dissatisfaction due to conflict can have detrimental effects on retention, productivity, morale, and quality of patient care. …


The Never-Ending Lap, Ennica D. Jacob, Alexis Reese Dec 2019

The Never-Ending Lap, Ennica D. Jacob, Alexis Reese

Capstones

This personal film documents the journey of a Haitian-American woman dealing with sexual trauma in a culture that doesn’t speak candidly on the topic. How can women of the African- American diaspora break the cycle of sexual trauma and what are coping mechanisms to navigate their life choices with awareness?

The Never-Ending Lap will follow Ennica’s own healing process, delving delve into the cycles of sexual trauma. The film will explore past experiences through journal entries, therapy sessions and her love for track and field as she is on the road to search for coping mechanisms and healing.

Link: https://ennicajacob.myportfolio.com/videos


Offering Medical Providers Capacity And Competence In Caring For Transgender And Non-Binary Patients: Evaluation Of A Pilot Digital Training Program, Lexis Manzara Dec 2019

Offering Medical Providers Capacity And Competence In Caring For Transgender And Non-Binary Patients: Evaluation Of A Pilot Digital Training Program, Lexis Manzara

Master's Projects and Capstones

Purpose: Stigma and discrimination in health care settings contribute to health disparities for transgender and non-binary (TGNB) people. Evidence suggests that a lack of training on the care for transgender and non-binary TGNB patients in medical school curricula has contributed to providers feeling unprepared to provide quality care for this population. Health care providers have the opportunity to play a key role in the reduction of health disparities for TGNB patients.

Methods: Twenty-five health care providers completed the eight-module digital training program. Pre- and post-tests assessed provider knowledge, self-efficacy, preparedness, and behavior. Paired samples t-tests were conducted to compare pre-and …


Redefining Trauma: Utilizing Restorative Justice To Repair Care Systems, Emebet Aklilu Dec 2019

Redefining Trauma: Utilizing Restorative Justice To Repair Care Systems, Emebet Aklilu

Master's Projects and Capstones

This project examined the ways in which restorative justice programming can improve trauma informed care among the African American population in Oakland, CA. With 23% of African American men and women living at or below the poverty line in the United States, this project assesses gaps in current trauma informed care practices as evident in the literature. Following a rigorous document review the author coded and organized key programming components following six factors detailed by Rowher, Schoones, and Young (2014). Further examination of these program components was conducted using Bloom’s taxonomy levels to assess program outcomes associated with specific modules …


Air Pollution & Asthma Prevalence: Hotspot Analysis On Environmental Injustice In Buffalo, New York, Zuveria Shaguphta Dec 2019

Air Pollution & Asthma Prevalence: Hotspot Analysis On Environmental Injustice In Buffalo, New York, Zuveria Shaguphta

Graduate Dissertations and Theses

This research aims to focus on the historical impacts of segregation in these communities (with Census Bureau data) and whether we see that these are the areas with continued segregation and a disproportionate number of TRI facilities. The third part of this research will be to investigate the presence of asthma in these neighborhoods as documented by the New York State Health Department. Asthma is a chronic disease in which the airways are inflamed due to some kind of external factor causing this reaction. Literature shows that there is a relationship between outdoor air pollution from combustion of fossil fuels …


A Single Case Study Of Sophomore College Students’ Self-Awareness And How It Relates To Teamwork At A Private College, Jeanne Thomas Dec 2019

A Single Case Study Of Sophomore College Students’ Self-Awareness And How It Relates To Teamwork At A Private College, Jeanne Thomas

CUP Ed.D. Dissertations

Teamwork is considered an essential 21st-century skill and is now included in most university curricula. Working in teams helps college students learn skills such as leadership and problem-solving, that can transfer to the workplace. Effective teams are defined as those with members who communicate well and whose members possess a high degree of self-awareness (SA). SA is the primary component of Goleman’s framework of emotional intelligence (EI). A single case study was conducted at a private college in the United States to better understand how sophomore students described SA and how it relates to teamwork. The participants were sophomore …


Examining The Relationship Of Exercise And Sleep In Students Across Multiple Academic Disciplines, Taylor Zewe Dec 2019

Examining The Relationship Of Exercise And Sleep In Students Across Multiple Academic Disciplines, Taylor Zewe

Honors Projects

Students in college learn the importance of balancing their academic studies with their sleep and exercise habits. The amount of sleep and exercise a student recieves has been examined in previous research studies. In these studies it was found that exercise had a postive affect on the amount of sleep received. However, there is little research on the affect academic discipline has on sleep habits and/or exercise habits of students in college. The purpose of this study is to examine the sleep and exercise habits among students in multiple academic majors at Bowling Green State University.


Biological And Psychological Implications Of Mindfulness Meditation For College Students, Kelsey Madison Dietrich Dec 2019

Biological And Psychological Implications Of Mindfulness Meditation For College Students, Kelsey Madison Dietrich

Honors Projects

The purpose of this capstone project was threefold: investigate the psychological implications of mindfulness meditation for college students enrolled in a semester-long course introducing these practices, investigate the biological implications of mindfulness meditation for these students, and create the Peer Education “Mindfulness” presentation for the Wellness Connection to introduce mindfulness meditation methods to a greater quantity of college students. The following paper describes the two components of this capstone project that examine the implications of mindfulness meditation opportunities available for college students specifically at Bowling Green State University in Bowling Green, Ohio.


Creative Arts-Based Parents Training Program For Parents Of Children With Autism Spectrum Disorder, Jung Eun Park Dec 2019

Creative Arts-Based Parents Training Program For Parents Of Children With Autism Spectrum Disorder, Jung Eun Park

Expressive Therapies Dissertations

This study evaluated the impact of the Creative Arts-based Parents’ Training (CAPT) program. The 6-week long, creative arts therapy-based program and its impact on parental stress and sense of competence for parents of children with Autism Spectrum Disorder (ASD) was examined. Korean Parenting Stress Index Short-Form (K-PSI-SF) and Korean-Parenting Efficacy Test (K-PET) were used as quantitative measurements. Qualitative data were also collected for the experimental group (n = 17) using questionnaires, art journaling, and a 30 min focus group interview. The control group (n = 15) only participated in quantitative measurements. There was no difference in age between …


Blueprint For Shared Safety Strategic Plan, Reann Ramos Dec 2019

Blueprint For Shared Safety Strategic Plan, Reann Ramos

Capstone Projects and Master's Theses

The Blueprint for Shared Safety strategic plan will be adopted by Santa Cruz County Community Corrections Partnership as a framework of principles and practices that community leaders can use to lead shared safety strategies. By shifting the focus from the traditional criminal justice system to investments that can truly make our communities safer, the Blueprint aims to re-envision public safety together. The Community Corrections Partnership Community Education and Engagement Workgroup (CCP CEEW) has conducted data analysis to identify the key assets and gaps in Santa Cruz County. After identifying the key assets and gaps there were recommendation review sessions that …


The Role Of Gamma Oscillations And Cortical Inhibition In The Development Of Working Memory In Adolescence, Christopher P. Walker Dec 2019

The Role Of Gamma Oscillations And Cortical Inhibition In The Development Of Working Memory In Adolescence, Christopher P. Walker

Dissertations & Theses (Open Access)

Adolescence is a dynamic period of social, cognitive, and biological changes. In particular, working memory, the ability to actively encode and maintain information over a short period of time, develops early in childhood and gradually increases in capacity and stability during adolescence. The precise neurophysiological mechanism by which working memory capacity increases during adolescence is unclear. The objective of this investigation was to evaluate the role of cortical gamma-band (> 30 Hz) oscillations—which are associated with working memory in adults—for the development of working memory capacity in adolescents, and to identify the extent to which the temporal profile of gamma-aminobutyric …


Implementing The Patient-Centered Care Paradigm In An Academic Research Environment, Fernando Orgas Dec 2019

Implementing The Patient-Centered Care Paradigm In An Academic Research Environment, Fernando Orgas

Theses & Dissertations

Research Focus. The healthcare landscape is transitioning from a provider-centered care model toward greater emphasis on patient-centered care (PCC). The shift to PCC reflects efforts to increase the quality of healthcare and the care experience. The current state of research within healthcare remains focused on how to provide high-quality and sound research that will bring new equipment, procedures, and verify strategies that may benefit healthcare globally. However, changes in the healthcare atmosphere bring a new perspective to research. How is the paradigm shift to patient-centered care implemented in an academic research environment? Does this holistic mindset fully cross into …


Veterans Using Mindfulness Practice To Cope With Trauma & Operational Stress Injuries, T'Challa Azhar Stuckey Dec 2019

Veterans Using Mindfulness Practice To Cope With Trauma & Operational Stress Injuries, T'Challa Azhar Stuckey

All Theses And Dissertations

Psychological distress due to military operations is impacting returning veterans mentally and physically. The purpose of exploring literature relating to veterans is to determine if mindfulness-based interventions (MBI) are beneficial in managing the symptoms of posttraumatic stress disorder (PTSD). Data generated by the research question “What are the therapeutic benefits of mindfulness-based interventions, if any, in managing the symptoms of PTSD among veterans?” were explored to determine the effectiveness of using mindfulness-based coping skills to manage symptoms such as hyperarousal, intrusive recollections, and avoidance. The studies that were analyzed reported on veterans who have served in the U.S. Armed Forces …


Examining The Relationship Between Yoga Participation And Health. You Down, Dog?, Bethany Forseth Hanson Dec 2019

Examining The Relationship Between Yoga Participation And Health. You Down, Dog?, Bethany Forseth Hanson

Theses and Dissertations

The prevalence of debilitating chronic diseases, such as cardiovascular disease (CVD) and Alzheimer’s disease, are increasing in the United States. Inflammation, mitochondrial dysfunction, stress and depression are common pathologies associated with these chronic diseases. Many individuals engage in yoga because they believe it will improve their health. However, research examining the impact of yoga on markers of health associated with chronic diseases is limited and often reports conflicting results. Therefore, the purpose of this dissertation is to examine the relationship between yoga and inflammation, protein content of oxidative phosphorylation complexes, stress and depression, which may support the use of lifestyle …


Cholesterol Efflux Capacity And Its Association With Metabolic Syndrome In A Multi-Ethnic Population (Dallas Heart Study): A Cross-Sectional Study, Oludamilola Akinmolayemi Dec 2019

Cholesterol Efflux Capacity And Its Association With Metabolic Syndrome In A Multi-Ethnic Population (Dallas Heart Study): A Cross-Sectional Study, Oludamilola Akinmolayemi

Dissertations & Theses (Open Access)

Metabolic syndrome (MetS) is a multi-component risk factor for cardiovascular disease (CVD) and type 2 diabetes. MetS has been found to be associated with increased risk of incident CVD, cardiovascular morbidity and mortality, and prevalence atherosclerosis. Cholesterol efflux capacity (CEC) is a measure of the functional property of high-density lipoprotein cholesterol (HDL-C). In addition, it characterizes the ability of HDL-C to accept cholesterol from extra-hepatic cells in the periphery to the liver and has been shown in clinical studies to be inversely associated with atherosclerosis cardiovascular disease (ASCVD) and incident cardiovascular disease (CVD) . Low HDL-C is one of the …


Factors Affecting Antiretroviral Treatment Entrance, Adherence And Retention Among Hiv Patients In Nigeria And Uganda, Nnenna Ananaba Dec 2019

Factors Affecting Antiretroviral Treatment Entrance, Adherence And Retention Among Hiv Patients In Nigeria And Uganda, Nnenna Ananaba

Dissertations & Theses (Open Access)

Introduction: The maximum benefits of antiretroviral therapy (ART) are achieved when HIV patients follow through the HIV Care Continuum. Understanding the factors that impact the Care Continuum are key in minimizing late ART uptake while increasing treatment retention and adherence in sub-Saharan Africa. Objectives: To explore factors that impact the various phases of the HIV Care Continuum, we review trends in median CD4 cells count and presentation with HIV advanced disease stage between 2013 and 2017. We also examined treatment retention rates and the impact of food security on ART adherence. Methods: Two datasets were reviewed. One dataset consists of …


Characterizing Risk & Burden Of Lower Cranial Neuropathy (Lcnp) As Late Effect Among Oropharyngeal Cancer Survivors, Puja Aggarwal Dec 2019

Characterizing Risk & Burden Of Lower Cranial Neuropathy (Lcnp) As Late Effect Among Oropharyngeal Cancer Survivors, Puja Aggarwal

Dissertations & Theses (Open Access)

Background: Lower cranial neuropathy (LCNP) is a rare but potentially disabling late effect of radiotherapy (RT) and other head and neck cancer therapies. Survivors who develop late LCNP may experience profound functional impairment with deficits in swallowing, speech, and voice. The aims of this research were: 1) to quantify the cumulative incidence of late LCNP and identify clinical predictors of late LCNP; 2) to investigate the impact of late LCNP on severity of cancer treatment-related symptoms, general functional impairment (GFI), and single item scores of the most severe symptoms; and 3) to quantify the association of late LCNP with swallowing-related …


Coy Arjate Adrusted Response Adaptive Randomization Designs With Targeted Learning, Hai Zhu Dec 2019

Coy Arjate Adrusted Response Adaptive Randomization Designs With Targeted Learning, Hai Zhu

Dissertations & Theses (Open Access)

Since Food and Drug Administration (FDA) issued the very first draft guidance in 2010, adaptive designs have been considered to be one of the most promising approaches to make drug development more efficient and less costly. Two approaches, covariate-adjusted response-adaptive (CARA) randomization and adaptive seamless phase II/III design (ASD) have garnered growing attention recently. However, most of the CARA designs are based on parametric models and suffered from model misspecification. The research of incorporating CARA into ASD is also limited and whether type I error rate can be controlled has not been answered. In this dissertation, a new family of …


Patient-Perceived Patient-Centered Medical Home Characteristics And Healthcare Utilization, Expenditure And Quality, Alissa Ratanatawan Dec 2019

Patient-Perceived Patient-Centered Medical Home Characteristics And Healthcare Utilization, Expenditure And Quality, Alissa Ratanatawan

Dissertations & Theses (Open Access)

The patient-centered medical home (PCMH) model is a care delivery model which patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand with the aims to improve healthcare quality while keeping healthcare cost growth under control. The objective of this study was to analyze health service utilization, expenditure and quality of civilian noninstitutionalized US adult population in healthcare facilities that have 3 domains of PCMH features, which are comprehensive care, patient-centered care, and accessible care, using patient’s perspective from the 2016 Medical …


The Potential Impact Of Restricting The Sale Of Tobacco At Tobacco Retail Outlets Surrounding Schools Across Major Metropolitan Areas Of Texas On Tobacco Advertisements, Udoka C. Obinwa Dec 2019

The Potential Impact Of Restricting The Sale Of Tobacco At Tobacco Retail Outlets Surrounding Schools Across Major Metropolitan Areas Of Texas On Tobacco Advertisements, Udoka C. Obinwa

Dissertations & Theses (Open Access)

Retail outlets that sell tobacco (ROST) are the leading channel of advertisements and promotional efforts for tobacco companies. Tobacco companies strategically target youth, young adults, racial and ethnic minorities and individuals in lower SES areas with more advertisements, which in turn influences their tobacco use behavior. Researchers have proposed instituting place-based restriction strategies as a way to control tobacco use. This dissertation examined the potential impact of i) restricting the sale of tobacco at ROST within 1000ft of schools and 2000ft of colleges and ii) restricting the sale of tobacco at ROST within 500ft of other ROST, on the number …


Clinical And Demographic Factors Associated With Peg-Asparaginase-Related Toxicities In Patients With Acute Lymphoblastic Leukemia, Priyadarshani Dharia Dec 2019

Clinical And Demographic Factors Associated With Peg-Asparaginase-Related Toxicities In Patients With Acute Lymphoblastic Leukemia, Priyadarshani Dharia

Dissertations & Theses (Open Access)

Introduction: Polyethylene glycol (PEG)-asparaginase is one of the first-line drugs in pediatric ALL treatment. Although a complete and prolonged treatment with PEGasparaginase has been instrumental in improving the survival of ALL patients, it is associated with four common toxicities: hypersensitivity, hyperbilirubinemia, pancreatitis, and venous thromboembolism (VTE). PEG-asparaginase-related toxicities may require modifications and delays in treatment, which often leads to poor treatment outcomes. Previous studies of PEG-asparaginase-related toxicities have mainly focused on individual toxicities. Further, these studies were conducted in study populations which were predominantly self-reported non-Hispanic whites. Therefore, there is a gap in the knowledge regarding the cumulative burden of …