Medicine and Health Sciences Commons^™

The Impact Of Increased Beef Intake On Cardiometabolic Health In Postmenopausal Women: A 16-Week Randomized Controlled Trial, Leen Samman

Biological Sciences Undergraduate Honors Theses

By 2030, it is projected that the number of post-menopausal women globally will reach 1.2 billion. Moreover, because of increases in life expectancy, women will spend a greater proportion of their later years at elevated risk of chronic disease associated with the hormonal changes of the menopausal transition. Dietary interventions, specifically high-protein diets have shown potential mitigating effects; however, most interventions have focused on total protein intake or protein supplements, not whole foods like lean beef. This randomized controlled trial aimed to assess the effects of daily lean beef consumption as part of a higher protein diet on cardiometabolic markers …

Oxytocin-Mediated Trust Formation In Relationship-Based Sales, Isabella G. Farrington

Biological Sciences Undergraduate Honors Theses

Trust is a critical driver of success in relationship-based sales, particularly in complex environments such as medical, pharmaceutical, and B2B markets where decisions involve uncertainty, risk, and long-term commitment. Existing research in marketing and psychology primarily explains trust through interpersonal behaviors, communication, and relationship management strategies. However, the biological mechanisms underlying trust formation remain largely underexplored in these contexts.

This thesis examines the role of oxytocin, a neuropeptide associated with social bonding and cooperation, in shaping trust and decision-making in professional sales environments. Drawing on research from neuroscience, neuroeconomics, and relationship marketing, it proposes that oxytocin-mediated processes provide a biological …

Baystate Health Nursing: Together In Excellence Newsletter - May 2026, Brenda Simpson Rn

Baystate Health Nursing: Together in Excellence Newsletters

Baystate Health Nursing: Together in Excellence Newsletter - May 2026

Improving Dimensional Stability Of Irreversible Hydrocolloid By Condensation Silicone Incorporation, Jefferson David Melo De Matos, João Pedro Oliveira De Batista, Jozely Francisca Mello Lima, Mário Alexandre Coelho Sinhoreti, Umberto Demoner Ramos, Daher Antonio Queiroz, Daniel Sartorelli Marques De Castro

Faculty, Staff and Student Publications

Background: Irreversible hydrocolloid (alginate) is widely used for dental impressions, but its poor dimensional stability over time limits accuracy when delays in pouring occur. Enhancing its stability through material modification, such as incorporating condensation silicone, may improve clinical outcomes.

Materials and methods: Three groups (n = 10) were evaluated: Group I (conventional alginate, Avagel), Group II (extended-pour alginate, Hydrogum 5), and Group III (alginate modified with condensation silicone). Specimens were fabricated using standardized molds and stored under controlled humidity. Dimensional stability was assessed at five time points (immediate, 24, 48, 72, and 120 h) by measuring mass and linear dimensions. …

Interventional Approach To Intermediate-High-Risk Pe: Catheter-Directed Mechanical Thrombectomy, Shreya Agarwal, Kirill Ruban, Ishan Kirti, Karina Ruban, Fadi Saab, Sujata Kambhatla, Pranay Gupta

Conference Presentation Abstracts

Acute pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. The clinical outcomes are largely determined by thrombus burden and its hemodynamic impact on the right ventricle (RV). Over the past decade, catheter-directed mechanical thrombectomy has emerged as a promising alternative for systemic thrombolysis for PE management, particularly in patients at high risk for major bleeding. This approach provides rapid mechanical debulking of thrombus without exposure to thrombolytics and has been associated with significant improvements in RV function and pulmonary artery pressures. We present a case of extensive bilateral PE successfully treated with mechanical thrombectomy, highlighting the …

Right Ventricular Involvement In Stress Cardiomyopathy: A Case Of Biventricular Takotsubo With Cardiogenic Shock, Ahmad Muhammad, Yazan Alkehef, Theodore Schreiber

Conference Presentation Abstracts

Introduction Takotsubo cardiomyopathy (TC) is characterized by transient left ventricular (LV) dysfunction following a stressor in the absence of obstructive coronary artery disease. We present a case of a less common variant with right ventricular involvement. Hospital course A 45-year-old woman with sickle cell disease and asthma presented with nausea, vomiting, abdominal pain, and fevers, one week after the death of her father. Examination revealed an irregular tachycardia. Labs demonstrated leukocytosis, elevated lactate, and markedly increased troponin. Chest imaging showed bilateral basilar opacities. ECG demonstrated atrial flutter with rapid ventricular response. She developed progressive respiratory failure requiring intubation. Repeat ECG …

Bulletin Ninth District Ny May 2026

Bulletin of the Ninth District Dental Association

In the May 2026 issue, the reader will find the following feature articles:

• "ADA Lobby Day 2026"
• "Dentistry for Individuals with Special Needs"
• "ADA Trustee Corner"
• "CE Navigator FAQ"
• "NYSDA Wins in 2025"
• "Peer Review and Quality Assurance: What is it and Why is it an Important Member Benefit?"

Also included are your monthly President's Message, event updates, continuing education opportunities, membership news and classifieds.

Dentistry For Individuals With Special Needs, William J. Maloney

Bulletin of the Ninth District Dental Association

Dentists have a profound responsibility to champion special needs patients through patience, trust, accessibility, collaboration, and individualized care—recognizing that thoughtful accommodations and compassion are essential to safe treatment, dignity, and lifelong oral health.

This article discusses social-emotional, practical, and clinical considerations for best serving patients with disabilities. A list of tips specifically for improving the experience of dental visits for pediatric patients with developmental disabilities is included.

Operative Versus Non-Operative Management Of Infant Perianal Abscesses: A Pediatric Surgery Research Collaborative Prospective Quality Improvement Study, Leigh Selesner, Chakshu Soni, Romeo C. Ignacio, Rimla Khan, Robert Wright, Alicia Mcintire, Bethany J. Slater, Nathan M. Novotny, Ryan T. Davis, Artem F. Dadamyan

Conference Presentation Abstracts

Abstract: Purpose Treatment of infant perianal abscesses (IPA) remains controversial, with ongoing debate between operative and non-operative management. Recurrence is common and prospective data to guide care are lacking. We performed the first multi-institutional prospective quality improvement (QI) study comparing non-operative to operative IPA management. Methods The primary endpoint was time to complete abscess resolution. Secondary endpoints included surgical intervention (incision and drainage ± fistulotomy) and abscess recurrence. Institutions were recruited through a national research collaborative. IRB approval was obtained individually. Between 2022 and 2025, we prospectively enrolled patients < 1 year of age with an abscess ≤2 cm from the anal verge. Patients with predisposing conditions (e.g. inflammatory bowel disease) were excluded. Management was determined by the treating provider, with either upfront surgical intervention (control group) or non-operative care per our QI protocol (protocol group, Figure 1). Data were collected on management prior to surgical evaluation, presentation, subsequent treatment and outcomes. Statistical analyses were performed using STATA, with p < 0.05 considered significant. Endpoints were compared between groups by non-parametric methods, with denominators based on available data. Results Fourteen institutions participated across the U.S., with a total of 288 patients (108 control, 180 protocol) enrolled. Median follow-up was 0.99 (interquartile range 0.23-3.93) and 1 (0.16-4.56) months for control and protocol groups. Abscess resolution occurred in 155 patients during follow-up (36/71 (51%) control, 119/134 (89%) protocol, p < 0.01). Median time to abscess resolution was 1.21 (0.33-4) and 1.13 (0.57-3.83) months for control and protocol groups (p=0.64). Recurrences were frequent in both cohorts (34/93 (37%) control, 62/153 (41%) protocol). Surgical intervention was significantly more common in the control group: incision and drainage were performed in 61/107 (57%) versus 19/166 (11%) and exam under anesthesia with fistulotomy in 31/106 (29%) versus 20/166 (12%) (both p< 0.01). Conclusions Time to abscess resolution was similar between patients treated with upfront surgical intervention and non-operative management according to our QI protocol. Significantly more patients underwent surgical intervention in the control group, without an impact on time to resolution. Our data support initial non-operative management of infant perianal abscesses, emphasizing antibiotics at initial presentation, sitz baths and family reassurance. Abbreviations: IPA - infant perianal abscess; QI - quality improvement; IRB - institutional review board

Fetal Vascular Malperfusion And Other Placental Lesions In Relation To Maternal Sars-Cov-2 Exposure: A Case–Control Study, Irene Mwandoto, Marleen Temmerman, Ingrid Gichere, Patricia Okiro

Pathology, East Africa

Background:

The morphologic characteristics of placentas associated with coronavirus disease-19 (COVID-19) have been described but with varying findings. Studies conducted at the onset of the pandemic reported frequency of Fetal Vascular Malperfusion (FVM), an umbrella term that describes occlusive vasculopathies that affect fetal circulation and their associated sequelae. Morphologic manifestations include thrombosis, avascular villi and vascular stromal karyorrhexis. Associated outcomes include fetal growth restriction, thromboembolic events such as neonatal stroke and fetal demise. Placental lesions associated with a severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection present a unique picture in histology, especially in the attempt to decipher the …

Breastfeeding Support For Mothers Of Low Birthweight Infants In Hospitals In Rural Western Kenya: An Exploratory Study, Fiona Dickinson, Florence Were, Alloys K’Oloo, Iwaret Otiti, Linda Tindi, Mwanamvua Boga, Mary Kimani, Laura Kiige, Kathy Mellor, Helen Nabwera

Centre of Excellence in Women and Child Health

Background One in ten newborns in sub-Saharan Africa weigh < 2500 g (i.e. low birthweight [LBW]). Breastfeeding difficulties from birth are common among LBW infants. This study explored the use of trained peer mothers to deliver breastfeeding support to mothers of LBW infants in healthcare facilities in rural Kenya.

Methods Five trained peer mothers provided breastfeeding support to 23 mothers of LBW infants across eight healthcare facilities in Homa Bay County. Qualitative, semi-structured interviews were conducted with 11 mothers, 10 healthcare providers and 5 peer mothers prior to and during the breastfeeding support intervention. Inductive thematic analysis was used.

Results Three key themes were discovered: mothers valued the confidence the peer mothers gave them to breastfeed their LBW infants, peer mothers found that the training and their previous experience caring for LBW infants enabled them to work collaboratively with mothers …

Global Perspectives On Central Nervous System Drug Innovation: Achievements, Barriers, And Priorities For The Next Decade, Hiroyuki Uchida, Gabriella Gobbi, Joseph Zohar, Allan Young, Dan Rujescu, Ming-Chyi Huang, Suresh Sundram, Lukoye Atwoli, Jana Vukovic, Kazutaka Ikeda

Internal Medicine, East Africa

Background Over the past decade, neuropsychopharmacology has shifted from stagnation to momentum, with first-in-class mechanisms and biomarker-enabled trials spanning psychiatry and neurology.

Methods We narratively synthesized advances from 2013 to 2026 across central nervous system (CNS) discovery and development, including pivotal trials, regulatory actions, digital/real-world evidence, genetics, artificial intelligence (AI), and implementation/global-access themes that are endorsed by international societies.

Results Therapeutic gains include rapid-acting drugs for treatment-resistant depression (intranasal esketamine); psychedelic-assisted therapy for posttraumatic stress disorder and depression; neuroactive steroid γ-aminobutyric acid-A receptor positive allosteric modulators (brexanolone, zuranolone) for postpartum depression; non-dopaminergic muscarinic agonists (xanomeline–trospium) for schizophrenia; orexin receptor antagonists …

Construction Workers Noise Exposure And Hearing Conservation Program Needs, Quinn Noelle Overlin

Doctoral Scholarly Projects & Capstones

Noise exposure among construction workers is a pervasive occupational hazard with serious implications for long-term hearing health and overall well-being. This literature review examines the extent of noise exposures in the construction industry and the long-standing need for implementation of effective hearing conservation programs (HCPs). It synthesizes current evidence on exposure levels, health outcomes, and the effectiveness of existing interventions. Findings reveal that construction workers are routinely exposed to noise levels that exceed occupational safety standards, resulting in a heightened risk of noise-induced hearing loss (NIHL) and associated health consequences. Despite regulatory frameworks and available intervention strategies, substantial gaps persist …

Shedding Light On The Invisible Work Of Peer Recovery Support Specialists Through The Design Of A Point Of Care Technology., Jessica A Pater, Elisabeth Andrews, Michelle Drouin, Mindy Flanagan, Dana Albright, Rachel Pfafman, Jeanne Carroll, Erik Hess, Tammy R Toscos

Health Services and Informatics Research

Peer Recovery Support Specialists (PRSSs) are certified professionals that provide social, informational, and logistical supportto people in recovery fromsubstance use disorders. In this study, we report the findings from design work completed with a teamof PRSSsto define workflowand informationalneeds for the developmentofa novel point of care software. Through our qualitative research we uncovered a significant amount of undocumented work that is necessary for a PRSS to provide individualized support to their clients. Thus, much PRSS work is not quantified and rendered "invisible." We present technology design strategies that help quantify these tasks and illuminate the complexity of PRSS work.

Analisis Faktor-Faktor Yang Mempengaruhi Angka Kematian Bayi Di Provinsi Sulawesi Selatan Menggunakan Regresi Komponen Utama, Salwa Zahirah Putri Wijaya, Sitti Sahriman Salam, Nasrah Sirajang, Audia Putri Damatia, Hildayanti Hildayanti

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Angka kematian bayi (AKB), khususnya kematian neonatal, merupakan indikator fundamental dalam menilai kualitas pelayanan kesehatan dan kesejahteraan masyarakat. Penelitian ini dilakukan untuk menganalisis faktor-faktor yang memengaruhi AKB di 24 kabupaten/kota di Provinsi Sulawesi Selatan. Variabel independen yang dikaji mencakup dimensi layanan kesehatan, kondisi sosial ekonomi, pendidikan perempuan, sanitasi, air bersih, dan indikator demografis. Data dianalisis menggunakan metode Regresi Komponen Utama (Principal Component Regression/PCR) untuk menganalisis pengaruh variabel-variabel dengan mempertimbangkan adanya potensi korelasi antar variabel independen, sehingga dihasilkan model yang stabil. Melalui analisis komponen utama, lima komponen berhasil dibentuk yang merepresentasikan 84,21% dari total variasi data. Komponen pertama (PC1) …

Stromal Interaction Molecule (Stim) Proteins In Microglia And The Impact On Store-Operated Calcium Entry (Soce) And Spinal Cord Injury Recovery, Norah G. Hill

College of Arts & Sciences Senior Theses

In spinal cord injury (SCI), worsening functional outcomes are largely because of secondary injury processes and prolonged chronic inflammation. A major contributor of secondary injury is overload of intracellular calcium, causing neuronal overexcitation and persistent inflammatory responses. One of the primary mediators of calcium entry into the cell is store-operated calcium entry (SOCE). In SOCE, sensors detecting calcium depletion from the endoplasmic reticulum stores are called STIM proteins (1-2). When calcium is low in the cell, STIM proteins will activate Orai channels to open, allowing for the influx of calcium into the cell. The purpose of this study was to …

The Influence Of Valence On Action Control: A Comparison Of Simon Effects In The Extrinsic Affective Simon Task (East) And The Spatial Simon Task, Yaara Aleissa

College of Arts & Sciences Senior Theses

People adjust their thoughts and actions in response to a changing environment every day and emotions may influence these actions. Understanding how emotion impacts action control in situations where emotion is central to the action (task-relevant) compared to when it is present in the environment as distracting information (task-irrelevant) is essential. Currently it is unclear when emotion most significantly modulates action control. This study seeks to compare how valence (positive versus negative emotion) impacts action control performance when valence is task-relevant and task-irrelevant by using two modified versions of the Simon conflict task.

The Simon task is a paradigm to …

Effects Of A Passive Assistive Hamstring Device On Overground Running Kinematics And Hamstring Activation., Quinn Castner

All Theses

Hamstring strain injuries are among the most common and recurring injuries in sports, occurring most often during the terminal swing phase of gait. Despite progress in rehabilitation, the incidence of injury has only increased, suggesting a need for a novel intervention. We designed a passive, assistive, wearable device with two specific criteria in mind: to offload the hamstrings during running, and do so without hindering normal kinematic patterns. The device consists of an adjustable elastic band anchored proximally at the waist and distally just above the ankle joint center. It stretches and shortens with the hamstrings, providing passive hip extension …

The Burnout Machine: Finding The Guide Between Burnout And Meaning Making Using Ifs And Role Theory For Mental Health Professionals (An Integrative Literature Review), Jade Ahneman

Expressive Therapies Theses

Burnout is a syndrome in which compounded stress leads sufferers to feel physical and mental exhaustion, mental distancing, cognitive and emotional impairment, depressed mood, psychological distress, and psychosomatic complaints. Originally thought of as a phenomenon affecting only individuals in helping roles (i.e., mental health workers, teachers, nurses, and police officers), research on burnout and its effective management has become increasingly important since the 1980s, highlighting its pervasiveness across occupational and personal realms. This integrative literature review focused on understanding the effects of burnout on master 's-level counseling students, investigating how Internal Family Systems theory (IFS) and drama therapy’s role theory …

Art Therapy And A Strength-Based Approach For Working With Children With Emotional And Behavioral Challenges: A Qualitative, Arts-Based Study, James D. Wyld

Expressive Therapies Theses

Abstract

            Children with emotional and behavioral challenges represent a vulnerable population that needs more attention and innovative forms of treatment. The behavior of these young people is often marked by impulsive behaviors and intense emotions in the process of getting their basic needs met. The current study explores how a combination of art therapy and a strength-based approach is beneficial and appropriate for children in a behavioral based therapeutic school. Progress was traced through one singular client in both group and individual settings over the course of 6 months. Interventions varied with the goals of increasing self-awareness, fostering autonomy, increasing …

Ai×Life 2026: Advances In Computational Biology Across Scales For Life & Health Sciences, Suma Mohan S., Devika N. T., Pranavathiyani G.

Conference Proceedings

Book of Abstracts of the International Conference, AIxLife 2026: Advances in Computational Biology Across Scales for Life & Health Sciences, held on 17–18 April 2026, SASTRA Deemed to be University, Thanjavur, Tamil Nadu, INDIA 

About the Conference

Conventional computational biology laid the foundation for biological data analysis through statistical models, algorithms, and curated databases, enabling insights into genes, proteins, and pathways. Today, the integration of artificial intelligence, spanning machine learning, deep learning, and large language models (LLMs) is driving a transformative shift across biological scales, from atomic and molecular interactions to pathways, cellular systems, organisms, and populations.

AI-powered approaches …

Addressing Socioeconomic Factors Related To Health Disparities In Predominantly Hispanic Texas Communities, Gabriela M. Gomez

Theses & Dissertations

This qualitative study examined the socioeconomic factors that influenced health outcomes in predominantly Hispanic Texas communities in San Antonio, Texas. Few studies have been conducted that address how socioeconomic conditions have shaped the lives of the Hispanic population in Texas, indicating a significant gap in the research. The research question guiding this study asked: How do Hispanic individuals between the ages of 26 and 64 who live in predominantly Hispanic communities describe health disparities in San Antonio, Texas? To address the research question, a qualitative inquiry was conducted using semi-structured in-person interviews with participants who met the inclusion criteria. A …

A New Generation Of Inhaled Vaccines, Clark Chapman

Undergraduate Honors Thesis Collection

Vaccines have stood the test of time as being one of the greatest developments in health history. Delivery of these life-saving vaccines has primarily remained reliant on intramuscular administration, which has its own collection of shortcomings. When considering what vaccine formulation is best suited to be a widely accessible and effective tool in the fight against respiratory pathogens, current data and science points to a number of improvements available to us. These improvements include:

• An inhaled formulation, uniquely stimulating mucosal immunity

• A dry powder formulation to improve long-term stability

• A live attenuated vaccine to increase immunogenic response …

The Role And Impact Of Servant Leaders In The Clinical Physical Therapy Space, Amelia Moor

Undergraduate Honors Thesis Collection

Servant leadership is an approach that is committed to improving the lives of others. The patient-centered model, commonly taught in healthcare courses, follows a structure that resembles the practice of servant leadership. Through this study, the clinical application of servant leadership was explored further. Physical therapy was the primary focus of understanding servant leadership in healthcare settings. Qualitative research was conducted using a phronetic iterative approach. Results displayed a recognition and usage of the servant leadership model in physical therapy settings, despite administrative and structural barriers.

Group B Streptococcus In Pregnant Women: Universal Guidelines And Protocols, Dania Presteguin

Undergraduate Honors Thesis Collection

Background: Group B Streptococcus (GBS) is a leading cause of maternal sepsis and neonatal mortality globally. Variability in screening and treatment guidelines influences global disease burden.

Objective: This study uses a cross-national analysis to compare screening and treatment guidelines and their impact on prevalence, screening, intrapartum antibiotic prophylaxis (IAP), and maternal-neonatal clinical manifestations Methodology: A systematic review of secondary literature was conducted using PubMed, Scopus, and CINAHL (2010-2025). Inclusion criteria include maternal GBS colonization and one or more measures of interventions and neonatal infection rates. No geographic or demographic restrictions were applied. A total of 67 studies were screened, and …

The Power Of Belief: Investigating The Intersection Of Religious Observance, Social Support, And Psychological Distress, Victoria R. Atwater

Undergraduate Honors Thesis Collection

Religion can act as a protective factor against stress and depression (Koenig et al., 2009; Krok, 2008) and can be examined through an individual’s relationship with religion or the efficacy of religious practices on mental health. In this study, 206 participants completed an online questionnaire that measured stress, depression, religious coping, religiosity (intrinsic religiosity, organized religious activities and non-organized religious activities), and social support using validated scales. The results indicate a positive correlation between stress, depression, and negative religious coping as predicted. While intrinsic religiosity and positive religious coping did not significantly influence stress or depression, organized religious activities were …

Dental Wear In Medieval Hungarian Populations, Sutton Walters

Honors College Theses

Dental wear can reveal past human behavior, offering insight into diet, daily activities and cultural practices (Berbesque et al., 2012; Deter, 2009; Estalrrich & Rosas, 2015; Górka, 2016; Molnar, 2008; Smith, 1984; Watson, 2014). Dental wear can reconstruct past life when other evidence is limited. This paper will address whether dental wear patterns observed in two medieval Hungarian populations, Kiskundorozsma–Kettőshatár I (KK) and SárrétudvariHízóföld (S), reflect sexual dimorphism patterns seen in hunter-gatherer vs. agriculturalist populations. Previous research demonstrates clear differences in wear between high- and lowwear subsistence strategies, whereas other studies report minimal or no sexual dimorphism and little variation …

Donor Sex And Platelet Storage Change The Therapeutic Effects Of Platelet-Derived Extracellular Vesicles On Endothelium, Mandeep Kaur, Malvika Gupta, Sowmya Shree Gopal, Charles E Wade, Jessica C Cardenas, Amit K Srivastava

Faculty, Staff and Student Publications

Platelet-derived extracellular vesicles (PEVs) play an active role in vascular protection and repair and are being explored as a viable alternative to platelet therapy. Because platelet function and stability are shaped by donor sex and storage conditions, these same factors are likely to influence the PEVs they release. Understanding these influences is key to developing PEVs into a safe and dependable therapeutic option. In this study, we investigated how donor sex and platelet storage affect the therapeutic properties of PEVs. To address this, PEVs were isolated from platelets of healthy male and female donors. Platelets were either processed immediately after …

Targeting The Dorsolateral Prefrontal Cortex With Transcranial Direct Current Stimulation To Improve Depression And Anxiety In Parkinson's Disease, Brock Renicks

Honors Theses

The aim of this study is to observe the outcomes of transcranial direct current stimulation (tDCS) as a treatment for Parkinson’s Disease (PD). This study will primarily look at changes in depression and anxiety, as these symptoms are often comorbid with Parkinson’s Disease. Transcranial direct current stimulation is a non-invasive, very low-intensity form of electrical stimulation of the brain. It is being increasingly used as a form of treatment for Parkinson’s Disease and depression and anxiety, however the literature is ambiguous, showing mixed results throughout various studies, with no standardization of tDCS administration. To determine the effect of tDCS on …

Substance Use And Childhood Environment In Adolescent Head Injury: Examining The Effects Of Race, Jessica A. Phelps

Department of Sociology: Dissertations, Theses, and Student Research

Adolescents participating in sports are at an increased risk of concussion, which is particularly important given the difficulties with cognitive function, emotion regulation, and impulsivity that may occur as a result of this brain injury. These symptoms can predispose adolescents to subsequent concussions, leading to further damage during a critical time in neurodevelopment which can result in mental health disorder development in adulthood. It is crucial to understand what factors may predispose youth to increased rates of concussion for these reasons. As such, this paper explored whether race/ethnicity, gender, grade in school, childhood environment, and risk-taking behaviors were associated with …