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Mental and Social Health Commons

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Minnesota State University, Mankato

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Articles 1 - 30 of 137

Full-Text Articles in Mental and Social Health

Cultural Healing Practices: Incorporating Cultural Healers Into Minnesota's Mental Health Care System, Raymond Shoup, Allyson Endersbe, Nayeli Hernandez Moctezuma, Patty Balderas-Johnson Apr 2022

Cultural Healing Practices: Incorporating Cultural Healers Into Minnesota's Mental Health Care System, Raymond Shoup, Allyson Endersbe, Nayeli Hernandez Moctezuma, Patty Balderas-Johnson

Master of Social Work Student Policy Advocacy Briefs

Minnesota’s approach to health and mental health is based on western cultural traditions of illness, help seeking behaviors, healing and wellness. This approach does not work for many of the cultural communities in Minnesota, especially those with a deep history of generational trauma, oppression, and discrimination. We need to make mental health a priority for Minnesotans by expanding the availability of holistic approaches rooted in the cultural traditions of Minnesota’s diverse cultural communities. We must address the impact of generational trauma and work to lessen the harm by incorporating cultural healing practices into our mental health care system, including the …


The Expression Of Satanist Identity: Does Visible Identification Of Satanism Predict Discrimination And Depression?, Allyson Dudley Jan 2022

The Expression Of Satanist Identity: Does Visible Identification Of Satanism Predict Discrimination And Depression?, Allyson Dudley

All Graduate Theses, Dissertations, and Other Capstone Projects

The current research examines the relationship between visible expression of religion, identification within Satanism, experiences of discrimination, and depression in a sample of modern Satanists (n = 1,272). Historically, Satanism has been scrutinized as immoral and a threat to public safety. The current research attempts to challenge that viewpoint by employing culturally competent methods and understanding of modern Satanism. Findings indicate a negative relationship between expression of Satanism and discrimination, expression of Satanism and depressive symptoms, in-group ties and discrimination, and identification (in-group ties and in-group affect) and depressive symptoms. Results show a positive relationship between identification with Satanism and …


Stress Coping Responses Of Undergraduate University Students Prior To & Since The Onset Of The Covid-19 Pandemic, Kaylee Diefenderfer Jan 2022

Stress Coping Responses Of Undergraduate University Students Prior To & Since The Onset Of The Covid-19 Pandemic, Kaylee Diefenderfer

All Graduate Theses, Dissertations, and Other Capstone Projects

The stress coping mechanisms used by undergraduate university students affects their psychological well-being, stress level, and mental health outcomes. Increasing students’ use of positive coping mechanisms may increase academic outcomes, and overall health and well-being. This study evaluated the stress coping mechanisms used by undergraduate university students prior to and since the COVID-19 pandemic began. The Brief COPE inventory was used to measure stress coping responses. The results of this research indicated a significant change in 9 out of the 14 main coping mechanisms used by undergraduate university students prior to since the pandemic began. The top two stress coping …


Perceptions Of Well-Being Among College Majors, Baylee Jahraus Jan 2022

Perceptions Of Well-Being Among College Majors, Baylee Jahraus

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this research was to assess the well-being perceptions of selected college students at a midsize midwestern university. To collect data, an adaptation of the Open Science Framework’s (n.d) College Student Subjective Wellbeing Questionnaire and the CDC’s (2018b) Health-related Quality of Life scale was used. The 26-item survey was distributed to junior and senior students enrolled in 300-400 level courses in a variety of majors. The findings for each research question are presented in the cross-sectional study. The results of the study indicate there are differences in perceptions of physical and mental health between males and females and …


Front End Justice: Diverting People Affected By Mental Illness From The Criminal Justice System, Ariel Esqueda, Kelliann Kutschke, Matthew Miller, Kayleigh Wendland Apr 2021

Front End Justice: Diverting People Affected By Mental Illness From The Criminal Justice System, Ariel Esqueda, Kelliann Kutschke, Matthew Miller, Kayleigh Wendland

Master of Social Work Student Policy Advocacy Briefs

Many of the people caught up in the criminal justice system are non-violent offenders struggling with mental illness, which cannot and should not be addressed through incarceration. Our jails and prisons are ill-equipped to provide effective mental health services. Incarceration compounds the problem by contributing to increased psychological distress. We are relying on the criminal justice system to respond to mental illness, rather than investing fully in the spectrum of mental health care from prevention to recovery. Minnesota must invest in diverting people affected by mental illness away from the criminal justice system and into community-based treatment, services, and supports …


Investing In A Culturally Diverse Mental Health Workforce In Minnesota, Emma Fuhrman, Teia Kopari, Cody Reinke, Josie Schultz Apr 2021

Investing In A Culturally Diverse Mental Health Workforce In Minnesota, Emma Fuhrman, Teia Kopari, Cody Reinke, Josie Schultz

Master of Social Work Student Policy Advocacy Briefs

Minnesota’s mental health workforce lacks in both cultural diversity and cultural responsiveness. Each is critical for providing equitable mental health care to Minnesota's increasingly diverse population. Without ensuring that Minnesota’s mental health workforce is culturally diverse, culturally responsive mental health care for Black, Indigenous and People of Color (BIPOC) will not be attainable. Minnesota must broaden, strengthen, and create structures to support a racially and ethnically diverse mental health workforce.


The Impact Of Social Isolation And Cognitive Decline In Older Adults: A Systematic Literature Review, Jody L. Doll-Wilhelm Jan 2021

The Impact Of Social Isolation And Cognitive Decline In Older Adults: A Systematic Literature Review, Jody L. Doll-Wilhelm

All Graduate Theses, Dissertations, and Other Capstone Projects

Background: During the COVID-19 pandemic, deaths of Alzheimer’s Disease (AD) and dementia patients surged. Increased social isolation and decreased activity levels in older adults have been suggested as contributing factors to accelerating AD and dementia. However, assessment tools to gauge interventions and outcomes of cognitive decline are variable among the literature.

Objective: Examine the impact of social engagement versus social isolation, like that experienced with the COVID-19 pandemic, on cognitive decline/dementia in older adults (greater than 60 years of age).

Method: A systematic search for studies evaluating the relationship between social isolation and social activity in cognitive …


Examining Differences In Rural, Micropolitan, And Metropolitan School Psychologists Roles And Delivery Of Mental Health Services, Ashley A. Williamson Jan 2021

Examining Differences In Rural, Micropolitan, And Metropolitan School Psychologists Roles And Delivery Of Mental Health Services, Ashley A. Williamson

All Graduate Theses, Dissertations, and Other Capstone Projects

Mental health service delivery in rural settings has become increasingly limited while rates of mental health concerns among youth have increased. Schools form a common hub in rural areas and they present an opportunity for the assessment of developing disorders as well as a means for delivering mental health services in an affordable and acceptable fashion. School psychologists supporting rural school districts are presented with a unique opportunity to provide various aspects of rural mental health service delivery. Over the last 40 years, little research has been published on rural school psychologist’s roles and responsibilities and their relationship to mental …


Younger Hmong People’S Willingness To Communicate About Depression, Wa Yang Jan 2021

Younger Hmong People’S Willingness To Communicate About Depression, Wa Yang

All Graduate Theses, Dissertations, and Other Capstone Projects

This research examines the underlying issues about mental illness, particularly depression within the Hmong community. Previous scholars have focused on the Hmong culture’s origins, mental health status of Hmong refugees arriving in the United States, martial roles and mental health on Hmong females, and comparisons of Hmong traditional healing and Westernized medicine. These studies intersect in fields including psychology, medicine and public health, Hmong history, and social work. However, one missing component to this body of scholarship has been communication. Thus, my study focused on younger Hmong people’s willingness to communicate about depression within their families. Specifically, I conducted semi-structured …


The Effects Of Therapist Expertise And Concerns Of Involuntary Hospitalization On The Disclosure Of Suicidal Ideations And Behavior, Zane Hensel Jan 2021

The Effects Of Therapist Expertise And Concerns Of Involuntary Hospitalization On The Disclosure Of Suicidal Ideations And Behavior, Zane Hensel

All Graduate Theses, Dissertations, and Other Capstone Projects

Suicide continues to grow as a complex and multi-faceted problem in prevention and treatment, particularly for college students with an increased predictor of risk of suicidal behaviors. Previous research has indicated that one of the largest concerns for suicide disclosure is a fear of involuntary hospitalization. Over 200 college students participated in examining therapist expertise and understanding information on involuntary hospitalization on their rate of suicide disclosure. A 2x2 MANOVA, a 2x2x2 MANOVA that included gender, and a factor analysis were performed on an ad-hoc 11-question survey assessing suicidal ideation and suicidal behavior disclosure. The results indicated that there was …


Treatment Of Adults With Attention-Deficit/Hyperactivity Disorder: A Systematic Literature Review, Bethanie M. Miller Jan 2021

Treatment Of Adults With Attention-Deficit/Hyperactivity Disorder: A Systematic Literature Review, Bethanie M. Miller

All Graduate Theses, Dissertations, and Other Capstone Projects

Objective: To compare treatment with stimulant medications to nonstimulant medications and/or nonpharmacologic interventions on professional and interpersonal functioning in adults with attention-deficit/hyperactivity disorder (ADHD).

Method: Systematic literature review of five databases; 22 articles containing 323 studies (N=21,370) were included in this review.

Results: Psychostimulants remain the most studied treatment for adults with ADHD and boast larger effect sizes than nonstimulant and nonpharmacologic therapy. Among nonpharmacologic therapy, cognitive behavior therapy (CBT) has proven most successful in randomized controlled trials. Effects of CBT are enhanced when combined with pharmacotherapy.

Conclusions: Psychostimulants continue to be the most frequently prescribed treatment for adults with …


The Critical Need For A Culturally Sensitive Suicide Risk Assessment Instrument For American Indian And Alaska Native Youth, Courtney E. Shaw Jan 2021

The Critical Need For A Culturally Sensitive Suicide Risk Assessment Instrument For American Indian And Alaska Native Youth, Courtney E. Shaw

All Graduate Theses, Dissertations, and Other Capstone Projects

Objective: This systematic literature review was conducted to better understand why there has been a significant increase in America Indian/Alaska Native (AI/AN) youth suicides in tribes across the United States today. The intent of this review is to understand key issues surrounding the increasing numbers of AI/AN youth with suicide ideation, plans, and attempt in order to be able to answer the following clinical question: Is there a valid and reliable culturally sensitive assessment tool designed to recognize at-risk AI/AN youth presenting for primary care? If not, what are key aspects to consider for developing an instrument that could …


Paternal Postpartum Depression Screening: A Critical Measurement That Is Long Overdue, Nicholas C. Mcclellan Jan 2021

Paternal Postpartum Depression Screening: A Critical Measurement That Is Long Overdue, Nicholas C. Mcclellan

All Graduate Theses, Dissertations, and Other Capstone Projects

The birth of a child is one of the most important events in a parent’s life. It is a time of intense emotion, the characteristics of which vary greatly depending on individual circumstances and the relationship between the mother and father. Joy is mixed with feelings of being overwhelmed by the multitude of responsibilities that come with caring for an infant. Changes in relationships and feelings of isolation are common and can be a source of duress for parents. Fortunately, the severity of these emotions is often mild and self-limiting. Sometimes, however, they are severe enough to negatively affect daily …


Comparing The Acceptability Of Treatment Rationales For Two Psychotherapies, Marin Gail Olson Jan 2021

Comparing The Acceptability Of Treatment Rationales For Two Psychotherapies, Marin Gail Olson

All Graduate Theses, Dissertations, and Other Capstone Projects

An effective treatment rationale is important because it can affect whether or not a client decides if they will commit to the therapeutic approach. In recent years, acceptance and commitment therapy (ACT) has developed as an approach that, although related to cognitive-behavioral therapy (CBT), is philosophically distinct. CBT typically places a greater emphasis on changing/eliminating “symptoms” of psychological disorders and the role thoughts play in directly influencing emotional and behavior problems. ACT, on the other hand, places a heavier emphasis on accepting and changing one’s relationship to aversive private experiences. When comparing the assumptions and goals underlying CBT and ACT, …


Predicting Mental Health Counseling Professionals’ Willingness To Discuss Sexuality Issues With Clients, Becca L. Thompson Jan 2021

Predicting Mental Health Counseling Professionals’ Willingness To Discuss Sexuality Issues With Clients, Becca L. Thompson

All Graduate Theses, Dissertations, and Other Capstone Projects

Sexuality is fundamental to the human experience and sexuality issues will affect every individual across the lifespan. Mental health counseling professionals (MHCPs) will likely encounter a client in their practice that presents with some facet of sexuality concern. MHCPs may be challenged by these disclosures or neglect to inquire about these needs due to underlying factors that contribute to decreased willingness to discuss sexuality with clients. This study explored the relationships of some of these factors, including sexual intervention self-efficacy, state anxiety, and trait anxiety, and further examined the extent to which these factors predict willingness to discuss sexuality with …


Supporting Resilience In Reserve Component Spouses During Deployment: The Impact Of Family Life Cycle Phase And Deployment History On Social Support Needs, Jennifer L. Ceminsky Jan 2021

Supporting Resilience In Reserve Component Spouses During Deployment: The Impact Of Family Life Cycle Phase And Deployment History On Social Support Needs, Jennifer L. Ceminsky

All Graduate Theses, Dissertations, and Other Capstone Projects

This exploratory study used a researcher developed survey to examine the relative value of instrumental, emotional, and informational support for Reserve Component spouses during deployment. Although all types of support were valued by nearly all study participants, significant differences were found between ratings of helpfulness for each type of support. Emotional support was the support type most valued by 73.1% of spouses in this study. Instrumental support was most valued by21.1%, and only 2.8% of spouses valued informational support most. Regression analyses were used to identify factors that were predictive of value placed on each type of social support. The …


The Relationship Between The Stigmatization Of Mental Illness, Communication Apprehension And The Willingness To Communicate, Madeleine Louise Winkler Jan 2021

The Relationship Between The Stigmatization Of Mental Illness, Communication Apprehension And The Willingness To Communicate, Madeleine Louise Winkler

All Graduate Theses, Dissertations, and Other Capstone Projects

This project explores how mental health stigmatization influences communication apprehension and the willingness to communicate about mental illness. A total of 153 people completed an online survey regarding three variables. Perceived stigma and communication apprehension when communicating about their own mental health were found to be positively correlated. Perceived stigma and communication apprehension when communicating about someone else’s mental health was also found to be positively correlated. Communicating about one’s own mental illness lead to higher levels of communication apprehension compared to communicating about someone else’s mental illness. Communication apprehension when talking about one’s own mental health and willingness to …


Promoting Health, Justice And Well-Being Of Minnesota's Lgbtq+ Community: Banning Conversion Therapy, Katelin Farmer, Ashley Hansen, Chelesa Schweim, Sarah Petersen Apr 2020

Promoting Health, Justice And Well-Being Of Minnesota's Lgbtq+ Community: Banning Conversion Therapy, Katelin Farmer, Ashley Hansen, Chelesa Schweim, Sarah Petersen

Master of Social Work Student Policy Advocacy Briefs

There are 853 cities in Minnesota, and only two have enacted protections for LGBTQ+ people from the harmful practice of conversion therapy. All Minnesotans deserve access to safe, ethical, affirming, and evidence-based mental health care.


Police Social Work In Minnesota: Starting The Conversation, Jenny Ellsworth, Taylor Fish, Alison Niesen, Natalia Pitts Apr 2020

Police Social Work In Minnesota: Starting The Conversation, Jenny Ellsworth, Taylor Fish, Alison Niesen, Natalia Pitts

Master of Social Work Student Policy Advocacy Briefs

Even with enhanced police officer training focused on improving responses to mental illness, chemical dependency, and other crisis-related calls, police officers remain ill-equipped to serve as trained mental health professionals. Officers respond to these service-related calls more frequently than crime-related calls, which is why community partnerships between police officers and social workers are needed to promote the safety and well-being of people in crisis.


Telepsychiatry Preferences Among College Students Diagnosed And Undiagnosed With A Mental Health Condition, Wendy Schuh Mar 2020

Telepsychiatry Preferences Among College Students Diagnosed And Undiagnosed With A Mental Health Condition, Wendy Schuh

Health Sciences Publications

College health and counseling centers report an increasing demand for mental health services while students continue to experience barriers such as shortage of providers, transportation, or stigma. Telepsychiatry has been established in some environments to overcome these barriers, but little research has explored an effective higher education model. The purpose of this study was to identify differences in telepsychiatry preferences among college students who have and have not been diagnosed with or treated for a mental health condition in the last year. Students (n = 537; Mage = 21 years; 71% female) at a medium-sized Midwestern university participated in a …


Coaching Women On The Impact Of Alcohol Intake On Mental Well-Being: A Systematic Literature Review, Amy Maloney Jan 2020

Coaching Women On The Impact Of Alcohol Intake On Mental Well-Being: A Systematic Literature Review, Amy Maloney

All Graduate Theses, Dissertations, and Other Capstone Projects

Alcohol intake among women has increased in recent years. Women’s bodies metabolize alcohol differently when compared to men and are at increased risk for adverse effects, both physically and mentally. The purpose of this systematic literature review is to explore the evidence related to the impact of coaching in primary care on drinking behaviors and over-all well-being of women. Four databases including PsycInfo, Academic Search Premier, CINAHL Plus with full text, and Gender Studies Database were searched using a variety of key words. Studies were included if they focused on female alcohol use and abuse, interventions specific to female alcohol …


The Impact Of Yoga On Symptom Management In Adults With Depression, Laura S. Eggen Jan 2020

The Impact Of Yoga On Symptom Management In Adults With Depression, Laura S. Eggen

All Graduate Theses, Dissertations, and Other Capstone Projects

Depression is one of the most prevalent mental health conditions worldwide. Despite continual advances in the fields of psychiatry and psychology, hundreds of millions of individuals continue to suffer due to ineffective treatment, adverse effects, lack of access to care, and the relapsing nature of the disease. Depression extends beyond the affected individual and burdens families, healthcare systems, and societies. Yoga is a mind-body modality, growing in popularity, that has been cited in the literature as a promising treatment for depression. The purpose of this paper is to systematically review recent literature on the impact of yoga on depression management …


The Efficacy Of Cognitive Behavioral Therapy In The Treatment Of Adults With Obesity, Hallie M. Tiffany Jan 2020

The Efficacy Of Cognitive Behavioral Therapy In The Treatment Of Adults With Obesity, Hallie M. Tiffany

All Graduate Theses, Dissertations, and Other Capstone Projects

Obesity is a complex condition increasing in prevalence and consequence throughout the United States and the world. Obesity is affected not only physiologically but by one’s psychological aspects of life. Obesity contributes to countless chronic health conditions and thus greatly impacts a person’s wellness. A literature review was conducted to identify the following if in obese adults the benefit of cognitive behavioral therapy for weight loss and/or maintenance. A total of 10 articles met inclusion criteria from searches from databases that included ProQuest, Medline, CINAHL, Cochrane, and PsycINFO as well as bibliography review. Level of evidence includes two articles that …


Search For The Cause Of Vaping Associated Lung Injury In Adolescents, Alexandra E. Krueger Jan 2020

Search For The Cause Of Vaping Associated Lung Injury In Adolescents, Alexandra E. Krueger

All Graduate Theses, Dissertations, and Other Capstone Projects

In August 2019 an unexplained, exponential rise in severe respiratory illnesses in previously healthy young adults, swept across America catching the attention of medical providers. Hospital admissions for lung injury increased 10-fold over two months’ time leaving practitioners scrambling for answers. All affected patients were found to have used e-cigarettes prior to symptoms and endorsed using nicotine and marijuana vape pens. The medical community quickly began to search for the cause of these vaping associated lung injuries. Understanding the mechanism of injury is important in order to assist in educating the public about the risks associated with e-cigarettes. The aim …


Childhood Anxiety, Cognitive Behavioral Therapy And/Or Pharmacological Treatment, Jennifer S. Mccarthy Jan 2020

Childhood Anxiety, Cognitive Behavioral Therapy And/Or Pharmacological Treatment, Jennifer S. Mccarthy

All Graduate Theses, Dissertations, and Other Capstone Projects

Objective: Evaluate best practice in managing anxiety in the pediatric population, including both school age children and adolescents. This literature review compared pharmacological treatment and cognitive behavioral therapy (CBT)’s effectiveness on the management of anxiety within the pediatric population.

Background: Up to 25% of children in the United States are affected by a mental health disorder, anxiety being the most prevalent. Childhood anxiety can have a distressing impact on social, family, and academic functioning. If persisting into adulthood it increases the risk of developing other co-occurring mental health conditions, substance abuse issues, and contributes to impaired employment retention and socioeconomic …


A Crisis In The Farming Community: A Pathway To Acceptable, Accessible And Available Mental Health Care In Rural Minnesota, Trevor Frybarger, Laura Koch, Kathy Thao, Taryn Wicks Apr 2019

A Crisis In The Farming Community: A Pathway To Acceptable, Accessible And Available Mental Health Care In Rural Minnesota, Trevor Frybarger, Laura Koch, Kathy Thao, Taryn Wicks

Master of Social Work Student Policy Advocacy Briefs

Minnesota relies on farmers to put food on our tables and to help drive our economy. The chronic stressors associated with an unstable farm economy is taking its toll on farm families all across Minnesota. Chronic stress can contribute to marital tensions, domestic violence, work disruption, depression, anxiety, and suicide. Minnesota has only 1 mental health counselor dedicated to doing outreach and crisis counseling to farm families. Many mental health professionals lack competency in working in rural communities, including understanding farm related stressors. Minnesota is doing some things right, like the Minnesota Farm and Rural Help Line. But, it needs …


Bridging The Gap: Supporting Transition-Age Youth Living With Mental Health Conditions, Oreoluwa Dasylva, Abbie Ensrud, Brittany Kruse, Cindy Schulz Mar 2019

Bridging The Gap: Supporting Transition-Age Youth Living With Mental Health Conditions, Oreoluwa Dasylva, Abbie Ensrud, Brittany Kruse, Cindy Schulz

Master of Social Work Student Policy Advocacy Briefs

The transition from adolescence to adulthood is a crucial time in a person’s life. For young people living with mental health conditions, becoming an independent, well-functioning, and productive adult can be especially challenging. It is imperative that supports be put in place to ensure transition-age youth have a smooth passage from child to adult mental health services. Nearly half of all life-long diagnosable conditions present by age 14. The Substance Abuse and Mental Health Services Administration (SAMHSA) finds the co-occurrence of serious illnesses and substance use disorders exist among transition-age youth more than any other developmental age. When left untreated, …


Positive And Negative Effects Of Social Media On Adolescent Well-Being., Katie Kennedy Jan 2019

Positive And Negative Effects Of Social Media On Adolescent Well-Being., Katie Kennedy

All Graduate Theses, Dissertations, and Other Capstone Projects

Social media use is rapidly growing among adolescents, studies cite that the rates of “constant use” doubled from 2015 to 2018 (Anderson & Jiang, 2018; Lenhart, 2015). Social media use can have a serious negative impact on areas of well-being including feelings of depression, anxiety, fear of missing out, body image, bullying and sleep. Mojtabai, Olfson and Han (2016) cite the problematic use of mobile phones and social media applications as one of the trends aligning with the increase in major depressive episodes. Conversely, use of social media can promote positive feelings of well-being including creating a sense of community, …


Program Review Of Naloxone Training Within The Wisconsin Department Of Corrections’ Community Corrections Division, Chelsea Calhoon Jan 2019

Program Review Of Naloxone Training Within The Wisconsin Department Of Corrections’ Community Corrections Division, Chelsea Calhoon

All Graduate Theses, Dissertations, and Other Capstone Projects

One of the fastest growing drug problems in the United States is the abuse of opioids (United States Department of Health & Human Services, 2018). With the rising overdose rates, the criminal justice system may offer a pivotal role in the decrease of overdose deaths through opioid overdose recognition and naloxone administration training (World Health Organization, 2014). Training evaluation based on the Effectiveness Theory find significant predictors of training effectiveness and retention to be correlated with the training program, age, and employment tenure (Cowman & McCarthy, 2016). This thesis’ research question is, “Do demographics correlate to training retention for opioid …


Demography, Risk, And Power: An Examination Of The Deceased Patient Population At The Hastings State Hospital, 1900-1978, Dawn T. Whitney Jan 2019

Demography, Risk, And Power: An Examination Of The Deceased Patient Population At The Hastings State Hospital, 1900-1978, Dawn T. Whitney

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this research is to investigate the Hastings State Hospital (HSH) and its cemetery (HSHC) within a multidisciplinary framework, invoking discourse analysis, demography, and critical race theory to examine how power and risk factors impact the treatment and disposal of the body at death. It incorporates perspectives from both anthropology and sociology to interpret the data, relying heavily on the ideas of Michel Foucault. Integrating these diverse analytical tools is important to this research because social and structural forces all intersect in the creation of identity, power, and inequality.

All data in this study represent patients that have …