Public Health Commons^™

The Relationship Between Insurance And Health Outcomes Of Diabetes Mellitus Patients In Maryland: A Retrospective Archival Study, Soo-Hoon Lee, Samuel L. Brown, Andrew A. Bennett

Management Faculty Publications

Background

Past studies examining the health outcomes of diabetes mellitus (DM) patients found that social determinants of health disparities were associated with variabilities in health outcomes. However, improving access to healthcare, such as health insurance, should mitigate negative health outcomes. The aim of the study was to explore the association between four types of health insurance, namely, Medicare Fee-For-Service (FFS), Medicare Managed Care (MC), Private FFS, and Private MC plans, and the health outcomes of DM patients, controlling for patients’ social determinants of health.

Methods

This is a retrospective cross-sectional archival record study to explore the relationships between types of …

Effects Of Moderate Sleep Restriction During 8-Week Calorie Restriction On Lipoprotein Particles And Glucose Metabolism, Joshua R. Sparks, Ryan R. Porter, Shawn D. Youngstedt, Kimberly P. Bowyer, J. Larry Durstine, Xuewen Wang

Faculty Publications

Study Objectives

This study examined how glucose, glucose regulatory hormones, insulin sensitivity, and lipoprotein subclass particle concentrations and sizes change with sleep restriction during weight loss elicited by calorie restriction.

Methods

Overweight or obese adults were randomized into an 8-week calorie restriction intervention alone (CR, n = 12; 75% female; body mass index = 31.4 ± 2.9 kg/m2) or combined with sleep restriction (CR+SR, n = 16; 75% female; body mass index = 34.5 ± 3.1 kg/m2). Participants in both groups were given the same instructions to reduce calorie intake. Those in the CR+SR group were instructed to reduce their …

Healthcare Leadership In The Context Of Cognitive Diseases Of Aging: A Community-Based Participatory Research Model, Dean Sherzai

Dissertations

The Problem

The world is facing a tsunami of chronic diseases of the brain such as dementia, Parkinson's, and stroke. But all populations are not affected equally. Though we are all at greater risk of developing these diseases, minority communities such as the Black and Hispanic populations are at much greater risk of succumbing to these conditions. To date we have spent billions of dollars on research and public health measures that have repeatedly failed, but over the last decade it has become evident that much of these diseases can simply be averted through effective public health and community-based measures …

A Case Of Primary Infertility Treated With Icsi And Tesa, Saumya Raj

Digital Journal of Clinical Medicine

No abstract provided.

Protecting Financial Stability: Lessons From The Covid-19 Pandemic, Howell E. Jackson, Steven L. Schwarcz

Faculty Scholarship

The COVID-19 pandemic has produced a public health debacle of the first order. But the virus has also propagated the kind of exogenous shock that can precipitate-and to a certain degree did precipitate-a systemic event for our financial system. This still not fully resolved systemic shock comes a little more than a decade after the last financial crisis. In the intervening years, much has been written about the global financial crisis of 2008 and its systemic dimensions. Considerable scholarly attention has focused on first devising and then critiquing the macroprudential reforms that ensued, both in the Dodd-Frank Act and the …

Photocatalytic Inactivation Efficacy Of Sars-Cov-2 In Hvac Systems, Andrew J. Freeman, Sudharshan Anandan, Ernest R. Blatchley Iii, W. Travis Horton, David M. Warsinger

Discovery Undergraduate Interdisciplinary Research Internship

The coronavirus pandemic has emphasized a need for robust and reliable air purification systems in buildings; with that comes a need for a standardized testing methodology for air purification technologies in HVAC air circulation systems. One such method of air purification is photocatalytic oxidation (PCO), a mechanism in which a catalyst irradiated by light produces reactive molecules that degrade a wide range of pollutants, including the aerosols that carry COVID. This technology has primarily been used in aqueous applications, but there have recently been developments in air purification that have made it a promising contender to existing technologies. One of …

Are Covid-19 Vaccine Boosters Needed? The Science Behind Boosters, Rachel M. Burckhardt, John J. Dennehy, Leo L. M. Poon, Linda J. Saif, Lynn W. Enquist

Publications and Research

Waning vaccine-induced immunity coupled with the emergence of SARS-CoV-2 variants has led to increases in breakthrough infections, prompting consideration for vaccine booster doses. Boosters have been reported to be safe and increase SARS-CoV-2-specific neutralizing antibody levels, but how these doses impact the trajectory of the global pandemic and herd immunity is unknown. Information on immunology, epidemiology and equitable vaccine distribution should be considered when deciding the timing and eligibility for COVID-19 vaccine boosters.

Partnership Between Islam And Palliative Care At Swedish Health Services (First Hill And Cherry Hill), Hodo Mohamud

Articles, Abstracts, and Reports

INTRODUCTION  The spiritual practice of Islam is considered one of the three major monotheistic religions. There is minimal research about Palliative care and Muslim patients in both Muslim majority and Muslim minority countries. Engaging in internal assessment of palliative care provision to Muslim patients is important for quality care. This project aimed to examine gaps in Palliative needs assessment of Muslims in one institution.

OBJECTIVES Assess Swedish palliative care team’s barriers to spiritual care (SC) and baseline knowledge of Islamic influences on healthcare. Interview Muslim patients and insights from a Muslim Imam trained in chaplaincy about PC experience. Develop …

Association Between Race/Ethnicity And Covid-19 Disease Outcomes In The United States: A Qualitative Systematic Review Of The Literature, Jacob Smith

MEDI 9331 Scholarly Activities Clinical Years

Background/Objective: As studies have shown disparities in coronavirus disease-19 prevalence and severity, we sought to evaluate differences in outcomes of acute SARS-CoV-2 infection by race/ethnicity.

Design: Systematic review

Data Source: Studies from PubMed were included.

Review methods: Articles published in English language from January 1, 2019 through March 22, 2020. Studies included were observational studies that examined racial or ethnic disparities in SARS-CoV-2 infection outcomes in the United States. One reviewer performed data extraction.

Results: Out of a possible 1,944 articles, 99 observational studies (82 individual-level and 17 population-level) were included. Differential rates of hospitalization or otherwise severe illness …

Investigations Into The Genetics Of Mixed Pathologies In Dementia, Adam Dugan

Theses and Dissertations--Epidemiology and Biostatistics

Alzheimer’s disease (AD) is an irreversible, progressive brain disorder that leads to a loss of memory and thinking skills. While tremendous progress has been made in our understanding of the genetics underlying AD, currently known genetic variants explain only approximately 30% of the heritable risk of developing AD. One hurdle to AD research is that it can only be definitively diagnosed at autopsy, making cruder, clinic-based diagnoses more common. In recent years, several brain pathologies that mimic AD’s clinical presentation have been identified including brain arteriolosclerosis, hippocampal sclerosis (HS), and, most recently, limbic-predominant age-related TDP-43 encephalopathy (LATE). It has become …

An Assessment Of Kentucky Birth Records, Focusing On Early-Onset Hypertensive Disorders Of Pregnancy, Environmental Metal Exposures, And Geocoding Precision, 2008-2017, Courtney J. Walker

Theses and Dissertations--Epidemiology and Biostatistics

Using live and stillbirth records from Kentucky (2008-2017), this dissertation assessed the county-level prevalence and geospatial patterns of early-onset hypertensive disorders of pregnancy (eHDP); examined the geocoding precision of addresses recorded on birth records, and evaluated the association between individual risk factors and environmental metal exposures on eHDP prevalence. After adjusting for maternal demographic factors and pre-existing health conditions, we observed that eHDP prevalence was 38% higher (aPR=1.38, 95%CI:1.16, 1.64) in counties with the highest prevalence of married women (> 53.8%) compared to lower prevalence areas (31.6%) had a 20% higher prevalence of eHDP(aPR=1.20, 95%CI:1.00, 1.44) compared to counties with …

Assessment Of Community-Based Art Service Model Linking Female Sex Workers To Hiv Care And Treatment In Blantyre And Mangochi, Malawi, Lung Vu, Brady Zieman, Adamson Muula, Vincent Samuel, Lyson Tenthani, David Chilongozi, Simon Sikwese, Grace Kumwenda, Scott Geibel

HIV and AIDS

The Population Council and partners (through Project SOAR) conducted this study to assess whether acquiring antiretroviral treatment medication through community-based drop-in centers would appeal to female sex workers in this context, to describe any observed effects on treatment outcomes, and to identify opportunities for improvement should this model be selected for future scale-up.

Hiv Knowledge, Service Utilization, And Exposure To Dreams Among Male Partners Of Adolescent Girls And Young Women In Malawi, Project Soar

HIV and AIDS

Project SOAR, in collaboration with the Center of Reproductive Health at the University of Malawi College of Medicine, conducted qualitative research in the Zomba and Machinga districts to understand how programs can better engage men living with HIV in care, treatment, and support services. This brief summarizes findings on men’s knowledge of HIV, use of HIV services, stigma, and exposure to PEPFAR’s DREAMS (Determined Resilient Empowered AIDS-free Mentored and Safe) program which took a multi-sectoral approach to reduce HIV risk among adolescent girls and young women and their male partners.

Optimizing Maternal And Child Health Outcomes Through Use Of Multidisciplinary 'Improve' Teams In Lesotho, Appolinaire Tiam, Vincent Tukei, Lauren Greenberg, Shannon Viana, Heather Hoffman, Laura Guay, Ramatlapeng Thabelo, Tsietso Mots'oane, Matsepeli Nchephe

HIV and AIDS

The “Integrated Management Team to Improve Maternal-Child Outcomes” (IMPROVE) intervention is a comprehensive, evidence-based strategy to improve maternal and child health (MCH) outcomes through patient-centered, participatory service delivery and multidisciplinary management teams (MDT). The intervention includes three key approaches: (1) multidisciplinary, integrated management teams of facility- and community-based health care and lay workers; (2) Joint Positive Health Dignity, and Prevention (PHDP)-focused counseling for patients and skills-building training and job aids for health workers; and (3) increased early community-based counseling and support for patients. This report summarizes the key findings from the implementation of this intervention in Lesotho (under Project SOAR), …

Implementación De Políticas De Prevención Y Control De La Obesidad Infantil En Estados Unidos Y Latinoamérica: Lecciones Para La Investigación Y La Práctica Transfronterizas, Mireya Vilar-Compte, Rafael Perez-Escamilla, Elizabeth Rhodes, Olga L. Sarmiento, Camila Corvalan, Rachel Sturke, Susan Vorkoper

Department of Public Health Scholarship and Creative Works

Aunque se han hecho avances en el desarrollo y aplicación a gran escala de inter-venciones eficaces contra la obesidad infantil, los retos siguen siendo importantes. Nuestro objetivo era comprender las causas del éxito de Estados Unidos y los países latinoamericanos en la implementación de políticas y programas (PYP) contra la obe-sidad e identificar oportunidades de mejora aplicando los principios de la ciencia de la implementación. Seleccionamos tres estudios de comparación de casos: (1) el etique-tado frontal en los envases de alimentos (México y Chile), (2) los programas de calles abiertas y calles para el juego (Colombia y Estados Unidos) y …

The Benefits Of Evidence Based Practices In Public Administration: Does Therapeutic Listening Training Increase Emotional Intelligence To Affect Change Management Outcomes In Public And Private Sector Organizations, John Sillup

West Chester University Doctoral Projects

Abstract

This doctoral dissertation considers change management as it relates directly to evidence-based practices in public administration. The problem under study was the lack of scholarly research on the effect of an administrative leader’s emotional intelligence (EI) has on follower self-efficacy during change management. This study provided findings on the effect of therapeutic listening training as a means to increase emotional intelligence to potentially affect change management outcomes in public and private sector organizations. Change management is a systematic and structured process of developing and implementing strategies and interventions for organizations transitioning from current state to a desired state. The …

Bedbug Education, Treatment, And Prevention, Elizabeth Bedford

Department of Entomology: Distance Master of Science Projects

Cimex lectularius (bedbug) has become a severe issue in more recent years due to travel, immigration, and importation of products. Unfortunately, most people do not know their biology hence do not treat these arthropods correctly. Many myths and misinformation are currently available to people on the internet and with pest professionals. Education and proper treatment must eradicate these pests in homes, commercial buildings, and other places. To prove whether or not education with treatment garners better results,ten homes were treated with the same heating and chemical process, with only five being educated before, during and after. All homes were inspected …

Unboxing The Japanese Sojourning Mom’S Pediatric-Going Experience: A Phenomenological Study Of Culturally And Linguistically Appropriate Health Services, Carolyn Oldham

Theses and Dissertations--Education Sciences

This study explores how twelve former Lexington-area Japanese sojourning mothers define culturally and linguistically appropriate services and how culture, gender and language shaped their health care beliefs, behaviors and experiences in pediatric settings. It is a naturalistic, pragmatic line of inquiry born in collaboration with Japanese sojourning moms across cups of matcha 末茶 and mugicha 麦茶. Framed by constructivist and intersectionality research lenses, this phenomenological study seeks to understand how study participants perceived the cultural and linguistic appropriateness of their interactions with Lexington-area pediatric offices and to begin to ascertain the meanings they created based on their subjective experiences. Its …

Hand Hygiene For Health Promotion, Phyllis Knight-Brown

Doctor of Nursing Practice Projects

For many years public health organizations, such as The World Health Organization (WHO) and The Centers for Disease Control and Prevention (CDC), have stressed the need for proper hand hygiene. Proper hand hygiene requires a prescribed process to rid the hands of potentially infecting organisms by using soap and water (handwashing) or hand sanitizer (sanitizing). These processes need to be performed at critical times to promote infection prevention. Many studies have shown that hand hygiene is a learned behavior that becomes habitual over time, and behavior change mechanisms in addition to education are needed to affect a long-term change in …

Organophosphate Pesticide Dose Estimation From Spot And 24-Hr Urine Samples Collected From Children In An Agricultural Community, Carly Hyland, Katherine Kogut, Robert B. Gunier, Rosemary Castorina, Cynthia Curl, Brenda Eskenazi, Asa Bradman

Public and Population Health Faculty Publications and Presentations

Background: Spot urine samples are often used to assess exposure to organophosphate (OP) pesticides in place of “gold standard” 24-hr samples, which are cumbersome to collect. Assessment of non-persistent chemicals using spot urine samples may result in exposure misclassification that could bias epidemiological analyses towards the null. Few studies have examined the validity of measurements of urinary metabolites in spot samples to estimate daily OP dose or the potential implications of reliance on spot samples for risk assessments.

Objective: Examine the validity of using first morning void (FMV) and random non-FMV urine samples to estimate cumulative 24-hr OP pesticide dose …

Semantics Of The Black-Box: Can Knowledge Graphs Help Make Deep Learning Systems More Interpretable And Explainable?, Manas Gaur, Keyur Faldu, Amit Sheth

Publications

The recent series of innovations in deep learning (DL) have shown enormous potential to impact individuals and society, both positively and negatively. The DL models utilizing massive computing power and enormous datasets have significantly outperformed prior historical benchmarks on increasingly difficult, well-defined research tasks across technology domains such as computer vision, natural language processing, signal processing, and human-computer interactions. However, the Black-Box nature of DL models and their over-reliance on massive amounts of data condensed into labels and dense representations poses challenges for interpretability and explainability of the system. Furthermore, DLs have not yet been proven in their ability to …

The Future Of Zoonotic Risk Prediction, Colin J. Carlson, Maxwell J. Farrell, Zoe Grange, Barbara A. Han, Nardus Mollentze, Alexandra L. Phelan, Angela L. Rasmussen, Gregory F. Albery, Bernard Bett, David Brett-Major, Lily E. Cohen, Tad Dallas, Evan A. Eskew, Anna C. Fagre, Kristian M. Forbes, Rory Gibb, Sam Halabi, Charlotte C. Hammer, Rebecca Katz, Jason Kindrachuk, Renata L. Muylaert, Felicia B. Nutter, Joseph Ogola, Kevin J. Olival, Michelle Rourke, Sadie J. Ryan, Noam Ross, Stephanie N. Seifert, Tarja Sironen, Claire J. Standley, Kishana Taylor, Marietjie Venter, Paul W. Webala

Journal Articles: Epidemiology

In the light of the urgency raised by the COVID-19 pandemic, global investment in wildlife virology is likely to increase, and new surveillance programmes will identify hundreds of novel viruses that might someday pose a threat to humans. To support the extensive task of laboratory characterization, scientists may increasingly rely on data-driven rubrics or machine learning models that learn from known zoonoses to identify which animal pathogens could someday pose a threat to global health. We synthesize the findings of an interdisciplinary workshop on zoonotic risk technologies to answer the following questions. What are the prerequisites, in terms of open …

The Size And Culturability Of Patient-Generated Sars-Cov-2 Aerosol, Joshua L. Santarpia, Vicki L. Herrera, Danielle N. Rivera, Shanna Ratnesar-Shumate, St. Patrick Reid, Daniel N. Ackerman, Paul W. Denton, Jacob W. S. Martens, Ying Fang, Nicholas Conoan, Michael V. Callahan, James V. Lawler, David Brett-Major, John Lowe

Journal Articles: Epidemiology

BACKGROUND: Aerosol transmission of COVID-19 is the subject of ongoing policy debate. Characterizing aerosol produced by people with COVID-19 is critical to understanding the role of aerosols in transmission.

OBJECTIVE: We investigated the presence of virus in size-fractioned aerosols from six COVID-19 patients admitted into mixed acuity wards in April of 2020.

METHODS: Size-fractionated aerosol samples and aerosol size distributions were collected from COVID-19 positive patients. Aerosol samples were analyzed for viral RNA, positive samples were cultured in Vero E6 cells. Serial RT-PCR of cells indicated samples where viral replication was likely occurring. Viral presence was also investigated by western …

Recommended Reporting Items For Epidemic Forecasting And Prediction Research: The Epiforge 2020 Guidelines, Simon Pollett, Michael A. Johansson, Nicholas G. Reich, David Brett-Major, Sara Y. Del Valle, Srinivasan Venkatramanan, Rachel Lowe, Travis Porco, Irina Maljkovic Berry, Alina Deshpande, Moritz U. G. Kraemer, David L. Blazes, Wirichada Pan-Ngum, Alessandro Vespigiani, Suzanne E. Mate, Sheetal P. Silal, Sasikiran Kandula, Rachel Sippy, Talia M. Quandelacy, Jeffrey J. Morgan, Jacob Ball, Lindsay C. Morton, Benjamin M. Althouse, Julie Pavlin, Wilbert Van Panhuis, Steven Riley, Matthew Biggerstaff, Cecile Viboud, Oliver Brady, Caitlin Rivers

Journal Articles: Epidemiology

BACKGROUND: The importance of infectious disease epidemic forecasting and prediction research is underscored by decades of communicable disease outbreaks, including COVID-19. Unlike other fields of medical research, such as clinical trials and systematic reviews, no reporting guidelines exist for reporting epidemic forecasting and prediction research despite their utility. We therefore developed the EPIFORGE checklist, a guideline for standardized reporting of epidemic forecasting research.

METHODS AND FINDINGS: We developed this checklist using a best-practice process for development of reporting guidelines, involving a Delphi process and broad consultation with an international panel of infectious disease modelers and model end users. The objectives …

Lying In Wait: The Resurgence Of Dengue Virus After The Zika Epidemic In Brazil, Anderson Fernandes Brito, Lais Ceschini Machado, Rachel J. Oidtman, Márcio Junio Lima Siconelli, Quan Minh Tran, Joseph R. Fauver, Rodrigo Dias De Oliveira Carvalho, Filipe Zimmer Dezordi, Mylena Ribeiro Pereira, Luiza Antunes De Castro-Jorge, Elaine Cristina Manini Minto, Luzia Márcia Romanholi Passos, Chaney C. Kalinich, Mary E. Petrone, Emma Allen, Guido Camargo España, Angkana T. Huang, Derek A. T. Cummings, Guy Baele, Rafael Freitas Oliveira Franca, Benedito Antônio Lopes Da Fonseca, T. Alex Perkins, Gabriel Luz Wallau, Nathan D. Grubaugh

Journal Articles: Epidemiology

After the Zika virus (ZIKV) epidemic in the Americas in 2016, both Zika and dengue incidence declined to record lows in many countries in 2017-2018, but in 2019 dengue resurged in Brazil, causing ~2.1 million cases. In this study we use epidemiological, climatological and genomic data to investigate dengue dynamics in recent years in Brazil. First, we estimate dengue virus force of infection (FOI) and model mosquito-borne transmission suitability since the early 2000s. Our estimates reveal that DENV transmission was low in 2017-2018, despite conditions being suitable for viral spread. Our study also shows a marked decline in dengue susceptibility …

Impact Of Extrinsic Incubation Temperature On Natural Selection During Zika Virus Infection Of Aedes Aegypti And Aedes Albopictus, Reyes A. Murrieta, Selene M. Garcia-Luna, Deedra J. Murrieta, Gareth Halladay, Michael C. Young, Joseph R. Fauver, Alex Gendernalik, James Weger-Lucarelli, Claudia Rückert, Gregory D. Ebel

Journal Articles: Epidemiology

Arthropod-borne viruses (arboviruses) require replication across a wide range of temperatures to perpetuate. While vertebrate hosts tend to maintain temperatures of approximately 37°C-40°C, arthropods are subject to ambient temperatures which can have a daily fluctuation of > 10°C. Temperatures impact vector competence, extrinsic incubation period, and mosquito survival unimodally, with optimal conditions occurring at some intermediate temperature. In addition, the mean and range of daily temperature fluctuations influence arbovirus perpetuation and vector competence. The impact of temperature on arbovirus genetic diversity during systemic mosquito infection, however, is poorly understood. Therefore, we determined how constant extrinsic incubation temperatures of 25°C, 28°C, 32°C, …

Mapping Heat Vulnerability Index Based On Different Urbanization Levels In Nebraska, Usa, Babak Jalalzadeh Fard, Rezaul Mahmood, Michael Hayes, Clinton Rowe, Azar M. Abadi, Martha Shulski, Sharon J. Medcalf, Rachel Lookadoo, Jesse E. Bell

Journal Articles: Epidemiology

Heatwaves cause excess mortality and physiological impacts on humans throughout the world, and climate change will intensify and increase the frequency of heat events. Many adaptation and mitigation studies use spatial distribution of highly vulnerable local populations to inform heat reduction and response plans. However, most available heat vulnerability studies focus on urban areas with high heat intensification by Urban Heat Islands (UHIs). Rural areas encompass different environmental and socioeconomic issues that require alternate analyses of vulnerability. We categorized Nebraska census tracts into four urbanization levels, then conducted factor analyses on each group and captured different patterns of socioeconomic vulnerabilities …

Viral Dynamics Of Acute Sars-Cov-2 Infection And Applications To Diagnostic And Public Health Strategies, Stephen M. Kissler, Joseph R. Fauver, Christina Mack, Scott W. Olesen, Caroline Tai, Kristin Y. Shiue, Chaney C. Kalinich, Sarah Jednak, Isabel M. Ott, Chantal B. F. Vogels, Jay Wohlgemuth, James Weisberger, John Difiori, Deverick J. Anderson, Jimmie Mancell, David D. Ho, Nathan D. Grubaugh, Yonatan H. Grad

Journal Articles: Epidemiology

SARS-CoV-2 infections are characterized by viral proliferation and clearance phases and can be followed by low-level persistent viral RNA shedding. The dynamics of viral RNA concentration, particularly in the early stages of infection, can inform clinical measures and interventions such as test-based screening. We used prospective longitudinal quantitative reverse transcription PCR testing to measure the viral RNA trajectories for 68 individuals during the resumption of the 2019-2020 National Basketball Association season. For 46 individuals with acute infections, we inferred the peak viral concentration and the duration of the viral proliferation and clearance phases. According to our mathematical model, we found …

Risk Factors For Workplace Sexual Harassment In Female Truck Drivers, Kimberly Marie Riddle

Theses and Dissertations--Nursing

Sexual harassment is one of the most common forms of workplace violence in the United States. Sexual harassment is defined as unwanted verbal and physical behaviors of a sexual nature (e.g., physical advances, requests for sexual favors, inappropriate sexist or sexual comments or jokes, pornography, or other unwanted conduct) that creates an uncomfortable working environment or interferes with the employee’s job responsibilities. In general, it is estimated that nearly one in every two women have experienced sexual harassment at the workplace over their lifetime. In male-dominated occupations, such as truck driving, law enforcement, firefighting, and construction, females may have a …

Factors Associated With Lifestyle Modification For Type 2 Diabetes Self-Management And Prevention, Leigh Anne Koonmen

Theses and Dissertations--Nursing

Diabetes is the seventh leading cause of death in the United States, affecting roughly 13% of U.S. adults aged 18 years or older. Type 2 diabetes accounts for 90-95% of all diabetes cases and is characterized by the progressive development of insulin resistance leading to sustained elevated blood glucose levels. Management of type 2 diabetes includes risk-reduction strategies and continuous medical care to prevent the development of complications.

Lifestyle is a major contributing factor to morbidity and mortality rates in the United States. Preventative health behaviors, such as engaging in physical activity, maintaining a healthy weight, and following a healthy …