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Articles 1 - 30 of 148
Full-Text Articles in Other Public Health
Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef
Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef
Theses and Dissertations
Corporal punishment (CP) and severe physical punishment (SPP) remain a major public health, child rights, and child protection policy concern. In Egypt, despite legislative reforms, survey-weighted analysis of the 2021 Egypt Family Health Survey (EFHS) 2021 (CAPMAS, 2022) reveals prevalence rates of 60.5% for CP and 27.4% for SPP among children aged 1–14 (author’s calculations using EFHS-2021, n=7623), yet evidence distinguishing the determinants of routine corporal punishment from escalation to severe physical punishment remains limited in low- and middle-income contexts. Guided by Bronfenbrenner’s ecological framework, this mixed-methods study identifies key drivers of CP and its escalation to SPP among Egyptian …
Iron Deficiency And Iron Deficiency Anemia: Inconsistent Screening Practices And Delayed Result Processing In Children 12-18 Months, Madonna J. Mahoney Marshall
Iron Deficiency And Iron Deficiency Anemia: Inconsistent Screening Practices And Delayed Result Processing In Children 12-18 Months, Madonna J. Mahoney Marshall
Doctor of Nursing Practice (DNP) Scholarly Projects - Archive
Introduction:
Iron deficiency and iron deficiency anemia in children aged 12 to 18 months are prevalent conditions that, if not identified and treated early, are associated with adverse neurodevelopmental outcomes.
Purpose:
This quality improvement project evaluated the impact of a standardized screening and follow-up protocol on laboratory result retrieval, provider review, and caregiver follow-through in a military pediatric clinic.
Method:
A pre-post intervention design guided by the Plan-Do-Study-Act framework was implemented over 11 weeks and included staff education, standardized workflows, and caregiver outreach.
Results:
The intervention improved laboratory completion and caregiver follow-up rates; however, sustainability was limited by staffing constraints …
Exploring The Association Between Nurse Characteristics And Intent To Leave Their Current Position In Counties With Rural Hospital Closures, Caroline A. King
Exploring The Association Between Nurse Characteristics And Intent To Leave Their Current Position In Counties With Rural Hospital Closures, Caroline A. King
2025 Fall Honors Capstones Projects - Archive
Increased rural hospital closures and nursing burnout may lead to greater morbidity/mortality for rural residents. Current literature fails to capture whether rural hospital closures influence nurses’ intent to leave their current position. In this cross-sectional study, descriptive and correlational statistical analyses were conducted on survey responses from a sample of nurses who lived in a rural county that experienced a hospital closure. 66% of nurses stated that, at one point, they had considered leaving their primary nursing position. Logistic regression model results revealed that nurse-reported age and gender were significant predictors of a nurse’s intention to leave their current position. …
A Quality Improvement Initiative To Streamline Flu Vaccine Documentation And Increase Staff Engagement, Carla E. Giron
A Quality Improvement Initiative To Streamline Flu Vaccine Documentation And Increase Staff Engagement, Carla E. Giron
Master's Projects and Capstones
Objective: This quality improvement project was implemented in an urban community health clinic primarily serving low-income and Latinx patients. Factors such as demographics, socioeconomic status, health, and transportation contribute to low U.S. influenza vaccination rates (Chen et al., 2020), while EHR training can improve provider satisfaction and efficiency (DiAngi et al., 2019). This microsystem faced inconsistent workflow processes, limited EHR training, and documentation errors that contributed to low staff satisfaction rates and influenza vaccination rates. An average of 11.4% of patients received a flu vaccine in October 2023 and 2024. Medical assistants (MAs) completed a pre-intervention survey indicating that 35% …
Standardizing The Use Of The Sinc Screening Tool In A Rural Clinic, Madison Foss
Standardizing The Use Of The Sinc Screening Tool In A Rural Clinic, Madison Foss
DNP Projects
Unmet contraceptive need represents a persistent quality gap in rural primary care, where reproductive health discussions are often inconsistently addressed. A rural primary care clinic in Shelbyville, Tennessee lacked a standardized, evidence-based process for screening women of childbearing age (15–44 years) for contraceptive needs. This quality improvement project evaluated the feasibility and effectiveness of implementing the Self-Identified Need for Contraception (SINC) screening tool to support routine, patient-centered care. The SINC tool consists of a single validated question designed to identify patients who wish to discuss contraception or pregnancy prevention during clinical visits. Plan–Do–Study–Act cycles were used to integrate the tool …
Barriers To Mental Health Access Among Immigrant Populations In The U.S., Cecilia Menzinger
Barriers To Mental Health Access Among Immigrant Populations In The U.S., Cecilia Menzinger
Capstones
No abstract provided.
Implementing Diabetes Education And Prevention Protocol, Lilyanna B. Conkle, Alyssa M. Woodall
Implementing Diabetes Education And Prevention Protocol, Lilyanna B. Conkle, Alyssa M. Woodall
Scholars Week
This Evidence-Based Practice project proposes the implementation of a diabetes education and prevention protocol in school systems to address the rising prevalence of diabetes among students. The initiative includes mandatory pre-academic year training for school staff to improve recognition and response to diabetes related emergencies. To support school nurses, often the sole healthcare provider on campus; a mobile app will be introduced to alert personnel during emergencies and provide evidence-based intervention steps. This approach aims to enhance student safety, improve health outcomes, and ensure timely, coordinated care.
Dietary, Behavioral, And Psychosocial Factors Related To Cardiovascular Disease Risk Among South Asian Americans: A Scoping Review, Lakshmi Meyyappan, Peggy A. Ursuy, Olivia S. Anderson
Dietary, Behavioral, And Psychosocial Factors Related To Cardiovascular Disease Risk Among South Asian Americans: A Scoping Review, Lakshmi Meyyappan, Peggy A. Ursuy, Olivia S. Anderson
Internet Journal of Allied Health Sciences and Practice
Purpose: South Asian Americans disproportionately represent the world’s prevalence of cardiovascular disease. This scoping review assessed the dietary and psychosocial factors associated with cardiovascular disease risk that South Asian Americans encounter and concluded with considerations for health professionals who encounter this population in practice. Method: Inclusion criteria included studies with the primary population as South Asian Americans and investigated diet or psychosocial factors as variables and cardiovascular disease as an outcome variable. Results: Thirteen studies were included. Analysis of nutritional factors showed that South Asian Americans have high dietary quality yet eating non-vegetarian diets and high alcohol consumption is associated …
A Workplace Posture Initiative To Reduce Work-Related Musculoskeletal Disorders, Carrie Isaac
A Workplace Posture Initiative To Reduce Work-Related Musculoskeletal Disorders, Carrie Isaac
Doctor of Nursing Practice (DNP) Scholarly Project
Problem: Work-related musculoskeletal disorders (WRMSDs) are a leading cause of occupational injury and discomfort in industrial workplaces. Although an ergonomic program existed at the project site, a formalized process to detect postural misalignments early had not been established. Relying on employee self-reporting, delayed intervention, and limited opportunities to prevent injuries before they progress.
Aim of the Project: A proactive posture screening program using PostureScreen® was implemented to identify postural deviations that could contribute to WRMSDs. Emphasis was placed on supporting employees through early awareness of posture-related issues and evaluation of alignment improvements following individualized intervention.
Review of the Evidence: Evidence …
Improving Hiv Nonoccupational Postexposure Prophylaxis Completion In Survivors Of Sexual Assault, Rebecca Aden
Improving Hiv Nonoccupational Postexposure Prophylaxis Completion In Survivors Of Sexual Assault, Rebecca Aden
Doctor of Nursing Practice Final Project Abstract
PURPOSE
This project aimed to increase adherence to HIV nonoccupational postexposure prophylaxis (nPEP) among adult survivors of sexual assault using a 24-hour nurse-led callback intervention to reinforce patient education and support treatment completion.
BACKGROUND
This project was implemented within a public healthcare system’s forensic nursing program. Sexual assault survivors face an elevated risk of HIV transmission, yet completion of the 28-day nPEP regimen often remains below 40%. Barriers to completion include limited understanding, gaps in follow-up, as well as psychosocial and socioeconomic challenges.
METHODOLOGY
The FADE QI framework was utilized for this project. The population included adult, non-incarcerated patients who …
Leading Change For Transgender And Gender Diverse Healthcare: Assessing Organizational Readiness, Braxten Lovett
Leading Change For Transgender And Gender Diverse Healthcare: Assessing Organizational Readiness, Braxten Lovett
Dissertations
Background: Transgender and gender-diverse (TGD) individuals face persistent stigma and systemic discrimination across multiple societal domains, with healthcare settings—intended as safe spaces—often being among the most harmful. Despite increased visibility of TGD populations and growing research on their health inequities, inclusive healthcare remains insufficiently addressed by many healthcare leaders, adding to the urgency to advance equitable, inclusive care. Additionally, structural cisnormativity and binary gender frameworks continue to perpetuate misinformation, erasure, and health disparities. Addressing these entrenched barriers requires systemic reform rooted in cultural humility, inclusive practices, and a commitment to dismantling cisnormative bias within healthcare delivery and policy. This study …
Commencement Program 2025, Loma Linda University
Commencement Program 2025, Loma Linda University
Commencement Programs
CONTENTS
2 | Message from the President
3 | 2025 Events of Commencement
5 | The Academic Procession
6 | Institutional Administration
7 | Board of Trustees
8 | Significance of Academic Regalia
9 | University History Highlights
11 | Criteria for Institutional Awards
13 | Loma Linda University Health and Loma Linda University Honorees
The Programs, The School Honorees, and The Speakers
29 | School of Medicine
50 | School of Pharmacy
63 | School of Dentistry
81 | School of Public Health
94 | San Manuel Gateway College
101 | School of Allied Health Professions - Allied Health …
Improving Health Literacy Related To Hypertension In A Minority Faith-Based Population, Kasaundra M. Beverly-Marshall, Kasaundra M. Beverly-Marshall
Improving Health Literacy Related To Hypertension In A Minority Faith-Based Population, Kasaundra M. Beverly-Marshall, Kasaundra M. Beverly-Marshall
Doctor of Nursing Practice Scholarly Projects
Background: Insufficient research on health literacy related to cardiovascular disease highlights a gap in healthcare. Healthy People 2030 and local community health programs acknowledge gaps in research with future goals to improve health literacy.
Local Problem: The health literacy rate for Winnebago County, IL (41%) is higher than both the State of Illinois and national health literacy rates, which aligns with the results of a community needs assessment survey.
Methods: A community-based health promotion project using a pre-post study design uses the health promotion model to engage participants in advancing cardiovascular health outcomes.
Interventions: DNP student assisted participants in creating …
Increasing Pediatric Asthma Follow-Up Visits And Decreasing Emergency Department Visits In A Primary Care Setting, Rima M. Basal
Increasing Pediatric Asthma Follow-Up Visits And Decreasing Emergency Department Visits In A Primary Care Setting, Rima M. Basal
Doctor of Nursing Practice (DNP) Scholarly Projects - Archive
The implementation of the asthma follow-up visits bundle in the pediatric primary care setting is an evidence-based practice project aimed at improving pediatric asthma management. This manuscript discusses the deployment of the bundle, which includes pre- and post- knowledge assessment for parents/caregivers, asthma education through a short video and handout, administration of the asthma control test (ACT), completion of a written asthma action plan (WAAP), and education about the patient portal and telehealth. The goal is to improve parent/caregiver knowledge, treatment adherence, follow-up visit compliance (in-person or virtual) and reduce emergency department (ED) utilization. Parent/caregiver knowledge increased by 23%, ACT …
Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi
Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi
Social Work Dissertations - Archive
This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …
Nurses Current State Of Knowledge On Prion Disease, Chelsy Grande
Nurses Current State Of Knowledge On Prion Disease, Chelsy Grande
Nursing | Senior Theses
Background: Prion disease is a rare neurodegenerative disorder that affects the central nervous system. Creutzfeldt-Jakob prion disease rapidly progresses, caused by an infectious pathogen that misfolds the normal prion protein which results in an accumulation of cellular prion proteins. Unfortunately, there is no cure for Creutzfeldt-Jakob disease, only palliative care to provide support as the disease progresses. There is a gap in providing support for the patients and their families due to the limited understanding from the nurses, which can lead to the unmet needs of patients and their families. The purpose of the study is to evaluate what nurses …
Addressing Barriers In The Primary Prevention Of Hypertension In Black People, Makalah Pierre Rn Bsn
Addressing Barriers In The Primary Prevention Of Hypertension In Black People, Makalah Pierre Rn Bsn
Honors Undergraduate Theses
Hypertension is a significant health concern among minority groups, and the black population is most at risk (Abrahamowicz et al., 2023). The black population experience higher prevalence rates of hypertension compared to other racial groups and are more likely to experience hypertension-related problems, including cardiovascular disease (CVD) and chronic kidney disease (CKD). This literature review explores various nursing interventions aimed at preventing hypertension within this population. In this review, the term “black people or persons” is a broad term used to describe both African Americans and people of Afro-Caribbean decent. This includes various backgrounds such as Haitian, Jamaican, or otherwise …
The Impact Of State-Mandated Certification Of Surgical Technologists On Surgical Site Infection Rates: Evaluating Policy, Practice, And Patient Outcomes, Katherine E. Geiger
The Impact Of State-Mandated Certification Of Surgical Technologists On Surgical Site Infection Rates: Evaluating Policy, Practice, And Patient Outcomes, Katherine E. Geiger
Graduate Student Theses, Dissertations, & Professional Papers
Abstract
Chairperson: Matthew Schertz, Ph.D.
Committee Member: Morgen J Alwell, Ph.D.
Committee Member: Jill Davis, M.Ed.
As a surgical technology instructor, I have witnessed firsthand the impact that certified surgical technologists (CSTs) have on patient safety, particularly in the prevention of surgical site infections (SSIs). This professional paper investigates the relationship between state-mandated certification of surgical technologists and SSI rates, with a focus on how standardized education and credentialing influence clinical outcomes. SSIs remain a significant concern in surgical environments, contributing to increased morbidity, longer hospital stays, and greater healthcare costs. The research presented here examines certification requirements across various …
Improving Food Security To Decrease Hypertension At An Urban Community Clinic, Christine S. Villalta
Improving Food Security To Decrease Hypertension At An Urban Community Clinic, Christine S. Villalta
Master's Projects and Capstones
Diet and lifestyle changes have been proven to reduce blood pressure in patients with hypertension, and a key dietary approach aligned with this recommendation is the DASH diet, which includes consuming fruits and vegetables. Food insecurity, defined as lacking enough safe, nutritious food to maintain an active and healthy life, is a growing crisis in the United States, affecting 13.5% of U.S. households in 2023. This is especially significant for those whose chronic disease management depends on the accessibility of healthy food. An urban community clinic implemented a Food Security Program to decrease food insecurity and reduce hypertension among their …
Impact Of Participation In Cardiac Rehabilitation Post Myocardial-Infarction: An Integrative Review, Zoie Maynard, Mallory Stinson
Impact Of Participation In Cardiac Rehabilitation Post Myocardial-Infarction: An Integrative Review, Zoie Maynard, Mallory Stinson
Master's Projects
As one of the most common causes of hospitalization, the prevalence of myocardial infarction is indisputable Since this condition is so ubiquitous, a treatment protocol is initiated with methods to help patients modify their lifestyle, treat their underlying disease process, educate them to prevent reoccurrence, and improve their healthcare outcomes. This protocol relies heavily on the use of cardiac rehabilitation. Despite the implementation of this treatment protocol, the concern for recurrence and rehospitalization remains. The goal of this integrative review is to determine how participation in cardiac rehabilitation post-myocardial infarction impacts healthcare outcomes including rates of rehospitalization and depression. The …
Supporting South Korea’S Aging Population: How Ai And Iot Acceptance Connects The Young And Old, Bobby Im
Supporting South Korea’S Aging Population: How Ai And Iot Acceptance Connects The Young And Old, Bobby Im
Master's Projects and Capstones
In 2024, South Korea surpassed every other nation by becoming the country with the lowest fertility rate (below 0.7%). Population decline will hinder future ability to care for their aging population and although the government and private corporations are investing millions of dollars on developing Artificial Intelligence-Internet of Things (AI-IoT) devices to support the aging, the acceptance levels and the amount of family support required is undervalued. By examining AI-IoT’s current use and role in South Korea’s public health system this paper shows how intergenerational support helps optimize existing procedures and equipment, increases the level of acceptance and use, and …
Investigating Nursing Students’ Levels Of Knowledge About Alzheimer’S Disease, Dilek Doruk Kondakci, Aliye Mandiracioğlu
Investigating Nursing Students’ Levels Of Knowledge About Alzheimer’S Disease, Dilek Doruk Kondakci, Aliye Mandiracioğlu
Makara Journal of Health Research
Background: Given that Alzheimer’s disease (AD) has become a major public health problem, this study aimed to investigate the AD knowledge level of nursing students who are health professional candidates.
Methods: The population of this cross-sectional study consisted of 346 nursing students taking up a 4-year program. They were asked to fill out a sociodemographic information form and answer questions from the Alzheimer’s Disease Knowledge Scale (ADKS).
Results: Among the participants, 67.6% were female and 98.8% were single. The mean age of the students was 20.55 ± 2.05 years. Their general knowledge about AD was low, with …
Preventive Strategies For Elder Abuse Within Hospice Care By Healthcare Professionals, Joshua Eason
Preventive Strategies For Elder Abuse Within Hospice Care By Healthcare Professionals, Joshua Eason
Nursing | Student Research Posters
Background: Healthcare professionals providing hospice care need to have particular specialized abilities, empathy, and trust. Unfortunately, some of these medical professionals are unable to provide their patients the care they need, so they will instead abuse and ignore them. Elder abuse must be identified and addressed in hospice care settings if older patients are to have their rights and dignity upheld and a standardized, compassionate end-of-life care program is to be provided for each patient.
Purpose: The purpose of this study is to examine the effectiveness and preventative strategies for elder abuse, implemented by healthcare providers within the hospice care …
Reimagining Equitable Care: Simulation-Based Education And The Dismantling Of Implicit Bias And Stigma Of Vulnerable Populations In Hospitals, Vanessa Smith
Nursing | Senior Theses
Background: Simulation-based education consists of using high-fidelity mannequins and equipment to provide a safe space for healthcare professionals to practice crucial skills within healthcare. Used within hospitals and schools, simulation most commonly surrounds practicing hands-on skills such as central line insertion, IV insertion, Ultrasound-guided procedures, code blue response, etc. However, a large portion of healthcare that is overlooked is tackling issues within patient-provider relationships. Simulation can help dismantle the negative behaviors and feelings providers push onto patients through the use of standardized patients and role-playing. By using these methods, simulation can reduce providers’ personal implicit biases and the stigma associated …
Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White
Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White
Doctor of Nursing Practice (DNP) Scholarly Projects - Archive
Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).
Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …
Advancing School Nursing Practice: A Novel Approach To Screening For Gastrointestinal Disorders In Children, Ashley Bunting, Isabella Cavlan
Advancing School Nursing Practice: A Novel Approach To Screening For Gastrointestinal Disorders In Children, Ashley Bunting, Isabella Cavlan
Nursing | Senior Theses
Background: Currently, mandated health screenings in California schools are limited to vision, hearing, and scoliosis; this leaves several other body systems unmonitored during the crucial years of childhood development. One such system is the gastrointestinal (GI) system, which plays a vital role in the normal growth, nutrition status, development, and overall health of children. Objective: By developing and implementing a GI-specific screening tool in the outpatient school setting, this research aims to increase the detection of GI disorders in children. Not only that, but school nurses can use this novel screening tool to promote early diagnosis, intervention, and …
Nurses Current State Of Knowledge On Prion Disease, Chelsy Grande
Nurses Current State Of Knowledge On Prion Disease, Chelsy Grande
Nursing | Student Research Posters
Human prion disease is a rare and fatal neurodegenerative disorder. Creutzfeldt- Jakob prion disease rapidly progresses, and is caused by prion, an infectious protein that damages the central nervous system (Bailey et al., 2000). The infectious pathogen is different from other infectious diseases as the normal prion protein misfolds, changing the structures and results in an accumulation of cellular prion proteins (Rentz, 2003). There is no cure for Creutzfeldt- Jakob disease, only palliative care to improve their symptoms and provide support as the disease progresses. How much do nurses know and understand about prion disease, and how can this influence …
Factors Associated With Postacute Covid-19 Syndrome Among Patients In Malaysia, Ahtheemathurra Ballasingam, Farida Islahudin, Siti Azdiah Abdul Aziz, Mohd Makmor-Bakry
Factors Associated With Postacute Covid-19 Syndrome Among Patients In Malaysia, Ahtheemathurra Ballasingam, Farida Islahudin, Siti Azdiah Abdul Aziz, Mohd Makmor-Bakry
Makara Journal of Health Research
Background: Post-acute COVID-19 is known to affect multiple organs. It is essential to determine factors that affect post-acute COVID-19 syndrome and medications needed by patients for optimized care.
Methods: A prospective cohort study was conducted among patients recruited by stratified sampling from two COVID-19 hospitals in Malaysia. Patients were followed up for 6 months using a standard questionnaire to identify demographics, symptoms, medications taken, and factors associated with post-acute COVID-19 syndrome.
Results: A total of 388 were successfully followed up. The most frequently reported symptom was respiratory symptoms (N = 168, 43.30%), of which cough (N = …
Assessing Social Determinants Of Health In Primary Care, Vicki Carpenter
Assessing Social Determinants Of Health In Primary Care, Vicki Carpenter
Doctoral Projects
The social determinants of health encompass the various circumstances and environments in which individuals reside, develop, labor, and experience aging (Social Determinants of Health, 2022). These variables significantly contribute to the existence of health inequities and disparities within populations. In order to effectively mitigate health disparities, it is imperative to consider the various determinants that influence health outcomes, as this consideration is crucial for advancing the goal of achieving health equity. This public health concern encompasses multiple sectors within our society, necessitating the collaboration of various organizations and communities to effectively address and mitigate its impact.
The fundamental …
Prevalence Of Substance Use Among Lesbian, Gay, And Bisexual High School Students In 2019 Vs. 2021, Jordyn Lee, Elisabeth Hayes, Adam Wyatt
Prevalence Of Substance Use Among Lesbian, Gay, And Bisexual High School Students In 2019 Vs. 2021, Jordyn Lee, Elisabeth Hayes, Adam Wyatt
Nursing & Health Sciences Research Journal
Background: Studies suggest that LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, plus) youth are at increased risk of engaging in alcohol and substance use. The COVID-19 pandemic forced many students to isolate in 2020 and 2021, and the impacts of this have been purported to be detrimental. This study examines the prevalence of alcohol and substance use among lesbian, gay, and bisexual (LGB) U.S. high school students before the pandemic in 2019 versus 2021. Methods: This cross-sectional descriptive study used results from the 2019 Youth Risk Behavior Survey (YRBS) and the 2021 Adolescent Behavior and Experiences Survey (ABES). The 2019 YRBS …