Public Health Education and Promotion Commons^™

Messaging About Very Low Nicotine Cigarettes (Vlncs) To Influence Policy Attitudes, Harm Perceptions And Smoking Motivations: A Discrete Choice Experiment, Reed M. Reynolds, Lucy Popova, David L. Ashley, Katherine C. Henderson, Charity A. Ntansah, Bo Yang, Emily E. Hackworth, James Hardin, Jim F. Thrasher Ph.D., Ma, Ms

Faculty Publications

Background To reduce smoking and the harms it causes, countries, including the USA, are considering policies to reduce nicotine in combustible tobacco to minimally addictive levels. Effective messages about very low nicotine cigarettes (VLNCs) and this policy are crucial in combating misperceptions threatening the policy’s effectiveness.

Data and methods A discrete choice experiment assessed messages about VLNCs. Participants were 590 adults who smoked exclusively, 379 adults who both smoked and used e-cigarettes, 443 adults who formerly smoked and 351 young adults who never smoked (total n=1763). Seven message attributes were varied systematically (source, harm, chemicals, nicotine, satisfaction, addictiveness and quitting …

The Effect Of Dental Insurance Coverage And Economic Fluctuations On Oral Health Outcomes In The United States, Laura Singletary

Senior Theses

Proper oral health is imperative to overall health, but obstacles often persist in

receiving proper oral health care. Lack of dental insurance coverage and economic recessions are two main factors contributing to oral health outcomes. Extended time without cleanings or addressing current oral health concerns exacerbates oral health problems into more costly procedures for the patient that are conveniently not covered by many insurance plans. This thesis investigates the oral health outcomes associated with periods following economic downturns, specifically citing the time of the Great Recession from 2007-2009.

Decoding Implant-Related Sickness: Unraveling The Complexities Of Breast Implant Illness, Madison M. Stewart

Senior Theses

This thesis investigates the phenomenon of breast implant illness (BII), examining its potential correlation with individual factors such as obesity and poor lifestyle habits. BII, characterized by nonspecific symptoms, is often self-diagnosed by patients influenced by social media and internet sources, leading to requests for implant removal. Conducting a comprehensive meta-analysis, the study scrutinizes existing literature to evaluate the association between BII, obesity, and lifestyle choices. Employing inclusion criteria, peer-reviewed publications are analyzed through systematic review methodology to offer insights into the interplay between BII and adiposity, exploring inflammatory mechanisms and patient behaviors like exercise and smoking. The research aims …

"Fueling For A Healthy Life:" A Cooking Class For Adolescent And Young Adult Childhood Cancer Survivors, Hope Dominique

Senior Theses

Following cancer treatment, childhood cancer survivors (CCS) are at an increased risk of developing chronic diseases and face an increased risk of health-related death during adulthood. Recent literature demonstrates that modifying lifestyle factors such as nutrition can reduce the risk of late mortality in survivors, suggesting that interventions promoting a healthy lifestyle may improve quality and quantity of life for CCS. However, many adolescent and young adult (AYA) CCS do not adhere to national dietary guidelines and face both real and perceived barriers to adopting healthier eating habits while in a critical period for establishing behaviors that contribute to lifelong …

A Historical Analysis Of Health Institutions, Professionals, And Advocates In The Civil Rights Movement In Columbia, South Carolina, Anusha Ghosh

Senior Theses

From 1900 to 1970, widespread racism severely restricted healthcare access for Black citizens in the South, leading them to establish and staff alternative healthcare institutions to support their community.

Such institutions faced debilitating issues such as chronic financial shortages and patient overflow. Despite these problems, oral histories, media, and primary written sources show that Black healthcare workers in alternative healthcare institutions demonstrated a greater ability to meet the health needs of Black patients due to cultural understanding and external community involvement.

Dr. Matilda Evans was an African-American woman physician who became a leader in medicine, public health, and education in …

Covid-19 Vaccine Effectiveness Among People Living With And Without Hiv In South Carolina, Usa: Protocol Of A Population-Based Cohort Study, Xueying Yang, Jiajia Zhang Ph.D., Bankole Olatosi, Sharon Weissman, Xiaoming Li Ph.D.

Faculty Publications

Introduction Despite the effectiveness of COVID-19 vaccines in preventing severe COVID-19 outcomes, a small percentage of fully vaccinated persons will develop symptomatic or asymptomatic infections with SARSCoV-2, which is referred to as ‘breakthrough COVID-19’. People living with HIV (PLWH) appear to have an elevated risk of severe COVID-19 outcomes, yet the effectiveness of the COVID-19 vaccine in this population remains unclear due to the limited research efforts in this population in the real world. This study aims to characterise and compare the breakthrough COVID-19 (eg, prevalence and disease severity) between PLWH and non-PLWH and then examine whether HIV markers play …

Waning Effectiveness Of Mrna Covid-19 Vaccines Against Inpatient And Emergency Department Encounters, Theodoros V. Giannouchos, Nicole L. Hair Ph.D., Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

In the United States, most real-world estimates of COVID-19 vaccine effectiveness are based on data drawn from large health systems or sentinel populations. More data is needed to understand how the benefits of vaccination may vary across US populations with disparate risk profiles and policy contexts. We aimed to provide estimates of mRNA COVID-19 vaccine effectiveness against moderate and severe outcomes of COVID-19 based on state population-level data sources. Using statewide integrated administrative and clinical data and a test-negative case-control study design, we assessed mRNA COVID-19 vaccine effectiveness against SARS-CoV-2-related hospitalizations and emergency department visits among adults in South Carolina. …

Food Systems Under Shock: The Evolution Of Food Security Status Of Karantina Residents After The Beirut Explosion, Mariana Makoukji, Nour El Houda Amhez, Abed Al Kareem Yehya, Hala Ghattas Ph.D., Yaser Abunnasr, Rami Zurayk

Faculty Publications

Robust food systems are crucial for ensuring access to affordable and nutritious food, particularly in times of crisis. Economic instability, currency devaluation, and political turmoil can disrupt food systems, leading to higher food prices, compromised nutrition, and increased vulnerability. Lebanon is a stark example of this, where a catastrophic explosion in Beirut’s Port in 2020 worsened an existing economic and humanitarian crisis. The depreciation of the Lebanese currency led to soaring food prices, impacting people’s ability to buy food, and pushing many into poverty, illustrating the significant impact of the state food systems during crises (FAO, 2021). In times of …

Urban School Neighbourhoods Dominated By Unhealthy Food Retailers And Advertisements In Greater Tunis: A Geospatial Study In The Midst Of The Nutrition Transition, Christelle Akl, Nehmat El-Helou, Gloria Safadi, Aline Semaan, Aya El Sammak, Tarek Trabelsi, Sonia Sassi, Chaza Akik, Jalila El Ati, Pierre Traissac, Hala Ghattas Ph.D.

Faculty Publications

Objective:

Food environments are a major determinant of children’s nutritional status. Scarce evidence on food environments exists in low- and middle-income countries (LMIC). This study aims to fill this gap by documenting the obesogenicity of food environments around schools in Greater Tunis, Tunisia – an LMIC of the Middle East and North Africa region with an ongoing nutrition transition and increasing rates of childhood obesity.

Design:

In this cross-sectional study, we assessed built food environments around fifty primary schools. Ground-truthing was performed to collect geographic coordinates and pictures of food retailers and food advertisement sets within an 800-m road network …

“Courtesy, Respect, And Follow Through”: A Mixed Methods Evaluation Of Faculty Members’ Experiences, Needs, And Approaches To Research Collaborations, Daniela B. Friedman Ph.D., Christina Ek, Jean Neils-Strunjas Ph.D, Ccc-Slp, Andrea Tanner Ph.D., James R. Hébert Scd, Lorie Donelle, Sue E. Levkoff, Freda Allyson Hucek, Brooks Yelton Ma, Lmsw, Dwayne E. Porter

Faculty Publications

Introduction: Guided by a communications-focused framework developed by an interdisciplinary team of authors, this paper presents data from a survey of health science faculty members to better understand how research collaborations are established and maintained. Methods: An electronic survey was distributed to faculty in six colleges at a Research 1 institution. Quantitative data were downloaded into Excel and then RStudio for descriptive analysis. Open-ended, qualitative responses were coded and analyzed for themes. Results: Most respondents were in public health (44.0%) or medicine (25.3%); 40.0% were tenured. A grant deadline was the main impetus reported for initiating research collaborations (86.1%). Most …

Reflecting On Partnerships Established And Sustained Over Four Cycles Of A Federally Funded Cancer Prevention And Control Research Program: Lessons Learned For Community-Academic Networks, Swann Arp Adams, Lauren Workman Ph.D., Mayank Sakhuja, Brooks Yelton Ma, Lmsw, Karen E. Wickersham Phd, Rn, Ciaran Fairman, Jan Eberth Ph.D., Sue Heiney Scd, James Hébert Scd, Freda Allyson Hucek, Lauren Schaurer, Daniela B. Friedman Ph.D.

Faculty Publications

Introduction: The Centers for Disease Control and Prevention (CDC) funded Cancer Prevention and Control Research Network (CPCRN) is a national network which aims to accelerate the adoption and implementation of evidence-based cancer prevention and control strategies and interventions in communities, enhance large-scale efforts to reach underserved populations and reduce their cancer-related health disparities, and develop the capacity of the dissemination and implementation work force specifically in cancer prevention and control. Methods: Our site has been a part of the CPCRN since its inception in 2002 with the exception of the 2004–2009 funding cycle. As community-based participatory research is a core …

Social Networks As Predictors Of Musculoskeletal Injury In U.S. Army Soldiers (Snap-Mski), Kristen L. Zosel

Theses and Dissertations

INTRODUCTION: Musculoskeletal injuries (MSKIs) are the leading cause of medical non-readiness among U.S. Army Soldiers, costing the Military Health System an estimated $4.7 billion annually in direct and indirect costs. Current MSKI mitigation efforts focus on individual attributes such as body mass index and gender. However, emerging research highlights the significance of social ties on health outcomes and behaviors. This study examined the patterns of MSKI within military social networks and how social interactions, along with health behaviors such as sleep, physical activity (PA), and diet, co-occur in Soldiers with and without MSKI. METHODS: Phase 1 involved a cross-sectional sociocentric …

Establishment Of A Birth-To-Education Cohort Of 1 Million Palestinian Refugees Using Electronic Medical Records And Electronic Education Records, Zeina Jamaluddine, Akihiro Seita, Ghada Ballout, Hussam Al-Fudoli, Gloria Paolucci, Shatha Albaik, Rami Ibrahim, Miho Sato, Hala Ghattas Ph.D., Oona M.R. Campbell

Faculty Publications

Introduction

By linking datasets, electronic records can be used to build large birth-cohorts, enabling researchers to cost-effectively answer questions relevant to populations over the life-course. Currently, around 5.8 million Palestinian refugees live in five settings: Jordan, Lebanon, Syria, West Bank, and Gaza Strip. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides them with free primary health and elementary-school services. It maintains electronic records to do so.

We aimed to establish a birth cohort of Palestinian refugees born between 1st January 2010 and 31st December 2020 living in five settings by linking mother …

Strategies Elementary School Children Use To Influence Mothers' Food Purchasing Decisions, Nazratun N. Monalisa, Edward A. Frongillo Ph.D., Christine E. Blake Ph.D., Rd, Susan E. Steck, Robin B. Dipietro

Faculty Publications

This study aimed to understand the strategies elementary-school-aged children used to influence mothers' food purchasing decisions. Semi-structured qualitative interviews were conducted with 40 children aged 6–11 years and their mothers living in South Carolina. Strategies to influence mothers' food purchases were collected from children and their mothers separately. The interviews were audio-recorded, transcribed verbatim, and open-coded. The constant comparative method was used for data analysis. Coding matrices were used to compare children's and mothers' responses on the children's strategies. Children reported 157 instances of 25 distinct strategies to influence mothers' purchasing decisions. Mothers had concordance with 83 instances of these …

No More Loosies: A Mixed-Methods Study On The Implementation And Enforcement Of The Loose Cigarette And Bidi Sale Ban In India, Mayank Sakhuja

Theses and Dissertations

Background: Sale of loose cigarettes and bidis (loosies) is widely accepted as a key factor in promoting the tobacco epidemic in India. This mixed-methods study aimed to broaden understanding around the sale and purchase of loosies addressed three aims: 1) To determine the prevalence and correlates of loosies purchase in India; 2) To examine the association between purchase behavior and health warning labels (HWLs) exposure and responses, and 3) To conduct a stakeholder analysis regarding the ban on the sale of loosies in India. Methods: Data from the 2018-19 Tobacco Control Policy (TCP) India survey (643 current cigarette users and …

Understanding Commitment Of Local Food Banks, Faith-Based Organizations, And Schools To Provide Nongovernment Food Programs, Eliza M. Fishbein, Edward A. Frongillo Ph.D., Sharraf Samin, Audrey L. Richards, Christine E. Blake Ph.D., Rd, Ruth P. Saunders, Cheri J. Shapiro

Faculty Publications

Background: Nongovernment food assistance is typically provided to families by faith-based organizations, schools, and food banks. Community organizations appear to be strongly committed to these programs, but little is known about the basis for this commitment. Objectives: The aim of this study was to examine the values and identities of community organizations to understand the reasons for their commitment to providing nongovernment food assistance. Methods: Thirty-three in-depth interviews were conducted with 36 leaders at faith-based organizations (19 participants), schools (14 participants), and a local food bank (3 participants) in South Carolina. Observations were made, and informational documents (e.g., flyers and …

Social Network Attributes Associated With Conversations About Smoking And Cessation And Differences By Socioeconomic Status, Victoria Catherine Lambert

Theses and Dissertations

Conversations about smoking and cessation in response to cessation messages appear to encourage quit attempts, yet there is some evidence that smokers with lower income and education have these conversations less often than their counterparts with higher income and education. No research has investigated the social network characteristics that encourage smokers to have these conversations or the mechanisms for SES differences in these conversations. Because social factors play a role in SES disparities in smoking and cessation as well as other health behaviors and outcomes, social network characteristics likely explain some SES differences in conversations about smoking and cessation. The …

A Comparative Analysis Of Adolescent Pregnancy Patient Outcomes In The United States And United Kingdom Healthcare Systems, Liza Hopper

Senior Theses

Individuals all across the world should have equal access to healthcare. However, one’s ability to receive and afford quality care differs between countries. Comparing the differences in healthcare structures in both the UK and the US provides great insight into how certain welfare models affect patient outcomes. In this project, I discuss the functionality of the healthcare systems in the UK and the US. Then, by delving into how they relate to adolescent pregnancy patient outcomes, one can compare how the healthcare policies relate to the patient outcomes of a vulnerable population group. In both countries, adolescent mothers, those who …

Basic Human Values Drive Food Choice Decision-Making In Different Food Environments Of Kenya And Tanzania, Christine E. Blake Ph.D., Rd, Eva C. Monterrosa, Krystal K. Rampalli, Abdullah Nurus Salam Khan, Ligia I. Reyes, Shiny Deepika Drew, Paula Dominguez-Salas, Salome A. Bukachi, Mariah Ngutu, Edward A. Frongillo Ph.D., Elyse Iruhiriye, Amy Webb Girard

Faculty Publications

Increased access to a variety of foods in low-and-middle-income countries (LMICs) has led to greater autonomy in food choice decision-making. Autonomy allows individuals to make decisions through negotiation of considerations in ways that are consistent with basic values. The aim of this study was to identify and describe how basic human values drive food choice in two diverse populations with transitioning food environments living in the neighboring East African countries of Kenya and Tanzania. Secondary data analysis was carried out on focus group discussions conducted with men and women in Kenya (n = 28) and Tanzania (n = 28) as …

Exploration Of The Association Between Obesogenic Environments And Childhood Overweight/Obesity Rates In Rural Counties In The United States, Kara Lea Ferguson Davis

Theses and Dissertations

Rising obesity rates, particularly among children, pose a significant public health concern. Of particular concern is the prevalence of childhood obesity in rural communities, with up to 38% of rural children classified as overweight or obese, compared to 30% of urban children. Rural communities often lack the typical built environment characteristics associated with increased physical activity rates and healthy eating behaviors. Further, research on obesogenic environments within rural areas is limited. This study aimed to address this research gap by examining the association between obesogenic environment features and childhood overweight/obesity rates across the urban-rural continuum.

Simple and multiple linear regression …

Babe (Body Appreciation And Better Eating), Just Add A Dash Of Self-Compassion: A Randomized Controlled Pilot Study For Black/African American Teenage Girls, Nkechi Bianca Okpara

Theses and Dissertations

Introduction

Body dissatisfaction contributes to disproportionately high rates of disordered eating behaviors observed in Black teenagers. Given that self-compassion is found to buffer against eating pathology and body dissatisfaction and is linked to reduced incidences of binge eating and disordered eating behavior. Incorporating the self-compassion construct, specifically centering on nutrition, with a program that combats negative body image, like the Body Project, may further help decrease body dissatisfaction and improve overall nutrition.

Purpose

The aim of this dissertation was to test (1) the acceptability and feasibility of a novel program, Body Appreciation and Better Eating, add self-compassion (BABE+SC), and to …

The Determinants Of Sustained Adherence To Covid-19 Preventive Measures Among Older Syrian Refugees In Lebanon, Nisreen Salti, Stephen J. Mccall, Berthe Abi Zeid, Noura El Salibi, Marwan Alawieh, Zeinab Ramadan, Hala Ghattas Ph.D, Sawsan Abdulrahim

Faculty Publications

Introduction Lebanon has battled the COVID-19 pandemic in the midst of an economic crisis. The evolution of the pandemic and a fragile health system have meant that public health policy has had to rely heavily on non-pharmaceutical interventions for disease control. However, changes in disease dynamics, an unraveling economy, and pandemic fatigue have meant that disease control policies need to be updated. Methods Using recent and timely data on older (50 years and above) Syrian refugees in Lebanon, this paper uses multivariate linear probability models to explore the determinants of adherence to two non-pharmaceutical COVID-19 prevention measures (wearing a mask …

Effects Of Size At Birth On Health, Growth And Developmental Outcomes In Children Up To Age 18: An Umbrella Review, Zeina Jamaluddine, Eman Sharara, Vanessa Helou, Nadine El Rashidi, Gloria Safadi, Nehmat El-Helou, Hala Ghattas Ph.D, Miho Sato, Hannah Blencowe, Oona M.R. Campbell

Faculty Publications

Background Size at birth, an indicator of intrauterine growth, has been studied extensively in relation to subsequent health, growth and developmental outcomes. Our umbrella review synthesises evidence from systematic reviews and meta-analyses on the effects of size at birth on subsequent health, growth and development in children and adolescents up to age 18, and identifies gaps.

Methods We searched five databases from inception to mid-July 2021 to identify eligible systematic reviews and meta-analyses. For each meta-analysis, we extracted data on the exposures and outcomes measured and the strength of the association.

Findings We screened 16 641 articles and identified 302 …

Inequalities In Wellbeing In Lebanese Children And Different Refugee Subpopulations: A Multidimensional Child Deprivation Analysis, Zeina Jamaluddine, Gloria Safadi, Alexandra Irani, Nisreen Salti, Jad Chaaban, Sawsan Abdulrahim, Alban Thomas, Hala Ghattas Ph.D.

Faculty Publications

Background and Objectives:

This study constitutes the first attempt to describe the overlapping deprivations faced by Lebanese children (Lebanese) and that of the three sub-populations of refugees living in Lebanon: Palestinian refugees living in Lebanon, Palestinian refugees from Syria and Syrian refugees.

Methods:

Using data from the United Nations International Children's Emergency Fund (UNICEF) Household Survey 2016 (n = 10,555 Lebanese; 7,106 Palestinian refugees living in Lebanon; 2,768 Palestinian refugees from Syria and 5,891 Syrian refugee children aged 2 to 17 years old), we report on single and overlapping deprivations (at least two concurrent deprivations) using indicators related to survival …

Development And Validation Protocol For An Instrument To Measure Household Water Insecurity Across Cultures And Ecologies: The Household Water Insecurity Experiences (Hwise) Scale, Sera L. Young, Shalean M. Collins, Godfred O. Boateng, Torsten B. Neilands, Zeina Jamaluddine, Joshua D. Miller, Alexander A. Brewis, Edward A. Frongillo Jr., Wendy E. Jepson, Hugo Melgar-Quiñonez, Roseanna C. Schuster, Justin B. Stoler, Amber Wuitch, Hwise Research Coordination Network

Faculty Publications

Introduction A wide range of water-related problems contribute to the global burden of disease. Despite the many plausible consequences for health and well-being, there is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts.

Methods and analysis After domain specification and item development, items were assessed for both content and face validity. Retained items are being asked in surveys in 28 sites globally in which water-related problems have been reported (eg, shortages, excess …

Why Understanding Food Choice Is Crucial To Transform Food Systems For Human And Planetary Health, Krystal K. Rampalli, Christine E. Blake Ph.D., Rd, Edward A. Frongillo Ph.D., Joseph Montoya

Faculty Publications

What, how and why people eat has long been understood to be important for human health, but until recently, has not been recognised as an essential facet of climate change and its effects on planetary health. The global climate change and diet-related health crises occurring are connected to food systems, food environments and consumer food choices. Calls to transform food systems for human and planetary health highlight the importance of understanding individual food choice. Understanding what, how and why people eat the way they do is crucial to successful food systems transformations that achieve both human and planetary health goals. …

Predictors And Barriers To Vaccination Among Older Syrian Refugees In Lebanon: A Cross-Sectional Analysis Of A Multi-Wave Longitudinal Study, Berthe Abi Zeid, Tanya El Khoury, Hala Ghattas Ph.D., Marwan F. Alawieh, Zeinab Ramadan, Sirine Anouti, Sawsan Abdulrahim, Stephen J. Mccall

Faculty Publications

Background:

Vaccination is important to prevent morbidity and mortality due to COVID-19 among older Syrian refugees. We aimed to elucidate the predictors of COVID-19 vaccine uptake among Syrian refugees aged 50 years or older in Lebanon and to understand their main reasons for not receiving the vaccine.

Methods:

This was a cross-sectional analysis of a five-wave longitudinal study, conducted through telephone interviews between Sept 22, 2020, and March 14, 2022, in Lebanon. For this analysis, data were extracted from wave 3 (Jan 21–April 23, 2021), which included a question on vaccine safety and on whether participants intended to receive the …

Predicting Adolescent Intervention Non-Responsiveness For Precision Hiv Prevention Using Machine Learning, Bo Wang, Feifan Liu, Lynette Deveaux, Arlene Ash, Ben Gerber, Jeroan Allison, Carly Herbert, Maxwell Poitier, Karen Macdonell, Xiaoming Li Ph.D., Bonita Stanton

Faculty Publications

Interventions to teach protective behaviors may be differentially effective within an adolescent population. Identifying the characteristics of youth who are less likely to respond to an intervention can guide program modifications to improve its effectiveness. Using comprehensive longitudinal data on adolescent risk behaviors, perceptions, sensation-seeking, peer and family influence, and neighborhood risk factors from 2564 grade 10–12 students in The Bahamas, this study employs machine learning approaches (support vector machines, logistic regression, decision tree, and random forest) to identify important predictors of non-responsiveness for precision prevention. We used 80% of the data to train the models and the rest for …

Covid-19 Vaccine Hesitancy And Vaccination Rate Among The Latino Population In South Carolina, Brynn E. Lynagh

Senior Theses

It is common knowledge that COVID-19 disproportionately impacts racial and ethnic minorities in the United States. Furthermore, these sects of the population exhibit increased vaccine hesitancy and lower vaccination rates as compared to the aggregated population of the United States, furthering the risk posed by COVID-19 to these communities. In particular, this study focuses on the Latino population in South Carolina, the vaccination rate among this community, and the perspectives which contributed to their vaccination decision. Two hundred Spanish and Portuguese speaking residents of South Carolina were interviewed using a paper survey conducted by pre-trained interviewers. The survey gathered data …

A Process For Converting An In-Person Training To Increase Church Capacity To Implement Physical Activity And Healthy Eating Practices And Policies To An Online Format, Sara Wilcox Phd, Ruth P. Saunders Ph.D., Jessica Stucker, Andrew T. Kaczynski Ph.D., Kelsey R. Day, Deborah Kinnard, Lindsay Decker, John A. Bernhart Ph.D., Mph, Ches

Faculty Publications

The implementation of evidence-based public health programs into practice is critical for improving health, but trainings for organizational change agents are often not scalable. To describe the process of converting a training that targets faith-based organizational capacity development from an in-person to an online format. We engaged in an iterative process to convert the training delivery mode from in-person to online that included assessing stakeholder support, consulting the literature on best practices, seeking a design team, consolidating content, designing engaging lessons, and building an online site. Feedback from end-users and other audiences was incorporated throughout. Pilot participants with characteristics like …