Women's Health Commons^™

Oxytocin, Cortisol, And Cognitive Control During Acute And Naturalistic Stress, Shari Young Kuchenbecker, Sarah D. Pressman, Jared Celniker, Karen M. Grewen, Ken D. Sumida, Naveen Jonathan, Brendan Everett, George M. Slavich

Health Sciences and Kinesiology Faculty Articles

Although stress is a strong risk factor for poor health, especially for women, it remains unclear how stress affects the key neurohormones cortisol and oxytocin, which influence stress-related risk and resilience. Whereas cortisol mediates energy mobilization during stress, oxytocin has anti-inflammatory, anxiolytic, and analgesic effects that support social connection and survival across the lifespan. However, how these neurohormones interrelate and are associated with cognitive control of emotional information during stress remains unclear. To address these issues, we recruited 37 college-aged women (M_age = 19.19, SD = 1.58) and randomly assigned each to a one-hour experimental session consisting of …

Association Of Cardiovascular Health And Epigenetic Age Acceleration, Tess D. Pottinger, Sadiya S. Khan, Yinan Zheng, Wei Zhang, Hilary A. Tindle, Matthew Allison, Gretchen Wells, Aladdin H. Shadyab, Rami Nassir, Lisa Warsinger Martin, Joann E. Manson, Donald M. Lloyd-Jones, Philip Greenland, Andrea A. Baccarelli, Eric A. Whitsel, Lifang Hou

Nursing Faculty Publications

BACKGROUND: Cardiovascular health (CVH) has been defined by the American Heart Association (AHA) as the presence of the "Life's Simple 7" ideal lifestyle and clinical factors. CVH is known to predict longevity and freedom from cardiovascular disease, the leading cause of death for women in the United States. DNA methylation markers of aging have been aggregated into a composite epigenetic age score, which is associated with cardiovascular morbidity and mortality. However, it is unknown whether poor CVH is associated with acceleration of aging as measured by DNA methylation markers in epigenetic age.

METHODS AND RESULTS: We performed a cross-sectional analysis …

Vulvar Lichen Sclerosus In Women Of Reproductive Age, Elysha Kolitz, Laura Gammon, Melissa Mauskar

Faculty, Staff and Students Publications

Vulvar lichen sclerosus (vLS) is an inflammatory skin condition that predominantly affects the vulvar and perianal regions. Approximately 50% of cases present prior to menopause; however, there is a paucity of data on vLS in women of reproductive age as well as during their pregnancies. A retrospective review was performed at two tertiary referral centers to better describe cases of vLS in women of reproductive age. Thirty-three patients with a mean age of 40 years met inclusion criteria. In this group, vulvar pruritus was the most common presenting symptom (52%); 61% had biopsy-proven vLS, 42% had at least one autoimmune …

Early Impact Of The Covid-19 Pandemic On Contraceptive Services In South Carolina And Alabama, Center For Applied Reasearch And Evaluation In Women's Health, East Tennessee State University

Center for Applied Research and Evaluation (CARE) in Women's Health Issue Briefs

The COVID-19 pandemic has significantly affected access to and the delivery of health care services, including contraceptive service2s. Despite the need for adequate and timely pandemic response, maintaining the safe and effective delivery of contraceptive services remains essential. This issue brief highlights findings from interviews conducted with 45 staff and providers at Federally Qualified Health Centers (FQHCs) and Health Department clinics, in South Carolina and Alabama, to assess the impact of the COVID-19 pandemic on contraceptive services in their clinics. The brief focuses on the following indicators: Overall Patient Volume, Contraceptive Care Patient Volume, Contraceptive Service Provision, Staffing Capacity, Medical …

Conducting Household Surveys On Reproductive Health In Urban Settings: Lessons From Karachi, Pakistan, Mirbaz Khan, Sidrah Nausheen, Imtiaz Hussain, Kristy Hackett, Kaneez Zehra, Khalid Feroz, David Cannin, Iqbal Shah, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: Data collection is the most critical stage in any population health study and correctly implementing fieldwork enhances the quality of collected information. However, even the most carefully planned large-scale household surveys can encounter many context-specific issues. This paper reflected on our research team's recent experience conducting surveys for a quasi-experimental evaluation of a reproductive health program in urban areas of Karachi, Pakistan. We aim to describe the issues encountered and lessons learned from this process, and present some potential solutions for conducting future household surveys in similar urban environments.
Methods: The study followed a three-stage random sampling design. Initially, …

Hello Darkness My Old Friend: An Experience Of A Transformative Session With Zero Balancing, James Mccormick

Journal of Transformative Touch

An Experience of a Transformative Session with Zero Balancing showing the effects of client experiencing an expanded state of consciousness furring a Zero Balancing session.

The Utility Of Genetic Risk Score To Improve Performance Of Frax For Fracture Prediction In Us Postmenopausal Women, Xiangxue Xiao, Qing Wu

School of Public Health Faculty Research

The ability of the fracture risk assessment tool (FRAX) in discriminating fracture and non-fracture in postmenopausal women remains suboptimal. Adding a genetic profile may improve the performance of FRAX. Three genetic risk scores (GRSs) (GRS_fracture, GRS_BMD, GRS_eBMD) were calculated for each participant in the Women’s Health Initiative Study (n = 23,981), based on the summary statistics of three comprehensive osteoporosis-related genome-wide association studies (GWAS). The primary outcomes were incident major osteoporotic fracture (MOF) and hip fracture (HF). The association between each GRS and fracture risk were evaluated in separate Cox Proportional Hazard models, with FRAX clinical risk factors adjusted for. …

The Association Between Cardiovascular Disease Knowledge And Risk Factors Among African American Breast Cancer Survivors In The Deep South, Michelle S. Williams, Chizoba Anyimukwu

Journal of Health Disparities Research and Practice

Purpose: African American breast cancer survivors in the Deep South have a disproportionately high burden of cardiovascular disease (CVD) mortality. Multiple potentially modifiable CVD risk factors are highly prevalent in this population, such as high blood pressure, obesity, and poor dietary habits. The purpose of this study was to assess the association between CVD health metrics and heart disease knowledge among the target population.

Methods: The Heart Disease Knowledge Questionnaire was used to assess the participants’ knowledge of heart disease and heart disease risk factors. Questions from My Life Check were used to assess the participants cardiovascular health metrics. Multivariate …

Impact Of 10-Valent Pneumococcal Conjugate Vaccine (Pcv10) On Nasopharyngeal Carriage In Children 2 Years Of Age: Data From A Four-Year Time Series Cross-Sectional Study From Pakistan, Muhammad Imran Nisar, Shahira Shahid, Sajid Muhammad, Farah Khalid, Amjad Hussain, Sheraz Ahmed, Sadia Shakoor, Furqan Kabir, Aneeta Hotwani, Syed Asad Ali, Anita K. M. Zaidi, Fyezah Jehan, Najeeha Talat Iqbal

Department of Paediatrics and Child Health

The dataset described in this paper was collected for a time-series cross-sectional study exploring the impact of 10-valent Pneumococcal Conjugate Vaccine (PCV10) on nasopharyngeal (NP) carriage in children under 2 years of age from a rural population in Sindh, Pakistan. The study was carried out in two union councils of Matiari - Khyber and Shah Alam Shah Jee Wasi (Latitude 25.680298 / Longitude 68.502711). Data was collected on socio-demographics, clinical characteristics and vaccination status using android phone-based application. NP samples were collected using standard World Health Organisation (WHO) techniques, culture and serotyping was done using sequential Multiplex PCR described by …

The International Perinatal Outcomes In The Pandemic (Ipop) Study: Protocol, Sarah J. Stock, Helga Zoega, Meredith Brockway, Rachel H. Mulholland, Jessica E. Miller, Jasper V. Been, Rachael Wood, Ishaya I. Abok, Belal Alshaikh, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Preterm birth is the leading cause of infant death worldwide, but the causes of preterm birth are largely unknown. During the early COVID-19 lockdowns, dramatic reductions in preterm birth were reported; however, these trends may be offset by increases in stillbirth rates. It is important to study these trends globally as the pandemic continues, and to understand the underlying cause(s). Lockdowns have dramatically impacted maternal workload, access to healthcare, hygiene practices, and air pollution - all of which could impact perinatal outcomes and might affect pregnant women differently in different regions of the world. In the international Perinatal Outcomes in …

Eccrine Spiradenoma: A Rare Adnexal Tumour With Atypical Presentation: A Case Report, Adnan Salim, Muhammad Usman Tariq, Sana Zeeshan

Section of Neurosurgery

First described in 1934, eccrine spiradenoma (ES) is a rare, benign adnexal tumour arising from eccrine sweat glands. It commonly presents as a slow-growing nodule on the upper trunk, and head and neck region, mostly in the age bracket of 15-35 years, with no gender preference. While no established guidelines exist for optimal management of malignant ES, some therapies have been studied. The diagnosis of this entity is extremely important as it can harbour a malignant component with disastrous outcomes which may be missed due to its strong resemblance to benign lesions, such as a papilloma. Here, we present the …

Delivering Maternal And Neonatal Health Interventions In Conflict Settings: A Systematic Review, Mariella Munyuzangabo, Michelle F. Gaffey, Dina S. Khalifa, Daina Als, Anushka Ataullahjan, Mahdis Kamali, Reena P. Jain, Sarah Meteke, Amruta Radhakrishnan, Shailja Shah, Fahad J. Siddiqui, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: While much progress was made throughout the Millennium Development Goals era in reducing maternal and neonatal mortality, both remain unacceptably high, especially in areas affected by humanitarian crises. While valuable guidance on interventions to improve maternal and neonatal health in both non-crisis and crisis settings exists, guidance on how best to deliver these interventions in crisis settings, and especially in conflict settings, is still limited. This systematic review aimed to synthesise the available literature on the delivery on maternal and neonatal health interventions in conflict settings.
Methods: We searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to …

A Scoping Review: Overview Of Current Respectful Maternity Care Research By Research Approach And Study Location, Hannah L. Shuman, Annika M. Grupp, Lauren A. Robb, Gurbani Bedi, Miloni Shah, Andrea Janis, Caroline G. Caldart, Ryan Melikian, Urvashi Gupta, Janki K. Vaghasia, Aishwarya Panneerselvam, Aisha Kazeem, Ndidiamaka N. Amutah-Onukagha, Diane L. Levine

Medical Student Research Symposium

Introduction: Disrespectful care during childbirth contributes to poor health outcomes, perpetuates disparities, and encourages childbirth outside of healthcare facilities. To measure disrespectful care, investigators use many research approaches. Most research has focused on low/low-middle income countries. This scoping review aims to 1) summarize current research and research approaches to analyze whether these approaches identify the same types of mistreatment and 2) identify gaps in current research analyzing disrespectful care during childbirth.

Methods: Following PRISMA guidelines, this review utilized search terms to filter articles from the Pubmed database. Using specific criteria, articles were then excluded by title and abstract, then full …

Does Delay In The Diagnosis Of Rudimentary Horn Pregnancy In Patients With Unicornuate Uteri Impact Treatment Outcomes?, Victoria Webber, Megan Fee, Damla Gonullu, Jessica Rausch, Omosalewa Itauma, Chidinma Abara, Awoniyi Awonuga

Medical Student Research Symposium

OBJECTIVE: Rudimentary horn pregnancy (RHP) is a very rare form of ectopic pregnancy (EP) that tends to rupture in the second trimester. Similar to other EPs, the treatment of RHPs is excision, hence delay in diagnosis (DID) can be detrimental. Our objective is to determine whether DID of RHP in patients with unicornuate uteri (UCU) impacts the treatment outcome.

DESIGN: Retrospective cohort study of published case reports in PubMed database.

MATERIALS AND METHODS: A computerized PubMed search of case reports of RHP from 2007 to 2020 was performed using the key words; unicornuate uterus, rudimentary horn, pregnancy, case. Data was …

Meropenem-Induced Pancytopenia In A Preterm Neonate: A Case Report, Kashif Hussain, Muhammad Sohail Salat, Naureen Mohammad, Ambreen Mughal, Sidra Idrees, Javaid Iqbal, Gul Ambreen

Department of Biological & Biomedical Sciences

Background: A post-marketing surveillance study has reported an association between meropenem use and the incidence of hematologic abnormalities, including leukopenia, thrombocytopenia, hemolysis, and neutropenia, but the precise incidence in neonates is unknown. Here, we report meropenem-induced pancytopenia in a preterm neonate.
Case presentation: A preterm newborn Pakistani received intravenous meropenem 40 mg/kg every 8 hours to treat Klebsiella pneumoniae in blood cultures and suspected meningitis. The baby developed severe thrombocytopenia, with a platelet count of 22 × 10³ cells/mm³, low hemoglobin level of 9.7 g/dl, and low absolute neutrophil count (ANC) of 816 cells/mm³ on days …

Characteristics Of Salmonella Recovered From Stools Of Children Enrolled In The Global Enteric Multicenter Study, Irene N. Kasumba, Caisey V. Pulford, Blanca M. Perez-Sepulveda, Sunil Sen, Nurulla Sayed, Jasnehta Permala-Booth, Sofie Livio Sofie Livio, Darren Heavens Darren Heavens, Ross Low Ross Low, Shahida Qureshi, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Background: The Global Enteric Multicenter Study (GEMS) determined the etiologic agents of moderate-to-severe diarrhea (MSD) in children under 5 years old in Africa and Asia. Here, we describe the prevalence and antimicrobial susceptibility of non-typhoidal Salmonella (NTS) serovars in GEMS and examine the phylogenetics of Salmonella Typhimurium ST313 isolates.
Methods: Salmonella isolated from children with MSD or diarrhea-free controls were identified by classical clinical microbiology and serotyped using antisera and/or whole genome sequence data. We evaluated antimicrobial susceptibility using the Kirby-Bauer disk diffusion method. Salmonella Typhimurium sequence types were determined using multi-locus sequence typing and whole genome sequencing was performed …

A Pathogenic Ufsp2 Variant In An Autosomal Recessive Form Of Pediatric Neurodevelopmental Anomalies And Epilepsy, Min Ni, Bushra Afroze, Chao Xing, Chunxiao Pan, Yanqiu Shao, Ling Cai, Brandi L. Cantarel, Jimin Pei, Nick V. Grishin, Stacy Hewson

Department of Paediatrics and Child Health

Purpose: Neurodevelopmental disabilities are common and genetically heterogeneous. We identified a homozygous variant in the gene encoding UFM1-specific peptidase 2 (UFSP2), which participates in the UFMylation pathway of protein modification. UFSP2 variants are implicated in autosomal dominant skeletal dysplasias, but not neurodevelopmental disorders. Homozygosity for the variant occurred in eight children from four South Asian families with neurodevelopmental delay and epilepsy. We describe the clinical consequences of this variant and its effect on UFMylation.
Methods: Exome sequencing was used to detect potentially pathogenic variants and identify shared regions of homozygosity. Immunoblotting assessed protein expression and post-translational modifications in patient-derived fibroblasts. …

Patient Recommendations For Providers To Avoid Stigmatizing Weight In Rural-Based Women With Low Income, Declan Watson, Katherine Hughes, Emma Robinson, Jacqueline Billette, Andrea E. Bombak

Journal of Patient-Centered Research and Reviews

Purpose: Weight stigma has become widespread within health care and disproportionately affects women, who are under greater appearance-based scrutiny than men. It is also well established that rural-based individuals with low incomes suffer greater health disparities compared with urban, higher-income counterparts, yet studies examining recommendations for nonstigmatizing health care among higher-weight women from low-income rural settings are lacking. This study examined the experiences and recommendations of higher-weight, low-income, rural women, with the aim of improving health care for similar populations.

Methods: In-depth, semi-structured interviews were conducted in a rural region of the Midwestern United States to explore participants’ recommendations for …

Risk Factors Of Breast Cancer Among Patients In A Tertiary Care Hospitals In Afghanistan: A Case Control Study, Zekrullah Baset, Jamshid Abdul Ghafar, Yasmin Parpio, Ahmed Maseh Haidary

School of Nursing & Midwifery

Background: Breast cancer is the second most common causes of women's death, worldwide. Data on risk factors associated with female breast cancer in the Afghan population is very limited. The aim of our study was to identifying risk factor associated with female breast cancer in Afghanistan.
Methods: A retrospective case-control study was conducted with inclusion of 201 cases and 201 controls. Patient information was collected by interviewing the patient through a structured questionnaire. Histopathological information was collected from the hospital integrated laboratory management system. The data was analyzed by using logistic regression with univariate and multivariable analyses to determine the …

Disparities In Cardiovascular Disease Outcomes Among Pregnant And Post-Partum Women, Mohamed M Gad, Islam Y Elgendy, Ahmed N Mahmoud, Anas M Saad, Toshiaki Isogai, Isadora Sande Mathias, Rabel Misbah Rameez, Johnny Chahine, Hani Jneid, Samir R Kapadia

Faculty, Staff and Students Publications

Background

The incidence of cardiovascular disease among pregnant women is rising in the United States. Data on racial disparities for the major cardiovascular events during pregnancy are limited.

Methods and Results

Pregnant and post‐partum women hospitalized from January 2007 to December 2017 were identified from the Nationwide Inpatient Sample. The outcomes of interest included: in‐hospital mortality, myocardial infarction, stroke, pulmonary embolism, and peripartum cardiomyopathy. Multivariate regression analysis was used to assess the independent association between race and in‐hospital outcomes. Among 46 700 637 pregnancy‐related hospitalizations, 21 663 575 (46.4%) were White, 6 302 089 (13.5%) were Black, and 8 914 …

Community As Medicine: A Trauma-Informed Yoga Program For Multi-Cultural Female Immigrants Identified In The Primary Care Setting, Katherine Rizzolo, Sean Lena, Maha Jaber, Jessica Schaumburg, Kiana Vakil-Gilani, Nicole Rebusi, Dianna Stade, Adriana Nadeau, Nicoleta Toma, Brian King, Lesley Gordon

Journal of Maine Medical Center

Introduction: The immigrant population in Maine represents a unique group of patients with complicated health care needs due to cultural, linguistic, and systemic barriers. We sought to bridge gaps in health access for immigrant women by expanding and integrating community resources through the development and evaluation of a trauma-informed yoga class.

Methods: A needs assessment via a focus group with immigrant women revealed barriers to care and community health needs. Health partners of the immigrant community were identified via word of mouth and a Google search. Yoga participants were recruited in the primary care clinic and by community outreach. Participants …

Trends In Diagnoses Of Neonatal Abstinence Syndrome At Newborn Hospitalization In Maine, 2009-2018, Emily C. Bauer Mph, Katherine Ahrens Phd, Jenny L. Carwile Mph, Scd

Journal of Maine Medical Center

Introduction: Incidence rates of neonatal abstinence syndrome (NAS) have increased in Maine, but whether this increase can be explained by use of different diagnosis codes over time is unknown. Our objective was to estimate trends in diagnoses of NAS at newborn hospitalization in Maine using different NAS case definitions.

Methods: We used International Classification of Diseases (ICD) diagnosis codes to identify newborns diagnosed with NAS in Maine between 2009 and 2018 using state-level hospital discharge data (n = 123 519). First, we considered only ICD-9 and ICD-10 codes used for confirmed NAS. Then we used an expanded ICD-10 NAS case …

The Impacts Of Terrorism On Maternal Health In Afghanistan, Kyla Rocanello-Snow

Global Sustainable Development Projects

Terrorism is both directly and indirectly harmful to maternal health. Terrorist attacks targeted at healthcare workers, hospitals and maternity wards are a direct impediment of maternal healthcare. Other terrorist activity and conflict produce overall instability, aggravating insecurity in the country. Attacks that disrupt functions within a community and a country at large indirectly impact maternal health as they target specific social determinants of health, including infrastructure for transportation, education, and healthcare. Terrorism and the influence of Islamic militia groups in Afghanistan continue to threaten the power and stability of the national government, making it difficult for policy enactment to improve …

A Systematic Review Of Approaches Used For Reproductive Health Interventions, Hanvit Park, Emma Hilbelink, Adejoke Ayoola

Summer Research

During 2011 in the United States, 48% of all pregnancies were unintended.1 This may be attributed to a lack of knowledge of women’sreproductive anatomy and bodily changes, and contraception. To promote women's reproductive health, it is essential for women to be educated about their reproductive system, associated bodily changes, risk of conception and contraceptive use.

Increasing Minority Representation In The Healthcare Field Through A Girl’S Summer Camp, Anna Christiansen, Dzifa Agbossey-Dimado, Adejoke Ayoola

Summer Research

• Despite increasing diversity among the United States’ population, the healthcare workforce, particularly in highly skilled roles, has failed to keep pace. The underrepresentation of minority groups within healthcare professions comes at the expense of quality and access to care, patient satisfaction, acceptability, general experience, and health outcomes.
• One promising approach to addressing this health inequity is increasing the diversity of the healthcare workforce across all skill-level roles so that it is representative of the population which it serves. Research suggests that exposing underrepresented groups to healthcare professions as a possible career path during formative career planning years (early middle school), …

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 …

The Association Of Pregnancy Control, Emotions, And Beliefs With Pregnancy Desires, Meredith G. Manze, Diana R. Romero, Prabal De, Josette Hartnett, Lynn Roberts

Publications and Research

Context

Standard pregnancy intentions measures do not always align with how people approach pregnancy. Studies that have investigated beyond a binary framework found that those with “ambivalent” feelings towards pregnancy are less likely to use contraception consistently, but the reasons for this are unclear. We sought to gain a nuanced understanding of pregnancy desires, and how perceptions about pregnancy are associated with contraceptive use.

Methods

We used non-probability quota sampling based on sex, age, and geographic region for a web-based survey of heterosexual men and women, aged 21–44 years, who could become pregnant/impregnate and were not currently pregnant (n = …

Data On Breastfeeding And State Policies In The United States, Chun Chen, Hong Xue, Qi Zhang

Community & Environmental Health Faculty Publications

Breastfeeding is critically important to maternal and child health in the United States. Examining the relationship between breastfeeding outcomes and state policies requires multidisciplinary efforts to link data from various sources. This article describes an integrated dataset that was used to understand the relationship between participation in a nutrition assistance program and low-income children's breastfeeding outcomes [1]. This dataset merged public health information from the National Immunization Surveys Data from 2006 to 2016 and matching state policy data from the Correlates of State Policy Project (CSPP), the U.S. Department of Agriculture/Economic Research Services (USDA/ERS) Supplemental Nutrition Assistance Program (SNAP) Policy …

A Mixed Methods Approach To Examine Racial Disparities In Adherence To Surveillance Mammography Among Breast Cancer Survivors, Megan C. Edmonds

Theses and Dissertations

PURPOSE: Annual surveillance mammography is a critical part of routine cancer care for breast cancer (BC) survivors; reducing mortality by 39%. However, disparities exist with regard to adherence to surveillance mammograms among BC survivors; Black women are 44% less likely to adhere than their White counterparts. Despite the existence of this racial disparity for over a decade, little is known about factors that explain reasons for Black BC survivors’ non-adherence. This is because most studies have not evaluated the role of healthcare delivery or psychosocial factors. Guided by the Behavioral Model for Vulnerable Populations, the purpose of this mixed methods …

Assessment Of Cooking Matters Facebook Platform To Promote Healthy Eating Behaviors Among Low-Income Caregivers Of Young Children In The United States: A Pilot Study, Qi Zhang, Jill Panichelli, Leigh Ann Hall

Community & Environmental Health Faculty Publications

How best to deliver healthy-eating education through social media among a low-income population remains understudied. To assess the impact of the Cooking Matters (CM) Facebook page on healthy eating behaviors among low-income caregivers, we conducted a pre–post survey of new CM Facebook followers in early 2020. A convenience sample was recruited at baseline from WICShopper app users and the CM Facebook page. The recruited sample included 397 low-income caregivers of a child younger than 6 who never followed CM Facebook. Among the baseline caregivers, 184 completed the follow-up survey. Paired t-test and McNemar–Bowker tests were conducted to compare the outcomes …