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Articles 1 - 30 of 37
Full-Text Articles in Multicultural Psychology
Impact Of An All-Gender Cabin Intervention At A Residential Summer Camp On Self-Esteem And Perceived Social Support In Lgbtq+ Youth, Suzanne D. Dinubile
Impact Of An All-Gender Cabin Intervention At A Residential Summer Camp On Self-Esteem And Perceived Social Support In Lgbtq+ Youth, Suzanne D. Dinubile
Doctoral Dissertations
This study is a program evaluation with a mixed-methods design that evaluated the impact of Camp Tawonga’s All-Gender Cabin Intervention and LGBTQ+ programming showed no statistically significant changes, likely due to small sample size, but descriptive trends indicated improved outcomes for LGBTQ+ youth in All-Gender cabins. Semi-structured interviews with six LGBTQ+ campers revealed increased self-awareness and acceptance, empowerment, self-confidence, and a stronger sense of belonging within the LGBTQ+ community, along with positive interactions with non-LGBTQ+ peers. Notably, the three campers in All-Gender cabins highlighted unique themes of identity affirmation, emotional and behavioral growth, and relief from minority stress. Findings support …
Bi+ Cismale Experiences With Straight Cismale Friends, Taylor M. Hardock
Bi+ Cismale Experiences With Straight Cismale Friends, Taylor M. Hardock
Antioch University Dissertations & Theses
Minority Stress Theory (2006) posits that individuals with a marginalized sexual identity have unique challenges and stressors. Bisexual+, or bi+, individuals have particular stressors related to not holding a monosexual identity, including specific mental health challenges. Research has shown that friendship can have many positive benefits on individuals, though the literature looking at friendship among bi+ identifying people is very limited. This qualitative study investigates the experiences of friendship between bi+ and straight cis men, especially as they may relate to minority stress and experiences of resilience and community belongingness. A thematic analysis was utilized to understand the personal experiences …
Internalizing Symptoms In Lgbtq+ Young Adults: Understanding The Roles Of Social Support And Resilience To Social Stigma, Chloe M. Sobolewski
Internalizing Symptoms In Lgbtq+ Young Adults: Understanding The Roles Of Social Support And Resilience To Social Stigma, Chloe M. Sobolewski
Theses and Dissertations
LGBTQ+ young adults are at increased risk of adverse mental health outcomes including internalizing symptoms. The current study seeks to better incorporate strengths when modeling internalizing symptoms outcomes in LGBTQ+ young adults. The present study is secondary analysis of data collected as part of a three-wave longitudinal study. LGBTQ+ young adults (N = 250) completed baseline questionnaires assessing resilience to social stigma, types of perceived social support (i.e., family, friend, significant other), and internalizing symptoms. Moderation models were not practically or statistically significant; however, covariates (i.e., age, socioeconomic standing, and childhood basic needs) stood out in their significant contribution in …
Lgbt+ Poc Well-Being And Resilience, Terra Reynoso
Lgbt+ Poc Well-Being And Resilience, Terra Reynoso
Electronic Theses, Projects, and Dissertations
Historically, both LGBT+ individuals and People of Color have each been subjected to stressors linked to oppression, with those belonging to both groups experiencing a potentially higher degree of distress. This study examined factors that contribute to resilience and well-being in LGBT+ People of Color to highlight potential means to mitigate this distress, guided by queer theory and intersectionality theory in order to provide a relevant framework to inform preliminary research, interview questions, and content analysis. Interviews were conducted with twelve participants with subsequent content analysis revealing the use of social support networks, access to community, productive coping strategies, and …
Finding Meaning In Loss: The Role Of Attachment Styles, Coping Strategies, And Resilience, Salma Seyam
Finding Meaning In Loss: The Role Of Attachment Styles, Coping Strategies, And Resilience, Salma Seyam
Theses and Dissertations
Grief is a deeply personal yet universal experience impacted by personal, social, and cultural factors. The present study examines how attachment styles, coping mechanisms, and resilience impact both grief intensity and the ability to find meaning after a loss, within an Egyptian sample. While previous studies have explored the experience of grief, few have looked at these factors within a Middle Eastern cultural context. A total of 140 bereaved Egyptians who experienced the loss of a loved one within the past three years completed standardized measures assessing grief intensity (Prolonged Grief Disorder-Revised; PG-13-R), coping strategies (Brief COPE), meaning-making (Grief and …
Do Resiliency And Coping Skills Moderate The Relationship Between Mood Disorders And Parenting Styles Due To Parental Relationship Distress?, Tiffany Burks
Electronic Theses and Dissertations
Parental relationship dynamics such as intimate partner violence (IPV), interpersonal distress (IPD), and parental alienation (PA) can significantly affect both mental health and parenting practices. This study examined whether personal strengths, specifically resilience and problem-focused coping, could help buffer these negative outcomes. Correlational analyses showed that IPV, IPD, and PA were positively associated with symptoms of depression and anxiety. IPV and PA were also negatively associated with the use of an authoritative parenting style. In contrast, resilience and problem-focused coping were linked to fewer mood-related symptoms and greater use of authoritative parenting. Multiple regression analyses revealed that IPV significantly predicted …
"La Vida Es Un Carnaval": An Exploration Of Cuban Identity And Nostalgia Through Dance/Movement Therapy - A Community Engagement Project, Maria Fernanda Mendez Mendoza
"La Vida Es Un Carnaval": An Exploration Of Cuban Identity And Nostalgia Through Dance/Movement Therapy - A Community Engagement Project, Maria Fernanda Mendez Mendoza
Expressive Therapies Theses
“La Vida Es Un Carnaval” is a community engagement project and thesis that explores how identity and nostalgic resilience show up through dance/movement therapy with Cuban immigrants living in the United States, specifically Massachusetts. This project brought together six Cuban-born participants, ages 26 to 67, each with their own unique migration stories; from the Rafter Balsero Crisis of 1994, to the “Wet-Foot/Dry-Foot” policy, and family reunification. Through a mix of in-person and online sessions, participants explored their experiences using intermodal activities including dance/movement therapy techniques, conversation, journaling, artwork, and music. Themes of cultural pride, “Cubanía” – Cuban-ness, culture shock, and …
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 …
The Boston Metco Program: Recent Alumni Experiences And Educational Equity, Maya Hernandez
The Boston Metco Program: Recent Alumni Experiences And Educational Equity, Maya Hernandez
Honors Theses
This project focuses on contemporary school integration practices by examining, in particular, the Boston METCO (Metropolitan Council for Educational Opportunity Inc) program and the experiences of its recent alumni. The METCO program, the United States’ longest-running voluntary school desegregation program, was created in 1966 to give students of color from the city of Boston better educational opportunities by busing them to the surrounding suburbs for school. To this day, it is a program meant to expand educational opportunities, increase diversity, and reduce racial isolation, by permitting students from Boston to attend public schools beyond district lines, in the suburbs. My …
Measuring Intersectional Strength And Stigma Among Racially Minoritized Gender Diverse Young Adults, Joseph Carter
Measuring Intersectional Strength And Stigma Among Racially Minoritized Gender Diverse Young Adults, Joseph Carter
Dissertations, Theses, and Capstone Projects
Background: Racially minoritized transgender and gender expansive young adults (RMTGEYA; aged 18-26) experience mental health inequities due to intersectional, multilevel stigma. RMTGEYA communities embody intersectional strength and resilience that can mitigate the impact of stigma. Understanding and capturing strength and stigma factors to address these inequities has significant implications for clinical science research and practice. There is, however, a complete absence of instruments that are validated to do so. Objective: The goal of this study is to conduct a three-phase, mixed methods study that centers intersectional and community engaged methods of psychometric development for a measure that captures daily experiences …
Social Support In Black Individuals: The Moderating Effects On The Relationship Between Resilience And Well-Being, Imani Elise Crosby
Social Support In Black Individuals: The Moderating Effects On The Relationship Between Resilience And Well-Being, Imani Elise Crosby
College of Graduate Studies: Theses & Dissertations
Black individuals possess numerous strengths and positive contributions that build strong communities and cultivate psychological well-being (Biglan et al., 2012). However, much of the current literature focuses on hardships Black individuals face, skewing the larger discourse of their lived experience. This exclusive focus on adversity often neglects pathways by which Black people thrive and flourish. It is important to consider how Black experiences relate to a sense of well-being. Resilience, or the ability to “bounce back” from adverse experiences is linked well-being outcomes (APA, 2012). However, it is unknown whether the promotive effects of resilience directly contribute to well-being outcomes …
Black And African American Young Adult Male Experiences: Implications For Building Resilience And Survival Skills Within Educational Settings And Public Spaces, Akimma Wright-D'Abreau
Black And African American Young Adult Male Experiences: Implications For Building Resilience And Survival Skills Within Educational Settings And Public Spaces, Akimma Wright-D'Abreau
Antioch University Dissertations & Theses
The aim of this study is to better understand, from the perspective of Critical Race Theory, the experiences of adolescent males who are Black and living in the United States and to examine how they build resilience and survival skills. Participants were between the ages of 18 and 26 and asked to recall adolescent experiences as part of a semi-structured interview with a Black Storytelling approach. There were six participants and data were analyzed using thematic analysis. According to the results, there were seven themes: (1) Policing In the United States of America Comes in Many Forms, (2) Recognizing Racism …
Survivor Experiences Of Male Childhood Sexual Abuse: A Literature Review, Elizabeth Burch B.S., Joseph T. Kenneally Psy.D., Stephanie Zepeda Phd
Survivor Experiences Of Male Childhood Sexual Abuse: A Literature Review, Elizabeth Burch B.S., Joseph T. Kenneally Psy.D., Stephanie Zepeda Phd
Psychology from the Margins
The World Health Organization (WHO) recognizes childhood sexual abuse (CSA) as a global health issue. CSA is a human violation that affects both female and male children and has a stronger detrimental impact on mental health than other traumatic childhood experiences. Despite a growing awareness of male survivors of CSA, male survivors are a marginalized group as most CSA research focuses on females. In addition, masculine norms can keep male adults from disclosing further, which can delay support and increase mental health issues. This meta- analysis reviews the current literature on this group of marginalized people and concludes with a …
Moderators To The Effects Of Childhood Traumatic Stress On Childhood Physical Health, Shaneze Gayle Smith
Moderators To The Effects Of Childhood Traumatic Stress On Childhood Physical Health, Shaneze Gayle Smith
Seton Hall University Dissertations and Theses (ETDs)
According to the United States National Statistics on Child Abuse, in 2017 Child Protective Service agencies in the United States received an estimated 4.1 million referrals involving approximately 7.5 million children. A substantial body of research has revealed that adverse childhood experiences (ACEs) have detrimental long-term effects on physical health and a large number of health conditions. However, little research exists regarding the effects of childhood maltreatment on childhood physical health. Identifying protective factors such as self-esteem can moderate the effects of ACEs, help children thrive, and potentially lower the risk of a variety of conditions like cardiovascular disease, cancer, …
Sexual Minority Thriving: Bouncing Beyond Adversity, Debra Crawford
Sexual Minority Thriving: Bouncing Beyond Adversity, Debra Crawford
Dissertations
Sexual minority individuals continue to face prejudice and discrimination due to their sexual minority identity. However, despite these negative experiences, many sexual minority individuals display resilience and thrive. Most of the literature on sexual minorities focuses on negative aspects of identifying as a sexual minority, rather than the positive qualities that these individuals possess that allow them to persevere. In a sample of 303 sexual minorities, this dissertation contained two studies. Study one investigated if posttraumatic growth mediated the relationship between resilience and thriving and if identity pride and existential anxiety moderated the relationship between resilience and thriving in a …
Humanitarian Workers' Perspectives On Mental Health And Resilience Of Refugee Youth: Implications For School Psychology, Diana Maria Diaków
Humanitarian Workers' Perspectives On Mental Health And Resilience Of Refugee Youth: Implications For School Psychology, Diana Maria Diaków
Graduate Student Theses, Dissertations, & Professional Papers
Almost half of the 79.5 million forcibly displaced persons worldwide are youth under the age of 18, including refugees. Refugee youth face deliberate threats across all migration stages including violence, abuse, exploitation, poor living conditions, limited or no access to healthcare and education, interrupted family structure, and discrimination. Noteworthy, school psychologists who practice in host countries face new challenges as these diverse youth enroll in public schools. During the migration stage, humanitarian workers are a primary source of psychosocial and educational support for refugee youth and their families. Therefore, the aim of this research study was to inform school psychology …
Development Of A New Measure To Assess For Poverty-Based Stress: The Poverty-Based Stressor Scale (Pbss), Brianna N. Allen
Development Of A New Measure To Assess For Poverty-Based Stress: The Poverty-Based Stressor Scale (Pbss), Brianna N. Allen
College of Graduate Studies: Theses & Dissertations
Poverty, typically measured by economic well-being or depravation, is the result of systemic flaws built into the structure of society that adversely impact multiple dimensions of health and well-being. The specific stressors that disproportionately impact low-income individuals are called poverty-based stressors, and they encompass multiple categories of risk including physical, psychosocial, and financial risks. Currently, there is not an adequate measure of poverty-based stressors for low-income adults in the United States (U.S.), which restricts our ability to accurately determine the effects of poverty on important health-related outcomes. The purpose of this dissertation was to develop a psychometrically sound measure of …
Advocacy In Lgbtq+ Cancer Care: Historical Resilience As A Model For Further Efforts In Psycho-Oncology, Alexandra M. Stookey
Advocacy In Lgbtq+ Cancer Care: Historical Resilience As A Model For Further Efforts In Psycho-Oncology, Alexandra M. Stookey
Psychology from the Margins
In the United States, an estimated 135,000 lesbian, gay, bisexual, transgender, queer (LGBTQ+) people will be affected by a cancer diagnosis in 2020, a significantly higher statistic than equivalent measures in non-LGBTQ+ populations (American Cancer Society, 2020). As the number of sexual and gender minority (SGM) individuals affected by this disease continues to increase and intergroup disparities in care become more empirically documented, the need for multi-level advocacy in the field of LGBTQ+ psychosocial cancer care becomes apparent. The current body of literature addressing culturally-informed practices, needs, and barriers to care for SGM people is sparse in psycho-oncology and has …
A Qualitative Evaluation Of The Phoenix Project: A Strengths-Based, Trauma-Informed Care Intervention For African American, Transitional Age, Young Adults Living In San Francisco’S Public Housing Community, Lena Miller
Doctoral Dissertations
A QUALITATIVE EVALUATION OF THE PHOENIX PROJECT: A STRENGTHS-BASED, TRAUMA-INFORMED CARE INTERVENTION FOR AFRICAN AMERICAN, TRANSITIONAL AGE, YOUNG ADULTS LIVING IN SAN FRANCISCO’S PUBLIC HOUSING COMMUNITY
Abstract
Persistent community violence has had a profound and destructive impact on many urban communities throughout the country. Post-Traumatic Stress Disorder (PTSD) resulting from community violence is becoming an increasingly frequent diagnosis of African American youth and young adults residing in San Francisco’s Bayview-Hunters Point (BVHP) community (San Francisco Department of Public Health, 2012). The Phoenix Project was designed to specifically address and heal symptoms of trauma and facilitate resilience among youth and young …
You Are Resilient: Trauma-Informed, Strengths-Based Treatment For Low-Ses, Urban Youth, Courtney Molina
You Are Resilient: Trauma-Informed, Strengths-Based Treatment For Low-Ses, Urban Youth, Courtney Molina
Dissertations
The focus in this review was to explore the benefits and optimal use of trauma-informed, strengths-based care for the therapeutic treatment of low-socioeconomic status (SES), urban youth. Specific focus was given to evidence-based research on the treatment of emotional and behavioral dysregulation among low-SES, urban youth. The review was guided by the following research questions: How can emotional and behavioral dysregulation be symptoms of trauma among low-SES, urban youth; What makes trauma-informed and strengths-based care optimal for the treatment of low-SES, urban youth with dysregulation; and What are clear guidelines for providing trauma-informed, strengths-based care to low-SES, urban youth with …
The Nigerian-American Immigration Experience: Overcoming Adversity Through Resilence., K. Chinwe Idigo
The Nigerian-American Immigration Experience: Overcoming Adversity Through Resilence., K. Chinwe Idigo
Electronic Theses and Dissertations
Nigerian-Americans are a fast-growing population in the United States, when compared to other immigrant groups. Despite growing numbers there is limited empirical research examining pathways that facilitate success among this immigrant population. This study addresses the dearth in literature by proposing and testing a modified ABCX model of family resilience among Nigerian-Americans. It is hypothesized that similar to other immigrant, and racial/ethnic minority groups in the United States, NigerianAmericans employ protective factors such as ethnic identity and resilience to buffer the effects of acculturative stress and perceived discrimination on well-being and psychological distress. Regression analyses suggest some consistency with the …
Examining The Factors That Mediate The Relationship From Legal Advocacy Satisfaction To Resilience, Desta T. Gebregiorgis
Examining The Factors That Mediate The Relationship From Legal Advocacy Satisfaction To Resilience, Desta T. Gebregiorgis
Clinical Psychology Dissertations
Sexual assault is a public health issue that can impact one’s resilience. Using a multisystemic approach to resilience, there may be person-level and environment-level factors that can affect one’s resilience, such as one’s coping self-efficacy, satisfaction with the court process, and negative effects associated with court process. Legal advocacy programs, such as those offered by the King County Sexual Assault Resource Center (KCSARC), support clients during the court proceedings. In order to better serve KCSARC’s clientele, it is helpful to understand how the legal advocacy program impacts post-trauma resilience. This dissertation had three phases: (a) evaluating the structural validity of …
Is Athlete Activism A Predictor Of Resilience?, Travis Robert Scheadler
Is Athlete Activism A Predictor Of Resilience?, Travis Robert Scheadler
Theses and Dissertations--Kinesiology and Health Promotion
Several athletes have taken personal responsibility to engage in activism, often with hopes of bringing social and political change. While scholars have identified several barriers preventing athletes from engaging in activism (e.g., public criticism, status and job loss, withdrawal of funding, anticipated distress; Cunningham & Regan, 2012), other scholars have identified personal benefits from engaging in activism (e.g., improved confidence, self-concept, belief in change, agency, life meaning; Klar & Kasser, 2009; Rabkin et al., 2019). Distress from the barriers, however, may be prerequisites to enhancing resilience, a theoretical construct that may help explain the benefits of activism. Thus, by applying …
Modeling Resilience In Resettled Syrian Refugees With Disabilities, Nicholas Sherwood
Modeling Resilience In Resettled Syrian Refugees With Disabilities, Nicholas Sherwood
Biennial Conference: The Social Practice of Human Rights
Since 2011, the ongoing conflict in Syria has displaced millions of individuals, many of whom are now resettled across foreign borders. The US currently hosts 21,000 Syrian refugees, and of these, at least 5,000 have a form of disability. Furthermore, many US-based resettlement agencies currently experience strain providing the specialized care required by many of these resettled Syrian refugees with disabilities (RSRD) in large part due to austerity measures imposed by the US Federal government. This research project asks of RSRD themselves: given the limitations placed on your care providers, what personal sources of strength do you utilize when you …
Resilience Among Survivors Of Adverse Childhood Experiences In Appalachia, Bridget Jeter
Resilience Among Survivors Of Adverse Childhood Experiences In Appalachia, Bridget Jeter
Electronic Theses and Dissertations
The empirical investigation of adverse childhood events (ACEs) and their relationship with health and well-being outcomes in later life is increasing. Less is known about factors that may promote resilience for those who have survived such challenges, such as how resilience may be facilitated for those with ACEs residing in a marginalized region such as South Central Appalachia. Multidimensional spirituality, social support, stigma related to ACEs, and Appalachian acculturation may serve as both valid cultural factors and potential indicators of resilience. Cross-sectional, simultaneous multiple regression analysis was performed on data collected from 272 adult patients of a South Central Appalachian …
Evaluating The Effectiveness Of Peer Engagement And Knowledge (Peak): A Community-Based Group Intervention For Youth In Hawai‘I, Jennifer T. T. Ho
Evaluating The Effectiveness Of Peer Engagement And Knowledge (Peak): A Community-Based Group Intervention For Youth In Hawai‘I, Jennifer T. T. Ho
Doctoral Dissertations
This study is a program evaluation with a mixed methods design that evaluated the effectiveness of Peer Engagement and Knowledge (PEAK), a six-week community-based group intervention that incorporates mindfulness-based interventions (MBIs) to address multiple health behaviors for multiracial youth in Hilo, Hawai‘i. A total of 51 youth, ages 12-23 years old, participated in this study which included pre-/posttest analyses of health risk factors such as substance use and depression and health promoting factors such as resilience, self-esteem, and mindfulness. Responses from two subsets of participants, who engaged in a focus group (n = 11) and composed gratitude letters ( …
Examining The Acculturation Experiences Of Syrian Refugee Emerging Adults In The United States Of America, Fatemah Alghamdi
Examining The Acculturation Experiences Of Syrian Refugee Emerging Adults In The United States Of America, Fatemah Alghamdi
Electronic Theses and Dissertations
Refugees are vulnerable populations who experience premigration traumatic events and postmigration acculturation stress. While research on immigrant mental health issues has been plentiful, there has been a clear lacuna of scholarly investigation into the acculturation experiences of Syrian emerging adults, particularly as it relates to the types and dynamics of acculturation behaviors. Acculturation is a factor that predicts emerging adults’ academic and occupational success and their interpersonal and intrapersonal relationships.
This qualitative investigation was conducted within the framework of interpretative phenomenology, which allows for meaningful, organic exploration and description of participants’ stories. Data were collected from 12 emerging adult Syrian …
Well-Being And Academic Performance In Immigrant Students: The Role Of Inequality Of Country Of Origin And Resilience, Yumiko Yamaguchi
Well-Being And Academic Performance In Immigrant Students: The Role Of Inequality Of Country Of Origin And Resilience, Yumiko Yamaguchi
Dissertations and Theses
Abstract
Research on the psychology of immigrants has primarily focused on their socioeconomic status, but has not factored in macroeconomic indicators. These provide a deeper understanding of the stressors experienced by immigrants through the lens of cultural gaps between home and host countries. This study examined predictors of psychological well-being (PWB) and academic performance among 376 immigrant college students by employing Bronfenbrenner’s bioecological model of development (1994) consisting of four levels of environmental factors: Macrosystem, exosystem, mesosystem and microsystem. The results revealed that higher PWB was predicted by mesosystem variables (lower perceived stress, lower acculturative stress) and microsystem variables (higher …
Examining The Perceived Influence Of A Comprehensive Youth Development Program For Promoting Black Male High School Persistence, Richard Gray Walker
Examining The Perceived Influence Of A Comprehensive Youth Development Program For Promoting Black Male High School Persistence, Richard Gray Walker
Dissertations
Black male youth in the United States drop out of high school at a rate consistently higher than their White counterparts. A lack of academic persistence contributes to lower workforce participation rates among Black Americans, which leads to lower national productivity and unrealized personal prosperity. Youth development research has developed an extensive body of knowledge regarding possible causes and contributing factors of minority high school dropout. Literature shows youth experience higher dropout rates when they grow up in adversity. Adversity risks such as dysfunctional families, cultural discontinuity between home and school, dysfunctional neighborhoods, or low-expectations from teachers contribute to graduation …
Non-Medical Use Of Prescription Drugs, Stress, Cultural Orientation, Utilization Of Healthcare, And Protective Factors Among College Students In China, Cheuk Chi Tam
Theses and Dissertations
Background: Non-medical use of prescription drugs (NMUPD) refers to the use of prescription drugs which are traditionally utilized to manage pain or treat psychiatric problems but without a doctor’s prescription. In 2010, an investigation by the Substance Use and Mental Health Services Administration (SAMHSA) revealed that 5.3% of young adults (18 to 25-year-olds) in the United States reported past-month NMUPD. NMUPD has become a growing concern owing to associations with consequences such as college dropout, poor academic achievement, and health jeopardizing behaviors. College students' NMUPD has been well documented in the United States. Limited studies, however, have been conducted among …