Relationships among dietary intake, dietary patterns, dietary quality and nutrient adequacy and substance use in Latina mother/daughter dyads

This study examined the relationships among dietary intake, substance use, socioeconomic and acculturation-related factors among Latinas in Miami-Dade County. Substance abuse is rising among Latinas. A fuller understanding of this problem is needed given the rise of the Hispanic population and the role of women in Latin society. A better understanding between substance use and dietary intake can guide nutrition interventions to reduce negative substance-related health consequences. A purposeful sample of 320 Latina mother/daughter dyads were recruited and interviewed face-to-face as part of the Latino Women's Study. Dietary intake was collected via a 24-hour recall and examined by (1) nutrient intake, (2) dietary patterns using cluster analysis, (3) quality of diet using the Healthy Eating Index (HEI) and (4) the Dietary Reference Intakes to determine nutrient adequacy. Substance use was measured with the Drug Use Frequency and the Healthy and Daily Living Form. Acculturation was measured with the Cultural Identity Scale. Three dietary patterns emerged based on the number of servings from the food groups established in MyPyramid. None were associated with substance use. Latinas who reported using cannabis, cocaine, sedatives without prescription and/or more than five alcoholic drinks on an occasion at least once a month during the previous twelve months had significantly lower HEI scores (64 vs. 60; F = 7.8, p = .005) and consumed fewer fruits (F = 16, p < .001) than non-users. Latinas classified as mothers whom reported consuming cannabis at least 1-7 times a week had significantly lower HEI scores (F = 4.23, p = .015, η2 = .027) than daughters with the same frequency of substance use. One dimension of acculturation, greater familiarity with Latin culture, was associated with good dietary quality (β = .142, p = .012) regardless of any type of substance used or income level. There was a high prevalence of inadequacy of folic acid intake (50-75%) regardless of substance use. Substance users consumed significantly more energy (1,798 vs. 1,615; p = .027) than non-users. Although effect sizes were small, associations between dietary intake and substance use among Latinas deserve further exploration while acknowledging the combined association with acculturation. ^

Inter-subjective and transnational racial effects: The role of the United States in the formation and evolution of the collective perception and racial relations in Cuba, 1898–1902

Since the arrival of the first African slaves to Cuba in 1524, the issue of race has had a long-lived presence in the Cuban national discourse. However, despite Cuba’s colonial history, it has often been maintained by some historians that race relations in Cuba were congenial with racism and racial discrimination never existing as deep or widespread in Cuba as in the United States (Cannon, 1983, p. 113). In fact, it has been argued that institutionalized racism was introduced into Cuban society with the first U.S. occupation, during 1898–1902 (Cannon, 1983, p. 113). This study of Cuba investigates the influence of the United States on the development of race relations and racial perceptions in post-independent Cuba, specifically from 1898-1902. These years comprise the time period immediately following the final fight for Cuban Independence, culminating with the Cuban-Spanish-American War and the first U.S. occupation of Cuba. By this time, the Cuban population comprised Africans as well as descendants of Africans, White Spanish people, indigenous Cubans, and offspring of the intermixing of the groups. This research studies whether the United States’ own race relations and racial perceptions influenced the initial conflicting race relations and racial perceptions in early and post-U.S. occupation Cuba. This study uses a collective interpretative framework that incorporates a national level of analysis with a race relations and racial perceptions focus. This framework reaches beyond the traditionally utilized perspectives when interpreting the impact of the United States during and following its intervention in Cuba. Attention is given to the role of the existing social, political climate within the United States as a driving influence of the United States’ involvement with Cuba. This study reveals that emphasis on the role of the United States as critical to the development of Cuba’s race relations and racial perceptions is credible given the extensive involvement of the U.S. in the building of the early Cuban Republic and U.S. structures serving as models for reconstruction. U.S. government formation in Cuba aligned with a governing system reflecting the existing governing codes of the U.S. during that time period.

Language learning strategy use by colombian adult English language learners: A phenomenological study

The purpose of this phenomenological study was to describe how Colombian adult English language learners (ELL) select and use language learning strategies (LLS). This study used Oxford’s (1990a) taxonomy for LLS as its theoretical framework. Semi-structured interviews and a focus group interview, were conducted, transcribed, and analyzed for 12 Colombian adult ELL. A communicative activity known as strip story (Gibson, 1975) was used to elicit participants’ use of LLS. This activity preceded the focus group session. Additionally, participants’ reflective journals were collected and analyzed. Data were analyzed using inductive, deductive, and comparative analyses. Four themes emerged from the inductive analysis of the data: (a) learning conditions, (b) problem-solving resources, (c) information processing, and (d) target language practice. Oxford’s classification of LLS was used as a guide in deductively analyzing data concerning the participants’ experiences. The deductive analysis revealed that participants do not use certain strategies included in Oxford’s taxonomy at the third level. For example, semantic mapping, or physical response or sensation was not reported by participants. The findings from the inductive and deductive analyses were then compared to look for patterns and answers to the research questions. The comparative analysis revealed that participants used additional LLS that are not included in Oxford’s taxonomy. Some examples of these strategies are: using sound transcription in native language and help from children. The study was conducted at the MDC InterAmerican campus in South Florida, one of the largest Hispanic-influenced communities in the U.S. Based on the findings from this study, the researcher proposed a framework to study LLS that includes both external (i.e., learning context, community) and internal (i.e., culture, prior education) factors that influence the selection and use of LLS. The findings from this study imply that given the importance of the both external and internal factors in learners’ use of LLS, these factors should be considered for inclusion in any study of language learner strategies use by adult learners. Implications for teaching and learning as well as recommendations for further research are provided.

Women of African descent: Persistence in completing doctorates

This study examines the educational persistence of women of African descent (WOAD) in pursuit of a doctorate degree at universities in the southeastern United States. WOAD are women of African ancestry born outside the African continent. These women are heirs to an inner dogged determination and spirit to survive despite all odds (Pulliam, 2003, p. 337).This study used Ellis’s (1997) Three Stages for Graduate Student Development as the conceptual framework to examine the persistent strategies used by these women to persist to the completion of their studies. Semi-structured interviews were conducted, transcribed, and analyzed for the 10 study participants. The study examined their beliefs, roles, and support systems utilized during their studies to help propel them to succeed. Interview data were analyzed using cross-case analysis to discover emerging themes and patterns. A comparative analysis was used to analyze the participants’ experiences and discover themes and patterns to review against the historical data. The findings showed that WOAD experienced feelings of isolation, neglect and racial prejudice as doctoral students. Their ability to formulate supportive relationships among each other and in their communities outside the university was key to their persistence to graduation. There still remains a need to create a more engaging and inclusive environment for nontraditional students, particularly those who are WOAD. The study concludes with six strategies of success used by these WOAD to persist to completion. Those six strategies include 1. Keeping the goal of earning a doctorate and graduating foremost on your mind. 2. Set a class and study schedule that allows you to balance family, work and study. 3. Take care of yourself, physically, mentally and emotionally. 4. Keep a goal chart to track your strides toward completion/graduation. 5. Establish a strong support system among your family, friends, colleagues and community; and 6. Do not let the “isms” (racism, sexism, and ageism) deter you.

Impact of a comprehensive nutrition and lifestyle education intervention on body weight and health-related outcomes in morbidly-obese Hispanic-Americans following laparoscopic Roux-en-Y gastric bypass

As morbid obesity increasingly affects Hispanic-Americans, the incidence of Roux-en-Y gastric bypass procedures (RYGB) among this population rises. Prospective research on the impact of postoperative educational interventions focused on Hispanic- Americans is needed to prevent premature weight loss plateau, weight regain, nutritional deficiencies, and relapse of obesity-related comorbidities. This randomized-controlled study evaluated the impact of a comprehensive nutrition and lifestyle education intervention (6 biweekly postoperative sessions that incorporated motivational strategies for behavioral change) as compared to a non-comprehensive approach (printed guidelines for healthy lifestyle). The variables to consider are body weight, obesity-related comorbidities (depression, diabetes, dyslipidemia, and others), nutrient status, physical activity, and eating habits in 144 morbidly-obese adult Hispanic-Americans 6 to 12 months following RYGB. Patients were randomly assigned to either the comprehensive intervention (n=72) or the comparison group (n=72). Participants (mean age 44.5 ± 13.5 years) were mainly Cuban-born females (83.3%). Intervention sessions attendance was 64%. At 12 months, both groups lost weight significantly, but those in the comprehensive intervention experienced greater excess weight loss than those in the comparison group (80% vs. 64% from preoperative excess weight, P<.001). Intervention participants were significantly more involved in physical activity (+ 14 min/week vs. – 4 min/week), had decreased depression, joint illness, and required less medication for comorbidities than comparison participants. Additionally, those in the comprehensive intervention had sustained supplement intake experiencing less folate deficiency (P=.014). The non-comprehensive intervention group significantly decreased their protein and supplement intake compared to the intervention group. Patients in the comprehensive intervention had significantly better eating habits reflected by fewer episodes of dumping syndrome, constipation, and night eating, than those in the comparison group who reported greater eating in response to negative emotions (P=.003). These findings support the importance of a comprehensive educational approach to achieve more effective weight reduction and health-related outcomes to prevent relapse of obesity-related comorbidities and nutritional deficiencies in Hispanic-Americans 6 to 12 months following RYGB.

GRE as a predictor of graduate student success at a Hispanic serving institution of higher education

Accurately predicting the success of graduate students is an important aspect of determining which students should be admitted into graduate programs. The GRE is a pivotal factor to examine since it is one of the most widely used criteria for graduate school admission. Even though the GRE is advertised as an accurate tool for predicting first year graduate GPA, there is a lack of research on long term success factors such as time to degree and graduate rate (Luthy, 1996; Powers, 2004). Furthermore, since most studies have low minority sample sizes, the validity of the GRE may not be the same across all groups (ETS, 2008b; Kuncel, Hezlett, & Ones, 2001). Another gap in GRE studies is that few researchers analyze student characteristics, which may alter or moderate the prediction validity of the GRE. Thus, student characteristics such as degree of academic involvement, mentorship interactions, and other academic and social experiences have not been widely examined in this context. These gaps in the analysis of GRE validity are especially relevant given the high attrition rates within of some graduate programs (e.g., an estimated 68% of doctoral student never complete their programs in urban universities; Lovitts, 2001). A sequential mixed methods design was used to answer the research questions in two phases. The quantitative phase used student data files to analyze the relationship of two success variables (graduation rate and graduate GPA) to the GRE scores as well as other academic and demographic graduate student characteristics. The qualitative phase served to complement the first phase by describing a wider range of characteristics from the 11 graduate students who were interviewed. Both proximal and distal moderators influence student behaviors and success in graduate school. In the first phase of the study, the GRE was the distal facilitator under analysis. Findings suggested that both the GRE Quantitative and the GRE Verbal were predictors of success for master’s students, but the GRE Quantitative was not predictive of success for doctoral students. Other student characteristics such as demographic variables and disciplinary area were also predictors of success for the population of students studied. In the second phase of the study, it was inconclusive whether the GRE was predictive of graduate student success; though it did influence access to graduate programs. Furthermore, proximal moderators such as student involvement, faculty/peer interactions, motivational factors, and program structure were perceived to be facilitators and/or detractors for success.

A youth vision of the city: The socio-spatial lives and exclusion of street girls in Bogota, Colombia

This dissertation documents the everyday lives and spaces of a population of youth typically constructed as out of place, and the broader urban context in which they are rendered as such. Thirty-three female and transgender street youth participated in the development of this youth-based participatory action research (YPAR) project utilizing geo-ethnographic methods, auto-photography, and archival research throughout a six-phase, eighteen-month research process in Bogotá, Colombia. ^ This dissertation details the participatory writing process that enabled the YPAR research team to destabilize dominant representations of both street girls and urban space and the participatory mapping process that enabled the development of a youth vision of the city through cartographic images. The maps display individual and aggregate spatial data indicating trends within and making comparisons between three subgroups of the research population according to nine spatial variables. These spatial data, coupled with photographic and ethnographic data, substantiate that street girls’ mobilities and activity spaces intersect with and are altered by state-sponsored urban renewal projects and paramilitary-led social cleansing killings, both efforts to clean up Bogotá by purging the city center of deviant populations and places. ^ Advancing an ethical approach to conducting research with excluded populations, this dissertation argues for the enactment of critical field praxis and care ethics within a YPAR framework to incorporate young people as principal research actors rather than merely voices represented in adultist academic discourse. Interjection of considerations of space, gender, and participation into the study of street youth produce new ways of envisioning the city and the role of young people in research. Instead of seeing the city from a panoptic view, Bogotá is revealed through the eyes of street youth who participated in the construction and feminist visualization of a new cartography and counter-map of the city grounded in embodied, situated praxis. This dissertation presents a socially responsible approach to conducting action-research with high-risk youth by documenting how street girls reclaim their right to the city on paper and in practice; through maps of their everyday exclusion in Bogotá followed by activism to fight against it.^

Incursión en el espacio ontológico de las novelas “La ninfa inconstante” de Guillermo Cabrera Infante y “Todos se van” de Wendy Guerra

This thesis examines the phenomenological projection of space in two Cuban novels: La ninfa inconstante (2008) by Guillermo Cabrera Infante (1929–2005), and Todos se van (2006) by Wendy Guerra (1970–). Both novels are paradigmatic of two generations of Cuban writers who portray the city of Havana as a backdrop against which to project socio-political and biographical narratives. To problematize ethical and political omissions in the novels, this work incorporates disciplines such as philosophy, urbanism, architecture, sociology and literary theory. Through the concepts of prominent phenomenologists, such as Gaston Bachelard, Martin Heidegger and Maurice Merleau-Ponty, amongst others, this study evaluates how space becomes a construction to ambivalent dynamics of truth telling within contrasting, suffocating sociopolitical contexts. In addition, it explores how these phenomenological spaces are defined in relation to power. For instance, the Cuban Revolution, and its aftermath of more than 52 years, brings forth a sense of displacement and placelessness. The novels present and develop both authors’ spatial consciousness (that we call “ontological space”), which is not necessarily a container of three-dimensional objects, but instead, fictional emergent constructions. This thesis concludes that literature can become a meaningful space to cope with unbearable realities.

Swimming against the tide: A study of a youth enrichment program seeking to empower inner-city Black youth

Serious inequities in our K-12 public education system, particularly in regard to the quality of education in predominately Black inner-city schools, are well-documented in the literature (Freeman, 1998; Ross, 1998). Moreover, there is general agreement that the most effective means of ameliorating that situation is through well-thought-out after-school programs and partnership initiatives (Beck, 1993; Gardner et al., 2001). ^ The purpose of this qualitative study was to examine the programmatic interventions of a youth enrichment program for inner-city Black youth currently in place at the Overtown Youth Center (OYC) in Miami, Florida, in order to: (a) discern those factors that support its claim that it is making a difference in students’ lives, (b) explore how any such factors are implemented, and (c) determine whether its interventions have served to equalize the playing field for these youth. ^ Two primary methods of data collection were used for this study. The first was participant observation conducted over the course of two years through a partnership initiative established and led by this author. The second was through in-depth interviews of the Center’s founder, staff, and students. Secondary methods used were the recording of informal conversations and the analysis of written documents. ^ Analysis of the data yielded four features of the Center that are indispensible to the students’ growth. The center provides the youth with (a) physical and psychological safety, (b) supportive relationships, (c) exposure to cultural and educational opportunities, and (d) assistance in building self-esteem. ^ The most significant finding of the study was that OYC has been successful at making a difference in students’ lives and at increasing their aspirations to attend college. By addressing the full spectrum of their needs, the Center has given them many of the necessary tools with which to compete and thereby helped equalize their opportunities to succeed in school and in life. ^ The study also noted a number of challenges for the Center to examine. The main issues that need to be addressed more seriously are staff turnover, staff indifference, nepotism, inconsistent student attendance, and insufficient focus on racial issues and African-American-centered education. Meeting those challenges would engender even greater positive outcomes.^

The civic achievement gap: A study on the civic knowledge, skills, and attitudes of Hispanic students in Miami-Dade County Public Schools

This study assessed the civic knowledge, skills, and attitudes of Hispanic eighth grade students in Miami-Dade County Public Schools (M-DCPS), Florida. Three hundred sixty one Hispanic students of Cuban (253), Colombian (57), and Nicaraguan (51) ancestry from 10 middle schools participated in the study. Two hundred twenty eight students were from low socio-economic status (SES) background, and 133 were of middle SES background. There were 136 boys and 225 girls. The International Association for the Evaluation of Educational Achievement Civic Education Student Questionnaire was used to collect data. The instrument assessed the students’ civic knowledge, skills, and attitudes. Multivariate analysis of variance was used to test for differences in the civic knowledge, skills, and attitudes of participants based on ancestry, SES, and gender. ^ The findings indicated that there was no significant difference in the civic knowledge, skills, and attitudes of Hispanic eighth grade students that were of Cuban, Colombian, and Nicaraguan ancestry. There was no significant difference in the civic skills and in five of the civic attitude scales for students from low SES families compared to those from middle SES families. However, there was a significant difference in the civic knowledge and in the civic attitude concerning classroom discussions and participation based on SES. The civic knowledge of middle SES students was higher than that of low SES students. Furthermore, middle SES Hispanic students displayed a higher mean score for the civic attitude of classroom discussions and participation than low SES students. There was no significant difference in the civic knowledge and in five of the civic attitude scales between boys and girls. However, there was a significant difference in the civic skills and the civic attitude of support for women’s rights between boys and girls. Hispanic girls displayed a higher mean score in civic skills than Hispanic boys. Furthermore, the mean score of civic attitude of support for women’s rights for Hispanic girls was higher than that of Hispanic boys. ^ It was concluded that Cuban, Colombian, or Nicaraguan participants did not demonstrate differences in civic attitudes and levels of civic knowledge and skills that eighth grade students possessed. In addition, when compared to boys, girls demonstrated a higher level of civic skills and a greater support for women’s rights and participation in politics and their roles in politics. Moreover, SES was demonstrated to be a key factor in the acquisition of civic knowledge, regardless of ancestry.^

Teoría y práctica del neobarroco en Severo Sarduy

This dissertation analyzes the theory and practice of the Cuban postmodern writer Severo Sarduy (1937–1993) from his early adult years in Cuba to his exile period in Paris, France, where he lived until his death. By studying his narrative through the light of his theoretical essays, this paper demonstrates that the author created his own type of reading model—from and for Sarduy. His literary work is influenced by three major elements: (post)structuralism, psychoanalysis, and Buddhism, which combined form what Sarduy himself called the Neobarroque style. The Sarduyan writing is a transgressive exercise expressed through his concept of simulación. This style breaks with the traditional art concept of mimesis (the representation of reality in the western world), and therefore with the correspondence between the signifier and the signified. Sarduy does not intend to represent reality but to go beyond it, achieving by his technique of signifying exhaustion to represent absence itself. The Neobarroque of Severo Sarduy is an aesthetic of the empty signifier based on the reckless expenditure, and ultimately exhaustion, of the artifices of language that precipitates in a signifier chain towards the infinite. His language does not transmit a message but it signifies itself, that is, a means without an end. Paradoxically, this signifier chain produces an excess of metaphors beyond the material limits of language and its support, the page. The space beyond language is the hipertelic technique inherited by Sarduy from his literary master, José Lezama Lima. This is also the empty space of no signification or nonsense in which occurs the depersonalization of the speaking subject; in Buddhist terminology this becomes the dissolution of the ego. The Sarduyan language is determined by a Lacanian psychoanalytic erotic drive (pulsion) known as the Barroquean desire, a death drive which directly relates to the exile condition of the author. But the genesis of this desire lies in a primordial desire of encounter with his origin: mother, maternal language, paradise, God. That is the reason why Sarduy not only poses an aesthetic question but also an ontological one. This other dimension of the Sarduyan writing is based on a liberating drive that permeates all his work—an ontological liberation expressed through language. The empty space created in the text provides the subject with the possibility of fusion with the all. Ultimately, Sarduy strives for a language that goes beyond the symbolic limits towards a place of constant dissolution, evanesce, and death-horror vacui. This corroborates the Sarduyan statement: “la simulación enuncia el vacío y la muerte.”

Sustainable rural development through alternative economic networks: Redefining relations in the commodity chain for export vegetables in western Guatemala

The current research considers the capacity of a local organic food system for producer and consumer empowerment and sustainable development outcomes in western Guatemala. Many have argued that the forging of local agricultural networks linking farmers, consumers, and supporting institutions is an effective tool for challenging the negative economic, environmental, and sociopolitical impacts associated with industrial models of global food production. But does this work in the context of agrarian development in the developing world? Despite the fact that there is extensive literature concerning local food system formation in the global north, there remains a paucity of research covering how the principles of local food systems are being integrated into agricultural development projects in developing countries. My work critically examines claims to agricultural sustainability and actor empowerment in a local organic food system built around non-traditional agricultural crops in western Guatemala. Employing a mixed methods research design involving twenty months of participant observation, in-depth interviewing, surveying, and a self-administered questionnaire, the project evaluates the sustainability of this NGO-led development initiative and local food movement along several dimensions. Focusing on the unique economic and social networks of actors and institutions at each stage of the commodity chain, this research shows how the growth of an alternative food system continues to be shaped by context specific processes, politics, and structures of conventional food systems. Further, it shows how the specifics of context also produce new relationships of cooperation and power in the development process. Results indicate that structures surrounding agrarian development in the Guatemalan context give rise to a hybrid form of development that at the same time contests and reinforces conventional models of food production and consumption. Therefore, participation entails a host of compromises and tradeoffs that result in mixed successes and setbacks, as actors attempt to refashion conventional commodity chains through local food system formation.^

Risk factors and associations for hepatitis C infection among Hispanic/Latino intravenous drug users in Miami-Dade County, Florida

Hepatitis C infection (HCV) continues to disproportionately affect Hispanics/Latinos in the United States. Hispanic/Latino intravenous drug users (IDUs), because of their risky injection and sexual behaviors, are prone to HCV infection and rapid transmission of the virus to others via several routes. With a prevalence rate of approximately 75% among IDUs, it is imperative that transmission of HCV be prevented in this population. This study aims to examine the associations between demographic, injection and sexual risk factors to HCV infection in a group Hispanic/Latino IDUs in Miami-Dade County, Florida. Preliminary unadjusted results in this sample reveal that age (OR=4.592, p=0.004), weekly injection (OR=5.171, p=0.000), daily injection frequency (OR=3.856, p=0.000) and use of a dirty needle (OR=2.320, p= 0.006) were all significantly associated with HCV infection. Being born outside the U.S. was significantly negatively associated with HCV infection (OR=0.349, p=0.004). Additionally, having two or more sex partners in the past three months (OR=0.472, p=0.014) was negatively associated with HCV infection. After adjusting for all other variables, older age (AOR=7.470, p=0.006), weekly injection (AOR=3.238, p=0.007) and daily injection frequency (AOR=2.625, p=0.010) were all significantly associated with HCV infection. Being born outside the U.S. (AOR=0.369, p=0.019) was a significant protective factor for HCV infection, along with having two or more sex partners in the past three months (AOR=0.481, p=0.037). When analyzing the significant variables in a backward regression model, having 2 or more sex partners in the past three months was not significant at the p

Influence of religious coping on the substance use and HIV risk behaviors of recent Latino immigrants

This study examines the influence of acculturative stress on substance use and HIV risk behaviors among recent Latino immigrants. The central hypothesis of the study is that specific religious coping mechanisms influence the relationship that acculturative stress has on the substance use and HIV-risk behaviors of recent Latino immigrants. Within the Latino culture religiosity is a pervasive force, guiding attitudes, behaviors, and even social interactions. When controlling for education and socioeconomic status, Latinos have been found to use religious coping mechanisms more frequently than their Non-Latino White counterparts. In addition, less acculturated Latinos use religious coping strategies more frequently than those with higher levels of acculturation. Given its prominent role in Latino culture, it appears probable that this mechanism may prove to be influential during difficult life transitions, such as those experienced during the immigration process. This study examines the moderating influence of specific religious coping mechanisms on the relationship between acculturative stress and substance use/HIV risk behaviors of recent Latino immigrants. Analyses for the present study were conducted with wave 2 data from an ongoing longitudinal study investigating associations between pre-immigration factors and health behavior trajectories of recent Latino immigrants. Structural equation and zero-inflated Poisson modeling were implemented to test the specified models and examine the nature of the relationship among the variables. Moderating effects were found for negative religious coping. Higher levels of negative religious coping strengthened an inverse relationship between acculturative stress and substance use. Results also indicated direct relationships between religious coping mechanisms and substance use. External and positive religious coping were inversely related to substance use. Negative religious coping was positively related to substance use. This study aims to contribute knowledge of how religious coping influence's the adaptation process of recent Latino immigrants. Expanding scientific understanding as to the function and effect of these coping mechanisms could lead to enhanced culturally relevant approaches in service delivery among Latino populations. Furthermore this knowledge could inform research about specific cognitions and behaviors that need to be targeted in prevention and treatment programs with this population.