Time trends and predictors of initiation for cigarette and waterpipe smoking among Jordanian school children: Irbid, 2008-2011

Smoking prevalence among adolescents in the Middle East remains high while rates of smoking have been declining among adolescents elsewhere. The aims of this research were to (1) describe patterns of cigarette and waterpipe (WP) smoking, (2) identify determinants of WP smoking initiation, and (3) identify determinants of cigarette smoking initiation in a cohort of Jordanian school children. ^ Among this cohort of school children in Irbid, Jordan, (age ≈ 12.6 at baseline) the first aim (N=1,781) described time trends in smoking behavior, age at initiation, and changes in frequency of smoking from 2008–2011 (grades 7–10). The second aim (N=1,243) identified determinants of WP initiation among WP-naïve students; and the third aim (N=1,454) identified determinants of cigarette smoking initiation among cigarette naïve participants. Determinants of initiation were assessed with generalized mixed models. All analyses were stratified by gender. ^ Baseline prevalence of current smoking (cigarettes or WP) for boys and girls was 22.9% and 8.7% respectively. Prevalence of ever- and current- any smoking, cigarette smoking, WP smoking, and dual cigarette/WP smoking was higher in boys than girls each year (p<0.001). At all time points, prevalence of WP smoking was higher than that of cigarette smoking (p<0.001) for both boys and girls. WP initiation was documented in 39% of boys and 28% of girls. Cigarette initiation was documented in 37% of boys and 24% of girls. Determinants of WP initiation included ever-cigarette smoking, low WP refusal self-efficacy, intention to smoke, and having teachers and friends who smoke WP. Determinants of cigarette smoking initiation included ever-WP smoking, low cigarette refusal self-efficacy, intention to start smoking cigarettes, and having friends and family who smoke.^ These studies reveal intensive smoking patterns at early ages among Jordanian youth in Irbid, characterized by a predominance of WP smoking. WP may be a vehicle for tobacco dependence and subsequent cigarette uptake. The sizeable incidence of WP and cigarette initiation among students of both sexes points to a need for culturally relevant smoking prevention interventions. Gender-specific factors, refusal skills, and smoking cessation of both WP and cigarettes for youth and their parents/teachers would be important components of such initiatives. ^

The Effectiveness of an Online Workshop on Behavior Management as a Professional Development Tool for Teachers

The current study examines the effects of an online workshop pertaining to classroom behavior management on teacher self-efficacy, attitudes, motivation, knowledge, and practices. In addition, information about teacher utilization of the Internet, their opinions about professional development, and experiences with classroom management were collected. Participants included 57 1st through 5th grade special and regular education teachers. Eligible teachers were those who teach an academic subject and had at least one child in the classroom they considered as disruptive. Teachers were randomized to either a training or waitlist group. Classroom observations of teacher practices and questionnaires were utilized. Teachers in the training group participated in two assessment points, baseline and post-workshop, and received access to the online course immediately following the baseline assessment. Teachers in the waitlist group participated in three assessment points, baseline, post-workshop, and follow-up, and received access to the online course immediately following the post-workshop assessment. Findings show that all teachers had access to the Internet at home and at school and used it on a daily basis. The majority of teachers indicated having some past training on all the techniques that were presented in the online workshop. All teachers expressed satisfaction with the workshop, indicating that it should be offered again. Post-workshop, findings showed significant group differences in knowledge with a large effect for the training group scoring higher than the waitlist group on a quiz. Secondly, group differences in self-efficacy, knowledge, and attitudes with teachers’ past-training as a moderator, was examined. Past-training was not found to be a significant moderator of self-efficacy, knowledge, or attitudes. However, the main effect for training group was significant for attitudes. In addition, teacher attitudes, but not knowledge and self-efficacy, significantly predicted motivation to implement. Next, the moderating effect of barriers on motivation and classroom management skill implementation was examined. Barriers were not found to be a significant moderator. Lastly, the training group was observed to be significantly more effective at giving commands compared to the waitlist group. The current study demonstrates the potential of a low-intensity online workshop on classroom management to enhance the accessibility of teacher professional development.

Work Creativity as a Dimension of Job Performance

To stay competitive, many employers are looking for creative and innovative employees to add value to their organization. However, current models of job performance overlook creative performance as an important criterion to measure in the workplace. The purpose of this dissertation is to conduct two separate but related studies on creative performance that aim to provide support that creative performance should be included in models of job performance, and ultimately included in performance evaluations in organizations. Study 1 is a meta-analysis on the relationship between creative performance and task performance, and the relationship between creative performance and organizational citizenship behavior (OCB). Overall, I found support for a medium to large corrected correlation for both the creative performance-task performance (ρ = .51) and creative performance-OCB (ρ = .49) relationships. Further, I also found that both rating-source and study location were significant moderators. Study 2 is a process model that includes creative performance alongside task performance and OCB as the outcome variables. I test a model in which both individual differences (specifically: conscientiousness, extraversion, proactive personality, and self-efficacy) and job characteristics (autonomy, feedback, and supervisor support) predict creative performance, task performance, and OCB through engagement as a mediator. In a sample of 299 employed individuals, I found that all the individual differences and job characteristics were positively correlated with all three performance criteria. I also looked at these relationships in a multiple regression framework and most of the individual differences and job characteristics still predicted the performance criteria. In the mediation analyses, I found support for engagement as a significant mediator of the individual differences-performance and job characteristics-performance relationships. Taken together, Study 1 and Study 2 support the notion that creative performance should be included in models of job performance. Implications for both researchers and practitioners alike are discussed.

Determinants of Waterpipe and Cigarette Smoking Progression among a School Based Sample of Adolescents in Irbid, Jordan: A Three-Year Longitudinal Study (2008-2011)

The prevalence of waterpipe smoking exceeds that of cigarettes among adolescents in the Middle East where waterpipe is believed as less harmful, less addictive and can be a safer alternative to cigarettes. This dissertation tested the gateway hypothesis that waterpipe can provide a bridge to initiate cigarette smoking, identified the predictors of cigarette smoking progression, and identified predictors of waterpipe smoking progression among a school-based sample of Jordanian adolescents (mean age ± SD) (12.7 ±0.61) years at baseline. Data for this research have been drawn from Irbid Longitudinal Study of smoking behavior, Jordan (2008-2011). The grouped-time survival analysis showed that waterpipe smoking was associated with a higher risk of cigarette smoking initiation compared to never smokers (P < 0.001) and this association was dose dependent (P < 0.001). Predictors of cigarette smoking progression were peer smoking and attending public schools for boys, siblings’ smoking for girls, and the urge to smoke for both genders. Predictors of waterpipe smoking progression were enrollment in public schools, frequent physical activity, and low refusal self-efficacy for boys, ever smoking cigarettes, friends’ and siblings’ waterpipe smoking for girls. Awareness of harms of waterpipe among boys and seeing warning labels on the tobacco packs by girls were protective against waterpipe smoking progression. In Conclusion, waterpipe can serve as a gateway to cigarette smoking initiation among adolescents. Waterpipe and cigarette smoking progressions among initiators were solely family-related among girls, and mainly peer-related among boys. The unique gender differences for both cigarette and waterpipe smoking among Jordanian adolescents in Irbid call for cultural and gender-specific smoking prevention interventions to prevent the progression of smoking among initiators.

The effectiveness of an enhanced congnitive behavioral intervention in improving behavioral outcomes related to HIV prevention

This study analyzed outcomes of an enhanced cognitive-behavioral intervention with dually diagnosed severely mentally ill adults. It specifically addressed the improvement of attitudes, skills, self-efficacy to use condoms and the heightening of condom use. The data were analyzed via a randomized three-group repeated measures design composed of the experimental (E-CB), standard care (SC) comparison or a no-treatment control condition as the between-subjects variable and pre-post measure as the within-subjects variable. The ECB focused on cooperative, application, hands-on, skill-building and role-playing activities for sexual assertiveness, negotiation in risk-taking and proper condom use. The SC comparison, was didactic in its approach and addressed risk- taking and proper condom use in one session, but did not involve application approaches to problem-solving risky situations or condom use. Multiple assessments were conducted at pre-, post- and six months post-intervention. The analysis indicated that the E-CB intervention led to more favorable attitudes toward condoms and to improved and maintained skills regarding their use by participants six months after the intervention compared to the standard care and control groups. No significant improvements in self-efficacy were found. A repeated measures ANOVA conducted on the transformed values of percentage of vaginal condom use indicated no significant differences between the experimental and standard care conditions but both had a significantly higher mean percentage vaginal condom use than the control group, averaged across pre- and six-month post-intervention. No gender differences were seen in attitudes, skills or self-efficacy to use condoms. This study shed light upon the effectiveness of the instructional approach for the enhancement of attitudes, skills and self-efficacy outcomes related to HIV prevention. For heightened effectiveness, future approaches must address multiple factors impacting learning in this population.

The Effect of Osteoporosis Education on Calcium Intake and Physical Activity in a Group of Community-Dwelling Black Older Adults

The unprecedented increase in the number of older adults is expected to increase the burden of osteoporosis on the individual and society. Blacks have been understudied in osteoporosis prevention education research. Although the risk of osteoporosis is low in this population, its consequences are significant. This study employs a two-group experimental design (experimental and wait-list control groups) to evaluate the effect of an osteoporosis education on two osteoporosis prevention behaviors (OPBs) – calcium intake (CI) and physical activity (PA), in a group of community-dwelling Black older adults, 50 years and older resident in South Florida. A final sample of 110 (mean age 70.15 years), 90% female and 10% male completed a battery of questionnaires at two assessment periods. The experimental group participated in six weekly education program sessions immediately following baseline assessment, and the wait-list control group received the education following end of program assessment by all participants. The weekly educational sessions were conducted in social settings (church or senior center) employing constructs of the Revised Health Belief Model. The sessions focused on improving CI; osteoporosis knowledge (OKT), self-efficacy (SE), health beliefs (HB) and PA. Findings revealed significantly greater increase in reported CI (M = 556 mg, Wilks’ λ = .47, F(1,108)=122.97, p< .001, η2=.53), OKT (p< .001), and SE (p< .001) among participants in the experimental compared to the wait-list control group. There was no significant difference between the two groups for PA and most of the HB subscales. OKT and SE were the best predictors of CI, while perceived barrier was a predominant factor predicting PA. Over the study period, a change in SE was the only variable related to changes in both OPBs. Attrition rate was lower than expected, which can be attributed to the settings utilized for the study. These findings support the importance of utilizing a familiar social setting. These results suggested the effectiveness of a program offered in multiple short sessions among this underserved minority population to improve OKT and SE resulting in a change in OPBs (increase in CI). However, there is need to explore alternative strategies to improve PA in this population group.

Does Hope Matter? The Influence of Dispositional Hope on Persistence in a Developmental Writing Course

The purpose of this study was to determine hope’s unique role, if any, in predicting persistence in a developmental writing course. Perceived academic self-efficacy was also included as a variable of interest for comparison because self-efficacy has been more widely studied than hope in terms of its non-cognitive role in predicting academic outcomes. A significant body of research indicates that self-efficacy influences academic motivation to persist and academic performance. Hope, however, is an emerging psychological construct in the study of non-cognitive factors that influence college outcomes and warrants further exploration in higher education. This study examined the predictive value of hope and self-efficacy on persistence in a developmental writing course. The research sample was obtained from a community college in the southeastern United States. Participants were 238 students enrolled in developmental writing courses during their first year of college. Participants were given a questionnaire that included measures for perceived academic self-efficacy and hope. The self-efficacy scale asked participants to self-report on their beliefs about how they cope with different academic tasks in order to be successful. The hope scale asked students to self-report on their beliefs about their capability to initiate action towards a goal (“agency”) and create a plan to attain these goals (“pathways”). This study utilized a correlational research design. A statistical association was estimated between hope and self-efficacy as well as the unique variance contributed by each on course persistence. Correlational analysis confirmed a significant relationship between hope and perceived academic self-efficacy, and a Fisher’s z-transformation confirmed a stronger relationship between the agency component of hope and perceived academic self-efficacy than for the pathways component. A series of multinomial logistic regression analyses were conducted to assess if (a) perceived self-efficacy and hope predict course persistence, (b) hope independent of self-efficacy predicts course persistence, and (c) if including the interaction of perceived self-efficacy and hope predicts course persistence. It was found that hope was only significant independent of self-efficacy. Some implications for future research are drawn for those who lead and coordinate academic support initiatives in student and academic affairs.

The impact of looping of fourth grade students on their reading achievement

This study examines the effects of looping (staying with the same teacher for two grade levels) on the reading achievement of fourth graders within a large, urban, multicultural school. Looping was expected to have a positive effect on reading achievement and reading qualities. Additional benefits, such as its effect on anxiety levels and self-concept were also assumed to accrue from looping. A causal-comparative design was employed. Four existing classrooms consisting of eighty-one fourth grade students comprised the treatment and comparison groups. The two "looping" treatment groups consisted of students who had the same teacher for their third and fourth grade school years. The remaining two classes comprised the comparison groups. Pre- and post-tests for reading achievement total scores and subscores for main idea and comparisons were obtained using the Florida Comprehensive Assessment Test (FCAT). Assessments were also obtained from the State-Trait Anxiety Inventory for Children, modified to reflect reading, and the Self- Perception Profile for Children. The difference in pre- and post-test FCAT scores were analyzed via a four group simple ANOVA to examine the effects of the looping model on reading achievement and reading qualities. Similar simple ANOVAs were performed to investigate the relationship of looping to anxiety and self-concept. The findings led to the conclusion that looping was significantly related to improvement in reading achievement and reading qualities. In addition, the hypothesized relationship of lower anxiety in the looping group compared to the comparison group was supported. There were no significant effects on self-concept for any of the comparisons. The study clearly demonstrated the positive effects of looping, on total reading achievement scores, on reading qualities of fourth grade students who participated in looping classes and on differences in students' anxiety. Looping did not have an effect on general self-concept. The results demonstrate the effects of looping on teaching methods. In looping practice teachers have the advantage of knowing their students and the students' readiness and can make adaptations of teaching methods accordingly. From the students' perspective, the looped students do not have to adapt to a new teacher and thus, experience lower anxiety.

Effects of student-faculty interactions on persistence of underprepared community college students.

The high concentration of underprepared students in community colleges presents a challenge to educators, policy-makers, and researchers. All have pointed to low completion rates and caution that institutional practices and policy ought to focus on improving retention and graduation rates. However, a multitude of inhibiting factors limits the educational opportunities of underprepared community college students. Using Tinto's (1993) and Astin's (1999) models of student departure as the primary theoretical framework, as well as faculty mentoring as a strategy to impact student performance and retention, the purpose of this study was to determine whether a mentoring program designed to promote greater student-faculty interactions with underprepared community college students is predictive of higher retention for such students. While many studies have documented the positive effects of faculty mentoring with 4-year university students, very few have examined faculty mentoring with underprepared community college students (Campbell and Campbell, 1997; Nora & Crisp, 2007). In this study, the content of student-faculty interactions captured during the mentoring experience was operationalized into eight domains. Faculty members used a log to record their interactions with students. During interactions they tried to help students develop study skills, set goals, and manage their time. They also provided counseling, gave encouragement, nurtured confidence, secured financial aid/grants/scholarships, and helped students navigate their first semester at college. Logistic regression results showed that both frequency and content of faculty interactions were important predictors of retention. Students with high levels of faculty interactions in the area of educational planning and personal/family concerns were more likely to persist. Those with high levels of interactions in time-management and academic concerns were less likely to persist. Interactions that focused on students' poor grades, unpreparedness for class, or excessive absences were predictive of dropping out. Those that focused on developing a program of study, creating a road map to completion, or students' self-perceptions, feelings of self-efficacy, and personal control were predictive of persistence.

Theoretical Foundations of Developing Modeling Instruction Curriculum for College Biology Courses

Modeling Instruction (MI) has been successfully implemented in high school science classes. Moreover, MI curriculum for introductory physics has also been developed at a university level. Noticing the gap, the author will provide theoretical foundations to support the statement that MI curriculum should be developed for college biology courses.

The effectiveness of an online workshop on behavior management as a professional development tool for teachers

The current study examines the effects of an online workshop pertaining to classroom behavior management on teacher self-efficacy, attitudes, motivation, knowledge, and practices. In addition, information about teacher utilization of the Internet, their opinions about professional development, and experiences with classroom management were collected. Participants included 57 1 st through 5th grade special and regular education teachers. Eligible teachers were those who teach an academic subject and had at least one child in the classroom they considered as disruptive. Teachers were randomized to either a training or waitlist group. Classroom observations of teacher practices and questionnaires were utilized. Teachers in the training group participated in two assessment points, baseline and post-workshop, and received access to the online course immediately following the baseline assessment. Teachers in the waitlist group participated in three assessment points, baseline, post-workshop, and follow-up, and received access to the online course immediately following the post-workshop assessment. Findings show that all teachers had access to the Internet at home and at school and used it on a daily basis. The majority of teachers indicated having some past training on all the techniques that were presented in the online workshop. All teachers expressed satisfaction with the workshop, indicating that it should be offered again. Post-workshop, findings showed significant group differences in knowledge with a large effect for the training group scoring higher than the waitlist group on a quiz. Secondly, group differences in self-efficacy, knowledge, and attitudes with teachers’ past-training as a moderator, was examined. Past-training was not found to be a significant moderator of self-efficacy, knowledge, or attitudes. However, the main effect for training group was significant for attitudes. In addition, teacher attitudes, but not knowledge and self-efficacy, significantly predicted motivation to implement. Next, the moderating effect of barriers on motivation and classroom management skill implementation was examined. Barriers were not found to be a significant moderator. Lastly, the training group was observed to be significantly more effective at giving commands compared to the waitlist group. The current study demonstrates the potential of a low-intensity online workshop on classroom management to enhance the accessibility of teacher professional development. ^

Work creativity as a dimension of job performance

To stay competitive, many employers are looking for creative and innovative employees to add value to their organization. However, current models of job performance overlook creative performance as an important criterion to measure in the workplace. The purpose of this dissertation is to conduct two separate but related studies on creative performance that aim to provide support that creative performance should be included in models of job performance, and ultimately included in performance evaluations in organizations. Study 1 is a meta-analysis on the relationship between creative performance and task performance, and the relationship between creative performance and organizational citizenship behavior (OCB). Overall, I found support for a medium to large corrected correlation for both the creative performance-task performance (ρ = .51) and creative performance-OCB (ρ = .49) relationships. Further, I also found that both rating-source and study location were significant moderators. Study 2 is a process model that includes creative performance alongside task performance and OCB as the outcome variables. I test a model in which both individual differences (specifically: conscientiousness, extraversion, proactive personality, and self-efficacy) and job characteristics (autonomy, feedback, and supervisor support) predict creative performance, task performance, and OCB through engagement as a mediator. In a sample of 299 employed individuals, I found that all the individual differences and job characteristics were positively correlated with all three performance criteria. I also looked at these relationships in a multiple regression framework and most of the individual differences and job characteristics still predicted the performance criteria. In the mediation analyses, I found support for engagement as a significant mediator of the individual differences-performance and job characteristics-performance relationships. Taken together, Study 1 and Study 2 support the notion that creative performance should be included in models of job performance. Implications for both researchers and practitioners alike are discussed.^

A Phenomenological Exploration of Black Male Law Enforcement Officers' Perspectives of Racial Profiling and Their Law Enforcement Career Exploration and Commitment

This phenomenological study explored Black male law enforcement officers’ perspectives of how racial profiling shaped their decisions to explore and commit to a law enforcement career. Criterion and snow ball sampling was used to obtain the 17 participants for this study. Super’s (1990) archway model was used as the theoretical framework. The archway model “is designed to bring out the segmented but unified and developmental nature of career development, to highlight the segments, and to make their origin clear” (Super, 1990, p. 201). Interview data were analyzed using inductive, deductive, and comparative analyses. Three themes emerged from the inductive analysis of the data: (a) color and/or race does matter, (b) putting on the badge, and (c) too black to be blue and too blue to be black. The deductive analysis used a priori coding that was based on Super’s (1990) archway model. The deductive analysis revealed the participants’ career exploration was influenced by their knowledge of racial profiling and how others view them. The comparative analysis between the inductive themes and deductive findings found the theme “color and/or race does matter” was present in the relationships between and within all segments of Super’s (1990) model. The comparative analysis also revealed an expanded notion of self-concept for Black males – marginalized and/or oppressed individuals. Self-concepts, “such as self-efficacy, self-esteem, and role self-concepts, being combinations of traits ascribed to oneself” (Super, 1990, p. 202) do not completely address the self-concept of marginalized and/or oppressed individuals. The self-concept of marginalized and/or oppressed individuals is self-efficacy, self-esteem, traits ascribed to oneself expanded by their awareness of how others view them. (DuBois, 1995; Freire, 1970; Sheared, 1990; Super, 1990; Young, 1990). Ultimately, self-concept is utilized to make career and life decisions. Current human resource policies and practices do not take into consideration that negative police contact could be the result of racial profiling. Current human resource hiring guidelines penalize individuals who have had negative police contact. Therefore, racial profiling is a discriminatory act that can effectively circumvent U.S. Equal Employment Opportunities Commission laws and serve as a boundary mechanism to employment (Rocco & Gallagher, 2004).

An Examination of Psychological Meaningfulness, Safety, and Availability as the Underlying Mechanisms linking Job Features and Personal Characteristics to Work Engagement

The present study tested a nomological net of work engagement that was derived from its extant research. Two of the main work engagement models that have been presented and empirically tested in the literature, the JD-R model and Kahn’s model, were integrated to test the effects that job features and personal characteristics can have on work engagement through the psychological conditions of meaningfulness, safety, and availability. In this study, safety refers to psychological perceptions of safety and not workplace safety behaviors. The job features that were tested in this model included person-job fit, autonomy, co-worker relations, supervisor support, procedural justice, and interactional justice, while the personal characteristics consisted of self-consciousness, self-efficacy, extraversion, and neuroticism. Thirty-four hypotheses and a conceptual model were tested in order to establish the viability of this nomological net of work engagement in which it was expected that meaningfulness would mediate the relationships between job features and work engagement, safety would mediate the relationships that job features and personal characteristics have with work engagement, and availability (physical, emotional, and cognitive resources) would mediate the relationships that personal characteristics have with work engagement. Furthermore, analyses were run in order to determine the factor structure of work engagement, assess whether or not it exhibits differential validity from organizational commitment and job satisfaction, and confirm that it is positively related to the outcome variable of organizational citizenship behavior (OCB). The final sample consisted of 500 workers from an online labor market who responded to a questionnaire composed of measures of all constructs included in this study. Findings show that work engagement is best represented as a three-factor construct, composed of vigor, dedication and absorption. Furthermore, support was found for the distinction of work engagement from the related constructs of organizational commitment and job satisfaction. With regard to the proposed model, meaningfulness proved to be the strongest predictor of work engagement. Results show that it partially mediates the relationships that all job features have with work engagement. Safety proved to be a partial mediator of the relationships that autonomy, co-worker relations, supervisor support, procedural justice, interactional justice, and self-efficacy have with work engagement, and fully mediate the relationship between neuroticism and work engagement. Findings also show that availability partially mediates the positive relationships that extraversion and self-efficacy have with work engagement, and fully mediates the negative relationship that neuroticism has with work engagement. Finally, a positive relationship was found between work engagement and OCB. Research and organizational implications are discussed.

Effect of the Supplemental Nutrition Assistance Program (SNAP) and Nutrition Education on Nutrition and Health Outcomes of HIV+ Individuals

Factors associated with and barriers to participation in Supplemental Nutrition Assistance Program (SNAP) and the effect participation has on food security, nutrition status, disease status and quality of life was investigated in a cross-sectional study including 175 HIV infected individuals. In addition, the effect of a targeted nutrition education on nutrition knowledge, readiness to dietary behavior change, nutrition status, disease status and quality of life was also investigated among a subset of the population (N = 45) in a randomized clinical control trial. SNAP participation rate was 70.3%, similar to the State of Florida and national participation rates. SNAP participation was positively and independently associated with being born in the US (P < 0.001), having monthly income less than $1000 (P = 0.006), and receiving antiretroviral treatment (P < 0.001). Participation barriers include denial of participation by program, recent incarceration, living in a shelter where participation is not allowed and unawareness of eligibility status. In regression analyses, SNAP participation was not significantly associated with improved food security, nutrition status, disease status and health related quality of life (HRQOL). Over half (56%) of the population experienced food insecurity and had inadequate intakes of half of the nutrients assessed. Illicit drug, alcohol and cigarette use were high in this population (31%, 55% and 63% respectively), and affected food security, nutrients intake, disease status and HRQOL. The nutrition education intervention resulted in a trend towards improvements nutrition knowledge, self-efficacy, and readiness to change without impacting nutrition status, disease state and quality of life. Food insecurity and other nutrition related issues, with implications for treatment, management and cost of HIV disease, continue to plague infected individuals living in poverty. More resources, including food and nutrition programs, specifically targeted towards this population are needed to address these issues.