Category: College of Public Health

Rest and Results: The Relationship Between Sleep, Stress, and Grade Point Average (GPA) in Undergraduates

Author(s): Michael Kaleem

Mentor(s): Ali Weinstein, College of Public Health

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Abstract

Michael Kaleem
URSP Abstract

Title
Rest and Results: The Relationship Between Sleep, Stress, and Grade Point Average (GPA) in Undergraduates

Authors: MK and AW

Background
Sleep plays an important role in college students’ cognitive functioning and overall academic success, making it a crucial area of study. However, the specific relationship between parameters of sleep and academic performance has not been well studied. In addition, college students have also reported increasing levels of stress over the past few years, and stress can affect both sleep and academic success. Therefore, the current investigation examined the associations between duration of sleep, sleep quality, and stress with academic success.

Methods
Data were collected by surveys completed by undergraduate students at a large, public university. Sleep duration and sleep quality were assessed by the Pittsburgh Sleep Quality Index (PSQI), and stress was measured with the Perceived Stress Scale. Academic success was operationalized as a self-reported GPA. Pearson correlations determined association between the variables of interest with p<0.05 set as the level of statistical significance. Results
There were 196 undergraduate students that participated (70.1% female, 36% white/non-Hispanic, 27.6% Asian/Pacific Islander, age: 18.1±0.5). Both sleep duration and sleep quality were statistically significantly related to GPA (r=0.17, p=0.02, r=-0.13; p=0.001, respectively). Therefore, as the number of hours of sleep increased and as sleep quality increased (lower number on PSQI is indicative of better sleep), GPA increased. Elevated stress levels were related to both sleep duration (r=-0.14; p=0.01) and sleep quality (r=0.40; p<0.001) but not significantly correlated to GPA (r=-0.01; p=0.92). Conclusion
This study found that sleep duration and sleep quality were positively associated with academic success. Although stress was not directly related to academic success, it was associated with both sleep duration and quality, suggesting that stress may influence academic success indirectly through its effects on sleep. Future research should explore how demographic, socioeconomic, and environmental factors influence sleep patterns and academic success to better inform strategies that support student success.

Audio Transcript

How many hours of sleep did you get last night? And do you think it affects your GPA? Sleep is something most college students sacrifice, yet it’s essential for memory, learning, and mental functioning. My name is Michael Kaleem, and our research explored the relationship between sleep, stress, and academic performance in undergraduates. We wanted to know: Could better sleep actually lead to better grades—and how does stress fit into the picture?

Sleep is more than just rest. During sleep, the brain strengthens memories, organizes information, and supports attention and problem-solving. So, in theory, students who sleep longer and sleep better should perform better academically. But college life is complex—so real data is needed to understand what’s actually happening.

Stress is one of the biggest disruptors of sleep. High stress can shorten sleep duration, worsen sleep quality, and impact mood and focus. Because stress influences both sleep and academic functioning, we wanted to understand whether stress plays a direct role in GPA—or whether its effects occur indirectly through sleep.
We surveyed 196 undergraduate students at a large public university. Sleep duration and sleep quality were measured using the Pittsburgh Sleep Quality Index, stress was assessed using the Perceived Stress Scale, and students self-reported their GPA. We used Pearson correlations to examine how these variables were related, with significance set at p < 0.05.
We found that both sleep duration and sleep quality were significantly related to GPA. Students who slept more hours tended to have higher GPAs. And students with better sleep quality—which means fewer sleep problems—also had higher GPAs. So in this sample, sleep really did matter for academic success.
Stress told a different story. Stress levels were not directly related to GPA. However, stress was strongly connected to both sleep duration and sleep quality. Students with higher stress slept fewer hours and had worse sleep quality. This suggests that stress may influence academic performance indirectly—by affecting the amount and quality of sleep students get.
Our findings show that sleep duration and sleep quality are important predictors of academic success. Even though stress didn’t directly affect GPA, it played a major role in disrupting sleep. This highlights a powerful message: helping students improve sleep habits and manage stress can support academic performance, cognitive functioning, and overall well-being.
Future research should explore how demographic, socioeconomic, and environmental factors influence sleep and academic outcomes. Understanding these differences can help universities design more effective programs to support healthier sleep, reduce stress, and improve student success across diverse populations.

College of Humanities and Social Science College of Public Health OSCAR Summer Team Impact Project

Karissa Raucheisen – Summer Team Impact project: Celebration Video

Author(s): Karissa Raucheisen

Mentor(s): Denise Hines, College of Public Health

Summer Team Impact Project: Reducing Inequalities in Fairfax County’s Domestic and Sexual Violence Services. Identify populations that are underserved according to their data. Populations were teenagers, refugees, transgender people, and people with disabilities. During the summer we worked on a scoping review and interviews with community leaders. A scoping review was conducted of relevant literature. For the interviews, I reached out to leaders in the teenage community to be interviewed. Then compare the data from the scoping review to the interview data.

hi everyone my name is Karissa Raucheisen and I’m here to talk to you about the summer team impact project that I worked on this summer here at George Mason University so the summer team impact project I got to work on was the reducing inequalities in the Fairfax County’s Domestic and Sexual Violence services to at-risk communities and so one of the first things we did was look at the populations that were underserved according to their data set some of these populations included teens transgender people and people with disabilities and so my group that I chose to do was teenagers and so there were two main things that we did with our data set the entire summer the first is a scoping review and the second is interviewed with people who were identified as Community leaders I am first going to talk about the scoping review that I did so if you don’t know what a scoping review is it’s essentially a review of all relevant literature through different databases or platforms and so I did the scoping review and got some data from that and so I wanted to talk a little bit about the process of the scoping review so when I started the scoping review I plugged in the search terms to the database and I also plugged in exclusion terms to narrow down my search results after I got the search results I screened them in or out through a title and Abstract reading and after that I was left with about like 17 or something articles and so of those articles I either screened them in or out through a full text reading meaning by I read the entire thing and after that I was left with a total of five articles and so after that I coded and did themes from that and that took a very long time but I thoroughly enjoyed it and so I got seven identified themes from that which I can’t talk about yet but I would happily talk about once I’m allowed to talk about and so after the scoping review we did interviews with Community leaders so that was my favorite part about working on the summer team impact project I got to email people about this project and if they would be interested in participating in the interview so I did teens again and so I just emailed people who are leaders within the teenage Community to ask them to interview and then after that we would gather data from that because we would record it and then we would transcribe the data and then code the data from that and so right now it’s just really comparing the data from the interviews to what we have in the scoping review right now so that’s pretty much all I have for you I just wanted to say uh thank you to everyone who helped me throughout this project which is uh Professor Booth Dr Hines and Dr Hand so thank you for allowing me to join you guys on this project I thoroughly enjoyed it thank you!

College of Public Health

The Impact of Abortion Bans on Maternal and Reproductive Health in Virginia

Author(s): Cityana Teshome, Eliza Liner, Holly Wilson, Katie Volante, Victoria Iveljic

Mentor(s): Daniel Freedman, Social Work

Title: The Impact of Abortion Bans on Maternal and Reproductive Health in Virginia
Co-authors: Victoria Iveljic, Katie Volante, Eliza Liner, Holly Wilson, and Cityana Teshome
IRB Approved – Yes
Faculty Sponsor: Dr. Daniel Freedman – [email protected]

Background: The overturn of Roe v. Wade returned the ability to regulate abortion to the states, no longer protecting the right to abortion at the federal level. Currently, 14 states have full bans on abortion (The New York Times, 2023). “It has been projected that a total ban on abortion would lead to a 21% increase in maternal mortalityâ€ (Kulczycki, 2022, as cited in Stevenson, 2021). Unsafe abortions present a slew of health risks including infection, hemorrhage, uterine perforation, internal organ damage, and mental distress (World Health Organization, 2021).

Purpose: The purpose of this study is to identify how the Dobbs v. Jackson Women’s Health Organization decision has impacted the medical care of individuals who can become pregnant in the state of Virginia.

Methods: This qualitative, phenomenological study primarily used snowball sampling to recruit participants. The target population was biologically female, English-speaking, Virginia residents who were 18 years or older who have been pregnant since the Dobbs decision. The researchers sampled from Planned Parenthood Centers, OB/GYN offices, and pre and postnatal support groups. Data was collected from semi-structured interviews and coded using thematic analysis. 10 respondents participated.

Results: Data has not yet been collected but will be completed by May 8, 2023.

Conclusions: This study has the potential to affect policy surrounding healthcare and reproductive rights. Based on themes generated after coding, individuals will have a detailed understanding of how recent legislation impacts the maternal and reproductive health outcomes of individuals in the U.S. who are able to become pregnant.

Welcome Everyone. My name is Katie Volante. My fellow group members are Victoria Iveljic, Eliza Liner, Holly Wilson, and Cityana Teshome and we’re here to present the research for our BSW capstone project which focuses on the impact of abortion bans on maternal and reproductive health in Virginia. For a little background on the issue, in 2022, the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization denied abortion as a protected right under the U.S. Constitution, reversing the nearly 50 years of legal precedent set forth in Roe v. Wade and, ultimately, returned the ability to regulate abortion to the states. And while abortion remains accessible in Virginia, it’s important to note that it’s not explicitly protected by state or federal law. Though there is no universal consensus in the U.S., for the purpose of our study, viability is understood as occuring at approximately 24 weeks of gestational age, abortion is defined as the termination of pregnancy before the fetus has reached the stage of viability, and an unsafe abortion is one performed by an unqualified provider or in an unsanitary environment.

So why do we care about the impacts of abortion bans on maternal and reproductive healthcare in Virginia? Let’s begin with the research on the subject. Statistics have shown that 4.7-13.2% of maternal deaths are caused by unsafe abortions. This is an abortion that is completed outside of, you know, a hospital without a doctor that is qualified to do so. A total ban on abortion exacerbates issues already occurring in communities of color such as non-Hispanic Black individuals, projecting a 33% increase of maternal mortality and, overall, maternal mortality rates increase by 21%. We have included a graphic that depicts the states in America in which a total abortion ban is in place and the states in which a six-week ban is in effect. Georgia is the only state presented in this graphic, um, to have a six-week ban in effect and 14 states have a full ban in effect including Idaho, North and South Dakota, Wisconsin, Texas, Oklahoma, Montana, Arkansas, Louisiana, Mississippi, Kentucky, Tennessee, West Virginia, and Alabama. We can start to understand how the overturn of Roe v. Wade is beginning to effect fetus-carrying individuals.

There are a number of predicted outcomes for the Dobbs ruling including an increase in barriers to accessing time sensitive abortion care and even denial of such access in general. This can then lead to unsafe abortions which can lead to physical health problems such as infection, hemorrhage, incomplete abortions, uterine perforation, internal organ damage, and mental distress. Mental distress can come in the form of stress, anxiety, depression, and a number of other mental health symptoms that negatively impact those who are or can become pregnant. As previously mentioned, a total ban on abortions would increase the number of unsafe abortions leading to an overall rise in the percentage of maternal mortality rates. Data has shown that stricter abortion laws and decreases in abortion access, such as with the Dobbs ruling, leads to an increase in birth rates. However, this has shown to be temporary until people find a way to terminate their pregnancies, which are usually in the form of unsafe and self-managed abortions, leading to a rise in maternal mortality. Previous research has also shown that marginalized communities are disproportionately affected when it comes to access to abortion and healthcare, in general. The Dobbs ruling is predicted to only make this problem worse. Furthermore, the Dobbs ruling also puts anyone in the U.S. who is able to get pregnant in a vulnerable state for legal surveillance, civic detention, forced interventions, and criminal prosecution.

Alright! So our research question is in which ways do abortion bans implemented after Dobbs v. Jackson Women’s Health Organization impact the medical care of people who can get pregnant in Virginia? And now to talk a little bit about our study design. So our study design is a phenomenology which means we really want to capture the lived experiences of people. We’re going to be conducting snowball sampling in order to get participants. So initially we’re recruiting with flyers, um, and then whoever answers those and meets screening criteria will be counted in the participant pool and then, once we interview those participants, we’re going to ask them, um, if they have any people that they recommend – their friends or family – that they think might also be a good fit for this study and sample from them. As far as measurement goes, we’re going to do semi-structured interviews so we’re going to be holding interviews virtually over Zoom, just due to geographic constraints, and ask a series of open-ended questions to try and capture, um, themes and broad responses – allow the participants to give as much or as little detail as they want. And as far as data analysis goes, we’re going to transcribe those interviews and then code them using thematic analysis which like I said earlier, um, is just going through those transcriptions and pulling out key themes to see what responses and what recommendations, details, things like that, are most prevalent in our participant pool.

We took our sampling from Planned Parenthood Centers, the – from OB/GYN offices, from support groups for people who were dealing with issues related to our study, and from hospitals. Some limitations: Participants had to contact a researcher in order for them to participate. Another limitation we had was time. We did not have as much time as we would like – as we would have liked to have had – to complete our study. And also funding. We were limited by the fact that we did not have really any money to complete the study or to incentivize people or anything like that. Um. So some implications of our study: policy change and also, um, it will affect the delivery of services. If there’s any questions, feel free to ask!

College of Public Health

Exploring the Association Between Video Games and Psychological Health

Author(s): Blanca Soriano, Jennifer Hernandez, Myrima Rychlik, Sara Awadalsayed, Vivian Vu

Mentor(s): Daniel Freedman, Social Work

Video games are one of the most popular hobbies for adults in the United States, particularly in the wake of COVID-19. Similarly, mental health concerns have grown significantly due to necessary social distancing and myriad hardships caused by the pandemic. Video games have been demonstrated to have positive effects on players’ mood, motivation, and cognition. However, negative effects on players due to excessive amounts of or reliance on gaming have also been posited. This research aims to draw and further clarify connections between video games and the psychological health of those who play them to gain deeper insight into both. The following two research questions are used to focus the study: (1) Is there a correlation between time spent playing video games and psychological well-being? (2) Is there a correlation between preferences in game genres and players’ psychological health? The objective of the research is to explore such associations via a cross-sectional, correlational study. Data collection is currently in progress. An online survey regarding players’ gaming habits, preferences, and psychological health (measured via the BRIEF Cope Scale and Symptom Checklist K-9) is being administered to participants. Responses (currently n = 82) will be selected for analysis using simple random sampling. Bivariate analysis of the relationships between pertinent variables will be conducted and descriptive statistics will be calculated (mean hours games are played daily/weekly in the sample, mean scores of the psychological assessments). This study will shed light on an under-researched area for assessment and intervention utilizing the person-in-environment perspective in mental health practice.

American adults play video games. This statement is a matter of fact that is supported by data indicating that American adults play an average of almost 8 hours of video games a week, but for a number of years, there seemed to be a general impression that video games are something made for and primarily consumed by children. In actuality, 66 percent of Americans-more than 215 million people – say they play video games regularly, and 76 percent of these people are over the age of 18. Furthermore, the amount of time Americans spent playing games grew significantly during the pandemic, as they offered stress relief, escapism, and opportunities to connect with others during a time of necessary social distancing. The COVID-19 pandemic, similarly, significantly affected Americans’ mental health, particularly with respect to rates of anxiety and depressive symptoms. Therefore, as a team of researchers, we began thinking about the intersection between video games and mental health. Video games are an increasingly common fixture in American adult life, and mental health issues are also increasingly common, so we set out to explore and understand potential connections between the two so as to gain deeper insight into both video games and Americans’ psychological health.

After reviewing literature on the topic, we noted two major areas that called for further research and clarification, thus leading to our two questions of focus. Firstly, is there a correlation between the amount of time an individual spends playing video games and their psychological well-being? Secondly, is there a correlation between preferences in game genres and players’ psychological health? To answer these questions, data is currently being collected and participants have been providing data through an online survey created by the researchers via Qualtrics. Links to the online survey were posted on Reddit, a social news and discussion website, and distributed on Discord, an instant messaging social platform popular in many gaming communities. Posting locations ranged in focus on video games in order to ensure that gamers of diverse levels of dedication are included and exclusion criteria was limited to being under the age of 18.

In the survey, participants indicate their average daily and weekly gameplay time, most often played game genres, and complete two standardized psychological assessments, the Symptom Checklist-K-9 and the Brief COPE scale. Current participants are between 18 and 71 years old (the mean age is 26.88 years), 48 percent male, 47 percent female, and three percent non-binary or another gender. 38 percent of respondents in the sample identify as White (non-Hispanic/Latino), followed by 20 percent identifying as Hispanic/Latino, 17 percent as Black or African American, 14 percent as Asian, and 11 percent as mixed or another race. There is more racial diversity amongst our participants than tends to be seen in comparable studies, many of which were performed in Europe.

Current participants report playing video games an average of 15.92 hours a week. Bivariate analysis of the relationship between average gameplay time and psychological health will constitute a correlation test to calculate the correlation coefficient once all data is collected. Bivariate analysis of the relationship between preferred game genre and psychological well-being will constitute a t-test and the online application SPSS will be utilized to conduct these statistical tests to determine to what extent the variables are associated. Our sample reports playing video games even more often than many national statistics, highlighting the presence of games in the environments of American adults. Thus, this study will shed light on an under-researched area for assessment and intervention utilizing the person-in-environment perspective in mental health practice. We also hope the research will provide further clarification on whether there is a particular amount of hours or point at which gaming is significantly associated with poorer mental health outcomes.

College of Public Health OSCAR

The Structural Determinants of Health: How Structural Racism Facilitates Community Violence in Washington, DC

Author(s): Nadia Altaher

Mentor(s): Debora Goldberg, Public Health

https://youtu.be/8ovMauNmhqE

Racism is deeply embedded in social determinants of health, establishing racial health inequities in populations of color. Recent measures have been taken to address this issue in Washington, DC including the 2020 Racial Equity Achieves Results (REACH) Amendment Act, which focuses on racial equity, social justice, and economic inclusion. To further these efforts, there is a need to understand the relationship between structural racism, unemployment, poverty, and violence. This research explores the correlation between historic racism, social determinants of health, housing policies, and community violence in Washington, DC. Methods include mapping racial covenants from 1940 to 2010, neighborhood displacement, and social determinants of health. Current mortgage lending in the neighborhoods across the city was used to measure the housing market and lending discrimination. Demographic data, drawn from various sources, were used to measure social determinants of health across statistical neighborhoods. Findings indicate Wards 5, 7 and 8, in South and Eastern parts of DC, have the highest rates of crime, unemployment and concentrated poverty, lowest house lending rates, and experienced the most housing displacement from 1940-2010. The district’s racial dissimilarity index of 70.9 indicates that the city is still highly segregated and that zip codes play a significant role in individual health and exposure to violence. To achieve health equity, measures must be taken to dismantle structural racism that include community based participatory research and policies that incorporate a historical context of the problem as well as voices of community members.

Hello, everyone. My name is Nadia Altaher. And today I’ll be discussing my research project on the structural determinants of health, specifically how systemic racism facilitates community violence in Washington, DC.

So what is structural racism? Why is it important? It is a product of history but has adapted its contexts over time to create conditions that allow for worse health outcomes in racially marginalized populations. And we still see these worse health outcomes and disparities today as we higher rates of maternal mortality, lower life expectancy, and worse mental health outcomes among racially marginalized populations. It permeates in the various social determinants of health which is the environment in which people live, work, and play. And determines a lot of out health outcomes. As you guys can see, health equity and health equality are completely different as health equity strives to provide greater resources and attention to disadvantaged populations. Structural racism is a driving force many of these health inequities we see today.

So why conduct this research? Well, previous research has shown that mental health problems are more prominent among populations experiencing racism or discrimination. While young individuals are disproportionately impacted by community violence, certain populations are more at risk than others, specifically those experiencing systemic racism, bias, discrimination – which all impact adverse childhood experiences and the environment in which they grow up in. So drivers for violence impact communities of color and place residents at greater risk for poor mental health outcomes, tying metnal health and community violence aspects and their social determinants together. So I wanted to look at this theoretical framework between historic racism, social determinants of health, as well as housing and lending policies in DC as they have affected gentrification, community demographics, as well as community displacement over time. I did this by measuring racial covenants from 1940 to 2010, looking at current and previous housing and lending policies, as well as demographic data from DC department of health.

So my results have found that Wards 5, 7, and 8 – historically black neighborhoods (according to the Racial Covenants) are characterized by the highest poverty rates, gross rent rates, and violence mortality rates. They also have the lowest life expectancy, educational attainment, and income levels.

They are coincidentally make up the majority of the Non-Hispanic Black community as 93.7% to 98% are located in Southeast and Northeast DC. While the non-Hispanic White population is about 61.1% to 72.8% in Northwest and Southwest DC. Ward 3, the highest percentage of White Americans has a higher life expectancy by 16 years compared to Ward 8 which also has a 6 times higher rate of infant mortality, which is also an indicator for systemic racism.

I also wanted to point out that the racial dissimilarity index in DC is 70.9, meaning that 70.9% of White residents would have to move to achieve complete White/Black integration in the city, concluding that the city continues to be highly segregated.

The DC homicide rate is 16.0 per 100,000. That might seem low, but it is three times higher than the national average of 5.3. 74% come from firearms and 26% from suicides. But the most important thing to look at is that 94% of the victims were Black and 88% were males living in Wards 5, 7, and 8. As you guys can see the browner the color, the higher the violence mortality rate.

So this is a table I created looking at the population make up of these wards and their current social determinants such as violence mortality rate, life expectancy, median income, and unemployment. And how they drastically change looking at the Wards 1-3 from Wards 5-8.

So I wanted to look at the DC housing and redlining policies as they have impacted the placement of housing that people currently have in the city. So historic redlining comes from the 1933 New Deal Project which used to further segregation efforts by refusing to lend mortgages in neighborhoods of color while ensuring mortgages and reinvestments in white neighborhoods. It led to lasting impacts of generational wealth and property ownership as Black individuals were less likely to own a property of value and live in disinvested communities that were deliberately maintained by racial segregation. According to a study done on DC Housing in 2005, less than 10% of lending applicants in underserved census tracts were denied loans inequitably. And many public housing projects have been slated for private redevelopment, adding to existing waitlists for rent vouchers to assist underserved populations for private housing.

So what does all this mean? Why is it important? Why should we address this? So drivers for structural determinants of health have a long-standing impact on community violence in Washington, DC. Community trauma from adverse childhood experiences stemming from concentrated poverty, low-quality housing, and community segregation from redlining practices during the Jim Crow Era play a significant role in perpetuating community violence to this day. It was found that the availability of affordable housing shapes families’ choices on where they live and has the potential to relocate low-income families to substandard housing in neighborhoods with higher rates of poverty and crime, and fewer health care services.

So my conclusion from this research project was to look more into the anti-racist housing policies to understand gentrification and violence in low-income DC neighborhood and understanding the historical contexts that allowed for current community demographics and individual displacement. I also wanted to look more into how we can prevent crime and invest in community safety – what changes must be made to community infrastructure involving diverse approaches with youth that are multi-sectoral, include public-private partnerships and have multiple stakeholders in the community.

Thank you for listening! I would like to acknowledge my mentor, Dr. Debora G. Goldberg. The college of public health, GMU undergraduate research scholars program, and the Office of Student Scholarships, Creative Activities, and Research for funding this project. Thank you everyone. I hope you have a great day.

College of Public Health

Impacts of Learning Environments on Stress in the Covid Era and Beyond

Author(s): Alex Ramirez, Amy Burkhart, McKenzie Lauber

Mentor(s): Dan Freedman, Social Work

Background: Due to the Covid-19 pandemic, students had to shift to completely virtual learning. Now, with classes shifting back to being in-person, students once again have to adjust to a shift in learning environments. Students naturally experience stress related to school, but with the pandemic and the changes to learning environments, it is unknown how significantly these changes impacted student stress.

Purpose:The aim of this study is to determine what method of learning students prefer and how the pandemic has influenced any change to learning environment preferences and stress levels.

Methods: The survey was conducted online through Qualtrics, and took participants roughly fifteen minutes to complete. Participants were recruited to take the survey through the Department of Social Work email list at GMU, as well as sending the flier out in the weekly student newsletter. Analysis of the data is being conducted on SPSS.

Results: Will have results by time of presentation. The study is currently finishing up with data collection.

Conclusions: Will be done by time of presentation; the study is still ongoing.

COVID 19 was a very stressful time and changed parts of our lives in many ways. For students a large part of that was the delivery of courses. We switched from majority in person learning to all online learning. Now there are hybrid options as well. It is unknown how the learning environment and stress has impacted the student. The purpose of this study is to see whether the learning mode or environment has an impact on stress levels for the college student and their preferences of how they like to learn. The methods we are using are a fifteen minutes qualtrics survey. This survey was sent out by email by the professors in the department of social work to both undergraduate and graduate social work students. We are currently in the data collecting stage and will have results by the end of April. We will have conclusions on this study by the time we present in May. Thank you.

College of Public Health

Dietary Habits, Attitudes, and Intakes of Indoor Rock Climbers

Author(s): Daniel Serruya

Mentor(s): Lawrence Cheskin, Nutrition

This project has three aims: first, to provide dietary data on a diverse group of climbers; second, to investigate the effect of specific interpersonal, intrapersonal, and environmental factors on eating habits in climbers, including disordered eating behaviors; and lastly, to understand if climbing ability or attitude has any correlation with dietary intake and eating habits. Rock climbing has evolved into a competitive sport over the past few decades. The importance of nutrition is acknowledged within the climbing community; however, there is not much research on nutrition for climbers. This study is designed to investigate and gather data on a diverse group of climbers of all skill levels to understand their dietary habits, attitudes, and intakes and how that may be linked to other lifestyle factors.

Gym climbers were asked to complete an online survey and we are currently randomly selecting participants to complete a three day food diary. The survey asked participants about their demographics, climbing habits, climbing attitudes, climbing ability, diet composition, eating habits, and eating attitudes. The Eating Attitudes 26 question test was used to investigate eating habits and attitudes

We found that there is not a statistically significant correlation between climbing ability and EAT-26 scores and that the prevalence of EAT-26 scores greater than 20 was higher in male-identifying participants compared to female-identifying participants (8.63% vs 6.71%).

Data suggests that the risk of disordered eating habits may not be exclusive to just top level climbers. The male climbers having a higher prevalence of scores greater than 20 suggests that male climbers have similar risk for disordered eating to female climbers, which contradicts current literature that suggests that women have higher prevalence of eating disorders.

Hi, that’s me right there. My name is Daniel Serruya, and, I enjoy rock climbing and call myself a climber. I am an undergraduate student at George Mason University studying community health and nutrition and I am interested in nutrition specific to climbers.

Within the climbing world, current research supports the widespread belief that being lightweight and lean is conducive to climbing better. To further emphasize this, here are some of the current world’s best climbers. As we can see, all of these climbers are lightweight and extremely lean. Achieving this type of physique is the result of rigorous training on top of diet.

The importance of diet for climbing is well known; however, there is a severe lack of scientific information and supporting resources about nutrition for climbers. In fact, many climbers, myself included, have seen fellow climbers with disordered eating habits while pursuing performance on the wall. One piece of academic literature published in 2022 titled Attitudes towards disordered eating in the rock climbing community: a digital ethnography written by Mattias Strand found that the online climbing community is very split on the threat of eating disorders and disordered eating for climbers. With the community being so split, and there being such little credible information on what climbers eat and how they compare to the general population, and athletes from other sports, there is a need for research to shed light on this topic.

Alongside my mentor, the department chair for the nutrition department here at George Mason, Dr. Lawrence Cheskin, we aim to shine a light on this new field by investigating the Dietary Habits, Attitudes, and Intakes of Indoor Rock Climbers

This project is a two part study consisting of a survey, and then a three-day food diary. For the survey, we asked participants about their demographics, climbing habits, attitudes towards climbing, climbing ability, diet composition, and eating attitudes.

Some published tools were used as a part of the survey: the IRCRA scale developed by the International Rock Climbing Research Association, the Healthy Eating Index, and the Eating Attitudes 26-question test, EAT-26 for short. The Eat-26 is designed to study eating habits and a score greater than 20 suggests that the testee may want to see a specialist.

We recruited 311 participants by having a recruitment poster on display in 45 different climbing gyms across the United States.

The data collected from this survey has two findings of interest. First, there is no significant correlation between climbing ability and disordered eating. We found that the prevalence of scores over 20 tends to increase with climbing ability, with the exception of the largest category, the advanced climbers. This suggests that the the presence of disordered eating habits is common at all ability levels, but may be more pronounced in the more skilled climbers due to a smaller sample size.

Second, the 139 male-identifying participants in this study had a somewhat higher prevalence of disordered eating habits than the 149 female-identifying participants did, 8.6% for the men and 6.7% for the women. This is groundbreaking since current studies suggest that eating disorders are much more common in women than men. This calls for more nutrition research on climbers and nutrition services that are specific to climbers.
Over the next few months, my mentor and I will collect food recalls from climbers of all skill levels in order to answer the question of “what do rock climbers eat?â€ so that we can compare the diets of climbers with the diets of the general population, and athletes in other sports.
I want to thank the Undergraduate Research Scholars Program, the Nutrition Department at George Mason University, every climbing gym and their staff listed here on the screen, Matthew Hicks, my mentor Dr. Lawrence Cheskin, and all of you for contributing to this important work!

College of Public Health

Effects of Substance Use Disorder Incarceration on African American Adult Children

Author(s): Bryce Quinn Schwendiman, Cristina Schuck Adao, Jackie Custer, Paige Crilly

Mentor(s): Daniel Freedman, Social Work

Background – Over-policing the African American community for the last forty years has led to an overrepresentation of this demographic in the United States jails and prison systems. Many of these individuals are parents, making their children a highly vulnerable population. Parental incarceration is one of many adverse childhood experiences that can lead to negative mental, physical, and social outcomes. To date, there is little known about these experiences from the now adult child’s standpoint and even less so specific to the African American individual’s experience.

Purpose – The purpose of this study is to understand the lived experience of adult children identifying as African American whose parent(s) were previously incarcerated (at participants’ age of 17 or under) and who had substance use disorders, specifically around an understanding of the emotional, mental, physical, and social impacts of those events.

Methods – Focus group. Online recruitment and snowball sampling. Thematic coding.

Results – Authors expect to find various important themes due to focus group transcription and coding. Themes surrounding negative and positive experiences with mental health and social support are expected to be found based on the literature review performed for the research.

Conclusions – The focus group questions aim to uncover topics surrounding the relationship outcomes of parental incarceration and substance use, social support needed or used during parental incarceration, and the mental and physical health outcomes of such experiences. Lastly, the authors aim to elucidate the programming needs of children experiencing parental imprisonment by analyzing transcribed focus groups.

Hello, my name is Cristina Adao and I’m working alongside Jackie Custer, Paige Crilly, and Quinn Schwendiman for our BSW Capstone which is discussing the effects of parental substance use disorder incarceration on African American adult children. Over policing the African American community for the last 40 years has led to an over-representation of this demographic in the United States jails and prison systems. Many of these individuals are parents, making their children a highly vulnerable population. Parental incarceration is one of many adverse childhood experiences that can lead to negative mental, physical, and social outcomes. Research conducted by Stack in 2020 states that “one in nine African American children have an incarcerated parent while only 1 in 57 white children do.” Despite this over-representation in our country’s Criminal Justice System, the lived experiences of adult children who identify as African American with a parent who has been incarcerated and manifests a substance use disorder is absent in the academic literature. The purpose of this study is to understand the lived experiences of adult children identifying as African American whose parents were previously incarcerated at participants age of 17 years or younger and who have also had substance use disorders. We seek to understand the emotional, mental, physical, and social impacts of these events. Informal observations were uncovered through conversations with individuals deemed knowledgeable about the topic of Interest. So, we spoke with individuals who have Professional Knowledge of the phenomenon, those who directly experience the phenomenon, and those identifying as African American. In documenting these interactions, narrative themes emerged and while the results are not based on research, they do align with those from the literature. We found that while the experiences of Parental incarceration were trying and stressful, contacts also disclosed strengths and resiliencies. Notable themes included the negative impacts of incarceration, such as obtaining steady employment and a lack of financial stability, as well as having social solid support. Overall the experiences provided both comfort and confusion and based on these observations we have suggested several guidelines for future research, policies, programs, and standards that include facilitating settings that are inviting for children who are visiting their incarcerated parent, advancing systemic changes to the treatment of those involved in the criminal justice system, developing formal and informal social support programs for children impacted by parental incarceration, and introducing Employment Services to incarcerated parents before re-entry into society. Thank you so much.

College of Public Health

Developing an Understanding of Strategies for Empowering Undocumented Students in Higher Education

Author(s): Angelica Guevara Lopez, Elizabeth Garcia Alvarez, Hana Missikir, Liliana Guevara, Mila Rivas, Wendi Ramirez- Montecin

Mentor(s): Dan Freedman, Social Work

Background: Only 5-10% of undocumented students continue onto higher education and even less successfully graduate with a degree (Gindling & Poggio, 2012). Approximately 450,000 undocumented students are currently enrolled in higher education institutions (Greico et al., 2012). These students often undergo difficulties that present an immense threat to their ability to be successful in college.
Purpose: The purpose of this study is to gain a better understanding of the obstacles that undocumented college students face; with the intention to ultimately find strategies to alleviate them of these impediments, promote their success, and empower them.
Methods: The sample will consist of 10 participants who identify as undocumented graduate and/or undergraduate students at George Mason University. Based on the university’s demographics, it is anticipated that participants will be of latino ethnic backgrounds and be part of a variety of programs across George Mason University. A purposive sampling method will be used.Ten in-person interviews consisting of open-ended questions will be conducted. The interviews will follow the same agenda and will focus on identifying the strengths, challenges, gaps, and limitations within the areas of mental health and resource accessibility for undocumented students. When interviews conclude, transcripts will be reviewed for the purpose of identifying the most common themes reported by the participants.
Results and Conclusions: The data collection is still in process, results and conclusions will be available before the day of the presentation.

Hello, my name is Angelica Guevara Lopez. Members of my group and I will be presenting our capstone project for our social work class for our submission to the Oscar 10th annual Celebration of student scholarships. Our capstone project is about developing an understanding of strategies for empowering undocumented students in higher education.

We will begin with background information about undocumented students.

Only 5-10% of undocumented students continue on higher education and even fewer successfully graduate with a college degree. There are approximately 450,000 undocumented students who are currently enrolled in higher institutions in the united states. Due to their immigration status, there are obstacles they face that make it harder for them in their college career which can result in them not completing college. Based on the facts and statistics on undocumented students, our group came up with our research question which is How can undocumented students in higher education be empowered?

In the next slide, we will discuss the purpose of the study.
The purpose of the study is to gain a better understanding of these and other issues that undocumented college students faced with the intention to ultimately alleviate undocumented students of these impediments as the outcomes of the study can help higher education institutions acquire insight and possibly implement the suggested changes to better serve their undocumented student population to help them reach their full potential as students/upcoming professionals.
Our study consisted of 10 undocumented undergraduate and or graduate students who attend George Mason we used a purposive sampling method to ensure accurate and real information in regards to the challenges the participants faced. We conducted a survey with 10 open-ended questions that took approximately 30 minutes to complete the participants were able to share their stories and comment on what has and hasn’t been challenging with regards to their higher education experience. we decided to do a serving to ensure the participants responses where anonymous the survey was confidential and no identifiable information would be revealed the survey focused on identifying the strengths challenges gaps limitations within areas of Mental Health and resource accessibility for undocumented students. We would review all completed surveys to identify common themes and find quotes that represent each theme. We would identify 3 to 5 themes. Thank you for your time

College of Public Health Honors College Undergraduate Research Scholars Program (URSP) - OSCAR

The lack and delay of endometriosis diagnosis in black women

Author(s): Nene Uwaomah

Mentor(s): Jhumka Gupta, College of Public Health

Endometriosis is a chronically painful condition with poor health related outcomes for those diagnosed with it. These outcomes may include chronic pain, infertility, and experiences with stigma, among others. While there is some research available on the experiences of women of color in other jurisdictions, the experiences of women of color in the DC metro area, who have been diagnosed with endometriosis, have yet to be characterized. This study serves to understand how black women and other women of color with symptoms suggestive of endometriosis experience medical racism. This will be done with a focus group from participants from the ENDO-Served study on endometriosis in women of color based in the DC metro area. The research question: are women of color who report discrimination in the healthcare setting more likely to have a lack or delay of diagnosis of endometriosis? The methodology used in this study was a qualitative methodology, done with interviews of women of color with endometriosis. Through these interviews the participants will express their experience with their diagnosis of endometriosis and the treatment they received from their healthcare provider. Results from this methodology will help us to explore a deeper understanding of the perceptions and stigma of this condition. As well as help to develop programs related to reducing barriers as well as time of diagnosis, addressing racism, and stigma, among black and other women of color. This research was conducted with the funding of OSCAR and URSP at George Mason University. The research was overlooked by Dr. Jhumka Gupta a professor at George Mason University, and Julia Mandeville, Ph. D candidate responsible for the study and creation of Endo-Served.

Hello and thank you for coming to my presentation. My name is NeNe Uwaomah and I’m presenting my study are women of color who report discrimination in the healthcare setting more likely to have a lack or delay of diagnosis of endometriosis. My mentor is Dr. Gupta from the Department of Community and Public Health at George Mason University.

Some background from how we got to this topic question; endometriosis is an understudied disorder of the uterus. Endometriosis is a disorder in the female reproductive system that occurs when tissues that normally line the uterus, grow outside of the uterus. It is a chronically painful condition with poor health related outcomes for those diagnosed with it. Endometriosis impacts 1 in 10 women, and is a condition characterized by debilitating pelvic pain and activity impairment that can also lead to infertility. Other than the lack of research into the experiences of women in these populations with endometriosis, there are also disparities in the diagnostic outcomes. Studies have found that Black women were less likely to be diagnosed with endometriosis (OR 0.49, 95% CI 0.2 9 -0.8 3)4, or were more likely to have a delay in diagnosis (µ=2.6 years older (95% confidence interval [CI], 0.5-4.6), when compared to white women(Li, et al, 2021).
The methodology used in the study included both qualitative and quantitative formats. First was an IRB approved Qualtrics survey prepared by Endo-Served. A project developed for the study of endometriosis in women of color in the DC, Maryland, and Virginia metropolitan area. The study identified key similarities between volunteers and their experience with endometriosis and the healthcare system. From the survey, significant numbers showed that discrimination was a factor with the women’s diagnosis along with stigma. From the survey participants a few women volunteered to participate in individual meetings to discuss their diagnosis story and experience in healthcare. Authentication of participants was prioritized. Their identities remain anonymous. It was ensured that the participants were aware of and comfortable with the study design and purpose. The interviews allowed the participants shared their difficulties with their diagnosis, as well as answer questions pertaining to their experience. The questions included;
Tell me your diagnosis story
2. Where did you first hear the word “endometriosis”?
a. Probe for family/friends, social media vs health care provider
3. In our data with ENDO-Served (explain what Endo-served is if they are not familiar), we are finding that women who reported learning about endometriosis for the first time from a family member/friend also reported more experiences with racism in a healthcare setting. Why do you think this is?
a. How, if at all, does this relate to your experiences?
4. What do you think needs to change regarding racism in healthcare settings?

The interviews resulted in similar answers between the four participants. ¾ of the women had to receive second and third opinions as their concerns were not taken seriously enough by their first physician. All of the women experienced excruciating pain, heavy bleedings, nausea, extended fatigue and some experienced problems with childbearing. Each woman explained their difficulties as they did not feel heard by their medical professionals and were stereotyped into the stigma that their pain tolerance was higher as black women. They were made to feel isolated and crazy, resulting in trauma of life alterations. When the women were diagnosed, all had to undergo surgery in order to remove cysts, fibroids, and growths. At the point of diagnosis, the women were in moderate and severe stages of endometriosis.
Most women had just first heard of endometriosis when they were being diagnosed, and those that did not first hear it through diagnosis, had looked up their symptoms through non-formal sources and discovered endometriosis. The cause of endometriosis is unknown, but it is believed to be a genetic or hereditary disorder. There is no cure, but a hysterectomy is the medical recommendation to cease major pain.
The lack of representation in research and clinical studies, is of consequence for women of color in the diagnosis, management and treatment of endometriosis which may result in misunderstanding, misdiagnosis and lack of appropriate treatment options when engaging with healthcare providers. This prompts a need for further research and action on this topic as there are many more women suffering in pain due to insufficient knowledge on this topic. Continued work on this study will help to foster a deeper understanding of the perceptions and stigma of this condition and additionally provide evidence for developing programming related to reducing barriers as well as time of diagnosis, addressing racism, and stigma, and facilitating help-seeking among Black women and other women of color.

Thank you for listening and I would like to also thank my mentors and co-organizers at George Mason University; Dr. Jhumka Gupta, Dr. Anna Pollack, Julia Mandeville, and Lauren Kornegey, as well as all the volunteers for the interviews and survey participants. And of course, a big thanks to Dr. Karen Lee and the undergraduate research scholars program and OSCAR for funding my project this semester.

College of Engineering and Computing College of Public Health Summer Team Impact Project Undergraduate Research Scholars Program (URSP) - OSCAR

Personalized Intervention Using Personalized VR Recovery Rooms and Avatars

Author(s): Omar Alsuhaibani, Taylor Dinh, Elizabeth Kwari, Sara Razavi

Mentor(s): Nathalia Peixoto, Bioengineering

This project focuses on creating a personalized virtual reality (VR) safe space and avatar for individuals that are recovering from substance use disorder. HTC Vive (VR headset), Unity (Game engine), VRoid (Avatar assembly and characterization), and Blender (3D-design software) are used to create the VR safe space and avatar. The HTC Vive is calibrated and linked to Unity, and eye tracking scripts are implemented in Unity. To test the effectiveness of the VR safe space and avatar, an E4 is connected to the computer and to Unity to record the heartbeat in real-time. The heartbeat is then translated into the avatar’s animation using VRoid to simulate the emotion during particular heart rates as an indication of stress, anger, or fear.

(Slide 1)
Hello we are one of the groups taking part in the STIP program for the summer of 2022. The topic of our group’s project focused on creating a personalized VR recovery room and avatar for individuals that are recovering from substance use disorder (SUD).

(Slide 2)
And this brings us to our group’s overall goal statement, a reiteration of what was previously stated. Our group wanted to create a personalized VR safe space and avatar for individuals recovering from substance-use disorder.

(Slide 3)
The reason we decided to do more research pertaining to the topic of VR and personalized intervention has to do with the various forms of literature that are in support of VR technology as a useful method for recovery therapy.

For example, there was one study where VR was used on patients & healthcare providers in COVID-19 rehabilitation units. They found that VR helped them to cope with the isolation and loneliness they felt while quarantining during the beginning of the COVID-19 outbreak.

Another example can be seen when patients in mental health care faculties used VR technology. It helped individuals that experienced high levels of stress reduce their stress levels and maintain a calmer attitude in their daily life.

Finally, in a study that was conducted on drug abusers in a drug rehabilitation center in China, researchers found that after VR treatment, the participant’s craving for drugs was severely reduced.

For this reason, our group felt that looking more into and trying to personalize VR safe spaces and avatars would be a viable and useful method to assist individuals recovering from substance use disorder.

(Slide 4)
The design of this project was created in a temporary manner by using HTC Vive, Unity, and Blender for the development of the personalized recovery room.

(Slide 5)
Hi, my name is Taylor Dinh, I was the programmer on this project. The video you can see here is a recording of the viewport and project windows within Unity. I programmed in Unity, a game engine which runs off of C#, in order to create a VR room that can be viewed and interacted with through the HTC Vive and controllers. Our original intention was to make a therapeutic room where people with substance use disorder could go into the room and see an avatar that would mimic their heart rate using the animation controller and an Empatica. Unfortunately, we could not get this to work, however, we did make a VR room that the participant can interact with.

(Slide 6)
For the Empatica set-up, E4 streaming desktop app was used in order to keep track of the real time data streaming from the device attached to the participant using a bluetooth dongle connected to the computer
The BLE github code to connect Unity to the E4 was used in order to attempt to connect the two so that the player could see their metrics in real time

(Slide 7)
In terms of the personalized avatar, our team had initially started constructing the avatar using Blender. However, it proved to be much more challenging than what had initially been expected. While it is a viable solution, it would take time and a lot of effort to construct a model personalized to an individual’s preference.
Instead, our group looked into personalizing avatars using VRoid. This method proved to be much easier in terms of personalizing the avatar compared to building it from scratch in Blender. Creating the avatar proved to be a lot easier in VRoid as it includes several type of customizable features and can be easily imported into Blender and then Unity which is very helpful. If you are interested in learned more about creating your own personalized avatar and importing it into Blender, you can check out the full version of this video on our teams website.

(Slide 8)
In conclusion, the VR personalized intervention room and avatar that this paper has attempted to develop went successfully in building a minimal demonstration of the capabilities VR technology can have. The VR personalized intervention room model developed here integrates highly important aspects, such as head tracking and eye-tracking, to ensure that the user focuses on the intractable objects around them. In addition, the model developed had the ability to present generic soothing images in an act to calm down the users.
The purpose of this paper was to demonstrate an inexpensive method to develop a personalized recovery room and avatar with the use of VR based on heart rate.
The results were relatively similar where the personalized recovery room was able to become developed, albeit not personalized to particular users and their needs. However, the results prove that the ability to develop personalized recovery rooms that implement important personal variables (such as the users’ dogs, family homes, or family pictures) is a lot more difficult and requires a lot more time by trained professionals.

College of Education and Human Development College of Public Health College of Science Honors College Summer Team Impact Project Undergraduate Research Scholars Program (URSP) - OSCAR

How do sleep, physical activity, and diet contribute to aerobic fitness in U.S. firefighters?

Author(s): Hana Khan

Mentor(s): Joel Martin, Marcie Fyock-Martin; Kinesiology

Abstract: Firefighting involves high intensity work and requires firefighters to maintain optimal levels of health. Unfortunately, due to the nature of their occupation, firefighters’ sleep, diet, and physical activity (PA) are often compromised, contributing to low aerobic fitness.

Purpose: To determine how sleep, PA, and diet behaviors contribute to low respiratory fitness in U.S firefighters. Methods: Participants included [10 males, 3 females, age: 36(30, 41), years of service: 14(10, 18), height(cm): 181.9(177.5, 185), mass(kg): (122.4(109.6, 121.7)] and needed to be Prince William County Firefighters and have no prior history of CVE, pulmonary, renal, and metabolic disease. Participants took a diet (REAP-S), sleep (PSQI), and PA survey (IPAQ-SF). Anthropometric measurements were taken using a BOD-POD®. The 3-minute step test was used to determine aerobic fitness. A Mann-Whitney U test with a p value of 0.05 was used to determine significant variables between two groups: those who performed poorly on the step test versus those who performed above poor. Effect size was calculated using Glass rank biserial correlation coefficient. The project was exploratory, so alpha was set to <0.01. Results- Variable(W-score, p-value): BF %(15, 1), PSQI(18.5, 0.6086), REAPS(18.5, 0.6066), and MPA(21, 0.3458), LPA (18, 0.6709), and Sitting time(12, 0.6709) FFM(11, 0.5541) showed no significant differences between groups. However, FM(4, 0.07593) and VPA(29, 0.02139) were statistically different between the groups. Conclusion: Post- statistical analysis showed that only VPA(29, 0.02139) and FM(4, 0.07593) were statistically different between the two groups. Vigorous physical activity is necessary in firefighters given the intense nature of their work. Excess fat mass is also a hindrance to performance and health as it can increase risk for cardiovascular events. Fire stations need to work towards implementing fitness programs to sustain firefighter aerobic fitness.[/expand] [expand title="Audio Transcript"]Hello! My name is Hana Khan. I'm currently an undergraduate student at George Mason and I am majoring in Community Health with a concentration in Nutrition. I'm so excited to share my research question with everyone that I worked on during my Summer Team Impact Project. So, my research question is: How do sleep, physical activity, and diet contribute to aerobic fitness in U.S. firefighters? You might be wondering, why is this an important or relevant question to ask? As I spent time in the project, it became apparent to me that many firefighters are not able to maintain healthy fitness levels, despite often having to perform physically difficult tasks. Their sleep, diet, and physical fitness levels have been shown in numerous studies to be sub-optimal, and studies have pointed to correlations between these three. Research has shown that aerobic fitness is especially important in firefighters- and yet, many do not have the required fitness levels needed to safely perform their jobs. It turns out, CVD is a leading cause of death in firefighters, most likely due to their work duties. Aerobic capacity is also correlated to CVD, where a low capacity means a higher risk. So I really wanted to focus on that with this topic. There were 13 participants in total, and their specific demographic information is listed on the slide under the methods section. The participants took a few surveys to assess their diet, sleep, and physical activity status. They then had some measurements taken, such as height, weight, body fat, etc. And finally, they performed a three minute step test, which is essentially a test that is used to determine aerobic fitness that involved stepping on and off plates raised to 12 inches to a metronome set to 96bpm. We divided the participants based on how they performed on the 3 minute step test. So one category was for those who performed poor, and one was for those who performed above poor. So after looking at all these variables from the surveys and measurements as seen in the table, and running them through a Mann-U-Whitney test, we found that only Vigorous Physical Activity (which we got from the physical activity survey) and Fat Mass (which we got from the anthropometric measurements) were significantly different between these two groups. Now, I will say that a limitation of this study is definitely that the surveys have self reported values, which means the participants may over or underestimate their responses. However, it cannot be ignored that fat mass and vigorous physical activity are both very important to firefighter fitness and performance. Vigorous physical activity is needed on the job when climbing and carrying things is needed, and excess fat mass can be a hindrance to performance and also increase CVD risk. Thus, I believe it would be beneficial for fire stations to provide individualized fitness programs aimed at targeting aerobic fitness and keeping firefighters active instead of launching them into a physically intense situation from a very low active situation. That's all from me, thank you for listening and I hope you gained something valuable from this presentation![/expand]