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Balasundaram RB, Boateng S, Yockey RA, Yording H, Tran D, Nguyen USDT. Oral health literacy, knowledge, practice and beliefs among Asian Americans: A scoping review. Community Dent Oral Epidemiol 2024. [PMID: 38922997 DOI: 10.1111/cdoe.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 03/15/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES The Asian American (AsA) population is at high risk for poor oral health outcomes and remains an underserved and understudied community. Low oral health literacy could explain poor oral health behaviours, practices and outcomes in this population. The aims were as follows: (i) provide a scoping review of oral health literacy, knowledge, practice and beliefs among AsA individuals residing in the United States; (ii) identify any instruments or tools translated into participants' language and (iii) determine whether the translated instruments had been assessed for validity and reliability. METHODS The current study used a scoping review framework based on PRISMA-ScR that included rigorous eligibility criteria, search strategy, independent selection process with adjudication, and standardized reporting of outcomes. The search was conducted on March 14, 2022, and updated on February 25, 2023 and February 13, 2024, in the following databases: Ovid MEDLINE, Embase, Web of Science and CINAHL. Peer-reviewed original research on oral health literacy, knowledge, awareness, practice, and beliefs related to oral health care in AsA subgroups published in English were included. Two reviewers independently assessed whether titles and abstracts should be included for review, with discrepancies adjudicated by a third reviewer. Data extracted from articles used a standard template that included study design, and measurement tools of oral health, knowledge, awareness, practice and beliefs, as well as results and conclusions of the publication. In addition, the template captured whether the translated and original measurement tools were assessed for reliability and validity. RESULTS Of the 367 papers identified, 10 studies that met eligibility criteria were included in the final review. Of these, four studies used previously validated tools to assess oral health measurements in AsA. Only five of the studies translated the tools into the participants' native language. Although AsA exhibited lower oral health literacy than Whites but higher than Hispanics and African Americans, none of the translated tools were assessed for reliability and validity. Acculturation and country of birth were factors influencing oral health behaviours related to good oral health practice and utilization, with AsA born in the United States exhibiting higher oral health utilization than those born in their country of origin. Oral health beliefs played a significant role in dental care utilization among AsA populations. CONCLUSIONS The scoping review on oral health in Asian American communities identifies a significant research gap, particularly in the lack of validated tools for assessing oral health literacy, which varies across ethnic groups. It notes that AsA generally have lower oral health literacy compared to Whites, but higher than Hispanics and African Americans. AsA born in the United States shows better oral health practices, influenced by acculturation and birth country. The findings emphasize the need for more thorough and culturally adapted research methods to address oral health disparities in this diverse group.
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Affiliation(s)
- Rohit Baal Balasundaram
- Department of Population and Community Health, University of North Texas Health Science Center School of Public Health, Fort Worth, Texas, USA
| | - Sarpong Boateng
- Department of Population and Community Health, University of North Texas Health Science Center School of Public Health, Fort Worth, Texas, USA
| | - R Andrew Yockey
- Department of Population and Community Health, University of North Texas Health Science Center School of Public Health, Fort Worth, Texas, USA
- Department of Internal Medicine and Geriatrics, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
- School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Hayley Yording
- Mary Couts Burnett Library, Texas Christian University, Fort Worth, Texas, USA
| | - Duong Tran
- Department of Diagnostic and Biomedical Sciences, UTHealth Houston School of Dentistry, Houston, Texas, USA
| | - Uyen-Sa D T Nguyen
- Department of Population and Community Health, University of North Texas Health Science Center School of Public Health, Fort Worth, Texas, USA
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Luo T, Beiter K, Tseng TS. Association between acculturation, dental floss use, dental visits and unmet dental needs among Asians in the United States: Findings from National Health and Nutrition Examination Survey (NHANES) 2011-2018. Community Dent Oral Epidemiol 2024; 52:101-110. [PMID: 37646317 DOI: 10.1111/cdoe.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/31/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES The objectives of this study were to examine the associations between acculturation and dental floss, regular dental visits and unmet dental care needs among Asian Americans, as well as the moderating effects of these associations. METHODS This study analysed national representative samples from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. A total of 2763 Asian Americans aged 20 and older were included in this analysis. The primary predictor, acculturation score, was determined by three questions: (i) language spoken at home (higher score for English), (ii) country of birth (higher score for United States) and (iii) length of time in the United States. Dental floss use, dental visits and unmet dental care needs were included as outcomes in this study. Descriptive statistics and logistic regressions were used to analyse the samples. RESULTS Acculturation was significantly associated with dental health behaviours: Individuals with higher levels of acculturation were more likely than less acculturated individuals to use dental floss (81.0% vs. 63.9%, respectively) and visit the dentist regularly (76.7% vs. 66.9% respectively). Insurance status moderated the association between acculturation and dental visits: Acculturation was significantly associated with dental visits in the past year among insured individuals (OR = 1.70, 95% CI: 1.29-2.23), but not among uninsured individuals. Unmet dental care needs were present in 11.1% of participants. While costs and insurance were the top two determinants of access to care, individuals with and without insurance differed with regard to their third major reason for unmet dental care needs: Being 'too busy' and not wanting to spend money on dental care. CONCLUSIONS Among the Asian population in the United States, those with high acculturation scores were more likely to engage in dental flossing and visit the dentist regularly compared to those Asians with lower acculturation scores. To encourage dental flossing and regular dental visits among Asians with lower acculturation scores, cultural adaptation and language accessibility suggests being considered. Future research is necessary to confirm the moderating effect of insurance status on the association between acculturation and regular dental visits. Additionally, our findings emphasize the impact of costs and insurance on access to dental care among Asians in the United States, highlighting the importance of future public health programmes in addressing these barriers.
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Affiliation(s)
- Ting Luo
- Moores Cancer Center, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Kaylin Beiter
- School of Medicine, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
| | - Tung-Sung Tseng
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
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Zhang K, Wu B, Tsay RM, Wu LH, Zhang W. The Moderating Role of Self-Rated Oral Health on the Association Between Oral Health Status and Subjective Well-Being: Findings From Chinese Older Adults in Hawai'i and Taiwan. Res Aging 2024; 46:3-14. [PMID: 36825677 DOI: 10.1177/01640275231158771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
This paper aims to address the research questions of whether individual's oral health status is associated with subjective well-being, as well as if there is possible moderating role of self-rated oral health among two groups of Chinese older adults (≥55 years old) in Honolulu, Hawai'i and Taichung, Taiwan. Using survey data collected in 2018 (N = 430, Honolulu) and in 2017 (N = 645, Taichung), ordinary least square regressions were applied. Results showed that, for both samples, oral health status was negatively and significantly associated with subjective well-being, and both associations were moderated by self-rated oral health. In addition, the moderating effects were more salient for the Honolulu sample, who enjoyed higher levels of self-rated oral health and life satisfaction. These results suggest the significant associations of both oral health status and self-rated oral health on individual health and well-being for Chinese older adults residing in different cultural contexts.
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Affiliation(s)
- Keqing Zhang
- School of English and International Studies, Beijing Foreign Studies University, Beijing, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
- NYU Aging Incubator, New York University, New York, NY, USA
| | - Ruey-Ming Tsay
- Department of Sociology, Tunghai University, Taichung, Taiwan
| | - Li-Hsueh Wu
- Department of Sociology, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Wei Zhang
- Department of Sociology, University of Hawai'i at Mānoa, Honolulu, HI, USA
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Mao W, Wu B, Chi I, Yang W, Dong X. Experiences of discrimination and oral health-related quality of life among foreign-born older Chinese Americans: Does resilience play a mediating role? Community Dent Oral Epidemiol 2023; 51:187-193. [PMID: 34958135 DOI: 10.1111/cdoe.12723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES It is well-established that racial discrimination influences quality of life, but there is scarce evidence about how racial discrimination affects oral health-related quality of life (OHRQoL). Furthermore, the pathways linking racial discrimination and OHRQoL remain unknown. Guided by the integrative framework of immigration, ageing, and oral health, psychosocial stressors and resources exert influences on OHRQoL. In addition, according to the compensatory model of resilience, resilient resources could counteract risk exposures to stressors given specific outcomes. Hence, this study examined the relationship between experiences of discrimination and OHRQoL and investigated resilience as a mediator in such a relationship among older Chinese immigrants. METHODS Data came from the Population Study of Chinese Elderly in Chicago collected between 2017 and 2019. The working sample included 3054 foreign-born older Chinese Americans aged 60 years or older. OHRQoL was measured by seven items from the Geriatric Oral Health Assessment Index. Experiences of discrimination (yes or no) were measured by the 9-item Experiences of Discrimination instrument. Resilience was measured by the 10-item Connor Davidson Resilience Scale. Mediation analysis was conducted to examine the direct and indirect pathways towards OHRQoL. RESULTS Experiences of discrimination were directly associated with poorer OHRQoL (b = -0.98, P < .05). Resilience partially mediated the relationship between discrimination experiences and OHRQoL. Specifically, discrimination experiences were associated with weaker resilience (b = -1.58, P < .05), and weaker resilience was associated with poorer OHRQoL (b = 0.06, P < .05). CONCLUSIONS Findings illustrate the importance of studying racial discrimination and resilience in OHRQoL. Interventions need to consider individuals' discrimination experiences and stress coping abilities to promote OHRQoL.
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Affiliation(s)
- Weiyu Mao
- School of Social Work, University of Nevada, Reno, Reno, Nevada, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Wei Yang
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | - XinQi Dong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA
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Marcus K, Balasubramanian M, Short S, Sohn W. Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed-methods systematic review. Community Dent Oral Epidemiol 2023; 51:327-344. [PMID: 35342972 DOI: 10.1111/cdoe.12745] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Culturally and linguistically diverse (CALD) communities experience widespread inequalities in dental care utilization. While, several studies have reported factors contributing to such inequalities, a synthesis of evidence is lacking for CALD carers. This review examined the barriers and facilitators to dental care utilization among CALD carers. METHODS Medline, CINAHL, ProQuest, Scopus and Web of Science were searched for dental utilization and related factors, without geographic limitations. An integrated mixed-method design was adopted, where both qualitative and quantitative findings were combined into a single synthesis. Critical appraisal was conducted using JBI tools, and a Universal Health Coverage (UHC) framework guided the synthesis approach. Reliability and researcher triangulation occurred throughout the conduct of this review. RESULTS A total of 20 papers were included: qualitative (n = 8), quantitative (n = 8) and mixed method (n = 4). Studies were from Australia, Canada, South Korea, Trinidad and Tobago, United Kingdom and the United States. Three studies insufficiently reported confounding variables and nine qualitative papers lacked philosophical perspectives. Affordability was the foremost barrier at the system level, followed by psychosocial negative provider experiences and language/communication issues at the provider level. Cultural, knowledge, attitudes and beliefs were individual-family level factors. Utilizing a UHC framework, the barriers and facilitators were aggregated at three levels; financial-system, provider and individual-family levels and illustrated in the rainbow model of CALD oral health. CONCLUSION The review strengthens evidence for multilayered, system-related policies and culturally sensitive provision of services for reducing oral healthcare inequalities in CALD carers.
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Affiliation(s)
- Kanchan Marcus
- Faculty of Medicine and Health, School of Dentistry, The University of Sydney, Surry Hills, New South Wales, Australia
| | - Madhan Balasubramanian
- Health Care Management, College of Business, Government and Law, Flinders University, Adelaide, South Australia, Australia
- Faculty of Medicine and Health, Menzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Short
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Woosung Sohn
- Faculty of Medicine and Health, School of Dentistry, The University of Sydney, Surry Hills, New South Wales, Australia
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Liu S, Zhang W, Zhang K, Wu B. The Association between Intergenerational Support and Self-Rated Health among Chinese Older Adults: Do Resilience and Gender Matter? J Appl Gerontol 2023; 42:111-120. [PMID: 36204775 DOI: 10.1177/07334648221127882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This study aims to examine the association between intergenerational support and self-rated health (SRH) levels using data collected from Chinese older adults residing in Honolulu, United States (N = 329). We also investigated the mediating role of resilience and the moderating role of gender in the association. We found that receiving emotional support was significantly and positively associated with better SRH for the whole sample. The positive effect of receiving emotional support on health was significant among older women only. In contrast, the beneficial effect of providing economic support on health was significant among older men only. We found that resilience significantly mediated the positive effect of received emotional support on SRH, and this effect was found for the whole sample and among older women. However, resilience did not mediate the positive effect of the economic support provided on SRH among older men.
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Affiliation(s)
- Sizhe Liu
- Department of Economic Sociology, 12634Shanghai University of Finance and Economics, Shanghai, China
| | - Wei Zhang
- Department of Sociology, 204835University of Hawai'i at Mānoa, Honolulu, USA
| | - Keqing Zhang
- School of English and International Studies, Beijing Foreign Studies University, Beijing, China
| | - Bei Wu
- School of English and International Studies, Beijing Foreign Studies University, Beijing, China.,Rory Meyers College of Nursing, 5894New York University, New York, USA
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Qi X, Zhang W, Wang K, Pei Y, Wu B. Social isolation and psychological well-being among older Chinese Americans: Does resilience mediate the association? Int J Geriatr Psychiatry 2022; 37. [PMID: 35866312 DOI: 10.1002/gps.5791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 07/11/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Social isolation imposes risks to an individual's psychological well-being. However, few studies have examined the role of resilience on these associations among older Chinese Americans, the fastest-growing aging population across all racial/ethnic groups in the United States. We aim to examine the associations of social isolation with indicators of psychological well-being and the mediating role of resilience in these associations. METHODS Data were derived from 398 Chinese older adults aged over 55 residing in Honolulu, Hawaii, in 2018. Psychological well-being was measured by psychological distress, life satisfaction, and happiness. Multivariate linear regressions and ordered logistic regressions were conducted. RESULTS Social isolation was positively associated with psychological distress and negatively associated with life satisfaction and happiness (all p < 0.05). By contrast, resilience was associated with lower levels of psychological distress and higher levels of life satisfaction and happiness (all p < 0.05). Moreover, the findings supported our hypothesis that resilience mediated the association between social isolation and psychological well-being. With regard to social isolation, resilience contributed to 32.0% of its association with distress, 24.9% of the association with life satisfaction, and 16.3% of the association with happiness. CONCLUSION Our findings revealed a significant association between social isolation and psychological well-being and the mediating role of resilience in the association of older Chinese Americans in Hawaii. The study findings expand our understanding of psychological resources in older Chinese Americans and emphasize the importance of developing intervention programs to foster social connection and resilience among an understudied population.
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Affiliation(s)
- Xiang Qi
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Wei Zhang
- Department of Sociology, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Katherine Wang
- Trinity College of Arts and Sciences, Duke University, Durham, North Carolina, USA
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, New York, USA
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Effect of Morbidities, Depression, Anxiety, and Stress on Oral Health-Related Quality of Life among Migrant Elderly Following Children in Weifang, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084677. [PMID: 35457544 PMCID: PMC9033005 DOI: 10.3390/ijerph19084677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 02/06/2023]
Abstract
This study explored the relationship between depression, anxiety, stress, morbidity, and oral health-related quality of life (OHRQoL) in the migrant elderly following children (MEFC) in Weifang, China. A total of 613 MEFC were selected using multistage cluster random sampling. The GOHAI scale was used to evaluate oral health-related quality of life. The DASS-21 scale was used to assess levels of depression, anxiety, and stress. Univariate analysis and binary logistic regression were used to analyze the correlation between these indicators and oral health-related quality of life, of which 43.9% were classified as having poor oral health. Logistic regression analysis showed that the MEFC who were of older age (OR = 0.965, p = 0.039), with hypertension (OR = 0.567, p = 0.004), with gastroenteropathy (OR = 0.263, p = 0.007), had received an outpatient service in the past year (OR = 0.669, p = 0.048), were depressed (OR = 0.338, p = 0.012), and anxious (OR = 0.414, p = 0.026) were less likely to report good oral health status. On the other hand, the MEFC with a high school education or above (OR = 1.872, p = 0.020) were more likely to report good oral health than those with primary school education and below. In conclusion, with regard to depression, anxiety, and stress: the results indicated that the fewer morbidities, the lower the level of depression and anxiety and the better the OHRQoL of MEFC. Targeted measures for government, communities, and family members were given to improve the OHRQoL of MEFC.
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Xu X, Zhao Y, Gu D, Pei Y, Wu B. Health Behaviors and Self-Reported Oral Health among Centenarians in Nanjing, China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7285. [PMID: 34299735 PMCID: PMC8304003 DOI: 10.3390/ijerph18147285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/01/2022]
Abstract
The role of health behaviors in oral health conditions in individuals of extremely old age remains understudied. This study included 185 participants aged 100 years or older from the Nanjing Centenarians Study (NCS) to examine the associations between health behaviors and oral health and investigate the potential moderating role of education and living arrangements in such relationships. The oral health status as an outcome included the self-reported oral health status and edentulous status. Health behavior variables included smoking, eating fruits, eating vegetables, participating in leisure activities, and practicing oral hygiene behaviors. Sociodemographic characteristics and health status were considered as confounders. Descriptive statistics, ordinal regression, and logistic regression models were used to address the research questions. Results showed that better oral health was reported by centenarians who were non-smokers, participated in more leisure activities, and practiced higher frequency of oral hygiene behaviors. Those who ate fruits daily and practiced more frequently oral hygiene behaviors were more likely to be dentate. The positive association of oral hygiene behaviors was stronger for centenarians who were formally educated and co-resided with family members. The results suggest that effective interventions should consider health behaviors and living arrangements in this growing population to improve their oral health status.
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Affiliation(s)
- Xin Xu
- Population Research Institute, Nanjing University of Posts and Telecommunications, Nanjing 210042, China;
| | - Yuan Zhao
- Population Research Institute, Nanjing University of Posts and Telecommunications, Nanjing 210042, China;
- Ginling College, Nanjing Normal University, Nanjing 210023, China
| | - Danan Gu
- Independent Researcher, New York, NY 10010, USA;
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA;
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA;
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Wu B, Mao W, Qi X, Pei Y. Immigration and Oral Health in Older Adults: An Integrative Approach. J Dent Res 2021; 100:686-692. [PMID: 33541196 DOI: 10.1177/0022034521990649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to develop an integrative framework on aging, immigration, and oral health. The methodology was a critical review that used immigration as a social determinant framework through which to evaluate its impact on the oral health of older immigrants. We reviewed recent empirical evidence on factors related to oral health in older immigrants. In a systematic search across multiple databases, we identified 12 eligible studies in this review. Among the eligible studies, most were conducted among East Asian immigrants (8 articles), followed by non-Hispanic White/European origin (2 articles), Mexican origins (1 article), and Iran and other Middle East regions (1 article). The research revealed knowledge gaps in the evidence base, including the dynamic relationship between acculturation and oral health, the role of environmental factors on oral health for immigrants, psychosocial stressors and their relationship with oral health, and oral health literacy, norms, and attitude to dental care utilization and oral hygiene practices. The development of the integrative framework suggests the pathways/mechanisms through which immigration exerts influences on oral health in later life. This provides opportunities for researchers, practitioners, and policy makers to gain greater insights into the complex associations between immigration and oral health among older adults.
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Affiliation(s)
- B Wu
- Rory Meyers College of Nursing and College of Dentistry, New York University, New York, NY, USA
| | - W Mao
- School of Social Work, University of Nevada, Reno, NV, USA
| | - X Qi
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Y Pei
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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