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Description
Low income, pregnant adolescents have an increased risk of adverse pregnancy outcomes, such as preterm birth, delivery of low birth weight babies and excessive gestational weight gain that increases the risk of postpartum overweight and obesity. Inadequate dietary intake is a modifiable risk factor that may differentially impact maternal health and fetal outcomes for pregnant adults and adolescents. To evaluate the effectiveness of a social media intervention on improving prenatal health knowledge and dietary intake, 22 racially diverse pregnant women (59% Black and 36% White) were recruited and adolescent (n=10) outcomes compared to those of adults (n=12) across the intervention. Pre- and post-intervention nutrition knowledge questionnaires and diet recalls were completed to assess nutrition knowledge and dietary intake. When assessing dietary change across the intervention, significant decreases in fat (pre vs. post, 97.9 ± 0.2 g vs. 90.2 ± 0.2 g, P=0.047) and folate intake (pre vs. post, 537.6 ± 0.3 μg vs. 531.2 ± 0.2 μg, P=0.041) were observed while significant increases in carbohydrate (pre vs. post, 318.9 ± 0.2 g vs. 335.9 ± 0.2 g, P<0.001), calcium (pre vs. post, 851.3 ± 0.3 mg vs. 893.5 ± 0.2 mg, P<0.001) and magnesium intakes (pre vs. post, 212.9 ± 0.2 mg vs. 227.8 ± 0.2 mg, P<0.001) occurred. These time effects occurred independent of group (adolescents vs. adults) as time*group interactions were not significant (p>0.05) with the exception of sugar intake. Increases in sugar intake across the intervention were greater among the adolescent group (adolescent vs. adult, 7.9 ± 0.2 g vs. 6.0 ± 0.2 g, P=0.023). Overall nutrition knowledge was limited and confusion regarding MyPlate recommendations persisted. The inadequate dietary behaviors observed suggest that future interventions should focus education on specific dietary nutrients such as added sugars and fiber to improve dietary intakes. The best way to actively engage pregnant adolescents is unknown: however, social media has the potential to reach teens and low-income women with education that may be key in allowing interventions to change dietary habits and behaviors.
ContributorsEllis, Megan (Author) / Whisner, Corrie M (Thesis advisor) / Bruening, Meg (Committee member) / Vega-Lopez, Sonia (Committee member) / Arizona State University (Publisher)
Created2016
Description
More than 200 hikers are rescued annually in the greater Phoenix area. This study
examined the impact of hiking in hot (HOT), dry temperatures versus moderate (MOD)
temperatures on dietary intake behaviors as well as markers of heat stress. Twelve
recreational mountain hikers climbed “A” Mountain four consecutive times (4-miles) on
a HOT day (WBGT=31.6 °C) and again on a MOD day (WBGT= 19.0 °C). Simulated
food and fluid behavior allowed participants to bring what they normally would for a 4-
mile hike and to consume both ad libitum. The following heat stress indicators (mean
difference; p-value), were all significantly higher on the HOT hike compared to the MOD
hike: average core temperature (0.6 °C; p=0.002), average rating of perceived exertion
(2.6; p=0.005), sweat rate (0.54; p=0.01), and fluid consumption (753; p<0.001). On the
HOT hike, 42% of the participants brought enough fluids to meet their individual
calculated fluid needs, however less than 20% actually consumed enough to meet those
needs. On the MOD hike, 56% of participants brought enough fluids to meet their needs,
but only 33% actually consumed enough to meet them. Morning-after USG samples
≥1.020 indicating dehydration on an individual level showed 75% of hikers after the
HOT hike and 67% after the MOD hike were unable to compensate for fluids lost during
the previous day’s hike. Furthermore, participant food intake was low with only three
hikers consuming food on the hot hike, an average of 33.2g of food. No food was
consumed on the MOD hike. These results demonstrate that hikers did not consume
enough fluids to meet their needs while hiking, especially in the heat. They also show
heat stress negatively affected hiker’s physiological and performance measures. Future
recommendations should address food and fluid consumption while hiking in the heat.
examined the impact of hiking in hot (HOT), dry temperatures versus moderate (MOD)
temperatures on dietary intake behaviors as well as markers of heat stress. Twelve
recreational mountain hikers climbed “A” Mountain four consecutive times (4-miles) on
a HOT day (WBGT=31.6 °C) and again on a MOD day (WBGT= 19.0 °C). Simulated
food and fluid behavior allowed participants to bring what they normally would for a 4-
mile hike and to consume both ad libitum. The following heat stress indicators (mean
difference; p-value), were all significantly higher on the HOT hike compared to the MOD
hike: average core temperature (0.6 °C; p=0.002), average rating of perceived exertion
(2.6; p=0.005), sweat rate (0.54; p=0.01), and fluid consumption (753; p<0.001). On the
HOT hike, 42% of the participants brought enough fluids to meet their individual
calculated fluid needs, however less than 20% actually consumed enough to meet those
needs. On the MOD hike, 56% of participants brought enough fluids to meet their needs,
but only 33% actually consumed enough to meet them. Morning-after USG samples
≥1.020 indicating dehydration on an individual level showed 75% of hikers after the
HOT hike and 67% after the MOD hike were unable to compensate for fluids lost during
the previous day’s hike. Furthermore, participant food intake was low with only three
hikers consuming food on the hot hike, an average of 33.2g of food. No food was
consumed on the MOD hike. These results demonstrate that hikers did not consume
enough fluids to meet their needs while hiking, especially in the heat. They also show
heat stress negatively affected hiker’s physiological and performance measures. Future
recommendations should address food and fluid consumption while hiking in the heat.
ContributorsPelham, Emily Claire (Author) / Wardenaar, Floris (Thesis advisor) / Whisner, Corrie (Committee member) / Levinson, Simin (Committee member) / Arizona State University (Publisher)
Created2020
Description
Healthy lifestyle behaviors including quality nutrition have been shown to successfully prevent chronic disease or minimize symptoms. However, many physicians lack the knowledge and skills to provide adequate nutrition counseling and education for their patients. A major component of this problem is that medical schools are not required to teach nutrition education. The purpose of this feasibility study was to compare the changes in the perceived importance of nutrition in the medical field in medical students before and after participating in a week-long interactive nutrition course in order to determine if a week-long course can positively influence students’ perceptions of nutrition. Ultimately by changing these perceptions, medical students may be able to better help patients prevent chronic disease. The participants were first year medical students at the Mayo Clinic School of Medicine (Scottsdale, AZ) who chose to participate in this medical school “Selective”. The study included a five-day curriculum of case-studies, lectures from specialized health professionals, and a cooking class led by a chef who trained in France. An anonymous pre- and post-study questionnaire with five-point Likert scale questions was used to measure changes in attitudes. The data suggest that students’ perceptions regarding the importance and relevance of nutrition in the medical shifted slightly more positive after attending this Selective, although these shifts in attitude were not statistically significant. Limitations of this study include a small sample size and selection bias, which may have decreased the potential of having significant results. Both of these factors also make the results of this study less generalizable to all medical students. This study supports the need for a larger experimental study of a similar design to verify that an interactive, evidence-based nutrition class and culinary experience increases medical students’ positive perceptions of nutrition in the medical field.
ContributorsBaum, Makenna (Author) / Johnston, Carol (Thesis advisor) / Levinson, Simin (Committee member) / Sears, Dorothy (Committee member) / Arizona State University (Publisher)
Created2020
Description
Objective: Migration to the United States (U.S.) has been associated with food insecurity and detrimental changes in diet quality. How these changes affect women in context of their neighborhood food environment has not been thoroughly explored. This study aimed to assess if food security is associated with diet quality and to explore if perceived food availability moderates this purported association in a sample of Mexican immigrant women.
Methods: Mexican-born women (n=57, 41±7 years) residing in the U.S. for more than 1 year self-reported food security status, monthly fast-food frequency, and their perception of fruit, vegetables, and low-fat product availability within their neighborhood via survey. Diet was assessed using the Southwest Food Frequency Questionnaire to estimate intake of fruit, vegetables, salty snacks, sugar, and healthy eating index (HEI)-2015 score. Bivariate correlations assessed the relationships between study variables. Independent samples t-tests compared dietary outcomes between women classified as food secure (n=41; high or marginal food security) and food insecure (n=16; low or very low food security). A moderation analysis assessed the effect of the perception of the neighborhood food environment on the relationship between food security and HEI-2015 score.
Results: Fifty four percent of participants worked full time and 42% had a monthly household income <$2,000. Time residing in the U.S. was 20±9 years. Relative to women classified as food secure, participants experiencing food insecurity had lower HEI-2015 (61±8 vs. 66±6; p=0.03). Albeit not significantly different, women experiencing food insecurity reported lower intake of fruit (236±178 vs. 294±239 g), vegetables (303±188 vs. 331±199 g), and salty snacks (6±5 vs. 8±10 g), as well as higher intake of sugar (99±55 vs. 96±56 g) and fast food (2.5±2.5 vs. 1.8±1.7 times per month); p>0.05 for all. Among women experiencing food insecurity, there was a trend for a lower perception of neighborhood fruit, vegetable and low-fat product availability being associated with lower HEI-2015 scores (54±6) relative to those who perceived moderate (63±6) or high (65±8) neighborhood availability of those foods (p=0.07).
Conclusions: HEI-2015 scores were associated with participants’ food security status. Findings suggest a need for better understanding of how neighborhood food availability may affect diet quality among Mexican immigrant women experiencing food insecurity.
Methods: Mexican-born women (n=57, 41±7 years) residing in the U.S. for more than 1 year self-reported food security status, monthly fast-food frequency, and their perception of fruit, vegetables, and low-fat product availability within their neighborhood via survey. Diet was assessed using the Southwest Food Frequency Questionnaire to estimate intake of fruit, vegetables, salty snacks, sugar, and healthy eating index (HEI)-2015 score. Bivariate correlations assessed the relationships between study variables. Independent samples t-tests compared dietary outcomes between women classified as food secure (n=41; high or marginal food security) and food insecure (n=16; low or very low food security). A moderation analysis assessed the effect of the perception of the neighborhood food environment on the relationship between food security and HEI-2015 score.
Results: Fifty four percent of participants worked full time and 42% had a monthly household income <$2,000. Time residing in the U.S. was 20±9 years. Relative to women classified as food secure, participants experiencing food insecurity had lower HEI-2015 (61±8 vs. 66±6; p=0.03). Albeit not significantly different, women experiencing food insecurity reported lower intake of fruit (236±178 vs. 294±239 g), vegetables (303±188 vs. 331±199 g), and salty snacks (6±5 vs. 8±10 g), as well as higher intake of sugar (99±55 vs. 96±56 g) and fast food (2.5±2.5 vs. 1.8±1.7 times per month); p>0.05 for all. Among women experiencing food insecurity, there was a trend for a lower perception of neighborhood fruit, vegetable and low-fat product availability being associated with lower HEI-2015 scores (54±6) relative to those who perceived moderate (63±6) or high (65±8) neighborhood availability of those foods (p=0.07).
Conclusions: HEI-2015 scores were associated with participants’ food security status. Findings suggest a need for better understanding of how neighborhood food availability may affect diet quality among Mexican immigrant women experiencing food insecurity.
ContributorsVerdezoto Alvarado, Adriana Patricia (Author) / Vega-Lopez, Sonia (Thesis advisor) / Ochoa, Candelaria Berenice (Committee member) / Melendez, Juana Maria (Committee member) / McCoy, Maureen (Committee member) / Arizona State University (Publisher)
Created2020
Description
Background: Children’s fruit and vegetable consumption in the United States is lower than recommended. School lunch is an opportunity for students to be exposed to fruits and vegetables and potentially increase their daily intake. The purpose of this study is to examine the relationship between tray color and fruit and vegetable selection, consumption, and waste at lunch.
Methods: Study participants (n=1469) were elementary and middle school students who ate school lunch on the day of data collection. Photographs and weights (to nearest 2 g) were taken of fruits and vegetables on students’ trays before and after lunch. Trained research assistants viewed photographs and sorted trays into variable categories: color of main tray, presence/absence of secondary fruit/vegetable container, and color of secondary fruit/vegetable container. Fruit and vegetable selection, consumption, and waste were calculated using tray weights. Negative binomial regression models adjusted for gender, grade level, race/ethnicity, free/reduced price lunch status, and within-school similarities were used to examine relationships between tray color and fruit and vegetable selection, consumption, and waste.
Results: Findings indicated that students with a light tray selected (IRR= 0.44), consumed (IRR=0.73) and wasted (IRR=0.81) less fruit and vegetables. Students without a secondary fruit/vegetable container selected (IRR=0.66) and consumed (IRR=0.49) less fruit and vegetables compared to those with a secondary container. Light or clear secondary fruit and vegetable containers were related to increased selection (IRR=2.06 light, 2.30 clear) and consumption (IRR=1.95 light, 2.78 clear) compared to dark secondary containers, while light secondary containers were related to decreased waste (IRR= 0.57).
Conclusion: Tray color may influence fruit and vegetable selection, consumption, and waste among students eating school lunch. Further research is needed to determine if there is a cause and effect relationship. If so, adjusting container colors may be a practical intervention for schools hoping to increase fruit and vegetable intake among students.
Methods: Study participants (n=1469) were elementary and middle school students who ate school lunch on the day of data collection. Photographs and weights (to nearest 2 g) were taken of fruits and vegetables on students’ trays before and after lunch. Trained research assistants viewed photographs and sorted trays into variable categories: color of main tray, presence/absence of secondary fruit/vegetable container, and color of secondary fruit/vegetable container. Fruit and vegetable selection, consumption, and waste were calculated using tray weights. Negative binomial regression models adjusted for gender, grade level, race/ethnicity, free/reduced price lunch status, and within-school similarities were used to examine relationships between tray color and fruit and vegetable selection, consumption, and waste.
Results: Findings indicated that students with a light tray selected (IRR= 0.44), consumed (IRR=0.73) and wasted (IRR=0.81) less fruit and vegetables. Students without a secondary fruit/vegetable container selected (IRR=0.66) and consumed (IRR=0.49) less fruit and vegetables compared to those with a secondary container. Light or clear secondary fruit and vegetable containers were related to increased selection (IRR=2.06 light, 2.30 clear) and consumption (IRR=1.95 light, 2.78 clear) compared to dark secondary containers, while light secondary containers were related to decreased waste (IRR= 0.57).
Conclusion: Tray color may influence fruit and vegetable selection, consumption, and waste among students eating school lunch. Further research is needed to determine if there is a cause and effect relationship. If so, adjusting container colors may be a practical intervention for schools hoping to increase fruit and vegetable intake among students.
ContributorsWeight, Raquelle (Author) / Bruening, Meg (Thesis advisor) / Adams, Marc (Committee member) / Martinelli, Sarah (Committee member) / Arizona State University (Publisher)
Created2020
Description
Background. Street food stands (SFS) are common ways in which people in Mexico access food, having been a part of the environment and culture of Mexican food for generations. However, no studies have used a validated assessment tool to reliably measure food and beverage availability at a variety of SFS. Nor have the availability, density, variety, and distribution of SFS and street foods and beverages been assessed across neighborhood income levels.Objective: This dissertation’s goal was to decrease gaps in knowledge about the role SFS may play in food availability in the Mexican food environment.
Methods: Survey design and ethnographic field methods were used to develop, test, and validate the Street Food Stand Assessment Tool (SFSAT). Geographic information system and ground-truthing methods were used to identify a sample of street segments across 20 neighborhoods representing low-, middle- and high-income neighborhoods in Mexico City on which to assess the availability, density, variety, and distribution of SFS and the foods and beverages sold at these food venues using the SFSAT.
Results: A sample of 391 SFS were assessed across 791 street segments. Results showed that SFS were found in all neighborhoods. Contrary to the initial hypothesis, most SFS were found in middle-income neighborhoods. While the availability of street foods and beverages was higher in middle-income neighborhoods, the variety was less consistent: fruit/vegetable variety was high in high-income neighborhoods whereas processed snack variety was higher in low-income neighborhoods. SFS were most often distributed near homes, transportation centers, and worksites across the three neighborhood income levels.
Conclusion: This study bridged the gap in knowledge about the availability, density, variety, and distribution of SFS and products sold at these sources of food by using an assessment tool that was developed, tested, and validated specifically for SFS. The findings showed that SFS were found across all neighborhoods. Furthermore, results also suggested that SFS can be a source of healthy food items. Additional studies are needed to understand the relationship between SFS availability, food consumption, and health outcomes in the Mexican population.
Methods: Survey design and ethnographic field methods were used to develop, test, and validate the Street Food Stand Assessment Tool (SFSAT). Geographic information system and ground-truthing methods were used to identify a sample of street segments across 20 neighborhoods representing low-, middle- and high-income neighborhoods in Mexico City on which to assess the availability, density, variety, and distribution of SFS and the foods and beverages sold at these food venues using the SFSAT.
Results: A sample of 391 SFS were assessed across 791 street segments. Results showed that SFS were found in all neighborhoods. Contrary to the initial hypothesis, most SFS were found in middle-income neighborhoods. While the availability of street foods and beverages was higher in middle-income neighborhoods, the variety was less consistent: fruit/vegetable variety was high in high-income neighborhoods whereas processed snack variety was higher in low-income neighborhoods. SFS were most often distributed near homes, transportation centers, and worksites across the three neighborhood income levels.
Conclusion: This study bridged the gap in knowledge about the availability, density, variety, and distribution of SFS and products sold at these sources of food by using an assessment tool that was developed, tested, and validated specifically for SFS. The findings showed that SFS were found across all neighborhoods. Furthermore, results also suggested that SFS can be a source of healthy food items. Additional studies are needed to understand the relationship between SFS availability, food consumption, and health outcomes in the Mexican population.
ContributorsRosales Chavez, Jose Benito (Author) / Jehn, Megan (Thesis advisor) / Bruening, Meg (Thesis advisor) / Lee, Rebecca E (Committee member) / Ohri-Vachaspati, Punam (Committee member) / Arizona State University (Publisher)
Created2020
Description
Background: Stores authorized by the Supplemental Nutrition Program for Women, Infants, and Children (WIC) have been shown to improve the community food environments of lower-income areas by stocking healthy food items in accordance with the program’s food package guidelines. Whether greater access to WIC-authorized stores is associated with improvements in diet among children from WIC and non-WIC households is not well understood. Methods: Secondary analysis of cross-sectional data collected in 2009-2010 and 2014 for the New Jersey Child Health Study (NJCHS). Surveys from 2,211 urban households with 3-18-year-old children. Counts of WIC stores near children’s homes determined through geo-coding of store and household addresses using roadway network distances of 0.5 and 1.0 mile. Children’s consumption was categorized in age-specific deciles of quantities consumed for each food category examined: fruits, vegetables, sugar from sugar-sweetened beverages, total added sugars. Associations between counts of WIC stores and children’s consumption were examined, first for the full sample, then by household WIC participation.
Results: No significant associations between WIC store counts near children’s homes and consumption were observed in the overall sample at any distance. A small, but significant inverse relationship was seen in total added sugar consumption among children residing in WIC households only, with each additional WIC store within a 0.5 mile roadway network associated with a 0.24-decile lower consumption (p = .047). In age-stratified exploratory analysis, higher vegetable (p = .024) and combined fruits and vegetables (p = .006) consumption were seen in the under 5 age group only.
Conclusions: Living close to more WIC-authorized stores was associated with healthier consumption, but only for a subset of children and only for a few food categories examined. Lack of a consistent pattern of healthier consumption among children suggests that access to WIC stores may have a positive, albeit limited impact on children’s diets.
Results: No significant associations between WIC store counts near children’s homes and consumption were observed in the overall sample at any distance. A small, but significant inverse relationship was seen in total added sugar consumption among children residing in WIC households only, with each additional WIC store within a 0.5 mile roadway network associated with a 0.24-decile lower consumption (p = .047). In age-stratified exploratory analysis, higher vegetable (p = .024) and combined fruits and vegetables (p = .006) consumption were seen in the under 5 age group only.
Conclusions: Living close to more WIC-authorized stores was associated with healthier consumption, but only for a subset of children and only for a few food categories examined. Lack of a consistent pattern of healthier consumption among children suggests that access to WIC stores may have a positive, albeit limited impact on children’s diets.
ContributorsStevens, Clinton (Author) / Ohri-Vachaspati, Punam (Thesis advisor) / Gosliner, Wendi (Committee member) / Martinelli, Sarah (Committee member) / Arizona State University (Publisher)
Created2021
Description
This study was designed to examine the associations between food skills, resilience, and coping during the Covid-19 pandemic. Between April and June of 2020, a sample of 154 students, faculty, and staff from Arizona State University were surveyed. Each respondent was administered a survey containing demographic questions, a food skill questionnaire, and the 14-item Resilience Scale (RS). Results indicate that food skill was correlated with resilience (p<0.001) at an r=0.364 and r2=0.1243 and that resilience was correlated with coping during the Covid-19 pandemic (p<0.001) at an r=0.455. Correlations were also run between resilience score and the separate domains of food skill score: all domains remained significantly associated with resilience score (p<0.001) with a r=0.340 and r2=0.1173 for ‘Food Selection and Planning,’ r=0.312 and r2=0.0958 for ‘Food Preparation,’ and r=0.294 and r2=0.0767 for ‘Food Safety.’ Data seems to be consistent with contemporary research suggesting positive associations between diet quality and physiological resilience and positive associations between resilience and coping during the Covid-19 pandemic.
ContributorsPhares, Savanna Julene (Author) / Johnston, Carol (Thesis advisor) / McCoy, Maureen (Committee member) / Irving, Andrea (Committee member) / Arizona State University (Publisher)
Created2020
Description
First year college students have been identified as a vulnerable population for weight gain and the onset of overweight and obesity. Research regarding the gut microbiome has identified differences in the microbial composition of overweight and obese individuals compared to normal weight individuals. Dietary components like dietary fibers, act as prebiotics, or fermentable substrate, that the gut microbiota use for metabolic functions including the production of short-chain fatty acids. The objective of this longitudinal, observational study was to assess changes in the gut microbiota over time in relation to changes in fiber consumption in healthy college students at a large a southwestern university (n=137). Anthropometric and fecal samples were collected at the beginning and end of the fall and spring semesters between August 2015 and May 2016. Both alpha, within sample, diversity and beta, between sample, diversity of participant gut microbes were assessed longitudinally using non-parametric pairwise (pre-post) comparisons and linear mixed effect (LME) models which also adjusted for covariates and accounted for time as a random effect. Alpha and beta diversity were also explored using LME first difference metrics and LME first distance metrics, respectively, to understand rates of change over time in microbial richness/phylogeny and community structure. Pre-post comparisons of Shannon Diversity and Faith’s PD were not significantly different within participant groups of fiber change (Shannon diversity, p=0.96 and Faith’s PD, p=0.66). Beta diversity pairwise comparisons also did not differ by fiber consumption groups (Unweighted UniFrac p=0.182 and Bray Curtis p=0.657). Similarly, none of the LME models suggested significant associations between dietary fiber consumption and metrics of alpha and beta diversity. Overall, data from this study indicates that small changes in fiber consumption among a free-living population did not have an impact on gut microbial richness, phylogeny or community structure. This may have been due to the low intake (~15 g/d) of fiber. Further study is needed to fully elucidate the role that fiber plays in the diversity and composition of the gut microbiota, especially when delivered from a variety of food sources rather than fiber supplements.
ContributorsLolley, Sarah (Author) / Whisner, Corrie (Thesis advisor) / Sears, Dorothy (Committee member) / Shepard, Christina (Committee member) / Arizona State University (Publisher)
Created2020
Description
In the United States, two-thirds of adults are considered hypertensive orprehypertensive. In addition, chronic illness, such as hypertension, cardiovascular disease, and type II diabetes, results in $3.5 trillion in annual healthcare cost and is the primary cause of disability and death. As a result, many individuals seek cheaper and simpler alternatives to combat their conditions. In this exploratory analysis, a study assessing nitrate intake and its effects on vascular function in 39 young adult males was investigated for underlying metabolic variations through a liquid chromatography – mass spectrometry-based large-scale targeted metabolomics approach. A two-way repeated measures ANOVA was used, and 18 significant metabolites were discovered across the time, treatment, and time & treatment groups, including prostaglandin E2 (p<0.001), stearic acid (p=0.002), caprylic acid (p=0.016), pentadecanoic acid (p=0.027), and heptadecanoic acid (p=0.005). In addition, log-transformed principal component analysis and orthogonal partial least squares – discriminant analysis models demonstrated distinct separation among the treatment, control, and time variables. Moreover, pathway and enrichment analyses validated the effect of nitrate intake on the metabolite sets and its possible function in fatty acid oxidation. This better understanding of altered metabolic pathways may help explicate the benefits of nitrate on vascular function and reveal any unknown mechanisms of its supplementation.
ContributorsPatterson, Jeffrey (Author) / Gu, Haiwei (Thesis advisor) / Johnston, Carol (Committee member) / Sweazea, Karen (Committee member) / Arizona State University (Publisher)
Created2020