Abstract
Researchers and policy makers are devoting considerable attention to the development and evaluation of sexual violence prevention programming for college campuses. Although several programs have been developed over the last decade, questions remain about whether programs can be effectively implemented across diverse campuses and whether individual-level factors like alcohol use moderate program effectiveness. The purpose of this pilot study was to evaluate the impact of a brief, sexual violence prevention program—The Men’s Program—on two diverse campuses. A secondary aim was to evaluate the moderating effects of heavy alcohol use on program effectiveness. Participants were 114 male college students attending a presentation of The Men’s Program on one of two campuses. Outcomes, including rape myth acceptance, bystander willingness to help, and bystander behavior, were assessed pre- and post-intervention and 1 month after completing the program. Campus-specific effects did not account for a significant amount of variance in any of these outcomes. Statistically significant reductions in rape myth acceptance (d = .32) and increases in willingness to intervene as a bystander (d = .40) were observed from pre-intervention to 1-month follow-up, although no significant changes in overall bystander behavior were observed. Across time, however, heavy drinking students were more likely to report engaging in bystander behaviors than non-heavy drinking students. Results suggest that programs can be easily implemented across different campuses and may do well to specifically emphasize effective intervention strategies relevant to social situations encountered by heavy drinking students.
Sexual violence is a major public health problem on college and university campuses across the United States. The term “sexual violence” refers to any type of unwanted sexual activity, from inappropriate touching to vaginal, oral, or anal penetration and attempted or completed rape (Basile, Smith, Breiding, Black, & Mahendra, 2014). Prevalence estimates suggest that between 19% and 25% of college women in the United States experience sexual violence (Fisher, Cullen, & Turner, 2000; Krebs, Lindquist, Warner, Fisher, & Martin, 2009), although prevalence is likely much higher if one considers other forms of sexual misconduct beyond assaultive violence such as harassment and other forms of unwanted sexual attention. Many incidents of sexual violence involve alcohol or other substance use. For example, 11% of respondents in a large sample of women from public universities reported being sexually assaulted while incapacitated due to alcohol or drug use (Krebs et al., 2009). In a separate sample of college women who reported being forcibly raped during the school year, 72% reported being raped while intoxicated (Mohler-Kuo, Dowdall, Koss, & Wechsler, 2004). The majority of these alcohol- and drug-related sexual assaults occur at house parties, bars, or restaurants (Lawyer, Resnick, Bakanic, Burkett, & Kilpatrick, 2010) where friends and bystanders with opportunities to intervene prior to the assault likely surrounded both the victim and perpetrator. It is not surprising, then, that sexual assaults, and alcohol- and drug-related sexual assaults in particular, are associated with heightened risk for long-term mental health problems, including posttraumatic stress disorder (PTSD), depression, and substance misuse (e.g., McCauley, Ruggiero, Resnick, Conoscenti, & Kilpatrick, 2009; Zinzow et al., 2010), as well as poor academic performance (Banyard et al., 2017).
In response to this problem, a number of campus-based sexual violence prevention programs have been developed over the last two decades that utilize bystander intervention training as a means to violence prevention. The goal of bystander education (Banyard, Plante, & Moynihan, 2004) is to empower men and women to recognize high-risk situations where a sexual assault may be more likely to occur, role-play and discuss potential responses that may be used in these situations, and increase willingness to intervene in high-risk situations. Several widely adopted bystander intervention programs have been shown to be effective at improving bystander behaviors and even reducing rates of violence, including the Bringing in the Bystander program (e.g., Banyard, Moynihan, & Plante, 2007) and Green Dot (e.g., Coker et al., 2016). Because many college sexual assaults are alcohol- and/or drug-related, prevention programs with bystander education may be most effective when the bystander education includes specific information addressing how to intervene with friends in risky alcohol- and drug-related situations. Another promising prevention program that combines bystander intervention with alcohol and drug education is The Men’s Program (Foubert, 2011), a peer-facilitated program for college men that aims to help increase men’s empathy toward women’s experiences with sexual violence and likelihood of intervening in situations where a sexual assault appears likely (e.g., intervening when a male student’s roommate tries to “hook up” with a visibly drunk woman at a house party). Preliminary evidence suggests that The Men’s Program is effective at improving bystander efficacy and willingness to help as a bystander among college men (Foubert, Newberry, & Tatum, 2007; Langhinrichsen-Rohling, Foubert, Brasfield, Hill, & Shelley-Tremblay, 2011). A recent review of campus-based sexual violence prevention programs, however, noted that much of the current evaluation research in this area is limited in scope given that many studies focus on the effects of single prevention programs implemented on a single campus (Banyard, 2014), and the available research on The Men’s Program is no exception.
In addition to questions about the extent to which campus-specific effects may impact outcomes, there are also questions about the extent to which individual-level factors like alcohol use may impact responsiveness to prevention efforts like The Men’s Program. Alcohol use is a well-known risk factor for sexual violence perpetration (e.g., Abbey, 2002; Koss & Gaines, 1993), and recent evidence suggests that heavy alcohol use is also associated with men’s willingness to engage as a bystander in high-risk situations. For example, in one recent study involving 242 college men, engaging in two or more heavy drinking episodes over the past month was associated with worse attitudes toward prosocial bystander behavior, increased comfort with sexism, more engagement in coercive sexual behavior, and perceived peer support for sexual aggression (Orchowski, Berkowitz, Boggis, & Oesterle, 2016). Another recent study involving college students recruited from two different campuses found that heavy drinkers are more likely to adhere to traditional rape myths than non-drinkers and non-heavy drinkers (Hayes, Abbott, & Cook, 2016). Thus, heavy drinking may also be an important factor associated with receptiveness and responsiveness to campus sexual violence prevention programming.
Recognizing these limitations in the extant literature on sexual violence prevention programs, this study sought to evaluate the impact of The Men’s Program on two diverse campuses—one military college and one liberal arts college. An exploratory goal of the study was to examine whether outcomes differed among heavy drinking students across campuses relative to non-heavy drinking male students.
Method
Participants
Participants for this study were 114 men enrolled at one of two colleges in the greater Charleston, SC, area—a military college (n = 75) and a small, liberal arts college (n = 39). The military college selected for this study is a predominantly male college (approximately 92% male) in contrast to the liberal arts college, which is predominantly female (approximately 65% female). Both campuses were similar with regard to the number of minority students enrolled on campus (24% at the military college and 20% at the liberal arts college).
Participants enrolled in this study were, on average, 19.71 years old (SD = 1.01), and the majority of participants were college sophomores (70.2%; n = 80) or freshmen (14.0%; n = 16), with smaller numbers of juniors (6.1%; n = 7) and seniors (8.8%; n = 10). One student (0.9%) identified as a graduate student. All participants were enrolled as full-time students. In terms of race and ethnicity, 95 participants identified as White (83.3%), 3 (2.6%) identified as Hispanic, 2 (1.8%) identified as Asian, 9 identified as African-American (7.9%), and 5 (4.4%) identified as multiracial. With regard to relationship status, 60 (52.6%) participants identified as single or not in a relationship, 52 (45.6%) identified as being in a monogamous relationship with a partner of the opposite sex, and 1 participant (0.9%) identified as being in a monogamous relationship with a partner of the same sex. Approximately half of the participants were student athletes (49.1%; n = 56), and approximately half of the participants reported having previously participated in a sexual violence prevention program (49.1%; n = 56).
Measures
Rape myth acceptance
Rape myth acceptance was assessed using the Updated Illinois Rape Myth Acceptance Scale (IRMA; McMahon & Farmer, 2011). The IRMA is a 22-item self-report measure, assessing four domains of subtle rape myths, including beliefs that victims’ behaviors invite sexual assault (She Asked for It subscale), denial of reported rape or sexual assault due to blaming victims and/or excusing perpetrators (Wasn’t Really Rape subscale), beliefs that perpetrators did not intend rape (He Didn’t Mean To subscale), and beliefs that victims often fabricate reports of rape (She Lied subscale). Items are scored on a 5-point scale from 1 (strongly agree) to 5 (strongly disagree) and can be summed to derive a total scale and subscale scores where higher scores reflect greater rejection of common rape myths. The IRMA demonstrated good internal consistency in the current sample (α = .89).
Willingness to intervene
Willingness to intervene in high-risk situations was assessed using the Bystander Willingness to Help Scale (BWHS; Banyard, Plante, & Moynihan, 2005). The BWHS is a 12-item self-report measure of respondents’ likelihood of engaging in a variety of bystander behaviors. Items are scored on a 5-point, Likert-type scale, ranging from 1 (not at all likely) to 5 (very likely). Scores on the BWHS are averaged to derive an overall indictor of respondents’ willingness to intervene as a bystander. The BWHS has been widely used in college student samples (e.g., Langhinrichsen-Rohling et al., 2011) and demonstrated good reliability in this sample (α = .86).
Bystander behavior
Self-reported engagement in actual bystander behaviors was assessed using the Bystander Behaviors Scale (BBS; Banyard & Moynihan, 2011). The BBS includes 26 items describing a variety of bystander behaviors, and respondents indicate whether they have actually carried out each behavior in the last 2 months by responding “yes” or “no” to each item. We modified the BBS to refer to the past month in the version administered at follow-up. Items assess four types of bystander behaviors, including behaviors associated with dealing with sexual and intimate partner violence-specific incidents, party safety, helping friends in distress, and confronting sexist, racist, and/or homophobic language. Cronbach’s alphas for each subscale ranged from .70 to .90 in this sample.
Alcohol use
Alcohol use was assessed using the Daily Drinking Questionnaire–Revised (DDQ-R; Collins, Parks, & Marlatt, 1984). The DDQ-R assesses typical drinking patterns over the past 30 days by asking respondents to indicate on a calendar how many drinks they typically consumed each day of the week and the typical number of hours spent drinking on that day. A number of variables reflecting the frequency and intensity of past 30-day alcohol use can be derived using this method, and the DDQ-R has demonstrated good psychometric properties in other samples of college students.
Experimental Intervention
The Men’s Program (Foubert, 2011) is a 1-hr, peer-facilitated, and manualized multimedia program. This program involves three major components: education about sexual assault and rape, building empathy for female victims, and emphasizing bystander intervention. Using a discussion-based format, peer-facilitators begin the program by engaging participants in a discussion about the definition of sexual violence along with definitions of mental incapacity and physical helplessness in the context of sexual violence. A highlight of this program is a 15 min video description of a rape situation in which the victim is a male police officer. Participants are notified that the content of the video is disturbing and that they are free to leave at any time. Peer facilitators lead a discussion to draw parallels between the police officer’s experience and women’s rape experiences to build empathy with female rape victims. Participants engage in a discussion about multiple strategies for helping survivors and also discuss personally relevant behaviors that can help end rape. Moreover, participants are taught ways to intervene in high-risk situations involving alcohol or other substance use where a man or woman appears to be at risk for sexual violence. Facilitators are taught to engage program attendees and invite questions to stimulate collaborative discussion about program topics.
Peer-facilitators at both sites included male students who were members of their respective campus chapter of One in Four (http://www.oneinfourusa.org/overview.php), a non-profit organization dedicated to the prevention of rape and sexual violence through the development, dissemination, and implementation of rape prevention programming. To ensure intervention fidelity, new peer-facilitators attended a 2-day training workshop on The Men’s Program provided by the program developer (Foubert), and peer-facilitators with experience presenting the program attended 1 day of the training workshop. Following the training, peer-facilitators were provided real-time feedback by two of the authors (J.L.W. and J.S.) who attended the programs being offered at both campuses during the implementation of the study and supervised peer-facilitators in the delivery of the intervention. Program attendance varied considerably across groups, but, for the purposes of this study, participants were recruited from one of seven different program offerings (our team recruited during four program offerings at the military college and three program offerings at the liberal arts college).
Procedure
Male college students attending a 1-hr presentation of The Men’s Program at one of two partner colleges in the greater Charleston, SC, area were recruited for this study. At the military college, all sophomore cadets were required to attend The Men’s Program at some point during their sophomore year, and, at the liberal arts college, student athletes across various teams were informed about The Men’s Program and encouraged to attend by their coaching staff. Across both sites and prior to the beginning of each program, a research assistant informed attendees about the opportunity to participate in a study evaluating the effectiveness of The Men’s Program. Participants provided written, informed consent before initiating any study-related procedures, and, after providing consent, completed several questionnaires assessing common rape myths, willingness to engage in bystander behaviors, past month alcohol use, and actual engagement in bystander behaviors. After receiving The Men’s Program, participants completed the same set of questionnaires (excluding the BBS). All participants received US$10 cash for completing pre-post evaluation measures. Participants also completed a 1-month follow-up assessment to assess whether or not any observed pre–post changes were maintained over time. For follow-up assessments, participants were emailed a personalized link containing all study outcome measures using Research Electronic Data Capture (REDCap), a Health Insurance Portability and Accountability Act (HIPAA)-compliant, secure, web-based application (Harris et al., 2009). Participants completing the 1-month follow-up evaluations received a US$20 money order. All study procedures were approved by the institutional review boards at the Medical University of South Carolina and each participating university.
Data Analysis Plan
Prior to conducting analyses, we corrected outliers and conducted transformations for variables with severely skewed or kurtotic distributions (Tabachnick & Fidell, 2006). A series of mixed-effects model repeated measures analyses were used to explore changes across time in terms of rape myth acceptance and willingness to intervene as a bystander (pre-intervention, post-intervention, 1-month follow-up) and bystander behavior (pre-intervention and 1-month follow-up). An advantage of using a mixed-effects modeling approach is that these models can accommodate missing data resulting from missed assessments or study dropout by estimating parameters based on information available for any given individual with missing data (Gueorguieva & Krystal, 2004).
Results
Participants who completed measures at all three time points were compared with participants who only completed pre–post measures. In all, 64.9% (n = 74) completed pre–post and 1-month follow-up measures. Those who completed follow-up measures and those who did not complete follow-up measures were compared with several baseline and demographic variables to assess whether study completers differed from non-completers in important ways. Rates of completion differed by campus, with follow-up rates across campuses ranging from 41% to 77.3%, χ2(1) = 14.85, p < .001. Completers did not differ from non-completers in terms of baseline scores on the IRMA, BWHS, BBS, or mean number of drinks per week assessed by the DDQ-R.
Primary Outcomes
To first examine any campus-specific effects, a series of unconditional models (i.e., no covariates) were estimated to determine whether scores on primary outcome measures varied by campus. Results of the unconditional models suggest that scores on the IRMA (Wald Z = .12, p = .90), BWHS (Wald Z = .69, p = .49), and BBS (Wald Z = .60, p = .55) did not significantly vary by campus. Therefore, campus was not included as a random effect in any of our subsequent models assessing program outcomes.
A series of separate mixed-model repeated measures analyses were conducted with each of our primary outcome measures. Time (pre-intervention, post-intervention, 1-month follow-up) was included as a within subjects factor, and exposure to prior sexual violence prevention programming was included as a covariate in each of our models. Means and standard deviations on each variable are presented in Table 1. A statistically significant main effect for time was observed on the IRMA, F(2, 191.34) = 17.67, p < .001, and each of the subscales on the IRMA, including the She Asked for It, F(2, 196.91) = 10.41, p < .001; Wasn’t Really Rape, F(2, 186.46) = 4.08, p = .02; Didn’t Mean To, F(2, 193.35) = 5.59, p = .004; and She Lied, F(2, 193.87) = 15.42, p < .001, subscales, such that participants across both campuses were less accepting of rape myths post-intervention. Gains were maintained at 1-month follow-up in all analyses except for the Wasn’t Really Rape (p = .27) and Didn’t Mean To (p = .52) subscale analyses.
M Scores Across Time on IRMA, BWHS, and BBS.
Note. Cell sizes vary slightly at follow-up due to missing data. IRMA = Updated Illinois Rape Myth Acceptance scale; BWHS = Bystander Willingness to Help Scale; BBS = Bystander Behavior Scale.
A statistically significant main effect for time was also observed on the BWHS, F(2, 196.35) = 29.64, p < .001, such that participants were more willing to engage as a bystander post-intervention with gains maintained at 1-month follow-up. No main effect for time was observed with regard to BBS total scores, F(1, 88.87) = .03, p = .87. A main effect for time was observed, however, on two BBS subscales—Helping Friends in Distress, F(1, 92.69) = 5.23, p = .02, and Confronting Language, F(1, 85.40) = 6.29, p = .01. On the Helping Friends in Distress subscale, participants were less likely to report engaging in bystander behaviors associated with helping friends in distress at 1-month follow-up than at pre-intervention. Participants were, however, more likely to report engaging in bystander behaviors associated with confronting sexist, racist, and/or homophobic language on the Confronting Language subscale at 1-month follow-up than at pre-intervention.
Moderation Analyses by Alcohol Use
Participants reported drinking, on average, 11.68 drinks (SD = 15.39) per week on a typical week in the past month at pre-intervention assessment. Forty (35.1%) were classified as heavy drinkers using National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines (>14 drinks per week; NIAAA, 2018). Table 2 shows means and standard deviations for heavy drinkers and non-heavy drinkers on the IRMA and BWHS. A series of separate 2 (drinking status) x 3 (time) mixed-model repeated measures analyses were conducted with each of our primary outcome measures to explore whether heavy drinking status moderated the effect of the intervention across campuses. Exposure to prior sexual violence prevention programming was included as a covariate in each of our models. No statistically significant drinking x time interactions were observed on the IRMA, IRMA subscales, or BWHS. A marginally significant interaction was observed on the She Asked for It subscale on the IRMA, F(2, 195.23) = 2.79, p = .06. In follow-up analyses, pairwise comparisons revealed that non-heavy drinkers maintained changes on the She Asked for It subscale at 1-month follow-up, whereas heavy drinkers did not maintain gains from post-intervention to 1-month follow-up.
M Scores on IRMA and BWHS by Pre-Intervention Drinking Status.
Note. Cell sizes vary slightly due to missing data. IRMA = Updated Illinois Rape Myth Acceptance scale; BWHS = Bystander Willingness to Help Scale.
Using BBS total scores, a main effect was found for drinking status such that, across time, heavy drinking students reported engaging in more bystander behaviors than non-heavy drinking students, F(1, 113.26) = 5.37, p = .02. A marginally significant drinking x time interaction was also observed, F(1, 88.24) = 3.00, p = .09. Follow-up analyses revealed that, at 1-month follow-up, but not at baseline, heavy drinkers reported having engaged in more bystander behaviors than non-heavy drinkers. On the BBS subscales (see Figure 1), marginally significant interactions were observed on two subscales: the Helping Friends in Distress subscale, F(1, 95.32) = 3.73, p = .06, and the Party Safety subscale, F(1, 92.10) = 3.58, p = .06. In each case, heavy drinkers reported having engaged in more bystander behaviors than non-heavy drinkers at 1-month follow-up but not at baseline.
Pre-intervention and 1-month follow-up scores on Bystander Behavior Scale subscales by heavy-drinking status.
Discussion
Sexual violence remains a serious problem on college campuses around the United States. Thus, identifying widely disseminable, high-impact programs aimed at preventing sexual violence is a public health priority. In line with this goal, the purpose of this study was to evaluate a sexual violence prevention program—The Men’s Program—on two diverse campuses by exploring changes at pre-, post-, and 1-month follow-up time periods among program attendees across a range of outcomes, including rape myth acceptance, willingness to intervene as a bystander, and reported bystander behavior. A secondary goal of this study was to examine whether outcomes differed among heavy drinking students across campuses relative to non-heavy drinking male students.
Our results suggest that attending The Men’s Program was associated with decreased rape myth acceptance and increased willingness to intervene as a bystander, with changes across outcomes generally maintained at 1-month follow-up. These findings are consistent with previous research suggesting that The Men’s Program is associated with changes in rape myth acceptance and willingness to intervene as a bystander relative to control conditions (e.g., Foubert, 2000; Langhinrichsen-Rohling et al., 2011). Despite attitude changes, there were, however, no statistically significant increases in reported bystander behaviors from pre-intervention to 1-month follow-up. Findings from other research teams, though, suggest that prevention efforts can impact actual behavioral change. For example, Banyard et al. (2007) reported that two versions of a bystander intervention program for male and female college students was associated with increases in reported bystander intervention behaviors 2 months after the program but that, at pre-intervention, women were more likely to report engaging in bystander behaviors than men. Even though these researchers found no gender differences in the impact of the program on bystander behaviors, the fact that our sample consisted entirely of male students may have impacted the range of bystander behaviors reported by this sample in that men may generally engage in fewer prosocial bystander behaviors than their female counterparts.
Our results also suggest that, despite sociocultural differences between campuses, campus-specific effects did not account for a significant amount of variance across any of the study outcomes. Although future multi-site studies with larger samples of participating campuses are needed to better understand the extent to which campus-specific effects may impact intervention outcomes, this study supports previous literature suggesting that existing brief prevention programs can be effectively implemented across a variety of educational institutions with similar effect. In a large cluster randomized controlled trial involving 26 high schools in Kentucky, for example, Coker et al. (2017) found that schools implementing Green Dot, a bystander-based violence prevention program, experienced significant reductions in sexual and interpersonal violence perpetration and victimization compared with schools that did not implement the program. In a multi-campus evaluation of the Green Dot program, Coker et al. (2016) similarly found that implementation of the Green Dot program was associated with statistically significant reductions in violence perpetration, although, in this multi-campus study, the program was only implemented on one of the three participating campuses. Thus, this study offers an important glimpse into the extent to which campus-specific effects may impact the effectiveness of sexual violence programming. These findings should be interpreted with caution, however, given that follow-up rates differed significantly across campuses (41% and 77%, respectively). Anecdotally, we suspect that follow-up rates were quite low on one partner campus because the final intervention program offered on that campus was approximately 1 month before winter break, and follow-up surveys were emailed to participants during their winter break, which may have adversely impacted response rates.
One of the more surprising findings from this study was that, across time, heavy drinking male students were more likely than their non-heavy drinking counterparts to report engaging in bystander behaviors. A marginally significant drinking x time interaction was further noted on two subscales of the BBS, including Helping Friends in Distress and Party Safety, revealing an interesting trend such that heavy drinking men reported more bystander behaviors across these domains at 1-month follow-up than non-heavy drinkers. Although seemingly counterintuitive, these results make sense when one considers that many campus sexual assaults occur at restaurants, bars, house parties, and other locations where alcohol is being consumed (e.g., Lawyer et al., 2010; Mohler-Kuo et al., 2004). That is, although responding similarly to prevention programming as non-heavy drinkers, heavy drinkers may be more likely to engage in bystander behaviors because, unlike non-heavy drinkers, they are present in high-risk situations where large amounts of alcohol are being consumed and have more opportunities to intervene. Although we cannot specifically ascertain whether or not this is the case given that we did not assess where and under what circumstances participants were actually drinking alcohol, future studies are needed to better understand why heavy drinking students may be more likely to engage in bystander behaviors than non-heavy drinking students. These findings also raise questions as to whether universities may be able to enhance the impact of sexual violence prevention programming by specifically tailoring programming for those students most likely to be in high-risk situations where large quantities of alcohol are consumed, which remains an important area for future investigation.
Although this study makes several important contributions to the sexual violence prevention literature, there are several important limitations. First, we did not include a comparison group of students who did not participate in The Men’s Program; so, attitude changes observed across time cannot be specifically attributed to participation in this program. Second, the program was only implemented on two campuses in the same geographic region, and our sample overwhelmingly consisted of White, male students. Previous research with college students has shown differences in rape myth acceptance as a function of race and ethnicity (Cowan, 2000; Kahlor & Morrison, 2007), and including more diverse campuses with more heterogeneous student bodies will help researchers better understand the extent to which campus-specific effects may actually impact the extent to which programs are similarly effective across campuses and among students from diverse racial and ethnic backgrounds. Third, this study evaluated an all-male program, and no studies have evaluated whether heavy alcohol use moderates the impact of prevention programming among female students receiving other types of prevention programming. Fourth, failure to find differences as a function of campus could be the result of inadequate power, and larger studies are needed in the future to derive more stable estimates of program effectiveness across campuses. Finally, it should be noted that effect sizes across study outcomes were relatively modest, as might be expected given that The Men’s Program is a 1-hr program. On the one hand, this is a strength of the program in that it creates greater opportunities for students with busy schedules, especially athletes and military college cadets, to attend prevention programming. A limitation of offering a single, 1-hr program, though, is that this leaves out the possibility for follow-up and additional training that might improve bystander efficacy. Thus, programs like The Men’s Program must be one piece in the fuller array of campus-wide prevention programming. Despite these limitations, this study extends previous work on sexual violence prevention programming by demonstrating that brief bystander intervention programs like The Men’s Program can be feasibly implemented with similar effect across campuses, whereas the impact of alcohol use on receptiveness to prevention programming remains an important area worthy of future investigation.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was conducted with support from the South Carolina Clinical and Translational Research Institute (NIH/NCRR#UL1RR029882, Community Engaged Scholars Award PI: Williams) and NIMH Training Grant T32 MH18869-26.