Abstract
There has been a rise over the past several years in behavior problems among preschoolers. Young children who exhibit disruptive behavior are at increased risk of problematic outcomes later in life. Children from racial or ethnic minority groups and/or disadvantaged backgrounds may be at greater risk for behavioral problems. Therefore, interventions are needed before these behaviors become more entrenched. Parents of children with disruptive behaviors have reported higher parenting stress levels, which has a negative effect on parenting behaviors. Three models of parenting styles and behaviors are discussed, with a focus on the literature on African American parenting styles. To contribute to the literature addressing parenting training programs with African American populations, a case is presented as an example of the usefulness of an evidence-based behavioral family intervention with a low-income African American single parent family. Treatment recommendations are presented when applying evidence-based parenting programs with African American and other racial or ethnic minority groups.
Keywords
Disruptive behavior problems constitute one of the most prevalent problems affecting children younger than 8 years (Egger & Angold, 2006). There has been a rise over the past several years in behavior problems among preschoolers. Epidemiological data indicate that nearly 20% of preschool-aged children have significant behavioral problems (Axelrad, Pendley, Miller, & Tynan, 2008). Young children who exhibit disruptive behavior problems such as temper tantrums, hyperactivity, physical aggression, and noncompliant or defiant behavior are at increased risk of problematic outcomes in later childhood, adolescence, and adulthood (Gross et al., 2003). There has been an increasing emphasis on identifying and treating young children with disruptive behavior problems before they enter school (Charach et al., 2013), as these behaviors become more entrenched and difficult to treat the longer they persist. Therefore, early childhood is an important time for identification and interventions to target behavioral problems. Children from racial or ethnic minority groups, especially urban, low-income, disadvantaged backgrounds, may be at greater risk for behavioral problems due to exposure to community violence, increased parental stress, and poor parenting practices (McLoyd, Kaplan, Hardaway, & Wood, 2007). Early identification, prevention, and intervention that reduce the negative trajectory of these youth are necessary to improve their outcomes later in life.
The responsibility of parenting children, especially young children with disruptive behaviors, comes with many challenges. “Parenting stress” has been defined as the difficulty that arises from the demands of being a parent (Anthony et al., 2005), which involve characteristics of the child, the parent, and the context (Reitman, Currier, & Stickle, 2002). Parents of children with disruptive behaviors have reported higher parenting stress levels (Levac, McCay, Merka, & Reddon-D’Arcy, 2008; Ostberg & Hagekull, 2013; Williford, Calkins, & Keane, 2007), which are associated to external stressors such as socioeconomic disadvantage (Morgan, Robinson, & Aldridge, 2002) and family structure (i.e., single parenting) (Belsky, 1993; Huaqing Qi & Kaiser, 2003). Family risk factors such as racial or ethnic minority status, poverty, economic hardship, exposure to criminality or violence, housing instability, family adversity and/or conflict, low educational attainment, and job instability have been identified as potential stressors related to problematic child behaviors and parental stress (Heinrichs, 2006; Huaqing Qi & Kaiser, 2003; Lansford et al., 2009; Morgan et al., 2002; Ostberg & Hagekull, 2013; Querido, Warner, & Eyberg, 2002).
It is difficult to discern whether parenting stress increases the risk for child disruptive behavior, or whether the child disruptive behavior increases parental stress. Regardless of linear or circular causality, previous research has identified a relationship between parenting stress and parenting behaviors (Anthony et al., 2005). Specifically, parenting stress has a negative effect on parenting behaviors, influencing the parent’s behavioral expectations, nurturance, and discipline strategies. In their study, Anthony and colleagues found that the parents who reported elevated stress tended to acknowledge using more strict (i.e., harsh) discipline and less nurturing behaviors such as warmth and responsiveness. These parents were also described as having unrealistic expectations of their children, which contribute to their stress level and parenting behaviors.
Three models of parenting have been described in the literature that characterized parenting styles and expectations of behavior on a continuum of responsiveness versus demandingness: authoritarian, authoritative, and permissive (see Baumrind, 1971). On one end of the continuum is the authoritarian parenting style, which is described as high behavioral expectations (i.e., demandingness) and punitive, often physical, disciplinary strategies that attempt to control the child’s behavior. On the other end of the continuum is a permissive parenting style, which consists of few demands, behavioral expectations, limits, or restrictions placed on the child. The authoritative parenting style is described as the balance between responsiveness (e.g., warmth, emotional support) and demandingness (e.g., clear and firm limit-setting). The authoritative parenting style is a combination of appropriate behavioral expectations and parental responsiveness. Specific child behavioral outcomes have been associated with the three parenting styles described above. According to Baumrind (1971), the authoritarian parenting style is associated with conduct problems in children such as hostility and resistance; the permissive parenting style leads to lower self-esteem, poor life satisfaction, ambiguous parent–child relationships where boundaries are diffuse, and impulse control and adjustment problems later in life; and the authoritative parenting style leads to the child’s sense of independence, purpose, responsibility, and self-esteem.
The authoritative parenting style has been described in the literature as having the best outcomes in children of all ages, races or ethnicities, and environments. However, there is not a clear consensus in the literature as to whether authoritative parenting universally produces better outcomes with diverse groups (Hunt, 2013). Some basic assumptions regarding the links between parenting styles and developmental outcomes may not be universal and cross-culturally valid (Whaley, 2000). Racial and ethnic and socioeconomic differences in parenting have been found among groups in the United States (Lansford et al., 2009; Querido et al., 2002). For example, those with fewer socioeconomic, environmental, educational, or coping resources are more likely to use harsh, punitive, often physical discipline methods as described in the authoritarian parenting style (Dietz, 2000; Lansford et al., 2009; Laskey & Cartwright-Hatton, 2009; Querido et al., 2002). It is theorized that poverty and the associated higher frequency of negative events (e.g., housing instability, family adversity) can place demands on parents that exceed their psychological coping resources (Anthony et al., 2005). Parents of higher socioeconomic status (SES) tend to place more emphasis on democratic, joint decision-making and usually endorse a more authoritative parenting style (Hunt, 2013). The literature on African American parenting has suggested that African American families tend to use physical discipline and authoritarian parenting practices more frequently than Caucasian American parents (Querido et al., 2002; Reitman, Rhode, Hupp, & Altobello, 2002). Physical discipline appears to be used across socioeconomic groups in African Americans; however, it may be associated with lower SES in Caucasians. For example, Heffer and Kelley (1987) examined race and income differences in 83 African American and Caucasian mothers and their beliefs on child behavior management strategies. They found that physical punishment was considered acceptable to 64% of low-income and 67% of middle-income African American mothers, whereas 60% of low-income and 25% of middle-income Caucasian mothers. These findings suggest that, unlike Caucasian Americans, physical discipline is not simply a social class phenomenon for African American parents (Whaley, 2000). Therefore, it is assumed, based on the research which describes a correlation between low SES and authoritarian parenting behaviors, and the likelihood that African Americans utilize physical discipline regardless of income, that African Americans of low income are more likely to utilize harsh discipline methods.
It is noteworthy to mention the broader historical context and functional significance of physical discipline in African American culture. Physical discipline represents different motivations and meanings for African American versus Caucasian parents, and derives from both historical and contemporary experiences with oppressive societal conditions (Whaley, 2000). According to the research, physical discipline (i.e., spanking) originally functioned as a means of instilling respect for the power of authority, which stems from learned behavior from the institution of slavery (Arnold, 1982; Belsky, 1993; Whaley, 2000). That is, slaves beat their children to enhance their chance of survival just as the slave masters beat them (Wright, 1982). Spanking may have also functioned as a means of teaching children obedience for greater likelihood of survival, to convey the nature of the world and survival in a hostile environment, and to protect them from greater harm for defiance or violation of social rules (Belsky, 1993; Whaley, 2000; Wright, 1982). This mechanism of survival holds contemporary significance and is present in the cultural attitudes, values, and child-rearing practices of African Americans today, although the era of slavery was abolished long ago. It is not uncommon for African Americans to utilize physical discipline as a form of preparation for contact with legal authorities. For example, a common saying in the African American community is “I’d rather my child get a beating from me than from the police,” (Whaley, 2000). Belsky (1993) cited the Rodney King beating as evidence to support the assertion that violation of societal rules has grave consequences for African Americans (Whaley, 2000).
Although the authoritarian parenting style is typically associated with poorer child outcomes than authoritative parenting, an authoritarian parenting style is not always associated with negative behavioral outcomes and adjustment problems in low-income African American samples (Greening, Stoppelbein, & Luebbe, 2010). One of the earliest studies was conducted by Baumrind (1972) who found that, unlike the Caucasian American subsample, an authoritarian parenting style was not associated with negative behavioral outcomes for African American preschool-aged children. More recent research with African American families suggest that authoritarian parenting practices may actually foster more positive psychosocial adjustment among low-income African American children rather than poor adjustment (Reitman, Rhode et al., 2002). In fact, Greening, Stoppelbein, and Luebbe (2010) found authoritarian parenting practices (i.e., high demands of the child, restrictions, inflexible limit setting, and demands for obedience) served as a buffering effect from suicidal behaviors in low-income African American children ages 6–12. Reitman, Rhode and colleagues (2002) have also suggested that authoritarian child-rearing practices convey respect and positive expectations among low-income African American children living in high-risk neighborhoods. These studies provide evidence that the use of physical discipline and the authoritarian parenting style can be a protective factor against the development of child behavior problems in African American families (Whaley, 2000), which is contradictory to earlier research. Perhaps these findings suggest that physical discipline is associated with negative outcomes for Caucasian American families, but not for African American families. However, Querido, Warner, and Eyberg (2002) found that, similar to the research with Caucasian American families, the authoritative parenting style was most predictive of fewer behavioral problems in their study of African American parents of preschool children, providing support for the cross-cultural validity and generalizability of the authoritative parenting style. This inconsistency in the research could be attributed to the fact that parenting styles have largely been examined with Caucasian families and have only recently been examined among African American families (Greening et al., 2010; Reitman, Rhode et al., 2002; Whaley, 2000). Whaley (2000) asserts there is an “ethnocentric bias” when researchers inappropriately generalize from studies of predominately Caucasian samples to African American samples from inner-city communities.
Parenting Programs
Psychosocial behavioral treatments in the form of parenting education and training have been found to demonstrate a large and sustained effect on early disruptive behavior problems (Comer, Chow, Chan, Cooper-Vince, & Wilson, 2013) and should be considered first-line treatment for young children aged 2–5 (Gleason et al., 2007). Parenting programs are typically delivered in a group format versus individualized therapy, which has been found to be cost-effective, expands access, decreases stigma and social isolation, promotes peer support, and optimizes provider resources (Comer et al., 2013; Gross et al., 2003; Sanders, 1999).
There are several psychosocial parenting interventions, particularly those who use behavioral approaches, designed to teach parents the use of positive strategies to manage their child’s behavior more effectively. Behavioral treatments such as Parent–Child Interaction Therapy (PCIT) (see Eyberg & Calzada, 1998; Hembree-Kigin & McNeil, 1995) and the Triple P-Positive Parenting Program (Triple P) (Sanders, 1999) have been the most frequently studied form of psychosocial behavioral intervention (Weisz & Kazdin, 2010), thus having the strongest empirical support as an intervention for young children with disruptive behavior problems (Sanders, 1999). These behavioral parenting interventions target child behavior problems indirectly by shifting the focus to parenting practices as a bi-directional intervention to improve the situation for both parent and child. The goal is to discourage coercive discipline in favor of more positive strategies to improve child behavior, improve the parent–child relationship, and increase the parent’s competency in their ability to handle their child’s problematic behaviors (Sanders, 1999).
This paper specifically focuses on the use of Triple P (see Sanders, 1999 for a description of the model) with an African American, low-income parent of a preschool-aged child. There is limited published data on the use of evidence-based parent training programs with African American populations (Fernandez, Butler, & Eyberg, 2011). Triple P has been applied to mostly Caucasian families in Australia, New Zealand, Europe, and Canada. To the authors’ knowledge, there is a scarcity of research on the efficacy of Triple P with low-income, U.S. racial/ethnic minority populations, especially African American parents. It is our hope that this article contributes to the literature base on the use of evidence-based parenting interventions with African American families.
Case Example
Ms. A is a 29-year-old African American single mother of 5 children ranging in ages from 9 to 12 months. Ms. A attended the parenting groups based on her concern for her 4-year-old daughter Z (her fourth child). Ms. A completed the 11th grade and currently works at a fast food restaurant. She lives in an urban area of a Southeastern state. Ms. A receives governmental benefits, including Medicaid, food stamps, and temporary assistance for needy families and she reported an annual family income below US$20,000. She is in a romantic relationship with her youngest child’s father who lives in another home. Ms. A and her 5 children live with the maternal grandmother who provides child care services while Ms. A goes to work. Ms. A reported she and the grandmother have differing parenting styles, with the grandmother being more lenient with the children regarding household rules and limit setting. She reported often feeling undermined by her mother when she provided consequences for her children.
Ms. A completed a checklist regarding her perceptions of the frequency and severity of Z’s problem behavior. She rated Z as noncompliant with chores or rules of the house, defiant, argumentative, spiteful, has tantrums/angry outbursts where she yells and screams, destroys objects, verbally and physically fights with her siblings, lies and denies wrongdoing, and constantly seeks attention. When asked to give an example of a typical conflict that she and Z have, she stated one of Z’s household chores was to clean the house (along with her 12-year-old sister), and Z often had a tantrum when she did not want to clean up. When Z has a tantrum, Ms. A yells at Z or Z gets a “whupin”, which was described as Z being spanked with a belt. Ms. A reported she often got angry at Z for her behavior, which was often expressed as increased yelling or physical discipline. Ms. A described herself as a “strict” parent who “doesn’t play or take no mess.” Ms. A described her relationship with Z as strained, and became tearful as she discussed how she does not like Z and thinks of her as the “devil child.” Ms. A stated she has not had behavior problems with her other children, and that Z’s behavior has ostracized her from her siblings.
Our Assessment
Our assessment of the family system focuses on both the child and the parent’s behavior. Let’s begin with Ms. A’s parenting style and behavior. According to her report, Ms. A appears to utilize an authoritarian parenting style with physical discipline and a lack of nurturance, warmth, and responsiveness in her interactions with Z. She seems to have high/unrealistic expectations of Z’s abilities which are not developmentally appropriate, as evidenced by her expectation that Z cleans the house to the same standard as her sister who is 8 years older than she is. Ms. A’s parenting style and behavior, whether causative or an exacerbation to Z’s behavior, are assumed to be related to the increase in Z’s problem behavior, her emotional dysregulation (i.e., anger and display of negative emotions), frustration tolerance, and relationship with her siblings. In turn, Z’s behavior increases Ms. A’s parenting stress level and her negative perception of Z. Ms. A is in need of an intervention to teach her positive parenting skills to improve Z’s behavior, role model adaptive behaviors and emotional regulation, and strengthen the parent–child relationship.
Our intervention: Ms. A participated in the Triple P group, which consisted of 5 face to face group parenting education sessions and 3 telephonic consultation sessions. Based on the goal of Triple P, our sessions were designed to help Ms. A not only manage Z’s problematic behavior more effectively, but also teach Ms. A how to encourage Z’s desirable behaviors, change Z’s problematic behaviors in positive ways, and improve the parent–child relationship. During the sessions, other methods of discipline (besides physical) were encouraged, including giving choices, quiet time and time-out from reinforcement, consequences and limit setting, developing a positive relationship through quality time, teaching new skills and behaviors, and planning ahead and maintenance of change.
Our goal was to help Ms. A become more balanced (i.e., authoritative) in her parenting style by providing more encouragement to Z to behave in appropriate and more adaptive ways and increase the opportunities for quality time to improve Ms. A and Z relationship. Ms. A and Z were instructed to spend at least 10–15 min daily doing something together, which was challenging for Ms. A, given her work schedule and other children to care for. However, Ms. A was able to make time in her daily schedule for Z, which seemed to decrease Z’s tantrums and need to gain attention in negative ways. Ms. A also spent time instructing Z on how to perform household chores via an “Ask-Say-Do” model where she assessed Z’s knowledge on how to clean the house (Ask), told her how to clean the house (Say), and then demonstrated for her while giving Z an opportunity to practice the new skill (Do). Ms. A was encouraged to incorporate less coercive discipline in favor of discipline strategies such as giving choices (when appropriate), warnings before consequences, quiet time and time-out, and removal of reinforcement to change Z’s behavior in positive ways, thus decreasing the use of physical punishment.
The grandmother was invited to the group sessions, but she was unable to attend while caring for Ms. A’s other children at their home. Therefore, with Ms. A’s consent, we spoke to the grandmother during telephonic consultations. We expressed our appreciation for the grandmother’s role in her family’s lives and of Ms. A’s efforts to become a better parent, and we asked the grandmother to continue to support Ms. A in her parenting efforts by respecting Ms. A’s authority over her children. We discussed some of the core principles of Triple P (i.e., empowerment and improving the parent–child relationship) and asked whether the grandmother would be willing to read and discuss the handouts given during the group sessions with her daughter. The grandmother expressed understanding and willingness to be more supportive of her daughter’s parenting efforts.
We met with Ms. A 6 weeks after the conclusion of the parenting groups. She reported improvement in Z’s behavior as well as their relationship, and felt more confident in her parenting ability to manage Z’s behavior. She no longer referred to Z as a “devil child” and described Z in more endearing terms. Ms. A stated although she continued to have difficulty finding time in her schedule to spend 10–15 min daily with Z, that she has made her relationship with Z more of a priority by having monthly outings with Z. Even Z’s siblings have noticed a difference in Z’s behavior. Ms. A told us what she found to be most helpful from the group sessions is “being prepared.” For example, she stated taking Z on routine errands with her previously was a frustrating experience, but now she anticipates long waits by carrying juice, snacks, crayons and paper in her purse. Ms. A reported being more affectionate with Z by giving her hugs, kisses, and eye winks to let her know she is doing a good job. Although she stated she continued to have some issues with her mother regarding undermining her authority, she recognized that this situation would most likely improve when she moved out of her mother’s house into her own place.
Discussion and Treatment Recommendations
The case example above shows the effectiveness of an evidence-based parenting intervention with a low-income African American parent of a preschool-aged child in teaching positive parenting behaviors and authoritative parenting skills. We hope that we have demonstrated that improving parenting behaviors may indirectly change the child’s behavior in positive ways. However, we recognize that there is limited empirical data on the use of evidence-based parent training programs with African Americans. Therefore, the following treatment considerations are recommended when applying Triple P or other evidence-based parenting training programs to African American or other racial/ethnic groups or people of color: Treatment adaptations may be needed to apply an evidence-based behavioral intervention (which has largely been studied with non-U.S. Caucasian populations) with low-income African American parents because of racial/ethnic/cultural and socioeconomic differences in family attitudes, parenting beliefs, and behaviors. When evidence-based treatment interventions are applied to new populations, adaptations are at times needed to improve the clinical utility in the new population (Eyberg, 2005). Delivery style and wording changes of the way information is presented in the manual (while maintaining the core features of the evidence-based parenting program) may be helpful for comprehension and “buy-in.” Additionally, audiovisual materials (i.e., pictures, images, etc.) that are representative of the population being served should be used to appeal to audio-visual learners and/or those with low literacy. The use of physical discipline (e.g., spanking) is a deeply held and entrenched parenting practice in African American culture which dates back to slavery (see Belsky, 1993; Wright, 1982). It is important to recognize the historical and functional significance of this discipline method in the African American community, and not develop an “ethnocentric bias” that this behavior is pathological and will lead to negative developmental outcomes (Whaley, 2000). Successful implementation of a parental training program must include consideration of the parent’s racial/sociocultural background and its influence on parenting attitudes, beliefs, and behavior. However, an appreciation of sociocultural differences in parenting styles should not lead to unconditional acceptance of punitive behaviors because of their cultural significance (Whaley, 2000). Regardless of the group leader’s personal parenting beliefs/practices on spanking, when treating African American (or other racial/ethnic group) populations, this behavior should be viewed on a continuum of harm, with spanking a child while clothed without leaving a bruise viewed as less severe, and beating the child with an object (e.g., belt, shoe) with/out clothes and leaving a mark as most severe. Conversations between group leader and parenting group surrounding issues of physical discipline should be respectful of their belief system while advisory of the duty to report suspected child abuse (i.e., physical discipline behaviors which leave bruises or marks on the child) explicitly stated. Instead of advocating for the elimination of physical discipline (which may be an entrenched belief which is highly resistant to change), increased efforts should be made to teach and encourage the use of positive, alternative discipline strategies with the expectation that the parents will self-govern and self-regulate in favor of non-physical methods once instilled with the tools to handle their child’s behavior more effectively. Use of group leaders who are culturally competent and knowledgeable and/or representative of the race/ethnicity of the population served may be helpful. The group leader should be knowledgeable and respectful of issues that affect the community and be comfortable discussing these issues. For example, group discussions may veer off into special issues and challenges raising African American children as a result of the historical, social, economic, and political climate (e.g., coping with racism, racial socialization, developing a positive racial identity, etc.). If this becomes a major focus of the group sessions, the group leader may want to obtain training in culturally specific African American parenting programs such as the Center for the Improvement of Child Caring’s (CICC) Effective Black Parenting Program (see CICC website for description of program at http://www.ciccparenting.org/EffBlackParentingDesc.aspx) The following resources for parents of African American children can be shared for parents who want further information: Raising Black Children by James P. Comer & Alvin Poussaint; The Black Parenting Book: Caring for our children in the first 5 years by Linda Villarosa; Black Parenting: Strategies for Training by Dr. Kerby T. Alvy; The African American Child: Development and Challenges 2nd edition Yvette R. Harris & James A. Graham. These resources focus on the psychological, social, economic, political, and cultural context in which African American families are embedded from a resiliency perspective. Although not necessary to successfully lead group sessions, a group leader who is also a parent may increase rapport-building between leader and participants, the participants’ ability to relate to the leader, and credibility. It may be helpful for the group leader to share the age and behavioral challenges of the group leader’s own child/ren as an introduction in the first group session in order to develop a bond with the group. The group leader should make program concepts relevant to the population served by interjecting anecdotal experience, relevance to issues in current events, or adapting the material to widely held cultural belief systems in the African American community (e.g., discussions of how African American children are perceived in society, culturally relevant lessons parents feel are important to teach to their children, etc.). Telephonic consultations should be offered between sessions or in lieu of group format sessions to clarify the need for parenting intervention, maximize investment, and develop strategies to overcome obstacles such as lack of time or childcare issues (Snell-Johns, Mendez, & Smith, 2004). These telephone sessions should be designed to coach the parent on positive parenting skills (versus between-session therapy). Biologically related (e.g., father, grandmother, aunts, and uncles) and non-biologically related family and/or friends should be included in the parenting interventions. Anyone who assumes child care responsibilities or has significant influence over the child (e.g., mother’s boyfriend/partner, godparents, neighbors, etc.) should be invited to attend the parenting groups. “Booster sessions” should be provided within the weeks or months following the conclusion of the parenting group, as parents may revert into old patterns of coercive discipline strategies and have difficulty using the positive discipline skills they learned during the parenting group (Gross et al., 2003). This is consistent with Myers et al.’s (1992) observations that parents regressed to earlier, more coercive parenting practices 1 year following the completion of the group intervention. Additionally, individual therapy sessions for the parent may be needed to address stressors unrelated to the child’s behavior that comes up in the weeks or months following the parenting group. Parents who participated in the intervention may demonstrate limited behavioral change if they feel the intervention was not relevant to their concerns. Therefore, the group leader should seek feedback from group members on how to improve the group’s cultural relevance, and utilize this feedback for improvement of the instruction. This feedback can be achieved through verbal feedback or written feedback in the form of a survey.
Conclusion
Improving the parenting skills of African American parents, especially those of low income, may indirectly increase their tolerance of stress, even if their immediate environmental conditions do not change, thus positively altering their child’s behavior and the health of the family system as a whole. Once given the resources to implement alternative discipline strategies, it is assumed that both parent and child will have better outcomes. While the authors are optimistic of the efficacy of evidence-based parenting interventions with low-income African American parents in the exposure to more positive discipline strategies, implementations of these evidence-based programs without recognition and consideration of the applied population’s psychological, cultural, social, and economic environment and its relevance to parenting will be a disservice to the given population. It is hoped that the case example and treatment recommendations described in this article serve as a springboard for further research with low-income African American parents of preschool-aged children. Other parent-focused psychosocial interventions and/or behavioral parental training programs should be explored for their usefulness with African American populations in future research, as well as future research with other racially and ethnically diverse groups from both lower and higher SES. Studies to explore group participants’ long-term maintenance of positive parenting practices may be warranted.
Footnotes
Acknowledgment
Dr. Kelch-Oliver would like to thank Marcus K. Oliver, Esq. for his editorial feedback.
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) received no financial support for the research, authorship, and/or publication of this article.