ISSN 2560-9815

Volume 2 | Issue 1 | August 2018

Te Young Researcher

Te Young Researcher SUMMER 2018 VOLUME 2, NUMBER 1

A journal dedicated to the publication of original research from secondary school students

Editor-In-Chief John Lambersky

Royal St. George’s College Editors Consulting Editors Arshia Amirzadeh Barrie Bennett Nicholas Bethlenfalvy Anthony Campbell Jason Bowles Conover Jeremy B. Caplan Kern Chepeha Hance Clarke Adam Fell Will Fripp Ryan Hamilton Michael Gemar William Howard-Waddingham Jennifer Goldberg Brendan Lai Tim Hutton Arman Majlessi John Lambersky Denis Miller Lori Loeb Pearse O’Malley William J. McCausland Oscar Peters Michael Simmonds Andrew Pyper Ted Higginbotham Jeremy Rau Jaime Malic Suzanne Akbari Financial Support Ira Jacobs Royal St. George’s College Layout and Design Editorial Ofce Jonathan Cresswell-Jones 120 Howland Avenue Toronto, ON, Canada M5R 3B5 www.theyoungresearcher.com

Produced and Distributed by Royal St. George’s College

ISSN 2560-9815 (Print) ISSN 2560-9823 (Online)

1 Table of Contents

5 On Fire For God: Exploring Adolescent Religious Development Ella F. Moxley

15 Flight to the Stone Age: Investigating the Impact of FAA Cockpit Regulations on Kidney Stones in American Airline Pilots Noor Said

27 Evolution of an Invasive Species: Solidago Canadensis in Europe and the Americas A Comparison Using Ribosomal ITS and 5S-NTS Sequences Rachael Dickenson

38 Comparing Modern Twitter Campaigns To Traditional Campaigning: A Comparison of the Frames and Tones of the 2016 and 1975 UK Referendums Lida Ehteshami

52 Smoke Break: Electronic vs Tobacco Cigarettes Isaac Gallogly

65 Efectiveness of Cognitive Behavioral Terapy for Major Depression in Stage II Pancreatic Cancer Patients from the Clínica General del Norte in Barranquilla, Colombia Hector Cure

78 Shifing Perceptions: A Quantitative Experimental Study Regarding the Efect of Positive Kinesics on People Who Stutter Steven Du

2 98 Race, Wrongful Convictions, and Texas: An Analysis of the Impact of Juror and Defendant Ethnicity on Wrongful Convictions in Texas William Howard-Waddingham

112 Evaluation of Essential Oils as an Alternative to Conventional Antibiotics Megan Leinenbach

123 CBD and Lymphoma Sophia Xu

135 Student Perceptions of the Implementation of Formative Assessment: A Royal St. George’s College Case Study Andrew Pyper

148 A Descriptive Study of Adolescent Perceptions of Rural Versus Urban Kentucky High School Student Mental Health Challenges Allison Tu

164 LED Color Temperature and its Efect on the Growth of Hydroponic Lettuce Seedlings Justin Shaw

3 Editorial

Te truth is hard to fnd.

We live in a world with so much information that it is difcult to tell what is right and what is wrong. Opinions can become fact, with little research done to support them. Te Young Researcher is published with the goal of dispelling this notion among youth, providing a forum for reliable and truthful research, and inspiring future young people to become more involved in academia. We believe this can be achieved no matter a person’s age or location. Anyone who is willing to work hard can add to our collective knowledge. Every paper published in this journal is devoted to truth. Te authors featured lef no stone unturned in their quest for new and meaningful information. Te papers represent a range of topics and represent the broad range of research necessary to fnd truth. Te papers analyzed pertinent topics in several important felds. To ensure the journal did not fall to publication bias, any result could be published regardless of its fndings: whether it established a landmark conclusion or concluded that the original hypothesis was incorrect. Te Young Researcher prides itself on utilizing a blind peer- reviewed process. In this manner, it ensures that the published research is of a high quality, and the research conducted is valid and truthful. We hope you enjoy this collection of studies and that it gives you a new understanding about the world.

Welcome to Te Young Researcher.

Te Editors Arshia Amirzadeh Brendan Lai Nicholas Bethlenfalvy Arman Majlessi Jason Bowles Conover Denis Miller Kern Chepeha Pearse O’Malley Adam Fell Oscar Peters Ryan Hamilton Andrew Pyper William Howard-Waddingham Jeremy Rau

4 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018

On Fire For God: Exploring Adolescent Religious Development

Ella F. Moxley

High school students are navigating new social relationships and milestones; in this process, they may be forced to reevaluate their own religious identity. Tis research study asked the question, “How do adolescents ages 16-18 view their own religious development in a time when they have gained greater autonomy from their parents, and what factors do they see as most important in forming their own religious identity?” Trough a series of half-hour phenomenological interviews with six carefully selected students, this study seeks a better understanding of those factors infu- encing the religious identity of adolescents. Interview questions were aimed at fnding shifs in the participants’ religious identity in adolescence. Te study is a critical investigation as it allows for a better understanding of what kind of events, people, or institutions are most infuential in a young person’s life. Data analysis revealed four distinct themes: community, personal relationships, educa- tion, and morality. I examine those themes and show how they reveal that late adolescence is a time of complex identity development. My principal conclusion is that adolescents are active agents in their development of religious identity. Tey use the messages they receive from outside sources to inform their own choices about their religious identity and the role that religion plays in their lives.

Keywords: Religious development, adolescents, socialization, autonomy

Introduction tance of religion within their overall identity (p. 879). Religious identity can or perhaps should be viewed Religious activities are an integral part of many as involving multiple factors, in which the family is a American teenagers’ lives, yet for many young people, compelling factor. Regnerus, Smith, and Smith (2004) their religious identity exceeds the ascribed beliefs in recognize how religion is inherently practiced in the which they were raised. Troughout adolescence, company of others (p. 27), which is why Zhai, Ellison, exploration, fueled in large part by doubt, can help Stokes, and Glenn (2008) make the claim that family young people better defne their religious identities can provide a socializing pull for the development of (Baltazar & Cofn, 2011, p. 188). Smith (2011) holds a religious identity (p. 380). Tis means that in order that identity for any group is made up of their mem- to understand a young person’s religious identity, it is bership, position, and status within a social group (p. critical to also understand how they are infuenced by 217). Nelson (2010) describes religious identity as their parents. composed of three signifcant elements: belief, action, Tis paper aims for a better understanding of how and membership (p. 337). As young people age, their complex social interactions, as well as important mo- personal beliefs, as well as memberships to certain ments in adolescents’ lives, can shape their religious groups, may shif in response to outside factors. identities. Te principal research question for this Another aspect of religious identity relevant to un- study asks “How do adolescents ages 16-18 view their derstanding how religion factors into a teen’s view of own religious identity development in a time when oneself is religious salience, which James, Lester, and they have gained greater autonomy from their par- Brooks (2014) describe as how one sees the impor- ents, and what factors do they see as most important 5 ON FIRE FOR GOD: EXPLORING ADOLESCENT RELIGIOUS DEVELOPMENT in forming their own religious identities?” Tis ques- young people’s orientation towards religion is ofen tion illuminates the lives of young adults and facili- more rigid and concrete during early stages of the life tates an understanding of those factors holding im- course in which parental stipulation is likely a potent portance for a young person’s growth into an adult. factor (p. 1027). Tese observations reveal that early stages of religious identity are ofen one dimensional due to the fact that young children have not yet criti- Literature Review cally examined the religious identity ascribed to them by their parents. High School Student’s Religious Experience As adolescents move further into biological and social development they not only gain new cognitive Troughout the last few decades, researchers fo- abilities, they also go through what Kox, Meeus, and cusing on religious identity have illuminated the Hart (1991) would call “turning points,” where chang- religious lives of adults by focusing on college-aged es in life correlate with shifs in how adolescents think young adults (18-22 year olds). Tis has lef a con- about their religious identity (p. 234). Tese changes siderable gap in understanding younger age groups, are immensely important because Armet (2009) fnds which led Bebiroglu, van der Noll, and Roskama that such changes can culminate in the development (2017) to focus on the “need to move beyond ex- of a young person’s identity, which is “one of the most amining adult conversations to study children and important tasks of adolescence” (p. 279). As children understand their perspectives” (p. 290). Te body of begin to mature, the way they relate to their own re- literature that does focus on a younger age group is ligious identity may shif. To become an active agent clear that the experiences of high school students are in defning one’s own identity is a critical transition critical to the feld due to the fact that young adults into more autonomous functioning and higher level are biologically primed to begin thinking more deep- thinking. ly about abstract religious concepts (Barry, Nelson, Davarya, & Urry, 2010, p. 312). Older Adolescence: Understanding how American teenagers de- velop their religious identity is especially relevant in Watson, Howard, Hood, and Morris’s (1988) re- the digital age. According to Bobkowski and Pearce search reveals that religious orientation ofen be- (2011), social media forces students to consider comes more exploratory in the adolescent years how they present their own identities in the face of which they attribute to youth experimenting with the decreasing privacy and increasingly complex social freedom they have to develop their own identities (p. norms within a matrix of rich social interactions (p. 276). Diferent researchers have concluded that this 744). Gaining insight into the religious identity devel- kind of exploration can result in a number of diferent opment process from the perspective of high school outcomes. For Twenge (2017), data, collected in a na- aged young adults is a vital yet understudied domain tional survey, suggests that as adolescents gain more of inquiry. As Petts (2009) clearly acknowledges, a autonomy, and start to question the status quo, they better understanding of religious change and stability are more likely to leave their religion (p. 122). can help adults understand adolescent development However, Pearce and Denton (2011) contradict as a whole (p. 552). this through a series of qualitative interviews from which they conclude that increased autonomy results Early Adolescent Religious Development in youth “[having] matured to the point that their faith is their own and that makes it deeper and stron- In a qualitative study of Muslim students, Peek ger” (p. 3). Although these theories seem contradic- (2005) concludes that for many young people, their tory to each other, they both rely on the assumption Muslim identity went unquestioned throughout their that as youth age, they may be inclined to take control early childhood since it was just a routine feature of their identities. of their daily lives (p. 224). Tis is consistent with Other researchers have found conclusions similar observations from Hofman (2012) who notes that to those of Rew, Wong, Torres, and Howell (2007), 6 ON FIRE FOR GOD: EXPLORING ADOLESCENT RELIGIOUS DEVELOPMENT who break down religious identity to fnd that al- researcher to deeply understand the experiences of though young people’s religiosity (religious practice) each individual participant. may decline in adolescence, their subjective beliefs I designed an interview schedule that was semi- (spiritual beliefs) are constant (p. 57). Tis impli- structured, with ten open-ended questions based cates the potential for religious shifs that occur at on the literature review. In a qualitative study done multiple layers of a student’s religious identity. It is by Ravishankar and Bernstein (2014), the research- important to recognize religiosity as a key element of ers asked people about the impact of religion in lives religious identity, but it is not the full story. Tis is through “interviews [that] were based on a guide, but why religious researchers Lopez, Huynh, and Fuligni themes were freely explored as they arose” (p. 1900). (2011) indicate that there is potentially no correla- In a similar fashion, I created the interview schedule tion between participation and afliation (p. 1298). so it was fexible in order to fully follow up with stu- In fact, the decline in participation may be a product dents’ responses. of young people’s social environments, not changes in identity, according to Desmond, Morgan, and Ki- Recruitment of Participants kuchi (2010) who note that peer pressure may not always infuence the subjective beliefs of adolescents Six students from a high school located in a col- (p. 266). Terefore, the religious lives and identities lege town (located within a Bible Belt state) between of adolescents may produce a variety of changes, best the ages of 16-18 were interviewed for approximately understood through a lens that takes into account 20-30 minutes. Although I originally intended to the multiple ways adolescents view and act on their perform an hour-long interview, the length had to be religious identities. Due to the complex nature of re- revised since the content of the interview was usually ligious identity, a qualitative methodology is used in sufciently covered in under 30 minutes. Te number order to better understand the process from the per- of students was chosen based on a number that would spective of participants. provide a saturation of data in the time constraints. Participants were selected through announcements in various school groups (i.e. Speech and Debate, Chris- Methods tians on Campus, Band). My use of announcements to recruit participants was not productive, so I began Qualitative Methodology using a snowball method, where I asked participants to nominate other potential participants who were As a result of the complex nature of religious de- within their social networks. Participants completed velopment, which goes beyond simple group mem- consent forms indicating that they were informed bership, and the fact that research fails to include about the potential risks and benefts of their involve- adolescents, a methodology that gave a direct voice ment as informants. In order to protect confdential- to young adults’ experiences proved essential to ad- ity, each participant was assigned a pseudonym: John dressing the research question. In a similar study, one (Baptist), Sadie (Catholic), Melody (Baha’i), Sahana that examined the religious development of college (Hindu), Ceedee (Buddhist), and Nathan (Deist). students, the authors point out that “qualitative stud- ies are thus needed for fuller descriptions” (Rew et al. Interview Content 2007, p. 57). Qualitative research can be efective as it gives greater meaning to quantitative trends recorded During the interview, the researcher asked stu- in literature, and it helps illuminate the inner work- dents questions that illuminated their shifs in re- ings of a larger phenomenon. ligious identity over the course of their lives. One A phenomenological interview process was deter- such question is “How do you feel your current reli- mined to be the best method to understand how high gious identity difers or is constant with the way you school students see their religious development in thought about religion 10 years ago?” Te questions relation to their life experiences. Te interview pro- that were incorporated into the schedule were also cess was best suited for the research as it allowed the loosely based on important themes in adolescent 7 ON FIRE FOR GOD: EXPLORING ADOLESCENT RELIGIOUS DEVELOPMENT religious development that were identifed through Community the literature review. For example, a paper by Vaidya- nathan (2011), analyzed how socialization functions Religious Community with religion, noting that religion and ethnicity are deeply intertwined (p. 384). Terefore participants All participants talked about the way their reli- were asked, “Do you think that your racial or ethnic gious community had a tremendous efect on their identity infuences your religious identity?” All ques- religious development because it created a sense of tions can be found in Appendix A. Tese questions belonging. For both Sadie and John, their religious captured a narrative of adolescents’ religious his- community was something they could turn to when tory that focused on how their religious development they faced bullying in their schools. John was an es- shifed or remained constant throughout their ado- pecially salient example of someone who found deep lescence. Te responses also gave insight into what friendships in his religious community afer facing factors promoted adolescents’ changes in or continu- social exclusion from his school peers. Sahana also ity of their identities. saw the way that the community she found in religion was helpful as it gave her a break from the external Data Analysis Procedure turmoil she faced in her middle school. She refects that “Sunday was not just like me going to Sunday All responses were recorded and then later tran- school it was like our family’s kind of ritual… it was scribed. Afer transcription, I analyzed the data by like really solid and all the holidays were extremely frst sensitizing myself to the interview transcripts. fun.” For her and many other students, a religious Ten through multiple readings of the transcripts, I community was a source of stability within their lives became familiar with the raw data and I oriented to in the midst of external stress. prevalent themes that repeated themselves within and across multiple transcripts. I was attentive to shifs in Summer Camp adolescents’ religious lives. A shif was defned as a factor, person, or event that prompted a change in re- For three participants, summer camp was also ligious identity or otherwise infuenced the change. one of the greatest forms of community that afected Important themes were coded and organized like their connection to their religious identity. For John, Halama and Halamová (2005) organized their data in whose family was not very religious, “It was really a qualitative study of Christian conversions. Temes moving to be there surrounded by so many people were placed into categories and subcategories (p. 71). that are really religious.” For Nathan, summer camp I used such a procedure to help organize the data served to move him further away from the Christian so I could compare categories across all six partici- faith in which he was raised when he realized that, pants, and I located four shared categories and eight “this isn’t spiritual energy this is more of just human common subcategories. Te common themes across energy… even if you were going to a Nirvana concert participants were then analyzed using analytical you would get the same feeling.” Most participants questions developed from this researcher’s original noted that the “energy” these camps ofered was questions. critical to either reafrming their religious identity or forcing them to reevaluate their participation in their Results religious institution.

I identifed four major themes and eight sub- themes afer comparing codes across all six partici- Personal Relationships pants. Overall themes moved from external factors that afect young people to more personal factors. Role Models. Major themes were community, personal relation- ships, education, and morality. All students spoke of specifc personal relation- ships that were especially monumental in shifing 8 ON FIRE FOR GOD: EXPLORING ADOLESCENT RELIGIOUS DEVELOPMENT how they viewed their religious identities. Many Education students had role models who afected their identity the most. Some students spoke of peers like Sadie, Learning whose Mormon friend helped reafrm her Catholic views as a young high school student because, in the For all students, learning in all contexts was critical words of Sadie, “she gave me a diferent point of view to their religious development. For Ceedee, schools from someone that’s my age and going through the were a critical component of this. During her earliest same thing as me.” Melody also had an older friend years of elementary school, she spent her weekdays at that was able to provide her with religious guidance a Christian private school and her weekends taking that Melody trusted because of their proximity in age. classes at a Buddhist temple. Despite the confusion Tis kind of empathy was something most students about her religious identity this created in her youth, looked for in a religious role model. When unable to she says that her experience with both means that “I connect to his religiously ambivalent parents, John can see the diferences and why this is better for me.” turned to his youth pastor. John refected on the “sur- Learning about diferent religions was important rogate family” he found with his pastor saying that for Melody and Sahana who credit the US History “I feel like it just plugged a missing hole because you class and its teacher as helping them understand how want your family to do the things you do.” Role mod- they wanted to interpret their religious doctrines. Sa- els have great power to shif an adolescent either fur- die says that learning about other religions through ther into a religious identity or away from it especially interactions with diferent people was helpful to her if they are able to provide a young person with sup- commitment to Catholicism owing to the fact that port and empathy that they might be missing from “When I have exposure to everything I have a rea- other fgures in their lives. son to keep being who I am.” All students took steps to critically interpret the religious messages around Parents them to make an informed decision about their re- ligious identities, which seemed to shif over their Te most repetitive relationship seen in all six in- lifetime. terviews was the relationship between children and parents. Students repeatedly talked about their par- Teaching ents in the context of freedom, choice, and autonomy. Sadie says that “I didn’t really have strict enforcement Teaching others helped participants reafrm their of certain things that other Catholic families might. I own identities. Most taught younger students at their feel like I wasn’t forced to believe any specifc thing.” religious institution. Ceedee and John both partici- She sees this freedom as contributing to her growing pated in youth groups where they took on leadership interest as an adolescent in the Catholic faith. roles. Others, like Melody, felt that they had a duty to On the other hand, Nathan had the opposite ex- inform the others around them about their religious perience. He describes conversations with his parents identities, especially if they were from a religious mi- saying, “When I talk to my dad about religion he gets nority. Melody used social media to create awareness furious. It’s an open-minded thing. When you talk of her Baha’i Faith. Nathan sought to create religious to open-minded people you tend to keep an open awareness among peers. He used Instagram to create mind.” Nathan desired to have parents who would lis- a podcast in order to create an open dialogue about ten and support his own independent exploration of religion with his friends. Social media for both Mel- his religious identity. He felt like his parents’ unwill- ody and Nathan, was a key platform used to inform ingness to hear his own ideas contributed to his shif users of diferent religious identities about their own away from the Catholic faith. Parents can be power- beliefs. Tey felt that these diferences made it all the ful fgures in adolescents’ lives and their response to more important that they educate others about their young people’s growing desire for independence can beliefs. be critical in shaping youth’s identity development es- pecially in the context of religion. 9 ON FIRE FOR GOD: EXPLORING ADOLESCENT RELIGIOUS DEVELOPMENT

Morality demonstrate that their religious identity did not ex- ist in a vacuum. As they develop religious, moral, Moral Code and political identities concurrently, they modify all identities in order to ft together with each aspect of Especially important for participants was the their personalities. adoption and application of a moral code embedded and taught by the religions with which they identifed. John saw others who acted with what he viewed as Discussion Christian morals, and this made him more interested in connecting to his Baptist identity. Soon he became Te central question asked by this study was how concerned about also demonstrating these morals. do adolescents ages 16-18 view their own religious On the other hand, Sahana lef her religious identity development in a time when they have gained greater due to its moral code. In middle school, she felt she autonomy from their parents, as well as addressed could not reconcile her sexual identity with her re- those factors they might see as most important in ligious identity as a Hindu. When she entered high forming their own religious identities. Te coding school, she associated with a new friendship group of various adolescents’ descriptions of their religious which is why she said, “I realized that I could be a developmental process reveals young people are very good religious person and not be the exact defnition much active agents in determining their own identi- of what some super old scriptures say you should be” ties. Te participants were aware of their parents’ in- and this helped her reconnect with her Hindu iden- fuence on their choice, yet they are also conscious tity. Tis reinterpretation of one’s religious doctrine of how a variety of other factors shape their choice. was very common for the participants. When one Tis matches Pearce and Denton’s (2011) fndings aspect of their religion did not work well with an- that parents can function as “social scafolding” to other aspect of their identity, they reinterpreted their infuence their children’s religious beliefs and prac- religion and critically evaluated its doctrine. Tis was tices but do not have the power to completely dictate done in a way diferent or even contrary to their par- a young person’s religious identity. (p. 9). For most ents’ interpretation in order to personalize their reli- of these students, their religious identity is one that gion and imbue a religious doctrine with their own they create for themselves, an identity that may be personal perspective. consistent with or inconsistent with their parents’ commitments. Te participants reinterpret their re- Politics ligious identities through their experiences with role models or their own refections on morality and the Politics was also very relevant to most of these other identities they hold. A combination of these adolescents. And, politics infuenced their stance institutions, people, and their other experiences have on religion. For Sadie, she ofen felt attacked for her led them to integrate their religious doctrine in a way identity as a liberal Catholic. She felt like many peo- that is unique from their parents or other religious ple saw the two identities as mutually exclusive. Sa- role models. die says “with anything you’re defending you should Te data indicate that the participants likely begin think about why you’re defending it.” Te more she to apply their religious knowledge to their everyday was forced to justify her religious identity to others life, much like Brown’s (1964) description of an in- the more she was able to reinterpret Catholicism to trinsic religious person: “He has made his Church’s make it ft for her. Melody was also very concerned beliefs his own (although he does not necessarily hold about politics. Afer asking questions about her re- them all strongly), and he carries them into his ev- ligious doctrine, and realizing it matched many of eryday dealings with others” (p. 94). Tis kind of de- her progressive stances on social issues, she says, “I scription is parallel to the way John emphasized “act- was just really proud of my faith in that moment. ing with Christian values” or the way Sahana chose to Like they aren’t going to allow something like that volunteer in her community in order to satisfy Hin- and that just made me really happy.” Participants duism’s doctrine of Karma. All students emphasized 10 ON FIRE FOR GOD: EXPLORING ADOLESCENT RELIGIOUS DEVELOPMENT the relationship between their religious identities and What factors have the greatest infuence on the doctrines they embody and the morality of their religious identity? actions in a wider world. Ultimately, the process can make them more autonomous in the formation of For most students, understanding their ascribed their religious identities. Te data suggest that the religious identity on a deeper level was infuential participants were functioning as intrinsic religious to them claiming an identity for themselves. Trusted thinkers. people, like parents, mentors, and teachers who were willing to logically explain the more abstract aspects How has autonomy afected religious of religion became important sources of infuence in development? these young people’s religious development. Even me- dia, such as a textbook or book explaining a religious For adolescents, a religious summer camp was one doctrine, was helpful to these youths as they sought of the most obvious examples of the way that the au- to understand what their religious identity was in the tonomy materialized in their life to give them an ex- context of the wider world. Tis trend is supported perience that helped solidify their religious identity. by Armet’s (2009) observation that “exploration is Desmond et al. (2010) clearly note “parents and peers an important dynamic in the process of forming an provide models for adolescents to observe and imi- intrinsic commitment to an ideology” (p. 281). Once tate and positive and negative reinforcement (rewards students learned about their religious identity, they and punishments) for religious behaviours” (p. 248). felt more empowered to apply it to their everyday life. Tis is true for many students until an event, such as Tis was especially true for students that practiced summer camp, helps them partially break away from a minority religion. For many of these students, peer the infuence of their parents and peers; those who support was lacking as they began to explore their re- had previously either closely regulated their religious ligious identity. Tis is unsurprising as Bowman and behaviour or had not participated in religious social- Smith (2010) clearly state that “students from these ization. Te freedom of summer camp allowed them minority groups are ofen faced with a lack of sup- greater agency in interpreting or reinterpreting their port and/ or understanding of their religion” (p. 598). religious doctrine in a way that made sense to them, Even so, for some students, teaching those around not just to their parents. them about their identity or at times defending their Autonomy also surfaces as a critical component religious choices became easier once they were fully of the development of religious identity as youth be- educated about the religious identity they were prac- come leaders and educators. Many students talked ticing. Terefore mentorship and education serve as about taking on leadership roles within their youth important sources of infuence in these young peo- group which matches Ji and Tameifuna’s (2011) re- ple’s lives. search which states that students who are given the chance to have leadership roles will have a higher What has contributed to students’ shifs in level of commitment to their religious institution religious identity? as they will feel more cognitively engaged (p. 309). Tis is most certainly true of students participating High school is a time of increased autonomy but in the study. Ceedee, who taught younger girls at her also a time when social pressures are magnifed. youth group, felt more engaged with her religion in a Youth are infuenced by peers especially since peers leadership role. Whether teaching younger students can ofen give students experiences with new per- at their religious institution, their friends of diferent spectives and religious identities that can be infuen- religions, or other peers, they felt more connected tial in solidifying their own. Petts (2009) explains that and more confdent of their religious identity. Shar- exposure to new religious beliefs can ofen prompt ing this aspect of themselves with others seemed to students to shif their own religious identities to make solidify the commitment they had made to their re- it better ft their own (p. 556). Even if exposure to ligious paths. peers did not prompt a conversion in religious iden- tity, for many students their interactions with friends 11 ON FIRE FOR GOD: EXPLORING ADOLESCENT RELIGIOUS DEVELOPMENT of diferent religions helped them reinterpret their Conclusion religious doctrine to make it better suit themselves. Tis is a phenomenon is noted by Shalev, Baum, and Ultimately, this research shows that high school is Itzhaky (2016) whose study reveals that people can a dynamic time for youth. Family changes, peers, a be infuenced to make changes in their religious lives growing sense of autonomy, and leadership contrib- and identities through their interactions with people ute to shifs in adolescents’ religious identities. Tis with whom they sustain close relationships (p. 135). directly contradicts Lopez et al.’s (2011) statement Ultimately, as students progress through adolescence, that the “stability of adolescents’ social environment they will begin to develop relationships with people across high school results in few challenges to their outside of the social circles of their parents. Tis will existing religious identities, with little need to rene- prompt exposure to new ideas that can result in shifs gotiate the extent of one’s identifcation” (p. 1305). in their religious identity. Tis clearly shows that it As students progress through high school they are is imperative that young people are given safe social likely to reevaluate how they relate to their ascribed environments and positive mentors who help them religious identity or even shif to new ones. Recogniz- explore the opportunities they have available to them. ing that young adults are infuenced by a myriad of Tis allows adolescents to solidify their identity and factors around them is critical. Future studies can rec- develop into well adjusted young adults. ognize the agency that younger adolescents have. Stu- dents are likely free thinkers who are processing the Limitations messages they are receiving around them to make co- herent choices about their identities. Future research Although this study reveals critical knowledge can look into the way a secular education can impact about the way adolescents process the world around students’ formation of their religious identities. Te them to solidify their religious identities, it is not surprising impact of US History on the religious without faw. Like any study that uses a qualitative identities of several young people in this study shows methodology, the information in this study cannot that a secular education can introduce new ideas into be generalized to a larger population. Compensating a students’ consciousness that changes their relation- for this is that qualitative inquiry can give a more nu- ship to their identities. Ultimately, this research re- anced explanation of a phenomenon. Te phenom- veals that adolescents can display advanced forms of enological aspect of this study also gives more agency critical thinking about their religious identities that to the participant to tell their own story. Te other show they have much to add to the feld and should major faw in this study is location based. Te school not be disregarded as passive or minor actors who in which the study was performed, is located in a col- simply follow the beliefs their parents ascribe. lege town in the Bible Belt. Tis location is known to be more liberal relative to other cities in the state. Te city itself is also known to have two high schools largely divided by class. Tis study was performed at the more afuent and less diverse high school which could contribute to some of the trends seen in the study as most students never had to contend with economic instability. Many of the students interviewed who came from minority religious backgrounds go to school with predomi- nantly Christian peers. Tis might afect their devel- opment of religious identities because of the possible alienation they felt in the school and community in which they were living.

12 ON FIRE FOR GOD: EXPLORING ADOLESCENT RELIGIOUS DEVELOPMENT

Ji, C., & Tameifuna, T. (2011). Youth Pastor, youth ministry, and youth attitude toward church. Review of Religious References Research, 52(3), 306-322. Retrieved from http://www. Armet, S. (2009). Religious socialization and identity for- jstor.org/stable/23055554 mation of adolescents in high tension religions. Review of Kox, W., Meeus, W., & Hart, H. (1991). Religious conver- Religious Research, 50(3), 277-297. Retrieved from http:// sion of adolescents: Testing the Lofand and Stark model www.jstor.org/stable/25593742. of religious conversion. SA. Sociological Analysis, 52(3), Baltazar, T., & Cofen, R. (2011). Te role of doubt in reli- 227-240. Retrieved from http://journals.berghahnbooks. gious identity development and psychological maturity. com/social-analysis/ Journal Of Research On Christian Education, 20(2), 182- Lopez, A., Huynh, V., & Fuligni, A. (2011). A longitudinal 194. doi: 10.1080/10656219.2011.590123 study of religious identity and participation during ado- Barry, C. M., Nelson, L., Davarya, S., & Urry, S. (2010). lescence. Child Development, 82(4), 1297-1309. Retrieved Religiosity and spirituality during the transition to adult- from http://www.jstor.org/stable/41289843 hood. International Journal Of Behavioral Development, Nelson, J. (2010). Teacher dispositions and religious identity 34(4), 311-324. Retrieved from http://dx.doi.org.ezproxy. in the public school: Two case studies. Te Journal of lib.ou.edu/10.1177/0165025409350964 Negro Education, 79(3), 335-353. Retrieved from http:// Bebiroglu, N., van der Noll, J., & Roskama, I. (2017). www.jstor.org/stable/20798353 Growing up in a diverse society: Adolescents’ interest Pearce, L. D., & Denton, M. L. (2011). A Faith Of Teir in parental religious socialization messages. Journal Of Own: Stability And Change In Te Religiosity Of America’s Family Communication, 17(3), 288-300. doi:10.1080/1526 Adolescents. New York: Oxford University Press. 7431.2017.1286348 Peek, Lori. (2005). Becoming Muslim: Te development of Bobkowski, P., & Pearce, L. (2011). Baring their souls a religious identity. Sociology of Religion, 66(3), 215-242. in online profles or not? Religious self-disclosure in Retrieved from http://www.jstor.org/stable/4153097 social media. Journal for the Scientifc Study of Religion, Petts, R. (2009). Trajectories of religious participation from 50 (4), 744-762. Retrieved from http://www.jstor.org/ adolescence to young adulthood. Journal for the Scientifc stable/41349951 Study of Religion, 48(3), 552-571. Retrieved from http:// Bowman, N., & Small, J. (2010). Do college students who www.jstor.org/stable/40405645 identify with a privileged religion experience greater Ravishankar, N., & Bernstein, M. (2014). Religion beneft- spiritual development? Exploring individual and in- ing brain tumour patients: A qualitative study. Journal of stitutional dynamics. Research in Higher Education, Religion and Health, 53(6), 1898-1906. Retrieved from 51(7), 595-614. Retrieved from http://www.jstor.org/ http://www.jstor.org/stable/24485295 stable/40927269 Regnerus, M. D., Smith, C., & Smith, B. (2004). Social con- Brown, L. (1964). Classifcations of religious orientation. text in the development of adolescent religiosity. Applied Journal for the Scientifc Study of Religion, 4(1), 91-99. Developmental Science, 8(1), 27-38. Retrieved from Desmond, S A., Morgan, K. H., & Kikuchi, G. (2010). http://www.tandfonline.com/loi/hads20 Religious development: How (and why) does religios- Rew, L., Wong, J., Torres, R., & Howell, E. (2007). Older ity change from adolescence to young adulthood? adolescents’ perceptions of the social context, impact, Sociological Perspectives, 53(2), 247-270. doi: 10.1525/ and development of their spiritual/religious beliefs and sop.2010.53.2.247 practices. Issues In Comprehensive Pediatric Nursing, Halama, P., & Halamová, J. (2005). Process of Religious con- 30(1-2), 55-68. doi:10.1080/01460860701366674 version in the Catholic charismatic movement: A qualita- Shalev, O., Baum, N., & Itzhaky, H. (2016). Religious tive analysis. Archiv Für Religions Psychologie / Archive identity in transition: Processes of change in the religious for the Psychology of Religion, 27, 69-91. Retrieved from identity of young religious Jewish newlyweds in Israel. http://www.jstor.org/stable/23910013 FamilyJournal, 24(2), 132-139. Hofman, L. (2012). Religious Experience, Development, Smith, J. (2011). Becoming an atheist in America: and Diversity. Pastoral Psychology, 61(5/6), 1025-1035. Constructing identity and meaning from the rejection of doi: 10.1007/s11089-011-0403-2 theism. Sociology of Religion, 72(2), 215-237. Retrieved James, A. G., Lester, A. M., & Brooks, G. (2014). Te from http://www.jstor.org/stable/41288569 Efects of Denomination on Religious Socialization for Jewish Youth. Youth & Society, 46(6), 875-891. doi:10.1177/0044118X12457084 13 ON FIRE FOR GOD: EXPLORING ADOLESCENT RELIGIOUS DEVELOPMENT

Twenge, J. M. (2017). Igen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy -- And Completely Unprepared For Adulthood Appendix A (And What Tis Means For Te Rest Of Us). New York, NY: Atria Books. Is there a pseudonym you would like to choose for Vaidyanathan, B. (2011). Religious resources or diferential this research paper to protect your identity? returns? Early religious socialization and declining atten- Warm Up Question: Can you briefy tell me a little dance in emerging adulthood. Journal For Te Scientifc bit about your family’s religious identity and practices? Study Of Religion, 50(2), 366-387. What religious identity did your parents instruct Watson, P., Howard, R., Hood, R., & Morris, R. (1988). Age you in and how do you identify currently? and religious orientation. Review of Religious Research, If diferent: Tell me about what prompted this 29(3). doi:10.2307/3511224 change and when? Zhai, J., Ellison, C., Stokes, C., & Glenn, N. (2008). How do you feel your current religious identity “Spiritual, but not religious”: Te impact of parental difers or is constant with the way you thought about divorce on the religious and spiritual identities of young religion 10 years ago? adults in the United States. Review of Religious Research, Do you remember the frst time you ever thought 49(4), 379-394. Retrieved from http://www.jstor.org/ about your religious identity? stable/20447513 Can you explain what it was like to think about your religious identity for the frst time? Has there ever been a time you doubted your reli- gious identity? Yes: What factors led to a turning point in your re- ligious identity and contributed to your doubt? How did you respond to this doubt? b. No: What factors made you feel more secure in your religious identity? Can you identify important individuals (peers, mentors, family, religious leaders) that you think have had the most infuence on your religious belief? How do you feel they have infuenced your view of religion? Do you feel as though you’ve infuenced your peers religious development? Do you express your religious identity online or have friends who express their identity online? Do you change the way that you express your reli- giosity in front of their friends. Do you think that your racial or ethnic identity in- fuences your religious identity? Do you feel as though the ways that you practice your religion have changed over the last few years? In the coming years, do you expect your religious identity to shif? Is there anything else you would like to share with me about your religious development today?

14 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018

Flight to the Stone Age: Investigating the Impact of FAA Cockpit Regulations on Kidney Stones in American Airline Pilots

Noor Said

Following the incidents of 9/11, the FAA implemented safety regulations that restricted pilots from exiting the cockpit. While pilots and other individuals from the commercial aviation industry speculated that these regulations prevented pilots from using the lavatory, thereby exacerbating dehydration and kidney stone prevalence, the issue remains relatively unexplored. To address this gap, a survey involving 280 American cargo and passenger airline pilots was conducted. Based on the results, passenger pilots intentionally reduced fuid intake in-fight due to FAA protocol, and the rate of nephrolithiasis amongst passenger pilots was higher than that of cargo pilots, who do not have a cockpit door and therefore were representative of a control group. From these fndings, it is recommended that further investigation is conducted on this issue and that current FAA pro- tocol be remedied to protect the safety of pilots and passengers.

Keywords: nephrolithiasis, FAA, aerospace medicine, airline pilots, dehydration

Introduction to nephrolithiasis as a result of their work and the be- haviour that it requires. According to Dr. Goldfarb Te most exigent health issues impacting devel- (2016), a nephrologist (kidney specialist) at New York oped countries today are not the plagues which domi- University who investigated 2012 NHANES data, nate discussions; rather, this age faces the onslaught of workers in the American transportation sector face chronic disease and a rise in preventable health condi- high exposure to kidney stones, with an average rate tions. Amongst these overlooked issues lies the rise of nephrolithiasis that is signifcantly higher than the in kidney stones, deposits of minerals and acid salts general population (Goldfarb, 2016). While several which crystallize in the kidney and fall into the ureter factors render these individuals more susceptible to (Ford-Martin & Cataldo, 2015). In recent years, the the condition, the proportion of those aficted with United States has faced a steady increase in the preva- nephrolithiasis in one particular group has seen a lence of kidney stones, and a National Health and troubling increase within the past two decades: com- Nutrition Examination Survey (NHANES) (2012) mercial airline pilots. estimates that the condition will afect approximately Defned as aviators who operate aircraf carrying one in ten Americans during their lifetime (Scales, passengers or cargo, commercial pilots are a particu- et al., 2012). If untreated, kidney stones cause severe larly crucial group to monitor because they may ex- physical discomfort and hinder daily activities. It has perience renal colic, the sudden onset of pain from been confrmed that nephrolithiasis, or kidney stone nephrolithiasis, while operating a plane. Renal colic’s formation, is infuenced by several modifable lifestyle symptoms include nausea, vomiting, a radiating sense factors, which may stem from occupation. of pain, and fainting. Terefore, pilots may become in- Within the realm of exposomics, defned as the capacitated, posing danger not only to themselves but cumulative exposures to health issues a person has also to passengers. A unique and unexplored reason during their lifetime, individuals are more susceptible for the suggested high kidney stone rate in pilots may 15 FLIGHT TO THE STONE AGE: KIDNEY STONES IN AMERICAN AIRLINE PILOTS lie in federal policy. Following the attacks of September stances. Firstly, it should be established that pilots are 11th, 2001, new safety regulations were implemented put through rigorous testing to receive a medical certi- by the Federal Aviation Administration (FAA). As fcation and operate a commercial plane. Additionally, a result of this intricate set of rules, a pilot may not while factors such as heredity, global warming, gen- exit the cockpit to use the restroom without calling in der, and location infuence nephrolithiasis, as demon- fight attendants. As described in an FAA handbook strated by researchers who analyzed 2012 NHANES (2004), attendants open and lock the cockpit (while data at the Cleveland Clinic’s Glickman Urological one attendant remains inside with the co-pilot), block & Kidney Institution, this paper will only investigate the aisle as the pilot uses the lavatory, and escort the primary modifable risk factors (Roudakova & Mon- pilot back into the cockpit (“Crew Resource Manage- ga, 2014). With regard to gender, only six percent of ment Training,” 2004). Tose in the aviation industry active commercial pilots are female according to a re- have complained about the process and speculated cent FAA study, although the following studies did not that it may contribute to nephrolithiasis in pilots by separate pilots by gender (FAA, 2018). Following the preventing them from using the lavatory, though little notion that overall kidney stone prevalence has been research has evaluated the validity of such a claim. In increasing, it is frst necessary to understand these a 2015 interview, president of the Aviation Medicine factors and how they difer in American pilots. Advisory Service Dr. Snyder disclosed that “more pilots have been calling… about kidney stones in re- Obesity cent years than in the period before September 2001” (Werfelman, 2014). Additionally, Silberman (2016), a Body mass and dehydration have dominated the former FAA medical certifcation manager, notes that discussion surrounding the increase in nephrolithia- those who fail to eliminate all traces of kidney stones sis, and there exists a considerable body of evidence or have recurrent nephrolithiasis may not be certifed showing that pilots have a greater susceptibility to for aviation (Silberman, 2016). Terefore, while the is- these risk factors, such as high Body Mass Index sue is overlooked, the consequences of a pilot having (BMI). High BMI is associated with intensifed excre- kidney stones are rather signifcant and complex. tion of uric acid and oxalate in the urine, which causes In the attempt to explore the cause of nephrolithiasis nephrolithiasis. Harvard Medical School professors in American airline pilots, this paper investigates the Ferraro, Taylor, and Curhan (2015) worked in col- impact of the aforementioned FAA policies, guided by laboration with nephrologists Sorenson and Gambaro the question: to what extent has the implementation of in a risk-factor study. Afer analyzing National Health post-9/11 cockpit regulations by the FAA infuenced Surveys I and II and categorizing data by factors in- kidney stone prevalence in American airline pilots? Ex- cluding BMI, they concluded that BMI had a strong tensive research was conducted to arrive at the justifca- direct correlation with nephrolithiasis (Ferraro et al., tion of this question, and in order to fully understand 2015). Supported by extensive evidence, these fnd- its signifcance, it is necessary to examine the intercon- ings are particularly unsettling when the population nected perspectives which revolve around it. is narrowed to U.S. pilots, who have been suggested to have unusually high BMIs. Bryman and Mills (2007), doctors of Aerospace Literature Review Medicine, searched FAA medical databases to estab- lish a pilot obesity rate. Afer analyzing the fles of Te issue of nephrolithiasis in airline pilots was 630,670 pilots, they found that nearly 70% of Ameri- derived from a pre-existing body of literature discuss- can pilots were overweight or obese, a rate consid- ing the rise in nephrolithiasis, FAA policies, and pilot erably higher than that of the general population at health. Tis literature review provides a comprehen- the time of publishing, which was a possible result of sive understanding of the trends and modifable risk prolonged sitting (Bryman & Mills, 2007). While the factors for nephrolithiasis and a range of perspectives study is outdated, it involved a large sample size and on the rise of kidney stones in pilots. In this review, it was the frst to determine a BMI distribution for U.S. is important to understand some background circum- pilots. Tough American pilots appear to have higher 16 FLIGHT TO THE STONE AGE: KIDNEY STONES IN AMERICAN AIRLINE PILOTS

BMIs than non-pilots, this does not hold true globally. in her article, she included survey data showing that Te fndings of cardiologists Syburra et al. (2017), pilots consumed less water than recommended, and who wrote and published an article in the peer-re- disclosed that more research should be done on the viewed European Journal of Cardio-Toracic Surgery on subject. Werfelman’s perspective gave this research di- European pilot obesity in collaboration with Swiss and rection, as it was possible that pilots avoided liquids British federal aviation branches, difer from those of due to cockpit regulations. Despite the idea that pilots Bryman and Mills (2007). From searching the MED- are more susceptible to these risk factors, there is in- LINE database for cardiovascular disease, the research- consistency in establishing a rate for pilot nephroli- ers found that the average pilot BMI was equal to or thiasis. lower than that of other Europeans (Syburra et al., 2017). Tis implies that fying an airplane alone is not associated with high BMI, contrary to the suggestion Rate of Pilot Nephrolithiasis made by Bryman and Mills (2007). While the suspect- ed American pilot BMI may be a reason for pilot neph- Due to these factors and their apparent exacerba- rolithiasis, water intake also plays a critical role. tion the aviation medical community believes that American pilots are highly susceptible to nephroli- Dehydration thiasis. However, there are discrepancies in establish- ing a stone rate. In Werfelman’s (2014) article, data With consistent dehydration, uric acid dilution is included from the aforementioned NHANES shows inhibited, raising acidity levels in the kidney (Ford- that pilots were 6.5 percent more likely to be afected Martin & Cataldo, 2015). Tis acidic environment is by kidney stones than the general population, which is the primary cause of nephrolithiasis. According to an signifcant given the non-pilot rate of nine percent; in article from Te Gale Encyclopedia of Medicine, the his interview, Dr. Snyder claims that this rate has been primary method of kidney stone prevention recom- growing in the past decade (Werfelman, 2014). How- mended by health organizations such as the National ever, a source from the peer-reviewed Journal of Urol- Kidney Foundation was to simply drink over eight ogy refutes this claim. In response to airline companies cups of water daily (Ford-Martin & Cataldo, 2015). claiming that pilots have had more kidney stones as a Yet, the aforementioned article by Goldfarb (2016) result of strict cockpit rules, the FAA funded research- found that transportation workers were most likely to ers to investigate the issue. CAMI, the Civil Aerospace develop kidney stones from dehydration (Goldfarb, Medical Institute, is the research branch for the FAA. 2016). Goldfarb (2016), who cited a large, represen- Using its data, researchers Hyams, Nelms, and Silber- tative survey of Americans (NHANES), has practiced man (2014) found that pilots had a rate of nephroli- nephrology for decades, and while this may contrib- thiasis which was nearly equivalent to that of other ute to personal bias, the source ofered relevant infor- Americans. Furthermore, they claim that the rate has mation on nephrolithic exposomics. Goldfarb’s (2016) not been rising, refuting airline company complaints fndings are applicable to the general transportation (Hyams, Nelms, & Silberman, 2014). However, sus- sector; however, several recent sources note that pension may arise as a result of nephrolithiasis detec- American pilots have avoided water in-fight. tion, and this data excluded inactive pilots. In a 2016 According to an article by Werfelman (2014), se- article, Silberman, former FAA medical certifcation nior editor for the Flight Safety Foundation, Ameri- manager, disclosed that “many pilots with kidney can pilots are severely dehydrated and must drink stones were unable to receive recertifcation” in past more water. Afer interviewing Dr. Snyder and evalu- years, meaning FAA data may have been biased in fa- ating data previously acquired by researchers from voufr of healthier pilots (Silberman, 2016). Terefore, the Aviation Medicine journal, Werfelman noted there are discrepancies in the establishment of pilot that nearly two-thirds of pilots avoided drinking liq- nephrolithiasis rates, and no research has been pub- uids while fying, contributing to fatigue and chronic lished showing changes in this rate over time, further health issues (Werfelman, 2014). While Werfelman complicating the current status of the issue. (2014) was heavily reliant on the interview of Snyder 17 FLIGHT TO THE STONE AGE: KIDNEY STONES IN AMERICAN AIRLINE PILOTS

Hypothesis Method

Te holistic review of this literature determines Study Design that, while pilots are susceptible to the same risk fac- tors as non-pilots, these factors are likely more preva- For the purpose of addressing the infuence of lent in pilots. Still, the true rate of pilot nephrolithia- FAA regulations on pilots, it was necessary to obtain sis is unclear, and a pilot-specifc cause infuencing a sample of commercial pilots employed by the United nephrolithiasis and risk factors has yet to be validated. States. Tere was no control over variables and sub- Tough pilot nephrolithiasis is a signifcant issue, cur- jects reported all information, meaning that this study rent literature on the subject is sparse. Dehydration was descriptive in nature (Kobayashi, n.d.). Because has not been attributed to a root cause, and only one this research ultimately explored a relationship de- outdated American pilot BMI analysis was found, pendent on the individual habits of its population of meaning these factors should be accurately evaluated. interest, the study included both qualitative and quan- Furthermore, nephrolithiasis and its risk factors have titative elements. Experimentation to identify true not yet been analyzed to address how diferent genres causation was neither ethical nor plausible, and it was of commercial pilots are infuenced. Cargo pilots, who impossible to control nephrolithiasis and pilot assign- lack a cockpit door and may therefore use the lavatory ment. Terefore, a survey was conducted to identify freely, may be infuenced diferently than passenger nephrolithic prevalence and address all aspects of the pilots, who have a cockpit door and must accordingly research question. adhere to the aforementioned FAA protocol. Tese To establish large, representative samples that issues, combined with anecdotal evidence and com- could be used for hypothesis testing, probability plaints from the aviation industry connecting cockpit sampling was used: random selection occurred afer regulations to nephrolithiasis, render further investi- collecting all pilot surveys and separating cargo pilots gation necessary. from passenger pilots. Te modifable risk factors ad- Given that these risk factors are modifable, iden- dressed in the survey were water intake (additionally tifying a pilot-specifc cause may bring forth a viable measured through lavatory usage), and BMI. In addi- solution. Tis research aimed to identify the impact tion to BMI, the survey identifed some external fac- of post-9/11 FAA cockpit protocol on nephrolithiasis tors which could be infuencing nephrolithiasis, such in American pilots, by establishing a BMI distribution as family history of kidney stones, gender, and age. and addressing how the cockpit rules have infuenced Te survey addressed the overall nephrolithiasis rate dehydration. Furthermore, this study aimed to estab- in American pilots, where cargo pilots were compared lish the frequency of nephrolithiasis for American to passenger pilots to identify whether signifcant dif- commercial pilots, grouped by their assignment and ferences could be found based on FAA rules. resulting adherence to the cockpit protocol. Based on existing literature, this research investigates the Ethical Considerations hypothesis that pilots are more overweight and obese than the general population, and that passenger pilots Given the need for many pilots to provide infor- consume less water than recommended as a result mation on a potentially sensitive topic, all measures of the FAA rules. Most importantly, passenger pilots were taken to keep the research ethical. Pilots could were hypothesized to have a higher susceptibility to feel uncomfortable answering questions regarding kidney stones than cargo pilots, as a result of cockpit their lavatory usage and kidney stone afiction. To ad- regulations altering pilot behaviour and exacerbating dress these components as noninvasively as possible, pre-existing risk factors for the condition. only a yes/no response to kidney stone history was recorded, no surgical procedures or complications were addressed, and a minimal number of questions addressed lavatory usage. Prior to the administration of the online surveys, all research materials, including 18 FLIGHT TO THE STONE AGE: KIDNEY STONES IN AMERICAN AIRLINE PILOTS the survey and an email for participants detailing the of 100 pilots was established to yield more accurate purpose of this research, were submitted to the stu- results. Emails were acquired from a passenger pilot dent’s high school Institutional Review Board (IRB) information list: the Delta, American, and United for a full review. With the addition of background to rosters (which included pilot names, fight hours, the email message, along with minor modifcations to and activity status) were searched and compiled into the wording of survey questions, the project was ap- an email list of those who would receive the survey. proved by the IRB. In addition, an FAA database naming all pilots with Te f nal approved survey (see Appendix A) was certifcations was used to add individuals to the email anonymous and featured the least invasive questions list, for a total of ffy pilot emails. Aside from receiv- which aligned with the research question. To preserve ing it by email, pilots could access the survey through respondent confdentiality, the survey was stored on a the AOPA Hangar, ProPilotWorld.com, and Airline password-protected account belonging to the research- Pilot Central forums. Te split-distribution method er. Following the conclusion of the research project, the allowed pilots from numerous locations and airlines survey was discarded digitally by erasing the content to participate, contributing to a representative sample. fles on the researcher’s computer, ensuring that re- spondent records were absolutely confdential. Procedure All participants were given contact information for the researcher and advisor, informed of the back- Te independent variable examined was the ad- ground and nature of the research project, and al- herence to the FAA cockpit rules. Commercial cargo lotted a space in the survey for additional questions pilots, who did not have a cockpit door and could use or concerns. Moreover, subjects were informed that the restroom freely, were the control group represent- the survey was voluntary and anonymous, no ques- ing all pilots if the post-9/11 FAA rules were not in tions were required, the survey could be withdrawn place. Te primary dependent variable was the pres- at any time without repercussions, and the electronic ence of kidney stones; however, due to the complexity records would be safely stored and destroyed at the of nephrolithiasis and its reliance on several risk fac- conclusion of the project by the researcher. tors, fuid intake and BMI were also addressed. Given its observational nature, there was no control over the Participants other existing variables in my survey. In addition, the year of kidney stone diagnosis, airline, age, sex, and In accordance with the population of interest, retirement status were recorded to verify subject in- American commercial pilots, the primary require- clusion. While questions based on pilot judgment ment for the survey respondents was that they were regarding the efect of FAA cockpit rules on their be- commercial airline pilots employed by the United haviour employed a Likert scale, others, such as fight States. Retired pilots were removed to avoid potential hours, were multiple choice or free response. Te pri- confounding variables such as old age, which infu- mary areas of interest were: ences likelihood of illness. Te study frame included t
Airline, to identify cargo pilots from all cargo or passenger pilots over eighteen years of age, passenger pilots with the goal of establishing samples representative of t
Presence of nephrolithiasis and year of diagnosis the current pilot population. t
BMI Tese subjects comprised two simple random sam- t
Infuence of FAA regulations on lavatory use ples (SRS) of cargo and passenger pilots who provided and water consumption basic information, which addressed the key compo- For comparison and hypothesis testing, subjects nents of the study. Because subjects would not be met were categorized into one of two samples based on in-person, it was necessary to verify that only Ameri- whether they few cargo or passengers. Afer the on- can commercial pilots would complete the survey. For line Google Forms survey was drafed and approved by greater variation amongst participants, the survey was the IRB, proper contact information and permissions both emailed and shared with pilot forum users. Prior were obtained. Prior to posting the surveys on the to survey administration, a minimum sample size aforementioned forums, consent was obtained from 19 FLIGHT TO THE STONE AGE: KIDNEY STONES IN AMERICAN AIRLINE PILOTS the AOPA (Aircraf Owners & Pilots Association) tion and lavatory habits provided insight on the extent Director of Medical Certifcation and forum adminis- of FAA policy infuence. Average water intake and the trators. Titled “Research Survey Opportunity for U.S. diferences in water consumption in and out of work Pilots,” the survey was posted with a description of were calculated for each group. To determine whether the research project. Te ProPilotWorld.com survey pilot dehydration was infuenced by the policies, re- was posted once by the administrator, while the other sponses to the opinion statements were graphed and sites permitted me to post the survey several times. compared. Tese measures allowed for a comprehen- Because the Airline Pilot Central site was divided into sive analysis of the infuence of the cockpit protocol sub-forums, I posted in the popular, yet relevant, “Pi- on pilot nephrolithiasis. lot Health” and “Major Airlines” categories, ensuring that many pilots could access the survey. To avoid bias towards forum users, ffy Delta, Results American Airlines, and United Airlines passenger pi- lots were emailed the survey with a detailed message Te collection of 280 cargo and passenger pilot on the nature of this research. Emails were acquired surveys resolved several crucial questions about the from the aforementioned FAA “Pilots with Certifca- impact of FAA regulations on pilot nephrolithiasis. To tions” database and airline rosters. If the email was not properly interpret the fndings of this study and es- immediately located, pilot names and airlines were in- tablish a focus on the FAA regulations’ infuence on put through Skrapp.io, a contact fnder program for nephrolithiasis in pilots, it is frst necessary to estab- those with business emails. Absolutely no subjects lish the diferences identifed between the two sample were coerced into participation, and all premises for groups. As mentioned previously, both cargo pilots the research and confdentiality were disclosed. and passenger pilots were sampled, and the fnal ran- Once two weeks had passed from the start date of domized groups which were analyzed consisted of 100 survey collection, the survey link was deactivated for individuals each. Te following table displays basic analysis. Cargo pilots were separated from passenger background information for each group: pilots, and a total of ten military pilots, non-American pilots, or individuals who failed to verify their current occupation as a pilot were excluded from the sample. PASSENGER CARGO Pilots were not excluded for non-response to certain PILOTS PILOTS questions, including height, weight, and geographical residence, as their opinion on FAA protocol remained Mean Age 40.1 45.1 valuable. Afer separation, the resulting 146 passenger pilot surveys were assigned numbers 1-146 and the 134 Mean # of 13.9 21.0 cargo pilots were numbered 1-134. One-hundred pilots Years Spent as of each group were selected for analysis using the ran- Pilot dom number generator on a TI-Nspire calculator. Mean Flight 7,533 10,088 A 2-proportion z-test was performed using the Hours random samples to determine whether the passenger Accumulated pilot population had greater frequencies of nephro- lithiasis, and pilot stone diagnoses were graphed by Gender 6% female 1% female Distribution year to observe potential trends. In addition to kidney 94% male 99% male stone rate diferences, risk factors were addressed for each group. Te BMIs and opinions on FAA policy Table 1 infuence were analyzed from each sample of active Comparison of Cargo and Passenger Pilot Samples pilots. While BMI, a confounding variable that could be causing high pilot nephrolithiasis, was used for Cargo pilots had a higher mean age and number comparison to the general population and to ensure of piloting years. Accordingly, the cargo fight hour similarity amongst the samples, questions on hydra- mean was 2,555 greater than that of passenger pilots. 20 FLIGHT TO THE STONE AGE: KIDNEY STONES IN AMERICAN AIRLINE PILOTS

Although both groups were disproportionately male, senger pilots had a higher nephrolithic rate, which a considerable diference was that the passenger pilot would imply that the adherence to FAA policies was sample consisted of fve more females. correlated with exacerbated kidney stone develop- Te primary objective of this project was to iden- ment. Based on the test (see Appendix B), conducted tify the true proportion of pilots who have had kidney at the fve percent signifcance level, passenger pilots stones, so this frequency was established for each sam- experienced a greater rate of kidney stones, with a P- ple group. Of the 200 individuals in the samples, a total value of .031 being lower than the alpha of .05. of nine cargo and eighteen passenger pilots reported While the incidence of nephrolithiasis appeared having had kidney stones, a proportion that appears to rather diferent amongst the two groups, it was also be increasing for passenger pilots when graphed: necessary to evaluate pilot opinions, as pilots are ulti- mately responsible for determining how FAA policies impact their in-fight habits. Fluid intake and bath- room usage were addressed to determine both current and prospective risk for nephrolithiasis. Based on sur- vey responses, 85% of passenger pilots reported that FAA rules deterred them from using the bathroom, making them more susceptible to nephrolithiasis: In conjunction with avoiding the lavatory more of- ten, passenger pilots were more likely to report that they intentionally decreased their fuid intake while fying a plane: these subjects reported drinking an average of 3.7 cups on piloting days, compared to 6.3 cups outside of work. In contrast, cargo pilots slightly increased fuid intake while fying, drinking 5.1 cups on workdays and Figure 1. Kidney Stone Count by Year 5.0 cups on non-workdays. Tese factors, combined (cases before 2000 not depicted on graph) with the large gap in kidney stone prevalence between the samples, suggest that FAA policies have made pas-

A 2-proportion z-test for Ppassengerpilot-Pcargopilot, where senger pilots more susceptible to nephrolithiasis. P represented the true proportion of pilots with kid- As mentioned previously, one of the additional goals ney stones, was performed to determine whether pas- of this survey was to identify a BMI distribution for

Figure 2. Passenger pilot agree- ment with the statement that FAA protocol prevents pilots from using the lavatory.

21 FLIGHT TO THE STONE AGE: KIDNEY STONES IN AMERICAN AIRLINE PILOTS pilots, since high BMI was identifed as a risk factor weight,” 2017). Terefore, other modifable factors unrelated to FAA policies that could be exacerbating have been aggravating pilot nephrolithiasis, of which nephrolithiasis. Here, the samples were only somewhat the most notable appears to be dehydration. similar, as 66% of passenger pilots and 78% of cargo pi- Te results of this survey suggest that the major- lots were overweight or obese. ity of passenger pilots avoided water as a direct re- sult of the FAA cockpit regulations. In conjunction with the fndings of Werfelman (2014), both samples Discussion consumed less than the recommended eight cups of water daily, implying that dehydration is an issue for Analysis of Results all pilots regardless of FAA rules. More signifcant to this research, this survey showed that passenger pi- Based on extensive investigation, it was found that lots deliberately reduced water consumption while the post-9/11 cockpit protocol enforced by the FAA working, a habit identifed by Goldfarb (2016) as the has exacerbated in-fight dehydration in passenger primary mechanism for nephrolithiasis in transporta- pilots, and is, therefore, a likely promoter of pilot tion workers due to uric acid accumulation (Goldfarb, nephrolithiasis. Te results of this study addressed the 2016). Furthermore, 85% of passenger pilots agreed rate of kidney stone development as well as the infu- that FAA cockpit rules deter pilots from going to the ence of modifable risk factors for pilots. According to lavatory, verifying that FAA cockpit protocol is a hin- the aforementioned hypothesis test conducted, there drance for passenger pilots who wish to use the bath- was statistically signifcant evidence to suggest that room. Tese pilots have accordingly reduced water passenger pilots have a higher rate of nephrolithiasis intake, making them more susceptible to nephroli- than cargo pilots. Considering the idea that the FAA thiasis. cockpit protocol is the only systematic diference be- tween the two populations, this supports the primary Limitations hypothesis that FAA rules cause higher stone rates. While overall nephrolithic prevalence was greater Several limitations to this research should be con- amongst passenger pilots, the samples were not large sidered, with the most prominent being the poten- enough to truly support hypothesized time trends tial for voluntary response bias: pilots who have had for stone development, though this would have been nephrolithiasis may have been more interested in the ideal. Alongside the fnding a rate of kidney stones, research and participated more frequently than oth- the understanding of BMI and dehydration in pilots ers, implying that the samples may not have been was also refned. fully representative. Furthermore, most participants Contrary to the fndings of Bryman and Mills were forum users: pilots who were not active on fo- (2007), both pilot samples displayed rather normal rums during the two weeks of survey collection lacked BMI distributions, disagreeing with the hypothesis representation. Due to potential bias and the survey’s that BMI would be higher amongst pilots than non- reliance on participant honesty, further studies should pilots. Surprisingly, the cargo pilot group, which re- be done to verify results. ported a slightly higher rate of obesity than passenger In addition to bias, there exists the issue of underly- pilots, experienced a lower incidence of nephroli- ing risk factors which were not controlled for: diet and thiasis, though this diference may have been due to other health issues may have been diferent between small sample size. While this shows that high BMI the two samples due to sampling variability. Such fac- was generally common, neither group was unusual tors were not examined due to limited time and re- in comparison to non-pilots. According to a report sources, meaning the analysis of risk factors was in- by the Center for Disease Control (2017), 70.7% of complete. Finally, due to small sample size, the results American adults are overweight or obese, imply- may contain inaccuracies, and could not be used to ing that commercial pilots do not have substantially identify time-trends in nephrolithiasis. Nonetheless, greater risk for kidney stones as a result of high BMI this project gives direction to the issue of the FAA than does the general population (“Obesity and Over- regulations’ infuence on pilot nephrolithiasis. 22 FLIGHT TO THE STONE AGE: KIDNEY STONES IN AMERICAN AIRLINE PILOTS

Conclusion and Future Directions References Bryman, D. A., & Mills, W. (2007, July 01). Co-Morbid Te fndings of this survey provide several interest- Conditions in Overweight and Obese Airmen: Trends ing implications for the aviation industry. Most im- and Aeromedical Implications. Retrieved November 07, portantly, it is apparent that passenger pilots are likely 2017, from http://www.ingentaconnect.com/content/ more susceptible to nephrolithiasis as a result of FAA asma/asem/2007/00000078/00000007/art00010 cockpit regulations, which have amplifed the preva- Federal Aviation Administration. (2004, January 22). Crew lence of a modifable risk factor, dehydration, by caus- Resource Management Training. Retrieved March 6, ing pilots to reduce fuid intake to use the lavatory less 2018. frequently. Additionally, this study contradicts former Federal Aviation Administration. (2018). 2017 Active Civil hypotheses that American pilots are more overweight Airmen Statistics[MS Excel]. Oklahoma City,: FAA and obese than non-pilot Americans (Bryman & Aeronautical Center. Mills, 2007). Ferraro, P. M., Curhan, G. C., Sorensen, M. D., Gambaro, From this study, there remain several questions re- G., & Taylor, E. N. (2015). Physical activity, energy intake garding the future of American airline pilots, and ad- and the risk of incident kidney stones. Te Journal of ditional research should be conducted to address the Urology,193(3), 864-868. doi:10.1016/j.juro.2014.09.010 extent of FAA infuence on nephrolithiasis. Te FAA’s Ford-Martin, P., & Cataldo, L. J. (2015). Kidney stones. In CAMI research branch, given its resources and access J. L. Longe (Ed.), Te Gale Encyclopedia of Medicine (5th ed., Vol. 5, pp. 2858-2861). Farmington Hills, MI: Gale. to pilots, should most likely address this issue. A time- Retrieved from http://go.galegroup.com/ps/i.do?p=GVR trends analysis should be conducted to estimate cur- L&sw=w&u=carmelhs&v=2.1&it=r&id=GALE%7CCX3 rent and future nephrolithiasis rates, and this survey 623301047&asid=5247f0a0fc9295e566f1b39e81ef5 or a similar study should be repeated on a larger scale. Goldfarb, D. S. (2016). Te exposome for kidney stones. Furthermore, if future research supports the fndings Urolithiasis,44(1), 3-7. doi:10.1007/s00240-015-0847-4 of this survey, a solution to the issue of nephrolithiasis Hyams, E., Nelms, D., & Silberman, W. (2011). Te inci- must be established, via an acceptable amendment to dence of urolithiasis among commercial aviation pilots. FAA protocol granting pilots unhindered access to the Te Journal Of Urology. Retrieved October 7, 2017. lavatory. If a high rate of nephrolithiasis persists, thou- Kobayashi, J. (n.d.). Study Types in Epidemiology Transcript. sands of pilots will not only be physically harmed but Northwest Center for Public Health Practice. also face losing certifcation. Additionally, undetected Obesity and Overweight. (2017, May 03). Retrieved April pilot kidney stones may result in the endangerment 11, 2018, from https://www.cdc.gov/nchs/fastats/obesity- of hundreds of passengers. Further investigation into overweight.htm this issue is critical: without it, the health and safety of Roudakova, K., & Monga, M. (2014). Te evolving countless individuals may sufer, and the future of the epidemiology of stone disease. Retrieved October 07, aviation industry may be compromised as it ascends 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/ into this new stone age. PMC3897053/. Scales, C. D., Smith, A. C., Hanley, J. M., Saigal, C. S., & Project, U. D. (2012, July). Prevalence of Kidney Stones in the United States. Retrieved October 30, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3362665/?report=reader Silberman, W. (2016, March 15). How Can Kidney Stones Impact Your Medical Certifcate? Retrieved November 26, 2017, from https://pilot-protection-services. aopa.org/news/2016/march/15/the-faa-and-kidney- stones?_ga=2.173084384.236171897.1511646294- 651958467.1504890767

23 FLIGHT TO THE STONE AGE: KIDNEY STONES IN AMERICAN AIRLINE PILOTS

Syburra, T., Nicol, E., Mitchell, S., Bron, D., Rosendahl, U., & Pepper, J. (2017). To fy as a pilot afer cardiac surgery. European Journal of Cardio-Toracic Surgery,53(3), 505- Appendix A 511. doi:10.1093/ejcts/ezx346 Airline Pilot Survey Werfelman, Linda. Dry and high. Aviation Medicine, June 2014. Retrieved October 30, 2017, from https://www. 2018 aviationmedicine.com/wp-content/uploads/2014/02/ All responses to this survey will be anonymously Dry-and-High.pdf. recorded and stored safely by the researcher. Your par- ticipation in this research study is voluntary. You may choose not to participate. If you decide to participate in this research survey, you may withdraw your survey at any time. If you decide not to participate in this study or if you withdraw from participating at any time, you will not be penalized. You are not obligated to answer every question in this survey. Te data acquired from this survey will be used in a research paper and pre- sentation regarding kidney stone prevalence in pilots and FAA cockpit rules, in which no survey participant names will be disclosed. Tank you for your time, and with any questions or request to cancel survey, please submit in the questions section of this survey or contact the author or research advisor at: ********@******** and ********@******** . Please provide age and gender: AGE: ______GENDER: ______Please verify your current occupation: Airline Pilot (passenger) Airline Pilot (cargo) Retired Airline Pilot Other (please specify)______Under what Airline are/were you most recently employed?______Under which country are you currently employed? Please select all that apply. United States of America Other (please specify)______How many years have you been a pi- lot? If retired, please include date of retire- ment:______Have you ever had a kidney stone? Yes No Prefer not to answer If your answer to the previous ques- tion was yes, in what year were you diagnos ed?______Have you ever been treated for a kidney stone? Yes 24 FLIGHT TO THE STONE AGE: KIDNEY STONES IN AMERICAN AIRLINE PILOTS

No Northeast Prefer not to answer Alaska Please select your current fight route type: Hawaii Domestic Other (please specify)______International Both domestic and international If you have any questions for the researcher, please Approximately how many hours of fight have you include them in the following response box, along accumulated? ______with your e-mail: How many cups of water (8 fuid ounces), on av- ______erage, do you drink on a day where you are in fig ______ht?______How many cups of water (8 fuid ounces), on aver- ______age, do you drink daily outside of work?______What is your approximate height ?______f______in ______What is your approximate weig ______ht?______lbs All data is stored in a password protected electronic Do you use the bathroom less frequently during format. To help protect your confdentiality, the sur- your fight as a result of FAA cockpit rules? veys will not contain information that will personally Yes identify you. Te results of this study will be used for No scholarly purposes only. By clicking “Submit my re- To what extent do you agree or disagree with the sponses,” I understand that my survey answers may be statement: “I avoid drinking beverages while fying a used in a research paper and presentation. I verify that plane to avoid needing to go to the lavatory” my answers are as I wish them to appear. Strongly disagree If you do not wish to participate in the research Disagree study, please decline participation by clicking on the Agree “Cancel” button. Strongly agree No opinion To what extent do you agree or disagree with the statement: “Te pilot cockpit protocol enforced by the FAA keeps airline pilots from using the bathroom as of- ten as they would like.” Strongly disagree Disagree Agree Strongly agree No opinion Does your family have a history of kidney stones? Yes No Not sure Which region of the United States do you currently live in? West Midwest South 25 FLIGHT TO THE STONE AGE: KIDNEY STONES IN AMERICAN AIRLINE PILOTS

Appendix B

Inference procedure: 2-Prop z-Test for P(Passengerpilot)-P(Cargopilot) Let P(Passengerpilot) = the true proportion of American passenger pilots who have had kidney stones Let P(Cargopilot)= the true proportion of Ameri- can cargo pilots who have had kidney stones Null hypothesis: P(Passengerpilot)=P(Cargopilot) Alternate hypothesis: P(Passengerpilot)>P(Cargopilot) Conditions: Pilot surveys included in both samples are ran- domly selected Each pilot being diagnosed with kidney stones is likely independent of other pilots both within and between the samples Te 100 cargo pilots and 100 passenger pilots in the samples include less than 10% of the total pilot population for their respective group I expect both successes and failures to result in at least .14(100)= 14 and .14(100)=14 successes, and .86(100)= 86 failures and .86(100)= 86 failures. Both successes and failures of both groups are at least 10, so sample size is large enough for us to proceed with the procedure. Mechanics: z=1.86 p^(cargopilot)=.09 and p^(passengerpilot)= .18. p^(pooled)=.135. P-value: .0321279. Conclusion: I reject the null hypothesis that the true proportion of American passenger pilots who have had kidney stones is equal to the true proportion of American cargo pilots who have had kidney stones, with an alpha of .05>p-value of .03. Tere is statistical- ly signifcant evidence at the 5% level to support the hypothesis that the true proportion of American pas- senger with kidney stones is greater than the true pro- portion of American cargo pilots with kidney stones.

26 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018

Evolution of an Invasive Species Solidago Canadensis in Europe and the Americas: A Comparison Using Ribosomal ITS and 5S-NTS Sequences

Rachael Dickenson

Te genus Solidago is recognized as an invasive species around the world. Tis study aims to iden- tify emerging genetic divergence in the species Solidago canadensis, a well-established species in both Europe and North America. Since the introduction of S. canadensis to Europe is far too recent for any changes to be manifested in morphology of the species, ribosomal ITS and 5S-NTS DNA were sequenced from samples collected on both continents and compared to identify genetic varia- tions. Geneious 8.1.8 sofware was used to align sequences, identify genetic variations, and build phylogenetic trees. Comparison of phylogenetic trees lacked sufcient reliability regarding location of origin and development of populations, therefore no defnite conclusions were reached regard- ing time and manner of introduction or rate of variation. However, an understanding was reached that more research on both ITS and 5S-NTS sequences is necessary before drawing full conclusions regarding origin and development of S. canadensis populations.

Keywords: Solidago canadensis, invasive species, rDNA sequencing, phylogenetic analysis, Internal Transcribed Spacer (ITS), 5S-Non-Transcribed Spacer (NTS)

Notable consequences of this intrusion include de- Introduction struction of native keystone species and subsequent ecological imbalances, disruption of natural land- Te genus Solidago, commonly called Goldenrod, scapes, decreased biodiversity, and adverse efects on contains over 100 species and is considered highly in- human food sources (Stace & Crawley, 2015). Current vasive in nearly all areas of the world outside of its na- combative measures to eliminate invasive species in- tive region in Midwestern North America (excepting clude physical removal and use of biological controls, one species native to Europe) (Sheppard, 2006). Ob- but unfortunately reestablishment of balanced ecosys- servation of the frequency of Solidago and similarly tems is ofen difcult to achieve. Several species of the invasive herbaceous plants gives rise to questions re- genus Solidago, including S. canadensis, are labeled by garding how quickly and in what manner such genera the Royal Horticulture Society in the British Isles as change to dominate a previously unintroduced area. invasive species commonly sold for ornamentation Most simply, invasive species are defned as “any but can quickly become unmanageable when intro- nonnative species that signifcantly modifes or dis- duced to a native ecosystem (Stace & Crawley, 2015). rupts the ecosystems it colonizes” (Raferty, 2015). Terefore, a question can be posed as to not only how Human globalization in recent decades has greatly these Solidago species afect a given area as an invasive spurred the introduction and encroachment of in- species, but how (if at all) their genetics change to fa- vasive species on native habitats around the world. cilitate invasion of an area once introduced. 27 EVOLUTION OF AN INVASIVE SPECIES: SOLIDAGO CANADENSIS

In the context of this study, it is important to under- Emergence and Relevance of stand how such noncoding DNA as the ITS and 5S- NTS sequences are related to coding sequences: In Intraspecies Variation each tandem repeat of ribosomal DNA (rDNA), ITS1 Genetic information of living organisms is known and ITS2 fank the 5.8S subunit of coding DNA while to spontaneously mutate through errors in DNA rep- 5S-NTS exists in the Intergenic Spacer (IGS) region lication during meiosis and mitosis, resulting in ben- between each complete repeat of rDNA (see Fig. 1), efcial, detrimental, or neutral impact on organism flling the unused spacer regions with additional re- survival. In other words, organisms with benefcial peats of code. mutations for their given situation are more likely to Solidago canadensis was selected as a well-estab- survive and those with detrimental mutations are less lished species of the genus Solidago in North Amer- likely to survive, while those with neutral mutations ica and Europe. Alternative species considered under will continue to exist as before (Hillis, Sadava, Heller, the given time and seasonal restrictions of this study & Price, 2012). For invasive species such as those of were Solidago gigantea (also native to North America the genus Solidago, introduction and invasion of new and invasive to Europe) and Impatiens glandulifera areas means exposure to diferent environmental fac- (native to the Himalayan region and invasive to Eu- tors, thereby afecting whether a given mutation is rope), included in the frst iteration of sequencing but considered benefcial, detrimental, or neutral upon thereafer discarded when it was determined that S. its spontaneous occurrence. Dong Yu, and He (2015) canadensis displayed the most variability. Stability of concluded that “climate and recipient communities S. canadensis populations in both North America and explained 71.39% species impact of S. canadensis,” Europe increases the likelihood of mutations hav- indicating that movement into regions with diferent ing been developed in Europe since its introduction characteristics likely results in diferent expression of as a garden plant in the mid-1700s (Sheppard, 2006) Solidago genes and eventual evolutionary divergence or that mutations have emerged in North America by development of mutations benefcial, detrimental, since the time of its passage to Europe. Furthermore, or neutral to a given Solidago species in a new area. identifcation of diferences between varying popula- Genetic changes in plants require millions of gen- tions in Europe may suggest whether a single large erations to accumulate and become manifested in introduction or several smaller introductions of S. morphology (Schaefer, 2015). Therefore ribosomal canadensis resulted in its eventual establishment as an Internal Transcribed Spacer (ITS) and 5S-Non Tran- invasive species. Discovery of which populations were scribed Spacer (NTS) sequences were selected for able to subdue native species may also provide insight use in this study. ITS and 5S-NTS are ribosomal non- into which areas of Europe and North America need coding DNA, proven to be one of the most variable sequences and commonly used in phylogenetic com- parisons (Alvadhani et. al., 2012 ; Álvarez and Wen- del, 2003). Use of these sequences in phylogenetic comparison, while unable to identify full mutations emerging in a given species, allows identifcation of intraspecies variation and divergence of new popula- tions. Phylogenetic comparison involves comparison of characteristics, in this case genetic characteristics, for the purpose of determining an organism’s evo- lutionary history. Diagrams known as phylogenetic trees display these diferences by creating “branches” to show which organisms frst developed genetic dif- ferences from the most recent common ancestor (see Fig. 1 Arrangement of sequences within Results for further explanation). rDNA repeats

28 EVOLUTION OF AN INVASIVE SPECIES: SOLIDAGO CANADENSIS improved management of S. canadensis to prevent and lead to false conclusions or results. Regardless, further introduction outside the native range of the Laureto and Barkman (2011) describe it as necessary species. for comparisons to determine parentage, necessitating “at least one species from each section and subsection of the genus… to represent the phylogenetic breadth Literature Review of the genus” in their own successful study involving Solidago species ancestry and phylogenetic develop- Previous research has been done regarding changes ment. in Solidago DNA sequences and its development fol- Despite extensive use of ITS sequences by Shae- lowing introduction to an environment, particularly fer, Laureto and Barkman, and their predecessors, by Schaefer (2015) in his examination of morpho- some concern is expressed regarding the reliability logical and genomic sequence diferences between of ITS sequences for phylogenetic trees due to their Azorean Solidago azorica and other Solidago speci- biparental nature and continual homogenization with mens from North America to determine ancestry and unstable pseudogenes (Álvarez & Wendel, 2003). optimal nomenclature for S. azorica. His use of phy- Otherwise stated, ITS sequences may contain un- logenetic trees derived from ITS sequence diferences equal amounts of genetic material from maternal and to identify S. azorica origin prior to its emergence paternal lineages, and constant recombination of re- as a distinct species demonstrates the practicality of peats due to the repetitive nature of these sequences such methods of comparison for use in this study. may result in combination of recent ITS sequences Schaefer’s use of morphology as a basis of comparison with disused and decaying ones. This combination between S. azorica and its potential parent species is has been shown to result in lower guanine-cytosine used efectively to support his conclusion, but is im- (GC) content, meaning less stable DNA structure practical in the context of this study due to my focus and thus less reliable sequencing results (Álvarez & on a given species, members of which are morpho- Wendel, 2003). The main focus of the study by Álva- logically indistinguishable. rez and Wendel (2003) is a comparison of ITS region A similar method of molecular analysis is used by sequencing against that of other viable sequences to Laureto and Barkman (2011) to identify origins of the determine which is most reliable in phylogenies. The S. houghtonii hybrid, including ITS sequences and ITS region was determined to be the least reliable of phylogenetic trees to determine ancestry of the given those examined due to it being the most homoplasious species. Morphology is not used as major support for of the study, meaning that it is the most likely to have conclusions of their study, but multiple other regions gene similarities not resulting from shared ancestry. of genetic information such as cpDNA intergenic One possible explanation for these similarities is con- spacers (within IGS region depicted in Figure 1) were vergent evolution, an occasion in which organisms used to further support results. Time and monetary re- of diferent ancestry develop similar characteristics strictions made sequencing of more than two regions through evolution under similar living conditions. impractical in the context of my study; however, use These similarities result in skewed phylogenetic con- of GenBank as done by both Schaefer and Laureto clusions regarding species origin and development. and Barkman was considered feasible. GenBank is a Nevertheless, research by Ritland, Ritland, & Straus publicly available database of genetic sequences by (1993) aims to distinguish between closely related researchers around the world, allowing additional species of the Mimulus family using ITS-based phy- data points to be added without the researcher need- logenies and attempts to account for possible mis- ing to obtain a separate sample from the given loca- leading results of ITS sequences by including three tion and go through the process of DNA extraction “clone” samples (plants of the same species, collected and sequencing. One of the few concerns regarding from the same location) of each species examined. inclusion of sequences from GenBank is that samples Multiple clones of each test sample may have lim- cannot be verifed as having been correctly identifed ited undue infuence of ITS based results, but limited and sequenced, meaning that an unreliable sequence Ritland et al. (1993) to eight samples for comparison. could possibly be included as a viable data point This number of samples was sufcient in his case 29 EVOLUTION OF AN INVASIVE SPECIES: SOLIDAGO CANADENSIS for distinguishing between eight given species, but such as phylogenetic trees will make it possible to de- insufcient for identifying diferences between popu- termine origins and development of the species since lations of varying geographic locations (especially its introduction to Europe. since samples of the same location could be from dif- ferent populations) as was the goal of my study.

Importance and Purpose of Study Materials and Methods

Very few studies have been published to compare Acquisition of Sample Materials intraspecies variation between populations and at- tempt to pinpoint methods of introduction into a Samples of S. canadensis to be used in this ex- given environment. Weber and Schmid (1998) ex- periment were requested via email from various in- amined morphological variations of Solidago species stitutions across the United States and Europe (see introduced to Europe with a study featuring statisti- acknowledgements), as well as several samples from cal analysis of shoot growth, leaves, and inforescence the herbarium at the Naturkundemuseum Stuttgart. measurements from 24 rhizome system samples All tissue samples were either silica-gel dried or her- gathered from diferent regions and climates between barium specimen leaves, with the exception of a single 44 and 61 degrees latitude on the continent. Teir re- silica-dried root sample. sults stated that “only a small and insignifcant pro- Tree separate iterations of DNA extraction, Poly- portion of variation among feld populations could merase Chain Reaction (PCR), and sequencing were be explained by correlation between the characters carried out over the course of this study. Te frst it- and latitude” (Weber and Schmid, 1998), suggesting eration contained eight tissue samples, four of which that not all diferences between population could be were S. canadensis (the others being Solidago gigantea explained by geographic latitude diferences. Dif- and Impatiens glandulifera), and sequenced ITS, ITS1, fering parent populations prior to introduction into ITS2, and 5S-NTS. Te second iteration contained Europe provides a possible explanation of these varia- nine samples and the third contained eight samples of tions. Gradual morphological change correlating to latitude change of sample collection was observed in controlled garden cultivation over the subsequent two years of the study, but the lack of correlation in feld populations was never analyzed as to whether such variations were genetic diferences (developed since introduction to Europe or present due to difer- ing parent populations) or simply characteristics of an identical genome expressed diferently under varying environmental conditions across Europe (as seems as- sumed by the authors). Te purpose of this experiment is to draw conclu- sions about introduction and variability of S. canaden- sis between Europe and North America using ITS and 5S-NTS sequencing and phylogenetic comparison in a manner similar to that of Schaefer (2015) with gel electrophoresis techniques based of those of Ritland et al. (1993). Te hypothesis is that if ITS and 5S-NTS rDNA are sequenced, aligned, and examined from both European and North American samples of S. canadensis, then variations will be observed in both spacer sequences and use of comparison techniques Fig 2: Gel electrophoresis image of frst iteration samples 30 EVOLUTION OF AN INVASIVE SPECIES: SOLIDAGO CANADENSIS

S. canadensis. Second and third iterations sequenced trophoresis was performed and examined in inverted only complete ITS and 5S-NTS due to monetary con- color as shown in Fig 2 , with the inclusion of a posi- straints and expediency of results, since sequencing tive and negative control to reveal possible contami- of ITS forward and reverse was both cheaper and less nations and determine which samples had enough time consuming than sequencing ITS1 and ITS2 sepa- replications of the desired noncoding region to be rately and combining the two. sent for full sequencing. Sufcient samples of the frst Sequences of S. canadensis and other Solidago spe- and third iterations were sent as part of a 96-well cies from GenBank for the ITS region were obtained plate (along with samples of unrelated projects by the and utilized in an additional phylogenetic tree (see Naturkundemuseum), and thus did not require man- Results) despite concerns expressed in the introduc- ual purifcation by the researcher. In the second itera- tion of this study. tion, preparation for sequencing of selected samples was performed in accordance with procedures listed General Procedure in PCR clean-up manual by Macherey-Nagel (2014). Following clean-up (when necessary), samples were Initial cell lysis and DNA extraction from sample labeled and sent to LGC Genomics for their “Flexi tissue was conducted following Macherey-Nagel pro- Run” service, yielding complete forward and reverse tocols for extraction of genomic DNA from plant tis- ITS and 5S-NTS sequences. sue using Nucleospin® Plant II kit (Macherey-Nagel, Afer receiving raw ITS, ITS1, ITS2, and 5S-NTS 2014). Prior homogenization of samples was com- data for samples of the frst, second, and third itera- pleted using metal beads and a high throughput ho- tions, a bioinformatics sofware called Geneious 8.1.8 mogenizer. Subsequent DNA was prepared for PCR (created by Biomatters Ltd.) was used to align forward with the addition of 0.2μl Taq Polymerase (isolated and reverse strands into full DNA sequences. In the from Termus aquaticus bacterium), 2.5μl 10X buf- case of the frst iteration, ITS1 and ITS2 sequences fer (green, with 20mM MgCl2), 2mM deoxynucleotide were combined to yield full ITS sequence for com- triphosphate solution (dNTPs), 1.0μl forward primer, parison with those of the second and third iterations. 1.0μl reverse primer, and 16.8μl nuclease-free water Forward strands of 5S-NTS in all three iterations were for each 1.0μl sample of DNA template. Forward and thoroughly garbled by sequencing errors, forcing the reverse primers were arranged in four combinations researcher to use only reverse sequences in 5S-NTS as follows: ITSA/ITSB for entire ITS amplifcation, comparisons. Furthermore, 5S-NTS reverse direction ITSA/ITSC for ITS1 amplifcation, ITSB/ITSD for of second iteration samples of required resequencing ITS2 amplifcation, and 5S-NTSF/5S-NTSR for entire due to unreadability of sequences. Te Geneious 8.1.8 5S-NTS amplifcation. program was then used to create phylogenetic trees PCR thermocycling program for ITS strands began of the ITS and 5S-NTS regions (see results), as well with 5 minutes at 95°C (for denaturation), followed as a phylogenetic tree based on ITS region sequences by 10 cycles of the following: 30 seconds at 95°C, 45 along with Solidago ITS sample sequences obtained seconds at 60°C (decreasing 0.5°C each cycle), and from GenBank. 1 minute at 72°C. Next was 30 cycles as follows: 30 seconds at 95°C, 45 seconds at 55°C, and 1 minute at 72°C. Te program was completed with 5 minutes at Results 72°C. PCR thermocycling for 5S-NTS began with 5 min- Unclear portions containing errors in sequencing, utes at 95°C (for denaturation), followed by 10 cycles generally located at the start and end of the sequences, of the following: 30 seconds at 95°C, 45 seconds at were removed along with sequences of primer DNA 64°C (decreasing 0.5°C each cycle), and 1 minute at so only true diferences would appear when DNA was 72°C. Next was 30 cycles as follows: 30 seconds at compared between samples. Tese diferences could 95°C, 45 seconds at 59°C, and 1 minute at 72°C. Te then be viewed in alignments by the Geneious 8.1.8 program was completed with 5 minutes at 72°C. program, as indicated in Figure 3 (below) by difer- Once PCR had been completed, agarose gel elec- ences between rows of sequencing. 31 EVOLUTION OF AN INVASIVE SPECIES: SOLIDAGO CANADENSIS

Clear diferences in sequences between samples are any particular division) is the changes per base pair indicated by diferent color box and letter (indicating for each phylogenetic tree. Samples which appear name of nitrogenous nucleotide base), such as that in diverge on the farther lef side of each image (earlier position 5 of Figure 3, where thymine is clearly indi- in the tree) are those with the most diferences from cated while all other samples at that position displayed the consensus alignment of the sequences, therefore cytosine. Less certain diferences are displayed as gray calculated to be the most genetically diferent in com- boxes where the sequencing was unclear or detected parison to the others in the tree. two base pairs at that position. One explanation for Sample titles as listed in Figures 4 and 5 are for- this uncertainty is the possible existence of two varia- matted as follows: uppercase letter R followed by itera- tions of code within the several tandem repeats of a tion number, underscore followed by sample number given specimen’s sequence, both of which would then within the previously specifed iteration, underscore be amplifed by the PCR and detected by sequencing followed by name of region sequenced (ITS for com- sofware. bined ITS forward and reverse primers or 5SNTSR for Furthermore, the Geneious 8.1.8 sofware was 5S-NTS reverse primer), then underscore followed by used to produce phylogenetic trees of both ITS and abbreviation for country of origin. 5S-NTS sequences (see Fig. 4 and 5). Numbers listed Notable areas of the ITS tree depicted in Figure 4 at the divisions in the tree are known as “bootstrap include the three lowermost samples, four samples values” and indicate how many out of the 100 possible to the lef and below the bootstrap value 56, and the phylogenetic trees the program creates that particular sample R3_7_ITS_US located in the upper right. division was present in. Tus, higher bootstrap values Notable areas of the 5S-NTS tree depicted in Figure indicate higher certainty that a given division or di- 5 include the two lowermost samples, as well as the viding variation occurred at the indicated point. Te location of all samples in the tree relative to their loca- number at the bottom of each image (not attached to tions in the ITS tree (Fig. 4).

Fig 3: Initial 30 base pairs in ITS alignment of all samples 32 EVOLUTION OF AN INVASIVE SPECIES: SOLIDAGO CANADENSIS

Fig 4: Phylogenetic tree for ITS sequences Fig 5: Phylogenetic tree for 5S-NTS sequences

As considered necessary for comparisons to deter- with the results seen in Figure 4 (5S-NTS sequences mine ancestry by Laureto and Barkman (2011), ITS being too short and unreliable) to create the phyloge- sequences from GenBank were used in compilation netic tree in Figure 6 (below).

33 EVOLUTION OF AN INVASIVE SPECIES: SOLIDAGO CANADENSIS

Analysis and Discussion

Analysis of ITS phylogenetic tree (Fig. 4) reveals that ITS samples R3_3, R3_4, and R3_6, collected from U.S. states Colorado, Wyoming, and New York, respectively, are signifcant due to their high amounts of variation from the ITS consensus sequence (see Fig. 3). Te lowest two samples of the ITS tree (R1_6 and R3_3, of Vermont and Colorado respectively) are grouped together because they have an identical vari- ation of cytosine rather than guanine in position 546 of ITS. Sample R3_4_ITS_US of Wyoming is located between the two lowermost samples and the rest of the samples because it is unsure at the same position (Fig. 7). Te lowermost sample, R3_3_ITS_US from Colorado, is farthest removed because it has another defnite diference in a diferent position not shared by any other samples in the alignment. Laureto and Barkman (2011) utilized a similar method involv- ing analysis of sequence alignment and comparison of specifc base pairs to supplement explanations of phylogenetic diferences displayed in the constructed Fig 6: Phylogenetic tree for ITS with GenBank trees. samples Based of these diferences, there is a possibility that sample R1_6_ITS_US from the state Vermont Inclusion of three non-Solidago plants allowed for may have been introduced to its area of collection what is referred to as “rooting”: a visual representation from Colorado, where sample R3_3_ITS_US was col- of how diferent populations are when compared to lected and within the native range of S. canadensis, much less closely related species such as the bottom before developing an additional variation. Further- three specimen included in Figure 6. Formation of an more, sample R3_4_ITS_US (collected in Wyoming) outgroup by use of 1-3 samples of a difering genus indicates uncertainty possibly due to its collection occurred also in studies by Schaefer (2015), Laureto location in the native region of the species, where and Barkman (2011), and Ritland et al. (1993). Te populations and gene pools are larger, causing greater amount of diference between given samples of S. variation and possibly resulting in the presence of canadensis and outgroup species also provides clear two diferent DNA sequence repeats within the same indication of directionality of evolutionary change sample. (Kinene, Wainaina, Maina, & Boykin, 2016) thus A grouping of four samples (titles beginning with clarifying which variations likely occurred earlier R1_4, R1_5, R1_7, and R3_6) are grouped in the same than others, due to their similarity to a species which clade of the ITS tree, indicating an identical amount of diverged from the last common ancestor of the tree diference from the ITS consensus sequence and thus much earlier. Inclusion of this phylogenetic tree con- the possibility of a shared origin. Te sample R3_6_ frms that all S. canadensis samples used in the study ITS_US was collected in the US state of New York, are closely related as populations within a given spe- meaning that it would be the parent population of the cies should be, thus ruling out possibilities of incorrect group. Te other three samples of the group were col- identifcation by the researcher in sample acquisition. lected in France and Germany, close enough together for the possibility that their populations could have developed following a single introduction from the 34 EVOLUTION OF AN INVASIVE SPECIES: SOLIDAGO CANADENSIS

typically be responsible for an unclear base interpreta- tion). Such possible sequencing errors are also noted by Laureto and Barkman (2011) in agreement with earlier statements by Álvarez and Wendel (2003) re- garding PCR errors and false variable sequences due to the recombinant nature of tandem repeat regions such as ITS. Due to the unclear forward primers of the 5S-NTS sequences and the shorter nature of that noncoding region, ITS results obtained by the researcher can be considered more reliable and more likely to be accu- rate than those of the 5S-NTS region. Additionally, many areas of the reverse 5S-NTS sequences were un- clear (similar to the forward primer but less severe) and thus were cut out by the researcher in editing prior to alignment, further shortening the number of positions available for comparison. Conficting phy- logenies between the two regions were noted imme- diately in the two trees (Fig 4 and 5), including most obviously the diference in the two lowermost samples from the ITS sequence results. Sample R2_9_5SNTS_ US, collected from the US state of North Carolina, was depicted the sequence most variable from the consensus, suggesting that it may have also originated from the same R3_6 sample population from Colo- rado. However, this same suggestion regarding the R2_ 9 sample is not refected in the more reliable ITS tree, leading the researcher to discard this evidence. Laureto and Backman (2011) avoided this confict in their study involving sequencing of multiple regions Fig 7: Position 546 of ITS alignment by determining percent variation for regions such as chloroplast DNA rather than focusing on individual New York population of the species into Europe. Simi- placement of samples within a phylogenetic tree. Tis lar groupings were identifed by Schaefer (2015) and was made possible by their study’s goal of diferen- supported by the multiple regions he sequenced, thus tiating between species, which can be indicated by allowing him to make practical conclusions regarding overall variance rather than specifc base pair poly- parent populations of S. azorica, the species whose an- morphisms. Unfortunately, this study’s goal of deter- cestry he was trying to determine. mining emergence of populations (that is, when and Te sample R3_7_ITS_US was collected from the in what manner populations came to difer within a US state of Colorado, within the native range of the given species), as indicated by emergence of polymor- species. Its signifcant diference from other samples phisms, means that such avoidance was not possible. of the ITS tree (see Fig 4) could be due to a lack of sequence clarity. Many base pairs in this sample were noted as uncertain, the sheer amount (as can be ob- Conclusion served in Fig 3) of which suggests sequencing errors unrelated to the sample or research methodology, ITS and 5S-NTS rDNA were successfully se- rather than the presence of two base pairs at one posi- quenced, aligned, and examined from both European tion in a single sample’s set of DNA repeats (as would and North American samples of S. canadensis with use 35 EVOLUTION OF AN INVASIVE SPECIES: SOLIDAGO CANADENSIS of comparison techniques such as phylogenetic trees. such sequencing errors as were an obstacle in this Previous studies in the feld were used as models for study can be prevented in the future through develop- methodology and analysis, but key diferences exist ment of more advanced DNA. Although no defnite when compared to conclusions by Shaefer (2015) and conclusions regarding S. canadensis variation were Laureto and Barkman (2011) in that the purpose of determined through my study, the lack of present re- their studies was simple ancestry and nomenclature, search in this area, demonstrated by studies such as while my study aimed to identify emerging variations that by Weber and Schmid (1998), continues to stand in a species and their geographic locations of origin. as a reason for additional exploration into how inva- Te hypothesis for this study was partially proven in sive species are changed by the communities which that variations were observed in both ITS and 5S-NTS they come to dominate. sequences. However, due to sequence unreliability and insufcient evidence, the researcher was unable to determine with certainty the origins and develop- Acknowledgements ment of S. canadensis populations since its introduc- tion to Europe. I would like to thank the Staatliches Museum fuer Naturkunde Stuttgart for allowing me to conduct my research in their laboratory facilities and use of their Future Directions equipment, as well as providing training in laboratory procedures and a number of tissue samples for anal- Given more time and fnancial resources, full re- ysis. My thanks are especially due to Dr. Mike Tiv, sequencing of the 5S-NTS region would beneft this Ms. Anne-Kristin Schilling, and Ms. Cornelia Krause research with the inclusion of clear and reliable data of the Naturkundemuseum for their help in planning for meaningful comparison to ITS results. Also, inclu- and supervising my laboratory work. I would like to sion of other S. canadensis genetic information, such thank Ms. Katie Stuble of the Holden Arboretum, St. as the ETS region of nrDNA recommended for use in Andrews University, Dr. Egan of the Elmira College conjunction with ITS by Laureto and Barkman (2011) Herbarium, Professor Fishbein of Oklahoma State or single-copy nuclear genes suggested by Álvarez University, Mr. Battaglia of Eckert Herbarium, and and Wendel (2003) as a more stable alternative to ITS Dr. Rohwer of the Universität Hamburg for providing sequencing for creation of phylogenetic trees, could sample tissue. Tanks also to Mrs. Stephanie Payne prove useful in confrming conclusions made from and Mr. Philip Bailey for their constructive feedback ITS and 5S-NTS results. Additional samples from the and encouragement, and Department of Defense same and more varied locations across Europe and the Education Activity and Stuttgart Community Spouses Americas would allow for more comparisons between Club for their fnancial support of my research. Fi- a larger number of potential populations and intro- nally, I would like to thank Mr. Daniel Coapstick, my ductions. teacher, for his instruction and experience in organi- On a larger scale, it has been made clear through zation and composition of a research project. my research that more exploration should be done to determine the origins and development of invasive species S. canadensis as was done by Schaefer (2015) regarding the origins of S. azorica. As pointed out by Stace and Crawford in their documentation of species invasive to the British Isles (2016), “this topic [devel- opment of S. canadensis and S. gigantea since intro- duction to Europe] has been almost totally neglected by researchers in Europe… DNA technology might change that”, meaning that many advances in this feld of study are yet to come with the refnement of exist- ing sequencing and comparison technology. Perhaps 36 EVOLUTION OF AN INVASIVE SPECIES: SOLIDAGO CANADENSIS

Sheppard, A. W., Shaw, R. H., & Sforza, R. (2006). Top 20 environmental weeds for classical biological control in References Europe: A review of opportunities, regulations and other Álvarez, I., & Wendel, J. F. (2003, April 4). Ribosomal ITS barriers to adoption. Weed Research, 46(2), 93-117. sequences and plant phylogenetic inference. Molecular Stace, C. A., & Crawley, M. J. (2015). Alien Plants. London: Phylogenetics and Evolution, 29(3), 417-434. doi:10.1016/ William Collins. s1055-7903(03)00208-2 Weber, E., & Schmid, B. (1998). Latitudinal population Avadhani M.N, Selvaraj C, Tarachand C & Rajasekharan diferentiation in two species of Solidago (Asteraceae) P.E (2012). Molecular characterization of medicinal and introduced into Europe. American Journal of Botany, aromatic plants by 5S rRNA NTS and PCR RFLP- A mini 85(8), 1110. doi:10.2307/2446344 review. Research in Biotechnology, 3(2), 41-48. Bertea, C. M., & Gnavi, G. (2012, January). Restriction frag- ment length polymorphism of the 5S-rRNA-NTS region: A rapid and precise method for plant identifcation. Methods in Molecular Biology Plant DNA Fingerprinting and Barcoding, 89-101. doi:10.1007/978-1-61779-609-8_8 Dong, L., Yu, H., & He, W. (2015). What determines posi- tive, neutral, and negative impacts of Solidago canadensis invasion on native plant species richness? Scientifc Reports, 5, 16804. doi:10.1038/srep16804 Hillis, D. M., Sadava, D. E., Heller, H. C., & Price, M. V. (2012). Principles of Life. Sunderland, MA: Sinauer Associates. Kinene, T., Wainaina, J., Maina, S., & Boykin, L. (2016). Rooting trees, Methods for. Encyclopedia of Evolutionary Biology, 489-493. doi:10.1016/ b978-0-12-800049-6.00215-8 Laureto, P. J., & Barkman, T. J. (2011). Nuclear and chloro- plast DNA suggest a complex single origin for the threat- ened allopolyploid Solidago houghtonii (Asteraceae) in- volving reticulate evolution and introgression. Systematic Botany, 36(1), 209-226. doi:10.1600/036364411x553289 Macherey-Nagel GmbH & Co. KG. (2014, January). Genomic DNA from Plant [User Manual Rev. 09]. Macherey-Nagel GmbH & Co. KG. (2014, July). PCR clean- up Gel Extraction [User Manual Rev. 03]. Raferty, J. P. (2015, November 25). Invasive Species. Retrieved March 27, 2017, from https://www.britannica. com/science/invasive-species Ritland, C. E., Ritland, K., & Straus, N. A. (1993). Variation in the ribosomal internal transcribed spacers (ITS1 and ITS2) among eight taxa of the Mimulus guttatus species complex. Molecular Biology and Evolution, 10(6), 1273-1288. Schaefer, H. (2015, April 29). On the origin and systematic position of the Azorean goldenrod, Solidago azorica (Asteraceae). Phytotaxa, 210(1), 47. doi:10.11646/ phytotaxa.210.1.5

37 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018

Smoke Break: Electronic vs Tobacco Cigarettes

Isaac Gallogly

Te use of electronic cigarettes is beginning to surpass the use of tobacco cigarettes, especially among youth and young adults. Because there is ample evidence that tobacco cigarettes are intrin- sically more dangerous, the potential impacts of the growth of electronic cigarettes is ofen ignored. In order to make inferences about the aforementioned impacts, a comparison was done between the chemical components of e-cigarette aerosol, using the Pax Labs JUULTM, and that of tobacco cigarette smoke. Te analysis was done through the use of a gas chromatograph mass spectrometer. It was found that there are a number of potentially dangerous compounds that are present in both types of aerosols. Terefore, the health efects related to these compounds can afect users of either type of cigarette. Based on the fndings of this study, electronic cigarettes need to be considered as much of a public health concern as tobacco cigarettes, and action must be taken accordingly. Te social and political campaign against tobacco cigarettes that has been witnessed in the United States should be used as a model for a similar campaign against electronic cigarettes.

Keywords: electronic cigarette, tobacco cigarette, aerosol, health, JUUL

matography, a method of gas analysis, but many have Introduction failed to evaluate modern electronic and tobacco ciga- rettes in the same experiment. In addition, a relatively Concurrent with modern advancements in tech- new electronic cigarette known as the JUULTM, which nology, electronic cigarettes are replacing convention- uses nicotine salts found in leaf tobacco as opposed to al tobacco cigarettes. Setting them apart, e-cigarettes free-base nicotine, has not been studied extensively, do not use tobacco and are comprised of a battery of yet has become one of the most popular products on varying voltage, a container in which a favoured solu- the market.4 Te purpose of this study is to evaluate tion is stored, a heating element such as a coil, and a to what extent the chemical composition of e-cigarette mouthpiece through which a user inhales an aerosol.1 aerosol, using the JUULTM, compares to that of tobac- For the purposes of this study, only electronic ciga- co cigarette smoke and to evaluate what implications rettes which use a nicotine-containing solution will particular similarities may have for the health of users be examined, and variances in battery voltage will be and the future of the electronic cigarette industry. deemed negligible. Many questions about the safety of this emerging technology, especially when com- pared to conventional tobacco cigarettes, have been Electronic Cigarette Industry raised. Like tobacco cigarettes, e-cigarettes expose users to Growth a number of chemicals that have the potential to cause adverse health efects; however, these consequences Recent studies reveal that the electronic cigarette are not fully understood.2,3 A number of studies have industry is growing exponentially, evidenced by the attempted to explain the potential impacts of elec- sales of electronic cigarettes. In 2015, the e-cigarette/ tronic cigarette usage through the use of gas chro- vapor industry amassed $3.3 billion in sales, showing 52 SMOKE BREAK: ELECTRONIC VS TOBACCO CIGARETTES incredible market value.5 In the same year, an obser- tributed to the growth of the electronic cigarette in- vational study done on a number of specialty vape dustry. A study done to determine the concentration shops showed that 58.2 million nicotine-containing of nicotine in the blood of users of electronic cigarettes electronic cigarette units were sold.6 and that of users of tobacco cigarettes concluded that Te usage of electronic cigarettes has increased the two amounts are very similar.11 Tese fndings considerably among youth and young adults. Usage suggest that the two modes are equally as efective at amid those aged 18-24 surpassed that of adults aged delivering nicotine. Terefore, the health efects as- 25 or older in 2014, and the gap continues to grow.7 sociated with nicotine in e-cigarettes are generally Additionally, electronic cigarettes have surpassed the same as for typical tobacco cigarettes.2 Tis is of conventional cigarettes in popularity among this age particular concern because nicotine has been found group.7 Tis trend resembles the trend identifed in to afect brain development of adolescents which are the 1964 Surgeon General Report on Smoking and the most common users of electronic cigarettes.7,8 On Health wherein conventional tobacco cigarette usage top of that, nicotine is a highly addictive drug and is was most popular among young adults.8 Such a re- the catalyst in the transition from experimentation semblance may suggest that the scope of the electronic with electronic or conventional cigarettes to sustained cigarette industry will, at its height, be similar to that smoking.8 of the tobacco industry in the mid 1900s. As these Tird, the public perception of e-cigarettes is con- numbers continue to grow, and electronic cigarettes ducive to the prolonging of their use. A number of continue to be used in place of tobacco cigarettes, it studies have shown that the most commonly cited rea- is increasingly vital that a comprehensive comparison sons for frst using electronic cigarettes among youth between the two be done in order to assess any poten- and young adults are favouring/taste, curiosity, and tial impacts of the large-scale transition. most importantly, low perceived harm as compared to tobacco products. Te use of e-cigs as a means to quit smoking tobacco cigarettes was not found as a Reasons for Growth commonly cited reason among this age group.2,12,13,14,15 According to these fndings, electronic cigarettes as a Accumulating research indicates that the increase whole are perceived as less harmful than conventional in popularity of electronic cigarettes, especially among cigarettes, and this is leading people to begin using youth, can be attributed to three factors. Te frst of them for recreational purposes rather than to stop which is accessibility and appeal. Producers of elec- smoking tobacco cigarettes.2 tronic cigarettes intentionally design favourings, like; As the electronic cigarette industry contin- fruit, cotton candy, and mint, to appeal to the group ues to grow, the tobacco cigarette industry continues that has the most interest in their products, young to decline. Regulation, on both the product itself and adults aged 18-24.2,9,10 Additionally, the accessibility of advertising, has played a large role in this decline.16 e-cigarettes resembles that of tobacco cigarettes as both Similar regulation does not currently exist to this de- are available for purchase at various convenience stores, gree for electronic cigarettes but may be an efective gas stations, specialty shops, and online.2 Currently, means at curbing the further growth of the industry. the FDA does not have the authority to regulate elec- tronic cigarette advertising, and has yet to implement Existing Knowledge a labeling system for e-cigarette packaging. On the contrary, the FDA, a U.S. regulatory agency, does both A recent study conducted by afliates of the Uni- for tobacco cigarettes. Consequently, consumers living versity of Rochester Medical Center substantiates that in the U.S. are not exposed to a printed record of the exposure to e-cigarette aerosol causes measurable oxi- potential risks associated with electronic cigarettes, like dative and infammatory efects in human lung cells.17 they are with tobacco cigarettes, during the purchase.10 Te scope of these consequences is unknown because Tis lack of regulation efectively increases the appeal the topic is so modern. A prospective study on the and accessibility of electronic cigarettes. current generation of e-cigarette users is needed to Second, the efciency of nicotine delivery has con- truly understand the efect of the inhalation of elec- 53 SMOKE BREAK: ELECTRONIC VS TOBACCO CIGARETTES tronic cigarette aerosol on the human body. pare the composition of electronic cigarette aerosol to However, there are a number of potentially harm- the composition of tobacco cigarette smoke. It is hy- ful compounds that are known to be found in said pothesized that the results will support the assertion aerosol. Based on several exploratory studies, these that e-cigarettes are harmful to the user’s health. Such can be grouped into three categories of carbon-based a fnding would promote initiatives leading to a public compounds.3,10,18 Te frst of which is carbonyls. One health campaign to curb their use and the growth of study observed the presence of carbonyls in 47 of 51 the industry, similar to the campaign against the to- electronic cigarette favourings tested.10 Te second bacco industry. category is volatile organic compounds. A separate study found that multiple VOCs were found present in electronic cigarette aerosol.18 Te third category is Methodology carcinogens. A study done by researchers at the In- stitute of Occupational Medicine and Environmen- Initially, a qualitative method involving the survey tal Health showed that the levels of formaldehyde, of high school students in regards to their use of elec- a carcinogen, observed in select electronic cigarette tronic and tobacco cigarettes was considered. How- aerosols was in the range of levels reported in tobacco ever, because the medical feld is concentrated with smoke. Tese researchers concluded that in some surveys of this nature, a quantitative scientifc design cases, electronic cigarettes “might expose their us- was chosen instead and modelled afer a number of ers to the same or even higher levels of carcinogenic studies which detail the use of gas chromatography to formaldehyde than tobacco smoke.” 3 Tis collection observe the presence of various compounds within an of studies also revealed that a number of metals are aerosol.18,21 Gas chromatography was chosen because found in electronic cigarette aerosol, including nickel, it is widely considered to be one of the most efective cadmium, and lead.18 However, for the purposes of methods of analyzing gaseous samples.33 Te intent the current study, metals will not be analyzed or con- of this design was to gather data that could clarify the sidered. link between electronic cigarette usage and potential Tough there are indeed harmful compounds health risks in order to show the possibility of impacts found in electronic cigarette aerosol, there are sig- on public and individual health similar to those of to- nifcantly more found in tobacco cigarette smoke.3,17,18 bacco cigarettes. Because of this, it is important to note that the use of electronic cigarettes is a popular strategy for the ces- sation of tobacco cigarette smoking. Te efectiveness Setup of this strategy varies.19 For the purposes of this study, an electronic cigarette and tobacco cigarette were acquired. Te Hypothesis JUULTM e-cigarette was chosen because of its patented use of nicotine salts as opposed to free-base nicotine Because of the presence of the previously men- and the lack of available research involving this new tioned compounds in electronic cigarette aerosol, the technology.4 Te JUULTM utilizes disposable cartridg- popularity of these devices is a public health concern.2 es to store the electronic cigarette favouring liquid Exacerbating the problem, electronic cigarettes are called pods. Each pod contains .7 mL of liquid and is perceived to be signifcantly less harmful than to- 5% nicotine by weight. Four favours of JUULTM pods bacco cigarettes.2 In addition, the use of electronic were chosen: mint, fruit, mango, and creme brulee. A cigarettes is high among youth, paralleling trends in Pall Mall Menthol cigarette was chosen as the tobacco tobacco cigarette usage at the height of their popular- sample because of its afordability and convenience. ity.20 Tese factors illustrate the need for more infor- All steps of the procedure were done in a local envi- mation about electronic cigarettes in order to avoid ronmental laboratory specializing in the analysis of the impacts of another cigarette smoking epidemic. air and dissolved gases. Te current investigation has been designed to com- 54 SMOKE BREAK: ELECTRONIC VS TOBACCO CIGARETTES

was unsuccessful for the creme brulee JUULTM pod. Procedure Te mass spectrometer assigned a retention time to every measured compound. Each retention time was Te frst step of the experiment involved design- then matched to the name of its specifc compound ing a device that would mimic human inhalation in using a reference library unique to the machine. Te order to extract gas from the two types of cigarettes. mass spectrometer also produced a graph for each For this, a number of devices were tested, all taking sample which matches each retention time to the rela- advantage of pressure diferences to force the gas out tive abundance of that particular compound. Relative of the cigarette and into a syringe. Te fnal design of abundance peaks can only be compared quantitatively the apparatus was modelled afer the device described within the same sample. in “Universal electronic-cigarette test: physiochemical characterization of reference e-liquid.” 21 It was com- prised of a sof plastic tube that was stretched around Results the mouthpiece of the electronic cigarette or the tip of the tobacco cigarette and then connected to a valve. A Using gas chromatograms retrieved from the mass 45 mL disposable plastic syringe was connected to the spectrometer (see Figure 1 in the appendix), the top valve to measure the amount of gas being collected. ffeen most concentrated compounds found within Te valve was included to ensure that no gas would each sample were compiled. Only ffeen were chosen escape the device during the extraction procedure. because at lower concentrations, health efects are of a Once the syringe was full, the gas was then trans- far smaller magnitude and not pertinent to this study. ferred to a 22 mL evacuated glass vial using a dispos- Each compound was then cross-referenced with all able needle. Te syringe was discharged entirely. Te four individual samples in order to observe possible collection process was repeated twice for each of four overlap. Te results of this analysis are refected in favours of JUULTM pods as well as for the Pall Mall Table 1. Unsurprisingly, a number of the same com- Menthol cigarette. Te vials were labeled accordingly pounds were found within each of the electronic ciga- and recorded on the chain of custody form. rette samples. Comparatively, nine of the compounds One vial of each type of sample was run through observed in the tobacco cigarette sample were also a gas chromatograph specifcally built for the lab in observed in at least one of the electronic cigarette use and calibrated to analyze a specifc set of volatile samples. Tese particular compounds are highlighted organic compounds. Tis particular calibration only in red in Table 1. included compounds expected to be found in con- taminated ambient air, so it did not test for many of the compounds that are generally found in e-cigarette Health Hazards favourings. Regardless, the test was run to ensure that a more thorough and expensive test using a mass Te Globally Harmonized System (GHS) for Haz- spectrometer was truly necessary in order to gather ard Communication is a United Nations initiative useful data. which works to create a uniform method for the clas- Because the results of the frst test were inconclu- sifcation and labeling of chemicals. Te United States sive, the remaining fve vials (one for each JUULTM is an active participant.22 With respect to this system, favour and one for the Pall Mall Menthol cigarette) and with reference to the National Center for Biotech- were sent through a PerkinElmer GC/MS/ATD Work nology Information’s PubChem database, each com- Station, equipped with a Clarus SQ8T Mass Spec- pound was paired with its corresponding GHS hazard trometer as well as a Clarus 680 Gas Chromatograph, codes and its potential inhalation symptoms. Tis confgured to run EPA Method 325B which tests for a data can be found in Table 2. Tis table also includes much larger array of organic compounds than the frst the PubChem CID of each compound which can be gas chromatograph that was used. Tis test was suc- used to quickly fnd the compound in the database. cessful for the mango, mint, and fruit JUULTM pods as well as for the Pall Mall sample; however, the test 55 SMOKE BREAK: ELECTRONIC VS TOBACCO CIGARETTES

Table 1. Compounds Found in E-cig and/or Tobacco Cigarette Aerosol Compounds highlighted in red were found in the tobacco cigarette sample as well as at least one of the electronic cigarette samples.

56 SMOKE BREAK: ELECTRONIC VS TOBACCO CIGARETTES

etone, ofen used in nail polish remover because of its To evaluate the potential health efects of a specifc solvent properties.24 Acetone is associated with seven compound, each GHS hazard code corresponds to a GHS hazard statements including “may cause respira- hazard statement; the statements ofer a brief descrip- tory irritation,” “suspected of damaging fertility or the tion of a possible health efect resulting from exposure unborn child,” and “caused damage to organs through to the compound. Most of the compounds are associ- prolonged or repeated exposure.” Found only in the ated with multiple hazard statements which range in tobacco cigarette sample, toluene can be associated severity. For a list of the GHS hazard codes identifed with the most GHS hazard statements (sixteen). in Table 2 and their corresponding hazard statements, see Table 3 which can be found in the appendix. Te total number of GHS hazard codes/statements Discussion associated with each compound is communicated in Figure 1. Found in all three of the JUULTM samples as Prior to the completion of this study, very little sci- well as the tobacco cigarette sample, acetaldehyde is entifc research surrounding the composition of vapor one of the most dangerous compounds identifed. It generated by the JUULTM electronic cigarette existed can be associated with ffeen GHS hazard statements, even though it has become one of the most popular including but not limited to the following: “toxic if in- products in the e-cigarette market. Its patented use haled,” “may cause drowsiness or dizziness,” and “may of nicotine salts found in tobacco leaves, as opposed cause cancer.” Also found in all four samples was ac- to freebase nicotine, makes it difcult to draw conclu-

Figure 1. Frequency of GHS Hazard Codes by Compound Frequency of hazard codes calculated using information from the National Center for Biotechnology Information PubChem compound database.23

57 SMOKE BREAK: ELECTRONIC VS TOBACCO CIGARETTES sions about the JUULTM based on past studies.4 How- Tobacco Cigarettes ever, the JUULTM is just one of many products that comprise the e-cigarette industry—an industry which In terms of health risks, this study confrms that is currently experiencing a growth that resembles the inhalation of tobacco cigarette smoke is more that of the tobacco cigarette industry in the twentieth dangerous than the inhalation of electronic cigarette century.5,6 Te data collected and presented in this aerosol. Te top four most hazardous compounds (as study allow for comparisons to be made between the measured by frequency of hazard codes) were found health hazards of the two types of cigarettes. With in the tobacco cigarette sample. Tese compounds are this in mind, the following was hypothesized before toluene, acetaldehyde, chloromethane, and propane. any collection of data was done: e-cigarettes contain Comparatively, the only one of these four found in types and quantities of molecules with the potential any of the electronic cigarette samples is acetaldehyde. be harmful to the user’s health. In general, the most severe hazard statements can be

Table 2. Potential Health Hazards and Inhalation Symptoms of Identifed Compounds

Information retrieved from the National Center for Biotechnology Information PubChem compound da- tabase.23

58 SMOKE BREAK: ELECTRONIC VS TOBACCO CIGARETTES associated with compounds found in the tobacco ciga- In some cases, the highly toxic compounds form- rette sample. Te most serious hazard statements include aldehyde, acrolein, and o-methyl benzaldehyde were “fatal if inhaled (H330),” “fatal if swallowed (H300),” detected in e-cigarette vapour; however, they were not “may damage fertility or the unborn child (H360),” and detected in this screening of the JUULTM.26,27 “causes damage to organs (H370).” All four of which Te compounds found in the electronic cigarette can be associated with at least one compound found in samples varied slightly. Tere were 13 compounds the tobacco cigarette sample. Additionally, the tobacco found in only one of the e-cigarette samples. Tis cigarette sample contained more compounds suspected variation likely exists in order to give each pod its of being human carcinogens than any of the three elec- unique favour. For example, levomenthol, which was tronic cigarette samples. Te compounds found in the found only in the mint sample is derived from mint tobacco cigarette sample associated with GHS hazard oils and is commonly used as a favouring.29 statements relating to carcinogenicity include the fol- lowing: propane, benzene, butane, chloromethane, and acetaldehyde. Tree of the fve—benzene, chlorometh- Comparison ane, and acetaldehyde—were identifed in past studies as potential human carcinogens.18,25 Relatedly, a number of A specifc goal of this study was to evaluate an elec- studies confrm that combustible tobacco cigarettes are tronic cigarette and a tobacco cigarette in the same inherently more dangerous to the user’s health than elec- experimental environment and through the same an- tronic cigarettes.3,17,18 alytical lense. Past research has shown similarities be- tween the composition of electronic cigarette vapour Electronic Cigarettes and combustible cigarette smoke, but has been wary to relate the health efects of the two. However, the Tough the tobacco cigarette sample contained GHS communication system provides a way to com- the majority of the most dangerous compounds, each pare the potential, rather than the observed, hazards of the electronic cigarette samples also contained a of each compound found in the aerosols. Tese haz- number of compounds associated with alarming GHS ards can be compared because in both types of ciga- statements. All three of the samples contained acetal- rettes, the compounds are being heated and burned to dehyde, acetone, benzoic acid, propionaldehyde, and a similar temperature in order to produce an aerosol isopropanol which were among the compounds asso- that is then inhaled into the lungs. ciated with the most severe GHS hazard statements. Specifc to this study, there were nine compounds Tese compounds have been identifed in electronic that were detected in the tobacco cigarette sample and cigarette vapour in past studies; the following infor- at least one of the three electronic cigarettes. Tis in- mation summarizes these fndings: cludes acetaldehyde, one of the most dangerous com- t
Acetaldehyde was detected unanimously.26,27 pounds detected. Across the nine compounds (high- t
Acetone was detected in all studies in which it lighted in red in Table 1), there are a large number of was tested.26,27 severe GHS statements that can be attributed to the t
One study which tested JUULTM vapour for the vapour/smoke generated by both types of cigarettes. presence of benzene found a large concentration In addition, past studies, compiled in the PubChem of benzoic acid in the sample, concurrent with compound database, have identifed a number of po- the fndings of this experiment.28 However, ben- tential inhalation symptoms that are associated with zoic acid has not been identifed in samples of the compounds that are consistent between the tobac- other types of electronic cigarettes. co cigarette and electronic cigarette samples including t
Propionaldehyde was only found in samples sore throat, cough, drowsiness, dizziness, headache, from electronic cigarettes when the battery volt- and nausea to name a few.23 Tis compositional con- age was increased considerably. gruity provides convincing evidence that the chemi- t
Tere is no evidence that isopropanol has been cals found in electronic cigarettes are signifcantly found in any e-cigarette vapour samples before similar to those found in combustible tobacco ciga- this study.26 rettes; consequently, inferences can be made about the 59 SMOKE BREAK: ELECTRONIC VS TOBACCO CIGARETTES health efects of e-cigarette use based on the efects of communication, which makes the chemicals found tobacco cigarette use that have already been identifed. within specifc products public knowledge, could po- With this in mind, it is important to evaluate the tentially assist in notifying consumers of the dangers full scope of these health efects as they may impact of using these products and motivate producers to be users and public health in general. In the twenti- more careful about the chemicals that are used. Ul- eth century, combustible tobacco cigarettes grew in timately, targeted ad campaigns, regulated labelling, popularity until the growth plateaued in response to and public ingredient lists should be implemented new information about the health efects associated with the intention of creating a more informed and with their use. Shortly afer, ad campaigns and new wary consumer base in order to decrease the use of FDA regulated labelling assisted in further halting the electronic cigarettes and stife the growth of the e- cigarette smoking epidemic, but these new cessation cigarette industry. methods did not take into consideration electronic cigarettes.20 Now, the United States is experiencing a similar phenomenon; however, instead of combus- Future Direction tible tobacco cigarettes, the use of electronic cigarettes is growing. Based on the fndings of this study, this Limitations growth could prove to be as substantial and impactful as the growth of the tobacco industry many years ago. Te GC Mass-Spec used in this experiment was Furthermore, the health efects of electronic ciga- only capable of identifying carbon-based compounds, rettes have the potential to be nearly as harmful to the as its intended purpose is to measure environmental human body as tobacco cigarettes; therefore, action contaminants. Terefore, the presence of metals in must be taken to curb the growth of the electronic the vapour samples was not determined. Tere are cigarette industry and the use of its products in order a number of metals that can potentially be dangerous to avoid impacts similar to those caused by tobacco when inhaled, so a test for the presence of these metals cigarette use. Tis could likely be accomplished by would contribute to a more thorough understanding targeted ad campaigns and FDA regulated labelling of the efects of electronic cigarette use. In addition, which have already proven to be successful in reduc- only one sample of each favour of JUULTM Pod and ing the number of tobacco cigarette smokers. For ex- one sample of the Pall Mall cigarette were run through ample, the frst federally funded anti-smoking media the GC Mass-Spec because of the cost associated with campaign, coined “Tips From Former Smokers,” re- operating the machine. A study which conducts mul- portedly motivated 1.64 million Americans to try to tiple trials may add credibility to the fndings, but quit smoking in the year 2012 alone.30 A similar of- the lack of trials should have no efect on the results fensive must be taken against electronic cigarettes to presented in this report because the Mass-Spec is ex- reduce their use, especially amongst youth and young tremely accurate. However, it is unable to quantita- adults. tively compare the concentration, or abundance, of a Another tactic that could potentially assist in compound between multiple samples; it can only do achieving this is the implementation of regulated so within the same sample. Tus, in order to provide labelling on, and the disclosure of chemicals found uniformity, only the top ffeen most abundant com- within, electronic cigarettes and related products. pounds found in each sample were documented. Tough the FDA has made it clear that warning la- Most importantly, the only electronic cigarette bels will be made mandatory in the near future, the that was tested in this study was the JUULTM and the content of these labels is still unknown.31 Ideally, e- only tobacco cigarette was a Pall Mall Menthol. Te cigarette warning labels will be modelled afer those JUULTM was the subject of this study because of its that can be found on packs of tobacco cigarettes. Also popularity and originality, but it does not necessarily worth noting, consumers are generally unaware of the represent the entire population of e-cigarettes. In or- chemicals found within electronic cigarette juice and der to fully understand the impact that this technolo- the health hazards associated with them. A system re- gy may have on public health, more e-cigarettes would sembling the Globally Harmonized System of hazard need to be tested. In terms of the tobacco cigarette, 60 SMOKE BREAK: ELECTRONIC VS TOBACCO CIGARETTES it is likely that there are many diferent compounds found in other brands of cigarettes, but the variation References has no efect on the conclusions made in this study.

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9. Kong G, Morean ME, Cavallo DA, Camenga DR, 18. Lukasz GM, Jakub K, Michal G, et al. Levels of selected KrishnanSarin S. Reasons for electronic cigarette carcinogens and toxicants in vapor from electronic ciga- experimentation and discontinuation among adoles- rettes. Tobacco control. 2014;23(2):133-139. doi:10.1136/ cents and young adults. Nicotine & Tobacco Research tobaccocontrol-2012-050859. 2015;17(7):847–54. https://www.ncbi.nlm.nih.gov/ 19. Al-Delaimy W, Myers MG, Leas EC, Strong DR, pubmed/25481917 Hofstetter CR. E-cigarette use in the past and quitting 10. Allen J, Flanigan S, Christiani D, et al. Flavoring behavior in the future: A population-based study. Am Chemicals in E-Cigarettes: Diacetyl, J Public Health. 2015;105(6):1213-1219. https://search. 2,3-Pentanedione, and Acetoin in a Sample of 51 Products, proquest.com/docview/1683109271?accountid=190116. Including Fruit-, Candy-, and Cocktail-Flavored 20. U.S. Department of Health and Human Services. Te E-Cigarettes. Environmental Health Perspectives [serial health consequences of smoking—50 years of prog- online]. June 2016;124(6):733-738. Available from: ress: a report of the Surgeon General. Atlanta, GA: U.S. OmniFile Full Text Select (H.W. Wilson), Ipswich, MA. Department of Health and Human Services, Centers Accessed November 27, 2017. for Disease Control and Prevention, National Center 11. Dawkins L, Corcoran O. Acute electronic cigarette for Chronic Disease Prevention and Health Promotion, use: nicotine delivery and subjective efects in regular Ofce on Smoking and Health, 2014. users. Psychopharmacology [serial online]. January 15, 21. Kim JJ, Sabatelli N, Tutak W, et al. Universal electronic- 2014;231(2):401-407. Available from: Academic Search cigarette test: physiochemical characterization of Main Edition, Ipswich, MA. Accessed November 27, reference e-liquid. Tobacco Induced Diseases. 2017;15:14. 2017 doi:10.1186/s12971-017-0119-x 12. Adkison SE, O’Connor RJ, Bansal-Travers M, Hyland 22. Foundation of workplace chemical safety programs. A, Borland R, Yong HH, Cummings KM, McNeill A, osha.gov. https://www.osha.gov/dsg/hazcom/global.html. Trasher JF, Hammond D, et al. Electronic nicotine Accessed March 1, 2018. delivery systems: international tobacco control four- 23. PubChem Compound Database. Bethesda, MD: country survey. American Journal of Preventive Medicine National Center for Biotechnology Information. 2013;44(3):207–15. pubchem.ncbi.nlm.nih.gov. Accessed March 2, 2018. 13. Berg CJ, Stratton E, Schauer GL, Lewis M, Wang [PubMed PMID: 26400175]. Y, Windle M, Kegler M. Perceived harm, addictive- 24. National Center for Biotechnology Information. ness, and social acceptability of tobacco products and PubChem Compound Database; CID=180, https://pub- marijuana among young adults: marijuana, hookah, chem.ncbi.nlm.nih.gov/compound/180 (accessed Mar. and electronic cigarettes win. Substance Use and Misuse 14, 2018). 2015;50(1):79–89. 25. Talhout R, Schulz T, Florek E, Benthem JV, Wester P, 14. Bold KW, Kong G, Cavallo DA, Camenga DR, Opperhuizen A. Hazardous Compounds in Tobacco KrishnanSarin S. Reasons for trying e-cigarettes and risk Smoke. International Journal of Environmental Research of continued use. Pediatrics 2016;138(3):e20160895. and Public Health. 2011;8(2):613-628. doi:10.3390/ 15. Camenga DR, Cavallo DA, Kong G, Morean ME, ijerph8020613. Connell CM, Simon P, Bulmer SM, Krishnan-Sarin S. 26. Ogunwale MA, Li M, Ramakrishnam Raju MV, et al. Adolescents’ and young adults’ perceptions of electronic Aldehyde Detection in Electronic Cigarette Aerosols. cigarettes for smoking cessation: A focus group study. ACS Omega. 2017;2(3):1207-1214. doi:10.1021/ Nicotine & Tobacco Research 2015;17(10):1235–41. acsomega.6b00489. 16. Adler J, Meiners R, Morriss A, Yandle B. Baptists, 27. Cheng T. Chemical evaluation of electronic cigarettes. Bootleggers & Electronic Cigarettes. Yale Journal On Tobacco Control. 2014;23(Suppl 2):ii11-ii17. doi:10.1136/ Regulation [serial online]. Summer 2016;33(2):313-361. tobaccocontrol-2013-051482. Available from: OmniFile Full Text Select (H.W. Wilson), 28. Pankow JF, Kim K, McWhirter KJ, Luo W, Escobedo JO, Ipswich, MA. Accessed November 27, 2017. et al. (2017) Benzene formation in electronic cigarettes. 17. Lerner CA, Sundar IK, Yao H, Gerlof J, Ossip DJ, et PLOS ONE 12(3): e0173055. https://doi.org/10.1371/ al. (2015) Vapors Produced by Electronic Cigarettes journal.pone.0173055 and E-Juices with Flavorings Induce Toxicity, Oxidative 29. National Center for Biotechnology Information. Stress, and Infammatory Response in Lung Epithelial PubChem Compound Database; CID=16666, https:// Cells and in Mouse Lung. PLOS ONE 10(2): e0116732. pubchem.ncbi.nlm.nih.gov/compound/16666 (accessed https://doi.org/10.1371/journal.pone.0116732 Mar. 23, 2018). 62 SMOKE BREAK: ELECTRONIC VS TOBACCO CIGARETTES

30. McAfee T, Davis KC, Alexander RL, Pechacek TF, 33. Libretexts. Gas Chromatography. Chemistry LibreTexts. Bunnell, R. Efect of the frst federally funded US https://chem.libretexts.org/Core/Analytical_Chemistry/ antismoking national media campaign. Te Lancet Instrumental_Analysis/Chromatography/Gas_ 2013;382(9909):2003–11. doi: http://dx.doi.org/10.1016/ Chromatography. Published March 13, 2015. Accessed S0140-6736(13)61686-4 June 20, 2018. 31. Te deeming regulation: FDA authority over e- cigarettes, cigars, and other tobacco products. Public Health Law Center. publichealthlawcenter.org. Published November 7, 2017. Accessed April 8, 2018. 32. Globally Harmonized System of Classifcation and Labelling of Chemicals (GHS). UNECE. http://www. unece.org/trans/danger/publi/ghs/ghs_rev07/07fles_ e0.html. Published 2017. Accessed April 16, 2018.

Appendix

Figure 2. Compiled Sample Chromatograms

63 SMOKE BREAK: ELECTRONIC VS TOBACCO CIGARETTES

Table 3. Hazard Codes and Corresponding Statements Information retrieved from GHS seventh revised edition, published by the Unit- ed Nations Economic Commission for Europe32

64 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018

Efectiveness of Cognitive Behavioural Terapy for Major Depression in Stage II Pancreatic Cancer Patients from the Clínica General del Norte in Barranquilla, Colombia

Hector Cure

Depression is a disorder with specifc symptoms that include prolonged periods of sadness. On- cologic (cancer) patients usually present depressive symptoms due to the efects of cancer and the aggressive treatments that can take a toll on their health. Additionally, pancreatic cancer can induce a signifcant amount of psychological distress in its patients. For this reason, this qualitative content analysis study aims to determine if cognitive behavioural therapy is the most efective treatment for major depression, characterized by at least two weeks of low-mood, in stage II pancreatic cancer patients. Cognitive behavioural therapy focuses on making patients understand that their thoughts can infuence their emotions, which then ends up infuencing behaviour and afecting relations. Te responses to 16 semi-structured post-treatment interviews are assessed in order to determine the efectiveness of the therapy. Cognitive behavioural therapy was able to address main issues in oncologic patients, such as fostering new optimistic perspectives (81.25%), providing empathetic listening (75.00%), and helping patients feel calmed (68.75%). Tese results suggest that cognitive behavioural therapy is efective for treating major depression in stage II pancreatic cancer patients.

Keywords: Cognitive behavioural therapy, major depression, stage II pancreatic cancer, Colombia

leading to a variety of disorders, including major de- Introduction pression (National Cancer Institute, 2017). Depression is a medical illness that negatively af- Cancer is a chronic disease that afects countless fects thoughts, emotions, and behaviour as it is char- people worldwide. Tis disease consists of the abnor- acterized by prolonged periods of sadness, loss of in- mal and uncontrolled division of cells in the body, terest in activities once enjoyed, and feelings of guilt invading diferent tissues and organs. Diferent types or worthlessness (American Psychiatric Association, of cancer can aggressively afect patients and decrease 2017). For every ten patients diagnosed with cancer, their lifespan exponentially by forming masses of tis- two of them become depressed (National Cancer In- sues called tumours in functional organs, disrupting stitute, 2017). Tis occurs when patients learn they the organs’ optimal functioning (National Cancer have cancer, feel unmanageable pain, are physically Institute). Terefore, doctors have to provide patients weakened by the disease, view themselves as a bur- with treatments to reduce the pain this disease may den to others, or take cancer medicines that have infict. However, cancer can deteriorate the mental been correlated to depression, such as amphotericin health of patients by inducing psychological distress, B, procarbazine, interferon alfa, l-asparaginase, corti- 65 EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY FOR MAJOR DEPRESSION costeroids, and interleukin-2 to treat this malady (Na- the staf at the hospital because there are not as many tional Cancer Institute, 2017). Consequently, it is of patients in further stages in conditions to speak en- utmost importance that doctors treat depression for tirely for an interview. oncologic patients to maintain a healthy immune sys- tem, prevent suicide attempts, and reduce depressive symptomatology. In Colombia, studies there are a few studies that Literature Review depict efective treatments for depression in can- cer patients. For instance, Rodriguez, Amboage, When it comes to identifying a type of cancer, stag- Blazquez, Torres, and Gaviria (2015) describes the ef- ing is used to describe the cancer size and how far it fectiveness mindfulness, relaxation, and visualization has grown, providing essential information to develop techniques for treating major depression in cancer a plan for treatment. For pancreatic cancer, the stages patients (Rodriguez et al., 2015). In addition, one of range from stages I (1) through IV (4) and the higher the most prominent studies conducted in Colombia the stage, the more advanced the cancer is (American by psychiatrists Mauricio Murillo and Ariel Alarcón, Cancer Society, 2017). In stage I the tumour is con- provide the steps doctors should take for efectively fned to the pancreas and is smaller than two centime- treating depression in oncologic patients by advising ters; in stage II cancer might have spread to three or them to use diferent psychotherapy interventions less nearby lymph nodes (small swellings throughout (Murillo & Alarcón, 2006). However, none of these the body’s lymphatic system that aid in immune re- studies in Colombia has addressed the efectiveness sponses); in stage III cancer can reach a size of over of a specifc type of therapy in a single type of can- four centimeters and may have spread to four or more cer. Afer all, there are about 45 infuential schools of lymph nodes; and in stage IV cancer can be any size thought in psychology, and each one has their way of and has spread to distant sites, such as the peritoneum managing mental disorders like depression through (lining of the abdominal cavity), liver, lungs, or bones the techniques and interventions advised by the re- (American Cancer Society, 2017). As cancer in the searchers in the studies mentioned previously. Addi- pancreas advances, several problems begin to pres- tionally, both of these studies do not take into account ent and these include, but are not limited to, jaundice the various type of cancer but instead base on the as- (yellowing of the skin and eyes), pain in the abdomen sumption that the treatments for major depression are and back, nausea and vomiting, gallbladder and liver as equally efective for all types of cancer. Tis study enlargement, blood clots, and diabetes (American aims to specify the knowledge in the feld by focusing Cancer Society, 2016). on the efectiveness of a single type of therapy, cogni- At the Johns Hopkins Oncology Center, Clark, tive behavioural therapy, and one of the most aggres- Loscalzo, Trask, Zabora, and Philip (2010) investi- sive types of cancer, pancreatic cancer, as 33-55% of its gated the psychological distress experienced by pa- patients face depression (Massie, 2004). tients diagnosed and treated with pancreatic cancer, Te general purpose of this research study is to the fourth major cause of cancer deaths in the United analyze the efectiveness of cognitive behavioural States. Tese researchers determined that pancreatic therapy for treating stage II pancreatic cancer patients cancer patients usually demonstrate elevated levels of in the Clínica General del Norte in Barranquilla, Co- distress when compared to other types of cancer due lombia. Te Clínica General del Norte is the site for to the physical symptoms that become present (Clark this study as it is one of the largest hospitals in Colom- et al., 2010). In fact, while depression is seen in 20% bia treating gastroenterological diseases and pancre- of cancer patients in general (National Cancer Insti- atic cancer. A content analysis and interview method tute, 2017), this percentage elevates to 33-55% when are used to evaluate the content of the responses to 16 it comes to pancreatic cancer patients (Massie, 2004). semi-structured post-treatment interviews on stage II Although there is no current data regarding depres- pancreatic patients to determine the efectiveness of sion rates for pancreatic cancer in Colombia, this per- the therapy. For this study, a sample of pancreatic can- centage remains in 17% and 28.8% when it comes to cer patients in stage II is collected due to the advice of other Spanish speaking countries like Spain and Ec- 66 EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY FOR MAJOR DEPRESSION uador (Rodríguez et al., 2015; González et al., 2015). experience with this treatment over the past years. Pancreatic cancer patients who sufer from depres- Barrera and Spiegel (2014) defne this treatment as a sion deal with certain difculties in their daily lives. therapeutic modality that focuses on making patients Specifcally, psychologists from Edinburgh pinpointed understand that their thoughts can infuence their fve main troubles cancer patients with major depres- emotions, which then ends up infuencing behaviour sion face: concern for other people’s well-being (65%), and afecting relations (Barrera & Spiegel, 2014). Tis difculties in interpersonal relations (61%), loss of in- type of therapy includes psychoeducation, which is terest in activities (56%), low mood (55%), and fears one of the key aspects in psychotherapies in Colom- of cancer recurrence (54%) (Kleiboer, 2011). Conse- bia as described by Mauricio Murillo and Ariel Alar- quently, current psychotherapies should address these cón (2006) in “Psychosomatic Medicine Treatments issues that cancer patients experience. in Cancer.” Although there is a variety of cognitive Today, there is a variety of treatments for depres- therapies, all of them follow the same assertion: a per- sion in oncologic patients in Colombia. Colombian son’s negative reasoning most likely will lead to illogi- psychiatrists Mauricio Murillo and Ariel Alarcón in cal thinking and, therefore, dysfunctional behaviour their article, “Psychosomatic Medicine Treatments (American Psychological Association). in Cancer” provide a current guideline for Colom- Recent studies support the efectiveness of cogni- bian psychiatrists to efectively treat depression in tive behavioural therapy for treating depression in oncologic patients. Tey summarize the process of cancer patients. At Comprehensive Cancer Center at psychological treatment for oncologic patients, which the Ohio State University, Brothers, Yang, Strunk, and includes: a psychoeducative group, an initial psycho- Andersen (2011), found that 61% of 36 cancer patients logical diagnosis, common psychological follow-ups, had signifcant clinical changes afer receiving cogni- group psychotherapy (focusing mostly on psychody- tive behavioural therapy for treating major depression namic therapy), individual psychotherapy (focusing afer being diagnosed with cancer, deeming the treat- more on expressive and supportive psychotherapy), ment efective (Brothers et al., 2011). Additionally, in family intervention, and “unspecifed” interventions another study at the Imam Reza hospital in Birjand, (Murillo & Alarcón, 2006). Rodriguez et al. (2015) Khodai, Dastgerdi, Haghighi, Sadatjoo, and Keramati also explicitly state the usefulness of using mindful- (2011) concluded that cognitive behavioural therapy ness, relaxation, and visualization interventions for is essential for decreasing depression in patients with treating major depression in cancer patients afer re- cancer. Tey claimed the treatment worked because it viewing the premise of each one of them and how in fostered positive thoughts as in a sample of 24 patients theory it can help reduce depressive symptomatology receiving the therapy there was a statistically signif- (Rodríguez et al., 2015). Although many types of in- cant decrease in depression, while no change in the terventions are recommended and used to treat de- control group (Khodai et al., 2011). pression in oncologic patients in Colombia (Murillo Arguments regarding the efectiveness of psychother- & Alarcón, 2006; Rodríguez et al., 2015) no studies apies versus antidepressants have emerged over time. indicate which treatments are the most efective for Te American Psychiatric Association Practice Guide- treating depression in patients with aggressive can- lines (APAPG) claim that cognitive behavioural therapy cers, such as pancreatic, or focus on a specifc type of and interpersonal psychotherapy are the most adequate therapy. treatments for major depression as their efectiveness At present, the most common types of psycho- compares to that of antidepressants (Horne & Watson, therapies include cognitive behavioural therapy, 2011). Additionally, in some cases psychotherapies are supportive-expressive group therapy, problem solving preferred over antidepressants as in the Brown Univer- therapy, cognitive-existential group therapy, support- sity Child & Adolescent Psychopharmacology Update it ive therapy, and mindfulness-based stress reduction. is stated that the FDA urged manufacturers to include However, cognitive behavioural psychotherapy is the warning statements and recommendations in antide- main psychological intervention performed on pa- pressant containers, which are correlated to an increase tients with pancreatic cancer at the Clínica General in certain depressive symptoms and suicidality (“FDA del Norte in Barranquilla due to the hospital’s positive Cautions Use of Antidepressants; APA Responds,” 2004). 67 EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY FOR MAJOR DEPRESSION

Determining the usefulness of a treatment for patients facing depression regarding the efectiveness depression in patients sufering from a specifc type of the cognitive behavioural therapy delivered at the of cancer is of utmost importance to improve the Clínica General del Norte. patient’s mental and physical health. In fact, at the Te data used in the present study was gathered University of Malaya, Chan, Ahmad, Yusof, Ho, and from Colombian patients who underwent cogni- Krupat (2014) found that depressed cancer patients tive behavioural therapy. At the Clínica General del are 4.31 times more susceptible to death than those Norte, 16 patients were enrolled to receive the psy- who don’t sufer from depression (Chan et al., 2014). chological therapy in 2018. Te Institutional Review Hence, this study attempts to determine if cognitive Board (IRB) approved the procedure for this study, behavioural therapy is efective for treating major de- and all patients signed an informed consent form. In pression in patients sufering from stage II pancreatic general, patients were screened by a psychologist at cancer, flling the gap in the feld by addressing a spe- the hospital for depression using the Hospital Anxi- cifc type of cancer and therapy. ety and Depression Scale (HADS), a fourteen-item scale that yields data related to levels of anxiety and depression (Snaith, 2003). Tose pancreatic cancer patients scoring ≥ 11 were fagged as having reported major depressive symptoms (Snaith, 2003), and their Methods doctors, with the permission of the participants, kept the patients’ medical information in a desig- Overview nated folder at the hospital to take them into account for the study. Te HADS scores were reviewed once For this study, a content analysis and interview again by the psychologist and interviews were con- method are used in which inferences are made by ducted to verify that patients who did not meet the interpreting and coding material, in this case, inter- criteria were excluded from the study (criteria for ex- views. Te cohort consisted of adult patients sufering clusion includes current alcohol or substance abuse, from stage II pancreatic cancer and depression at the psychotic symptoms, history of depression, or any Clínica General del Norte in Barranquilla, Colombia, other type of chronic disease). Since all patients met who received fve sessions of cognitive behavioural the criteria for participating in the study, the patients therapy. Te interviews evaluate the efcacy of this were enrolled by asking them to sign an informed treatment by providing insight into its advantages consent form that described the purpose of the study. and disadvantages. Tis methodology is adapted from Te patients received fve cognitive behavioural ther- Orengo-Aguayo and Segre (2010), in their study, “De- apy sessions within a three-week timeframe. Follow- pression treatment delivered at the point-of-care: a ing advised practices from Mayo Clinic, due to the qualitative assessment of the views of low-income US fact that it is a top-rated institution in the United mothers.” Orengo-Aguayo and Segre (2010) evaluate States, the number of cognitive behavioural therapy the views of low-income US mothers facing depres- sessions at the Clínica General del Norte usually var- sion on a psychological intervention called “Listen- ies between fve to twenty, depending on whether the ing Visits” through content analysis and interview treatment is short, medium, or long-term; the level method with participants’ responses to a post-treat- of depression, gravity of symptoms, speed of prog- ment semi-structured interview assessing their views ress, and amount of stress; and the extent of support of the intervention (Orengo-Aguayo & Segre, 2010). from relatives (Mayo Clinic, 2017). Te choice of fve Terefore, these researchers were able to determine sessions was feasible for the Colombian-based trials the strengths and weaknesses of the psychological at the Clínica General del Norte as the study was to be intervention provided to the patients, and the pos- conducted in three weeks. For cognitive behavioural sibility of making it available for a larger population. therapy at the hospital, there is no stipulated protocol For this reason, the content analysis and interview for the number of sessions, but all participants com- methods are applicable for this research study as they pleted fve sessions initially. Patients at the hospital would elucidate the views of stage II pancreatic cancer usually receive the therapy for as long as they are 68 EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY FOR MAJOR DEPRESSION hospitalized and afer the study was completed with Measures the initial fve sessions, the patients who remained hospitalized continued to receive the treatment. For In the interviews, patients were asked three open- research assessments, patients completed two inter- ended questions that can be used to assess the partici- views. Te hospital’s psychologist conducted the frst pants’ views about the treatment for major depression one to diagnose major depression in the patients. around three main domains: participant impression (Q1: Te second and fnal interview was conducted at the When your healthcare provider frst told you that he or end of the three-week time frame for the assessment she wanted to do this treatment with you, what did you of the treatment. think about this idea?), treatment success (Q2a: What do you think about the treatment in terms of its helpfulness? and Q2b: Can you describe for me a specifc example of Participants how the treatment was helpful to you?), and suggested improvements (Q3: What would you change about the Te patients in this study underwent cognitive be- treatment?) (Orengo-Aguayo and Segre, 2010). havioural therapy sessions. In the sample of 16 partici- pants, the average age was 63 years-old; most people are diagnosed with pancreatic cancer are within this Data Analysis range (45 years-old and above) (American Cancer So- ciety, 2016). All of these patients sufered from major Using qualitative content analysis, the themes that depression and stage II pancreatic cancer. Addition- surfaced from the patient’s responses to the questions ally, they all were undergoing chemotherapy. All of were recorded and defned. Tis analytic approach is the patients were Colombian. optimal to identify the themes that appear in the data and classify them systematically by using codes, thus emphasizing the patients’ perspectives on a given top- Procedure ic. Tis method included a two-step basic approach, congruous with a “goal-free” evaluation (Scriven, Of the 16 participants, all of them agreed to be in- 1991) where the patients’ views about the helpfulness terviewed to share their views regarding cognitive be- of cognitive behavioural therapy were assessed. In havioural therapy, and the qualitative assessment was the frst step, a coding manual was developed to code completed afer these interviews. For the interviews, the interviews. All responses to each question were the participants’ responses were recorded in the form read to generate themes that arose from the data. Te of notes. All the interviews were recorded in Spanish, themes were then transformed into a group of clear Colombia’s ofcial language, and then transcribed codes for each question. Moreover, each code was de- into English. Aferward, the notes were passed into an fned by including important characteristics of what electronic document and organized in tables for fur- to include if seen in the responses. Te objective was ther extraction and analysis. Te interviews were not to create an understandable manual where the codes audio-recorded because this population of patients for the questions express the themes that were seen in in critical situations might be reluctant to participate the responses. In the second step, the responses were if they were audio-recorded. Instead, it was decided coded. Te object of analysis was the response pro- to safeguard the environment of trust in the study by vided by a patient to a question coded. Te responses making an efort to record the patients’ responses ver- to the three questions were coded independently. Fi- batim in written form. In the interviews, the patients nally, the analysis of the data analysis was expressed were encouraged to share their honest opinion about through a quantitative abridgment of the patients’ cognitive behavioural therapy and were told how coded responses that refect how many of the partici- valuable their feedback was for the improvement of pants favoured a code (Table 1). Additionally, para- the service. phrased responses are presented for illustrative pur- poses and, each one contains the patient’s number in the study. 69 EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY FOR MAJOR DEPRESSION

Initial Views Results Te patients’ initial impressions of cognitive behav- Te data is organized in Table 1 in such way that ioural therapy are expressed in the four main themes the themes in the responses to the three questions are that came up from the data (Table 1). Te majority of shown. For each of the items, the percentage of par- the patients (75.00%) endorsed cognitive behavioural ticipants endorsing each thematic code is presented therapy.1 Some of the patients (12.50%) expressed along with the number of times the theme was recur- some uncertainty about cognitive behavioural thera- rent in the responses of the 16 patients. py but were open or curious to receive the interven-

Table 1. Temes: Patients’ Responses in Interviews (N = 16)

Initial Views About Cognitive Behavioural Terapy Number (percentage) Endorsed 12 (75.00) Uncertain Positive 2 (12.50) Uncertain Negative 1 (6.25) Negative 1 (6.25) Examples of How Cognitive Behavioural Terapy Was Helpful Number (percentage) Fostered a new perspective (positive thoughts) 13 (81.25) Supplied empathy and a space to talk 12 (75.00) Were calming or relaxing 11 (68.75) Turned to faith 9 (56.25) Gave advice and were helpful in problem-solving 9 (56.25) Improved communication in interpersonal relationships 7 (43.75) Helped patient feel less isolated 6 (37.50) Medical information was provided 3 (18.75) Participant did not fnd cognitive behavioural therapy helpful 1 (6.25)

Suggested Changes to Cognitive Behavioural Terapy Number (percentage) No change 9 (56.25) Longer sessions/more sessions 6 (37.50) Medication 1 (6.25)

* Note: Patients could address several themes, therefore, percentages can exceed 100%

70 EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY FOR MAJOR DEPRESSION tion.2 One patient (6.25%) was skeptical of receiving feelings of loneliness (37.50%) were mentioned as cognitive behavioural therapy because she didn’t feel well.6 Some patients thought that the therapy was comfortable talking about something so personal but useful in terms of providing advice and solving decided to go forward with it. 3 Additionally, one pa- problems they might face (56.25%); it improved tient (6.25%) had a negative view regarding the treat- their relations with their relatives (43.75%), espe- ment as he denied the usefulness of psychological cially communication; and that they received medi- therapies but did not care about having to receive the cal information in case they had questions about treatment.4 their health situation (18.75%).7

Examples of How Cognitive Behavioural Suggested Changes Terapy Was Helpful When the patients were asked if they would change In the sample, one patient (6.25%) claimed that anything about the treatment they received, about half cognitive behavioural therapy wasn’t useful. Howev- (56.25%) said that they would not change anything.8 er, the majority (81.25%) of participants in the study Of the patients who did suggest any changes, 37.50% indicated that cognitive behavioural therapy helped stated that they would have liked more or longer ses- them view their situation with a new positive perspec- sions.9 One patient (6.25%), who did not believe that tive (Table 1).5 cognitive behavioural therapy helped him, suggested The second most frequently disclosed help- he be prescribed antidepressant medication to help ful aspect of cognitive behavioural therapy, noted him neurobiologically.10 by 75.00% of participants, was that the interven- tion provided empathy (the empathy displayed by the psychologist) and a space to talk. Addition- Discussion ally, most patients felt calmed after the sessions (68.75%), reducing their feelings of anxiety. Turn- Stage II pancreatic cancer patients received cogni- ing to the Catholic faith (56.25%) and reduced tive behavioural therapy as a possible intervention to

1 Yes, I accepted this treatment because I knew I needed to face my problems in order to move on, and even more when I have four children waiting for me to come home. (Patient 2) 2 I was apprehensive of receiving the treatment at frst because I wasn’t really sure what it was, but decided to go for it because I wasn’t feeling well internally. (Patient 6) 3 I was doubting if I should receive the treatment at frst because I didn’t feel comfortable talking about this difcult situation with other people. In the end, the doctor was able to convince me to go forward with it. (Patient 10) 4 Initially, I was confused about receiving a psychological treatment because I’ve never gone to a psychologist in my life. I didn’t care, but I knew I wasn’t crazy and that God would give me strength to move forward. (Patient 12) 5 I felt that I was treated well. It was helpful in every aspect, especially because I was now seeing life in a beautiful way. I realized that I want to enjoy the rest of my time with family. (Patient 11) 6 Te sessions helped keep a positive attitude. I always believed that God would take me out of this dark hole. As time passed, I began feeling less anxiety and more open to talk, especially because of the empathy I received from the psychologist. I fnally understood I wasn’t alone in this situation. (Patient 6) 7 I felt that I wasn’t alone and that I was being heard and understood by the psychologist. Initially, I was extremely anxious and worried, but I received clear and pertinent information about my disease. Te doctor advised me to turn to family for support as well. (Patient 8) 8 I wouldn’t change anything. As it is, it is excellent. Everyone was so professional and it was oriented to what I needed. It helped me get out of a crisis. (Patient 2) 9 I would like to have more sessions because they really helped me a lot, and I believe there is more work to do in order to feel even better. (Patient 8) 10 If you wanted to treat my depression, why not just give me medication. Everything is in the brain and works through chemicals. I didn’t need the therapy. (Patient 12) 71 EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY FOR MAJOR DEPRESSION treat major depression. Tis study assessed their views gist before and believed that God would help him move toward this type of therapy, delivered by a psycholo- forward, especially afer mentioned that he “wasn’t gist from the hospital where they were admitted. To crazy and that God would give [him] the strength to condense the results, three main fndings were ob- move forward” (Patient 12). Tis patient didn’t believe served. First, when the doctor frst discussed therapy the treatment helped him and wanted antidepressant with the patients, the majority (75.00%) had support- medication instead by stating that “everything is in the ive views of the therapy. Second, the patients indicated brain and works through chemicals” (Patient 12). that the most helpful component of cognitive behav- Afer receiving cognitive behavioural therapy, ioural therapy was that it provided them with a new 81.25% of the patients in the study noted that the most perspective on their situation, allowing them to think helpful aspect of the therapy was that they were en- positively. Tird, a little more than half of the patients couraged to adopt a new perspective of their situation, would not change anything about the delivery of the especially one that is generally positive. Tis major- treatment, and 37.50% would have liked longer or ity showcases that the therapy implemented served its more sessions. purpose as it focuses on the importance of the patient Afer reviewing patient responses, the high percent- understanding how obstructive thought patterns as a age of positive views most patients had when intro- consequence of an adverse situation can afect their duced to cognitive behavioural therapy could be attrib- behaviour (Barrera & Spiegel, 2014). Terefore, since uted to the fact that the patients were able to internalize the treatment helped the patients generate new posi- that they were not themselves anymore and that their tive thoughts about their situation, it means that their diagnosis completely changed their mentality. For in- cognition was transformed to think and, therefore, act stance, both patients 3 and 5 voiced their concerns of in a healthy way to cope with their disease, following had similar responses as both addressed their concern the premise of cognitive behavioural therapy. For ex- of not feeling mentally well, mentioning that they knew ample, one of the patients mentioned that the therapy they “needed the support from a psychologist” because was “helpful in every aspect, especially because [she] they knew they were “in a bad mental state” (Patient was now seeing life in a beautiful way” and “realized 3) and were not “feeling like [themselves] anymore” that [she] wanted to enjoy the rest of [her] time with (Patient 5). Moreover, some patients mentioned their family” (Patient 11). Additionally, 75% of the patients endorsement towards the treatment because they had claimed that the intervention supplied empathy and hopes of going back to their families and enjoying the a space to talk. Most of these patients deal with high time they had lef with them. Patients 1 mentioned levels of stress, especially because pancreatic cancer that he had “the encouragement to move forward for has the highest rate of psychological distress when [his] family” (Patient 1) and patient 2 claimed that she compared to other cancer groups (Clark et al., 2010). realized she had to face her problems and “even more Hence, they might need to vent their concerns during when [she has] four children waiting for [her] to come the sessions. In efect, the Handbook of Psychotherapy home” (Patient 2). Te most common views of hope in Cancer Care: Te International Psycho-oncology So- and cancer seen in the media express that patients with ciety’s Training Guide indicates that in the frst step of cancer only have the hope of a cure (Duggleby et al., cognitive behavioural therapy, patients should have 2010). However, the sample expressed hope for im- the opportunity to talk for “simple ventilation of emo- proving their quality of life, which encouraged them to tions,” as it allows to build trust between the patient receive psychotherapy. Tese fndings are in agreement and psychologist and to clearly establish that the with European psychologists who found that oncologic patient feels the need to change their coping mecha- patients’ meaning of hope focused on comfort, main- nisms (Horne & Watson, 2011, p. 45). As most pa- taining relationships, and peace (Duggleby et al., 2010). tients felt they had an ample opportunity to talk and Furthermore, there was only one patient in the data share their story with the psychologist, building trust that presented negative views regarding the treatment. for further efective sessions. Patients also mentioned Tis outlier could be attributed to the patient’s lack feeling extreme pain, which made them feel stressed of understanding of the treatment and high religious and anxious most of the times. Both chronic and acute value as he stated that he had never gone to a psycholo- pain can generate elevated amounts of stress in onco- 72 EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY FOR MAJOR DEPRESSION logic patients, and these events, as well as knowing the cancer diagnosis. Tus, concerns about other people’s diagnosis, can lead to extreme levels of disquietude or well-being are addressed. Also, feelings of concern for demoralization; but cognitive behavioural therapy can family members can also lead to feelings of isolation be useful in managing pain (which is associated to un- or loss of interest. Patient 16, for instance, mentioned certainty, death, and disease progression) by helping that the therapy helped change how she isolated her- patients to not view the pain as a sign that the dis- self from her family: “She [the psychologist] helped ease is advancing, helping reduce worrisome feelings me solve problems I had with my family by making (Horne & Watson, 2011, p. 44). Te results show that me realize that I shouldn’t just hide away from them to the sessions of this psychological therapy helped the not make them sufer” (Patient 16). In turn, the data patients feel more calmed and relaxed, making their shows that 37.50% of the sample felt that the therapy levels of anxiety decrease. Patient 4 was one of the was vital in reducing their feelings of isolation, which 68.75% of the patients who mentioned that the treat- can improve mood or diminish the loss of interest due ment helped reduce feelings of anxiety or worry: “In to new optimistic perspectives and better bonds with the beginning, I felt full of angst, but [the psycholo- family members or friends (Ge et al., 2017). gist’s] words calmed me down… Also, there were a Furthermore, the data indicate that more than lot of resources to understand more my condition, half of the patients (56.25%) strengthened their reli- which I usually wanted to know about when I felt pain gious faith afer receiving therapy. Most patients, who around my stomach as I began to worry” (Patient 4). identifed as Catholic, mentioned that they knew that Tis depicts how the therapy reduced patient’s levels God would help them overcome their current situa- of stress through efective communication with the tion. In fact, patient 13 claimed that she prayed with psychologist and calmed the patient by providing use- the psychologist: “We also prayed together, and God ful information about his or her medical condition. gave me a lot of hope in this situation” (Patient 13). Recent studies in the Comprehensive Cancer Cen- None of the studies regarding cognitive behavioural ter at the Ohio State University and the Imam Reza therapy mention religious faith as a possible aspect hospital in Birjand have shown that cognitive behav- to treat depression or even an outcome afer receiv- ioural therapy has been efective in signifcantly re- ing cognitive behavioural therapy. Tis theme might ducing depressive symptomatology in cancer patients have emerged due to cultural factors; approximately with depression by enabling them to have a more 80% of the Colombian population is Catholic (U.S. optimistic regarding their situation (Brothers et al., Department of State, 2009). A prevailing trend, which 2011; Khodai et al., 2011). Considering that patients emerged from the data, is the role of religion as a cop- with cancer and depression face certain troubles and ing mechanism; the cohort expressed belief in a God concerns in their daily lives, this study might also sug- that has and continues to help alleviate their depres- gest that cognitive behavioural therapy is efective in sion and cancer. Generally, there is a strong positive diminishing these issues. Some of the main problems correlation between hope and spiritual well-being in faced by depressed cancer patients are “concerns about cancer patients at any stage, and this relationship in- other people’s well-being,” “problems in interpersonal creased in the fourth (last) stage of cancer (Liaquat et relations,” “loss of interest,” “low mood,” and “cancer al., 2013). Patients tended to increase their focus on recurrence” (Kleiboer et al., 2011). However, cancer their relationship with God as they experienced pain, recurrence does not apply to this study as the patients giving them hope to cope with cancer and major de- have not yet recovered from cancer. Te results show pression. Henceforth faith can become a key aspect of how that 43.75% of the patients addressed interper- cognitive behavioural therapy as in several patients it sonal relations issues, indicating that they were able had the potential to change negative thought patterns to improve their communication with their family to ones full of optimism and hope: “ I always kept my members or friends. Further, 56.25% of the patients faith and knew that in one way or another, God would claimed that the therapy was useful in problem-solv- get me out of this situation” (Patient 5). In less reli- ing and in giving advice. Patient 15 mentioned that, gious contexts with medical practitioners or patients in the treatment, she received advice on how to deal who are disinclined to invoke this avenue of therapeu- with knowing that her family is sufering due to her tic conversation, it is also possible to solely focus on 73 EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY FOR MAJOR DEPRESSION optimism regarding their current situation, which is them only a few months lef to live. Most patients do the core of the treatment (Horne & Watson, 2011). not fully recover, and have less than six months to Afer asking the patients if they would suggest live, while those who do undergo a successful surgi- any changes, the majority (56.25%) answered that cal procedure (only 20%) have less than 15 months, they would not change anything as their treatment which is still signifcantly low (Argüello, 2006). Tis was successful. Furthermore, six patients (37.50%) might be another signifcant factor to explain the mentioned that if they were to change anything, they small sample size. Consequently, having a small sam- would want longer or more sessions. Cognitive be- ple size raises the question if this study can be gener- havioural therapy is known to be a short-term psy- alized to Colombia, therefore, further investigation chological therapy, adjusting to the need of the pa- with a larger and diverse sample size is required to be tient. However, it might be possible that fve sessions able to generalize this study to a population beyond of cognitive behavioural therapy were not sufcient this cohort. Moreover, the interviews were not audio as in some instances patients might need more ses- recorded. Although the participants’ answers were sions to improve their mental health (Mayo Clinic, recorded as notes, it was not possible to verify that 2017). Additionally, the hospital would not, in some their exact words were transcribed for verbatim, es- cases, have the patients hospitalized for more than a pecially afer translating responses from Spanish into month, limiting the psychologists’ access to the pa- English. However, the main idea of what the patients tient for follow-ups or more sessions. For this rea- were saying should not have changed much. Another son, it might be ideal to implement programs, such limitation was the fact that hospitals could not usu- as internet-delivered cognitive behavioural therapy ally hold patients for more than a month, making it (ICBT). In fact, Swedish psychologists from the Uni- hard to calculate results based on only fve sessions, versity of Gothenburg concluded that ICBT, which which probably made the results slightly skewed. For can last up to 12 months, was as efective as cognitive further research, it would be advisable to increase behavioural therapy afer the frst six months (Erik- the number of therapies to determine if the results son et al., 2017). ICBT sessions would be more fea- are the same. Additionally, having a control group sible for patients and psychologists as such sessions or an alternate version of the therapy to compare in would consist of seven online modules with activi- this study might generate a more accurate analysis ties to be completed and weekly therapist e-mail or of the situation now that the passage of time or an telephone support. alternative treatment might be as efective as cog- nitive behavioural therapy. Furthermore, two main biases might have afected the honest response of the patients. First, the patients were told that their Limitations feedback was valuable for the improvement of the delivery of the therapy, possibly pressuring them to Tere are limitations to this study that may have respond with positive examples of how the therapy hindered the accuracy of the results. First of all, the worked. Te second bias might have arisen from the sample size of the study was too small. Tis can be location of the interviews. Since the interviews were attributed to the rareness and severity of stage II performed in the hospital, it might have infuenced pancreatic cancer. In a study at the Memorial Sloan patients to endorse the therapy and provide positive Kettering Cancer Center in the United States, the re- feedback regarding the delivery of the treatment as it searchers were able to collect a sample of 467 patients is possible that they don’t feel comfortable answering in 15 years, averaging around 31 patients per year the contrary while in the hospital that is providing (Argüello, 2006). However, since pancreatic cancer them healthcare. in the United States is two times more common than in Colombia (Argüello, 2006), an appropriate sample for Colombia is approximately 15 patients a year. Also, the severity of pancreatic cancer can take a toll on the patients’ health in unpredictable ways, giving 74 EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY FOR MAJOR DEPRESSION

Conclusion and Future Directions Acknowledgements

In this study, the majority of stage II pancreatic I would like to thank the Clínica General del Norte cancer patients sufering from depression indicated in Barranquilla, Colombia, for giving me their full that they valued cognitive behavioural therapy as support to conduct my study there and interview their an approach to treat depression. Although cognitive patients. I would also like to give a special thanks to behavioural therapy has proven to be successful in Dr. Laura Ojeda, the chief psychologist of the hospital, treating major depression in cancer patients in re- for helping me understand the theory behind cogni- cent studies conducted at the Comprehensive Cancer tive behavioural therapy for facilitating interviews Center at the Ohio State University and the Imam with eligible patients. Reza hospital in Birjand (Brothers et al., 2011; Kho- dai et al., 2011), the signifcance of these fndings are that they present a pioneer study in Colombia; this study suggests that cognitive behavioural therapy as a plausible efective therapy for major depression in pancreatic cancer patients specifcally. Studies like the ones conducted by Murillo and Alarcón (2006) and Rodríguez et al. (2015) on therapies for depres- sion in oncologic patients don’t address the course of treatment for specifc types of cancer (Murillo & Alarcón, 2016; Rodríguez et al., 2015), and the way therapies for depression might difer for patients who sufer from diferent cancer types. Terefore, further research should examine the views of a large sample of oncologic patients who are treated with cognitive be- havioural therapy but sufer from other types of can- cer in order to see if there is any variation. Tis would elucidate the relationship between cancer types and cognitive behavioural therapy by depicting for which type of cancer patients sufering from depression the treatment might work better. Finally, the implementa- tion of cognitive behavioural therapy in other hospi- tals in Barranquilla as a standard treatment for major depression in pancreatic cancer patients may help to signifcantly reduce depressive symptomatology and improve quality of life in this type of patients, but fur- ther investigation is required.

75 EFFECTIVENESS OF COGNITIVE BEHAVIOURAL THERAPY FOR MAJOR DEPRESSION

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Liaquat, S., Sultan, S., & Hussain, I. (2013). New horizon of spiritual well-being and hope among cancer patients: A psychological aspect. Journal On Educational Psychology, 6(4), 30-35. Retrieved from https://fles.eric.ed.gov/full- text/EJ1101758.pdf Massie, M.J. (2004). Prevalence of depression in patients with cancer. JNCI Monographs, 2004(32), 57-71. Retrieved from https://doi.org/10.1093/jncimonographs/ lgh014 Mayo Clinic. (2017). Cognitive Behavioral Terapy. Retrieved from https://www.mayoclinic.org/tests- procedures/cognitive-behavioral-therapy/about/ pac-20384610 Murillo, M., & Alarcón, A. (2006). Tratamientos psico- somáticos en el paciente con cáncer. Revista Colombiana De Psiquiatría, 35, 92-111. Retrieved from http://www. scielo.org.co/scielo.php?script=sci_arttext&pid=S0034- 74502006000500007&lng=en&tlng=. National Cancer Institute. (2017). Depression (PDQ®)– Patient Version. Retrieved from https://www.cancer.gov/ about-cancer/coping/feelings/depression-pdq National Cancer Institute. (n.d.). NCI Dictionary of Cancer Terms. Retrieved from https://www.cancer.gov/ publications/dictionaries/cancer-terms?cdrid=45333 Orengo-Aguayo, R. E., & Segre, L. S. (2016). Depression treatment delivered at the point-of-care: A qualitative assessment of the views of low-income US mothers. Journal of Reproductive & Infant Psychology, 34(1), 35. do i:10.1080/02646838.2015.1101753 Rodríguez, V. P., Amboage, A. M., Blázquez, M. H., Torres, M. Á, & Gaviria, M. (2015). Depresión y cáncer: Una re- visión orientada a la práctica clínica. Revista Colombiana De Cancerología, 19(3), 166-172. doi:10.1016/j. rccan.2015.04.005 Scriven, M. (1991). Prose and cons about goal-free evaluation. American Journal of Evaluation, 12, 55–62. doi:10.1177/109821409101200108 Snaith RP. (2003). Te hospital anxiety and depres- sion scale. Health and Quality of Life Outcomes. 1:29. doi:10.1186/1477-7525-1-29. U.S. Department of State. (2009). International religious freedom report 2009. Bureau of Democracy, Human Rights, and Labor. Retrieved from https://www.state. gov/j/drl/rls/irf/2009/127384.htm

77 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018

Shifing Perceptions: A Quantitative Experimental Study Regarding the Efect of Positive Kinesics on People Who Stutter

Steven Du

Tis study examined the efects of kinesics on male adolescents’ perception of people who stut- ter (PWS). Twenty-four male participants from an all-boys high school viewed an audio clip of a person who stutters (PWS), a video of a PWS exhibiting positive kinesics, and a video of a PWS ex- hibiting negative kinesics. Afer each clip, the participant completed a semantic diferential survey to determine the participant’s perception of the speaker. Te data was analyzed statistically using XLSTAT. Te results indicate that positive kinesics has a signifcant positive efect on perception, kinesics has a signifcantly diferent efect on the perception of male and female speakers, and the perceptions of PWS may have shifed over time. Te results did not show that negative kinesics had a signifcant negative efect on the perception of PWS.

Keywords: stuttering, stutterer, people who stutter, kinesics, perception,

Introduction shows that these negative perceptions of PWS have a deleterious efect on their interpersonal relationships, For 75 minutes, Philip Garber kept his hand raised, sociality, and employment opportunities (McAllister, wanting to pose a question about the exploration of Collier, & Shepstone, 2012; Plexico, Manning, & Lev- the New World to his history class. Te professor, itt, 2009; Van Borsel, Brepoels, & De Coene, 2011). however, showed no intention of acknowledging Although there are defned consequences that stem him. In fact, she had already told him not to speak in from a negative perception of PWS, the factors that af- class, characterizing his speech as “disruptive” and an fect this perception are less clear. Specifcally, there is “infringe[ment] on other students’ time”. Despite his a gap in knowledge within the understanding of how talkative nature, Philip has an acute stutter that makes the kinesics, which are the visual aspects of non-verbal expressing his ideas difcult. While Philip’s story, as communication, of PWS afect how others perceive reported by Perez-Pena (2011) in the New York Times, them. Previous studies have focused on the percep- is an especially egregious example of discrimination tions of speech impediments independently of ap- against people who stutter (PWS), it refects a broader pearance (Rice, Hedley & Alexander, 1993; Mcallister, negative perception of PWS. et al., 2012; Blood & Blood, 2007; Craig & Hancock, Te current research on the perceptions of PWS 2003; Woods & Williams, 1976). Tese studies have 78 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER concluded that stuttering is perceived negatively with of stuttering in the hopes of providing “a basis for a lower ratings ranging from confdence to ability to more systematic and efcient approach in the study succeed (Rice et al., 1993; Woods & Williams, 1976). of stuttering” (p. 489). Since then, many researchers Other studies have determined there is also a nega- have used Wingate’s defnition to examine the efect of tive correlation between stuttering and educational diferent listeners (varied by gender, familiarity with outcomes (McAllister et al., 2012). Te results of these stuttering, profession etc.) and diferent PWS (varied studies, which are generally negative, may contribute by gender, age, participation in speech therapy, se- to the growing negative perception of PWS. verity of stuttering etc.) on how a PWS is perceived. Nonetheless, the current research has also dem- While there are conficting results between studies onstrated that the perceptions of PWS are malleable, on some subjects, the research consistently shows especially amongst children and adolescents. For ex- that listeners react more negatively as the stuttering ample, studies show that the perception of PWS are becomes more severe, and that PWS are rated more sensitive to media portrayals, self-acknowledgement negatively than their fuent counterparts are (Boyle, of stuttering, and enrolment in speech therapy (Col- 2017; Collins & Blood, 1990; Gabel, 2006; Von Tiling, lins & Blood, 1990; Gabel, 2006; Miller, Mathers- 2011; Woods & Williams, 1976). Furthermore, many Schmidt, & Fraas, M, 2015). Te lack of knowledge people hold negative stereotypes of PWS that extend regarding the factors that infuence the perception of beyond the physical traits of stuttering. When asked stuttering has led this paper to focus on the relation- to describe stuttering, listeners confated their own ship between kinesics and perception, thus informing preconceived notions of PWS’ personality traits with the research question: how do kinesics afect male the physical traits associated with the speech impedi- Canadian high school students’ perception of people ment (Hughes, Gabel, Irani, & Schlagheck, 2010). Tis who stutter? suggests that listeners’ perceptions of PWS are based To investigate the relationship between kinesics on not only an adverse response to the act of stutter- and the perceptions of PWS, 24 participants were ing but also a negative preconception of PWS. sampled to participate in an experiment. Te partici- Te negative social stereotypes and stigmas sur- pants viewed an audio clip of a PWS, a video of a PWS rounding stuttering were frst explored in Woods and exhibiting positive kinesics, and a video of a PWS Williams (1976). By using a stratifed sample of 156 exhibiting negative kinesics. Afer each clip, the par- participants from varying backgrounds, Woods and ticipant flled out a semantic diferential survey, which Williams examined the stereotypes associated with ascertained the participant’s perception of the speak- male PWS. Te researchers found signifcant difer- er. Based on previous research conducted by Blalock ences between the traits ascribed to stuttering and (1982), which showed that positive kinesics improved fuent males across all demographics of listeners: message reception, the researcher hypothesized that “many people expect a stutterer to be diferent from positive kinesics would have a favourable efect on the a non-stutterer in certain undesirable ways” (p. 274). perception of PWS. Specifcally, the average PWS is expected to exhibit “shyness, anxiety, lack of self-confdence, and social withdrawal” (p. 276). Te researchers observed no Literature Review gender-based diferences in the data of listeners’ per- ceptions, which reafrms previous results from Schro- Perceptions of Stuttering eder (2002). Contrastingly, other studies contend that female listeners judge PWS more positively than male Stuttering is a major physical impairment. Stut- listeners do (Burley & Rinaldi, 1986; Dietrich, Jensen, tering limits speech and communication, which is a & Williams, 2001). While there is no consensus on the fundamental part of daily social interactions. Stutter- subject, this paper recognizes the possibility of gen- ing is even considered a disability under the Ameri- der-based perceptions of PWS. can with Disabilities Act. In spite of its importance, More concerning is the conclusion from Woods research into stuttering only began in earnest when and Williams (1976) that educators and speech pa- Marcel Wingate (1964) created a standard defnition thologists were no less likely to hold negative stereo- 79 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER types of PWS. A subsequent study conducted by Rice approach to the study of body motions, Birdwhistell et al. (1993) found that similar biases and preconcep- legitimized an otherwise undervalued feld of study. tions existed against children with speech-language Researchers ofen study kinesics in a business en- impairment. Once again, there was no diference in vironment, where efective and efcient communica- perception between educators, speech pathologists, tions are paramount. A study conducted by Blalock employers, and the public. Such a pervasive stereotype (1973) investigated the impact of kinesics on message of PWS would suggest that PWS actually behave in perception between management and employees. the undesirable manner in which they are described. Blalock concludes that positive kinesics increases the However, previous studies into PWS and fuent speak- credibility of a message, while negative kinesics has an ers did not fnd a signifcant diference in personality adverse efect. Tese efects are enhanced when posi- (Beech & Fransella, 1968). tive kinesics is paired with negative verbalization (e.g. Te origins of this seemingly unfounded stereotype poorly phrased, unpleasant delivery) or negative ki- of PWS has eluded researchers. Woods and Williams nesics is paired with positive verbalization. Similarly, (1976) suggest that listeners wrongly extrapolate the Chu, Strong, Ma, and Greene (2005) argue that kine- state of anxiety a PWS experiences while speaking to sics are a powerful tool in business negotiations, es- his or her overall personality. More recently, a study pecially between negotiators of diferent nationalities. conducted by Miller et al. (2015) attempts to fnd an Chu et al. fnd that negotiators tend to move closer explanation in media portrayals of PWS. Miller et al. and gesture to emphasize important points, smile to (2015) conclude that stuttering is generally portrayed gain cooperation, and make continual eye contact to negatively – ofen for comedic efect – across all media gain power. Te positive efects of good kinesics were platforms (e.g. literature, YouTube, television, mov- also noticed in teaching, another feld that empha- ies). Moreover, Miller et al. (2015) fnd that media sizes communication. Orton (2007) explores the use portrayals are pivotal in shifing listeners’ attitudes of gestures in the teaching and learning of modern towards PWS: “[m]ore negative portrayals of stutter- languages, an endeavour that has neglected the use ing lead to more negative perceptions of PWS while of kinesics in favour of verbal channels of expression. more positive portrayals of stuttering in turn lead to Orton surmised that body motions played an integral more positive perceptions of PWS” (p. 72). Miller et role in learning: “language teachers could most ben- al.’s (2015) study also suggests that listeners’ percep- efcially make rich use of gestures in their teaching” tions are afected by non-auditory factors such as the (“Conclusion,” para. 1). Not only does kinesics play appearance and behaviour, which has prompted this an integral role in business interactions, its ability to paper to focus on the relationship between the kine- change message perception suggests that it could also sics of PWS and perception. have a powerful efect on the perceptions of PWS.

Infuence of Kinesics on Communication Impact of Stuttering on PWS

Although other researchers have examined the Te negative perceptions of PWS ofen create infuence of body language, anthropologist Ray Bird- complications that infuence their health and social whistell formalized the feld of study now known as involvement. Tese ramifcations start from a young kinesics. Kinesics, derived from the Greek word ki- age and persist through adulthood. Children and ado- nisis (motion), is “the systematic study of the visually lescents who stutter risk being bullied and excluded sensible aspects of nonverbal interpersonal commu- at school. A self-reported survey conducted by Blood nication” (Birdwhistell, 1970, p. 354). In his seminal and Blood (2004) found that 43% of PWS experienced work Introduction to Kinesics, Birdwhistell (1982) cre- bullying, which was signifcantly higher than the 11% ated an annotation system for kinesics based on three of fuent speakers who experienced bullying. Tese classifcations: facial expression, body language, and negative interactions and attitudes are internalized by gestures. Furthermore, Birdwhistell (1970) estimates PWS, resulting in “lower quality of life, hope, self-es- that only about 30% of meaning in social interactions teem, and self-efcacy” (Boyle, 2017, p. 922). Te ap- is conveyed by spoken word. By creating a systematic prehension of potential negative reactions ofen cause 80 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

PWS to withdraw or limit social interactions (Plexico created by Birdwhistell (1970), focusing on facial ex- et al., 2009). Te transition into adulthood yields pression, body language, and gestures; similar consequences. Stuttering continues to have a stuttering was assessed based on the standard negative efect on interpersonal relationships, inter- defnition of stuttering proposed by Wingate (1964), fering with conversations and dating (Van Borsel et which has been widely cited by subsequent studies al., 2011). Despite this, a quantitative analysis of adult on stuttering (Brundage, Bothe, Lengeling, & Evans, PWS found no signifcant diferences in educational 2006; Conture & Kelly, 1991; Miller et al., 2015); and attainment or employment outcomes (as measured listeners’ perceptions were determined using a se- by pay) although PWS were observed to hold posi- mantic diferential scale, which was notably applied to tions of lower status (McAllister et al., 2012). Te re- the feld of stuttering in Woods and Williams (1976) searchers suggest that the propensity for PWS to hold and has continued to be efective in determining lis- lower-ranking positions “refect[s] their preference teners’ attitudes of stuttering (Burley & Rinaldi, 1986; for avoiding occupations perceived to require good Miller et al., 2015; Rice et al., 1993). spoken communication abilities” (p. 106). Tis con- In the experiment, participants listened to a PWS clusion is supported by a study from Klein and Hood without visuals as a control. Ten, they were shown (2004), which reported that half of the stuttering par- two videos: one with a PWS exhibiting positive kine- ticipants sought employment positions that required sics, and the other with a PWS exhibiting negative ki- minimal speaking. Te signifcant ramifcations that nesics. As evidenced in Burley and Rinaldi (1986), the the negative perception of stuttering has on PWS sex of the speaker has a signifcant efect on the listen- speak to the importance of further understanding the ers’ perceptions. Tus, this process will be repeated on underlying factors that create such a perception. videos with a speaker of another sex. Te selection and Te consequences that arise from the negative ste- content of these videos will be discussed in a later sec- reotypes of PWS demonstrate that the perceptions of tion. Afer each video sample, the participants flled PWS are formed from factors more complex than the out a 10-item semantic diferential scale (see Appen- physical trait of stuttering. However, few studies situ- dix A). Te scale consists of numbers (one through ate stuttering and its perception in a greater context, seven) assigned to bipolar adjective pairs (negative/ analyzing stuttering in conjunction with other exter- positive, dull/intelligent). Positive traits were assigned nal factors. None has specifcally examined the rela- to the high end of the scale (seven), while negative tionship between stuttering, kinesics, and perception traits were assigned to the low end of the scale (one). of PWS. Tis paper will provide a greater understand- Participants were provided with a defnitions sheet ing of the efect of kinesics on the perceptions of PWS. to ensure that there was a standardized understand- ing of the personality adjectives (see Appendix B). Furthermore, participants were given instructions to circle the number that most accurately refected their Methodology perceptions about the personality traits of the speaker. Participants were also given the chance to familiarize Experimental Design themselves with the scale through a sample question so that they knew how to use the scale properly. Upon In this correlational study, an experiment was con- completion of the survey, the researcher collected the ducted to determine the efect of a PWS’s kinesics on materials for analysis. Statistical analysis was per- their perception by male adolescents. While a qualita- formed on the data to determine if signifcant difer- tive method might be able to provide a more detailed ences existed between the trait ratings across video description about the perceptions of PWS, there is no samples. consistent process to compare the individual descrip- tions. As such, this study uses standardized measures Video Samples to analyze the relationship between these variables quantitatively, where kinesics was evaluated based on Te videos and audio clips used in this study were the only comprehensive annotation system that was chosen from a series of TED Talks about personal 81 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER experiences with stuttering. Tis allowed for the consisted of 24 students, with six students from each content and message to be consistent between clips. grade. Te desired sample size was calculated using Furthermore, the videos that were chosen featured the sample size formula for fnite populations: speakers with similar appearances to avoid poten- tially confounding factors like race, body type, or height. Te stutter rate was also kept consistent be- tween clips with speakers of the same sex (see Ap- pendix C). Each video clip was shown to a selected where panel of two teachers and three grade 12 students p = 0.5; that assigned it a kinesics score based on body lan- z is the z-score associated with the confdence level; guage, facial expression, and gestures (see Appendix e is the margin of error; and D). Te clips were compiled into one video that was N is the population size. shown to each participant individually on the same As such, a 24-person sample is sufcient for a de- laptop. Afer the initial instructions were read (See sired 95% confdence level and a 20% margin of error, Appendix E) and any questions were answered, the given that the population of the school is 613 students. experimenter lef the room to allow the participant Te participants maintained full autonomy dur- to respond individually and uninfuenced. ing the experiment and were allowed to withdraw at any time without penalty. Tose who withdrew would Participants have their responses disregarded and omitted from the analysis. Te data was recorded without attribut- Participants for this study were randomly selected ing names to responses, and the data was used for the from a private boys’ high school in a region situated sole purpose of this study. on the outskirts of the Greater Toronto Area. Tis school was chosen for its convenience of sampling. However, the consistency of demographics within the school allowed for a more representative sample Results of educated adolescents. Furthermore, due to the po- tentially confounding efect of the listeners’ sex on Te data from the experiment were analyzed to perception, this study chose to focus on male listen- determine the efect of kinesics on the perception of ers. (Burley & Rinaldi, 1986; Dietrich et al., 2001). PWS. Te analysis focused on three main areas of in- From a random sample of students, the selected vestigation: the holistic efect of kinesics on percep- individuals were asked to complete a screening sur- tion, the efect of kinesics on individual personality vey (see Appendix F). Students who indicated they traits, and the diference in efect between positive were performing at grade-level expectations; had and negative kinesics. Since the data was bifurcated no impairments associated with vision, hearing, or based on the sex of the speaker, a secondary analysis language comprehension; and used English as their was conducted on the relationship between sex, kine- primary language were selected as participants in the sics, and perception. Te data are summarized in the experiment. Most importantly, students were asked following charts and tables. Statistical analyses were whether they stuttered (now or previously), had conducted using XLSTAT. a family member who stuttered, or had close rela- tions with a friend who stuttered. Students who met any of the above criteria were excluded to obtain a Holistic Efect of Kinesics on Perception representative perception by reducing the confound- ing efect of familiarity with stuttering (Woods & A multivariate analysis of variance (MANOVA) Williams, 1976). Consent forms (see Appendix G) using the Wilk’s Lambda test was performed on the were given to the selected students, and those who datasets to determine the holistic efect of kinesics returned the forms signed by a parent or guardian on perception. Of the six group comparisons (fe- participated in the experiment. Te fnal sample male control-positive, female control-negative, fe- 82 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Figure 1. Mean Likert ratings across participants for clips containing female PWS.

Figure 2. Graphical rep- resentation of the mean Likert rating for clips con- taining female PWS.

83 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Figure 3. Mean Likert ratings across participants for clips containing male PWS.

Figure 4. Graphical representation of the mean Likert rating for clips containing male PWS.

Figure 4. Graphical repre- sentation of the mean Likert rating for clips containing male PWS.

84 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Figure 5. Summary of statistical output for MANOVA using the Wilk’s Lambda Test.

male positive-negative, male control-positive, male to be more superfcial. Traits that are more associated control-negative, male positive-negative), only the with cognitive behaviour and mental competence female control-negative comparison did not achieve (not credible/credible, incompetent/competent, un- statistical signifcance. On balance, this indicates friendly/friendly, not humorous/humorous, stupid/ that the overall perception of speakers exhibiting intelligent) did not achieve signifcance for any of the positive or negative kinesics is signifcantly diferent comparisons. Tis trend indicates that cognitive trait from the control. A summary of the MANOVA data ratings are less sensitive to a change in kinesics than can be seen in Figure 5. behavioural trait ratings.

Efect of Kinesics on Individual Traits Positive vs Negative Kinesics

For the comparisons to the control that achieved A MANOVA was used to compare the negative statistical signifcance, post-hoc testing (with a Bon- sample data with the positive sample data for both ferroni correction for α = 0.05) was performed to de- speakers (see Figure 6). Both comparisons achieved termine the efect of kinesics on the individual trait statistical signifcance, indicating that positive kine- ratings. Despite being holistically diferent from the sics has a diferent efect on perception than negative male control, none of the individual trait ratings for kinesics. As seen in Figures 1 and 3, the mean Likert the male negative sample was signifcantly diferent ratings for the speaker exhibiting positive kinesics are from the control. Contrastingly, three adjective pairs signifcantly higher than the control. As such, positive – tense/relaxed, shy/outgoing, afraid/brave – achieved kinesics shifs listener perception favourably. Con- signifcance for both the female control-positive and trastingly, the efect of negative kinesics on perception the male control-positive comparisons. Tese traits is negligible. Not only did the MANOVA comparison manifest themselves in surface behaviour and tend for the female negative-control fail to achieve signif- 85 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Figure 6. Summary of the univariate analyses of variance (ANOVA) conducted on individual trait ratings.

Figure 7. Summary of the mean change in trait ratings between the control and positive samples for both speakers.

86 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Figure 8. Graphical representation of the mean change in trait ratings between the control and positive samples for both speakers. cance (Figure 5), but the ANOVA for male negative- suggest that kinesics has a diferent efect in shifing control also failed to fnd signifcant diferences be- overall perceptions of male and female PWS. Tis is tween individual trait ratings (Figure 6). especially prominent for ratings of confdence, where the female speaker benefted much more from posi- tive kinesics than did the male speaker. Sex of the Speaker, Kinesics, and Perception

A separate analysis was conducted to determine Discussion if the change in perception for the male speaker was signifcantly diferent from that of the female speaker. Te three main fndings from the data are explored While the vastly diferent kinesics scores for the nega- below. Te results show that positive kinesics has a tive samples (6.6 for male, 11 for female) made it in- signifcant efect on perception, kinesics has a signif- consistent to compare the changes in perception from cantly diferent efect on the perception of male and control to negative, the similarity in kinesics scores for female speakers, and the perceptions of PWS may the positive samples (19.6 for male, 17.4 for female) have shifed over time. allowed for a meaningful comparison. Te data used for this analysis are summarized below. Efect of Kinesics

A MANOVA, F(10, 24) = 5.700, p = 0.004, per- Te results of this study demonstrate that positive formed on these data found that there was a signif- kinesics has a pronounced efect in shifing percep- cant diference in the change in perception between tions favourably, with the largest efect on surface the male and female speakers. However, post-hoc test- traits associated with behavior (tense/relaxed, shy/ ing revealed that only the changes in ratings for the outgoing, afraid/brave). On the other hand, cognitive unsure/confdent adjective pair between the speakers traits (stupid/intelligent, not credible/credible, incom- were statistically signifcant (p = 0.003). Tese trends petent/competent) experienced an insignifcant posi- 87 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER tive change from positive kinesics. While there is no is a diference in the body language of males and fe- research examining the efect of kinesics on the per- males, which infuences viewers’ perceptions of their ceptions of PWS, the fndings of this study comple- personality. Te participant responses from this study ment research conducted by Miller et al. (2015) and demonstrate a marked diference in the way kinesics af- Blalock (1973). Miller et al. fnds that negative media fects the perceptions of male and female PWS, afrm- portrayals of PWS had a negative efect on perception ing the conclusions from Koppensteiner and Grammer. and, conversely, that more positive portrayals of PWS had a positive efect on perception. However, Miller et Contemporary Perceptions of Stuttering al. found that the positive efect did not reach signif- cance for any individual traits. Blalock’s study, which Lastly, the current study provides evidence that the focused on the perception of messages in a business perceptions of PWS may have shifed over time, re- environment, similarly concluded that the use of posi- fecting a greater acceptance of stuttering. Although tive body language had a favourable efect on overall this study found that listeners rated PWS in the con- message perception. Furthermore, Blalock reported trol sample to be tense, shy, and afraid, it also found that the perception of messages from speakers with that listeners rated PWS to be friendly, sharp, com- negative vocalization is not signifcantly afected petent, and intelligent. Tis contradicts earlier stud- by the use of negative kinesics. Te results of this ies, which found that listeners had negative baseline study, which show that negative kinesics has a negli- ratings for all personality traits. For example, Woods gible efect on the overall perception of PWS, confrm and Williams (1976) concluded that listeners ascribed Blalock’s previous fndings. undesirable traits, such as stupid and unfriendly, to male PWS. Collins and Blood (1990) drew the same Efect of Gender and Kinesics conclusion with female PWS. Tese diferences in fndings might be attributed to the fact that the PWS Tis study also concluded that kinesics has a sig- in this study shared personal experiences with stutter- nifcantly diferent efect on the perception of male and ing, which could skew the results positively. However, female speakers. As concluded from the analysis in the more recent studies conducted by Gabel (2006) and previous section, this is especially prominent for ratings Miller et al. (2015) show that listeners are starting to of confdence, where the female PWS benefted much rate PWS more positively, which is a trend refected in more from positive kinesics than did the male PWS. the results of this study. Although not focusing specifcally on the efect of kine- sics and conducted on subjects of both genders, previ- ous research has suggested that listeners’ perception is Conclusions afected by the sex of the speaker. A study conducted by Burley and Rinaldi (1986) noted that there were signif- Implications, Limitations, and Future cant diferences in the rating of male and female PWS, Research where listeners were likely to rate male speakers more positively. An explanation for the diference in the way Understanding the diferent factors that afect the kinesics afects the perceptions of male and female perceptions of PWS is key to shifing those perceptions. speakers observed in this study may be found in anoth- Tis study shows that there is a signifcant positive ef- er study conducted by Koppensteiner and Grammer fect on perception associated with positive kinesics. (2011). Te study examined how the body movements Tese fndings have larger social and clinical implica- of male and female speakers afected viewers’ percep- tions that can help PWS improve their interaction with tions of personality. Participants viewed videos of pub- others. PWS can use this information to both empower lic performances where the speakers’ movements were themselves and change the attitudes of those around rendered into stick fgure movies. Te results showed them. Furthermore, by integrating positive kinesics that stick fgures representing male speakers were rated building techniques into speech therapy, speech lan- more favourably than stick fgures representing female guage pathologists have another tool to help PWS build speakers. Terefore, the researchers suggest that there confdence and cope with their speech disorder. 88 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Several limitations to this current study warrant discussion. First, the small sample size reduces the References generalizability of the results. Since the participants Beech, Harold Reginald, & Fay Fransella. Research and were only chosen from an all-boys private board- Experiment in Stuttering. Pergamon Pr., 1968. ing school, extrapolation of these conclusions to the Birdwhistell, R. L. (1970). Kinesics and Context: Essays on greater population would be erroneous. Furthermore, Body Motion Communication. Philadelphia: University of the use of two diferent speakers may have introduced Pennsylvania Press. Retrieved from Questia School. confounding variables. Although measures were tak- Birdwhistell, R. L. (1982). Introduction To Kinesics: en to ensure that the speakers featured in the videos An Annotation System For Analysis Of Body Motion had similar physical appearances, not all the visual And Gesture. Ann Arbor, MI: University Microflms factors could be controlled. For example, one female International. speaker was blonde and wore glasses while the other Blalock, M. B. (1982). Te use of kinesics in establishing was a brunette woman who did not wear glasses. In and determining meaning in superior-subordinate com- addition, one male speaker had slightly darker skin munications (Doctoral dissertation, Proefschrif Baton and facial hair. Tough these diferences may afect Rouge, Louisiana State University). the data, there should not be a signifcant diference in Blood, G., & Blood, I. (2004). Bullying in adolescents who the way the speakers are evaluated. stutter: Communicative competence and self-esteem. While this study has established the link between Contemporary Issues in Communication Science and kinesics and the perceptions of PWS, further research Disorders, 31, 69-79. could be done to determine the efect of kinesics on Boyle, M. P. (2017). Personal perceptions and perceived public opinion about stuttering in the United States: listeners’ physiological and emotional responses to Implications for anti-stigma campaigns. American stuttered speech. A previous study identifed that lis- Journal Of Speech-Language Pathology, 26(3), 921-938. teners respond negatively to stuttered speech through doi:10.1044/2017_AJSLP-16-0191 a variety of physiological responses, such as a lower Brundage, S. B., Bothe, A. K., Lengeling, A. N., & Evans, J. J. heart rate, a lower breathing rate, and the tendency to (2006). Comparing judgments of stuttering made by stu- avoid eye contact with the speaker (Guntupalli, Ever- dents, clinicians, and highly experienced judges. Journal hart, Kalinowski, Nanjundeswaran, & Saltuklaroglu, of Fluency Disorders, 31(4), 271-283. doi:10.1016/j. 2007). Te study also found that listeners responded jfudis.2006.07.002 with negative emotions, such as discomfort, embar- Burley, P. M., & Rinaldi, W. (1986). Efects of sex of rassment, and unhappiness. Given the positive efect listener and of stutterer on rating of stuttering speak- of positive kinesics on listeners’ perceptions of PWS, ers. Journal of Fluency Disorders, 11(4), 329-333. there is potential that positive kinesics could also mit- doi:10.1016/0094-730X(86)90020-3 igate negative listeners’ responses. Chu, Y., Strong, W. F., Ma, J., & Greene, W. E. (2005). Even though there exists a negative perception of Silent messages in negotiations: Te role of nonverbal people who stutter, this study provides compelling evi- communication in cross-cultural business negotia- tions. Journal of Organizational Culture, Communications dence that these perceptions can be favourably changed and Confict, 9(2), 113. Retrieved from Questia School. with positive kinesics. Te understanding gained from Collins, C. R., & Blood, G. W. (1990). Acknowledgement this study can help inform useful practices in speech lan- and severity of stuttering as factors infuencing nonstut- guage therapy that can help people who stutter to better terers’ perceptions of stutterers. Journal of Speech and approach their interactions with others. Indeed, there is Hearing Disorders, 55(1), 75-81. still more to discover in the diferent factors that infu- Conture, E. G., & Kelly, E. M. (1991). Young Stutterers’ ence the perceptions of people who stutter. By gaining a nonspeech behaviors during stuttering. Journal of greater understanding of these factors, such as kinesics, Speech Language and Hearing Research, 34(5), 1041. people who stutter are able to empower themselves and doi:10.1044/jshr.3405.1041 potentially mitigate the complications associated with a Dietrich, S., Jensen, K. H., & Williams, D. E. (2001). negative perception. Efects of the label “stutter” on student perceptions. Journal of Fluency Disorders, 26(1), 55-66. doi: 10.1016/ S0094- 730X(00)00030-9 89 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Gabel, R. M. (2006). Efects of stuttering severity and Purkey, E. [Tedx Talks]. (2016, Oct 26). Stuttering [Video therapy involvement on attitudes towards people who File]. Retrieved from https://www.youtube.com/ stutter. Journal of Fluency Disorders, 31(3), 216-227. doi: watch?v=L1ZMKPDPM2A 10.1016/j.jfudis.2006.05.003 Rice, M. L., Hedley, P. A., & Alexander, A. L. (1993). social Guntupalli, V. K., Everhart, D. E., Kalinowski, J., biases toward children with speech and language impair- Nanjundeswaran, C., & Saltuklaroglu, T. (2007). ments: A correlative causal model of language limita- Emotional and physiological responses of fu- tions. Applied Psycholinguistics, 14(4), 445-471. Retrieved ent listeners while watching the speech of adults October 9, 2017. who stutter. International Journal of Language Schroeder, L. B. (2002). Listener attitudes towards stuttering: & Communication Disorders, 42(2), 113-129. divergence in gender (master’s thesis). doi:10.1080/10610270600850036 Van Borsel, J., Brepoels, M., & De Coene, J. (2011). Hughes, S., Gabel, R., Irani, F., & Schlagheck, A. (2010). Stuttering, attractiveness and romantic relationships: University students’ explanations for their descriptions Te perception of adolescents and young adults. of people who stutter: An exploratory mixed model Journal of Fluency Disorders, 36(1), 41-50. 10.1016/j. study. Journal of Fluency Disorders, 35(3), 280-298. jfudis.2011.01.002 doi:10.1016/j.jfudis.2010.05.006 Von Tiling, J. (2011). Listener perceptions of stuttering, Klein, J. F., & Hood, S. B. (2004). Te impact of stutter- prolonged speech, and verbal avoidance behaviors. ing on employment opportunities and job perfor- Journal of Communication Disorders, 44(2), 161-172. doi: mance. Journal of Fluency Disorders, 29(4), 255-273. 10.1016/j.jcomdis.2010.09.002 doi:10.1016/j.jfudis.2004.08.001 Washington, M. [Tedx Talks]. (2014, May 18). Te Ting Koppensteiner, M., & Grammer, K. (2011). Body move- Is, I Stutter [Video File]. Retrieved from https://www. ments of male and female speakers and their infu- youtube.com/watch?v=9MegHiL93B0 ence on perceptions of personality. Personality and Wingate, M. E. (1964). A standard defnition of stutter- Individual Diferences, 51(6), 743-747. doi:10.1016/j. ing. Journal of Speech and Hearing Disorders, 29(4), paid.2011.06.014 484-489. doi:10.1044/jshd.2904.484 Lopez, J.V. [Tedx Talks]. (2015, Feb 2). Why you should Woods, C. L., & Williams, D. E. (1976). Traits attributed to embrace your stutter [Video File]. Retrieved from https:// stuttering and normally fuent males. Journal of Speech www.youtube.com/watch?v=8J5RUvs2rZA Language and Hearing Research, 19(2), 267. doi:10.1044/ McAllister, J., Collier, J., & Shepstone, L. (2012). Te impact jshr.1902.267 of adolescent stuttering on educational and employment outcomes: Evidence from a birth cohort study. Journal of Fluency Disorders, 37(2), 106-121. doi: 10.1016/j. fudis.2012.01.002 Miller, T., Evans, D. L., Mathers-Schmidt, B. A., & Fraas, M. (2015). Stuttering in the movies: efects on adolescents’ perceptions of people who stutter (master’s thesis). Orton, J. (2007). Gesture: In modern language teaching and learning. Babel, 42(2), 12. Retrieved from Questia School. Parker, S.B. [Tedx Talks]. (2013, Jun 29). Stammering and Creativity [Video File]. Retrieved from https://www. youtube.com/watch?v=qeGqMAjTU-U Perez-Pena, R. (2011, October 10). Stutterer speaks up in class; His professor says keep quiet. New York Times. Retrieved April 01, 2018, from https://www.nytimes. com/2011/10/11/education/11stutter.html Plexico, L. W., Manning, W. H., & Levitt, H. (2009). Coping responses by adults who stutter: Part I. Protecting the self and others. Journal of Fluency Disorders, 34, 87–107.

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Appendix A – Semantic Diferential Survey

91 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Appendix B – Defnitions Sheet Not Homorous- Unamusing; does not have a good sense of what is funny

Defnitions Intelligent- Smart; quick to understand Stupid- Not smart; slow to understand Sharp- Quick thinker; clever Dull- Slow thinker; foolish; unskilled

Credible- Believable; trustworthy Not Credible- Not believable; untrustworthy Appendix C – Video and Audio Transcripts Competent- Capable; having the ability to do what is needed Incompetent- Incapable; not having the ability Female A1 to do what is needed

Relaxed- At ease; free; comfortable Tense- Tight; rigid; anxious

Confdent- Self-assured; believes in oneself Unsure- Uncertain; hesitant

Outgoing- Friendly; socially confdent Shy- nervous around others; timid

Brave- showing courage; ready to face danger Afraid- flled with fear; scared

Friendly- pleasant; kind; easy to get along with Unfriendly- Mean; unpleasant; hard to get along with

Humorous- Amusing; has a good sense of what is funny 92 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Female V1 Female V2

Male A2

93 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Male V3

Stutter Rates

Stutter Rate V1 10.8 V2 11.2 A1 11.3 Male V4 V3 6.1 V4 6.9 A2 7.6

94 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Appendix D – Kinesics Rating Survey

Kinesics Scores

Kinesics Score V1 17.4 V2 11 A1 V3 6.6 V4 19.6 A2

Appendix E – Participant On the frst survey, you will fnd an example question that we will fll out together to make sure Instructions you know how the scale works. Te statement reads “Cheetahs are…” If you believe cheetahs are slow, cir- cle 1. If you believe cheetahs are fast, circle 7. If you Instructions believe cheetahs are between fast and slow, circle a number in between. Does that make sense? Tank you for agreeing to participate in my re- Please rate all the traits relative to the previous search project regarding the perceptions of people clips. Please have a look over the defnitions sheet to who stutter (PWS). In this experiment, you will be familiarize yourself with the terms. watching videos of diferent speakers and rating their We will now begin the experiment. You will be personality traits on a semantic diferential scale. watching and listening to a series of 2 audio clips and Some of the personality traits will not be explicitly four videos. Afer each, please fll out the correspond- evident in the video. Please rate those traits based on ing survey form (for clip A1, fll out form A1). If you what you believe they would be based on what you are unsure about any of the personality adjectives, have seen. please refer back to the defnitions sheet. 95 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Appendix F – Screening Survey Appendix G – Consent Forms

Dear Parent/Guardian, Participant Screening Survey I have been selected to participate in the AP Cap- stone Research Program. Te aim of this program Are you currently failing an English course? is to encourage and support high school students in producing meaningful and valuable research. At the Yes ____ No____ end of the year, this research will be submitted to the College Board, with the goal of being published in an Do you sufer from learning disabilities? academic journal. Tis research has been approved by my teacher, ______, and an internal ethics re- Yes ____ No____ view board.

Do you have any hearing or visual impairments? My research will focus on understanding the dif- ferent factors that afect the perception of people who Yes ____ No____ stutter (PWS) by adolescents. Te participants in my project will be students in grades 9, 10, 11, and 12. Is English your primary language (i.e. English is the Participation in this research will involve the comple- language you use the majority of the time) tion of a consent form, screening survey, demograph- ics survey, watching video clips of diferent speakers, Yes ____ No____ and questionnaires that will determine your son’s attitudes towards each speaker. All clips have been Does anyone close to you (family member, close screened by adults and other students to ensure that friend) stutter? the language use was appropriate. Te data collection will take place afer class time, and it is expected to Yes ____ No____ take about 30 minutes.

Do you or have you ever stuttered? All information collected in my research will be treated confdentially and no participants will be Yes ____ No____ identifed by name in any publication resulting from the research.

First and foremost, the results of my research will allow the academic feld to gain valuable information about how stuttering is perceived by adolescents. Be- yond this, the study may also help participants gain a better understanding of stuttering and increased ex- posure to the academic research process.

Student participation in this research project is vol- untary and no student will be disadvantaged through non-participation. Participants may also withdraw from the study at any time or abstain from answering any question.

96 THE EFFECT OF POSITIVE KINESICS ON PEOPLE WHO STUTTER

Attached to this information sheet is a form seek- Parent and Student Consent Form ing consent from both you and your son for him to participate in this research project. Upon signing, please have your son return the form to me, either by Perceptions of People Who Stutter hardcopy or via email. I, ...... (Student) consent to my Please do not hesitate to contact me by email at participation in this AP Research Project. ______or by phone at ______if you have any questions regarding this research. If you I, ...... (Parent/Guardian) consent have any further questions, you can also contact my to my son’s participation in this AP Research Project. research advisor and teacher ______by email at ______. I have read the information sheet provided and un- derstand the purpose and nature of the research. Yours sincerely, I give permission for my son to view video clips ______that do not contain nudity, violence, or explicit lan- Grade 12 AP Research Student guage and for any survey data collected from my son to be recorded and analyzed.

I understand that any information or personal de- tails gathered during this research are confdential and that my son’s name or any other identifying infor- mation will not be used or published in the presenta- tion of the research fndings.

I understand that participation in this research is voluntary and that my son can withdraw from the re- search at any time, knowing that there will be no pen- alty or discriminatory treatment for doing so.

Signed (Student) ...... Date......

Signed (Parent/Guardian)...... Date......

97 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018

Race, Wrongful Convictions, and Texas: An Analysis of the Impact of Juror and Defendant Ethnicity on Wrongful Convictions in Texas

William Howard-Waddingham

Tis study explored how diferent states are impacted by wrongful convictions, how diferent races are represented in Texas exonerations, and the connection between juror and defendant ethnic- ity in Texas wrongful convictions. Tis study employs a quantitative method. Te study fnds that Texas, New York, and Illinois are the states most impacted by wrongful convictions, that stark racial disparities exist in Texas exonerations, and that there is no connection between juror and defendant ethnicity in Texas wrongful convictions. Tese fndings imply that House Bill 34 (a criti- cal piece of Texas legislation that will be explored later in this study) will not be entirely successful from its lack of stipulations regarding racism, yet also clarify that racial discrimination does not originate with Texas’s jurors, providing a direction for future research.

Keywords: Wrongful Convictions, Racism, Juror Discrimination, Defendant Ethnicity.

Introduction American men. While the new legislation deals with a number of the factors Gould and Leo (2013) men- Despite advancements for racial equality over the tion, notably that of jailhouse informants and forced past half-century in the United States, racism remains confessions, it fails to take into account any issues of a meaningful issue and continues to impact Ameri- racism. In not tackling racism, House Bill 34 lies con- can society in a number of facets. For instance, im- trary to the fndings of Feagin (2013), who establishes plicit racial biases have ofen been conjectured to that wrongful convictions in the United States have impact wrongful convictions in the United States. inordinately afected black men. While wrongful convictions are an important issue House Bill 34 has been uniformly praised for its in virtually every American state, they are a particu- initiative; however, far too little empirical work has larly pressing issue for Texas, as the state ranks frst been done to corroborate its actions and investigate nationally for the greatest number of cases overturned the impact of race on wrongful convictions. I tackled by DNA evidence (Te Innocence Project, 2009). Ac- this issue by questioning House Bill 34’s efectiveness cording to Gould and Leo (2013), wrongful convic- through a comparable analysis of wrongful convic- tions are mainly attributed to perjured testimony, tions in Texas, while also searching for the causes falsifed confessions, or jailhouse informants. While behind racial discrimination in the Texas judicial Texas has recently established new legislation (House system. Tis analysis was conducted with a quantita- Bill 34) attempting to curb future wrongful convic- tive approach. First, the analysis determines the states tions (Te Innocence Project, 2017), it remains to be most impacted by wrongful convictions through a seen whether these new regulations will signifcantly state-by-state analysis comparing exonerations to mitigate wrongful convictions, especially for African state population. Further, it compares the propor- 98 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS tion population of each ethnic group in Texas to the ticularly struggled with this issue, ranking frst among percentage of wrongfully convicted people who are of American states in convictions overturned on DNA the same ethnicity; this area of the study lent insight evidence (Te Innocence Project, 2009). Additionally, into the efectiveness of House Bill 34. Finally, it in- Huf (2002) and Huf (2004) estimate an error rate of vestigates the possibility of racism in past wrongful 0.5% in the American criminal justice system through convictions by conducting a correlational analysis of a study of prosecutors, judges, and attorneys general. all recorded wrongful convictions in Texas, examin- Tis error rate would result in 7500 wrongful convic- ing the ethnicity of the defendant and the racial com- tions annually in index crime trials (index crimes be- position of the county where each trial was held and ing those of the highest severity in the United States) attempting to retrieve a connection between the two (Huf, 2002; Huf, 2004). Te numbers would, in fact, factors. Although the racial composition of the jury be even greater for the entirety of the American jus- will not equally mirror the racial composition of each tice system, as there would be wrongful convictions in county, a good estimate of jury ethnicity can be re- non-index crimes. trieved utilizing this information (which will be fur- ther explained later in this study). While this study Factors Infuencing Wrongful Convictions does not necessarily hold the answers to crafing a legislation which truly combats wrongful convictions, Trough these disturbing statistics, a considerable I hope that my fndings provide insight into an impor- degree of research has been undertaken to determine tant topic, and suggest whether or not House Bill 34 is the contributing factors within cases of wrongful worthy of the praise it has so far received. convictions. Most researchers agree on the basic fac- tors involved in wrongful convictions. According to Acker (2009), Gould, Hail-Jares, and Carrano (2014), Literature Review Gould and Leo (2010), Huf (2002), and Huf (2004), the most signifcant contributing factors to wrongful Innocent Until Proven Guilty convictions include false confessions, tunnel vision (a phenomenon where police will acutely focus on one Te line between innocence and guilt is ofen suspect while ignoring others), forensic error, inef- blurred in the United States of America; for instance, fective assistance of defense counsel, prosecutorial Ferguson (2016) assesses that too ofen, the American error, and eyewitness mistakes. Additionally, Gould precept of innocent before proven guilty is not upheld and Leo (2010) and Neuschatz, Lawson, Swanner, in American judicial systems. Hamer (2007) contin- and Meissner (2008) charge that jailhouse informants ues this narrative by establishing the increased preva- (prisoners incentivized to lie under oath to convict lence of reverse burdens in Western judicial systems, a a peer through the promise of lighter sentencing or concept where the defendant is forced to prove inno- increased privileges) ofen impact trials involving an cence on a balance of probabilities instead of the pros- innocent defendant through providing false testi- ecution establishing guilt beyond a reasonable doubt. mony. Hewitt and Natapof (2012) reafrm this idea, as they fnd that informants are ofen used to develop Prevalence of Wrongful Convictions cases and retrieve convictions; the authors also estab- lish that these informants are ofen benefciaries for Tis worrying trend is refected in the signifcant “snitching,” as many have either received money or rates of wrongful convictions in the United States. drugs (for drug-addicted informants) for their eforts. For example, Gross, Jacoby, Matheson, Montgomery, Moreover, lost confessions (the instances in which po- and Patil (2005) fnd that 340 American inmates were lice are unable to withdraw a confession from a guilty exonerated from 1989-2003. Among this group, 80% suspect, forcing them to investigate innocents) can of- had been imprisoned for more than 5 years, and the ten cause police to charge an innocent person with a group had collectively spent 3400 years in prison (an crime (Cassell, 1998). Since the majority of crimes are average of 10 years per inmate) for crimes that they solved through police interrogation, lost confessions did not commit (Gross et al., 2005). Texas has par- increase the chances that an innocent person will be 99 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS charged when the guilty suspect is not (Cassell, 1998). Heilig, Brown, and Brown (2012) analyze that many Finally, Dervan and Edkins (2013) and Schneider issues of race still pervade Texas, as although Afri- (2013) point to the efect of plea bargain proceedings can Americans are aforded many equal rights, they on an innocent defendant as an important factor in are still marginalized and are only given an “illusion wrongful convictions. For instance, Dervan and Ed- of inclusion” (p. 1). Additionally, Horry, Wright, and kins (2013) undertook an empirical research study Tredoux (2010) suggest that people will ofen hold where over 50% of the innocent participants willingly inherently racial biases towards diferent ethnicities. admitted to guilt when they were ofered a beneft Gross, Possley, and Stephens (2017) fnd that African (such as lighter sentencing or a lesser charge) for do- Americans in the United States judicial system are im- ing so. pacted in numerous ways from racism, ranging from inherent and unconscious biases and institutional House Bill 34 racism to explicit discrimination. Tese inherent and systemic could act as a cause towards Texas wrongful House Bill 34 tackles many of the factors infuenc- convictions. Tis idea is aided by the work of Gross et ing wrongful convictions (Te Innocence Project, al. (2017), who empirically prove that wrongful con- 2017). For instance, the legislation establishes clear victions have repeatedly targeted African Americans. guidelines for decreasing false confessions, mitigating For example, African Americans comprise 47% of the errors in forensic investigation, decreasing the impact 1900 exonerations recorded by the National Registry of eyewitness error, and regulating the use of jailhouse of Exonerations, despite only accounting for 13% of informants (Te Innocence Project, 2017). In many the American populace (Gross et al., 2017). Further, facets, Texas has established the most comprehensive racial disparities in wrongful conviction rates exist for legislation in the United States to decrease wrongful virtually every major crime (Gross et al., 2017). For convictions (Te Innocence Project, 2017). murder, innocent African Americans defendants are 7 times as likely as innocent white defendants to be Factors Impacting Wrongful Convictions: convicted of murder, African American inmates con- Correlation or Causation? victed of murder are 50% more likely to be innocent than fellow convicted murderers, and, while only 15% However, while the factors previously analyzed of murders by African Americans saw a white victim, have clearly been proven to correlate with wrongful 31% of wrongfully convicted African Americans were convictions, various researchers conjecture there is no convicted for the murder of a white person (Gross et causal relationship between these factors and wrong- al., 2017). Sexual assault and drug crimes see similar ful convictions. For instance, Gould et al. (2014) and racial disparities in their conviction and exoneration Gould and Leo (2010) admit that their research was statistics (Gross et al., 2017). Feagin (2013) reafrms limited as they could not determine whether the fac- the work of Gross et al. (2017), as he fnds that wrong- tors were causal and could not determine whether the ful convictions have specifcally targeted African factors related to wrongful convictions were also exis- Americans. African Americans are also signifcantly tent in cases involving a legitimately guilty defendant. more likely to be wrongfully convicted of crimes with a white victim, suggesting that race may act as a causal Racism as a Causal Factor for Wrongful factor to wrongful convictions (Feagin, 2013). Convictions Remaining Gap in Research Racism is still a signifcant issue in the United States of America 50 years afer the Civil Rights Movement. First, a gap in the research exists regarding the For instance, although many fundamental aspects of states most impacted by wrongful convictions. Te In- racial inequity have been mended, inherent and sys- nocence Project (2009) found Texas to have the most temic racial biases continue to exist. By utilizing the wrongful convictions overturned by DNA evidence, critical race theory (a critical societal analysis exam- but this literature review could not retrieve a study ining the relationship between law, race, and power), that has categorically examined this issue to retrieve 100 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS the states most afected by wrongful convictions as a tween race and wrongful conviction, the study frst whole. As exonerations are prompted by many factors retrieved all Texas exonerations listed by the National other than DNA evidence, for example through new Registry of Exonerations, subdivided them based on or diferent testimony, Te Innocence Project (2009)’s the race of the defendant, and established the per- work will not have captured the full scope of Ameri- centage of the sample that was African American. It can exonerations. For this reason, this study con- then contrasted this percentage with the percentage ducted a state-by-state analysis to determine the states African American population of Texas (utilizing in- with the greatest number of exonerations in American formation from the United States Census Bureau) to history; this fnding gives clarity to future research on discover whether African Americans are inordinately which states are important ones to analyze wrongful afected by wrongful convictions in the state. Tis convictions within. process was repeated with whites, Hispanics, and all Moreover, while extensive research has been under- other ethnicities that have been wrongfully convicted taken on the factors related to wrongful convictions in Texas. Tese steps mirrored those taken by Gross and some research has been undertaken on potential et. al (2017) but analyzed a narrower sample (Gross et causal factors, a signifcant gap remains in the re- al. (2017) analyzed the United States as a whole while search, particularly pertaining to racism. For instance, this research just examined Texas). this literature review could only retrieve one empiri- Furthermore, this study individually analyzed each cal, statistically proven, study directly linking wrong- Texas exoneration by retrieving the race of the defen- ful convictions with racism, in the work of Gross et. dant and contrasting that with the racial composition al (2017). Even with the work of Gross et. al (2017), it of the county where the defendant’s trial took place. was not discovered what prompted the racial dispari- While many would assume that the racial composi- ties in wrongful convictions, as it was only established tion of each jury would match the racial composition that a correlation between race and wrongful convic- of the county, Wheelock (2011) presents a diferent tions existed, not why it existed or what caused it. Tis view. Trough an empirical study, Wheelock (2011) study attempted to fll this gap by thoroughly inves- discovered that African Americans are severely un- tigating one potential factor of wrongful convictions derrepresented in Georgia juries, as the percentage of African Americans. It did so through investigating of African Americans in juries is just under ⅓ less potential juror discrimination by linking the ethnicity than the overall percentage of African Americans in of jurors with the race of the wrongfully convicted de- Georgia; it was also found likely that similar dispari- fendant. Tis study also extended the work of Gross et ties would exist in other Southern states, including al. (2017) by replicating their work on a smaller scale Texas. African American underrepresentation on ju- by examining the racial disparity of wrongful convic- ries is ofen owed to the practice of peremptory chal- tions in Texas. While this study does not empirically lenges, which allow for candidate jurors to be barred prove racism in the Texas judicial system, it provides from jury duty without reason (Naidof, 2013). Naid- further insight into wrongful convictions and helps to of (2013) reafrms the work of Wheelock (2011) by assess the potential success of House Bill 34 in deter- assessing that whites are severely overrepresented on ring future wrongful convictions. criminal trial juries in Texas. One example is of Dallas County, which has dismissed 92% of potential Afri- can American jurors by peremptory challenges; only Method 2.8% of jurors in criminal trials were African Ameri- can (Naidof, 2013) despite the county being 23.5% Tis study was conducted with a quantitative ap- African American (United States Census Bureau, proach. It frst sought to fnd the states most impacted 2016). While research has not been undertaken to al- by wrongful convictions by conducting a state-by- low for a completely accurate assessment of the racial state analysis. Tis analysis compared the percentage composition of juries in Texas (except for in Dallas of American wrongful convictions attributed to each County), the estimate of Wheelock (2011) is likely state to the percentage of the American population a fair approximation for most Texas exonerations as each state accounts for. To study the connection be- Wheelock (2011) suggests that African Americans 101 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS are barred from jury duty at similar rates across the Southern region of the United States. Terefore, this study estimated that the percentage African Ameri- can population is reduced by ⅓ in each jury in every county besides Dallas County (where I can use ex- act statistics) while white participation is increased by ⅓ (while not perfect, Wheelock (2011) suggested that white ofen fll the spots of the underrepresented African American jurors, a sentiment also expressed by Naidof (2013)). Tis study used a correlational method to assess the change in the rates of wrongful convictions of diferent ethnicities to the racial dis- parity of the county and the projected racial disparity of each jury. Tis method was ideal, as it allowed for quantitative assessment of a potential factor related to wrongful convictions in Texas, allowing for one to es- tablish whether the race of the juror and the defendant has impacted rates of wrongful conviction. Trough the correlational method, it became clear whether in- creased rates of white jurors, for example, results in increased rates of wrongful convictions of African American defendants, shedding light on the potential impact of juror discrimination. Tis research flled a gap in the knowledge regard- ing the causations of wrongful convictions in Texas and helped to assess House Bill 34’s efectiveness. While this research would not seek to empirically prove that Texas juries are inherently racist, it helped clarify whether race impacts wrongful convictions in Texas and whether House Bill 34 will be an efective deterrent to wrongful convictions in the state.

102 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS

Results

Table 1

Prevalence of Wrongful Convictions Per State

State # of Percent- State Wrongful age of USA Proportion Convic- Exonerations of American tions Attributed to Population: State

Texas 337 15.7% 8.8% Utah 16 0.7% 1.0%

New York 255 11.9% 6.1% Oregon 16 0.7% 1.3%

Illinois 214 10.0% 3.9% Iowa 14 0.7% 1.0%

California 195 9.1% 12.2% Nevada 14 0.7% 0.9%

Michigan 84 3.9% 3.1% Kentucky 13 0.6% 1.4%

Florida 70 3.3% 6.5% Montana 13 0.6% 0.3%

Pennsylvania 68 3.2% 3.9% Minnesota 13 0.6% 1.7%

Ohio 63 2.9% 3.6% Kansas 10 0.5% 0.9%

Massachusetts 61 2.8% 2.1% Nebraska 10 0.5% 0.6%

North Carolina 60 2.8% 3.2% West Virginia 10 0.5% 0.6%

Louisiana 56 2.6% 1.4% Alaska 8 0.4% 0.2%

Wisconsin 56 2.6% 1.8% Arkansas 8 0.4% 0.9%

Virginia 51 2.4% 2.6% Colorado 8 0.4% 1.7%

Washington 48 2.2% 2.3% South Carolina 7 0.3% 1.5%

Missouri 46 2.1% 1.9% New Mexico 7 0.3% 0.6%

Oklahoma 34 1.6% 1.2% Rhode Island 5 0.2% 0.3%

Georgia 32 1.5% 3.2% South Dakota 5 0.2% 0.3%

Indiana 32 1.5% 2.1% North Dakota 4 0.2% 0.2%

New Jersey 30 1.4% 2.8% Wyoming 4 0.2% 0.2%

Alabama 27 1.3% 1.5% Hawaii 3 0.1% 0.4%

Tennessee 26 1.2% 2.1% Maine 3 0.1% 0.4%

Maryland 25 1.2% 1.9% Delaware 2 0.1% 0.3%

Arizona 22 1.0% 2.2% Idaho 2 0.1% 0.5%

Connecticut 21 1.0% 1.1% New Hampshire 1 0.05% 0.4%

District of 20 0.9% 0.2% Vermont 1 0.05% 0.2% Columbia Total 2148 100% 100% Mississippi 18 0.8% 0.9%

103 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS

All data in Table 1 was collected from the Nation- ican history: New York and Illinois. New York has ac- al Registry of Exonerations (2018) and the United counted for 11.9% of American wrongful convictions States Census Bureau (2017). Te data in Table 1 was but only 6.1% of the American populace; meanwhile, ordered from high to low of the number of wrong- 10% of all American wrongful convictions have taken ful convictions in each state. As seen in Table 1, there place in Illinois despite the state only representing have been 2148 recorded exonerations of wrongfully 3.9% of the US population. While small discrepancies convicted inmates in the United States of America. exist within other states, all are relatively minor; the Texas has accounted for 337 of these exonerations - percentage each other state accounts for American 15.7% of all American wrongful convictions, and the wrongful convictions lies fairly close to its proportion most of any state. Tis comes despite Texas account- of the American population, as shown in Table 1. ing for a mere 8.8% of the United States population. Tese discrepancies also exist in the states with the second and third most wrongful convictions in Amer-

Table 2

Wrongful Convictions by Race in Texas

Race # of Wrongful Convic- Percentage of Texas Exon- Ethnicity Proportion of Texas Population tions erations Attributed to Each Ethnicity

African Americans 163 48.4% 12.6%

White 103 30.5% 79.4%

Hispanic 63 18.7% 2.3%

Asian 7 2.1% 4.8%

Other 1 0.3% 0.9%

Total 337 100% 100%

All data in Table 2 was collected from the National of Texas exonerations. Tese stark disparities do not Registry of Exonerations (2018) and the United States exist within the other ethnic groups that have experi- Census Bureau (2017). Te data in Table 2 was or- enced Texas wrongful convictions, as Asians comprise dered from high to low of the number of wrongful 4.8% of Texas’s population and 2.1% of wrongful con- convictions of each ethnicity. Within Texas wrongful victions, while other ethnicities (such as Indigenous convictions, there are sharp discrepancies between Americans, Alaskans, or Pacifc Islanders) account for ethnic prevalence in the Texas populace and the pro- 0.3% of Texas wrongful convictions and 0.9% of the portion that difering ethnicities account for Texas populace. wrongful convictions, as evidenced in Table 2. Tese clear disparities exist for African Americans, whites, and Hispanics. For instance, African Americans only account for 12.6% of the Texas populace, yet account for 48.4% of all Texas exonerations. Whites comprise 79.4% of Texas’s population, but only 30.5% of Tex- as’s exonerations. Finally, Hispanics represent only 2.3% of the Texas population but account for 18.7% 104 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS

Table 3

Wrongful Convictions by County: The Efect of Juror and Defendant Ethnicity County Projected Projected Projected Propor- Propor- # of # of # of # of Proportion Proportion Proportion tion of tion of African Whites His- Others of White of African of Minority African Minor- Americans Wrong- panics Wrong- Jurors American (non-white) American ity (non- Wrongfully fully Wrong- fully Jurors Jurors Exonera- white) Convicted Con- fully Con- tions Exonera- victed Con- victed tions victed

Harris 76.6% 13.2% 23.4% 51.1% 74.4% 46 23 18 3 2013-2018 Harris 62.9% 12.6% 37.1% 78.1% 87.5% 50 8 6 0 2005-2012 Dallas 75.9% 2.8% 24.1% 73.3% 86.7% 11 2 1 1 Table 2 1995-2004 Harris 65% 12.2% 35% 44.4% 77.8% 4 2 3 0 1995-2004 Wrongful Convictions by Race in Texas Bexar 1995- 71.3% 4.8% 28.7% 0% 83.3% 0 1 5 0 Race # of Wrongful Convic- Percentage of Texas Exon- Ethnicity Proportion of Texas Population 2004 tions erations Attributed to Each Montgom- 87.9% 2.9% 12.1% 0% 25% 0 3 1 0 Ethnicity ery 2013- 2018 African Americans 163 48.4% 12.6% Travis 71.3% 6.2% 28.7% 25% 50% 1 2 1 0 White 103 30.5% 79.4% 1995-2004 Hispanic 63 18.7% 2.3% Galveston 86.6% 8.7% 13.4% 66.7% 66.7% 2 1 0 0 2013-2018 Asian 7 2.1% 4.8% Montgom- 84.9% 2.9% 15.1% 0% 33.3% 0 2 0 1 Other 1 0.3% 0.9% ery 2005- 2012 Total 337 100% 100% Dallas 80.4% 2.8% 19.6% 0% 100% 0 0 0 2 2013-2018 Bexar 2005- 75.4% 5.0% 24.6% 0% 50% 0 1 1 0 2012 Galveston 81.7% 9.2% 18.3% 50% 100% 1 0 1 0 2005-2012 Lamb 1995- 77.5% 2.9% 22.5% 0% 100% 0 0 2 0 2004 Montgom- 89.5% 2.3% 10.5% 0% 0% 0 2 0 0 ery 1995- 2004 San Jacinto 85.6% 6.9% 14.4% 0% 0% 0 2 0 0 2005-2012 Tarrant 75.5% 8.5% 24.5% 0% 0% 0 2 0 0 1995-2004 Angelina 82.1% 10.0% 17.9% 0% 0% 0 1 0 0 2005-2012 Bexar 2013- 80.9% 5.1% 19.1% 0% 0% 0 1 0 0 2018

105 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS

Brown 87.7% 2.4% 12.3% 0% 0% 0 1 0 0 2005-2012 Cameron 87.2% 0.33% 12.8% 0% 100% 0 0 1 0 2005-2012 Collin 75.1% 6.1% 24.9% 100% 100% 1 0 0 0 2013-2016 Denton 79.6% 6.1% 20.4% 0% 0% 0 1 0 0 2013-2018 Denton 77.8% 5.6% 22.2% 0% 100% 0 0 1 0 2005-2012 Denton 83.7% 3.9% 16.3% 0% 0% 0 1 0 0 1995-2004 Ellis 2005- 81.6% 6.0% 18.4% 0% 0% 0 1 0 0 2012 Hale 1995- 68.7% 3.9% 31.3% 0% 0% 0 1 0 0 2004 Hidalgo 78.0% 0.17% 22% 0% 100% 0 0 1 0 1995-2004 Jeferson 68.5% 22.4% 31.3% 0% 0% 0 1 0 0 1995-2004 Lavaca 80.4% 4.5% 19.6% 100% 100% 1 0 0 0 2013-2018 Leon 1995- 87% 6.9% 13% 0% 100% 0 0 1 0 2004 McLennan 77.3% 10.1% 22.7% 100% 100% 1 0 0 0 1995-2004 Midland 84.9% 4.1% 15.1% 0% 100% 0 0 1 0 2013-2018 Nueces 88.7% 2.6% 11.3% 0% 0% 0 1 0 0 2013-2018 Nueces 82.8% 2.7% 17.2% 0% 0% 0 1 0 0 2005-2012 Nueces 74.8% 2.8% 25.2% 100% 100% 1 0 0 0 1995-2004 Sabine 92.4% 4.7% 7.6% 100% 100% 1 0 0 0 2013-2018 Shelby 79.1% 6.5% 20.9% 100% 100% 1 0 0 0 1995-2004 Upshur 89.1% 6.7% 10.9% 0% 0% 0 1 0 0 1995-2004 Van Zandt 91.8% 1.8% 8.2% 0% 0% 0 1 0 0 2005-2012 Webb 1995- 82.3% 0.27% 17.7% 0% 100% 0 0 1 0 2004 Williamson 83.7% 4.2% 16.3% 0% 100% 0 0 1 0 2013-2018

All data in Table 3, Figure 1, Figure 2, Figure 3, ed frst by the number of wrongful convictions per and Figure 4 was collected from the National Reg- county, then alphabetically, then reverse-chronolog- istry of Exonerations (2018) and the United States ically. Each county was further categorized through Census Bureau (2016). Te data in Table 3 was list- restricting the years in which it was examined. It was 106 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS

restricted by rounding it towards the nearest analy- sis undertaken on the racial disparity of each county, using the 2000 census, the 2010 census, and the 2016 American Community Survey (United States Census Bureau, 2016). Table 3 only examined Texas exon- erations from 1995 onwards, as the 2000 census is the most recent publically available census providing county racial disparity information; despite attempts to retrieve information from earlier censuses, I was unable to. As referenced previously, the proportion of African American jurors in Table 3 was projected by multiplying the African American proportion population of each county by 0.667; the lost African American juror population was added to the white population to project the proportion of white jurors. Projected minority juror population was calculated by subtracting the projected white juror population from 100. Tese steps were taken in accordance to the work of Wheelock (2011) to attempt to accu- rately project juror ethnicity populations. Te only exception to this was for projecting juror population in Dallas county, as the work of Naidof (2013) al- lowed for exact knowledge of juror population in Dallas county. Tere were four correlational analyses conducted afer the data was collected, as illustrated above. Te correlational analyses were all conducted using the data from Table 3. Te frst correlational analysis (Figure 1) analyzed the connection between the projected proportion of white jurors (indepen- dent clause) and the proportion of wrongful convic- tions of African Americans per county (dependent clause); this found no correlation. Te second cor- relational analysis (Figure 2) analyzed the connec- tion between the projected proportion of African American jurors (independent clause) and the pro- portion of wrongful convictions of African Ameri- cans per county (dependent clause); this found no correlation. Te third correlational analysis (Figure 3) analyzed the connection between the projected proportion of white jurors (independent clause) and the proportion of wrongful convictions of minorities (all non-white ethnicities) per county (dependent clause); this found no correlation. Te fourth corre- lational analysis (Figure 4) analyzed the connection between the projected proportion of minority jurors (independent clause) and the proportion of wrong- ful convictions of minorities per county (dependent clause); this found no correlation. 107 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS

Results Alignment First, this study found that African Americans com- prise nearly half of all Texas exonerations, despite only Tese fndings fll a gap in prior research, as they accounting for a small percentage of the Texas popula- extend and expand on areas of prior research in the tion. It also found that whites are severely underrepre- feld. While the extent of wrongful convictions in the sented in Texas wrongful convictions, as they make up United States are widely known, this is the frst known a far smaller proportion of exonerations than they do state-by-state breakdown of wrongful convictions. of the Texas population. Lastly, it established that His- Further, while work has been done on a national scale panics are also disproportionately afected by wrong- to analyze the racial disparity of wrongful convic- ful convictions, being wrongfully convicted even at tions, in the work of Gross et al. (2017), this is the frst rates higher than that of African Americans in Texas. known research that has analyzed the racial composi- Tese fndings flled a gap in research regarding Texas tion of wrongful convictions in Texas. Trough fnd- wrongful convictions by providing the frst known ing stark discrepancies between racial population and analysis of the ethnic disparity of Texas exonerations. racial proportion of wrongful convictions, it confrms Finally, this study discovered that juror ethnicity that exploring potential race-related motives in Texas does not correlate to rates of wrongful convictions of wrongful convictions is an important area of study. non-white defendants. In four correlational analyses Finally, through analyzing the connection between undertaken, it was discovered that no correlation ex- racial composition of jury members and the racial dis- isted in the following relationships: white jurors and parity of wrongful convictions on a county-by-county African American defendants, African American ju- basis, this research attempted to provide quantitative rors and African American defendants, white jurors answers to an unexplored area of literature surround- and minority defendants, and minority jurors and ing wrongful convictions. It has long been speculated minority defendants. Tis flled a gap in the research, that race may factor into wrongful convictions, such as little empirical work has been conducted to analyze as in the work of Gross et al. (2017), yet no quantita- the potential efect of racism in wrongful convictions. tive research had been undertaken to attempt to fnd Trough this fnding, it seems clear that Texas jurors the cause of the lopsided wrongful convictions of mi- are not motivated by racism. norities. Implications Discussion Te fndings of this study are meaningful as they Major Results shed light on a number of pertinent issues. First, it confrms that Texas has the most exonerations of any In the course of this study, three signifcant results state, making it a topical state to examine wrongful were drawn from the data collected. First, it was es- convictions within. As wrongful convictions are clear- tablished that Texas is disproportionately afected by ly a signifcant issue in Texas, it is evident that research wrongful convictions in the United States, as the state should continue to be conducted to evaluate the fac- has registered the greatest amount of exonerations of tors infuencing wrongful convictions in the state. any American state; the proportion of American ex- Further, the fndings of this study clearly evidence onerations it accounts for also outstrips the propor- a stark racial disparity in Texas wrongful convictions. tion of the American populace Texas accounts for. From this, it appears probable that racial discrimina- While Te Innocence Project (2009) found that Texas tion factors into wrongful convictions in Texas, making accounted for the most wrongful convictions over- it clear that House Bill 34 will not completely tackle the turned by DNA evidence of any American state, this causes of Texas wrongful convictions. Tis is impor- research clarifed that Texas also has the most exon- tant as it can act as a guide for future research: while it erations of any state, flling a gap in the research. has now been determined that race impacts wrongful Further, it was discovered that races are impacted convictions in Texas, further work can be done to clar- in diferent ways by wrongful convictions in Texas. ify where the racial discrimination originates within. 108 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS

While House Bill 34 is undoubtedly an excellent piece Moreover, this study relates to the work of Horry, of legislation that tackles many causes of wrongful con- Wright, and Tredoux (2010), who found that inher- victions and will likely help to mitigate future wrong- ent biases ofen impact the means by which diferent ful convictions, through failing to account for racism it ethnicities treat each other. Trough the results of this leaves the legislation lacking in its quest to dramatically study, it seems clear that this fnding does not hold change Texas’s judicial landscape. true in the Texas criminal justice system between ju- Trough analyzing the connection between juror rors and defendants. ethnicity and defendant ethnicity, this study looked Finally, this study provides greater depth to the into one potential area of racial discrimination in the fndings of Acker (2009), Cassell (1998), Dervan Texas judicial system: jurors. To show signs of poten- and Edkins (2013), Gould, Hail-Jares, and Carrano tial racism, a positive correlation should have existed (2014), Gould and Leo (2010), Hewitt and Natapof between white jurors and African American exoner- (2012), Huf (2002), Huf (2004), Neuschatz, Lawson, ees or between white jurors and minority exonerees. Swanner, and Meissner (2008), and Schneider (2013). Further, racism could have been suggested through a Tese authors all conducted extensive research re- negative correlation between African American jurors garding the factors relating to wrongful convictions. and African American exonerees or between minority Tis research extends their work by adding a factor jurors and minority exonerees. Ultimately, no correla- that does not impact wrongful convictions, at least in tion was found in any of the analyses. Trough this Texas: juror and defendant ethnicity. fnding, it seems largely confrmed that racial dis- crimination within the Texas judicial system does not Limitations and Alternate Explanations originate within jurors, meaning that one potential cause of racism has likely been eliminated. Te results of this study are limited through a lack of information in certain areas of the research. First, Relation to Past Literature although Texas has the most exonerations of any state, it is unknown whether Texas actually has the most Tis study extended and clarifed the work of a wrongful convictions in the United States. One ex- number of key pieces of literature. First, it extended planation could be that Texas is far more diligent in the fndings of Te Innocence Project (2009) through searching out wrongful convictions than other states, clarifying how difering states are afected by wrongful meaning that they would have obviously registered convictions. Te Innocence Project (2009) discovered more exonerations. Unfortunately, without the proper that Texas has the greatest number of wrongful con- information to determine if this is the case, it is im- victions overturned by DNA evidence in the United possible to know whether Texas has the most wrong- States, but had not determined that Texas accounted ful convictions of any state. for the greatest number of overall exonerations. Tis Second, and most importantly, was the lack of study extended the work of Te Innocence Project conclusive information regarding jury composition. (2009) by proving that Texas was inordinately afected While I was able to estimate jury composition, us- not only by DNA exonerations, but by wrongful con- ing the work of Wheelock (2011), it remains unclear victions in general. whether the approximations were accurate. Te situa- Further, this study narrowed the work of Gross et. tion in Dallas County clearly shows these limits. Dal- al (2017). Gross et. al (2017) discovered in their work las County was the only county with conclusive in- that African Americans compose 47% of all American formation regarding jury composition, through the exonerations; this study found the racial disparity of research conducted by Naidof (2013). In that study, wrongful convictions in Texas, providing a more spe- it was found that African Americans only accounted cifc version of the research conducted by Gross et. al for 2.8% of criminal jury members, despite African (2017). It also extends the work of Gross et. al (2017) Americans composing 23.5% of the Dallas County through proving that race seemingly impacts wrong- population (Naidof, 2013). Dallas County’s Afri- ful convictions in Texas, as well as in the United States can American proportion population is signifcantly as a whole. greater than that of Texas overall (only 12.6% of Tex- 109 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS as’s population is African American), making Dallas House Bill 34 - which lacks stipulations to tackle County one of the most African American counties in factors of racial discrimination - will not be entirely Texas. Despite this, Dallas County had the eight lowest successful. While it accounts for many factors infu- projected total of African American jurors of all the encing wrongful convictions, its failure to account for counties examined in this study. Trough these rev- racism makes it lacking in its goal to drastically alter elations, it becomes clear that similarly large dispari- the landscape of Texas wrongful convictions. Finally, ties could exist in other Texas counties, and not fol- a potential source of racism within the Texas judi- low the one-third-reduced rule of Wheelock (2011). ciary, juror discrimination, was thoroughly examined Trough this, it becomes unclear whether African by comparing projected ethnic rates of jurors to rates Americans are barred from jury duty at similar rates of African American and minority wrongful con- to Dallas County in all of Texas. If so, this would sug- victions. Trough the fndings of the study, it seems gest state-wide discriminatory practices against Afri- probable that juror discrimination is not the cause of can Americans, making it impossible to determine if the disproportionate degree of wrongful convictions juror ethnicity played a meaningful role in wrongful of African Americans, clarifying the feld of literature convictions. Trough this limitation, it is quite pos- and providing direction for future research. sible that the fndings could conclude diferently; with accurate statistics regarding juror ethnicity, it is well within the realm of possibility that the correlational analyses could fnd correlations. References Directions for Future Research Acker, J. R. (2009). Te Innocence Commission: Preventing wrongful convictions and restoring the criminal justice Future research on this topic should be defned by system. Justice System Journal, 30(1), 114-V. Retrieved the clarifcations provided by this study. Te research from https://search.proquest.com/docview/194783057?a conducted has evidenced that African Americans are ccountid=36317 disproportionately afected by wrongful convictions, Cassell, P. G. (1998). Protecting the innocent from false but has also likely ruled out juror discrimination. For confessions and lost confessions--and from miranda. this reason, future research should delve further into Journal of Criminal Law & Criminology, 88(2), 497-556. other potential sources of racism within the Texas ju- Retrieved from https://search.proquest.com/docview/218 dicial system, such as institutional and systemic biases 392094?accountid=36317 towards African Americans. Dervan, L. E., & Edkins, V. A. (2013). Te innocent defen- dant’s dilemma: An innovative empirical study of plea bargaining’s innocence problem. Journal of Criminal Law & Criminology, 103(1), 1-48. Retrieved from https:// Conclusion search.proquest.com/docview/1356989938?account id=36317 Trough the course of this study, three signif- Feagin, J. (2013). Race and justice: Wrongful convictions of cant inquiries were tackled. First, the study provided African American men. Contemporary Sociology, 42(1), clarifcations on the states most impacted by wrongful 81-83. Retrieved from https://search.proquest.com/docvi convictions through a state-by-state analysis compar- ew/1464870765?accountid=36317 ing the proportion of American exonerations attribut- Ferguson, P. R. (2016). Te presumption of innocence ed to each state versus the proportion of the American and its role in the criminal process. Criminal Law populace each state accounted for. In this analysis, it Forum, 27(2), 131-158. Retrieved from :http://dx.doi. was discovered that Texas, New York, and Illinois are org/10.1007/s10609-016-9281-8 the states most afected by wrongful convictions. Next, Gould, J. B., Hail-Jares, K., & Carrano, J. (2014). New the validity of House Bill 34 was assessed through an- data, new fndings: An updated assessment of wrongful alyzing the racial disparity of wrongful convictions in convictions. Judicature, 97(4), 167-171. Retrieved from Texas. As African Americans were found to be wrong- https://search.proquest.com/docview/1510295447?acco fully convicted at inordinate rates, it seems likely that untid=36317 110 THE IMPACT OF ETHNICITY ON WRONGFUL CONVICTIONS IN TEXAS

Gould, J. B., & Leo, R. A. (2010). One hundred years Neuschatz, J. S., Lawson, D. S., Swanner, J. K., & Meissner, later: Wrongful convictions afer a century of research. C. A. (2008). Te efects of accomplice witnesses and Journal of Criminal Law & Criminology, 100(3), 825-868. jailhouse informants on jury decision making. Law and Retrieved from https://search.proquest.com/docview/849 Human Behavior, 32(2), 137-49. Retrieved from http:// 016354?accountid=36317 dx.doi.org/10.1007/s10979-007-9100-1 Gross, S. R., Jacoby, K., Matheson, D. J., Montgomery, N., & Schneider, S. (2013). When innocent defendants falsely con- Patil, S. (2005). Exonerations in the United States 1989 fess: Analyzing the ramifcation of entering Alford pleas through 2003. Journal of Criminal Law & Criminology, in the context of the burgeoning innocence movement. 95(2), 523-553,555-560. Retrieved from https://search. Journal of Criminal Law & Criminology, 103(1), 279-308. proquest.com/docview/218403709?accountid=36317 Retrieved from https://search.proquest.com/docview/135 Gross, S., Possley, M., & Stephens, K. (2017). Race and 6989945?accountid=36317 wrongful convictions in the United States. National Te Innocence Project (2009). New York leads most states in Registry of Exonerations. Retrieved from http://www.law. number of wrongful convictions, must enact reforms to umich.edu/special/exoneration/Documents/Race_and_ prevent them, Innocence Project report fnds. Retrieved Wrongful_Convictions.pdf from https://www.innocenceproject.org/new-york-leads- Hamer, D. (2007). Te presumption of innocence and most-states-in-number-of-wrongful-convictions-must- reverse burdens: A balancing act. Te Cambridge Law enact-reforms-to-prevent-them-innocence-project- Journal, 66, 142-171. Retrieved from :http://dx.doi. report-fnds/ org/10.1017/S0008197307000062 Te Innocence Project (2017). Texas governor signs land- Heilig, J. V., Brown, K. D., & Brown, A. L. (2012). Te illu- mark comprehensive legislation to prevent wrongful sion of inclusion: A critical race theory textual analysis of convictions. Retrieved from https://www.innocencepro- race and standards. Harvard Educational Review, 82(3), ject.org/texasgovernorsignslandmarkbill/ 403-424,437-439. Retrieved from https://search.proquest. United States Census Bureau (2016). American fact fnder. com/docview/1082045819?accountid=36317 Retrieved from https://factfnder.census.gov/faces/nav/ Hewitt, S., & Natapof, A. (2012). Snitching: Criminal in- jsf/pages/index.xhtml formants and the erosion of American justice. Journal of United States Census Bureau (2017). US Census Bureau American Studies, 46(3), 12. Retrieved from http://dx.doi. quickfacts. Retrieved from https://www.census.gov/ org/10.1017/S0021875812001193 en.html Horry, R., Wright, D., & Tredoux, C. (2010). Recognition Wheelock, D. (2011). A jury of one’s “peers:” Te racial and context memory for faces from own and other ethnic impact of felon jury exclusion in Georgia. Justice System groups: A remember-know investigation. Memory and Journal, 32(3), 335-359. Retrieved from https://search. Cognition. Retrieved from https://link.springer.com/ proquest.com/docview/916423795?accountid=36317 content/pdf/10.3758%2FMC.38.2.134.pdf Huf, C. R. (2002). Wrongful conviction and public policy: Te American Society of Criminology 2001 presiden- tial address. Criminology, 40(1), 1-18. Retrieved from https://search.proquest.com/docview/220703512?accou ntid=36317 Huf, C. R. (2004). Wrongful convictions: Te American ex- perience. Canadian Journal of Criminology and Criminal Justice, 46(2), 107-120. Retrieved from https://search. proquest.com/docview/216095379?accountid=36317 Naidof, C. (2013). Confronting the fear of “too much justice”: Te need for a Texas racial justice act. Texas Journal on Civil Liberties & Civil Rights, 19(1), 169-215. Retrieved from https://search.proquest.com/docview/150 9762909?accountid=36317 National Registry of Exonerations (2018). Browse cases: Detailed view. Retrieved from https://www.law.umich. edu/special/exoneration/Pages/detaillist.aspx

111 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018

Evaluation of Essential Oils as an Alternative to Conventional Antibiotics

Megan Leinenbach

Te purpose of this study was to determine if synergistic interactions between essential oils can increase their antibacterial efcacy by testing essential oils. Te following combinations were as- sessed for efective inhibition of E.coli and S. aureus growth: tea tree oil as the control solution, tea tree/oregano solution, tea tree/thyme solution, and tea tree/wintergreen solution. A Kirby-Bauer disc difusion was employed to assess antibiotic efcacy. When comparing the diferent combina- tions to the control solution, the results of this study signify the presence of synergistic interactions between select essential oils; the combinations that were proven to increase antibacterial efcacy when compared to the control were the tea tree/oregano and tea/tree thyme solution. Te com- bination with the greatest antibacterial efcacy for inhibiting E. coli and S. aureus growth was tea tree and oregano oil, which had an average inhibition percentage of 59.53% (E. coli) and 55.91% (S. aureus). Tis result was found to be statistically signifcant (p < 0.05) using an ANOVA single factor test.

Keywords: Essential oils, natural medicine, bacterial growth, synergism

number of deaths, it is vital that the public is aware Introduction of this biological phenomenon and that this be ad- dressed to meet the needs of patients with antibiotic- An increasing number of antibiotic resistant strains treatable illnesses. of bacteria are posing a health risk to Americans. Since While multiple bacteria have developed a resis- the introduction of penicillin in 1940, antibiotics have tance to antibiotics, this study will focus exclusively been the dominant method used to treat infections; on Escherichia coli and Staphylococcus aureus. E. coli is however, antibiotic resistance has been increasing a gram-negative bacterium1 that is a common inhab- among bacteria populations due to selective pressures itant of the intestinal tract of warm-blooded animals; (Ott & Morris, 2008). In fact, antibiotic resistance has there are four strains of E. coli that can cause diarrheal been detected in bacteria for all of the more than 100 illness and disease (Jenson, 2003). Further demon- antibiotics in use as of 2008 (Ott & Morris, 2008). Te strating this assertion, Christina Gorman (2011) of Center for Disease Control (2017) details the impact University of California: Santa Barbara writes that dis- of antibiotic resistance by stating that at least 2 million ease-causing strains of E. coli are resistant to fourteen people in the United States are infected with antibi- diferent antibiotics and are consistently the subject of otic resistant bacteria each year, and 23,000 people die research evaluating alternative treatment options. Roa each year as a direct result of these infections. With et al. (2015) classify Staphylococcus aureus as a gram- antibiotic resistance being the cause of such a large -positive2 bacterium that can be found on the skin and

1 Gram-negative bacteria have cell walls composed of a thin layer of peptidoglycan, which may afect the way essential oils enter through the cell wall and membrane of the bacteria.

112 ESSENTIAL OILS AS AN ALTERNATIVE TO CONVENTIONAL ANTIBIOTICS in the nares of humans. Additionally, Staphylococcus ics is a rare event (Richardson, 2017); thus, the drugs aureus has become an acute threat to infection control that can be used to combat infections caused by resis- with the increasing prevalence of methicillin-resistant tant bacteria are limited. In a study done by Adabara S. aureus (MRSA) and its ability to resist multiple (2012), a member of the Department of Microbiology drugs (Rao et al., 2015). Although the work of the at Federal University of Technology, it was found the aforementioned authors focused on two diferent bac- 60% of bacterial samples in a Nigerian hospital con- teria, their fndings collectively demonstrate the con- tained antibiotic resistant bacteria, encompassing sequences of antibiotic resistance and its implications many diferent species. With such a large percentage regarding public health. of collected bacterial isolates being resistant, it is ap- Due to the prevalence of antibiotic resistance, vari- parent that the resistance of bacterial communities ous research studies have been conducted to gain a has become a serious issue. Te fortuitous results of deeper understanding of how this phenomenon oc- this study substantiate the critical nature of antibi- curs. Laxminarayan and Brown (2000), had an envi- otic resistance and its global reach. While antibiotic ronmental perspective when analyzing the mecha- resistance allows all bacterial species to evolve in re- nisms of antibiotic resistance, asserting that natural sponse to their surroundings, MRSA is the most fre- selection fosters antibiotic resistance. Te authors go quent cause of antibiotic resistant infection in humans further in depth, attributing the development of an- Richardson, 2017. Rao et al. elaborate on Richardson’s tibiotic resistant strains to plasmid transfer3, muta- claims about S. aureus by stating that it ofen infects tion, and the overuse of broad-spectrum antibiotics4 healthy individuals who do not possess risk factors, in hospitals (Laxminarayan & Brown, 2000). Build- such as surgery or residence in a long-term facility ing on Laxminaryan and Brown’s argument, Lauren (2015). Te presence of antibiotic-resistant bacteria Richardson, who has a PhD in pharmacology from in both the healthy community and hospitals makes University of Washington, ofers similar information containing the growth of resistance ever more urgent, in her PLOS biology article; Richardson identifes the leading medical researchers to pursue an innovative overuse of antibiotics as a primary source of growing technique with which to treat antibiotic resistant in- antibiotic resistance, indicating that “overuse threat- fections; one of these proposed methods is the appli- ens [antibiotics] efcacy”, again, taking an environ- cation of essential oils. mental approach to explaining antibiotic resistance. According to Stephen Bent, a professor at Univer- Richardson also ascertains mutation as a mechanism sity of California: San Francisco’s School of Medicine, of antibiotic resistance, attributing the mutation of the United States has seen a surge in the popularity one bacterium to the development of further muta- of herbal products in the last decade, and, as of 2007, tion, leading resistance to become a property of the were used by twenty percent of the American popula- microbial community (Richardson, 2017). Both Rich- tion for aromatherapy, depression, and nausea among ardson and Laxminarayan’s ideas attribute the overuse other uses (2008). Various oils and their antibiotic of antibiotics to the evolution of bacterial communi- efcacies have been studied extensively; however, in ties in response to environmental conditions, mean- this study, the focus will remain on four essential oils ing that an alternative to conventional antibiotics that have been shown to have antibiotic properties: tea must be identifed in order to limit antibiotic use. tree, thyme, oregano, and wintergreen oil. Tea tree oil, While antibiotic resistance is a concern for the obtained from Melaleuca alternifolia, has been found medical community, society itself tends to underesti- to inhibit the growth of multiple bacteria, including mate the signifcance of this biological phenomenon; Escherichia coli and Candida species (Ott & Morris, although a multitude of medical discoveries have 2008). Of the multiple essential oils that have been re- been made recently, the discovery of new antibiot- searched, tea tree oil has shown the greatest potential

2 Gram positive bacteria have a cell wall that is composed of a thicker layer of peptidoglycan than gram-negative bacteria. 3 Plasmid transfer: the ability to directly transfer genetic material between bacteria 4 Broad-Spectrum Antibiotics: antibiotics that act against a wide range of disease-causing bacteria, including both gram-negative and gram-positive bacteria.

113 ESSENTIAL OILS AS AN ALTERNATIVE TO CONVENTIONAL ANTIBIOTICS as an inhibitory agent for bacterial growth, and orega- Te curative potential of essential oils in combat- no oil has been shown to have consistent antibacterial ting infection by antibiotic-resistant bacteria was efects against common bacteria (Ott & Morris, 2008). addressed by Ott and Morris (2008), in their article Additionally, both wintergreen and thyme oil are rec- Homeopathic Alternatives to Conventional Antibiotics. ognized as having antibiotic and antimicrobial prop- Ott and Morris addressed how a myriad of essential erties (European Medicines Agency, 2014). While es- oils and herbs are capable of hindering the growth of sential oils are currently popular for their commercial microorganisms, including E. coli and S. aureus (Ott use, they were frst used by classical civilizations, most & Morris, 2008). Te work of Ott and Morris not only notably in India, for their medicinal properties (Bode- deemed essential oils as efective bacterial growth in- ker, Buford, Chamerlain, and Bhat, 2001). Medical hibitors, but it also distinguished between the efcacy professionals have turned to these past treatments in of diferent essential oils. While data obtained prior to the hopes that they will illuminate the solution to cur- this point was limited to a single bacteria or disease, rent medical issues, such as antibiotic resistance. the work of Ott and Morris applied essential oils to Bodeker et al. (2001) studied the medicinal po- multiple bacteria, greatly increasing knowledge re- tential of two popular agroforestry5 species; this re- garding natural medicine. Te data collected suggests search revealed that both species were suitable for the that tea tree oil is an extremely efective inhibitor of E. treatment of priority diseases in Sub-saharan Africa, coli growth and identifed oregano, thyme, and win- such as AIDS and Malaria, also including treatment tergreen oil as supplementary growth inhibitors (Ott of urinary diseases, boils, skin diseases, ulcers, ma- & Morris, 2008). laria, fever, colic, and infammation. Research studies Te present body of research has led to an aug- evaluating the efectiveness of essential oils to address mented interest in the homeopathic use of essential antibiotic resistance, such as those by Ott, Morris, oils. In fact, many articles have been published de- Bodeker, Bufort, Bhat, and Chamberlain, have made lineating the procedure used to test the efcacy of it apparent that it is possible to utilize essential oils essential oils as antibiotic inhibitors (Morris, 2010; as a treatment option opposing antibiotics; the use of Scheppler, Sethakorn, Styer, 2003). However, the cur- essential oils could be especially efective in countries rent body of research on this topic has yet to address where new medical technology has yet to become several gaps in the research of natural medicine, such readily available. While the work of Bodeker et al. does as the efects of combining essential oils or how the demonstrate the pharmaceutical potential of essential concentration of bacteria afects the efcacy of es- oils, it is relatively generalized, making its application sential oils. Te lack of knowledge about essential oils to antibiotic resistance particularly onerous. However, and natural medicine has led physicians to develop the potential of essential oils as bacterial growth in- a penchant for conventional antibiotics and become hibitors was further analyzed by S. Alizadeh-Salteh, skeptical of the reliability of essential oils as a com- K. Arzani, R. Omidgeigi, and N. Safaie in their work mon treatment (Bent, 2008). While plant pathologists discussing how essential oils can be used to inhibit and microbiologists have already conducted consid- the growth of Rhizopus stolonifer, a chief source of erable research on the efcacy of individual essential destructive postharvest disease of fruit (2010). In ad- oils and their inhibitory efects on multiple strains of dition to the work of Bodeker et al., which generally bacteria, research concerning the efects of these oils classifed essential oils as having medicinal potential, in combination is lacking. By researching the poten- this new research highlighted the use of essential oils tial synergistic interactions of essential oils, this study specifcally to inhibit bacterial growth rather than can contribute to the growing body of work concern- treat symptoms of disease. Tese results further dem- ing alternative medicine and address the knowledge onstrated the potential of essential oils as bacterial gap regarding the efects of combining essential oils. growth inhibitors, demonstrating how essential oils Additionally, the use of gram-negative (E. coli) and could be advantageous for the inhibition of R. stoloni- gram-positive (S. aureus) bacteria in the research will fer growth as well as other bacterial species. allow for a deeper understanding of how the classif-

5 Agriculture incorporating the cultivation and conservation of trees 114 ESSENTIAL OILS AS AN ALTERNATIVE TO CONVENTIONAL ANTIBIOTICS cation of bacteria may afect the efcacy of essential tial oil was ordered. Te brand “Plant Terapy” was oils in combination. Tis fostered the question: How chosen because of their company imposed regulations do the synergistic interactions of select essential oils – to ensure the consistency and quality of their oils; tea tree, thyme, oregano, and wintergreen oil – afect Plant Terapy tests their oils multiple times, send- their antibacterial efcacy as an Escherichia coli and ing them to a third-party laboratory to undergo Gas Staphylococcus aureus growth inhibitor? Analyzing Chromatography and Mass Spectrometry tests. In ad- the results of prior studies and the efcacy of indi- dition, two microorganisms were used to determine vidual essential oils led to the hypothesis that a com- the inhibitory properties of these essential oils; the bination of tea tree and oregano oil would have the bacterial strains that were used included Escherichia greatest antibiotic efcacy. coli (ATCC 11775) and Staphylococcus aureus (ATCC 29213).

Methodology Disc Difusion Te methodology chosen for this study was a modi- fed Kirby-Bauer disc difusion, which was chosen Plate Preparation due to its success in producing results for prior stud- ies conducted by the aforementioned researchers. Tis Te susceptibility of bacteria to essential oil combi- method was chosen because a Kirby-Bauer disc difu- nations was determined using a modifed Kirby-Bauer sion poses minimal risk to healthy individuals and is a disc difusion assay. Twenty-four Mueller-Hinton agar standard procedure used in clinical laboratories to test plates were used to cultivate bacterial cultures; twelve the susceptibility of patient’s bacterial isolates to antibi- plates were used for each bacteria. Each Mueller-Hin- otics (Scheppler et al., 2003); Since this methodology is ton agar plate was divided into four separate quad- ofen used to test antibiotic susceptibility and the goal rants, labelling the respective quadrant on the bottom of this study was to test susceptibility to essential oils, a of the plate. Two categories of plates were tested: con- Kirby-Bauer disc difusion was an appropriate choice trol plates and test plates. Control plates were used to for this study. Additionally, this method utilizes flter determine the inhibitory potential of each essential oil paper discs, which can absorb any solution, making the individually; therefore, no combinations were tested creation of precise essential oil combinations and their on control plates. Test plates were used to obtain data exposure to bacteria a relatively simple process. Finally, for combinations of essential oils. For test plates, these the quantitative nature of a Kirby-Bauer disc difusion quadrants included “Control”, “Oregano and Control”, allows for easy comparison between control and test “Wintergreen and Control”, and “Tyme and Con- groups. Overall, this was an optimal methodology for trol”. For the purpose of this project, the “Control” this study because it provided a safe way to obtain accu- solution is tea tree oil. For control plates, these quad- rate data comparing the inhibitory potential of essential rants included “Tea Tree”, “Oregano”, “Wintergreen”, oils in combination. and “Tyme”. Plates were swabbed evenly with bac- teria, E. coli and S. aureus respectively. To do this, a sterile swab was dipped into the bacterial suspension Materials broth and streaked over the surface of the plate.

Four essential oils that are commonly used for their Disk preparation medicinal properties and commercial purposes [tea tree (leaf) (Melaleuca alternifolia), oregano (fower) Control Plates: Following the swabbing of all agar (Origanum vulgare), thyme linalool (fowering tops) plates, flter paper discs were prepared. Each quadrant (Tymus vulgaris), and wintergreen (leaf) (Gaultheria of an agar plate contained one flter paper disc that procumbens)] were purchased from Plant Terapy at had absorbed a solution for testing; for discs on con- planttherapy.com; one 10 mL container of each essen- trol plates, individual oils were absorbed. Each plate 115 ESSENTIAL OILS AS AN ALTERNATIVE TO CONVENTIONAL ANTIBIOTICS was comprised of one disc per essential oil: tea tree, Data Measurement oregano, wintergreen, and thyme oil (four total oils were tested, meaning one oil was tested per quadrant); Afer 24 hours of incubation, the zone of inhibi- each disc contained 6 µL of solution. Once these discs tion6 was measured in millimetres for each quadrant; were prepared, each was placed in its respective quad- this data was used to arbitrate the inhibition percent- rant using sterilized forceps. Plates were incubated at age. Te inhibition percentage of the bacterial growth 37 °C for 24 hours. was calculated by utilizing the data obtained from test Test Plates: Filter paper discs on the test plates plates. Te three quadrants of the test plate were com- tested combinations of essential oils; these plates were pared to the control quadrant of that respective plate. also composed of one quadrant dedicated to a control Te following equation was used: disc for tea tree oil. For the control quadrant of the test Inhibition Percentage = 100 (T-C) / C, where C is plates, 6 µL of tea tree oil was absorbed by the flter pa- the diameter of the zone of inhibition for the control per discs by directly applying the solution to the disc quadrant (tea tree oil individually) and T is the diam- using a micropipette. Since each disc must contain a eter of the zone of inhibition for the test quadrant. total 6 µL of solution total and the combinations were Considering the goal of this research project was mixed at a 1:1 ratio, combination discs contained 3 µL to evaluate the antibacterial properties of essential of tea tree oil (control solution) and 3 µL of a supple- oils, this methodology was an appropriate choice. Te mentary oil. Once these discs were prepared, each disc modifed Kirby-Bauer disk difusion allowed for data was placed in its respective quadrant using sterilized to be obtained for all combinations and individual es- forceps. Plates were incubated at 37 °C for 24 hours. sential oils; Te dependent variable of the Kirby-Bauer disc difusion (the diameter of the zone of inhibition) corresponded to the goal of this study: measuring the inhibitory potential of essential oil combinations.

Results

Herbs, including essential oils, are defned as any form of a plant product, including leaves, stems, fow- ers, roots, and seeds (Noller, Kumar, Lajis, & Ali, 2008). When evaluating the possible presence of syn- ergistic interactions between select essential oils as bacterial inhibitors, the data that was obtained con- frmed that combining certain essential oils can in- crease their efcacy in certain cases.

Figure 1: Agar Plate Diagram Tis picture provides an example of what a correctly prepared plate will look like afer incubation. Tis plate has four correctly labelled quadrants, each with one fl- ter paper disc containing it respective solution, as de- scribed previously.

6 Te area where bacterial growth was inhibited

116 ESSENTIAL OILS AS AN ALTERNATIVE TO CONVENTIONAL ANTIBIOTICS

TABLE 1: ANOVA SINGLE FACTOR (ESCHERCHIA COLI)

SUMMARY Groups Count Sum Average Variance Column 1 9 142 15.77778 0.694444 Column 2 9 226 25.11111 3.111111 Column 3 9 155 17.22222 5.944444 Column 4 9 187 20.77778 1.444444 ANOVA Source of Variation SS df MS F P-value F crit Between Groups 467.6667 3 155.8889 55.70223 8.43E-13 2.90112 Within Groups 89.55556 32 2.798611 Total 557.2222 35

Te ANOVA single factor test for E. coli test plates shows a P-value of 8.43 x 10-13, signifying that the results of this study concerning the inhibition of E. coli growth are statistically signifcant.

TABLE 2: T TEST: TWO-WAY SAMPLE ASSUMING UNEQUAL VARIANCES (ESHERICHIA COLI) Key A B (Control C (Control + D (Control (Control) + Oregano) Wintergreen) + Tyme Combinations *A-B A-C *A-D *B-C *B-D *C-D T--test P-value 1.8109E-08 0.123522 6.82E-08 1.06E-06 2.79E-05 0.00202 Adjusted P-value 0.008 0.008 0.008 0.008 0.008 0.008

To determine which combinations had a statistical diference, a t test: two-way sample assuming unequal variances was conducted. Te P-value was adjusted from .05 to .008 to account for the six tested combinations. Te resulting P-values from the t-test demonstrated statistically signifcant results for all combinations, exclud- ing the tea-tree and wintergreen oil combination (A-C).

FIGURE 1: ESCHERICHIA COLI: TEST PLATES

117 ESSENTIAL OILS AS AN ALTERNATIVE TO CONVENTIONAL ANTIBIOTICS

TABLE 3: SINGLE FACTOR ANOVA (STAPHYLOCOCCUS AUREUS) SUMMARY Groups Count Sum Average Variance Column 1 9 142 15.77778 0.694444 Column 2 9 226 25.11111 3.111111 Column 3 9 155 17.22222 5.944444 Column 4 9 187 20.77778 1.444444 ANOVA Source of SS df MS F P-value F crit Variation Between Groups 467.6667 3 55.70223 55.70223 8.43E-13 467.6667 Within Groups 89.55556 32 2.798611 Total 557.2222 35

A single factor ANOVA test was conducted to determine if the results concerning the microorganism Staphy- lococcus aureus were statistically signifcant. With a P-value of 8.43 x 10-13, the results can be deemed statistically signifcant.

TABLE 4: T TEST: TWO-WAY SAMPLE ASSUMING UNEQUAL VARIANCES (STAPHYLOCOCCUS AUREUS) Key A B (Control + C (Control + D (Control (Control) Oregano) Wintergreen) + Tyme) Combination *AB *AC AD *BC *BD *CD T-test P-value 4.32E-08 1.88E-05 0.218088 6.94E-12 8.93E-08 2.31E-08 Adjusted 0.008 0.008 0.008 0.008 0.008 0.008 P-value

A t test: two way sample assuming unequal variances was conducted to determine which combinations had statistically signifcant results concerning their potential synergistic interactions and the inhibition of Staphy- lococcus aureus growth. Te P-value was adjusted from .05 to .008 to account for the six combinations. Te results show that all combinations proved a statistical diference except for control and thyme oil (tea tree and thyme oil).

FIGURE 2: STAPHYLOCOCCUS AUREUS: TEST PLATES

118 ESSENTIAL OILS AS AN ALTERNATIVE TO CONVENTIONAL ANTIBIOTICS

SUMMARY TABLE 5: INHIBITON PERCENTAGE (ESCHERICHIA COLI) TABLE 6: INHIBITON PERCENTAGE (STAPH- YLOCOCCUS AUREUS) Groups Count Sum Average Variance Column 1 9 142 15.77778 0.694444 Plate number Control + Oregano Control + Wintergreen Control + Tyme Column 2 9 226 25.11111 3.111111 Plate 1 62.50% 6.25% 37.50% Column 3 9 155 17.22222 5.944444 Plate 2 46.67% 6.67% 33.33% Column 4 9 187 20.77778 1.444444 Plate 3 50% 25% 25% Plate 4 62.50% 6.25% 37.50% Plate 5 60% 13.33% 46.67% Plate 6 52.94% 17.65% 17.65% Plate 7 41.18% 17.65% 17.65% Plate 8 73.33% 0% 46.67% Plate 9 86.67% -13.33% 26.67% Average 59.53% 8.83% 32.07%

TABLE 6: INHIBITON PERCENTAGE (STAPHYLOCOCCUS AUREUS) Plate number Control + Oregano Control + Wintergreen Control + Tyme Plate 1 62.50% -43.75% 0% Plate 2 78.57% -21.43% 21.43% Plate 3 64.29% -21.43% 14.29% Plate 4 40% -33.33% 6.67% Plate 5 66.67% -33.33% 6.67% Plate 6 76.92% -15.34% 23.08% Plate 7 38.89% -63.64% -5.56% Plate 8 43.75% -37.50% 6.25% Plate 9 31.58% -31.58% -10.53% Average 55.91% -33.48% 7%

Discussion When analyzing the statistically signifcant re- sults and looking at the potentially synergistic com- Te results of this study signify the presence of binations, it is apparent that the combination with synergistic interactions between tea tree and oregano the highest mean inhibition zone diameter (IZD) is oil, making it the combination that is most efective Control-Oregano (tea tree and oregano oil) for both at inhibiting bacterial growth for both E. coli and S. bacteria. Tis illustrates that the combination with aureus. Tese fndings supported the initial hypothe- the greatest antibacterial potential is control-oregano sis that the combination with the greatest antibacterial (Figure 1 & Figure 2). Te inhibition percentages for efcacy would be tea tree and oregano oil. E. coli further support the claim that the control-oreg- 119 ESSENTIAL OILS AS AN ALTERNATIVE TO CONVENTIONAL ANTIBIOTICS ano combination has the greatest antibacterial efca- tion of tea tree and wintergreen oil was not proven to cy; the average inhibition percentage for the control- have a statistical diference from the control, mean- oregano combination was 59.53 percent, meaning that ing that the addition of wintergreen oil to tea tree this combination’s IZD was 59.53 percent larger than oil did not have any efect on the solutions antibiotic the control groups IZD. Furthermore, this inhibi- efcacy; however, this combination did prove a sta- tion percentage is considerably larger than that of the tistical diference for S. aureus. Unlike the tea tree/ other two combinations, further supporting the data oregano oil combination, the tea tree/wintergreen oil demonstrated by the ANOVA, TTEST, and averages combination had antagonistic efects on the growth IZDs (Table 5). Te inhibition percentages for S. au- of S. aureus. While the average IZD for tea tree oil reus also demonstrate the antibacterial efcacy of the alone was 15.6 mm, the average IZD for tea tree and control-oregano combination; the average inhibition wintergreen oil was 10.7 mm, decreasing the zone of percentage for the control-oregano combination was inhibition by 33.5% (Figure 2). Tis is a signifcant 55.91 percent. Tis inhibition percentage is consider- fnding because the tea tree/wintergreen combination ably larger than that of the other two combinations. In was the only tested solution that led to a smaller IZD addition to the synergistic interaction that is demon- for either bacteria. From this case, one can conclude strated by this data, one can see how the combination that although combining essential oils consistently of wintergreen and tea tree oil is antagonistic with an led to an increase in efcacy, it is possible for a com- inhibition percentage of -33.48%. bination to have adverse efects. Should the tea tree/ Tese results gave way to a variety of fascinating wintergreen solution be used in a medical setting to fndings. For both E. coli and S. aureus, the tea tree treat a S. aureus infection, the results would have been and oregano oil combination had the greatest degree detrimental to the patient because of the antagonis- of antibacterial efcacy with an inhibition percentage tic relationship between these oils; with this in mind, of 59.53% (E. coli – Table 5) and 55.91% (S. aureus it is important that one understands that combining – Table 6); however, the t-test proved that the same essential oils can increase and decrease antibacterial combinations did not elicit the same results for both efcacy in certain cases. bacteria. Te combinations that proved a statistical Prior studies and literature stress the urgent need diference for E. coli were tea tree/oregano oil and tea to address the increasing growth of antibiotic resistant tree/thyme oil (Table 3) when the values were com- bacteria, as the increasing use of antibiotics has led pared to the control (tea tree oil alone). Te combina- to greater antibiotic resistance and there is a need to tions that proved a statistical diference for S. aureus identify an alternative treatment method. When ana- were tea tree/oregano oil and tea tree/wintergreen oil lyzing the data presented in the study, it is apparent (Table 4). Tese results show that combining essen- that essential oils do have antibacterial properties and tial oils does cause a change in efcacy, although this their efcacy can be increased by combining them change is not consistent between bacterial species. with supplementary oils; in particular, the combina- Further analyzing these results, it is apparent that tion of tea tree and oregano oil had the greatest in- utilizing essential oils as a medical treatment would crease in antibacterial efcacy; however, the next step, require a deeper understanding of how the inhibi- afer identifying the particularly efective essential oil tory potential of an oil will change in the presence of solutions, is to implement natural and holistic medi- various bacteria. Tis assertion is further supported cine into treatment regimens. While holistic medicine by the work of Ott and Morris (2008), whose study is unconventional in the United States, it is the main demonstrates that the inhibitory potential of essential form of medicine in 80% of the currently developing oils individually will vary based on the bacterial spe- world and was used by ancient civilizations for over cies being tested. 5,000 years; furthermore, plants and plant-based solu- Furthermore, the results demonstrated that com- tions make up 20% of pharmaceuticals in the United bining essential oils does not always lead to an in- States (Noller, Kumar, Lajis, & Ali, 2008). Considering crease in antibiotic efcacy. For E. coli, the combina- their widespread use, essential oils could be used as

7 Nephropathy- medical term used to denote disease or damage of the kidney, which can eventually result in kidney failure

120 ESSENTIAL OILS AS AN ALTERNATIVE TO CONVENTIONAL ANTIBIOTICS a frst line of defence for fghting bacterial infections (essential oils) be put in place, patients and medical in the United States and ultimately across the world; professionals would likely become more confdent in thus, patients could initially address their infections the efcacy of essential oils. with natural medicine and utilize conventional antibi- Te results of this research examined the presence otics if the essential oils or herbs were not producing of synergistic interactions between select essential the desired efects. Tis solution would allow physi- oils, with the combination of tea tree and oregano oil cians to prescribe fewer antibiotics, limiting the sur- having the greatest antibacterial efcacy. However, vival of antibiotic resistant bacteria and the toxic side this study only addressed four essential oils: tea tree, efects of antibiotic usage. oregano, wintergreen, and thyme oil; further research While the results of this study demonstrate an opti- could be conducted to look into potential synergistic, mistic future for essential oils as an alternative to con- or antagonistic interactions, between other essential ventional antibiotics, there are limitations concerning oils. Prior research shows that other oils that were not this research project and the use of essential oils as tested in this study, such as citrus and curry oil, also a treatment option. Regarding the execution of this exhibited relatively high antibacterial efcacies (Ott methodology, there was potential for contamination & Morris, 2008). Conducting research on these oils when swabbing the agar plates and transitioning them could reveal a combination that has a higher degree from the biosafety cabinet to the incubator. of efcacy than those in this study. Furthermore, this One limitation regarding the use of natural medi- study only addressed oils in combination with tea tree cine as a treatment is a lack of regulation. According oil; in the future, combining other oils, such as pure to Stephen Bent (2008), herbs are currently defned oregano oil with other oils, may provide additional in- by law as dietary supplements, meaning that manu- formation surrounding medical implications. facturers can produce, sell, and market herbs without Not only could one look into other combinations in demonstrating their efcacy or safety. Additionally, in the future, but using the tested combinations on other order for a “dietary supplement” (i.e. natural medi- bacteria would allow researchers to gain a deeper un- cine and essential oils) to be removed from the mar- derstanding of how changing the bacteria afects the ket, it must be deemed unsafe by the FDA, directly efcacy of the essential oils. As discussed earlier, the contrasting to the regulation of drugs, which must be results for E. coli and S. aureus were diferent, showing proven as safe and efective by the FDA before they that the results for one bacteria are not applicable to can be sold (Bent, 2008). Tis regulatory structure, all. In addition, this study did not compare essential or lack thereof, limits the reliability of essential oils oils directly to antibiotics, but rather compared com- and natural medicine and their use as a medical treat- binations to individual oils. In the future, a study com- ment. In conjunction with a lack of regulation is the paring the combinations with the greatest efcacy to potential for contamination when producing essential antibiotics directly would not only allow for a greater oils (Hosihuzzaman & Iqbal Chaudhary, 2008). Tis understanding of how essential oils inhibit bacterial contamination, in extreme cases, can lead to the toxic- growth but also demonstrate their efcacy in com- ity of essential oils; in the past, contamination has led parison to other treatment options. to reports of nephropathy7 caused by commonly used Overall, the results of this study demonstrated that Chinese herbs; of the nephropathy cases, 43 patients synergistic interactions are present between select developed end-stage renal failure and 39 had prophy- essential oils and of all the combinations that were lactic renal removal (Bent, 2008). Tese cases have tested, tea tree and oregano oil had the greatest inhibi- demonstrated how contamination and lack of regula- tory potential. Using this data, one can identify new, tion of essential oils can have implications regarding innovative ways to combat bacterial infections, par- their medical usage. With potential contamination ticularly of the bacteria that were studied: Escherichia putting the health of the patient at risk, it is difcult coli and Staphylococcus aureus. While antibiotics are to implement essential oils into treatment regimens. commonly used to treat patients with bacterial infec- Should more stringent regulations concerning the tions, the results of this study show that essential oils marketing and production of dietary supplements can be an efective treatment option, particularly if combinations with high efcacy are utilized. 121 ESSENTIAL OILS AS AN ALTERNATIVE TO CONVENTIONAL ANTIBIOTICS

Richardson, L. A. (2017). Understanding and Overcoming References Antibiotic Resistance . PLOS: Biology, 1-5. Roa, Q., Shang, W., Hu, X., & Rao, X. (2015). Adabara, N., Ezugwu, B., Momojimoh, A., Madzu, A., Staphylococcus aureus ST121: A Globally Disseminated Hashiimu, Z., & Damisa, D. (2012). Te Prevalence and Hypervirulent Clone. Journal of Medical Microbiology, Antibiotic Susceptibility Pattern of Salmonella typhi 1462-1473. among Patients Attending a Military Hospital in Minna, Scheppler, J., Sethakorn, N., & Styer, S. (2003). CULTURED Nigeria. Advances in Preventative Medicine. INQUIRY: Students learn about the scientifc process and Alizadeh, S., Arzani, K., Omidgeigi, R., & Safaie, N. (2010). gain critical thinkingskills through disc difusion assays. Essential Oils Inhibit Mycelial Growth of Rhizopus National Science Teachers Association, 56-61. Stolonifer . European Journal of Horticultureal Science , 278-282. Bent, S. (2008). Herbal Medicine in the United States: Review of Efciacy, Safety, and Regulation. San Fransisco: Grand Rounds at University of California . Bodeker, G., Buford, G., Chamberlain, J., Chamberlain, J., & Bhat, K. (2001). Te Underexploited Medicinal Potential of Azadirachta indica A. Juss (Meliaceae) and Acacia ni- lotica (L.) Willd. ex Del. (Leguminosae) in sub-Saharan Africa: a Case for Review of Priorities . Te International Forestry Review , 285-298. Center for Disease Control . (2017, August 18). Antibiotic/ Antimicrobial Resistance . Retrieved from Centers for Disease Control and Prevention : https://www.cdc.gov/ drugresistance/index.html European Medicines Agency. (2014, February 5). Quality of essential oils as active substances in herbal medicinal prod- ucts/traditional herbal medicinal products. Retrieved from European Medicines Agency: http://www.ema.europa. eu/ema/index.jsp?curl=pages/regulation/general/gen- eral_content_000712.jsp&mid=WC0b01ac0580033a9b Gorman, C. (2011). E. coli on the March. Scientifc American, 26. Henry, J. Expert Advisor. Hosihuzzaman, M., & Iqbal Chaudhary, M. (2008). Protocols on Safety, Efcacy, Standardization, and Documentation of Herbal Medicine. Pure and Applied Chemistry, 2195-2230. Laxminarayan, R., & Brown, G. M. (2000). Economics of Antibiotic Resistance: A Teory of Optimal Use. Resources for the Future, 0-36. Miskinyte, M., Sousa, A., Ramiro, R., Mourna de Sousa, J., Kotlinowski, J., Caramalho, I., . . . Gordo, I. (2013). Te Genetic Basis of Escherichia coli Pathoadaptation to Macrophages. PLOS: Pathogens. Morris, A. (2010). Investigation of Essential Oils as Antibiotic. Te American Biology Teacher, 49-500. Ott, J. A., & Morris, A. N. (2008). Homeopathic Alternatives to Conventional Antibiotics. Bios, 50-55.

122 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018

Does CBD Induce Apoptosis in Difuse Large B Cell Lymphoma?

Sophia Xu

Tis study assessed the ability of cannabidiol (CBD), a compound derived from cannabis, to induce apoptosis in difuse large B-cell lymphoma (DLBCL). Tis experiment consisted of cell viability as- says and apoptosis assays, both of which measure important qualities needed in cancer treatment. CBD demonstrated a strong capability in inhibiting cell viability, at concentrations near 50-100 uM, thereby emphasizing its potential in minimizing relapse. CBD actively induced apoptosis at concentrations above 25 uM, with apoptosis frequencies reaching nearly 100%. Tese results reinforce the idea that CBD induces apoptosis throughout many diferent types of cancers, includ- ing DLBCL. Tus, this study demonstrates that CBD has a great potential in cancer treatment by eradicating cancer cells in DLBCL.

Keywords: CBD, DLBCL, Apoptosis, Cell Viability, Cancer Treatment

are a number of treatments for Non-Hodgkin lym- Introduction phoma, ranging from chemotherapy and radiation to immunotherapy (“American Cancer Society,” n.d.). Te need to fnd a solution to the medical world’s However, each method of treatment has its own nega- leading problem of cancer rises each year, as the pro- tive aspects that indicates the need for more efective jected increase of deaths as a result of cancer are ex- treatment. For example, these treatments are extreme- pected to grow from 8.2 million in 2012 to 23 mil- ly expensive, averaging at 5,871 USD a month, making lion in 2030 (“Cancer Statistics,” n.d.). Within that this option unafordable to many families and ofen statistic, Non-Hodgkin lymphoma is recognized as cutting treatment short, consequently afecting the one of the most common cancers in the United States, potential of relapse (Kutikova et al., 2006). Addition- responsible for a predicted 74,680 diagnoses in 2018 ally, chemotherapy and radiation are associated with (“Key Statistics for Non-Hodgkin Lymphoma,” n.d.). negative side efects such as extreme fatigue, nausea, Tis increase in diagnoses emphasizes the importance vomiting, and most notably, hair loss, which can be of developing efective treatments for this cancer. uncomfortable for patients and should be addressed Non-Hodgkin lymphoma primarily afects T lympho- in the development of new treatments (“American So- cytes and B lymphocytes, which results in a decreased ciety of Clinical Oncology,” 2017). Most importantly, ability to resist pathogens (“American Cancer Soci- chemotherapy and radiation are nonspecifc tech- ety,” n.d.). In a very aggressive form of Non-Hodgkin niques, meaning that these treatments will not only lymphoma, known as difuse large B-cell lymphoma target malignant cells, but will also attack the body’s (DLBCL), B-lymphocytes enlarge and multiply out own healthy cells (“Chemotherapy to Treat Cancer,” of control to form tumours. DLBCL accounts for 30- 2015). Tis consequently weakens the immune system 40% of all Non-Hodgkin lymphoma cases and is ofen and the patient’s overall health, resulting in a longer be fatal, if untreated, suggesting the importance of ad- and extremely debilitating recovery process. Tus, dressing this disease (Li et al., 2018). Currently, there there arises a clear need to fnd better treatment for 123 DOES CBD INDUCE APOPTOSIS IN DIFFUSE LARGE B CELL LYMPHOMA?

DLBCL that is able to address the problems associated (Wilcox, 2017). Tese receptors are responsible for with current treatments. releasing chemical signals, producing the “high” ef- Recently, studies have pointed towards cannabi- fect of marijuana in the brain (Mackie, 2008). Tus, noids, compounds derived from cannabis, as a plau- in order to minimize any ethical concerns, this paper sible treatment for cancers (Lee, 2012). Tese canna- will be limited to CBD rather than the psychoactive binoids have long been known for their therapeutic cannabis compound Δ9-THC. agents by alleviating pain and nausea, but their rela- CBD represents a strong potential candidate for tionship in the study of cancer is relatively new (Gro- cancer treatment as it addresses many of these prob- tenhermen & Muller-Vahl, 2012). Even so, positive lems associated with current treatments. Not only is efects of cannabinoids have been noted for certain cannabidiol associated with therapeutic efects such as cancers. In 2008, a team of Harvard scientists demon- the alleviation of pain and nausea, thereby countering strated that the cannabinoid Δ9-tetrahydrocannabinol the negative side efects from current treatment, but (Δ9-THC) signifcantly reduced the spread of lung CBD has proven to solely target cancer cells, ensuring cancer (Preet et al., 2007). Similarly, cannabidiol that the body’s own healthy cells will not be attacked (CBD) activates cell death in aggressive breast cancer (Massi et al., 2006). Tus, CBD addresses the most cells through the intrinsic apoptotic pathway (Ligresti important concern with current cancer treatments, in et al., 2006). Tese benefts have contributed to the that CBD would result in a stronger recovery process. increased interest in cannabinoids and their potential Furthermore, a CBD drug might be more fnancially in the realm of cancer treatment. While these can- afordable for families. Altogether, CBD could provide nabinoids have been increasingly researched among a much better option for cancer patients in terms of diferent cancers, there is a notable gap in research cost, health, and efciency. Tis study will focus on concerning cannabinoids and their functions in lym- the efect of CBD on DLBCL. phoma, presumably because lymphoma already has Ultimately, the purpose of cancer treatment is to efective treatment described above, whereas in other eradicate cancerous cells that form tumours. In terms cancers, such as breast cancer, these treatments are of current cancer treatments, radiation uses electro- not as efective, especially in the latter stages. Yet, as magnetic waves to eradicate these cells. Chemother- previously indicated, these treatments come with se- apy focuses on the special ability of these cancerous vere consequences and need to be addressed with the cells to multiply rapidly in order to target and ef- development of new cancer treatments. As such, this fectively eradicate these cells. In this case, apoptosis paper will focus on the therapeutic relations that can- would be the mechanism by which CBD would pos- nabinoids have with Non-Hodgkin Lymphoma. sibly eradicate DLBCL cells. As a result, this paper will Tere are many diferent types of cannabinoids, evaluate the degree at which CBD induces apoptosis each of which has notable positive efects on the hu- in DLBCL cells as an indicator of its potential as can- man body. Out of those cannabinoids, Δ9-THC and cer treatment. CBD have been most commonly researched in terms Apoptosis refers to programmed cell death in that of cancer treatment. However, there are certain con- this type of cell death follows a very systematic ap- cerns that arise with the use of cannabinoids as drugs. proach. Tere are generally two methods to induce Tese cannabinoids are extracted from cannabis, cell death: apoptosis and necrosis. Necrosis involves more commonly known as marijuana. While these an external factor, such as a puncture, that induces cannabinoids would be used strictly for its medical death. As a result, necrosis causes harm in the human applications, cannabis is known for its psychoactive body due to infammation in the area surrounding the or “high” efect, and this drug can be abused for other wound. In contrast, apoptosis involves the collapse of reasons. However, it is important to note that the key the cell and is therefore what this paper will measure diference between these two cannabinoids is that Δ9- since apoptosis would harm the patient less in com- THC demonstrates this psychoactive efect, whereas parison to necrosis. Te process of apoptosis can be CBD lacks it (Kohn, 2016). In fact, CBD has been conducted in numerous ways. Ultimately, when the shown to reduce these psychoactive efects, due to the cell prepares for its death, proteins known as caspases absence of a large binding afnity for CB1 receptors are activated to break down the cellular components 124 DOES CBD INDUCE APOPTOSIS IN DIFFUSE LARGE B CELL LYMPHOMA? that are required for the cell to survive (Elmore, 2007). wards breast cancer cells. Te study also indicated that For example, the activation of caspases initiates the among the possible underlying mechanisms involved enzymes, DNases, to destroy the nucleus, including in this inhibition, CBD directly activated the capsaicin the DNA, of the cell, which contributes to its demise receptor (TrpV1). Tis receptor functions primarily to (Enari et al., 1998). Once the cell collapses, macro- detect and regulate body temperature, which could af- phages are sent to remove these cells, making the pro- fect these tumour-related activities. Additionally, the cess overall very clean, and thus producing no harm- activation of TrpV1 may have indirectly activated CB2 ful efect parallel to that of necrosis (Fink & Cookson, receptors via oxidative stress. Tese CB2 receptors are 2005). Te two major pathways involved in apoptosis directly involved in immune suppression, the induc- are the extrinsic pathway or death receptor activated tion of apoptosis, and the induction of cell migration pathway and the intrinsic or mitochondrial pathway (Basu et al., 2011). In 2011, another study concluded (Elmore, 2007). Each of these mechanisms of apopto- that CBD induces apoptosis through mitochondrial- sis is critical to understanding the processes that CBD mediation in breast cancer (Shrivastava et al., 2011). may undertake in conducting apoptosis in DLBCL. Tus, CBD alters tumour-related activities in breast Tis study consists of two experiments: one which cancer and potentially induces apoptosis through assesses the efect of CBD on cell viability and one various mechanisms including the activation of CB2 which assesses the efect of CBD on apoptosis. Both of receptors and mitochondrial-mediation, as demon- these measures are important qualities of cancer treat- strated by both studies (Ligresti et al., 2006; Shrivas- ment that needs to be evaluated. Cell viability evalu- tava et al., 2011). ates the potential for a cell to recover from treatment, In glioma, numerous mechanisms for apoptosis have thereby determining the extent at which CBD can re- been identifed, including the release of cytochrome C duce the potential for relapse in patients. On the other and the activation of caspase-9 and caspase-8 pathways hand, the apoptosis assay measures the ability of CBD (Massi et al., 2006). Cytochrome c plays an active role to induce cell death in DLBCL and determine the best in ATP synthesis in the mitochondria, and its release concentration for a drug. from the mitochondria to the cytosol is associated with the activation of a caspase cascade, thereby trig- gering apoptosis (Ow et al., 2008). Additionally, while Literature Review CBD suppressed proliferation of human glioma cell lines, there was no reported efect of CBD on healthy Te research of cannabinoids in the feld of cancer monocytes (Massi et al., 2006). Tis suggests that CBD has largely pertained to other cancers and is specif- is specifc to cancerous cells and solely induces apopto- cally lacking in the realm of lymphoma. Tus, the gap sis in afected, cancerous cells in glioma. Tis fnding is in research is determining how CBD interacts with signifcant since healthy human body cells were unaf- DLBCL. However, it is also important to understand fected, while cancer cells were destroyed. Furthermore, the mechanisms by which CBD interacts with various this result directly addresses issues with chemotherapy cancers to provide information that could be used for and radiation and their inability to diferentiate be- this experiment. As such, this paper recognizes the tween healthy and cancer cells. relationship between CBD and breast cancer, glioma, In Leukemia, CBD led to CB2 mediated reduction and leukemia, as these studies have proven to yield and activation of caspase-8, caspase-9, and caspase-3 promising results that are comparable to those of this (McKallip et al., 2006). Furthermore, CBD exposure research. initiated the breakdown of the mitochondrial mem- In breast cancer, CBD was found to efectively in- brane and release of cytochrome C (McKallip et al., hibit breast cancer cell proliferation through the down 2006). All of these mechanisms are correlated with the regulation of Id-1 expression, which is responsible for induction of apoptosis. Correspondingly with glioma, tumour proliferation, migration, and invasion when CBD had no efect on healthy human monocytes, found in high quantities (Ligresti et al., 2006). Tus, whereas it induced apoptosis in cancer cells (Gallily et CBD has been shown to efectively inhibit the activi- al., 2003). Tis suggests that this characteristic could ties of tumours, correlating to a strong response to- be replicated across diferent types of cancers. 125 DOES CBD INDUCE APOPTOSIS IN DIFFUSE LARGE B CELL LYMPHOMA?

Te similarities and relationships in how CBD in- uM, 3.1 uM, 6.25 uM, 12.5 uM, 25 uM, 50 uM, and duces apoptosis in various cancers suggests a link be- 100 uM of CBD were used. Tese concentrations were tween intrinsic and extrinsic apoptotic pathways. For established by a serial dilution to evaluate cell viabil- example, an increasingly dominant reaction of CBD ity on a greater spectrum. Te apoptosis assays used on cancer cells is the release of cytochrome c, which the same concentrations, with the exception of 100 is associated with the intrinsic pathway in apoptosis, uM. Te primary reason for the omission of 100 uM suggesting that this may be a common characteristic is that an apoptotic trend can be established in lower of CBD-induced apoptosis. Based upon these studies, concentrations. However, in order to consider CBD’s CBD seems to conduct apoptosis in a consistent meth- implications as a drug, it will be necessary to evalu- od through the release of cytochrome c and the activa- ate the most efective concentration at which CBD tion of caspases. On the other hand, it is presently un- inhibits both cell viability and induce apoptosis. Tus, clear as to how CBD induces apoptosis and the method the same concentrations from the cell viability assays through which this occurs, specifcally in DLBCL. were used for the apoptosis assays (with the excep- However, based upon the successful conduction of tion of 100 uM) in order to efectively compare each apoptosis in breast cancer, glioma, and leukemia, it is concentration point and determine possible drug likely that CBD will also induce apoptosis in DLBCL. concentrations required for treatment in the future. Cannabidiol was obtained from Tocris Cookson Inc. (Ellisville, MO). For therapeutic compound screen- Materials and Methods ings, CBD was prepared as 1000-fold stock solutions in tissue culture grade dimethyl sulfoxide (DMSO) in DLBCL cell lines were established in the labora- order to freeze the cells to prevent the formation of tory. Tese cell lines were extracted from a total of 24 crystals that may damage the cells and produce inac- patient samples. As a basic growth medium, 1% peni- curate data. Te fnal concentration of DMSO in me- cillin/streptomycin (Hyclone, Logan, UT, USA) was dia was 0.1%, a concentration that has shown no tox- used with cell culture of RPMI-1640 medium (Gibco, icity or efect on the DLBCL cells. For the cell viability Rockville, MD, USA) and 15% fetal calf serum (Gib- assay, cells from representative DLBCL cell lines were co). All 24 cell lines (CJ, LP, RC, TMD-8, WP, LY-19, plated at 5,000 cells per well, with 20 uL medium and MZ, 8LR, HT, MS, Toledo, BJAB, u2392, DS, Pheifer, 10% fetal bovine serum to acquire ample data to accu- McA, SUDHL-4, HF, SUDHL-6, HBL-1, DB, EJ, Val) rately establish a conclusion. Tese cells were incubat- were routinely tested for any small parasitic bacteria, ed for 96 hours, as per apoptosis protocol, and DMSO also known as mycoplasma, using a MycoSEQ™ My- was added. Fetal bovine serum is used primarily for its coplasma Detection kit (Invitrogen, Carlsbad, CA, low level of antibodies and many growth factors. Te USA). Tis step is particularly important as mycoplas- cell viability assays were performed using the Cellt- ma can induce morphological changes, alter growth iter-Glo Luminescent Cell Viability Assay (Promega, rates, and efectively alter the cell viability assays to Madison, WI, USA) by adding CellTiter-Glo Reagent be conducted (“Mycoplasma Detection and Elimina- and recording luminescence. For the apoptosis assays, tion,” n.d.). Tese stocks of authenticated cell lines the cells were incubated for 48 hours with the appro- were then stored in liquid nitrogen to guarantee that priate CBD dilution and DMSO was added. Only the the cells and growth medium would not evaporate. cell line RC was used in the assay in order to mini- Two experiments were conducted: the cell viability mize time constraints. Unlike the cell viability assays, assay and the apoptosis assay. Te cell viability assay the induction of apoptosis will not difer per cell line. measures the ability of the DLBCL cells to recover Tus, a general trend can be concluded and extended afer exposure to CBD, thereby measuring its ability from the apoptosis assay, suggesting that one cell line to relapse. Te apoptosis assay was used to measure will sufce. Te Annexin V/PI staining method, with the degree at which CBD would be able to induce cell fow cytometry, was used to assess apoptosis. Te as- death in cancerous cells and is the precursor in de- says were performed in duplicate. Statistical analysis termining the efcacy of a drug for treating cancer. consisted of standard deviation in the cell viability as- For the cell viability assay, concentrations of 0 uM, 1.5 says to determine the precision of these trials. 126 DOES CBD INDUCE APOPTOSIS IN DIFFUSE LARGE B CELL LYMPHOMA?

demonstrated by the various starting points of each Results trend for the cell lines. Using this control, a compari- son can be made to determine the efectiveness of var- Cell Viability Assays ious CBD concentrations by contrasting the number of viable cells lef to the control. Control- Te control for the cell viability assays Variables- Te primary variable that was manipu- was established through untreated cells in each cell lated in the cell viability assay was the CBD concen- line, exhibited by the 0 uM column in Figure 1, Figure tration in order to establish both the efectivity of 2, and Figure 3 below. Tis information is important each concentration and address the implications of because cell viability difers per trial per cell line, as CBD as a drug. Tis information will be particularly

Cell Lines 1-8 Table 1. Average Cell Viability count of DLBCL cell lines 1-8 (CJ, LP, RC, TMD-8, WP, LY-3, LY-19, MZ). Averages are taken from three trials of each cell line.

Figure 1. Tis graph corresponds to the set of values in Table 1. In each cell line, a general, predicted downward trend is established in each cell line. From 50 - 100 uM, each cell line exhibits the lowest cell viability count. Error bars represent standard deviation. 127 DOES CBD INDUCE APOPTOSIS IN DIFFUSE LARGE B CELL LYMPHOMA?

Cell Lines 9-16 Table 2. Average Cell Viability count of DLBCL cell lines 9-16 (8LR, HT, MS, Toledo, BJAB, u2392, DS, Pheifer). Averages are taken from three trials of each cell line.

Figure 2. This graph corresponds to the set of values in Table 2. In each cell line, a general, predicted down- ward trend is established in each cell line. Once again, each cell line exhibits the greatest reduction in cell viability count from 50 -100 uM. important in understanding the necessary concentra- stable decrease in cell viability, from the control to 0 tions of CBD for a viable drug treatment. Tus, this viable cells at 100 uM. Another variable includes the experiment is dose-dependent and should produce a 24 cell lines that were tested. In Figure 1, Figure 2, and dose-dependent trend downwards. A serial dilution Figure 3, the results of the cell lines are divided into was established in which each dosage was half of the three groups of eight cell lines, labelled accordingly. previous concentration. Tus, with these concentra- Te groupings of these cell lines demonstrate the dif- tions ranging from 0 uM to 100 uM, a wide spectrum ference in days in which the assays were performed. is created to examine the ability of CBD to inhibit Te structuring of these experiments into three cell viability at all concentrations, in comparison to a groups helps to ensure that any possible mistakes that limited scope that may exclude this potential. Ideally, may have occurred would not afect all 24 cell lines. these dose response graphs would depict a relatively 128 DOES CBD INDUCE APOPTOSIS IN DIFFUSE LARGE B CELL LYMPHOMA?

Cell Lines 17-24 Table 3. Average Cell Viability count of DLBCL cell lines 17-24 (McA, SUDHL-4, HF, SUDHL-6, HBL-1, DB, EJ, Val). Averages are taken from three trials of each cell line.

Figure 3. Tis graph corresponds to the set of values in Table 3. In each cell line, a general, predicted downward trend is established in each cell line. Tere are minimal increases depending on the cell line. In these trends, the low- est cell viability count and greatest decrease begins at 25 uM and continues until 100 uM.

Results (Figures 1-3). As seen in Figures 1-3, a reduction in cell viability by 100 uM, suggesting that general downward trend is established in each cell CBD is efective in inhibiting cell viability. Generally, line. Tis trend fuctuated near the initial cell viability at 100 uM, cell viability is most efectively inhibited, values and remained stagnant until a certain concen- with the exception of cell line MZ. Te tables corre- tration. In Figure 1 and Figure 2, an abrupt decrease spond with the data presented in the graph, in order is depicted at 50 uM. On the other hand, this same to concisely show the points used. Te cell viability decrease occurs at Figure 3 at 25 uM. Additionally, data listed in the table were taken as the average of in Figures 1-3, all graphs demonstrate a signifcant three trials in order to ensure accuracy. 129 DOES CBD INDUCE APOPTOSIS IN DIFFUSE LARGE B CELL LYMPHOMA?

Cell Line RC Table 4. Tis table indicates the frequency of apoptosis in cell line RC (cell line 3). Tese concentrations were established from the cell viability assays.

Figure 4. Tis graph corresponds to the set of values in Table 4.

Apoptosis Assays lishment of a control at 0 uM allows for an efective comparison to determine the apoptotic frequencies Control- In the apoptosis assays, the control was that were induced as a result of CBD, rather than by established when CBD had a concentration of 0 uM, the cell’s own function. as seen in Figure 4. Tis control installs the basis for Variable- Te primary variable that was manipu- the apoptosis assays, allowing for comparison to see lated was CBD concentration. While a serial dilution if CBD induces apoptosis or inhibits apoptosis. Since was also utilized, the concentrations ranged from 0 the cells can conduct apoptosis themselves, the estab- uM to 50 uM as apoptotic frequency as 50 uM suf- 130 DOES CBD INDUCE APOPTOSIS IN DIFFUSE LARGE B CELL LYMPHOMA? fced to indicate a successful conduction of apoptosis Standard deviation varies per cell line per trial sug- in the cell line. Te dependent variable measured the gesting a wide variance in the data. Tis would suggest frequency of apoptosis. that these results are not consistent and can vary thor- Results (Figure 4/ Table 4). As seen in Figure 4, an oughly. However, the calculated coefcient of variation, increasing, positive trend is established in the apopto- used to measure relative variability, is less than 100% sis assays in cell line RC. Interestingly, the frequency for the cell lines. Tus, while the standard deviation is of apoptosis at 3.1 uM is lower than the control. Gen- large at some concentrations for certain cell lines, this erally, a dosage curve for apoptosis should increase variability is accounted for by the coefcient of varia- exponentially when corresponded with a serial dilu- tion, thus afrming that these results are plausible. tion. Between 6.2 uM and 25 uM, a steady increase Analysis of Apoptosis Assay (Figure 4/Table 4). A in apoptotic frequency is established. Te highest higher frequency of apoptosis indicates a greater ca- frequency of apoptosis is established at 25 uM and 50 pability of CBD to inhibit cancer cells. Terefore, the uM, at nearly 100%. expected general trend is a continuous increase in apoptosis frequency as concentration increases. Tus, if this trend is exhibited, it can be deduced that CBD would be efective in inducing apoptosis and can then Discussion and Analysis be considered for cancer treatment. Contrarily, while CBD demonstrated efective inhibition of cell viabil- Analysis of Cell Viability Assays (Figure 1-3). Te ity, if a negative trend is established in the apoptosis decreasing values for cell viability demonstrate that assays, CBD can be ruled out for its implications as DLBCL was actively inhibited through the exposure a drug. In Figure 4, the positive trend is established of CBD. On the other hand, if cell viability increased where apoptosis frequency increases with concen- from the control, CBD would have adverse efects tration. However, the exception is the concentration by promoting DLBCL. Since cell viability was inhib- at 3.1 uM. Since the control has been established at ited, CBD demonstrates a greater potential in cancer 27.9%, the expectation is that the subsequent concen- treatment. In Figure 1, each line indicates the general trations would yield an apoptosis frequency greater trend of decreasing cell viability, afrming the hy- than this value. Nevertheless, at 3.1 uM, apoptosis pothesis that cell viability will signifcantly decrease frequency decreased from the control, suggesting that as CBD concentration increases. Te exception is cell CBD may actually reduce apoptosis in DLBCL at that line MZ that increases in cell viability from 50 uM concentration. Tis deviation can be attributed to to 100 uM. Tis directly proposes that CBD reduces human error, similar to the cell viability assays, but apoptosis frequencies in high concentrations, refuting should further be looked into for future studies. the hypothesis that cell viability is inhibited. However, From the data presented in Figure 4, the greatest this event can be explained by sources of error. It is reduction, found by the slope, occurs at 12.5 uM, with likely that the well-received varying amounts of CBD 25-50 uM having the greatest apoptosis frequency at due to air bubbles in the pipet or cells may have been nearly 100%. Tis suggests that studies looking into picked up from earlier trials, which will all contribute the plausibility of CBD as a drug for DLBCL should to inconsistent data readings. Since the other cell lines focus on the concentration range of 25-50 uM. follow the trend without variations, this is likely a con- Discussion (Figures 1-4/ Tables 1-4). Te purpose sequence of human error. of this research is to ultimately determine whether In all of the fgures, the general trend seems to be a CBD can induce apoptosis in DLBCL, as this repre- stabilizing efect with minimal changes to cell viability, sents the essential marker for cancer treatment. Te followed by a large decrease in cell viability. Te points induction of apoptosis in cancerous cells represents at which this extensive reduction occurs will be impor- the frst step in developing cancer treatment, since tant in determining adequate concentrations for a po- the primary goal is to eradicate cancerous cells. While tential CBD drug. In both Figure 2 and Figure 3, this apoptosis was the primary focus of this experiment, reduction occurs at 50 uM and continues until 100 uM, both cell viability and apoptosis were measured. Tese whereas in Figure 1, this trend begins at 25 uM. cell viability assays represent a measure of the ability 131 DOES CBD INDUCE APOPTOSIS IN DIFFUSE LARGE B CELL LYMPHOMA? of the DLBCL cells to recover from CBD treatment, were not examined. Terefore, the mechanisms of which is a signifcant factor to consider for treatment. apoptosis could not be compared to previous studies As such, this assay provides insight on the implica- presented in the Literature Review. Tis remaining tions of a CBD drug, as an anticancer drug would not lack of knowledge does limit the potential of CBD as only have to induce apoptosis in cancerous cells but a drug for DLBCL and suggests a need for further re- also minimize the potential for relapse. Figure 1 and search in this area. Furthermore, time limitations re- Figure 2 suggest that CBD is capable of inhibiting cell strained the number of trials performed for the apop- viability, specifcally at concentrations around 50 uM tosis assay, thereby obstructing statistical analysis due to 100 uM, as indicated by the abrupt reduction in cell to lack of ample data. However, the apoptosis assay viability at 50 uM. Similarly, Figure 3 suggests that demonstrates a signifcant diference between the CBD is capable of inhibiting cell viability at concen- control concentration and subsequent concentrations. trations from 25 uM to 100 uM. Tus, a higher con- With nearly a 70% diference in apoptotic frequency, centration, between 50 uM to 100 uM, should be used the assertion that CBD induces apoptosis in DLBCL is to account for all cell lines. However, the key factor indisputable. Additionally, since this experiment was that determines whether or not CBD could function conducted in vitro, it cannot fully replicate results in as potential cancer treatment lies in its capabilities to the environment of the human body. Tus, the results eradicate DLBCL through the induction of apoptosis. produced from this experiment cannot be guaranteed While cell viability is an important measure to evalu- in the human body. Nonetheless, since human cell ate, if CBD does not induce apoptosis, CBD could lines were utilized and the induction of apoptosis was be ruled out for treatment altogether. Overall, the ascertained by the assays, this experiment does indi- apoptosis assays hold greater priority than the cell vi- cate the ability of CBD to induce apoptosis in human ability assays as the induction of apoptosis in DLBCL DLBCL cell lines. Given these circumstances, this pa- represents the ultimate marker for cancer treatment. per represents a degree to which CBD would induce From Figure 4, the positive trend established asserts apoptosis in the human body but is not fully represen- that CBD does induce apoptosis in DLBCL, especially tative. Despite these limitations, the successful con- at concentrations greater than 25 uM. Tis suggests duction of apoptosis in cell line RC and the successful that a concentration point between 50 uM to 100 uM inhibition of all twenty four cell lines in terms of cell would be successful in inhibiting cell viability and viability afrms the possibility of CBD as an antican- inducing apoptosis. Altogether, these results suggest cer drug. that CBD induces apoptosis and can be considered as a candidate for cancer treatment, given its benefts in reducing cell viability. Statistical analysis illustrates Conclusion and Future Directions that these results, while varied, are therefore reliable. Tese results overall represent a consensus among the Te results of this study directly suggest that CBD scientifc community that CBD does induce apoptosis in has a strong potential for treating DLBCL. Te results cancer. As previously stated, CBD has proven to induce concluded from the cell viability assays indicate that apoptosis through varying, but similar, mechanisms in CBD is efective in reducing the potential for relapse breast cancer (Ligresti et al., 2006), glioma (Massi et al., in cancerous large B lymphocytes. Tis assay is par- 2006), and leukemia (McKallip et al., 2006). Tis paper ticularly important in addressing relapse in cancer, in has efectively shown that CBD does induce apoptosis in that certain cancerous cells may escape treatment and DLBCL, thus indicating that in a larger context, CBD in- metastasize to other parts of the body. Te apoptosis duces apoptosis in multiple cancers. assays were the main focus of this paper and the re- sults from Figure 4 indicate that CBD is efective in inducing apoptosis in DLBCL. Tis confrms the hy- Limitations pothesis that CBD induces apoptosis in DLBCL. Te results from this paper indicate that CBD does Although the apoptosis assays provided reliable induce apoptosis in DLBCL, which is the frst step results, the methods of apoptotic inductions by CBD in addressing its implications as a drug. However, in 132 DOES CBD INDUCE APOPTOSIS IN DIFFUSE LARGE B CELL LYMPHOMA? order to fully address this possibility, other factors should be looked into. First, this paper indicates the References concentrations of CBD at which it is most efective in American Cancer Society. (n.d.). What Is Non-Hodgkin reducing cell viability and promoting apoptosis. Tese Lymphoma? 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134 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018

Student Perceptions of the Implementation of Formative Assessment: A Royal St. George’s College Case Study

Andrew Pyper

Formative assessment has been widely implemented for its well-researched positive benefts. Despite this, an absence of research exists when it comes to student evaluations of its implementation. To address this for my school, Royal St. George’s College or RSGC, I asked students questions about formative assessment accord- ing to the Nicol & Macfarlane-Dick (2007) model in both a survey and an interview. Te results revealed that formative assessment allows students to learn about what good performance is, self-assess their own work, and focus on improving, not on their grades. Tat said, students could learn more if teachers were to make forma- tive assessment more rigorous as well as, providing more feedback. Unfortunately, feedback is ofen formulaic, and when it is given students are not applying all suggestions or approaching teachers as much as they should. In addition, the results of this study reported that teachers should use feedback more frequently to learn about their students. Keywords: formative assessment, formative feedback, formative grades, pedagogical practices, student per- ceptions, teacher feedback

Introduction that formative assessment is the best way to do this. Also in that paper, the authors outline seven generally Many in the educational feld are familiar with for- accepted key principles to help teachers implement mative assessment as it has been implemented around formative assessment. Tese are as follows: formative the world for its positive benefts. Haroldson (2012) assessment teaches students about what constitutes notes that formative assessment is divided into several good performance, it improves a student’s ability to categories. Tose include the formative use of summa- self-assess, it teaches students about how they need tive tests, questioning students to spark discussion and to improve, it creates situations where students can learning, and written and oral feedback during class discuss their learning with teachers, it increases self- and with class activities. Some of its positive benefts esteem and motivation in students, it helps students were discussed by Nicol and Macfarlane-Dick (2007) achieve their academic goals and it allows teachers to who, when combining pre-existing literature on for- tailor teaching around information gained from its mative assessment, found evidence that supports its implementation. Tough the importance of forma- implementation. Tey discuss how students need op- tive assessment has been clearly studied, a gap exists portunities to develop self-regulation in school and between the idea and its implementation in reality. In- 135 STUDENT PERCEPTIONS OF THE IMPLEMENTATION OF FORMATIVE ASSESSMENT terestingly, some research reports on student’s percep- explanation and a student’s understanding (Higgins, tion of formative assessments when it has been imple- Hartley, & Skelton, 2001). Tis meant that educa- mented efectively; however, an absence of research tional experts started to lobby for the implementation is noted when it comes to student perception of the of formative assessment in day-to-day schooling in implementation of formative assessment. Tat is why the 1990’s and early 2000’s (Hutchinson & Hayward, I conducted a mixed-method case study at RSGC to 2005). Presently, formative assessment is still used address this gap. In the study, I combined a survey widely in many education systems (Cotton, 2017). Re- with interviews to discover whether the four types searchers Nicol and Macfarlane-Dick (2007) went fur- of formative assessment mentioned above match the ther than this and argued that formative assessment seven key principles of its implementation that were needed to be tailored for more student learning. With also mentioned above. I also segmented this analysis a sound basis for student-based learning and a subse- into specifc portions of the population by asking stu- quent sound basis for formative assessment, many re- dents about their grades and courses. Other schools searchers have found that formative assessment does can examine the RSGC case study as a model for how have positive efects on student learning (Kingston & formative assessment is being used efectively or inef- Nash, 2011) fectively at their respective schools. Deconstruction of Formative Assessment

Literature Review As stated earlier, researchers Nicol and Macfarlane- Dick (2007) found that student assessment should be Introduction to Formative Assessment tailored to create more student-based learning. Tey then combined this principle with pre-existing liter- Formative assessment has been widely implement- ature to create seven key principles for what forma- ed in schools across North America. Te purpose tive assessment should do. Tose seven principles, of this assessment is to create teacher feedback that summarized below, act as guidelines for the efective students can learn to improve their understanding of implementation of formative assessment that encour- content (Sadler, 1983). Formative assessment, there- ages student-based learning and will be used later for fore, is implemented through the formative use of the method. summative tests, the questioning of students to spark Formative assessment teaches students about what discussion and learning, and the use of written and constitutes good performance. oral feedback during class and with class activities. In It improves a student’s ability to self-assess. this way, formative assessment is set of tools that give It teaches students about how they need to improve. formative feedback. It creates situations where students can discuss their learning with teachers. Chronology It increases self-esteem and motivation in students. It helps students achieve their academic goals. Formative assessment became widely adopted by It allows teachers to tailor teaching around infor- education systems across North America as views on mation gained from its implementation. teaching shifed. Historically, teaching was very one Although many studies discuss similar attributes dimensional with teachers contributing to most if of correct implementation of formative assessment not all of the student’s learning, but recent literature (Koh, 2010; Hobson, 1997; Orsmond, Merry, & Cal- has discussed the importance of letting students par- laghan, 2004). I chose the model by Nicol and Mac- ticipate in their learning (Barr & Tagg, 1995). More farlane-Dick (2007) because it efectively combines all specifcally, student-based learning seeks to encour- the attributes other studies have discussed in a clear age active learning, give students more responsibil- and organized manner. ity, autonomy, and accountability, and create student “Helps clarify what good performance is” (Nicol and teacher interdependence (Lea, Stephenson, & & Macfarlane-Dick, 2007, p. 205). Without forma- Troy, 2003). It also reduces the gap between a teacher’s tive assessment, students and teachers difer on their 136 STUDENT PERCEPTIONS OF THE IMPLEMENTATION OF FORMATIVE ASSESSMENT understanding of goals (Norton, 1990). For example, col & Macfarlane-Dick, p. 210). research suggests that teachers cannot express all of “Encourages positive motivational beliefs and the goals on a rubric in a way that a student will un- self-esteem” (Nicol & Macfarlane-Dick, 2007, p. derstand (Rust, Price, & O’Donovan, 2003; Yorke, 205). When assessments are given with grades, stu- 2003). Research has also stressed that students must dents focus more on the grades than on the feedback understand teacher feedback in order for it to be ef- because of concerns over their grades and their ego. fective (Hounsell, 1997). Formative assessment flls Tis means they ofen do not use the feedback to help this gap by allowing students to better understand the their learning in the ways that have been listed above goals set by the teacher (Nicol & Macfarlane-Dick, (Dweck 2000; Butler 1998; Butler, 1987). Tis then 2007). afects the motivation of students who either work “Facilitates the development of self-assess- harder to achieve a better grade or who take a low ment…in learning” (Nicol & Macfarlane-Dick, grade as a sign they should not try because they are 2007, p. 205). Students beneft from understanding not good (Nicol & Macfarlane-Dick, 2007). Formative what good performance is because they can use this assessment does not have these elements. Instead it as a basis for their own performance (McDonald & focuses on the learning process (Nicol & Macfarlane- Boud, 2003; Taras, 2001; Taras, 2002; Taras, 2003). In Dick, 2007). order for them to understand what good performance “Provides opportunities to close the gap between is, they need to be able to assess their work. Trough current and desired performance” (Nicol & Mac- the integration of teacher feedback, formative assess- farlane-Dick, 2007, p. 205). With many formative ment allows students to practice assessing their own assessment tasks, teachers will give students the op- work directly (McDonald & Boud, 2003; Haroldson, portunity to apply the feedback they gave to improve 2012). their work. Tis then allows students to learn through “Delivers high quality information to students the use of feedback (Nicol & Macfarlane-Dick, 2007). about their learning” (Nicol & Macfarlane-Dick, “Provides information to teachers that can be 2007, p. 205). Trough formative assessment activi- used to help shape teaching” (Nicol & Macfarlane- ties, students can read and act on teacher feedback. Dick, 2007, p. 205). When teachers start providing a Tis helps them understand teacher expectations and multitude of formative feedback they learn about the enables students to apply their teacher’s input (Nicol issues and abilities of each student, which can then & Macfarlane-Dick, 2007). Teacher feedback should be refected in their feedback; more tailored feedback not be authoritative and strictly corrective but instead will then increase the efectiveness of the other prin- give the student a sense of what the teacher experi- ciples listed above (Yorke, 2003). ences when reading the work to shif the focus of high quality feedback towards the student (Lunsford, Teory Versus Implementation 1997). Teacher feedback should also be given regu- larly and consistently to maximize the amount of time A substantial amount of research confrms the students spend correcting their own work (Gibbs & importance of formative assessment, a considerable Simpson, 2004). amount of which has been included in this literature “Encourages teacher and peer dialogue around review. Now that a basis for the efective implementa- learning” (Nicol & Macfarlane-Dick, 2007, p. 205). tion of formative assessment has been established the Even when students do get feedback from teachers, it next step is to discuss how the implementation of for- is hard for them to understand what is written when mative assessment difers from the theory. Diferences trying to correct their work (Chanock, 2000). More in implementation ofen occur due to researchers hav- formative assessment creates more opportunities for ing diferent interpretations of formative assessment. teachers and students to discuss their learning (Nicol (Dorn, 210; Crossouard & Pryor, 2012: Clark, 2012). & Macfarlane-Dick, 2007). When these discussions Given the theory and research has established the ra- happen, students are better able to understand their tionale and value of formative assessment, the prob- expectations, discuss misunderstandings and ques- lems mainly stem from an improper use of formative tions with teachers, and get immediate feedback (Ni- assessment. Understanding how formative assess- 137 STUDENT PERCEPTIONS OF THE IMPLEMENTATION OF FORMATIVE ASSESSMENT ment is being implemented is important to ensuring centage grade, and boxes were given so students could students are obtaining its benefts. In this study, I am check of the courses they are taking. Tere may be a focusing on one aspect of implementation, the role of separation between student perceptions and actuality, the student in formative assessment. but the results of this study can be extended to explain the correct implementation of formative assessment or problems with this implementation. Other schools Method can then examine the RSGC case study as a model for how formative assessment is being used efectively or Research Plan inefectively at their respective schools. Tese insights can also then be used as a basis for studying specifc Te goal of this study is to use student perceptions strategies employed by RSGC or similar schools. For- to determine whether or not formative assessment is mative assessment has become an integral part of being implemented correctly at RSGC. Trough the many schools, and it would be a waste of resources to review of relevant literature on the topic, we can be be employing it inefectively. confdent that formative assessment does help stu- dents if implemented correctly. Nicol and Macfarlane- Justifcation Dick (2007) outlined seven key advantages of forma- tive assessment that occur when it is implemented In this study, I collect both qualitative and quantita- correctly. Student perception of formative assessment tive data to make the research more meaningful (Cre- could, therefore, be broken down into student per- swell, 2013). By using both, the results are more likely ception of each advantage in the model. In this study, to illustrate whether or not formative assessment is be- students in the senior school, grades ten through ing implemented correctly. Te purpose of this study twelve, were given surveys and were asked questions is to focus on student perception because students are in a recorded interview. Tis study used stratifed- the ones who experience the efects of formative as- random sampling to select students. Te strata were sessment. Tis same logic was used by Vandercruysse, based on grade level in order to ensure a complete Vandewaetere, Cornillie, and Clarebout (2013) who representation of education levels, and as such, there found that student perception of educational gam- were seven grade twelve students, six grade eleven ing needed to be evaluated to analyze its efectiveness. students, and six grade ten students. All participants Additionally, this study used a case study method be- were male since RSGC is an all-boys school. Before cause this creates the most meaningful fndings with students were asked the questions, they were given a limitations of time and money. In this study, I also defnition of formative assessment and were informed segment the population based on subject area and that the study was meant to address their perceptions, on academic grades. Te segmentation is based on not their desires. Te questions, which are listed in subjects because the variety of pedagogical practices Appendix A, are based on the seven key principles. in specifc subjects can create subject-specifc per- Tey were answered by a yes or a no on the survey ceptions and the segmentation is based on academic and were elaborated on during the discussion. Te performance because on top of measuring intelligence survey portion of the method gave quantitative data, separations in grades represent diferences in work and the interview gave qualitative data. In this way, ethic and attitudes which that create performance the quantitative data gives basic answers to questions, specifc perceptions (Ariani, 2016). Te questions in and the discussion added explanations to these basic this study are based on the study conducted by Nicol answers. Students were also asked during the survey and Macfarlane-Dick (2007) and the reasoning for the portion about the academic path they are pursuing questions can be found in the literature review. Tis and their grades. Tis subdivides perceptions into cer- model is also justifed in the literature review. In ad- tain segments of the school to more specifcally target dition, in this study I use grades ten to twelve because the weaknesses or strengths of the implementation of these students would be more familiar with formative formative assessment. Te questions are listed in Ap- assessment in high school. pendix B and students were given space to write a per- 138 STUDENT PERCEPTIONS OF THE IMPLEMENTATION OF FORMATIVE ASSESSMENT

Findings and Results mark overall.” Some also stated that formative assess- ment allows you to improve your knowledge and thus Te fndings and results of this study can be found assess your future work. Participant G states that “I’ll below. Each category of the Nicol and Macfarlane- learn more. If you see more feedback about your own Dick (2007) model is listed with the relevant question work, then you’ll understand more and more what’s number in addition to survey and interview data. See expected of you.” Participant N also brought up an in- Appendix A for a complete list of the questions. teresting point when they stated that “I can tell that “Helps Clarify What Good Performance Is” (Ni- I got stuf wrong, instead of having it, uh, negatively col & Macfarlane-Dick, 2007, p. 205) impact my grade in a course, uh, have more incentive Question 1 Survey. As you can see in Appendix C, to make sure I get it right.” all of the participants stated that formative assessment “Delivers High Quality Information to Students does help clarify what good performance is. About Teir Learning” (Nicol & Macfarlane-Dick, Question 1 Interview. Many participants, when 2007, p. 205) asked this same question in an interview, discussed Question 3 Survey. Te frst question in this cat- that when the teacher provides feedback, their mark- egory was whether students received actionable feed- ing or comments provide insight into what they are back regularly. Appendix C shows that, ten answered looking for when summative assessments come yes and, nine answered no. A majority of the science around. For example, participant J states that forma- and engineering students in the sample population tive assessment allows you to “see the lesson plans and were concentrated into the yes category whereas those how they’re set out, so everything kinda is laid out in that answered no were from a variety of courses. Ad- front of you, so you can prepare for several assign- ditionally, the average summative average of those ments.” Participant C goes further into detail when who answered yes was 89.1% whereas it was 86.1% for they state that those who answered no. “in Math for example, that they want you to just Question 4 Survey. Te second question in this know… oh, at least, uh, specify you, uh, be strict about category was whether students apply the feedback units, be strict about straight lines, and some may not, they are given. Again, as displayed in Appendix C so it just makes it easier to tell what the teachers are eleven answered yes and, eight answered no. Te av- looking for.” erage summative average of those in the yes category However, participant N said that “there’s a discon- was 89.9% and the average summative average of nect, where sometimes they [teachers], uh, expect those in the no category was 86.4%. It is also inter- more than what they have in formative assessments.” esting to note that the distribution of no answers was Tis was also mentioned in other interviews. higher for grade ten students. “Facilitates the Development of Self-Assess- Question 3 Interview. Many students who an- ment…in Learning” (Nicol & Macfarlane-Dick, swered no to the frst question stated that the feed- 2007, p. 205) back they received was formulaic and not applicable. Question 2 Survey. As stated in Appendix C, only Participant G states that “On formative stuf, a lot of two out of nineteen participants disagreed that for- the time, they won’t really give you so much feedback, mative assessment helps you develop self-assessment they’ll just give you numbers.” Students ofen dis- skills. cussed in other questions that the benefts of forma- Question 2 Interview. Tose that answered yes tive assessment are not as great because they do not stated that formative assessment gives you informa- apply all suggestions given to them. tion about what a teacher is looking for that you can Question 4 Interview. One of the central themes apply when looking over your own work. Tey also that came up was that participants ofen disagree with state that it allows you to search for specifc things the teacher. Participant H outlines how they would in the future. For example, participant O states that not apply feedback “When I would disagree or I have a “once I have an idea what the teacher is looking for, strong opinion on why I don’t want to have it or some- I can better assess my own work, and make sure that one else has told me, otherwise.” I’m checking all the boxes for…to get to improve my “Encourages Teacher and Peer Dialogue Around 139 STUDENT PERCEPTIONS OF THE IMPLEMENTATION OF FORMATIVE ASSESSMENT

Learning” (Nicol & Macfarlane-Dick, 2007, p. 205) jority of people gave was that when they applied given Question 5 Survey. As displayed in Appendix C feedback or learned from their mistakes, they could eleven students said yes an eight said no. improve their work in the future. For example, par- Question 5 Interview. Tose students who an- ticipant R says that swered yes said that they could gain more benefts “I think if, uh, my…my grades do improve afer from formative assessment if they talked to teachers. formative assessment, because it gives me an idea of For example, participant P states that “It helps me what the teacher is expecting. Um, and then also be- point out mistakes that I’ve made, and then I can ask ing able to apply their…their suggestions also, uh, im- the teachers about what I can do or should do.” One of proves, like, my work as well. So, yes.” the main reasons participants mentioned for not talk- “Provides Information to Teachers Tat Can Be ing to teachers was that the simplicity of the formative Used to Help Shape Teaching” (Nicol & Macfarlane- assessments means it is not needed. For example, par- Dick, 2007, p. 205) ticipant J states that Question 9 Survey. Appendix C shows that for this “for formative learning in general, if it indicates question eleven people answered no and eight people that I need to maybe step it up, or study even more answered yes. Te average summative average of those for that certain type of unit, or information, then, yes, who answered no was 89% and it was 85.9% for those for sure, I’ll approach the teacher, and really fnd out who answered yes. what needs to be done in order for me to achieve that Question 9 Interview. One prevailing sentiment better mark, but then in general, for formative quiz- expressed by those who said no was that they do not zes, when usually maybe one out of one marks, or out notice teachers adapting their teaching to individual of ten marks, and multiple choice, then I don’t think students. Participant M says it really matters.” “I think they generally cater their teaching to the Some also stated that they already talk to teachers whole class, so I think it’s rare for someone, for them with or without formative assessment. to change their style of teaching for one person, but I “Encourages Positive Motivational Beliefs and can defnitely see it changing if, like, a whole class is, Self-Esteem” (Nicol & Macfarlane-Dick, 2007, p. struggles with something.” 205) However, some said teachers would be happy to Question 6 Survey. Te frst question under this talk to you if you approached them directly. Another category was whether students are concerned with common sentiment was that teachers could not learn their formative grades. Te data in Appendix C shows from summative use of formative tests because the that only three students said yes. marking was not individualized. For example, par- Question 7 Survey. Te second question under ticipant F states that “So, like obviously like I think this category was whether formative grades afected of multiple choice questions, it’s…it’s really not gonna students’ self-esteem. Te same people who answered help them learn about you very much. So, it depends yes on the prior question also answered yes with the on the assessment I guess.” addition of three more people. Te average academic average of these people was 84.5% compared to 88.8% for those who answered no. Discussion For both questions, the majority of no answers came from people above grade eleven. “Helps Clarify What Good Performance Is” (Nicol Question 6 & 7 Interview. Students did not elabo- & Macfarlane-Dick, 2007, p. 205) rate beyond a yes or no in the interview. Question 1. Te literature stresses the importance “Provides Opportunities to Close the Gap Between of students being able to understand goals set by the Current and Desired Performance” (Nicol & Macfar- teacher, and it states that formative assessment does lane-Dick, 2007, p. 205) this when appropriately implemented. Te fact that all Question 8 Survey. All participants except for two participants agree shows that formative assessment is answered yes to this question. being implemented correctly in this respect. However, Question 8 Interview. Te reasoning that the ma- the assertion that formative assessments are easier 140 STUDENT PERCEPTIONS OF THE IMPLEMENTATION OF FORMATIVE ASSESSMENT than real assessments contradicts this slightly. If this back with teachers because it is formulaic. Further re- occurs, students cannot use an easier formative as- searchers or the school could study what would hap- sessment to learn about their performance when that pen if the style of feedback changed. will be lower on the real test. “Encourages Positive Motivational Beliefs and Self- “Facilitates the Development of Self-Assessment… Esteem” (Nicol & Macfarlane-Dick, 2007, p. 205) in Learning” (Nicol & Macfarlane-Dick, 2007, p. 205) Question 6. Te literature makes it clear that Question 2. Again, the literature emphasizes the since formative assessment does not afect academic importance of students being able to assess their own standing students can focus on feedback, not on their work, and it states that formative assessment does this marks. Te fact that most students do not care shows when implemented correctly. Te fact that almost all that formative assessment is being implemented cor- participants agree shows that formative assessment is rectly. Further research could be conducted to deter- being implemented properly in this category. mine whether the fact that students disregard com- “Delivers High Quality Information to Students ments is connected with a lack of concern. About Teir Learning” (Nicol & Macfarlane-Dick, Question 7. As stated before, the literature indi- 2007, p. 205) cates that since formative assessment does not afect Question 3. Te literature states that to reap the academic standing students can focus on feedback, benefts of formative assessment it must happen regu- not on their marks. Since most students’ self-esteem is larly. Te fact that some people do not get feedback or not afected, it is being implemented correctly. Te fact that it is formulaic and not useful shows it is not be- that students with lower grades are more concerned if ing implemented correctly. As per the literature these researched further could prove the literature. Also, if students do worse on summative assignments than students with low grades are afected by formative as- those that get feedback regularly. If the school were sessments, they could actually be lowering their self- to address this issue, they should focus on and study esteem. In the last two questions, the students from formative assessments in non-STEM courses in more lower grades were most concerned. Tis could also be detail because these were both pointed out by the data researched further. and mentioned in interviews. “Provides Opportunities to Close the Gap Between Question 4. Te literature shows that to get the Current and Desired Performance” (Nicol & Macfar- most out of formative assessment students must also lane-Dick, 2007, p. 205) apply changes a teacher gives them. Tis is shown Question 8. One of the fundamental principles of by the fact that students who do use suggestions are formative assessment is that it allows a student to im- better of academically than those who do not. Te prove a piece of work and learn while doing it. Te problem is that students disregard feedback they do fact that most agree shows that this is being estab- not think is right or do not understand instead of ap- lished at RSGC. proaching the teacher. Tis last part will be addressed “Provides Information to Teachers Tat Can Be later. Further research could be conducted to fnd out Used to Help Shape Teaching” (Nicol & Macfarlane- what types of feedback students disregard and how Dick, 2007, p. 205) to stop this or why this is a problem with students in Question 9. According to the literature an added grade ten. beneft of formative assessment is that when a teacher “Encourages Teacher and Peer Dialogue Around does it, they learn about their students and can tailor Learning” (Nicol & Macfarlane-Dick, 2007, p. 205) their future feedback. Te survey showed that eleven Question 5. According to the literature, there is a people found teachers did not do this and eight did. disconnect between what a teacher writes and what Tis shows that to an extent teachers are not learn- a student understands. To understand entirely, stu- ing about their students learning. Furthermore, some dents need to approach teachers with questions and people who said yes were then uncertain in the inter- concerns. For example, they could approach teachers view. Participants stated that feedback giving is ofen with questions about the feedback they disagree with formulaic. However, this could be a mechanism teach- instead of disregarding it. Participants also pointed ers use to learn about their students. Since students out in the interview that they do not discuss feed- are limited in their perspectives, further research 141 STUDENT PERCEPTIONS OF THE IMPLEMENTATION OF FORMATIVE ASSESSMENT could interview teachers at RSGC to determine if ing all suggestions or approaching teachers as much they do this. However, one common theme was that as they should be. However, despite a slight concern, because feedback was ofen not individualized, espe- formative assessment is allowing students to focus cially on tests, it would be hard for teachers to tailor on improving, not on their grades. Students also fnd their feedback. Further research could also examine that their work does improve when implementing it. if teachers would learn more about their students if In conclusion, teachers should use feedback to learn more students discussed formative assessment with about their students more ofen. their teachers.

Limitations References Ariani, D. W. (2016). Why do I study? Te mediating efect Some limitations of this study include the fact that of motivation and self-regulation on student perfor- perceptions of young students are not always accu- mance. Business, Management and Education, 14(2), 153. rate, some people had diferent answers to the survey Barr, R.B., & Tagg, J. (1995) A new paradigm for under- than what they expressed in the interview, and that graduate education. Change, 27(6), 13–25. it was evident that some participants did not under- Butler, R. (1987). Task-involving and ego-involving proper- stand questions. It is also possible that a certain type ties of evaluation: Efects of diferent feedback conditions of student was the most likely to agree to participate on motivational perceptions, interest, and perfor- thus adding bias to the sample population. Te small mance. Journal of Educational Psychology, 79(4), 474. number of people who did agree to participate also re- Butler, R. (1988). Enhancing and undermining intrinsic stricts this studies ability to make a conclusion. Also, motivation: Te efects of task‐involving and ego‐in- there may be a disconnect between the experiences of volving evaluation on interest and performance. British male students in this school and female students in Journal of Educational Psychology, 58(1), 1-14. other schools thus reducing the ability to extend the Chanock, K. (2000). Comments on essays: Do students results to other schools. In addition, despite being in- understand what tutors write?. Teaching in Higher structed not to, some participants answered based on Education, 5(1), 95–105. desires, not experience. Lastly, diferent participants Clark, I. (2012). Formative assessment: A systematic and could have difering ideas on relative topics like what artistic process of instruction for supporting school and lifelong learning. Canadian Journal of Education, 35(2), 24. constitutes regular actionable feedback. Cotton, D. (2017). Teachers’ use of formative assess- ment. Delta Kappa Gamma Bulletin, 83(3). Creswell, J. W. (2013). Research design: Qualitative, quantita- Conclusion tive, and mixed methods approaches. Tousand Oaks, CA: Sage Publications. Te primary goal of this study was to examine the Crossouard, B., & Pryor, J. (2012). How theory matters: student perceptions of the implementation of forma- Formative assessment theory and practices and their tive assessment. By segmenting this according to the diferent relations to education. Studies in Philosophy and Nicol and Macfarlane-Dick (2007) model and by in- Education, 31(3), 251-263. vestigating student’s perceptions in each of these cate- Dorn, S. (2010). Te political dilemmas of formative assess- gories the results of this study could specify implemen- ment. Exceptional Children, 76(3), 325-337. tation perceptions. Te results revealed that formative Dweck, C. S. (2000). Self-Teories: Teir Role In Motivation, assessment is being implemented in a way that allows Personality, And Development. Didcot, UK: Psychology students to learn about what good performance is and Press. self-assess their own work. Tat said, students could Gibbs, G., & Simpson, C. (2005). Conditions under which learn more if teachers were to make formative assess- assessment supports students’ learning. Learning and ment harder. Tis study also revealed that not enough Teaching in Higher Education, (1), 3-31. feedback is being given, it is ofen formulaic and not Haroldson, R.A. (2012). Student Perceptions of Formative useful, and when it is given students are not apply- Assessment in the Chemistry Classroom (Dissertation). 142 STUDENT PERCEPTIONS OF THE IMPLEMENTATION OF FORMATIVE ASSESSMENT

Higgins, R., Hartley, P., & Skelton, A. (2001). Getting the Taras, M. (2002). Using assessment for learning and learn- message across: Te problem of communicating as- ing from assessment. Assessment & Evaluation in Higher sessment feedback. Teaching in Higher Education, 6(2), Education, 27(6), 501-510. 269-274. Taras, M. (2003). To feedback or not to feedback in student Hobson, E. H. (1997). Forms and functions of formative self-assessment. Assessment & Evaluation in Higher assessment. Te Clearing House, 71(2), 68. Education, 28(5), 549-565. Hounsell, D. (1997). Contrasting conceptions of essay- Vandercruysse, S., Vandewaetere, M., Cornillie, F., & writing. Te Experience of Learning, 2, 106-125. Clarebout, G. (2013). Competition and students’ Hutchinson, C., & Hayward, L. (2005). Te journey so perceptions in a game-based language learning far: Assessment for learning in Scotland. Curriculum environment. Educational Technology Research and Journal, 16(2), 225-248. Development, 61(6), 927-950. Kingston, N., & Nash, B. (2011). Formative assessment: Yorke, M. (2003). Formative assessment in higher educa- A meta‐analysis and a call for research. Educational tion: Moves towards theory and the enhancement of Measurement: Issues and Practice, 30(4), 28-37. pedagogic practice. Higher Education, 45(4), 477-501. Koh, L. C. (2010). Academic staf perspectives of forma- tive assessment in nurse education. Nurse education in practice, 10(4), 205-209. Lea, S. J., Stephenson, D., & Troy, J. (2003). Higher education students’ attitudes to student-centred learn- ing: Beyond ‘educational bulimia’?. Studies in Higher Education, 28(3), 321-334. Lunsford, R. F. (1997). When less is more: Principles for re- sponding in the disciplines. New Directions for Teaching and Learning, 1997(69), 91-104. McDonald, B., & Boud, D. (2003). Te impact of self- assessment on achievement: Te efects of self-assess- ment training on performance in external examina- tions. Assessment in Education: Principles, Policy & Practice, 10(2), 209-220. Nicol, D.J., & Macfarlane-Dick, D. (2007). Formative as- sessment and self‐regulated learning: Amodel and seven principles of good feedback practice. Studies in Higher Education 31(2),199-218. Norton, L. S. (1990). Essay-writing: What really counts?. Higher Education, 20(4), 411-442. Orsmond, P., Merry, S., & Callaghan, A. (2004). Implementation of a formative assessment model incorporating peer and self‐assessment. Innovations in Education and Teaching International, 41(3), 273-290. Rust, C., Price, M., & O’Donovan, B. (2003). Improving stu- dents’ learning by developing their understanding of as- sessment criteria and processes. Assessment & Evaluation in Higher Education, 28(2), 147-164. Sadler, D. R. (1983). Evaluation and the improve- ment of academic learning. Te Journal of Higher Education, 54(1), 60-79. Taras, M. (2001). Te use of tutor feedback and student self-assessment in summative assessment tasks: Towards transparency for students and for tutors. Assessment & Evaluation in Higher Education, 26(6), 605-614.

143 STUDENT PERCEPTIONS OF THE IMPLEMENTATION OF FORMATIVE ASSESSMENT

Appendix A

Survey and Interview Questions about Formative Assessment

Principle Questons “Helps clarify what good performance is” (Nicol 1. Does feedback given for formative as- & Macfarlane-Dick, 2007, p. 205). sessment tasks help your understanding of performance goals set by the teacher? “Facilitates the development of self-assess- 2. Does formative assessment feedback ment…in learning” (Nicol & Macfarlane-Dick, improve your ability to assess your own 2007, p. 205). work? “Delivers high quality informaton to students 3. Do you receive actionable feedback about their learning” (Nicol & Macfarlane-Dick, regularly? 2007, p. 205). 4. Do you apply all suggestions given to you by a teacher? “Encourages teacher and peer dialogue around 5. Do you have more conversations with learning” (Nicol & Macfarlane-Dick, 2007, p. teachers about your learning when you 205). have been given formative feedback? “Encourages positve motvatonal beliefs and 6. Are you concerned with your formative self-esteem” (Nicol & Macfarlane-Dick, 2007, p. grades? 205). 7. Do formative grades afect your self- esteem? “Provides opportunites to close the gap be- 8. Do you believe your work improves af- tween current and desired performance” (Nicol ter you apply suggestions given during & Macfarlane-Dick, 2007, p. 205). formative assessment? “Provides informaton to teachers that can be 9. Do you fnd teachers are able to learn used to help shape teaching” (Nicol & Macfar- about your learning when they have lane-Dick, 2007, p. 205). given you formative feedback?

144 STUDENT PERCEPTIONS OF THE IMPLEMENTATION OF FORMATIVE ASSESSMENT

Appendix B

Personal Survey Questions

Topic Questons Academic Performance 10. If you feel comfortable doing so, please record your summative average? If you do not know your average please estimate or extrapolate based on previous performance. Your answers are completely confdential.

Subject Area 11. Please place an X next to the types of cours- es you are pursuing or plan to pursue. If you are unsure select undecided.

Business

Fine Arts

Humanities/Social Sciences

Science/Engineering

Undecided

145 STUDENT PERCEPTIONS OF THE IMPLEMENTATION OF FORMATIVE ASSESSMENT

Appendix C

Survey Results

Par- tci- Grade pant Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Science/Engi- 10 A Yes No Yes No No No Yes Yes No 80% neering Science/Engi- 10 B Yes Yes Yes No Yes No No Yes Yes 89% neering Science/Engi- 10 C Yes Yes No No No Yes Yes No No 88% neering Humanites/ Social Scienc- es, Science/ 10 D Yes Yes Yes No No Yes Yes No Yes 78% Engineering Fine Arts, Humanites/ Social Scienc- es, Science/ 10 E Yes Yes No No Yes No Yes Yes Yes 84% Engineering Humanites/ Social Scienc- es, Science/ 10 F Yes Yes Yes Yes No Yes Yes Yes Yes 92% Engineering Humanites/ Social Sci- 11 G Yes Yes No No Yes No No Yes No 86% ences 11 H Yes Yes No Yes No No No Yes Yes 84% Business Science/Engi- 11 I Yes Yes Yes No Yes No No Yes No 95% neering Business, Hu- manites/So- 11 J Yes Yes No Yes Yes No No Yes Yes 85% cial Sciences

146 STUDENT PERCEPTIONS OF THE IMPLEMENTATION OF FORMATIVE ASSESSMENT

Science/Engi- 11 K Yes Yes Yes Yes No No No Yes No 93% neering Business, Hu- manites/So- 11 L Yes Yes No No No No No Yes No 80% cial Sciences Science/Engi- 12 M Yes Yes Yes No Yes No No Yes No 92% neering Science/Engi- 12 N Yes Yes No Yes No No No Yes No 89% neering Science/Engi- 12 O Yes Yes Yes Yes No No No Yes No 91% neering Science/Engi- 12 P Yes Yes Yes No Yes No No Yes Yes 86% neering Science/Engi- 12 Q Yes Yes No No No No Yes Yes Yes 89% neering Business, Hu- manites/So- 12 R Yes No Yes Yes No No No Yes No 95% cial Sciences 12 S Yes Yes No Yes Yes No No Yes No 90% Business

147 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018

A Descriptive Study of Adolescent Perceptions of Rural Versus Urban Kentucky High School Student Mental Health Challenges

Allison Tu

Research has evaluated mental health perspectives of adults, but no studies gather Kentucky stu- dents’ input on these issues. Understanding youth perceptions is critical to creating efective mental health interventions, as students experience these issues frsthand. Capturing rural and urban di- vides is also crucial to create programming applicable to both student groups. Terefore, this study aimed to characterize the similarities and diferences between the student-reported perceptions of mental health challenges facing urban versus rural students. Data was collected through four focus groups at urban and rural high schools. Tematic analysis through ATLAS.ti showed that students perceived that peers, family, lack of resources, and high stress infuenced mental health in both urban and rural areas. Diferences between urban and rural perceptions revolved around social media, community culture, and overdose. Tese results serve as a foundation for future research assessing youth perceptions to identify an efective intervention to improve Kentucky students’ mental health.

Keywords: Adolescent; mental health; Kentucky; rural; urban; youth perceptions

to severe issues such as substance abuse or suicide. Introduction As Stagman and Cooper (2010) report, “children and youth with mental health problems have lower edu- Youth mental health issues in the United States are cational achievement, greater involvement with the skyrocketing. For instance, one in fve adolescents criminal justice system, and fewer stable and longer- sufers from a diagnosable mental health disorder term placements in the child welfare system,” a fnd- (National Alliance on Mental Illness, n.d.). In Ken- ing corroborated by several other studies (Erickson tucky, the situation is even more dire—according to & Abel, 2013; Valdez, Lambert, & Ialongo, 2011). As the Kentucky-specifc data from the Youth Risk Be- further evidence that mental health issues jeopardize havior Survey, almost one-third of Kentucky youth education and future success, over 40% of students report they are so sad, anxious, or hopeless they have afected by a mental health disorder do not complete stopped pursuing activities that they normally enjoy secondary school, the highest dropout rate of any dis- (Kann et al., 2016). Te national data from this survey ability group (Wagner, Newman, Cameto, & Levine, refects an alarming trend: the percentages of youth 2005; National Alliance on Mental Illness, n.d.). Ad- who seriously considered attempting suicide and ditionally, poor mental health in adolescence has been youth who made a suicide plan follow a quadratic pat- associated with future anxiety, depression, and suicide tern, decreasing from 1991-2009 but increasing from (Valdez, Lambert, & Ialongo, 2011). 2009-2015 (Kann et al., 2016). While mental health is critical for adolescents, few Positive mental health, however, is critical for ado- receive appropriate intervention or treatment. Te av- lescents in several respects. Untreated mental health erage delay between the onset of symptoms and treat- challenges signifcantly decrease quality of life, are ment is 10 years and up to 80% of youth who require detrimental to academic performance, and can lead treatment do not receive it, indicating that youth are 148 RURAL VERSUS URBAN KENTUCKY HIGH SCHOOL STUDENT MENTAL HEALTH unable to access suitable services (National Alliance dearth of mental health providers, particularly in ru- on Mental Illness, n.d.; Stagman & Cooper, 2010). ral regions, renders services inaccessible (Jameson & Services themselves also may be inefective; a meta- Blank, 2007; Smalley et al., 2010). Tis shortage is par- analytic review by Farahmand, Grant, Polo, and Dufy ticularly acute in Kentucky—two million Kentuckians (2011) identifed only 17% of reviewed school-based reside in these mental health care professional short- mental health programs as efective. Tough youth age areas and less than 60% of the total need for men- mental health is a consequential concern, few studies tal health providers is met in the state (Kaiser Family have attempted to elucidate adolescent perspectives Foundation, 2016). on mental wellness. Understanding these perceptions, however, is pivotal to the improvement of the issue, Urban versus rural mental health as youth are the preeminent stakeholder in their own well-being and have unique insights into drivers of Mental health culture. Research agrees that resi- poor mental health. dents of rural areas have unique attitudes and culture regarding mental health and mental health inter- ventions that difer from the culture in urban areas. Literature Review Rural residents have been found to have more sig- nifcant stigmas surrounding mental illness due to Barriers to efective mental health values of self-sufciency (Story et al., 2016; Bischof prevention and treatment et al., 2014). Focus groups conducted by Bischof et al. (2014) found that “rural residents ofen do not ‘even A lack of mental health education, signifcant believe in therapists’” and that mental illness is con- stigma surrounding mental health, and a lack of ac- sidered particularly shameful in these communities. cessible services are the key factors upon which the Bischof’s fndings that rural mental health practices literature converges as barriers to efective mental must be sensitive to this culture to be efective are cor- health prevention and treatment. Research suggests roborated by other rural health studies (Bischof et al., that both mental health education and mental health 2014; Jameson & Blank, 2007). services are inaccessible and inadequate. Story and Mental health service access. Limited access to her colleagues report that “the prevalence of mental mental health services and education in nonmetro- illness and death by suicide … may be related to limit- politan areas due to a lack of competent professionals ed mental health literacy” (Story et al., 2016). Te lack may be a driver of stigma-focused rural mental health of awareness caused by poor mental health education, culture (Jameson & Blank, 2007; Smalley et al., 2010). in turn, leads to a second major barrier, stigma. Research is inconsistent, however, on whether this Stigma, ofen defned as “an actual/inferred at- leads to increased mental illness rates in rural popu- tribute that damages the bearer’s reputation and de- lations—Story et al. (2016) and Bischof et al. (2014) grades him/her to a socially discredited status,” pre- found higher rates of mental illness in nonmetropoli- vents students from accessing necessary mental health tan areas while Jameson and Blank (2007) stated that services (Mukolo, Hefinger, & Wallston, 2010). For rate of illness was similar across rural-urban divides, adolescents, a lack of mental health education is a key but severity is increased in rural areas. Others report perpetuator of stigma, making it one of the most fre- that urban youth are at a higher risk of experiencing quently reported reasons for not seeking treatment for mental illness than others students due to violence and mental distress (Jameson & Blank, 2007; Mukolo, He- poverty-related stressors (Farahmand, Grant, Polo, & finger, & Wallston, 2010; Topkaya, 2015). Stigma in- Dufy, 2011; Valdez, Lambert, & Ialongo, 2011). creases when incorrect labels and stereotypes are ap- plied to the mentally ill and research has found stigma Gaps in the current literature levels to decrease with appropriate mental health edu- cation (Story et al., 2016; Larson & Corrigan, 2010). Tough recognition and treatment of mental health Finally, many cannot access efective mental health disorders are critical, there remain signifcant gaps in intervention. A consensus has been established that a the literature surrounding adolescent mental health. 149 RURAL VERSUS URBAN KENTUCKY HIGH SCHOOL STUDENT MENTAL HEALTH

Few recent studies, and none in Kentucky, have ana- groups, as each participant’s attitudes, culture, and lyzed student perspectives on the issue, which are crit- life experience are varied. Group discussion allows ical to inform the policies and programs that directly participants to comment on others’ ideas, leading to impact youth. Analysis of these perceptions, in turn, more productive conversations (Bischof et al., 2014). allows for the creation of more efective solutions Neither surveys nor individual interviews would al- (Aarons et al., 2009; Landeweer, Molewijk, Hem, & low the same degree and quality of insights that group Pedersen, 2017). In Kentucky, no studies compare ur- conversations do. ban versus rural mental health of students, but these Analysis of these rich discussions of youth percep- geographic distinctions are crucial to developing poli- tions elucidated similarities and diferences across cies efective for both groups. urban and rural adolescents, flling the gap of under- Terefore, the present study aims to fll this gap in standing student perspectives and answering the re- the body of knowledge by answering the following search question. Tis research, though specifc to the question: What are the similarities and diferences state of Kentucky, provides a foundation upon which between the student-reported perceptions of mental to base future local and far-reaching studies of mental health challenges facing urban versus rural Kentucky health from a youth point of view. high school students? No hypothesis for this research Four total focus groups were conducted with Ken- was created to avoid potential researcher bias that tucky high school students—two at one urban Ken- could skew the analysis of the largely qualitative data. tucky high school and two at one rural Kentucky high Instead, two assumptions were made. It was assumed school. Te US Department of Agriculture defnition that mental health is a concern in both rural and ur- was used to classify schools as either rural or urban. ban areas of Kentucky. More specifcally, it was also Tis defnition, ofen used in clinical psychology stud- assumed that mental health is a concern at the par- ies, assigns all counties in the United States a number ticular urban and rural schools at which the study was on a scale of 1 (most urban) to 9 (most rural). Coun- conducted. ties between 1 and 3 are considered urban, while counties rated 4-9 are considered rural (US Depart- ment of Agriculture, 2016). Tough this defnition has been criticized for its lack of preciseness on levels more specifc than county borders, the majority of Methodology studies in this feld continue to use this norm; there- fore, this research uses the same defnition (Jameson Tis mixed descriptive study involved collection & Blank, 2007). Te urban groups were conducted in of primarily qualitative, and some quantitative, data Jeferson County, a 1 on the scale, and the rural groups collected from focus groups. Data was analyzed by were conducted in Nelson County, a 6 on the scale. conducting a thematic analysis through coding in the Te principals of Kentucky schools in Jeferson and qualitative analysis sofware ATLAS.ti to character- Nelson Counties were contacted to ask their interest ize the similarities and diferences of perceptions of in participating in this study. Te frst two schools to mental health among rural and urban Kentucky high respond with written agreement of interest and ap- schoolers. As opposed to surveys or interviews, focus proval for this study were used. For each focus group, groups were chosen as the data collection method for 6-10 students were recruited through a convenience this study because, according to Bischof et al. (2014), sampling method. Tis sampling method was selected “they allow researchers to understand the group dy- because sampling by randomly selecting students was namics that surround an individual’s perception and infeasible—schools were unwilling to release a stu- processing of the subject matter.” Focus groups pro- dent roster. vide insight into the general attitude surrounding a To identify the convenience sample, fyers were topic, which is particularly useful to understand for distributed within the building and over school an- mental health, which is heavily infuenced by an indi- nouncements. Included on the fyer was information vidual’s surrounding community. Additionally, a wide about the incentive for participating (free refresh- range of perspectives can be discussed during focus ments), a description of the study, and the contact in- 150 RURAL VERSUS URBAN KENTUCKY HIGH SCHOOL STUDENT MENTAL HEALTH formation of the researcher. Interested students were such as a library or closed classroom, was determined asked to contact the researcher and return a consent for the focus group. form (included in Appendix A) with parental consent To inform the questions asked during these ses- and student assent before participating. sions, a pilot focus group was conducted with six stu- As shown in Table 1 and Table 2, a total of 15 stu- dents at the researcher’s school. Data from this pilot, dents participated in the urban focus groups and a the questions for which are included in Appendix B, total of 13 students participated in the rural focus were only used to modify the procedure for the actual groups. Each focus group fell within the target range focus groups and were not included in data analysis. of 6-10 participants. While the study was open to both Based on the questions that participants seemed to female and male students, there were far more female have difculty answering and whether the data ob- than male participants. Grade levels of the students tained answered the research question of this study, varied, but urban students were mostly sophomores the focus group questions were revised, and the fnal and rural students were mostly seniors. Tis is likely version is included in Appendix C. Te revised ques- due to interested students asking their friends of the tions included largely open-ended qualitative items, same grade level to participate with them. though question 9, which asked all participants to rate Afer enough students volunteered to participate, factors contributing to stigma on a scale of 1-5 (5 be- the researcher coordinated with individual students ing the most impact), was quantitative. Tis varying over text or email to identify a date and time for the data type was included to provide a fuller picture of focus group that was convenient. In coordination with the emerging themes and to allow all students in the school staf, a location that ensured students’ privacy, focus group to contribute their thoughts.

Table 1. Total participants in urban focus groups by gender and grade level

Table 1

Characteristics of Urban Participants Se- Total Participants Females Males Freshmen Sophomores Juniors niors Focus group 1 6 5 1 2 2 2 0 Focus group 2 9 7 2 0 9 0 0 Total 15 12 3 2 11 2 0

Table 2. Total participants in rural focus groups by gender and grade level Table 2

Characteristics of Rural Participants Total Participants Females Males Freshmen Sophomores Juniors Seniors Focus group 1 6 3 3 0 0 2 4 Focus group 2 7 6 1 0 2 0 5 Total 13 9 4 0 2 2 9

151 RURAL VERSUS URBAN KENTUCKY HIGH SCHOOL STUDENT MENTAL HEALTH

Te researcher facilitated the discussion by asking data. Te rural focus groups and urban focus groups the questions in Appendix C and prompting students were separated into diferent document groups in AT- with further information or follow-up questions as LAS.ti, allowing for separate analysis and later com- necessary. Data analysis, informed by the protocol parison. Using ATLAS.ti, the researcher assigned ap- of Fielden, Sillence, and Little (2011), who conduct- propriate codes, which identifed concepts in the data ed youth focus groups about obesity, and a thematic that related to the research question, to each statement analysis guide written by Braun and Clarke (2006), made by focus group participants (Fielden, Sillence, began by reviewing the notes and audio recording of & Little, 2011). Each initial code was categorized into the session immediately afer the session ended. Tis an overarching theme, and themes that did not have review strengthened the remaining steps of analysis sufcient support were discarded. A list of codes, de- by allowing refection on how the data collection pro- scriptions, and groupings, exported from ATLAS.ti, is cedure could be improved (Fielden, Sillence, & Little, included in Appendix D. As suggested by Braun and 2011). In this study, no improvements were found to Clarke (2006), the relationships among themes were be necessary. placed into a thematic map for clearer visualization. Afer all four focus groups were conducted, each Finally, the transcriptions were reviewed to ensure discussion was transcribed verbatim by the research- nothing was missed. Overall, the thematic analysis al- er, including verbal ticks such as “like” or “um.” Initial lowed for the capturing, characterization, description, ideas about potential themes were recorded, consid- and relation among the student-reported themes, an- ered an essential step in analysis (Fielden, Sillence, swering the research question by revealing similarities & Little, 2011). Resulting transcriptions and notes and diferences between rural and urban youth. were then re-read at least three times to increase the researcher’s familiarity with the data, allowing for ac- curate coding (Braun & Clarke, 2006). Te analysis Results and Discussion then moved to ATLAS.ti, a qualitative data analysis sofware, which was used to facilitate coding of the Signifcant themes

Figure 1. Key themes identifed through thematic Four total focus groups, two in urban settings and analysis. Each theme related to the unique high school two in rural settings, were conducted with Kentucky experience; red outlines represent negative infuence on high school students. Tematic analysis of the four mental health, blue outlines represent positive infu- focus groups was informed by Fielden, Sillence, and ence, and outlines of both colors indicate both positive Little (2011) and Braun and Clarke (2006) and con- and negative infuences. ducted using ATLAS.ti coding sofware. Analysis re- vealed several signifcant similarities and diferences between rural and ur- ban settings. Students discussed both positive and negative infuences on mental health in relation to two cat- egories: contributors to mental health symptoms or contributors to mental health stigma. Each major theme con- nected to the broad category of the unique high school experience, fur- ther demonstrating the importance of capturing youth perspectives. Tree themes—community interactions, overdose, and social media—repre- sented the primary diferences be- tween the responses of rural and ur- 152 RURAL VERSUS URBAN KENTUCKY HIGH SCHOOL STUDENT MENTAL HEALTH ban students. Te following diagram represents major ing talking to their guidance counsellors about men- themes that arose, including similarities and difer- tal health for fear that their symptoms would be dis- ences and relationships among the key themes. cussed with their parents. In terms of mental health stigma, students felt that the generational gap between them and their parents led to misunderstandings and perpetuation of stigma. Urban and Rural Similarities One student reported “In their [parents’] generation, there wasn’t any understanding whenever it comes to Tematic analysis revealed that several issues— mental health issues. It was either you’re sane or you’re family dynamics, peer interactions, lack of resources, insane.” Participants generally felt that family mem- and high stress levels—were reported by both urban bers would be unsupportive or wouldn’t understand and rural students. Students reported stress as a con- mental health challenges because the current world tributor to mental health symptoms, and lack of re- presented unique difculties regarding technology sources, family relationships, and peer relationships and contemporary political unrest. However, some as driving both mental health symptoms and mental students, particularly those who were open about per- health stigma. Each of these themes is further ex- sonal experience with mental health issues, stated that plored. their parents were supportive. Tese signifcant infu- Family Relationships. Participants in both the ru- ences of parents and family on mental health, either ral and urban focus groups stated that family relation- positively or negatively, align with existing research. ships, particularly with parents, generally perpetu- Smokowski et al. (2015) found that negative relation- ated both mental health symptoms and mental health ships between rural students and parents led to higher stigma. Students felt pressured to meet their parents’ rates of anxiety and depression, while positive rela- high expectations or please their parents, particularly tionships were associated with lower rates of depres- if they had exceptionally low or high achieving sib- sion. Oldfeld, Humphrey, and Hebron (2016) found lings. As one urban male participant stated, “I feel like a similar relationship, associating insecure parental I have to overcome, like compensate for both of their attachment with emotional difculties. [his siblings’] mistakes and be even better than that Peer interactions. Analysis of quotes about peer so they [his parents] have a glory in their life.” When interactions demonstrated that similarly to how stu- compared to their siblings, students felt pressure from dents felt about family interactions, rural and urban their parents to fll the shoes of older siblings or pave participants associated peers with both positive and the way for younger siblings, leading to stress. Rural negative impacts on mental health. Students felt that students stated, “you’re supposed to literally pave the their close, trusted friends would be supportive if they way for your younger siblings,” and “I have two suc- were told that a peer was experiencing mental health cessful sisters that have gone through college … And symptoms. An urban participant stated, “If I came up I’m just trying to keep up.” Urban and rural students to [friend’s name] and was talking about how I had also expressed the feeling that they’d be a burden on mental health symptoms, I think she’d be shocked at their parents if they were to experience or discuss frst, but she’d be very supportive.” mental health concerns; an urban participant stated However, both rural and urban students believed “I feel like a lot of people don’t even go to anyone [for that friends with whom they were less close would mental health help] because they don’t want to put deny the issue, make jokes at the expense of the stu- that on anyone else.” dent experiencing mental health challenges, or not Participants also felt that their parents didn’t un- take the issue seriously. For example, a rural student derstand their circumstances; a rural student stated said, “One thing that’s very prominent is the fact that that “parents don’t seem to really understand what’s whenever you tell somebody that you have anxiety or going on until you literally have to scream it at their depression, they’re like ‘but you don’t really, do you?’” face that this is what is happening.” Tis disconnect Participants mentioned that these reactions, many of prevented students from discussing mental health which occur through social media, may be due to a concerns with parents. Students also reported avoid- lack of awareness or understanding of mental health. 153 RURAL VERSUS URBAN KENTUCKY HIGH SCHOOL STUDENT MENTAL HEALTH

Students believed that a general culture of not taking One signifcant theme among both urban and rural mental health seriously—for example, an urban stu- students was the weaknesses of school counsellors in dent stated “saying phrases like ‘I’m gonna kill myself’ providing mental health guidance. Students reported is just so common that you just don’t think it’s true”— being told that counsellors were an available resource, made it difcult to tell when students were truly strug- but they didn’t feel as though counsellors would be gling and when students were being facetious. helpful in mental health concerns. Urban students Additionally, urban and rural students both feared felt that counsellors were inaccessible, documenting that if they were to discuss a mental health challenge a long appointment process before one could meet with a peer, they would be judged and treated as an with a counsellor and feeling that their counsellors outcast. One participant said, “I’m scared, I don’t want were too busy with other students or tasks to help. them to think diferently of me, like I know judgment Rural students felt that their counsellors “probably is a very big deal in our society” to explain why she was wouldn’t do jack about it,” meaning that they would hesitant to start a conversation about mental health. likely not do anything to address the concern. Tis is Tis fear may drive mental health symptoms; a partic- likely driven by Kentucky’s lack of school counsellors; ipant said, “a lot of people don’t want to be judged so the student-to-counsellor ratio in 2014-15 was 453:1, they keep it to themselves and it builds up and builds close to double the recommended ratio of 250:1 (Na- up just because they don’t want other people to see tional Association for College Admission Counseling them in a bad way,” refecting that students ofen hide & American School Counsellor Association, n.d.). their symptoms until they reach a breaking point. Tis lack of counsellors may contribute to their inac- Tis signifcant infuence, both positive and nega- cessibility. tive, of peers on mental health is corroborated by cur- High stress levels. Students reported that bal- rent literature. Mackrell and Lavender (2004) exam- ancing school with other obligations, such as work, ined the impact of peer relationships in the context of maintaining a social life, standardized testing, apply- mental health, fnding that peers are signifcant sourc- ing for college, and feeling pressured to meet family es of support in crisis, while Jones et al. (2011) found expectations, led to high levels of stress. A rural stu- that increased loneliness among youth led to a higher dent reported feeling overwhelmed, saying “It’s hard incidence of depression and suicide. Oldfeld, Hum- to juggle it as a teenager because there’s just so many phrey, and Hebron (2016) established that positive things.” Additionally, identify conficts, a hallmark of peer relationships are a strong predictor of well-being. adolescents’ development, were reported by students Current research also demonstrates the negative infu- as drivers of youth mental health symptoms. Students ence of peers, particularly signifcant stigmatization discussed struggling with determining who they are and teasing of peers struggling with mental health and what they’d like to pursue afer high school. Tis challenges (Mackrell & Lavender, 2004; O’Driscoll, pressure of feeling forced to plan the rest of their lives Heary, Hennessy, & Mckeague, 2012). as teenagers compounded other stressors, such as Lack of resources. Troughout the focus groups, school and social pressure. For example, one urban students discussed a dearth of mental health resources student stated, “I don’t have that clear image of what as a perpetuating factor of mental health stigma and I’m gonna do so I don’t know what to do from here symptoms. Students cited a lack of awareness, a result on out, it’s confusing.” Current literature supports this of poor mental health education, as a major factor in fnding; teens report stress levels that are higher than stereotyping. For example, a rural male participant stat- those of adults and 30% feel depressed or sad because ed “A lot of people go through and see people who are of stress (Bethune, 2014). Studies of both urban and depressed or anxious as just generally crazy … Tat’s rural adolescent populations found signifcant links why people are probably so afraid to be able to be open between high stress levels and depressive symptoms about it too.” While school counsellors and staf, hot- (Carleton, Esparza, Taxter, & Grant, 2008; Young & lines, parents, therapy, medication, and friends were Chau, 2016). mentioned when students were asked what mental health resources were available, no other community resources or evidence-based programs were discussed. 154 RURAL VERSUS URBAN KENTUCKY HIGH SCHOOL STUDENT MENTAL HEALTH

‘God’s always with you, you should never be sad.’ And Urban and Rural Diferences I was like, ‘well why am I sad? I must be upset about something.’” Tis fnding is consistent with Bischof et Tematic analysis of rural groups and urban al. (2014)’s landmark study, which reported the im- groups showed three primary diferences in mental portance of considering unique cultural factors when health perceptions. Tese variations revolved around providing mental health care to rural patients. community interactions, social media, and overdose. Social media. Urban students considered social Community interactions. As opposed to urban media to be largely detrimental to mental health, stat- students, rural students reported both positive and ing “Let’s say I just post a picture … somebody can negative infuences of community culture, while ur- screenshot that and post it on their page and make fun ban students believed that community culture had of me,” and “media is one of the biggest factors [that little impact on mental health. Rural students felt a contributes to stigma], just because … people joke strong sense of connection and comfort with their about depression and all that a lot.” peers—rural focus group participants discussed feel- However, rural students believed that social media ing very open about broaching the topic of mental can be benefcial to mental health, citing various web- health with close friends. Students stated that “I know sites as ways to cope with sadness. Students in one fo- us friends are always here for each other” and “there’s cus group agreed that watching inspirational or funny this mutual respect that we all have for each other,” videos on YouTube allows them to relieve stress and demonstrating their close bonds. feel better. Participants also found comfort in seeing Simultaneously, however, rural participants felt others’ mental health journeys on social media, which that community culture had signifcantly more impact helped them feel less isolated. on stigma than urban students. Students believed that Prior research has noted that social media may have this stigma was a result of ingrained do-it-yourself at- negative impacts on mental health, including symp- titudes and immense focus on religion. One partici- toms driven by cyberbullying (Brown & Bobkowski, pant said “My dad always taught me that if you can’t 2011). Other studies, however, have found that students do it yourself, then there’s no point in trying at all,” who spend more time on social media report lessened while another stated “they’re [church members] like anxiety, possibly because they are using communication tools in a constructive manner (George, Russell, Piontak, Figure 2. Average contributions of six factors to stigma, & Odgers, 2017). Little research investigates diferential as reported by urban and rural students. infuences of social media on urban versus rural adoles- cents, and more investigation is necessary to characterize relationships between youth social media use and commu- nity environment. Overdose. Overdose of family members, friends, or peers as a contributor to mental health symptoms was reported solely by ur- ban students. Both urban and rural students discussed drug use among adolescents as a coping mechanism, but no rural students mentioned overdose. Tis contrasts with national statistics—the nonmetro overdose death 155 RURAL VERSUS URBAN KENTUCKY HIGH SCHOOL STUDENT MENTAL HEALTH rate was slightly higher in 2015 than the metro over- same themes would likely arise in other urban and ru- dose rate, at 17.0 cases per 100,000 people compared ral schools, more focus groups would need to be con- to 16.2 urban cases per 100,000 (Mack, Jones, & Ball- ducted with students in other communities to gener- esteros, 2017). Tis fnding may be a result of the spe- alize fndings to all Kentucky high schoolers. cifc communities in which the study was conducted Additionally, the convenience sampling method having a diferent relationship to drug overdose, but used to recruit participants may have resulted in a more investigation is necessary. sample of students who were more understanding of Quantitative data: contributions of factors to or comfortable discussing mental health. Tis may stigma have biased the data to refect more awareness of and One quantitative item was included during the fo- less stigma or stereotyping around the issue. However, cus groups to evaluate the degree to which students the themes relating to driving factors of mental health believed diferent factors contributed to stigma. Te challenges and stigma around mental health chal- mean values for each of these factors are included in lenges, which represent the bulk of the data collected, Figure 2. are likely the same across populations with or without As this study was primarily qualitative, the sample interest in mental health. size was relatively small, including a total of 28 stu- Tough this study had some limitations, the data dents. A more comprehensive quantitative study with generated is still valuable in understanding the unique a larger sample size would be necessary to glean more factors that drive mental health symptoms and stigma insights from this data. However, this data does sup- among Kentucky high schoolers. Tis represented port the qualitative fndings. Te largest diferences a foundational study in Kentucky student mental between urban and rural students were with media, health—no previous research has evaluated adoles- with a diference of 2.07, and community culture, with cents’ perceptions of the issue. Understanding these a diference of 1.33, which were two of the three the- perspectives is critically important; students have a matic diferences between urban and rural areas. unique understanding of their own mental health Overall, analysis of quantitative and qualitative concerns and the policies and programs that intend data revealed that the infuence of family dynamics, to address their well-being. If efective ways to im- peer interactions, lack of resources, and high stress prove youth mental health are to be developed, stu- levels were similarities across urban and rural stu- dents’ perspectives must be understood. Tis research dents, while the roles of community culture, social provides a base upon which to further explore youth media, and overdose represented diferences. Tis mental health through additional focus groups and fnding summarizes adolescent perspectives to fll the targeted surveys. preexisting gap of a lack of youth voice about mental health. Conclusion and Future Directions

Limitations & Implications To allow for generalization of these themes to all Kentucky students, a further study will involve ad- Te four focus groups conducted to gather data ditional focus groups across more urban and rural for this study were likely able to capture a represen- schools, geographic locations, and communities in tative and complete picture of student perceptions of the state. A quantitative survey will be developed mental health in the individual rural and urban high based on the results of these additional sessions. Tar- schools—Greg Guest and colleagues found that 90% geting the survey to certain themes that arose from of themes were able to be discovered afer three to this research and that will arise in further studies six focus groups (Guest, Namey, & Mckenna, 2017). will allow the survey to focus on the most important However, the sample size of one rural and one urban themes. Eventually, a policy or program recommen- high school limited this study in that the fndings are dation to improve youth mental health that applies to not fully generalizable to urban or rural Kentucky urban and rural Kentucky high schoolers will be de- high school students as a whole. While many of the veloped from this work. A recommendation informed 156 RURAL VERSUS URBAN KENTUCKY HIGH SCHOOL STUDENT MENTAL HEALTH by student perspectives will be the most efective in Carleton, R. A., Esparza, P., Taxter, P. J., & Grant, K. E. (2008). Stress, religious coping resources, and depres- improving the well-being of Kentucky youth. sive symptoms in an urban adolescent sample. Journal Te emerging themes identifed in these focus for the Scientifc Study of Religion,47(1), 113-121. groups, supplemented by quantitative data, represent doi:10.1111/j.1468-5906.2008.00395.x new insights about mental health through the lens of DeRigne, L., Porterfeld, S., & Metz, S. (2009). Te infu- adolescents. While research has previously been con- ence of health insurance on parent’s reports of children’s ducted regarding adult perspectives on mental health unmet mental health needs. Maternal & Child Health issues, evaluating student perspectives revealed men- Journal, 13, 176-186. doi:10.1007/s10995-008-0346-0 tal health factors that revolve around the high school Erickson, A., & Abel, N. R. (2013). A high school counsel- experience (Story et al., 2016; Bischof et al., 2014; De- lor’s leadership in providing school-wide screenings for Rigne, Porterfeld, & Metz, 2009; Farahmand, Grant, depression and enhancing suicide awareness. Professional Polo, & Dufy, 2011). Investigation and comparison School Counseling, 16(5), 283-289. Retrieved July 3, 2017, of rural and urban perspectives showed that the in- from http://www.jstor.org/stable/profschocoun.16.5.283 fuence of family, peers, high stress levels, and lack of Farahmand, F. K., Dufy, S. N., Tailor, M. A., DuBois, D. resources were similar between both groups, while L., Lyon, A. L., Grant, K. E., & ... Nathanson, A. M. overdose, social media, and community culture were (2012). Community-based mental health and behavioral programs for low-income urban youth: A meta-analytic diferent. review. Clinical Psychology: Science & Practice, 19(2), Tese results indicate that several factors, par- 195-215. doi:10.1111/j.1468-2850.2012.01283.x ticularly social media and overdose, need further Farahmand, F. K., Grant, K. E., Polo, A. J., & Dufy, investigation. Results from this work will provide a S. N. (2011). School-based mental health and be- foundation for further research investigating youth havioral programs for low-income, urban youth: perspectives of mental health and an eventual policy A systematic and meta-analytic review. Clinical or program recommendation to improve adolescent Psychology: Science & Practice, 18(4), 372-390. well-being. doi:10.1111/j.1468-2850.2011.01265.x Fielden, A. L., Sillence, E., & Little, L. (2011). Children’s un- derstandings’ of obesity, a thematic analysis. International Journal of Qualitative Studies on Health and Well-Being, References 6(3), 10.3402/qhw.v6i3.7170. http://doi.org/10.3402/qhw. v6i3.7170 Aarons, G. A., Wells, R. S., Zagursky, K., Fettes, D. L., & George, M. J., Russell, M. A., Piontak, J. R., & Odgers, C. L. Palinkas, L. A. (2009). Implementing evidence-based (2017). Concurrent and subsequent associations between practice in community mental health agencies: A daily digital technology use and high-risk adolescents’ multiple stakeholder analysis. American Journal of Public mental health symptoms. Child Development,89(1), 78- http://doi.org/10.2105/ Health, 99(11), 2087–2095. 88. doi:10.1111/cdev.12819 AJPH.2009.161711 Guest, G., Namey, E., & Mckenna, K. (2017). How many Bethune, S. (2014). Teen stress rivals that of adults. Monitor focus groups are enough? Building an evidence base for on Psychology,45(4), 20. doi:10.1037/e508692014-007 nonprobability sample sizes. Field Methods, 29(1), 3-22. Bischof, R. J., Reisbig, A. M., Springer, P. R., Schultz, S., doi:10.1177/1525822x16639015 Robinson, W. D., & Olson, M. (2014). succeeding in rural Jameson, J., & Blank, M. B. (2007). Te role of clini- mental health practice: Being sensitive to culture by ft- cal psychology in rural mental health services: ting in and collaborating. Contemporary Family Terapy, Defning problems and developing solutions. Clinical 36(1), 1-16. doi:10.1007/s10591-013-9287-x Psychology: Science & Practice, 14(3), 283-298. Braun, V., & Clarke, V. (2006). Using thematic analysis in doi:10.1111/j.1468-2850.2007.00089.x psychology. Qualitative Research in Psychology,3(2), 77- Jones, A. C., Schinka, K. C., Dulmen, M. H., Bossarte, R. 101. doi:10.1191/1478088706qp063oa M., & Swahn, M. H. (2011). Changes in loneliness during Brown, J. D., & Bobkowski, P. S. (2011). Older and newer middle childhood predict risk for adolescent suicidality media: Patterns of use and efects on adolescents health indirectly through mental health problems. Journal of and well-being. Journal of Research on Adolescence,21(1), Clinical Child & Adolescent Psychology,40(6), 818-824. do 95-113. doi:10.1111/j.1532-7795.2010.00717.x i:10.1080/15374416.2011.614585

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Kaiser Family Foundation. (2016). mental health care childhood and adolescence. Journal of Child health professional shortage areas (HPSAs). Retrieved Psychology and Psychiatry,53(10), 1054-1062. November 1, 2017, from https://www.kf.org/other/ doi:10.1111/j.1469-7610.2012.02580.x state-indicator/mental-health-care-health-professional- Oldfeld, J., Humphrey, N., & Hebron, J. (2016). Te role of shortage-areas-hpsas parental and peer attachment relationships and school Kang-Yi, C. D., Mandell, D. S., & Hadley, T. (2013). School- connectedness in predicting adolescent mental health based mental health program evaluation: Children’s outcomes. Child and Adolescent Mental Health,21(1), 21- school outcomes and acute mental health service use. 29. doi:10.1111/camh.12108 Journal Of School Health, 83(7), 463-472. Smalley, K. B., Yancey, C. T., Warren, J. C., Naufel, K., Ryan, Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., R., & Pugh, J. L. (2010). Rural mental health and psycho- Flint, K.H., Hawkins, J., . . . Zaza, S. (2016). Youth risk logical treatment: A review for practitioners. Journal Of behavior surveillance — United States, 2015. Surveillance Clinical Psychology, 66(5), 479-489. Retrieved October Summaries, 65, 1-174. Retrieved October 3, 2017, from 4, 2017. https://www.cdc.gov/mmwr/volumes/65/ss/ss6506a1. Smokowski, P. R., Bacallao, M. L., Cotter, K. L., & Evans, C. htm. B. (2015). Te efects of positive and negative parent- Landeweer, E., Molewijk, B., Hem, M. H., & Pedersen, ing practices on adolescent mental health outcomes in R. (2017). Worlds apart? A scoping review addressing a multicultural sample of rural youth. Child Psychiatry diferent stakeholder perspectives on barriers to family & Human Development,46(3), 333-345. doi:10.1007/ involvement in the care for persons with severe mental s10578-014-0474-2 illness. BMC Health Services Research, 17(1). doi:10.1186/ Stagman, S., & Cooper, J. L. (2010). Children’s Mental s12913-017-2213-4 Health: What Every Policymaker Should Know. Larson, J. E., & Corrigan, P. W. (2010). Psychotherapy Retrieved October 2, 2017, from http://www.nccp.org/ for self-stigma among rural clients. Journal of Clinical publications/pdf/text_929.pdf Psychology, 66, 524-536. doi:10.1002/jclp.20679 Story, C. R., Kirkwood, D., Parker, S., & Weller, B. E. (2016). Mack, K. A., Jones, C. M., & Ballesteros, M. F. (2017). Illicit evaluation of the better todays/better tomorrows youth drug use, illicit drug use disorders, and drug overdose suicide prevention program: Increasing mental health deaths in metropolitan and nonmetropolitan areas — literacy in rural communities. Best Practice In Mental United States. Morbidity and Mortality Weekly Report, Health, 12(1), 14-25. 66(19), 1-12. doi:10.15585/mmwr.ss6619a1 Topkaya, N. (2015) Factors Infuencing Psychological Help Mackrell, L., & Lavender, T. (2004). Peer relation- Seeking in Adults: A Qualitative Study. Educational ships in adolescents experiencing a frst episode of Sciences: Teory & Practice, 15(1), 21–31. doi:10.12738/ psychosis. Journal of Mental Health, 13(5), 467-479. estp.2015.1.2094. doi:10.1080/09638230400006775 US Department of Agriculture. (2016, October 12). Mukolo, A., Hefinger, C. A., & Wallston, K. A. (2010). Te Rural-Urban Continuum Codes. Retrieved October 10, stigma of childhood mental disorders: A conceptual 2017, from https://www.ers.usda.gov/data-products/ framework. Journal of the American Academy of Child rural-urban-continuum-codes/ and Adolescent Psychiatry, 49(2), 92-198. Retrieved Valdez, C., Lambert, S., & Ialongo, N. (2011). Identifying November 3, 2017. patterns of early risk for mental health and academic National Alliance on Mental Illness. (n.d.). Mental Health problems in adolescence: A longitudinal study of urban Facts CHILDREN & TEENS. Retrieved October 1, 2017, youth. Child Psychiatry & Human Development, 42(5), from https://www.nami.org/NAMI/media/NAMI-Media/ 521-538. doi:10.1007/s10578-011-0230-9 Infographics/Children-MH-Facts-NAMI.pdf. Wagner, M., Newman, L., Cameto, R., & Levine, P. (2005). National Association for College Admission Counseling & Changes Over Time In Te Early Postschool Outcomes American School Counsellor Association. (n.d.). STATE- Of Youth With Disabilities. A Report Of Findings From BY-STATE STUDENT-TO-COUNSELLOR RATIO Te National Longitudinal Transition Study (NLTS) And REPORT 10-YEAR TRENDS. Retrieved March 7, 2018, Te National Longitudinal Transition Study-2 (NLTS2). from https://www.nacacnet.org/globalassets/documents/ Menlo Park, CA: SRI International. publications/research/ratioreportdr3.pdf. Young, C. C., & Chau, L. L. (2016). In their own words: O’Driscoll, C., Heary, C., Hennessy, E., & Mckeague, Rural adolescent stressors and relationship to depressive L. (2012). Explicit and implicit stigma to- symptoms. Western Journal of Nursing Research,39(9), wards peers with mental health problems in 1255-1270. doi:10.1177/0193945916670131

158 RURAL VERSUS URBAN KENTUCKY HIGH SCHOOL STUDENT MENTAL HEALTH Appendix A

Te consent form on the following page is the form, including both parent or guardian consent and youth assent, that all participants returned to the researcher prior to the focus group sessions.

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Appendix B Appendix C

Pilot focus group questions: Finalized focus group questions: What does mental health mean to you? Tell me your name and your favorite favor of ice Do you associate a stigma with “mental health?” cream. (Icebreaker) Why? What do you think of when you hear the phrase How do you think the stigma surrounding mental “mental health”? health is infuenced by cultural factors? When you hear about someone who is experi- What do you think contributes the most to de- encing mental health symptoms, what are your frst velopment of mental health challenges among high thoughts? schoolers? Follow-up question: How do you imagine your What do you think is the most signifcant barrier friends would respond to this news? for high school students to accessing mental health Follow-up question: To what extent do you think treatment? there’s a stigma attached to people experiencing men- How does your school address mental health? Is it tal health symptoms? Stigma is defned as an attribute efective? Why or why not? that an actual or inferred attribute that damages the Are you aware of any good resources you could use bearer’s reputation and degrades him or her to a so- if you thought you were experiencing a mental health cially discredited status. challenge? Why do you like those resources? How can you tell when you or your peers are expe- What would help you better discuss mental health riencing mental health symptoms? topics with your family or peers? What do you think are some of the factors that con- What do you think is the best way to prevent and tribute to high school students experiencing mental treat mental health challenges? health symptoms? Is there anything else you’d like to tell the group? What do you or your peers do to deal with mental health symptoms? Are you aware of any good resources within or out- side of school you could use if you thought you were experiencing a mental health challenge? Follow-up question: What’s good about those re- sources? What gets in the way of more students using those resources? I’m going to read a list of factors and ask you about how strongly they contribute to the stigma surround- ing mental health. Please hold up fngers from 1-5, with fve being the strongest impact on stigma. Fac- tors included community culture, religious culture, heritage, family, peers, and media. What stands out most to you about how these dif- ferent factors contribute to the stigma around mental health? If you were experiencing more mental health symptoms, what would you want people in your life to do for you? Is there anything else you’d like to tell the group?

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treating mental health disorders having to balance so many things Appendix D personality at once Comment: by Allison n-beingdiferent Tis appendix includes a list When participants discuss Comment: by Allison of codes, grouped by the the- the role of personality in mental Not wanting to stand out or be matic grouping in ATLAS.ti. Te health, whether it’s negative, posi- diferent “theme” grouping of codes, at the tive, or neutral statement of fact n-burden end of the appendix, indicates spamaccount Comment: by Allison codes used to classify quotes into Comment: by Allison Negative infuence of feeling broad categories, which facilitated For discussion about spam ac- like a burden analysis. Temes for the thematic counts on social media n-community analysis were then identifed by support Comment: by Allison examining relationships among Comment: by Allison Negative infuence of commu- individual codes and code groups. Discussing wanting mental nity and community culture Project: AP Research health support/discussing support n-coping Report created by Allison on in general Comment: by Allison 4/20/2018 treatnormally When participants discuss neg- Code Report ‒ Grouped by: Comment: by Allison ative coping mechanisms. Code Groups Discussing wanting to be treat- n-counsellor All (79) codes ed normally Comment: by Allison trust Negative or unhelpful school Groupless Comment: by Allison counsellors Teme of being able to trust n-cyberbullying 13 Codes: or connect with or feel close with Comment: by Allison environment someone or a group For discussion about cyberbul- Comment: by Allison understand lying When students discuss the im- Comment: by Allison n-denial pact of environmental factors on When students discuss want- Comment: by Allison mental health ing to be understood or the role of When participants discuss de- good-quote someone else understanding what nial of symptoms Comment: by Allison the person is going through n-drugs Notable or good quotes unexpected Comment: by Allison honesty Comment: by Allison When participants discuss Comment: by Allison When participants discuss how drugs and negative infuences on Honesty or getting to the point mental health symptoms can be mental health when it comes to interactions unexpected n-expectations about mental health Comment: by Allison isolation Negative infuence Negative infuence of expecta- Comment: by Allison tions, from parents, self, or anyone When students discuss isola- 36 Codes: n-failure tion, feeling isolated, etc n-awareness Comment: by Allison listen Comment: by Allison Negative infuence of fear of Comment: by Allison When participants discuss lack failure or of making mistakes Listening to someone with of awareness/how lack of aware- n-family mental health concerns ness is bad Comment: by Allison medication n-balance Negative infuence of family on Comment: by Allison Comment: by Allison mental health Medication in reference to Negative efects or infuence of n-future 161 RURAL VERSUS URBAN KENTUCKY HIGH SCHOOL STUDENT MENTAL HEALTH

Comment: by Allison n-money Comment: by Allison Not knowing about the future is Comment: by Allison When people discuss being stressful Negative infuence of money or treated diferently/treating others n-gender worrying about fnances on mental diferently Comment: by Allison health Negative gender biases, stereo- n-noresources Positive infuence types, infuence Comment: by Allison n-generationalgap Not knowing about resources or 11 Codes: Comment: by Allison not knowing if/what resources are p-club Discussing a generational gap/ available Comment: by Allison discussing the diferences in the n-overdose Positive infuence of a club “times” when students’ relatives Comment: by Allison p-community were young, etc Negative infuence of peer or Comment: by Allison n-heritage family overdose When students describe a close Comment: by Allison n-peers community/positive infuences of Negative infuence of heritage, Comment: by Allison community culture of ethnic background Negative peer infuences p-coping n-hidesymptoms n-school Comment: by Allison Comment: by Allison Comment: by Allison Positive coping mechanisms When participants discuss hid- Negative impact of school/stan- p-exercise ing mental health symptoms dardized testing, ofen in terms of Comment: by Allison n-identity causing mental health symptoms Exercising and positive infu- Comment: by Allison n-selfpressure ences on mental health Identify confict or negative in- Comment: by Allison p-family fuence of identity High self-expectations or self Comment: by Allison n-internalthought pressure Positive infuence of family on Comment: by Allison n-sleep mental health Negative internal thoughts/ Comment: by Allison p-music cycles of spiraling, etc Not getting enough sleep Comment: by Allison n-job n-solvealone Positive efect of music on men- Comment: by Allison Comment: by Allison tal health Negative efects of having a When people discuss trying to p-outlet job or balancing work with other resolve mental health symptoms Comment: by Allison things on their own Positive coping through outlets n-joking n-sports p-peers Comment: by Allison Comment: by Allison Comment: by Allison Tis code is for when people Negative infuence of sports on Positive infuence of peers discuss joking about mental health mental health p-religion or not taking mental health seri- n-stereotype Comment: by Allison ously in a negative way. Comment: by Allison Positive infuence of religion or n-judgement When participants seem to have church Comment: by Allison a negative stereotype around men- p-school Negative infuence of judge- tal health or mention a negative Comment: by Allison ment stereotype Positive infuence of school, in- n-media n-stress cluding teachers, on mental health Comment: by Allison Comment: by Allison p-sleep Negative infuence of media on Negative infuence of stress Comment: by Allison mental health n-treateddiferently Positive efects of sleep on men- 162 RURAL VERSUS URBAN KENTUCKY HIGH SCHOOL STUDENT MENTAL HEALTH tal health Symptoms t-stigma Comment: by Allison Speakers-Rural 7 Codes: Any time participants are refer- s-anxiety ring to stigma, negative, positive, 4 Codes: Comment: by Allison or neutral B-Rural When anxiety is discussed t-symptoms Comment: by Allison s-actdiferently Comment: by Allison Tis code is for when boys are Comment: by Allison Anything relating to mental speaking during the rural focus Symptom of acting diferently, health symptoms, perpetuating groups. commonly seen in question 4 them or causing them Group-Rural s-apathy Comment: by Allison Comment: by Allison Tis code is for when the group When students discuss the is speaking during rural focus symptom of apathy groups. s-eating G-Rural Comment: by Allison Comment: by Allison Symptom of changing eating Tis code is for when girls habits are speaking during rural focus s-overwhelmed groups. Comment: by Allison Moderator-AT Feeling overwhelmed Comment: by Allison s-sleep Tis code is for the moderator Comment: by Allison speaking in both the rural and ur- Changing sleep habits as a ban focus groups. symptom s-smallchange Speakers-Urban Comment: by Allison When students discuss small 4 Codes: changes in behavior B-Urban Comment: by Allison Temes Tis code is for when urban boys are speaking during focus 5 Codes: groups. t-coping Group-Urban Comment: by Allison Comment: by Allison Teme of coping mechanisms Tis code is for when the group t-interaction is speaking during urban focus Comment: by Allison groups. When participants are discuss- G-Urban ing an interaction between them Comment: by Allison and someone else about mental Tis code is for when urban health, negative, positive, or neu- girls are speaking. tral Moderator-AT t-resources Comment: by Allison Comment: by Allison Tis code is for the moderator Anything relating to mental speaking in both the rural and ur- health resources, education, treat- ban focus groups. ment, or other 163 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018

LED Colour Temperature and its Efect on the Growth of Hydroponic Lettuce Seedlings

Justin Shaw

Previous research has shown that diferences in light quality can have profound efects on the growth of hydroponic lettuce. Tis experiment attempts to determine the correlation between the colour temperature of LED grow lights and the growth of hydroponic lettuce. Initially, this study exposed a total of 252 Butterhead lettuce seedlings to various temperatures of white LED lights to determine if there was any correlation between the warmth of light emitted and the growth of let- tuce seedlings. Growth was measured in four variables: height, number of leaves, wet mass, and dry mass. When harvested at 28 days, the results suggest that there is a statistically signifcant difer- ence between plants grown under 3,000K and 6,000K conditions, with results showing as much as a 232% increase in growth for plants grown under 6,000K lights.

Keywords: Colour Temperature, LED, Hydroponics, Butterhead Lettuce

Introduction To meet these goals by exclusively developing more new land would require a land mass the size of Brazil By the year 2050, the United Nations projects that (Despommier, 2012). According to a NASA-funded the global population will exceed 9.7 billion people, Stanford researcher, the vast majority of new agricul- the majority of whom will be moving into cities, tak- tural land developed in the past decade came from the ing up a more Western diet (United Nations, 2017). unsustainable deforestation of rainforests in develop- Current agricultural outputs would thus be insuf- ing countries (Gibbs et al., 2010). Even without the cient to feed the world without an estimated 60% in- harmful environmental side-efects of deforestation, crease in global food production by 2050 (Alexandra- current agricultural development is nowhere close to tos and Bruinsma, 2012; Despommier 2009; Godfrey the scale that would be necessary to support a 60% et al., 2010; Ray et al., 2013). To put this in perspec- increase in global food production. Terefore, the frst tive, meeting those projections would require growing method of increasing agricultural output by develop- more food in the next ten years than has ever been ing more farmland is unfeasible. Unfortunately, vari- grown in the course of human history (Bourne, 2015). ous environmental factors (such as global warming Historically, there are two main ways to increase the and water scarcity) have restricted the efciency of total agricultural output (Tornton, 2012; Tilman et agricultural production and already pose harmful en- al., 2001): vironmental side efects, making the second method - develop more new land, or unlikely to be efective (Alexandratos and Bruinsma, - increase the efciency of current agricultural 2012; Godfray et al., 2010; Ray et al., 2013). For in- practices. stance, according to a paper published in the journal 164 LED COLOUR TEMPERATURE AND HYDROPONIC LETTUCE SEEDLINGS

Science, it is projected that over the next decade pes- same crop, and can be grown year-round (Barbosa et ticide usage will increase threefold, which would push al., 2015; Winter et al., 2017). Most soil-based grow- many coastal marine zones past the point of no return ers harvest their crops at most three times per year, (Tilman et al., 2001). Tis is because agricultural pes- but hydroponic plant factories can harvest up to 22 ticide runof creates an abundance of nitrogen in riv- times per year in a fraction of the space (Despommier, ers and streams, feeding algae which consume all of 2013; Fischetti, 2008). In a hydroponics system, plants the dissolved oxygen in an area. Tese areas are called are cultivated in a solution that contains all the nu- a dead-zones because there is no dissolved oxygen in trients needed for plant growth instead of soil. Tis the water, making it ecologically ‘dead’ or incapable means they can be grown indoors which efectively of supporting complex life. Te use of chemical pes- eliminates the need for chemical pesticides, herbi- ticides along the Mississippi River has created a large cides, or fungicides that are used in traditional out- dead-zone in the Gulf of Mexico the size of a small door agriculture. Additionally, this allows the farmer state (Diaz and Rosenberg, 2008; Tilman et al., 2001). to stack multiple tiers of plants, which increases the Given the increasing frequency of droughts, water us- density of plants that can be grown in a given area. age is also a large concern given that agriculture ac- Tere are many diferent types of hydroponic systems, counts for about 70% of all freshwater usage in the each being specialized to a specifc set of objectives United States (Barbosa et al., 2015; Winter et al. 2017). and constraints. Regardless of the system used, the For these reasons, increasing the efciency of current most common way to germinate seeds is with an ex- agricultural practices is becoming more and more panded rock fber called rockwool. Tis report will difcult. Some argue that these kinds of Malthusian focus on the colour temperature of LED lights and doomsday predictions have always been predicted how they afect the germination of seeds grown in and have never come true; however, the methods that rockwool. Because the nursery conditions are gener- were efective for farmers yesterday are inefective to- ally the same for each of the diferent types of systems day (Godfrey et al., 2010; Tornton, 2012; Tilman et described below, the results of this paper can easily be al., 2001). To feed the growing global population with- applied to all systems described below (Both, 1998). out sacrifcing the health of our planet, a radically new Nutrient Film Technique. Te Nutrient Film way of growing food is necessary. Technique (NFT) cycles nutrients past exposed roots via a pump (Figure 1). NFT systems are generally the least expensive hydroponic systems to purchase and operate because when the water is running continu- Literature Review ously, it oxygenates itself. In other systems, where the water is not cycled, the use of an air pump must be Hydroponics implemented to oxygenate the solution. Lack of prop- er oxygenation can lead to negative crop yields (Both, Te use of hydroponic farming has the potential to 1998). Te NFT system is also ideal for urban areas radically change the way food is grown. Hydroponic that have footprint constraints. Te end of one tube technology was frst deployed in World War II to pro- can be connected to the beginning of another and the vide the US Armed Forces with fresh fruit and veg- whole system can be stacked several layers high, cre- etables in the desolate, and ofen barren islands of the ating a dense agricultural environment that decreases Pacifc. Te technology sustained American troops in the farm’s footprint and saves money (Both, 1998; de- their victorious island-hopping campaign across the Anda and Shear, 2017). Pacifc as it could grow large quantities of food with- out taking up a large footprint on each island (Jones Jr., 1982). Hydroponic farming is an efcient way of produc- ing enough food to meet the growing needs of grow- ing global populations. Hydroponic systems do not need soil, can use up to 11 times less water for the 165 LED COLOUR TEMPERATURE AND HYDROPONIC LETTUCE SEEDLINGS

vided by fsh (Figure 3). Te result is an artifcial mi- cro-ecosystem: the fsh produce organic compounds that are vital to plant growth and the plants absorb organic compounds which also cleans the water for the fsh. In all of these systems, it is not uncommon to see the nutrient solution be substituted for an aqua- ponics system.

Figure 1: NFT systems cycle nutrients past exposed roots via a pump (Mchunu et al., 2017).

Deep Water Culture. Another type of system, called Deep Water Culture (DWC), uses a nutrient solution in which roots are submerged. As the water level decreases, due to plant metabolism and evapora- tion, more of the roots are exposed to the air which in- creases oxygenation to the roots as they mature. How- Figure 3: In Aquaponics, plant nutrients are provided ever, the use of this system still requires an oxygenator by fsh (FAO, 2014). for best results. Tis system is best for areas with ample amounts of natural sunlight and open space as Aeroponics. In addition to hydroponics, many it would be difcult to scale up this setup in an urban other systems have been developed as an alternative environment without the ability to stack multiple lay- to traditional agriculture. One example is aeropon- ers (Both, 1998; deAnda and Shear, 2017). ics where nutrients are taken from a reservoir and Floating Raf Culture. A variation on the DWC sprayed out of a fne nozzle at exposed roots. Aero- method, Floating Raf Culture (FRC) uses a foating ponics systems are great for high density urban ar- raf which holds the plants above the reservoir (Figure eas because they can produce a lot of fresh fruit and 2). Tis method is very common in commercial hy- vegetables in a small space. Tis misting method can droponic systems where space and light are not issues. be stacked on top of itself, which increases food pro- duction density similar to the NFT method. In many plant factories, this method is common because ev- erything can be automated. Additionally, the quality of crops coming out of these high-tech plant factories has the potential to be greater than traditional agricul- ture because farmers can customize each aspect of the internal environment (like CO2 content or humidity) to specifc tastes or preferences.

Figure 2: FRC uses a raf which holds the plants above Research Objective the reservoir (Mchunu et al., 2017). In response to the growing dangers of industrial Aquaponics. Unlike the other methods, an Aqua- agriculture, hydroponics ofers a viable alternative ponics system is not about the structural design of the that is capable of meeting targets for future demands farm; rather it is about the nutrients that are delivered at a fraction of the cost (Barbosa et al., 2015; deAnda to the plant. In aquaponics, plant nutrients are pro- and Shear, 2017; Winter et al., 2017). However, the 166 LED COLOUR TEMPERATURE AND HYDROPONIC LETTUCE SEEDLINGS efciency of current hydroponic technology is not fcient but have not been tested on plant growth. able to meet those targets. Terefore, the objective Plants perceive light diferently than humans. of this experiment is to examine the efects of co- While the range of light plants can absorb is roughly lour temperature on the growth of Butterhead lettuce the same as the visible spectrum in humans, the ef- seedlings in a simulated hydroponic environment. fciency (the ratio of the quantity absorbed by the cell to the quantity of light that hits the cell) at which they absorb each wavelength is vastly diferent. Te spectrum of light available for plants is called photo- Photobiology synthetically active radiation (PAR). Tis describes the range of wavelengths of light from about 400nm It is generally accepted that plants grow best when to 700nm. Tere are two common ways of measur- the majority of emitted light is in the red and blue ing the brightness of light in the PAR spectrum, ei- (RB) spectrum (Folta and Maruhnich, 2007; Lee et al., ther by ‘weighing’ all photons in the spectrum equally, 2014; Su et al., 2014; Wang et al., 2015). Small quanti- called photosynthetic photon fux (PPF), or by giving ties of other wavelengths have also been proven ben- a weight to certain photons based on the plant’s abil- efcial for plant metabolism (Smith et al., 2017). Tis is ity to absorb that wavelength, called yield photon fux because the photoreceptors (a cell protein that absorbs (YPF). Generally speaking, red photons are easier to light) absorb red and blue photons (particles of light) absorb, due to their lower energy, thus resulting in more efciently than other wavelengths. Competing about 20% to 30% more photosynthetic activity than studies have also contested whether or not the use a blue photon (McCree, 1971). Because you have to of green light is efective for plant growth (Folta and know the specifc frequency of the light source be- Maruhnich, 2007; Kim et al., 2004; Smith et al., 2017). fore you can weight the wavelengths, YPF is harder to For instance, new research has shown that green light measure than PPF. may also play a role in the creation of specifc plant Another diference between plant and human light proteins that aid in growth (Kim et al., 2004; Smith et perception is how each perceives brightness. Te hu- al., 2017). Other research shows that this light might man retina uses a logarithmic scale when sensing not correlate into measurable plant development (Su light. Tis means going from one to two light sources et al., 2014). In general, using red and blue Light Emit- would have the same efect as from 50 to 100 light ting Diodes (LEDs) has been shown to be more ef- sources. However, plants are linear in their perception fcient that only using white (Lee et al., 2014). Addi- of light; the diference between one light and two is tional studies show that the use of far-red (the region equivalent to the diference between 50 and 51. Tis between red and infra-red) lighting can enhance plant means that controlling the brightness level in lights is fowering (Deitzer et al., 1979). crucial. To measure brightness, Biologists describe the Tis experiment used three diferent colour tem- density of photons hitting a given surface area every peratures of light (3,000K through 6,000K) that vary second, photosynthetic photon fux density (PPFD). in the proportion of red light to blue light. Each of PPFD will be discussed more in relation to Photoperi- the lights is technically ‘white’ so it contains all wave- odism (section 3.3). lengths of colours, but in general the higher the colour According to Dr. Toyoki Kozai, Professor Emeritus temperature the bluer the light. Terefore, the 3,000K and Chief Director of the Japan Plant Factory Asso- light has the highest proportion of red photons and ciation Center for Environment, Health, and Field the 6,000K light has the highest proportion of blue Sciences at Chiba University, due to an insufcient re- photons. search base on the topic, “there should be more room In addition to the colour of light, the type of bulb is for improving the [lighting use efciency] of [closed also important in horticultural research. Recent stud- plant production systems]” (Kozai, 2013). While ies with new LEDs have shown that LEDs can be more there is a surplus of knowledge about the diferences energy efcient than the industry-standard Philips T5 in efciencies between growing methods and solution High Output Compact Fluorescent Light (Reineke et contents, and wavelength of various lighting systems, al., 2009). Organic LEDs (OLEDs) are even more ef- more research needs to be done on the colour temper- 167 LED COLOUR TEMPERATURE AND HYDROPONIC LETTUCE SEEDLINGS ature of indoor hydroponic lighting systems (Kozai, - it increases the humidity inside the enclosure 2013; Reineke et al., 2009). “Lighting Use Efciency” which aids the growth of lettuce seedlings, is one of the most vital, yet underdeveloped aspects - it protects the LED lights from water damage. of plant factories. Tis paper aims to fll that gap by Te interior of each chamber was painted white evaluating the varying ‘efciencies’ of diferent colour to refect as much light as possible, which increases temperatures of LED lights. the efciency of the LEDs dramatically. In each of the two growing periods, 21 rockwool cubes (42 seeds) Butterhead Lettuce were soaked in a nutrient-rich bath for 2 hours and then placed in each of the three chambers. Rockwool Butterhead lettuce is the most widely used crop cubes can hold water for a matter of weeks before dry- in research-based hydroponics as it grows relatively ing out, but nutrient levels may vary over that time. quickly (Barbosa et al., 2015; Brechner and Both, 2013; Excessive watering can lead to nutrient buildup and Jones, 2005; Ryder, 1999; Tyson et al., 2013). Lettuce can harm vital plant functions, so nutrients were re- grows best in cooler climates and is well documented plenished by spraying each chamber with a nutrient in research-related studies of hydroponics (Dufault solution every three days. Afer the standard growth et al., 2009; Fischetti, 2008). Butterhead lettuce can period of 28 days (afer planting), various measure- be sold at a local farmer’s market for a proft to help ments were taken (described in section 3.6). subsidize the initial costs of building a small-scale “Closed Plant Production System” (CPPS), although Crop Selection these systems are generally inexpensive (Becraf, 2017; Brechner and Both, 2013; deAnda and Shear, Tis paper uses Butterhead lettuce as a test crop as 2017; Jones, 2005). it grows relatively fast, is compact, and is supported by a large base of past research. Te large base of litera- ture surrounding Butterhead lettuce means this paper Methods has direct and pragmatic implications for both com- mercial hydroponic growers, and academic research- In order to determine if various colour tempera- ers alike as they incubate their own lettuce seedlings tures of LED lights will have any efect on the growth and are questioning the relationship between colour of lettuce, this experiment developed a quantitative temperature and plant growth as a means of improv- experimental approach that closely modelled com- ing the efciency of plant production. mon commercial hydroponic germination techniques to measure the growth of lettuce seedlings in a hydro- Nutrients ponic simulation. Tis study germinated a total of 252 Butterhead lettuce seeds in hyper-absorbent expand- In hydroponic conditions, all of the nutrients need- ed rock-fber cubes (Rockwool) in 3 diferent cham- ed for plant growth are dissolved into a solution to bers each with a diferent colour temperature of light. which the roots are exposed. Tis type of setup is ad- Rockwool is the most common growth medium for vantageous because the nutrients available to the plant both commercial and laboratory-oriented growers as can be more accurately controlled. In general, plants it closely models traditional soil-based growing while need two categories of nutrients: micronutrients absorbing a large volume of water for its size. Two and macronutrients. Tis paper utilizes a discipline- seeds per rockwool cube were planted in each of the standard mix of Masterblend™ 4-18-38, Calcium Ni- three chambers, grown over the course of two grow- trate, and Magnesium Sulfate. Te numbers 4–18–38 ing periods. A scaled down version of a Closed Plant in the fertilizer naming system stand for the relative Production System (CPPS), and utilized a standard abundance of Nitrogen, Phosphorous, and Potassium 11- by 22-inch gardening tray and humidity dome, all (NPK). For example, this experiment used a formula enclosed by identical rigid white containers. Te hu- with 4% Nitrogen, 18% Phosphorous, and 38% Potas- midity dome is a standard-ft transparent dome which sium by volume. Te combination of these ingredi- serves two functions: ents sufciently satisfes both the macro- and micro- 168 LED COLOUR TEMPERATURE AND HYDROPONIC LETTUCE SEEDLINGS nutrient requirements of the plants. Te specifc ratio Dimensions of ‘Growth’ between these chemicals is very important as a lack of nutrients may lead to visual defciencies. However, a In general, the metrics for measuring plant growth more in-depth justifcation for each of the nutrients is vary widely based on the objective of the research. beyond the scope of this research paper. However, it is typical to include at least three diferent quantitative measures so as to get a wide breadth of Photoperiodism data about each plant in order to tell a complete story. While no individual measurement fully explains the Past research has shown that plants need to spend status of the plant, a combination of these three per- specifc amounts of time in both light and dark- spectives can give a more detailed picture of how each ness. Te photoperiod of this experiment is tuned plant grew under the various conditions. Te follow- precisely with that of developing lettuce seedlings; ing three measurements were the most common way 18 hours of light and 6 hours of dark. Te use of a of measuring plant growth in academic biological re- digital 24-hour timer ensures that all of the trials get search. the same amount of light. Although this model at- Height. Height (the distance from the base of the tempts to equalize the amount of light that hits each plant at the surface of the rockwool to the tip of the plant’s leaves, diferences in the PPFD output of the longest leaf) can have various implications in biologi- lights themselves may also limit the consistency of cal terms. In general, a large height value can imply the light absorption of the plants. Tis is to say that that the plant grew fully and prospered in the given some lights may be fractionally ‘brighter’ than oth- conditions. From an evolutionary standpoint, a taller ers which may infuence data. Tis can not be cor- plant is favoured over a small plant as tall plants have rected for as the diference in PPFD between colour easier access to sunlight than do plants of smaller temperatures is an intrinsic property of each light, stature. However, that is not always the case. ‘Bolting’ and should be considered as such when evaluating is a term used to describe a plant that does not have the data processes. adequate light and thus grows thin and tall in an at- tempt to reach light. Tis is a potential drawback of LED Strips this method of measurement however, in combina- tion with other measures, the height of a plant is an Due to both cost and space constraints, the use of integral aspect of its overall growth. a high density and relatively low-cost lighting was es- Number of Leaves. Te number of leaves can have sential. For this reason, LED light strips were the best multiple implications with respect to plant growth. It choice because they output a lot of light relative to is widely agreed that the more leaves a plant has, the their size, were easily attachable to the interior of each healthier its growth is. Growing a new leaf requires a box, and could be wired together and supplied by a lot of energy that the plant must spend and thus is a standard computer power supply unit (PSU) which good indicator of its overall stage of growth. However, was repurposed for this experiment. the number of leaves does not describe the health or size of those leaves, so while a plant may have a large Colour Temperature number of leaves, they might all be small, discoloured, or misshapen. Te manufacturer of the LED light strips does not Biomass. Tis paper utilizes two ways of fnding the provide strips in the 4,000 Kelvin (K) range. Tis is mass of each plant: wet mass and dry mass. Whereas most likely because the 4,000 K phosphor is too ex- the wet mass is the mass of the plant as grown in the pensive to be proftable for the company. While this chamber (including the water inside the plant), the limitation is unfortunate, having three sample points dry mass is the mass of the plant devoid of water (by at 3000K, 5000K, and 6000K was sufcient to demon- evaporating water out of the plant). Tis paper used a strate a correlation between colour temperature and standard convection oven set to 100 degrees Fahren- the various methods of measuring growth (described heit to dry the plants over a period of 4 hours, afer in section 3.6, below). which the plants were cooled down and their mass 169 LED COLOUR TEMPERATURE AND HYDROPONIC LETTUCE SEEDLINGS was taken. For both the wet and dry mass, only the # of leaves 3,000 K 5,000 K 6,000 K average mass was recorded because the scale was inac- curate at lower masses. Te mass of all plants was tak- Average 8.7 10.8 12.2 en simultaneously and the data (Table 3 and 4) repre- Standard 2.3 2.8 4.0 sent the average. Te dry mass shows the actual mass Deviation of organic matter that was grown in the process of Table II. Number of leaves afer 28 days of growth in a creating the plant. Tis is important because it serves controlled-environment chamber under various colour to show how much ‘growth’ the plant ended up doing temperatures of LED lights. via the net change in organic matter that was created by the plant. Additionally, wet mass is an important Note: Te data in this table shows the average num- statistic as it shows the absorption of water (and there- ber of leaves on each plant under each of the three fore nutrients) by a plant. If a plant’s wet mass is not diferent colour temperatures of LED lights (3,000, signifcantly greater than its dry mass, the plant failed 5000K, and 6,000 Kelvin). In general the average to absorb water from the rockwool which would lead number of leaves increases as the colour temperature to negative growth yields. In hydroponics, where all increases. Tere is a notable gap between the 3000K the nutrients are dissolved in a solution, diferent wet and 5000K plant average (8.7 versus 10.8 leaves). Tis mass values may indicate diferent absorption rates as diference is less notable between 5000K and 6000K a result of the colour temperature. Terefore, analysis (10.8 versus 12.2 leaves). Tis relationship is almost of both the wet and dry masses will provide a more perfectly linear with a remarkably high Pearson cor- complete picture of the true growth of the plant, espe- relation coefcient (R2 = 0.996). cially when such plant is grown in hydroponic condi- tions. Average Mass (g) 3,000 K 5,000 K 6,000 K Results Wet Mass 3.1 5.7 18.9 Dry Mass 3.0 4.9 12.3 Height (cm) 3000K 5000K 6000K Average 9.4 13.1 13.2 Table III. Wet and dry masses of seedlings afer 28 days of growth in a controlled-environment chamber under Standard Deviation 4.2 4.2 4.7 various colour temperatures of LED lights. Table I. Height of seedlings afer 28 days of growth in a controlled-environment chamber under various colour Note: Tis table describes the wet mass and dry temperatures of LED lights. mass of each plant 28 DAP. As shown above, both the average wet mass and dry mass of the plants increases Note: Tis table shows the height (in centimetres) with increasing colour temperature. Tere is a notable of each seedling grown under three diferent colour lack of change between the wet and dry masses of the temperatures of LED strip lights; 3000K, 5000K, and 3000K chamber (3.1g wet versus 3.0g dry) because the 6000K. Notably, there is nearly no diference between plants grown in this chamber had trouble absorbing the heights of 5000K and 6000K plants. Both the water. Te rockwool was constantly dry but for the 5000K and 6000K chambers had plants that grew very sake of reliability no extra water was given. Te cor- tall and sturdy (13.1 and 13.2cm, respectively), com- relation was moderately strong (Wet Mass R2 = 0.718, pared to 9.4cm for 3000K. Overall, the data is strongly Dry Mass R2 = 0.754). correlated with a linear ft as the Pearson correlation coefcient (R2 = 0.901).

170 LED COLOUR TEMPERATURE AND HYDROPONIC LETTUCE SEEDLINGS

Discussion Conclusion

Germination Rates Results

Throughout the course of this paper, the germi- Te results of this paper have profound implica- nation rates between different colour temperatures tions as to the viability of hydroponics to act as an varied substantially. For example, of the seedlings alternative to traditional agricultural practices. Tra- initially fertilized in the 3000K chamber (two seeds ditional hydroponic intuition would point toward the per Rockwool cube), less than 30% germinated. low colour temperature light as having the best output Contrastingly, a larger percentage of the seeds in as they have the greatest red-to-blue light ratio. How- the 6000K chamber germinated (67% germination ever, the results of this paper points in the opposite rate). This has two main implications. First, the direction, that the cooler light (highest colour tem- sample size representing 3,000 K plants is smaller perature) was best for plant growth. than the other two which may vary they validity of Tis experiment found that colour temperature the data slightly. Second, the difference in germi- was strongly correlated (R2 of 0.901) with the height nation rates may be correlated with the difference of a plant grown in hydroponic conditions (ranging in colour temperature. However, further research from an average of 9.4cm to 13.2cm in height). Tis must be done in this area in order to determine trend was consistent across all temperatures of light the underlying factor causing this significant dis- and was justifed by multiple trials of over 250 indi- crepancy of germination rates between colour tem- vidual seeds. peratures as the results from this experiment are Additionally, the number of leaves on each plant insufficient to describe this relationship with any was very strongly correlated (R2 of 0.996) to an in- certainty. crease in colour temperature (averaging 8.7 to 12.2 leaves). Although the standard deviation increased Experimental Constraints dramatically for the 6000K enclosure, this can be at- tributed solely to the lack of space in the enclosure. While there was enough time to replicate the initial Te large plants completely dominated the 6000K en- trial, some accuracy was lost due to the time and space closure which meant that the smaller plants were too constraints of this experiment. A lack of room inside small to thrive. the chamber meant there was a smaller-than-optimal Perhaps most impressive, the average wet mass of carrying capacity for each enclosure. Te larger plants the plants grown under 6000K LEDs was 232% higher dominated the enclosures and blocked light from than that of the 5000K plants and the dry mass saw reaching the smaller plants. Tis was nearly made up similar improvements. While there is only a moder- for by repeated trials; however, further research may ate linear correlation between a plant’s biomass and fnd it best to use larger chambers for conducting this colour temperature, it is possible that a quadratic or type of research to prevent crowding. Te culmination even exponential ft may be a more appropriate ft for of these issues was that each trial was stopped short the data. of a full growing period (40-50 DAP) to allow room Tis research orients itself in opposition to tradi- for the next trial, which slightly decreased the validity tional hydroponic intuition, creating a new under- of the data. Tis decrease in growth duration ended standing of the relationship between the colour of up being inconsequential as afer 28 days of grow- light and horticultural growth. Our results suggest ing there were signifcant and measurable diferences that higher colour temperatures are conducive to between groups. Future research should look to opti- greater growth in plants. mize the length of the growth period of each trial with oversized enclosures.

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Implications References Te objective of this paper was to fnd and optimize Alexandratos, N., & Bruinsma J. (2012). World agriculture the best growing conditions for Butterhead lettuce us- towards 2030/2050: the 2012 revision. ESA Working ing only diferences in the colour temperature of LED paper, No. 12-03. Rome, FAO. Retrieved from: https:// lights. Against conventional intuition, the results of goo.gl/n2BaVr. this paper suggest that a higher colour temperature Barbosa, G.L., Gadelha, F. D. A., Kublik, N., Proctor, A., (cooler light) is strongly correlated with both the Reichelm, L., Weissinger, E., Wohlleb, G.M., & Halden, number of leaves (R2 was 0.996) and height (R2 was R. U. (2015). Comparison of land, water and energy 0.901) and moderately correlated with the wet (R2 requirements of lettuce grown using hydroponics was 0.718) and dry masses (R2 was 0.754). Tis has vs. conventional agricultural methods. International tremendous implications for hydroponic researchers Journal of Environmental Research and Public Health, 12, and commercial growers alike as the results of this 6879- 6891. paper can be directly translated into optimizing the Becraf, A. (2017). Potential for home-use hydroponic lighting conditions for commercial hydroponic farms, systems to increase food security in Cape Eleuthera, Bahamas. i-ACES, 3(1), p. 12-18. Retrieved from: https:// especially in states like California where Butterhead goo.gl/T8oAV9. lettuce is commonly grown hydroponically. To that Both, A. J., Albright, L. D., & Langhans, R. W. (1997). end, hydroponic growers of all backgrounds, whether Coordinated management of daily PAR integral and growing in a high-tech lab or in an abandoned ware- carbon dioxide for hydroponic lettuce production. Acta house in the inner city, should look to use higher co- Horticulturae, 456:45-51. Retrieved from: https://goo.gl/ lour temperature lights to grow their lettuce. P4YsED. Both, A. J., Scholl, S. S., Albright, L. D., & Langhans, R. Looking Forward W. (1998). Comparing continuous lettuce production in nutrient flm technique and foating hydropon- While past research has a primary focus on the ics. In Proceedings of the 15th International Lettuce biochemical properties of hydroponics, this paper Conference and Leafy Vegetable Crops Workshop (pp. examines the diference that the colour temperature 16-17). Retrieved: of LED lights can have on the overall growth of hy- Bourne, J.K. Jr. (2015). Te End of Plenty. New York, NY: droponically-grown Butterhead lettuce. Even among W.W. Norton Company. Inc. Retrieved from: https://goo. photo-biological research, there is a strong need for gl/FTQgbg. more research on the biological application of new Brechner, M., & Both, A. J. (2013). Hydroponic Lettuce LED technology including colour temperature, co- Handbook. Cornell Controlled Environment Agriculture, 504-509. Retrieved from: https://goo.gl/KpAsPd. lour-programmable, and even organic-LED (OLED) lighting technology. deAnda, J., & Shear, H. (2017). Potential of Vertical Hydroponic Agriculture in Mexico. Journal of Sustainability, 9(1), 140. Retrieved from: https://goo.gl/ CLnqRv. Acknowledgements Deitzer, G., Hayes R., and Jabben R. (1979). Kinetics and time dependence of the efect of far red light on the pho- I would like to thank my mentor, Dr. Toyoki Kozai toperiodic induction of fowering in Wintex barley. Plant for his expert guidance in this feld and for giving me Physiol. 64:1015–1021. words of encouragement throughout this journey. I Despommier, D. (2013). Farming up the city: the rise of would also like to thank the Gig Harbor High School urban vertical farms. Trends Biotechnol, 31(7), 388-389. English and Science departments for helping guide Despommier, D. (2009). Te rise of vertical farms. Scientifc my research process, specifcally Mrs. Hupper and American, 301(5), 80-87. Retrieved from: https://goo.gl/ Mrs. Marten for their constant support and endless TJrDAu. generosity. Diaz, R. J., & Rosenberg, R. (2008). Spreading dead zones and consequences for marine ecosystems. Science, 321(5891), 926-929. 172 LED COLOUR TEMPERATURE AND HYDROPONIC LETTUCE SEEDLINGS

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Contributors Isaac Gallogly conducted this research while a se- nior at Hampton High School, in the suburbs of Pitts- burgh, Pennsylvania. He plans to attend Vassar Col- Hector Cure was born in Bogota, Colombia on lege in the fall of 2018. September 11 of 1999. He is currently a Senior at Co- legio Nueva Granada. For the past two years, he has William Howard-Waddingham is a high school participated in two research studies in the medical student in his senior year. He will be attending Yale feld, such as PET Scans for pancreatic cancer detec- University for Political Science as a member of the tion, the experience of the Clínica General del Norte Class of 2022. He is passionate for social justice re- with GIST. Tis year he was able to conduct his own form, prompting the topic of inquiry. study that united both psychology and medicine by trying to fnd if cognitive behavioral therapy was ef- Megan Leinenbach is a junior at Lake Howell High fective for treating depression in stage II pancreatic School. Within the last year, she has conducted mi- cancer patients. Hector is going next fall to the Uni- crobiological research about the antibacterial efcacy versity of Pennsylvania to study molecular and cel- of essential oils. In her school, Megan is involved in lular biology and psychology on the pre-med track. student government, national honors society, science Additionally, at school, he is the president of the tutor- honors society, math honors society, the academic ing committee of the National Honor Society, and he team, and sofball. gives tutoring sessions to children from impoverished communities as well as his classmates. Aside from Ella Moxley is a senior at Norman North High his academics, he is a black belt in karate and men- School in Norman, Oklahoma. She is involved in tors lower belts and occasionally swim. Finally, Hec- Speech and Debate and National Honors Society. Next tor loves to travel around the world and he would like year she will attend Oberlin College and study envi- to travel to several Asian countries, including China, ronmental policy. She would like her teacher, Janice Korea, and Tailand. Last summer, Hector traveled to Mullan, and her research consultant, Ann Beutel. Africa to do social service in Tanzania with an organi- zation called Projects Abroad, and two summers ago Andrew Pyper currently attends Royal St. George’s he visited Tokyo and Dubai. He would love to contin- College, and afer his graduation, he will be attending ue learning about new cultures and traveling to amaz- Te University of Chicago to pursue his passion for ing places with a strong cultural heritage. economics.

Rachael Dickenson is a 12th grader whose lifelong Noor Said is currently a senior high school student interest in plants and guidance from stellar mentors enrolled in AP Research. In her free time, Noor enjoys led her to research involving invasive species. She reading, painting, and traveling with her family. looks forward to doing more research in the future and hopes to become an environmental engineer. Justin Shaw is a student at Gig Harbor High School located in Gig Harbor, Washington. He is passionate Steven Du is a grade 12 student who attends St. about fnding new ways to use technology to solve Andrew’s College. He will be studying sofware en- practical problems in the world. He is also an arma- gineering next year but takes a keen interest into the ture kite-fier, programmer and soccer player. social sciences. Allison Tu is a student at duPont Manual High Lida Ehteshami is a junior at DeBakey High School in Louisville, Kentucky. She is passionate about School in Houston, Texas. She is interested in inter- student advocacy and is a member of the Prichard national relations, economics, and issues involving Committee Student Voice Team and an ambassador global politics. In the future, she hopes to become an to the separate organization Student Voice. She is international lawyer. dedicated to elevating the principles of student-driven movements to her own work, and founded and serves 174 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018 as Executive Director of STEMY, a nonproft organi- Her primary goal is to help young people to achieve zation aiming to break gender, racial, and socioeco- their dreams. She received her M.D. from Hebei nomic barriers through student-driven STEM educa- Medical University in China in 1997, and her Ph.D. tion. She is also passionate about adolescent mental in Neuroscience from University of Arkansas in 2007. health, and founded a student alliance to improve the Ten for eight years, she has focused on researching wellbeing of Kentucky students. the molecular mechanisms in visual transduction in University of Texas Health Science Center at Houston. Sophia Xu is a junior student at Michael E. De- During those years working as a physician and a sci- Bakey High School for Health Professions. She is par- entist, she also enjoyed training students and helping ticularly interested in the feld of medical science and them with their career goals. Terefore, in 2015 she is currently working towards becoming a non-inva- became a High School Science teacher. Personally, she sive cardiologist. She is currently the District J Rep- enjoys sewing, biking, and playing badminton. resentative for the Houston Mayor’s Youth Council and co-founded Future Business Leaders of America Stacey Marten is in her fourth year as the Librarian (FBLA). She is also working in MD Anderson to fur- and Tech Lead at Gig Harbor High School. Teaming ther her research. In her free time, she teaches piano up with the AP Research teacher, Jessica Hupper, was to students, afer acquiring her teaching certifcate by the perfect partnership for a librarian that emphasizes taking theory, basic harmony, intermediate harmony, strong research skills for students. Before obtaining level 10, and music history. In piano, she has won 1st her certifcation in Library/Media studies she taught division, 3rd place at Blinn’s Piano Competition and social studies and history classes for 14 years at Sedg- 1st place in the Independent Music Association com- wick Junior High in South Kitsap, Washington. She is petition. In other awards, her team won 3rd place in National Board certifed in Social Studies & History/ Community Awareness for raising Parkinson’s Dis- Adolescent & Young Adulthood. ease and 1st place in Medical Innovations in Health Occupations Students of America (HOSA). Janice Mullan, a teacher at Norman North High School in Norman, Oklahoma, leads the Norman North High School’s AP Capstone program and also teaches English 4. She has taught for 20 years. She was and continues to be deeply involved in the devel- Faculty and Advisors to opment and implementation of the AP Capstone pro- gram within the school district. She earned a Bach- Contributors elor’s degree in Journalism (Professional Writing) from the University of Oklahoma. She served 12 years Ernesto Carriazo teaches at Colegio Nueva Grana- in the Air Force and spent three of those years teach- da in Columbia. ing journalism to fedgling Armed Forces journalists. Afer her time in the service, she became a student Daniel Coapstick is an AP Research teacher at again and earned her Masters in Education (English) Stuttgart High School in Germany. from the University of Central Oklahoma, and began teaching English including AP English Literature and Kathy Fries teaches at at duPont Manual High AP English Language. Four years ago, her principal School in Louisville, Kentucky. approached her to undertake a new curriculum, AP Capstone, which has proven to be a truly invigorat- Jessica Hupper teaches at Gig Harbor High School ing program that develops invaluable confdence in in Gig Harbour, Washington. the students as they hone their academic writing and presentation skills. Her students each year have been Hongyan Li is a teacher at the DeBakey High a delight as they enthusiastically pursue a wide range School for Health Professions at Houston, TX. She of research interests and topics using inquiry-based teaches AP Research, Biology, and Forensic Science. and cooperative learning strategies, renewing her own 175 THE YOUNG RESEARCHER, VOL. 2, NO. 1, 2018 passion for not only teaching and aiding students, but Tonya Sukhu teaches at the Michael E. DeBakey also the joys of academic research. High School for Health Professions in Houston, Texas.

Brian O´Connor teaches at Colegio Nueva Grana- Alesia Williams has a background in the humani- da in Columbia. ties. She has a BA in art history from Berea College and has completed coursework for a MA from the Shannon Roos is an English and AP Capstone University of Cincinnati. She has a MAT with a focus teacher and an instructional coach at Hampton High on English from Spalding University. She has been School in Pennsylvania. She holds a bachelor’s degree teaching in the public school system in Louisville, KY in English and secondary education from Carlow for sixteen years. Tirteen of those years have been at University and her master’s degree in instructional duPont Manual High School which has fve magnets technology from Wilkes University. Trough her and is typically ranked as the best high school in Ken- teaching and coaching she strives to help students see tucky. She has been teaching AP English Language themselves as problem solvers who can face challeng- and Composition for ten years and AP Research es with curiosity and confdence. She looks forward to for one year. She is focused on helping her students continuing to support these ideas in the AP Research achieve at the highest levels especially in regards to course. academic writing. She encourages her students to think of themselves as writers and to pursue writ- Michelle Satchwell is an English teacher at Carmel ing competitions and publication. Her students have High School in Carmel, Indiana. She teaches AP Re- been recognized with top honors from the NCTE and search in the AP Capstone program as well as dual- KCTE writing competitions, the Scholastic Art and credit and honors classes. She has been an AP College Writing competition, and the MIT INSPIRE research Board Consultant for AP Capstone since 2014. Co- competition. author of Reading Lists for College-Bound Students and STACS: Strategies to Acquire Composition Skills, Edison Yagoubian is a graduate of UCF college Mrs. Satchwell was the Carmel Clay school corpora- of sciences. His degree focus is on molecular & mi- tion’s Teacher of the Year in 2004 and is an Armstrong crobiology. He has postgraduate research experience Teacher Educator at Indiana University. Mrs. Satch- in malaria prevention and clean water maintenance. well is a devoted educator who delights in helping her He has been teaching AP level biology/physics since students reach their potentials. 2010, and he has been a research advisor for two years. His focus as an advisor is always on maintaining a Samantha Scheepers is an Upper School English high standard for the student projects and guiding and AP Research teacher at St. Andrew’s College. She young researchers to ask deeper questions, approach is also the chair of school’s Standing Committee for a problem from many perspectives, and to remember Excellence in Teaching and Learning. She holds a that research is the cornerstone of innovation. Master’s of Teaching, specializing in metacognition and reading comprehension, as well as a BA (Hons.) with high distinction in English and Renaissance Studies from the University of Toronto. She has re- cently completed a teaching fellowship focused on leadership in independent schools at Columbia Uni- versity and has presented her research on cooperative learning through the International Boys’ School Co- alition.

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Editors of the Journal

Suzanne Conklin Suzanne Conklin Akbari is professor of English and Medieval Studies Akbari at the University of Toronto, and was educated at Johns Hopkins and Columbia. Her research focuses on the intersection of English and BA, MA, MPhil, Comparative Literature with intellectual history and philosophy, ranging PhD from neo-platonism and science in the twelfh century to national identity and religious confict in the ffeenth century. Akbari’s books are on optics and allegory (Seeing Trough the Veil), European views of Islam and the Orient (Idols in the East), and travel literature (Marco Polo); she is cur- rently at work on Small Change: Metaphor and Metamorphosis in Chaucer and Christine de Pizan. She is volume editor for the Norton Anthology of World Literature (Volume B: 100-1500), co-editor of the Norton Anthology of Western Literature, and editor of Te Oxford Handbook to Chaucer. She has begun a new research project called Te Shape of Time, contrasting the temporal breaks found in medieval chronicle traditions with poetic narrations of the historical past. Akbari is cross-appointed to the fol- lowing units at the University of Toronto: Centre for Medieval Studies; Centre for Comparative Literature; Centre for Jewish Studies; Department of Near and Middle Eastern Civilizations; Centre for Reformation and Renaissance Studies. Barrie Bennett Barrie Bennett is professor emeritus at the Ontario Institute for Studies in Education at the University of Toronto (OISE/UT). His research work BPE, MEd, PhD focuses primarily on the design of powerful learning environments for students and teachers through the process of systemic change. He is currently working in districts in three countries on long-term projects related to instructional intelligence and systemic change (Australia, Ireland and Canada). Instructional intelligence involves intersecting the current research on curriculum, assessment, and instruction guided by what is known about how students and teachers learn. Tat intersection being driven by what is known about change and systemic change. He also assists teachers, schools, and districts with issues related to classroom management and school wide-discipline. Barrie has taught at the elemen- tary and secondary levels, as well as, having worked in group homes, pris- ons, and security units for juvenile ofenders. He has written six books: Cooperative Learning: Where Heart Meet Mind; Classroom Management: A Tinking and Caring Approach; Beyond Monet: Te Artful Science of Instructional Integration; Graphic Intelligence: Playing With Possibilities and most recently Power Plays. Currently he is just fnishing a text titled, Efective Group Work: Beyond Cooperative Learning.

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Anthony Anthony Campbell established Grow for Good Urban Teaching Farm in Campbell 2013 as a business model innovation laboratory and learning centre for young entrepreneurs. He spent time working throughout North America, BA, MA, PhD Europe, Australia, Asia and now resides in his hometown of Toronto. Examples of Anthony’s work are documented in Te Innovator’s Field Guide (2014), co-authored by David Crosswhite and Peter Skarzynski, as well as multiple Harvard Business School and Corporate Executive Board case studies chronicling the innovation and capability-building eforts of companies such as Samsung, Whirlpool, Best Buy and McDonald’s. Previously, Anthony taught Film Studies, Writing and English Literature at Te University of Western Ontario. Jeremy B. Caplan Jeremy Caplan is an Associate Professor in Psychology Department at the University of Alberta, where he is also the Principal Investigator at the ScB, PhD University of Alberta Computational Memory Lab. Te lab is focused on human verbal memory behaviour and its basis in cognitive and neural processes. Te team takes several approaches towards research, including mathematical modeling, measures of behaviour in the cognitive psychol- ogy tradition, and measures of brain activity using electroencephalogra- phy (event-related potentials and oscillations) and functional magnetic resonance imaging. He has been a referee for 38 academic journals. Hance Clarke Dr. Clarke is the director of Pain Services and the medical director of the Pain Research Unit at the Toronto General Hospital. He is appointed BSc, MSc, MD, to the Institute of Medical Sciences at the University of Toronto and is a PhD, FRCPC graduate of the Royal College Clinician Scientist Program. His research interests include identifying novel acute pain treatments following major surgery, identifying the factors involved in the transition of acute postsur- gical pain to chronic pain, studying the genetics of acute and chronic pain afer surgery, and identifying risk factors associated with continued opioid use and poor health related quality of life afer major surgery as well as the efcacy of hyperbaric medicine. Over the past fve years he has authored 47 peer reviewed manuscripts. Will Fripp Will Fripp is a public afairs and political risk analyst for Canadian and international clients. A B.A. in History and Political Science from Victoria BA, MA University at the University of Toronto and an M.A. in Intelligence and International Relations from the University of Salford in Manchester, England, he is a historian specializing in intelligence and espionage, and its modern infuences. Will anchored www.spiesintheshadows.com, a web based curriculum outlining Canadian foreign intelligence history and its impacts on Canada’s national development. An occasional lecturer, Will’s writings and review articles appear in peer-reviewed academic journals like Intelligence and National Security, and elsewhere.

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Michael Gemar Michael Gemar received undergraduate degrees in Psychology and Philosophy from Rice University, and a PhD in experimental psychol- BSc, BA, PhD ogy from the University of Toronto. He has worked as a researcher at the Centre for Addiction and Mental Health, examining the cognitive and neural correlates of mood disorders, and was involved in a landmark study demonstrating the efcacy of mindfulness meditation to prevent depressive relapse. He has co-authored numerous journal articles, and taught for over a decade at U of T. More recently, he has worked in the area of health policy, and is currently at a Canadian non-proft. Jennifer Goldberg Jennifer Goldberg holds an M.A. in History from the University of Toronto. Her graduate studies focused on teacher misconduct in 19th BA, BEd, MA century Ontario, and her research is published in Historical Studies in Education. She currently teaches at Havergal College, where she has also served as Chair of Teaching and Learning. In this capacity, she has explored the role of feedback in student learning, and has presented on this work at the National Coalition of Girls’ Schools and Conference of Independent Teachers of English. Margaret S. Margaret Herridge is a Professor of Medicine and Senior Scientist at the Herridge University of Toronto. She is also a senior clinician in Critical Care and Respiratory medicine at University Health Network. Her research focus is BSc, MSc, MPH, on long-term outcomes afer critical illness for patients and families and MD, FRCPC specifcally on functional, neuropsychological, healthcare utilization and quality of life metrics. Her graduate studies were in Cell and Molecular Biology at Queen’s University where she subsequently obtained her degree in Medicine. Afer completing her clinical training in Internal Medicine/ Respirology and Critical Care at the University of Toronto, she obtained her Master of Public Health in Epidemiology and Statistics from the Harvard School of Public Health. Ted Ted Higginbotham is a graduate student at Te University of Toronto and Higginbotham Hospital for Sick Children. His research is focused on further delineat- ing the role of genomic structural variation in autism spectrum disorder BSc, MSc and human disease. Ted is a contributing member of the Clinical Genome (Candidate) Resource (ClinGen), an international consortium working to defne the clinical relevance of genes for use in precision medicine and translational research. Tim Hutton Tim Hutton is a teacher-librarian at Royal St. George’s College. He has a BA in History and American Studies from the University of Toronto BA, MLIS and a Masters in Library and Information Science from San Jose State University. At the secondary level, he has taught courses in the social sciences, humanities and communications technology, including a locally designed interdisciplinary course in urban studies.

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Ira Jacobs Professor Ira Jacobs became dean of the Faculty of Kinesiology & Physical Education at the University of Toronto on July 1, 2010, and was re- Dip Phys Ed, appointed to his current second decanal term. Before assuming this role, MHK, DrMedSc Jacobs was chair of York University’s School of Kinesiology and Health Science from 2007 until 2010, and a federal government scientist from 1982 until 2007. Jacobs earned his doctorate in clinical physiology from Sweden’s Karolinska Institute, where he specialized in skeletal muscle metabolism. For the next 25 years, he did extensive exercise physiology research in Canada’s human sciences laboratory, operated by the Department of National Defence. Tere, Jacobs rose to the position of chief scientist and led a unique international research group that helped to enhance the per- formance of military special operations units through their research into physiological, nutritional and pharmacological strategies. He is a past president of the Canadian Society for Exercise Physiology and the Canadian Council of University Physical Education and Kinesiology Administrators. He is a fellow of the American College of Sports Medicine, an international fellow of the US National Academy of Kinesiology, and in 2016, he was named a Fellow of the Canadian Academy of Health Sciences. Jacobs’ research has led to the publication of more than 200 scientifc articles, reports and book chapters about his research interests that in- clude the physiological responses to physical exertion in environmental extremes, performance enhancement through pharmacological and nutri- tional manipulation of metabolism, and exercise pharmacology. During his term as dean, the Faculty of Kinesiology & Physical Education has been rated as among the top academic programs in the world for kinesiology, physical education, sport and exercise sciences.

John Lambersky John Lambersky is a teacher and head of the Canadian and World Studies department at Royal St. George’s College in Toronto, where he leads the BA, MA, BEd, AP Capstone program. He has presented his work on teaching practice at PhD the conferences of the International Boys’ School Coalition, the National Association of Independent Schools, and the Canadian Accredited Independent Schools. His academic research is focused on school culture as a mechanism for school improvement. His work has been featured in Leadership and Policy in Schools, Te Dalhousie Review, and Te Nashawaak Review.

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Lori Loeb Lori Loeb is Associate Professor of Modern British history at the University of Toronto. She has a Masters in Museum Studies and a PhD BA, MA, PhD in History. A specialist in the Victorian period, she is the author of Consuming Angels: Advertising and Victorian Women. Generally, she writes about things in nineteenth-century Britain. A past Deputy Chair and Associate Chair (Graduate) of the History Department, she is cur- rently MA Coordinator. She teaches courses in nineteenth and twentieth- century British history, Victorian material culture and the English country house. Jaime Malic Jaime Malic recently completed her PhD in Educational Leadership and Policy at the Ontario Institute for Studies in Education at the University of BA (Hons), MA, Toronto. Her research focused on leadership values and practices in inde- BEd, PhD pendent schools in Ontario. Jaime has more than ten years of experience as an educator in both independent and public schools. She currently teaches AP Capstone Seminar and senior English courses at St. Clement’s School. Jaime has served as both a Reader for AP Capstone Seminar and a writer on the Item-Writing Committee for the Ontario Secondary School Literacy Test. She has written for Independent Teacher and presented on various topics at the Conference of Independent Teachers of English Annual Conference, the Ontario Advanced Placement Administration Conference, and the Advanced Placement Annual Conference. William J. William McCausland is an associate professor of economics at the McCausland Université de Montréal. His research applies Bayesian statistical methods in two main areas. Te frst is discrete choice, at the interface of econom- BASc, MEng, ics and psychology, where researchers study how people make choices MA, PhD from a small menu of available options. Te second is time series mod- elling in economics, which has many applications in macroeconomics and fnancial economics. His undergraduate studies were in Engineering and he received his Ph.D. degree in economics from the University of Minnesota. Michael Michael Simmonds has worked in independent schools for over two de- Simmonds cades. He taught science, biology, chemistry, physics, and math before be- coming an administrator and Head of School. He earned graduate degrees BPE, M.A., Dip. from both McGill and Columbia universities respectively before receiving Ed., MEd, EdD his doctorate from the University of British Columbia in Educational Policy & Leadership. His work on accountability synopticism is published in the peer-reviewed, Te International Education Journal: Comparative Perspectives. He currently works at Havergal College as the VP School Life, Operations & Student Wellness.

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Guidelines for Contributors

Te Young Researcher is a peer-reviewed journal Tis is an open-access journal. By submitting your dedicated to publishing the best original research article, you agree to have it published in the journal. from secondary school students. You always retain copyright as the author. Te journal’s mission is to provide a larger audi- Since the journal publishes original research, by ence for the original academic research of ambitious submitting your work you afrm that it is yours, that secondary students, provide a forum for peer-review, it is free from issues of academic dishonesty, and that and create a community of young researchers. In ad- it has not been submitted elsewhere. dition, the journal strives to advance the quality of To read more about TYR, about our editorial pro- academic writing in secondary schools. cess, or to submit an article, please visit our website: Te Young Researcher is edited by secondary school www.TeYoungResearcher.com. students working closely with scholars and active re- Please direct any questions to TeEditors@TeY- searchers at universities and in the community. Te oungResearcher.com journal operates a blind peer-reviewed review process, following those found in academic research journals. Te journal encourages submissions of original re- search (including relevant replication studies) from a wide range of academic disciplines within the social sciences, humanities, and sciences.

Submission Guidance: - No more than 5,000 words, excluding references and appendices (in English) - Articles should have the following sections or equivalent: Introduction Literature Review Method, Process, or Approach Findings or Results Discussion, Analysis, and/or Evaluation Conclusion and Future Directions References - Papers should be formatted using discipline- appropriate methods (MLA, APA, and Chicago are acceptable). - Papers should have an abstract (no more than 150 words) and have 4-6 keywords - All units of measurement should be in metric wherever possible - All studies involving human participants must have been approved by a Research Ethics Board

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