{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T02:56:47Z","timestamp":1769050607020,"version":"3.49.0"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T00:00:00Z","timestamp":1633737600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T00:00:00Z","timestamp":1633737600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Res Methodol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Parent participation in children\u2019s health interventions is insufficiently defined and measured. This project quantified parent participation to enable future examination with outcomes in an intervention focused on 4th graders, aged 9\u201311\u2009years, and their families living in northern Colorado.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Indices were developed to measure type (Parent Participation Profile; PPP) and intensity (Parent Engagement Intensity; PEI) of engagement in <jats:italic>Fuel for Fun (FFF)<\/jats:italic>, an asymmetric school-and family-based intervention for 4th graders. Study arm-specific participation opportunities were catalogued and summed to calculate the PPP. An algorithm considered frequency, effort, convenience, and invasiveness of each activity to calculate PEI. Indices were standardized (0\u2013100%) using study arm-specific divisors to address asymmetric engagement opportunities. Parents who completed \u226575% of the PPP were defined as Positive Deviants. Youth height and weight were measured. Youth BMI percentile change was compared with parent Positive Deviant status using general linear modeling with repeated measures that included the participation indices.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 1435 youth, 777 (54%) had parent participation in at least one activity. Standardized means were 41.5\u2009\u00b1\u200925.4% for PPP and 27.6\u2009\u00b1\u200920.9% for PEI. Demographics, behaviors or baseline <jats:italic>FFF<\/jats:italic> outcomes did not differ between the Positive Deviant parent (n\u2009=\u2009105) and non-Positive Deviant parents (n\u2009=\u2009672); but more Positive Deviant parents followed an indulgent feeding style (<jats:italic>p<\/jats:italic>\u00a0=\u20090.015). Standardized intensity was greater for Positive Deviant parents; 66.9\u2009\u00b1\u200920.6% vs 21.5\u2009\u00b1\u200912.7% (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001) and differences with non-Positive Deviant parents were related to activity type (<jats:italic>p<\/jats:italic>\u00a0\u22640.01 for six of eight activities). Standardized participation intensity was associated with engagement in a greater number of standardized activity types. Among participating parents, standardized intensity and breadth of activity were inversely related to the youth BMI percentile (n\u2009=\u2009739; PEI r\u2009=\u2009\u22120.39, <jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001; PPP r\u2009=\u2009\u22120.34, <jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001). Parent engagement was not associated with parent BMI change.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>An activity-specific intensity schema operationalized measurement of parent engagement in a complex, unbalanced research design and can serve as a template for more sensitive assessment of parent engagement. Positive deviance in parent engagement was not a function of personal, but rather activity characteristics. PPP and PEI increased with fewer requirements and convenient, novel, and personalized activities. Parent engagement indices affirmed lower engagement by parents of overweight\/obese youth and concerns about target reach.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12874-021-01398-4","type":"journal-article","created":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T20:10:49Z","timestamp":1633896649000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Quantifying parent engagement in the randomized Fuel for Fun impact study identified design considerations and BMI relationships"],"prefix":"10.1186","volume":"21","author":[{"given":"Barbara","family":"Lohse","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leslie","family":"Cunningham-Sabo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,10,9]]},"reference":[{"key":"1398_CR1","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1111\/hex.12490","volume":"20","author":"S Shen","year":"2017","unstructured":"Shen S, Doyle-Thomas KAR, Beesley L, Karmail A, Williams L, Tanel N, et al. How and why should we engage parents as co-researchers in health research? A scoping review of current practice. Health Expect. 2017;20:543\u201354.","journal-title":"Health Expect"},{"key":"1398_CR2","doi-asserted-by":"publisher","first-page":"10469","DOI":"10.3390\/nu7125546","volume":"7","author":"T Burrows","year":"2015","unstructured":"Burrows T, Hutchesson M, Chai LK, Rollo M, Skinner G, Collins C. Nutrition interventions for prevention and management of childhood obesity: what do parents want from an eHealth program? Nutrients. 2015;7:10469\u201379.","journal-title":"Nutrients."},{"key":"1398_CR3","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1177\/1090198116644703","volume":"44","author":"HD De Heer","year":"2017","unstructured":"De Heer HD, de la Kaye K, Skapinsky K, Goergen AF, Wilkinson AV, Koehly L. Let\u2019s move together: a randomized trial of the impact of family health history on encouragement and co-engagement in physical activity of Mexican-origin parents and their children. Health Educ Behav. 2017;44:141\u201352.","journal-title":"Health Educ Behav"},{"key":"1398_CR4","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1007\/s11121-019-01018-0","volume":"20","author":"M Epstein","year":"2019","unstructured":"Epstein M, Oesterle S, Haggerty KP. Effectiveness of facebook groups to boost participation in a parenting intervention. Prev Sci. 2019;20:894\u2013903.","journal-title":"Prev Sci"},{"key":"1398_CR5","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.4676","volume":"6","author":"SJ Finan","year":"2018","unstructured":"Finan SJ, Swierzbiolek B, Priest N, Warren N, Yap M. Parental engagement in preventive parenting programs for child mental health: a systematic review of predictors and strategies to increase engagement. PeerJ. 2018;6:e4676.","journal-title":"PeerJ."},{"key":"1398_CR6","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1177\/1524839909331909","volume":"11","author":"O Garcia-Dominic","year":"2010","unstructured":"Garcia-Dominic O, Wray LA, Trevi\u00f1o RP, Hernandez AE, Yin Z, Ulbrecht JS. Identifying barriers that hinder onsite parental involvement in a school-based health promotion program. Health Promot Pract. 2010;11:703\u201313.","journal-title":"Health Promot Pract"},{"key":"1398_CR7","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1007\/s10567-015-0182-x","volume":"18","author":"R Haine-Schlagel","year":"2015","unstructured":"Haine-Schlagel R, Walsh NE. A review of parent participation engagement in child and family mental health treatment. Clin Child Fam Psychol Rev. 2015;18:133\u201350.","journal-title":"Clin Child Fam Psychol Rev"},{"key":"1398_CR8","doi-asserted-by":"publisher","first-page":"1182","DOI":"10.1186\/s12889-016-3829-8","volume":"16","author":"N Heredia","year":"2016","unstructured":"Heredia N, Ranjit N, Warren JL, Evans AE. Association of parental social support with energy balance-related behaviors in low-income and ethnically diverse children: a cross-sectional study. BMC Public Health. 2016;16:1182.","journal-title":"BMC Public Health"},{"key":"1398_CR9","doi-asserted-by":"publisher","first-page":"1968","DOI":"10.1007\/s10826-018-1030-7","volume":"27","author":"JI Martinez","year":"2018","unstructured":"Martinez JI, Haine-Schlagel R. Observational assessment of engagement strategies to promote parent homework planning in community-based child mental health treatment: a pilot study. J Child Fam Stud. 2018;27:1968\u201380.","journal-title":"J Child Fam Stud"},{"key":"1398_CR10","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1186\/s12889-017-4466-6","volume":"17","author":"SL Williams","year":"2017","unstructured":"Williams SL, Van Lippevelde W, Margarey A, Moores CJ, Croyden D, Esdaile E, et al. Parent engagement and attendance in PEACH\u2122 QLD \u2013 an up-scaled parent-led childhood obesity program. BMC Public Health. 2017;17:559.","journal-title":"BMC Public Health"},{"key":"1398_CR11","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1037\/ccp0000140","volume":"84","author":"EB Winslow","year":"2016","unstructured":"Winslow EB, Poloskov E, Begay R, Tein J, Sandler I, Wolchik S. A randomized trial of methods to engage Mexican American parents into a school-based parenting intervention. J Consult Clin Psychol. 2016;84:1094\u2013107.","journal-title":"J Consult Clin Psychol"},{"key":"1398_CR12","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1186\/s12889-019-6741-1","volume":"19","author":"K Morgan","year":"2019","unstructured":"Morgan K, Van Godwin J, Darwent K, Fildes A. Formative research to develop a school-based, community-linked physical activity role model programme for girls: choosing active role models to inspire girls (CHARMING). BMC Public Health. 2019;19:437.","journal-title":"BMC Public Health"},{"key":"1398_CR13","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12889-016-2701-1","volume":"16","author":"A Norman","year":"2016","unstructured":"Norman A, Nyberg G, Elinder LS, Berlin A. One size does not fit all-qualitative process evaluation of the healthy school start parental support programme to prevent overweight and obesity among children in disadvantaged areas in Sweden. BMC Public Health. 2016;16:37.","journal-title":"BMC Public Health"},{"key":"1398_CR14","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1111\/josh.12497","volume":"87","author":"SV Sharma","year":"2017","unstructured":"Sharma SV, Chow J, Pomeroy M, Raber M, Salako D, Markham C. Lessons learned from the implementation of brighter bites: a food co-op to increase access to fruits and vegetables and nutrition education among low-income children and their families. J Sch Health. 2017;87:286\u201395.","journal-title":"J Sch Health"},{"key":"1398_CR15","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1186\/1471-2458-11-881","volume":"11","author":"W Van Lippevelde","year":"2011","unstructured":"Van Lippevelde W, Verloigne M, De Bourdeaudhuij I, Bjelland M, Lien N, Fernandez-Alvira JM, et al. What do parents think about parental participation in school-based interventions on energy balance-related behaviours? A qualitative study in 4 countries. BMC Public Health. 2011;11:881.","journal-title":"BMC Public Health"},{"key":"1398_CR16","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1016\/j.jneb.2018.06.009","volume":"50","author":"AS Garcia","year":"2018","unstructured":"Garcia AS, Dev DA, Stage VC. Predictors of parent engagement based on child care providers\u2019 perspectives. J Nutr Educ Behav. 2018;50:905\u201312.","journal-title":"J Nutr Educ Behav"},{"key":"1398_CR17","doi-asserted-by":"publisher","first-page":"509","DOI":"10.3390\/nu10040509","volume":"10","author":"P Love","year":"2018","unstructured":"Love P, Laws R, Litterbach E, Campbell K. Factors influencing parental engagement in an early childhood obesity prevention program implemented at scale: the infant program. Nutrients. 2018;10:509.","journal-title":"Nutrients."},{"key":"1398_CR18","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1037\/fam0000036","volume":"28","author":"KT Bamberger","year":"2014","unstructured":"Bamberger KT, Coatsworth JD, Fosco GM, Ram N. Change in participant engagement during a family-based preventive intervention: ups and downs with time and tension. J Fam Psychol. 2014;28:811\u201320.","journal-title":"J Fam Psychol"},{"key":"1398_CR19","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1007\/s11121-018-0897-2","volume":"19","author":"NJ Hackworth","year":"2018","unstructured":"Hackworth NJ, Matthews J, Westrupp EM, Nguyen C, Phan T, Scicluna A, et al. What influences parental engagement in early intervention? Parent, program and community predictors of enrolment, retention and involvement. Prev Sci. 2018;19:880\u201393.","journal-title":"Prev Sci"},{"key":"1398_CR20","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1186\/s12889-016-3453-7","volume":"16","author":"A Evans","year":"2016","unstructured":"Evans A, Ranjit N, Hoelscher D, Jovanovic C, Lopez M, McIntosh A, et al. Impact of school-based vegetable garden and physical activity coordinated health interventions on weight status and weight-related behaviors of ethnically diverse, low-income students: study design and baseline data of the Texas, grow! Eat! Go! (TGEG) cluster-randomized controlled trial. BMC Public Health. 2016a;16:973.","journal-title":"BMC Public Health"},{"key":"1398_CR21","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1016\/j.jneb.2016.06.011","volume":"48","author":"A Evans","year":"2016","unstructured":"Evans A, Ranjit N, Fair CN, Jennings R, Warren J. Previous gardening experience and gardening enjoyment is related to vegetable preferences and consumption among low-income elementary school children. J Nutr Educ Behav. 2016b;48:618\u201324.","journal-title":"J Nutr Educ Behav"},{"key":"1398_CR22","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s12966-016-0327-4","volume":"13","author":"G Nyberg","year":"2016","unstructured":"Nyberg G, Norman A, Sundblom E, Zeebari Z, Elinder LS. Effectiveness of a universal parental support programme to promote health behaviours and prevent overweight and obesity in 6-year-old children in disadvantaged areas, the healthy school start study II, a cluster-randomised controlled trial. Int J Behav Nutr Phys Act. 2016;13:4.","journal-title":"Int J Behav Nutr Phys Act"},{"key":"1398_CR23","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s13012-016-0537-9","volume":"12","author":"L Wolfenden","year":"2017","unstructured":"Wolfenden L, Nathan N, Janssen LM, Wiggers J, Reilly K, Delaney T, et al. Multi-strategic intervention to enhance implementation of healthy canteen policy: a randomized controlled trial. Implement Sci. 2017;12:6.","journal-title":"Implement Sci"},{"key":"1398_CR24","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1186\/s12889-016-3118-6","volume":"16","author":"L Cunningham-Sabo","year":"2016","unstructured":"Cunningham-Sabo L, Lohse B, Smith S, Browning R, Strutz E, Nigg C, et al. Fuel for fun: a cluster-randomized controlled study of cooking skills, eating behaviors, and physical activity of 4th graders and their families. BMC Public Health. 2016;16:444.","journal-title":"BMC Public Health"},{"issue":"3","key":"1398_CR25","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.jneb.2015.01.006","volume":"47","author":"R Belue","year":"2015","unstructured":"Belue R, Smith S, Wamboldt P. About eating: an online program with evidence of increased food resource management skills for low-income women. J Nutr Educ Behav. 2015;47(3):265\u201372.","journal-title":"J Nutr Educ Behav"},{"key":"1398_CR26","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1080\/01639625.2017.1286194","volume":"39","author":"MJ Herington","year":"2018","unstructured":"Herington MJ, van de Fliert E. Positive deviance in theory and practice: a conceptual review. Deviant Behav. 2018;39:664\u201378.","journal-title":"Deviant Behav"},{"key":"1398_CR27","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1249\/01.MSS.0000078924.61453.FB","volume":"35","author":"C Craig","year":"2003","unstructured":"Craig C, Marshall A, Sj\u00f6str\u00f6m M, Bauman A, Booth ML, Ainsworth BE, et al. International physical activity questionnaire (IPAQ): 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:81\u201395.","journal-title":"Med Sci Sports Exerc"},{"key":"1398_CR28","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.appet.2004.08.007","volume":"44","author":"SO Hughes","year":"2005","unstructured":"Hughes SO, Power TG, Fisher JO, Muelle S, Nicklas TA. Revisiting a neglected construct: parenting styles in a child-feeding context. Appetite. 2005;44:83\u201392.","journal-title":"Appetite"},{"key":"1398_CR29","doi-asserted-by":"publisher","first-page":"e1096","DOI":"10.1542\/peds.2012-0895","volume":"130","author":"EP Parks","year":"2012","unstructured":"Parks EP, Kumanyika S, Moore RH, Stettler N, Wrotniak BH, Kazak A. Influence of stress in parents on child obesity and related behaviors. Pediatrics. 2012;130:e1096\u2013104.","journal-title":"Pediatrics."},{"key":"1398_CR30","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1016\/j.jneb.2019.05.287","volume":"51","author":"S Godleski","year":"2019","unstructured":"Godleski S, Krall J. Confirmatory factor analyses support a 4-factor structure of the Satter eating competence inventory\u2122 and migration of an internal regulation item to the eating attitudes subscale. J Nutr Educ Behav. 2019;51:1003\u201310.","journal-title":"J Nutr Educ Behav"},{"key":"1398_CR31","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.appet.2014.12.228","volume":"87","author":"B Lohse","year":"2015","unstructured":"Lohse B. The Satter eating competence inventory for low-income persons is a valid measure of eating competence for persons of higher socioeconomic position. Appetite. 2015;87:223\u20138.","journal-title":"Appetite"},{"key":"1398_CR32","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/S1499-4046(06)60045-6","volume":"35","author":"T Marsh","year":"2003","unstructured":"Marsh T, Cullen KW, Baranowski T. Validation of a fruit, juice, and vegetable availability questionnaire. J Nutr Educ Behav. 2003;35:93\u20137.","journal-title":"J Nutr Educ Behav"},{"key":"1398_CR33","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1093\/her\/16.2.187","volume":"16","author":"KW Cullen","year":"2001","unstructured":"Cullen KW, Baranowski T, Rittenberry L, Cosart C, Hebert D, de Moo C. Child-reported family and peer influences on fruit, juice and vegetable consumption: reliability and validity of measures. Health Educ Res. 2001;16:187\u2013200.","journal-title":"Health Educ Res"},{"key":"1398_CR34","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1017\/S1368980000000392","volume":"3","author":"KW Cullen","year":"2000","unstructured":"Cullen KW, Baranowski T, Rittenberry L, Cosart C, Owens E, Hebert D, et al. Socioenvironmental influences on children\u2019s fruit, juice and vegetable consumption as reported by parents: reliability and validity of measures. Public Health Nutr. 2000;3:345\u201356.","journal-title":"Public Health Nutr"},{"issue":"6","key":"1398_CR35","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1016\/j.jneb.2019.02.009","volume":"51","author":"EH Ruder","year":"2019","unstructured":"Ruder EH, Lohse B, Mitchell DC, Cunningham-Sabo L. Parent food and eating behaviors assessments predict targeted healthy eating index components. J Nutr Educ Behav. 2019;51(6):711\u20138.","journal-title":"J Nutr Educ Behav"},{"key":"1398_CR36","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s40795-019-0286-7","volume":"5","author":"MP Prescott","year":"2019","unstructured":"Prescott MP, Lohse B, Mitchell DC, Cunningham-Sabo L. Child assessments of vegetable preferences and cooking self-efficacy show predictive validity with targeted diet quality measures. BMC Nutrition. 2019;5:21.","journal-title":"BMC Nutrition"},{"key":"1398_CR37","doi-asserted-by":"crossref","unstructured":"Hodder RK, Stacey FG, Wyse RJ, Clinton-McHarg T, Tzelepiz F, James EL, et al. Interventions for increasing fruit and vegetable consumption in children aged five years and under (review). Cochrane Database Syst Rev. 2018;5(5):CD008552.","DOI":"10.1002\/14651858.CD008552.pub4"},{"issue":"1","key":"1398_CR38","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1089\/chi.2019.0103","volume":"16","author":"A Mehdizadeh","year":"2020","unstructured":"Mehdizadeh A, Nematy M, Vatanparast H, Khadem-Rezaiyan M, Emadzadeh M. Impact of parent engagement in childhood obesity prevention interventions on anthropometric indices among preschool children: a systematic review. Child Obes. 2020;16(1):3\u201319.","journal-title":"Child Obes"}],"container-title":["BMC Medical Research Methodology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12874-021-01398-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12874-021-01398-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12874-021-01398-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T20:13:28Z","timestamp":1633896808000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedresmethodol.biomedcentral.com\/articles\/10.1186\/s12874-021-01398-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,9]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1398"],"URL":"https:\/\/doi.org\/10.1186\/s12874-021-01398-4","relation":{},"ISSN":["1471-2288"],"issn-type":[{"value":"1471-2288","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,9]]},"assertion":[{"value":"26 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 October 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Data collection procedures were reviewed and approved by the Colorado State University and Rochester Institute of Technology Institutional Review Boards for the protection of human subjects under IRB application 19-9204H. Methods were carried out in accordance with the relevant guidelines and regulations, e.g., the Declaration of Helsinki. Parents provided a written Informed consent prior to study participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"205"}}