Thomas A Arcury

Wake Forest School of Medicine, Winston-Salem, North Carolina, United States

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Publications (388)695.11 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this paper is to present and evaluate descriptively bivariate associations between urinary metabolites of pesticides and herbicides and migrant camp conditions, violations, and personal worker behaviors at home for farmworkers who do not apply pesticides. We studied 183 migrant farmworker camps in eastern North Carolina in 2010. Data and urine samples were collected from 371 men. Predictor measures included violations in six domains of housing regulations and nonviolation characteristics and personal behaviors that might impact urinary metabolites. Cockroaches and bathroom violations were predictive of increased exposure to pyrethroids and cyfluthrin/chlorpyrifos, respectively. Changing and storing clothing and shoes in sleeping rooms increased the number of detects for the diazinon metabolite. Farmworkers had exposures to multiple chemicals. No single housing domain was identified as critical to mitigating housing-related exposure; specific attention should be paid to changing and storing soiled clothing in sleeping rooms, and insect infestations. Am. J. Ind. Med. © 2013 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 03/2014; 57(3). DOI:10.1002/ajim.22284
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    ABSTRACT: Objectives: We sought to identify coherent profiles of diabetes beliefs within discrete domains (ie causes, symptoms, consequences, self management, and medical management), and delineate consistency of belief profiles over one month. Methods: Diabetes beliefs of rural-dwelling older adults were assessed with the Common Sense Model of Diabetes Inventory at baseline (N = 593) and one month later (N = 563). Results: A discrete number of belief patterns were identified in each belief domain using latent class analysis. Belief patterns varied by the extent to which more popular or folk notions of diabetes encroached on biomedical understandings of the disease. Belief patterns were generally stable over time. Conclusions: A manageable number of belief patterns can be identified and used to strengthen patient-centered care and, potentially, enhance diabetes management.
    03/2014; 1(2). DOI:10.14485/HBPR.1.2.3
  • Joanne C Sandberg, Carla Strom, Thomas A Arcury
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    ABSTRACT: The primary objective of this exploratory study was to delineate the broad range of adjustments women breast cancer survivors draw upon to minimize cancer-related limitations at the workplace. The study also analyzed whether survivors used strategies to address work-related limitations in isolation or in combination with other strategies, and whether they used formal or informal strategies. Semi-structured, in-depth interviews were conducted with 14 women who were employed at the time of diagnosis of breast cancer and who continued to work during treatment or returned to work. Interviews were conducted 3 to 24 months after diagnosis. An iterative process was used to systematically analyze the data (the transcripts) using qualitative methods. Participants who worked during or after treatment adjusted their work schedule, performed fewer or other tasks, modified or changed their work environment, reduced non-work activities at the workplace, used cognitive prompts, and acted preemptively to make work tasks manageable after their return to work. Survivors used multiple adjustments and drew upon both formal and informal tactics to minimize or prevent cancer- or treatment-related effects from negatively affecting job performance. Knowledge about the broad range of both formal and informal strategies identified in this study may enable health care and social services providers, as well as cancer survivors and employers, to identify a wide range of specific strategies that may reduce the negative effects of work-related limitations in specific work settings. Insights gained from this analysis should inform future research on work and cancer survivorship.
    Women s Health Issues 02/2014; DOI:10.1016/j.whi.2013.12.007
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    ABSTRACT: Document beliefs about the contribution of physical activity to preschool-aged children's health held by Latino mothers in farmworker families, and delineate their perceived barriers or constraints that impose limits on preschool-aged children's physical activity. Qualitative data obtained through semi-structured in-depth interviews (N = 33) with mothers of preschool-aged children living in Latino farmworker families in North Carolina. Mothers universally agree that regular vigorous physical activity is good for preschool-aged children's health, including obesity prevention. However, excessive physical activity can produce illnesses, as well as other physical and emotional problems, and should be limited. Mothers wanted their children to engage in more sedentary forms of activity because they believed it would benefit learning. Physical and chemical hazards in rural environments, distance to parks and play spaces, and lack of familiarity and concerns about neighbors constrained children's physical activity. Although physical activity is believed to be beneficial, strong cultural beliefs and real contextual barriers undermine preschool-aged Latino farmworker children's level of physical activity.
    Journal of Immigrant and Minority Health 02/2014; DOI:10.1007/s10903-014-9990-1
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    ABSTRACT: Objectives. We sought to describe work organization attributes for employed immigrant Latinas and determine associations of work organization with physical health, mental health, and health-related quality of life. Methods. We conducted a cross-sectional survey with 319 employed Latinas in western North Carolina (2009-2011). Measures included job demands (heavy load, awkward posture, psychological demand), decision latitude (skill variety, job control), support (supervisor control, safety climate), musculoskeletal symptoms, mental health (depressive symptoms), and mental (MCS) and physical component score (PCS) health-related quality of life. Results. Three fifths reported musculoskeletal symptoms. Mean scores for depression, MCS, and PCS were 6.2 (SE = 0.2), 38.3 (SE = 0.5), and 42.8 (SE = 0.3), respectively. Greater job demands (heavy load, awkward posture, greater psychological demand) were associated with more musculoskeletal and depressive symptoms and worse MCS. Less decision latitude (lower skill variety, job control) was associated with more musculoskeletal and depressive symptoms. Greater support (supervisor's power and safety climate) was associated with fewer depressive symptoms and better MCS. Conclusions. Work organization should be considered to improve occupational health of vulnerable women workers. Additional research should delineate the links between work organization and health among vulnerable workers. (Am J Public Health. Published online ahead of print January 16, 2014: e1-e8. doi:10.2105/AJPH.2013.301587).
    American Journal of Public Health 01/2014; DOI:10.2105/AJPH.2013.301587
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    ABSTRACT: OBJECTIVE: To describe time spent in sedentary and moderate-to-vigorous physical activity (MVPA) by children in Latino farmworker families and delineate sources of variation in sedentary and MVPA. METHOD: Data were from mother-child dyads (N = 248) in Latino farmworker households in North Carolina. Physical activity was assessed using accelerometers; mothers described their children's characteristics and their physical and social environments. RESULTS: Children spent 6.2 hours/day sedentary (Median=369 minutes), and 6.0 minutes/day in MVPA. Children in Head Start spent more time sedentary, whereas children living where dogs roam freely were less sedentary. Children whose mothers limited screen time spent 2 more minutes in MVPA. CONCLUSIONS: Preschool-aged Latino children in farmworker families are sedentary, engaging in little MVPA.
    American journal of health behavior 01/2014; 38(5):717-725. DOI:10.5993/AJHB.38.5.9.
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    ABSTRACT: This study examined the use of self-care strategies to address difficulty sleeping among community-dwelling older adults. Data were collected from a series of 18 questionnaires administered to 195 rural African American and white older adults in North Carolina. Participants reported whether they had experienced difficulty sleeping and strategies used to respond to the symptom. The most widely used strategies included ignoring the symptom, staying in bed or resting, and praying. Herb and supplement use were not reported. Ethnicity, income, and education were associated with use of specific self-care strategies for sleep. This variation suggests that older adults may draw on cultural understandings to interpret the significance of difficulty sleeping and influence their use of self-care strategies, including complementary and alternative medicine use. This information may enable health care providers to communicate with the older patients about sleep difficulty strategies to minimize sleep problems.
    01/2014; 19(1):36-42. DOI:10.1177/2156587213510005
  • Thomas A Arcury, Dana C Mora, Sara A Quandt
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    ABSTRACT: The nature of poultry processing puts workers at risk for developing neurological injuries, particularly carpal tunnel syndrome (CTS). Many poultry processing workers are Latino immigrants. This qualitative analysis uses an explanatory models of illness (EMs) framework to describe immigrant Latino poultry processing workers' (Guatemalan and Mexican) beliefs of CTS. Understanding these workers' CTS EMs provides a foundation for recommendations to reduce the risk factors for this occupational injury. In-depth interviews were completed with 15 poultry processing workers diagnosed with CTS. Systematic qualitative analysis was used to delineate beliefs about causes, symptoms, physiology, treatments, quality-of-life and health implications of CTS. Participants' EMs largely reflect current biomedical understanding of CTS. These EMs are similar for Guatemalan and Mexican workers. Beliefs about causes include factors in the work environment (e.g., repetition, cold) and individual physical weakness. Treatments include over-the-counter medicine, as well as traditional remedies. Most know the future impact of CTS will include chronic pain. These workers know what causes CTS and that curing it would require quitting their jobs, but feel that they must endure CTS to support their families. Latino poultry processing workers, whether Guatemalan or Mexican, have a fairly complete understanding of what causes CTS, how to treat it, and what they must do to cure it. However, situational factors force them to endure CTS. Policy changes are needed to change the structure of work in poultry processing, particularly line speed and break frequency, if the prevalence of CTS is to be reduced.
    Journal of Immigrant and Minority Health 12/2013; 17(3). DOI:10.1007/s10903-013-9967-5
  • Sara A. Quandt, Thomas A. Arcury
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    ABSTRACT: Disparities in access to healthy foods are increasingly documented in US populations through public health research. Such disparities parallel disparities in chronic disease morbidity and mortality, the focus of much medical research. The Forsyth Healthy Living Collaborative (FHLC) is designed to bring together community and medical-school based researchers to address locally-recognized public health concerns and create community-linked research infrastructure. This roundtable presentation will highlight successful strategies centered on the local food environment undertaken by the FHLC. Guided by a diverse Food Environment Committee, a series of events and research projects have been conducted. Events included a community forum focused on healthy eating for children that brought together community members and researchers to consider national and regional approaches to disparities; and workshops on research methods that could engage community members in producing data with which to reveal patterns of existing disparities. Workshops included GIS (geographic information systems), NEMS (Nutrition Environment Measurement Survey), and photovoice research methods. Research included mapping of food sources (community gardens, farmers markets, grocery stores) with socioeconomic data, qualitative research on perceptions of the local food environment, and pilot intervention research to test a program linking local farms with clients of community non-profit agencies. The FHLC's role in facilitating the events and research and the larger impact of these on the community's increasing focus on the connection between food and health in local policy development demonstrate how medical researchers and communities can collaborate to build community research infrastructure.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Although most fresh produce in the US is harvested by Latino migrant and seasonal farmworkers, this low income, largely immigrant population has limited access to food. Low food security has been documented previously for farmworker families, but specific factors beyond income responsible for this are unknown. This study uses mixed methods to identify factors associated with variation in food security within this at-risk population. 248 farmworker families in North Carolina with a 2-3 year old child were recruited for a prospective two-year survey of child health. 27% were migrant workers; 73% were seasonal workers who currently reside in NC year round. Food security was measured using the USDA 18-item module. In-depth semi-structured interviews with a purposive sample of 32 mothers explored constraints on family and child feeding. Less than one-half of families reported high (39%) or marginal (9%) household food security in the previous year; the remainder reported low (35%) or very low (17%) food security. Low or very low food security was associated with migrant (rather than seasonal) farm work, low maternal education, lack of documentation among family adults. Qualitative data revealed constraints on food access reflecting rural residence (food deserts, transportation problems), difficulties accessing food benefits due to migration, and limited ability to cook or store food in migrant camps. These data show that food insecurity continues to be a problem among those who harvest much of America's food. Insights gained from interviewing mothers suggest environmental and policy factors underlying the problem of food insecurity.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Farmworkers are at risk for health consequences of pesticide exposure. While acute exposure causes immediate symptoms, most exposure is likely low level and chronic, with possible health effects manifest years later as neurodegenerative diseases. We hypothesized that subclinical effects might be detected in current farmworkers to provide evidence of early stage neurodegeneration. From animal studies, olfactory function, an early sign of Parkinson's disease, is known to be sensitive to pesticide exposure. The study objective was to compare olfactory function in comparable samples of exposed and non-exposed workers. Migrant farmworkers (n=304) and a comparison sample of non-farmworkers (n=247) 18+ years and self-identified Latino/Hispanic were recruited in North Carolina with the help of community partners. Non-farmworkers were restricted to those with no occupational pesticide exposure in the previous 3 years. Odor identification and odor threshold tests were administered in a clinic setting and analyzed using logistic and linear regressions, adjusting for age, gender, and smoking. Lifetime pesticide exposure was obtained using the NINDS common data elements questionnaire to confirm group pesticide exposure differences. The total sample was 84% male, 23% current smokers, and 97% born in Latin America. Farmworkers and non-farmworkers did not differ in odor identification performance (p=0.6726). However, non-farmworkers detected a standard odor at significantly lower concentrations than did farmworkers (p<.0001). Farmworkers display significant non-selective impairment in olfactory function, compared to non-farmworkers. These results suggest that subclinical markers signal neurological effects before neurodegenerative diseases can be detected. Such data could be important in demonstrating health consequences of occupational pesticide exposure.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Abstract This study documents older adults' sources of health information, describes the purposes for health information seeking, and delineates gender and ethnic variation in health information seeking. Sixty-two African American and white adults age 65 and older completed qualitative interviews describing their use of complementary therapies. Interviews identified how individuals obtained and shared health information. Friends, not family, were the dominant source of health information. Participants ranged from active seekers to passive consumers of health information. Information seeking was common for benign symptoms. More women than men discuss health information with others. Friends are the primary source of health information for rural older adults. There is substantial passivity in the pursuit of health information. Identifying health information sources of rural older adults can support the dissemination of information to those who share it with others.
    Gerontology & geriatrics education 11/2013; DOI:10.1080/02701960.2013.844693
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    ABSTRACT: Community-based participatory research (CBPR) joins communities and researchers to facilitate encouraging community members to participate in research relevant to their health. In prospective epidemiological studies, CBPR designs should aid in participant retention. 371 Latino males (210 exposed migrant farmworkers and 161 non-exposed non-farmworkers) were enrolled in a prospective CBPR study of the neurological effects of occupational pesticide exposure. The sample was constructed via face to face recruitment employing community partners who visited potential participants in their homes. Participants were enrolled at a clinic visit where biological sample collection and neurological testing were conducted. Those who returned for a second clinic three months later were compared to those who did not on age, education, marital status, social integration and participation, CES-D, and exposure status (farmworker vs. non-farmworker). Overall, 68.7% of the 371 participants were retained. The retention rate for farmworkers was 65.7%; the rate for the non-farmworkers was 72.7%. Retained participants differed only on exposure status. The community partners reported that community members discontinued participation due to lack of trust in the study, fear of contributing blood samples, peer influence, seasonal demands of farm work, and loss to follow up due to the transient nature of the population being studied. While stable non-migrant populations will always be easier to retain in prospective studies, retention strategies focused on potentially modifiable barriers such as fear and lack of trust are needed to enhance retention. Community partnerships provide the appropriate context for exploring such barriers and developing effective solutions.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Preschool age children of Latino farmworkers are at risk for early childhood caries and subsequent oral health (OH) problems; many face significant barriers in accessing dental care. We compare OH and hygiene between migrant and seasonal farmworker children and note disparities between maternal knowledge and practices. The Nios Sanos Study is a cohort (N=248) of mothers and preschool age children from migrant and seasonal farmworker families recruited in North Carolina. Mothers reported the child's OH condition, hygiene behaviors, and professional care, as well as their beliefs about child OH in response to the Behavioral Risk Factor Questionnaire of the NIDCR Centers for Research to Reduce Disparities in Oral Health. At interview, children averaged 44.3 7.4 months. Migrant mothers rated their child's OH condition and OH-related quality-of-life significantly worse than did seasonal mothers. 87% of children had ever had teeth examined by a healthcare provider, and 83% had had fluoride varnish applied in the previous year; rates did not differ between migrant and seasonal families. Children enrolled in Head Start were more likely to have had examinations and varnish applied than those not in Head Start. Mothers exhibited high levels of knowledge of proper child oral hygiene, but rates of recommended practices were substantially lower. Farmworker families, particularly migrants, frequently live in crowded, substandard housing and share facilities with other families. Steps to help families achieve appropriate OH practices should prioritize behaviors and problem-solve with mothers ways to best meet child OH needs in the context of farmworker living conditions.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Community-based participatory research (CBPR) has become essential in health disparities and environmental justice research; however, the scientific integrity of CBPR projects has become a concern. Some concerns, such as appropriate research training, lack of access to resources and finances, have been discussed as possibly limiting the scientific integrity of a project. Prior to understanding what threatens scientific integrity in CBPR, it is vital to understand what scientific integrity means for the professional and community investigators who are involved in CBPR. This analysis explores the interpretation of scientific integrity in CBPR among 74 professional and community research team members from of 25 CBPR projects in nine states in the southeastern United States in 2012. It describes the basic definition for scientific integrity and then explores variations in the interpretation of scientific integrity in CBPR. Variations in the interpretations were associated with team member identity as professional or community investigators. Professional investigators understood scientific integrity in CBPR as either conceptually or logistically flexible, as challenging to balance with community needs, or no different than traditional scientific integrity. Community investigators interpret other factors as important in scientific integrity, such as trust, accountability, and overall benefit to the community. This research demonstrates that the variations in the interpretation of scientific integrity in CBPR call for a new definition of scientific integrity in CBPR that takes into account the understanding and needs of all investigators.
    Social Science [?] Medicine 11/2013; 97:134-42. DOI:10.1016/j.socscimed.2013.08.023
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    ABSTRACT: The reliability of an item designed to measure health belief is often confounded with response consistency at the person level. The study applied contemporary measurement methods to an inventory of common sense beliefs about diabetes and used a sample of N = 563 adults with diabetes to test the hypothesis that individuals whose beliefs are congruent with a biomedical model are more consistent in their responses. Item-level analysis revealed that the domains of Causes and Medical Management were the least reliable. Person-level analysis showed that respondents who held views congruent with the biomedical model were more consistent than people who did not.
    Journal of Health Psychology 10/2013; DOI:10.1177/1359105313506761
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    ABSTRACT: PurposeThe purpose of the study was to assess the performance of a Short Diabetes Knowledge Instrument (SDKI) in a large multi-ethnic sample of older adults with diabetes and to identify possible modifications to improve its ability to document diabetes knowledge.Research Design and MethodsA sample of 593 African American, American Indian, and white female and male adults 60 years and older, with diabetes diagnosed at least 2 years prior, was recruited from 8 North Carolina counties. All completed an interview that included a 16-item questionnaire to assess diabetes knowledge. A subsample of 46 completed the questionnaire a second time at a subsequent interview. Item-response analysis was used to refine the instrument to well-performing items. The instrument consisting of the remaining items was subjected to analyses to assess validity and test-retest reliability.ResultsThree items were removed after item-response analysis. Scores for the resulting instrument were lower among minority and older participants, as well as those with lower educational attainment and income. Scores for test-retest were highly correlated.Conclusions The SDKI (13-item questionnaire) appears to be a valid and reliable instrument to evaluate knowledge about diabetes. Assessment in a multi-ethnic sample of older adults suggests that this instrument can be used to measure diabetes knowledge in diverse populations. Further evaluation is needed to determine whether or not this instrument can detect changes in knowledge resulting from diabetes education or other interventions.
    The Diabetes Educator 10/2013; 40(1). DOI:10.1177/0145721713508824
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    ABSTRACT: This study examines older adults’ fears of diabetes complications and their effects on self-management practices. Existing models of diabetes self-management posit that patients’ actions are grounded in disease beliefs and experience, but there is little supporting evidence. In-depth qualitative interviews were conducted with a community-based sample of 74 African American, American Indian, and White older adults with diabetes. Analysis uses Leventhal’s Common Sense Model of Diabetes to link fears to early experience and current self-management. Sixty-three participants identify fears focused on complications that could limit carrying out normal activities: amputation, blindness, low blood glucose and coma, and disease progression to insulin use and dialysis. Most focus self-management on actions to prevent specific complications, rather than on managing the disease as a whole. Early experiences focus attention on the inevitability of complications and the limited ability of patients to prevent them. Addressing older adults’ fears about diabetes may improve their diabetes self-management practices.
    Journal of Applied Gerontology 10/2013; 32(7):783-803. DOI:10.1177/0733464811435506
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    ABSTRACT: The prevalence of bifid median nerves and persistent median arteries, their co-occurrence, and their relationship to carpal tunnel syndrome (CTS) are only understood partially. We screened 1026 wrists of 513 Latino manual laborers in North Carolina for bifid median nerves and persistent median arteries using electrodiagnosis and ultrasound. A total of 8.6% of wrists had a bifid median nerve, and 3.7% of wrists had a persistent median artery independent of subgroup ethnicity, age, gender, or type of work. An association with definite carpal tunnel syndrome was not found. The presence of either anatomic variant was associated with a high likelihood of co-occurrence of another variant in the same or the contralateral wrist. The occurrence of median anatomic variants can be determined in field studies using ultrasound. Persistent median arteries and bifid median nerves tend to co-occur but do not put manual laborers at additional risk of developing CTS. Muscle Nerve, 2013.
    Muscle & Nerve 10/2013; 48(4). DOI:10.1002/mus.23797
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    ABSTRACT: To examine the demographic, health and diabetes management correlates of physician trust in a rural, multiethnic population with diabetes. 563 older (≥ 60 years) African American, American Indian and White adults completed in-home surveys, including the 11-item General Trust in Physicians Scale. Higher trust scores were seen among: older (>75) participants (p < .01), those with fewer (<3) chronic health conditions (p < .01), and those who adhered to physical activity (p < .05) and dilated eye exam (p < .01) guidelines; the latter remained significant (eye exam, p = .019) or approached significance (physical activity, p = .051) after adjustment for potential confounders. Physician trust may influence patient adherence to diabetes management recommendations. Efforts should be made to build trust in the patient-provider relationship to enhance patient outcomes.
    American journal of health behavior 09/2013; 37(5):660-6. DOI:10.5993/AJHB.37.5.10

Publication Stats

5k Citations
695.11 Total Impact Points


  • 1970–2015
    • Wake Forest School of Medicine
      • • Center for Worker Health
      • • Department of Family and Community Medicine
      Winston-Salem, North Carolina, United States
  • 2002–2013
    • Wake Forest University
      • Department of Family and Community Medicine
      Winston-Salem, North Carolina, United States
  • 2011
    • Guilford College
      Greensboro, North Carolina, United States
  • 2005–2011
    • University of North Carolina at Greensboro
      • • Department of Nutrition
      • • Department of Public Health Education
      Greensboro, NC, United States
  • 1996–2008
    • University of North Carolina at Chapel Hill
      • • Cecil G. Sheps Center for Health Services Research
      • • Department of Biostatistics
      • • Center for Urban and Regional Studies
      North Carolina, United States
  • 2006
    • University of Toledo
      Toledo, Ohio, United States
    • Hampton University
      Hampton, Virginia, United States