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Received: 30 January 2025
Revised: 19 February 2025
Accepted: 22 February 2025
Published: 26 February 2025
Citation: Fuster, M.; Wang, Y.;
Stoecker, C.; Rose, D.; Hofmann, L.P.;
Pasterz, A.; Knapp, M. Factors
Associated with High Sugary
Beverage Intake Among Children in
Louisiana: A Survey of Caregivers in
New Orleans and Baton Rouge.
Nutrients 2025,17, 799. https://
doi.org/10.3390/nu17050799
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Article
Factors Associated with High Sugary Beverage Intake Among
Children in Louisiana: A Survey of Caregivers in New Orleans
and Baton Rouge
Melissa Fuster 1, * , Yin Wang 2, Charles Stoecker 2, Donald Rose 1, Lisa P. Hofmann 3, Annie Pasterz 1
and Megan Knapp 3
1
Department of Social Behavioral and Population Sciences, Tulane University Celia Scott Weatherhead School
of Public Health and Tropical Medicine, New Orleans, LA 70112, USA; diego@tulane.edu (D.R.);
apasterz@tulane.edu (A.P.)
2Department of Health Policy and Management, Tulane University Celia Scott Weatherhead School of Public
Health and Tropical Medicine, New Orleans, LA 70112, USA; ywang119@tulane.edu (Y.W.);
cfstoecker@tulane.edu (C.S.)
3Department of Public Health Sciences, Xavier University of Louisiana, New Orleans, LA 70125, USA;
lhofmann@xula.edu (L.P.H.); mknapp@xula.edu (M.K.)
*Correspondence: mfuster@tulane.edu
Abstract: Background/Objectives: Sugar-sweetened beverage (SSB) consumption is as-
sociated with child obesity, an understudied issue in the southern United States, where
obesity rates are the highest in the country. We examined the factors associated with high
SSB intakes among children aged 2–12 years in two major cities in Louisiana, New Orleans
and Baton Rouge. Methods: We conducted a cross-sectional study using an online survey.
The sample consisted of caregivers of children aged 2–12 years who eat restaurant meals
(either dine-in, delivery, or take-out) at least once a month and reside in or near New
Orleans or Baton Rouge, LA. Multivariable logistic regression was used to examine factors
associated with high child SSB intake frequency (
≥
4 times/week), including restaurant
use, caregiver attitudes towards SSB, and their demographics (n = 1006). Results: Most
caregivers reported weekly child SSB consumption (74.6%
≥
1
×
/week; 38.1%
≥
4+/week)
and restaurant use (58.8%
≥
1
×
/week). High SSB frequency (
≥
4+/week) was associated
with a higher frequency of restaurant use, lower caregiver education, agreement with the
statement that SSBs are an important part of family meals, and disagreement with the state-
ment that restaurants should not offer SSBs with children’s meals (p< 0.05). Conclusions:
Our results revealed a high frequency of SSB consumption among children who dine at
restaurants monthly, with significant associations observed between SSB intake, restaurant
meals, and pro-SSB attitudes. These findings may support the need for regulations, such as
healthy default beverage policies for children’s menus, to potentially reduce SSB intake and
shift social norms, particularly in regions with high childhood obesity rates like Louisiana
and the southern USA.
Keywords: child nutrition; sugar-sweetened beverages; restaurant use; survey; parents/
caregivers; United States of America (USA)
1. Introduction
Sugar-sweetened beverages (SSBs), which include sodas, fruit drinks, sports drinks,
and sweetened waters, teas, and coffees, are the largest source of added sugar in children’s
diets and are associated with weight gain and obesity [
1
,
2
]. Almost two-thirds of children
Nutrients 2025,17, 799 https://doi.org/10.3390/nu17050799
Nutrients 2025,17, 799 2 of 10
in the United States (USA) consume at least one SSB per day, with the highest intake among
Black, Mexican-American, and non-Mexican Hispanic children and children from low-
income families [3,4]. Reduction of SSB intake can decrease the risk of obesity and related
diseases [
5
]. Childhood obesity is disproportionally high within some subpopulations
of the USA, with higher and statistically significant prevalences among non-Hispanic
Black youth than White youth and among children from families of lower socioeconomic
status [
6
,
7
]. These issues are of particular concern in southern USA states, as the region
has the highest obesity rate in the country (34.1%) [
8
]. Louisiana has the third-highest
childhood/adolescent obesity rate (22.2%, 10–17-year-olds) and the fourth highest among
adults (38.1%) [9].
Restaurants, encompassing full-service and fast-food establishments, are a key en-
vironment to influence healthy food and beverage choices, as they are an increasingly
prominent source of food and beverages globally. In the USA, an estimated one-third of
all calories consumed come from food and beverages acquired away from the home, and
almost half of food/beverage dollars are spent on eating outside the home [
10
]. Nearly
half of SSB intake occurs away from home [
11
], making restaurants a prime environment
for reducing consumption. Among children ages 4–19 years, 36% consume food from
fast-food restaurants in a given day, with the highest rates among non-Hispanic and Black
children [
12
,
13
]. Consumption of meals in restaurants, especially combination meals or
meals from the children’s menu, is associated with higher SSB intake [
14
,
15
]. Research
also shows children are more likely to purchase an SSB with a combination meal than as
a separate item [
15
,
16
]. In restaurant settings, Black and Hispanic individuals purchased
more beverage calories and grams of sugar per capita than White individuals, with the
highest amounts purchased by non-Hispanic Black adolescents and young adults [15].
Past research concerning SSB intake frequency and parental characteristics (e.g., ed-
ucation, gender, age, race/ethnicity, and income) has shown that parents and caregivers
are critical in controlling and influencing child food practices at home and at restaurants
through modeling food consumption behavior and facilitating food access [
17
–
20
]. Re-
search shows that caregiver attitudes about SSB intake among children, particularly a
favorable view towards SSBs, can be a strong factor influencing child SSB intake [
17
]. Poli-
cies, such as healthy default beverage ordinances, and educational interventions may be
important to support caregivers in making healthier beverage selections for their children.
There is a paucity of research specifically addressing the southern United States, a
region with the highest rates of obesity in the country and where sweetened beverages
are important staples in local food cultures [
21
]. Addressing this need, the objective of
this manuscript was to examine SSB intake frequency among children 2–12 years of age,
caregiver attitudes, and associated demographic characteristics to inform interventions to
reduce SSB consumption.
2. Materials and Methods
Our data collection included New Orleans and Baton Rouge, the two largest cities in
Louisiana. Participants’ eligibility was determined based on initial screening questions.
Inclusion criteria included being an adult (18 years or older), living in or near the target
city (New Orleans, LA, USA or Baton Rouge, LA, USA), being a parent or caregiver to a
child between the ages of 2–12, and having ordered from or eaten at a restaurant with their
children in their city of residence within the last 30 days. We selected the age range, as
most children’s menus are marketed to children up to 12 years of age. The surveys were
conducted in September 2022 and distributed using an online marketing research firm
(Centiment, Denver, CO, USA), which has access to a diverse pool of respondents. The
company recruits participants using social media platforms and affiliate networks. Potential
Nutrients 2025,17, 799 3 of 10
participants received invitations to participate that included minimal study information
to avoid selection bias. The surveys also utilized fingerprinting technology to ensure
unique participants completed the survey and applied measures (e.g., attention checks and
response validation) to ensure panelists are fully engaged [
22
]. Participants who completed
the survey were compensated directly by Centiment. A total of 1006 participants consented
to participate and completed the survey (506 in New Orleans, LA and 500 in Baton Rouge,
LA, USA). These sample sizes allow us to estimate proportions with 5% precision when the
confidence level is 95% for each city. This calculation assumes a 20% non-response rate and
allows for a Bernoulli distribution with the highest possible variance (i.e., a proportion of 0.5).
Data were collected using online surveys administered via Qualtrics. The survey was
developed to be completed within 15 minutes. The survey included a landing page provid-
ing information about the study and participation. The survey questions were developed
based on past research [
23
–
25
]. Before full implementation, the survey underwent two pilot
tests. First, we shared the survey with a small convenience sample of caregivers
(n = 10),
to
assess how the questions were interpreted by the target audience, ensure clarity, and con-
firm the estimated completion. Second, before the full distribution, the survey underwent
a soft launch with 20 participants as a second verification of the survey questions and to
confirm the survey logic was working as intended.
Children’s SSB consumption frequency was collected via the following question:
“Thinking about the last 30 days (last month), in general, how often does your child or
children consume sugar-sweetened drinks? Please include sodas/pop/carbonated drinks,
fruit drinks (Hi-C), sweetened/flavored milk drinks, etc.”, with responses ranging from
once per month or less to once a day or more. Following previous research, we categorized
intakes of four or more times a week as high [
26
], generating a dichotomous outcome
indicator to explore factors associated with high child SSB intake.
The main explanatory variables in the study were the frequency of restaurant use,
attitudes concerning sugary beverages, and selected demographic characteristics. Restau-
rant use was assessed via the following question: “Thinking about the past 30 days, how
often have your children (or child) eaten meals from restaurants? (Please include meals
consumed at a restaurant or purchased at a restaurant as take-out or delivery)”. Frequency
choices ranged from once a month to more than once a day.
We questioned caregivers about two different attitudes using the following phrases:
“Sugary-sweetened drinks are an important aspect of family meals” and “Restaurants
should not offer sugar-sweetened drinks with children’s meals”. Responses applied a
5-point Likert scale for agreement, and responses were collapsed into three categories for
analysis (disagree, neutral, agree). Lastly, we collected information on basic demographic
characteristics, including gender, household income, race/ethnicity, and education level.
The gender questions included non-binary categories (trans, non-conforming/gender
variant). However, given the small count of some responses, gender was ultimately
assessed using a dichotomous variable (female/non-female). Income was asked at the
household level, and the responses were collapsed to denote households with incomes
above or below USD 50,000, which was the closest data cut to the 2022 median household
income in Louisiana of USD 58,330 [
27
]. We asked participants to identify their racial
and ethnic background, with responses collapsed into three categories to denote Black,
White, and other/multi-racial for analysis, based on data distribution. Education level was
assessed as the highest level completed and collapsed into 3 categories for the multivariable
runs: high school graduate or less, some college, and bachelor’s degree or higher, to limit
the model specification to categories sufficiently large for statistical inference.
Statistical analyses were conducted using Stata version 16 (StataCorp LLC, College
Station, TX, USA), and a threshold of p< 0.05 was used to determine statistical significance
Nutrients 2025,17, 799 4 of 10
for all estimates. Multivariable ordered logistic regression models were estimated for each
of the three survey questions (frequency of restaurant use, attitude toward SSB importance
in family meals, and attitude toward restaurants not offering SSBs with children’s meals) to
explore the associations between caregivers’ responses to these survey questions and their
sociodemographic characteristics, including gender, race/ethnicity, educational attainment,
and income levels, excluding cases with missing data. Respondents that selected “Prefer
not to answer” for these variables were set to missing.
Furthermore, a series of multivariable logistic regression models were employed to
assess factors potentially associated with SSB intake of children, as denoted by a dummy
indicating whether children consumed SSBs at least four times per week. These factors in-
cluded caregivers’ gender, race/ethnicity, educational attainment, income levels, restaurant
use, caregivers’ attitudes toward SSB importance, and their attitudes toward the statement
that restaurants should not offer SSBs. As a sensitivity analysis, we also estimated bivariate
odds ratios of the associations between attitudes and SSB uptake.
3. Results
3.1. Sample Characteristics
Table 1displays the sociodemographic characteristics of the participating caregivers,
closely split between New Orleans and Baton Rouge. Most respondents self-identified
as female, while more than half self-identified as White. Approximately one-third of the
sample had a high school degree or less, with the rest having attended at least some college
or more. Additionally, close to half of respondents reported household incomes of less than
USD 50,000 per year (Table 1).
Responses varied regarding restaurant use frequency and agreement with statements
concerning SSBs. Within our sample, more than half reported consuming meals from
restaurants on a weekly basis (Table 1). Nearly half of the respondents disagreed with the
statement, “Sugar-sweetened beverages are an important aspect of family meals” while two
in five respondents disagreed that “Restaurants should not offer sugar-sweetened drinks
with children’s meals” (Table 1).
Table 1. Sample characteristics (n = 1006).
Characteristics Overall
n %
Location New Orleans 506 50.3%
Baton Rouge 500 49.7%
Gender Female 741 73.7%
Male 259 25.7%
Trans female 1 0.1%
Non-conforming/gender variant
5 0.5%
Race/Ethnicity Asian 14 1.4%
Black/African American 302 30.0%
Latin/Hispanic 17 1.7%
Native American 11 1.1%
NH/Pacific Islander 2 0.2%
White 596 59.2%
Multiracial 64 6.4%
Education Level Less than high school 24 2.4%
High school/GED 268 26.6%
Some college 329 32.7%
Bachelor’s degree 248 24.7%
Post-graduate education 137 13.6%
Nutrients 2025,17, 799 5 of 10
Table 1. Cont.
Characteristics Overall
n %
Annual Household Income <USD 9999 78 7.8%
USD 10,000–USD 24,999 141 14.0%
USD 25,000–USD 49,999 248 24.7%
USD 50,000–USD 74,999 181 18.0%
USD 75,000–USD 99,999 130 12.9%
USD 100,000–USD 149,999 136 13.5%
USD 150,000 and greater 61 6.1%
Prefer not to say 31 3.1%
Child SSB Intake Frequency 1+/day 255 25.3%
4–6/week 128 12.7%
2–3/week 252 25.0%
1/week 116 11.5%
2–3/month 146 14.5%
1/month or less 109 10.8%
Restaurant Use Frequency 1/month 142 14.1%
2/month 272 27.0%
1/week 277 27.5%
2–3/week 256 25.4%
4+/week 59 5.9%
SSBs are an important part of
family meals
Disagree 481 47.8%
Neutral 326 32.4%
Agree 199 19.8%
Restaurants should not offer
SSBs with children’s meals
Disagree 413 41.1%
Neutral 369 36.7%
Agree 224 22.3%
Abbreviations: SSBs: Sugar-sweetened beverages.
3.2. Factors Associated with Restaurant Use and Attitudes About SSBs
Several socio-demographic characteristics were found to be associated with restaurant
use frequency and attitudes concerning SSBs (Table 2). Restaurant use was significantly as-
sociated with caregiver gender and income. Respondents who reported higher income and
did not self-identify as female were more likely to report higher restaurant use compared
with their counterparts (Table 2). Concerning SSB-related attitudes, we found significant
associations with gender and race/ethnicity. Concerning the statement that SSBs are impor-
tant parts of family meals, the level of agreement was significantly associated with gender,
race/ethnicity, and education. Compared with their counterparts, female caregivers and
those with some college (compared with those with high school or less) were less likely
to agree with the statement. On the other hand, those self-identifying as Black were more
likely to agree, compared to their White counterparts (Table 2). We also found gender and
race/ethnicity to be significantly associated with the attitude that restaurants should not
offer SSBs with children’s meals. Higher likelihood of agreement was found among respon-
dents not self-identifying as female and among those self-identifying as Black, compared
with those self-identifying as white (Table 2).
Nutrients 2025,17, 799 6 of 10
Table 2. Caregiver sociodemographic characteristics associated with restaurant use and caregiver
attitudes about sugar-sweetened beverages.
Covariates: Restaurant Use SSB are Important in
Family Meals
Restaurants Should Not Offer
SSB with Children’s Meals
OR [95% CI] OR [95% CI] OR [95% CI]
Gender
Non-Female REF REF REF
Female 0.741 *
[0.568, 0.967]
0.497 **
[0.378, 0.653]
0.647 ** [0.493, 0.850]
Race
White REF REF REF
Black 1.133
[0.861, 1.491]
1.681 **
[1.276, 2.214]
1.636 ** [1.244, 2.151]
Other/Multiracial 1.010
[0.692, 1.475]
0.935
[0.631, 1.385]
1.205 [0.825, 1.761]
Caregiver educational
attainment
High school or less REF REF REF
Some college 1.289
[0.948, 1.751]
0.689 *
[0.507, 0.935]
0.837 [0.621, 1.129]
Bachelor’s degree or
higher 1.300
[0.942, 1.795]
0.989
[0.715, 1.368]
1.133 [0.821, 1.565]
Annual household income
≤USD 49,999 REF REF REF
≥USD 50,000 1.691 **
[1.284, 2.227]
0.954
[0.721, 1.264]
0.93 [0.705, 1.227]
n 975 975 975
Abbreviations: OR: Odds ratios for adjusted (multivariate) model for ordered logistic regressions; REF, reference,
which denotes the reference category of the regression estimates for categorical variables; SSB, sugar-sweetened
beverage. Notes: Each column is a separate multivariate ordered logistic regression model for three different
outcomes. The order of the outcome “restaurant use” is restaurant use monthly (level 1), restaurant use weekly
(level 2), and restaurant use 2
×
/week (level 3). The order of the outcome “attitude about SSB importance”
disagrees with the statement “SSBs are an important aspect of family meals” (level 1), neutral about the statement
(level 2), and agree with the statement (level 3). The order of the outcome “attitude about the statement that
restaurants should not offer SSBs” disagrees with the statement (level 1), neutral about the statement (level 2),
and agree with the statement (level 3). Odds ratios are followed by 95% confidence intervals in square brackets.
Significance levels: * p< 0.05, ** p< 0.01.
3.3. Factors Associated with High Sugary Beverage Intake
In general, 38% of the sample reported an overall child SSB consumption frequency of
four or more times per week (Table 1). High intake frequency was significantly associated
with more frequent restaurant use. Compared with those using restaurants monthly,
caregivers who dined in restaurants weekly were about 49% more likely to report high
SSB intake of their children, while those who dined in restaurants twice or more per week
had twice the likelihood of reporting high child SSB intake (Table 3). The associations
between caregivers’ attitudes toward the two SSB-related statements and their children’s
SSB intake frequency were essentially aligned. High SSB consumption was more likely
to be found among children whose caregivers were neutral or agreed that SSBs were an
important part of family meals, while high consumption was less likely to be reported by
caregivers who stayed neutral or held views that restaurants should not offer SSBs with
children’s meals (Table 3). Regarding the sociodemographic characteristics, caregivers with
the highest education level (bachelor’s degree or higher) were less likely to report high SSB
intake among their children compared with those with the lowest education level (high
school or less) (Table 3).
Nutrients 2025,17, 799 7 of 10
Table 3. Factors associated with high children’s sugar-sweetened beverage intake frequency
(4+/week).
Child High SSB Intake (4+/week)
Covariates Adjusted ORs [95% CI]
Caregiver gender
Non-Female REF
Female 1.325 [0.956, 1.838]
Caregiver race
White REF
Black 1.045 [0.757, 1.442]
Other/Multiracial 0.999 [0.628, 1.589]
Caregiver educational attainment
High school or less REF
Some college 0.926 [0.655, 1.308]
Bachelor’s degree or higher 0.584 ** [0.400, 0.854]
Annual household income
≤USD 49,999 REF
≥USD 50,000 0.824 [0.598, 1.134]
Restaurant use frequency
Monthly (≤2 month) REF
1/week 1.494 * [1.058, 2.109]
≥2/week 2.001 ** [1.433, 2.795]
Caregiver level of agreement: “SSBs are an
important part of family meals”
Disagree REF
Neutral 1.956 ** [1.428, 2.679]
Agree 1.670 ** [1.139, 2.448]
Caregiver level of agreement: “Restaurants should
not offer SSBs with children’s meals”
Disagree REF
Neutral 0.426 ** [0.312, 0.582]
Agree 0.312 ** [0.212, 0.460]
n 975
Abbreviations: OR: odds ratios for adjusted (multivariate) model; CI: confidence intervals for OR; REF, reference,
which denotes the reference category of the regression estimates for categorical variables; SSB, sugar-sweetened
beverage. Note: Significance levels: * p< 0.05, ** p< 0.01
4. Discussion
High child SSB intake frequency (4+ times a week) was reported by 38.1% of care-
givers of children between the ages of 2–12 included in the study. This is higher than
what has been reported in a previous analysis of the 2021 National Survey of Children’s
Health where high intake was found among 21% of respondents. However, the National
Survey included younger children (1–5 years old) in their sample, and older children
in that sample (4 and 5-year-olds) showed higher intake frequencies (27.7% and 25.6%,
respectively) [
26
]. High SSB intake was significantly associated with parental education.
This association has been documented in previous research [
26
,
28
,
29
]. While past research
has documented greater overall frequency of SSB consumption among Black and Hispanic
families, compared to Non-Hispanic White, this study found no significant association
between child SSB intake frequency and race/ethnicity [
26
,
29
]. This may be the result of
our sample distribution, where more than half of the caregivers self-identified as White,
but an additional explanation may be the context of our work. Louisiana is among the
states with the highest SSB intake in the country, where 68% of adults consume at least
one SSB per day [
30
]. The southern US region presents the highest proportions of adults
that consume SSBs on a daily basis [
31
], a trend that concurs with the region’s historical
Nutrients 2025,17, 799 8 of 10
preference for sweet and soft drinks, with many of today’s leading beverage brands tracing
their roots back to the region [21].
Our findings concerning the positive association between child SSB intake frequency
and restaurant use concur with past research [
11
,
14
]. We found that restaurant use with
children was significantly associated with income and gender, that is, lower use was found
among respondents with lower income and self-identifying as female. Research examining
gender and feeding behaviors has shown that fathers tended to eat out more when feeding
their children, and such eating occasions were significantly and positively associated with
SSB consumption [
20
]. While gender was not significantly associated with overall child
SSB intake frequency in this study, future research may examine differences in beverage
choice and amount within restaurant meals to explore this association further.
Our study also underscored the importance of social norms concerning SSBs in family
meals and restaurant meals, which supports what past research has shown. Woo Baidal
et al. reported that negative attitudes toward SSBs were associated with lower consumption,
and these associations remained after adjusting for age and race/ethnicity [
19
]. While
our results showed no significant associations in child SSB intake frequency by caregiver
race/ethnicity, caregivers identifying as Black were more likely to perceive SSBs as impor-
tant parts of family meals. This perception was also associated independently with lower
educational attainment.
A higher percentage of our sample disagreed with the statement that restaurants
should not offer SSBs with children’s meals—a factor potentially hinting at resistance
towards restaurant/business regulations, such as the requirement for restaurants to offer
healthy beverages as the default choice with these meals. While some past work has
documented positive attitudes towards policies that promote healthier choices in restau-
rants, these were documented among restaurant-initiated changes, such as the voluntarily
adopted LiveWell initiative [
32
]. USA-based research examining public attitudes about
healthy eating policies documents how this issue is seen as one of personal responsibility,
and this view is linked to opposition to government regulation [33].
While our study contributes to the growing research on the influence of restaurant
meals on children’s dietary quality, in an under-researched population, our results inter-
pretation must account for some limitations. First, our sample is not representative of
the broader population in the state or region. It specifically focused on caregivers who
report eating at restaurants at least once a month and was limited to participants from the
two largest cities in the state. Results may be different from caregivers with less frequent
restaurant use or living in less urban settings. Consideration should also be given to inher-
ent limitations of self-report and recall bias, which may lead to over- or under-reporting
SSB consumption and restaurant use. While our results largely concur with past research,
future work can address the association between restaurant use and SSB intake among
children in more rural settings, with a lower density of restaurants. Our study did not
capture interpersonal variables that may influence SSB frequencies, including children’s
pestering behavior and exposure to marketing [
17
]. Past research has also shown that SSB
frequency varies by child age and gender, and parental age [
17
,
26
,
29
], which are variables
not addressed in the current analysis.
5. Conclusions
This research focused on an understudied population in a region with one of the highest
SSB intakes in the USA. The results have the potential to support the implementation of
restaurant-based policies to address SSB consumption, including a recently implemented
healthy default beverage ordinance in New Orleans, LA, USA. This policy requires restaurants
to offer healthy default beverages (water, low or non-fat milk, 100% juice) with children’s
Nutrients 2025,17, 799 9 of 10
meals [
34
], with the possibility to tackle children’s SSB consumption in restaurants. Policies
like this may have the potential to facilitate healthier choices and change social norms around
child beverage consumption. At the same time, our work also underscores the need to
independently address social norms, through public education campaigns, since they clearly
influence SSB consumption, and may do so even in the presence of regulations that require
restaurants to offer healthier default options for children’s meals.
Author Contributions: M.F. and M.K. led the study conceptualization and survey design, oversaw
the data collection and analysis, and secured funding. M.F. led the manuscript writing effort. Y.W.
conducted the statistical analysis and drafted the results section. C.S. supervised and advised on
the analysis procedures and results presentation. D.R. contributed to the survey design. L.P.H. and
A.P. assisted with the manuscript editing and formatting. All authors contributed to the manuscript
revisions and editing. All authors have read and agreed to the published version of the manuscript.
Funding: The research was supported by the following funding sources: Tulane University Institu-
tional Funds; the National Institutes of Health (grant number 5U54MD007595-17); and additional
support for M.F. provided by NIH-NHLBI (grant number 1K01HL147882). The funders had no role
in the design, analysis or writing of this article.
Institutional Review Board Statement: All procedures involving research study participants were
approved 2 May 2024 by the Xavier University of Louisiana Office of Research and Sponsored
Programs (Study #894).
Informed Consent Statement: Written informed consent was obtained from all subjects.
Data Availability Statement: The original contributions presented in this study are included in the
article. Further inquiries can be directed to the corresponding author.
Acknowledgments: The authors wish to thank Hannah Smith for her assistance with the survey
development and preliminary analysis and Emily Dimond for background research.
Conflicts of Interest: The authors declare no conflicts of interest.
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