Off the Quill 2020-2021

OFF THE QUILL 

HONORS RESEARCH AND 

CREATIVE ARTS JOURNAL 

VOLUME 16 

2020-2021 EDITION 

OFFICE OF HONORS PROGRAMS 

TEXAS WOMAN’S UNIVERSITY

CONTRIBUTORS 

Cover art: 

Girl on Fire 

Katelyn Garst 

Publication Secretary: 

Alyssa Lumsden 

Judges: 

Amanda Greenwood 

Anna Whitaker 

Alyssa Lumsden 

Isabelle Kenneke 

Joanna Simmons 

Marjorie Lim

TABLE OF CONTENTS 

CREATIVE Pages 1-39 

Abandoned Barn 

Olivia Brookshire 

Butterflies 


Colorado 


Distance 


Hidden Cave 


Spring Bees 


Sunset Feels 


Reflections 

Blair Baumann 

Cobalt 

Katelyn Garst 

Colorado Waterfall 

Anna Hammond 

It’s a Florida Orange Sunrise 

Anna Hammond

Looking Back 

Anna Hammond 

Ribbon of Water 

Anna Hammond 

Thriving in Hard Places 

Anna Hammond 

Pink Sunset 

Emma Lane 

Through the Window 

Emma Lane 

Yin and Yang 

Emma Lane 

Girl in the Blue Hat 

Alexandra Mack 

Spiraling 


Roses & Time 

Addison Stone 

Hilltop Embers 

Victoria Wilburn 

Hilltop Embers No. 2 


Lighthouse Eyes 

Sophia Vignovich

The Start of Forever 


The Girl Who Controlled Emotion 

Jianna Covarelli 

Be The $100 Tip 

Jenna Seachman 

When You Want to Be a Masterpiece But Instead You’re A Disasterpiece 


Outstanding Creative Submission Pages 38-39 

9:48pm Central Time 


POETRY Pages 40-57 

Immigration Healthcare 

Shachar Albalancy, Angel Rivera Rojas, SaraYoon 

The Lions 

Ryan Atbin 

Devil’s Water 

Katelyn Garst 

COVID in College 

Abbey Harrison 

06-21-18 

Emma Lane 

A Year to Remember 

Emma Lane

i’d like to be alone again 

Marjorie Lim 

Divine Design 

Cambria Washington 

Skin 

Dana Willis 

Outstanding Freshman/Sophomore Submission Pages 55-56 

Cambiat 

Christian Fulenwider 

Outstanding Junior/Senior Submission Page 57 

Blueberry Pie 

Amber Gaudet 

RESEARCH Pages 58-209 

The Social Effects of Menopause on Perimenopausal and 

Postmenopausal Women 

Shachar Albalancy 

Race Relations at Texas Woman’s University 

Kathryn Fazi 

New media, New Journalism: How literary techniques in The New 

Yorker’s ‘Vivian Gornick is Rereading Everyone, Including Herself’ are 

heightened in digital spaces 

Amber Gaudet 

Sula, The Holy Bible, and Literary Trauma 

Emily Gentry 

Letter Knowledge: Effective Pedagogical Practices for Implementation in 

the Classroom 

Regan Goodchild

Sex Work in a Digital World 

Caitlin Guest 

Survey of the Nutrition Counseling and Dietitian Referral Practices of 

Pediatricians in the Dallas-Fort-Worth Area 

Brandon Kelley 

The Relationship between Vegetarian Diets and Eating Disorders: Does 

It Exist? A Systematic Review 

Amanda Putnam 

Exploring the Relationship between Violent Video Games and 

Aggression 

Katheryne Ricardo 

Fostering Creativity in Children 

Yelena Sorensen 

Brainstem Research 

Haley Tate 

Chair Yoga 

Haley Tate 

The Sound of Silence: A Look Into Noise-Induced Hearing Loss 

Rhea Tibrewal 

Cultural Expression Through the Haka Dance 

Analisa Trevino-Contreras 

Coronavirus and Climate Change: An Analysis 

Anna Whitaker 

Sarah McIntire Award for Pages 193-209 

Outstanding Capstone 2020 

Vesicular proteins associated with HDAC8-H1.3 novel protein complex 

in MCF-7 breast adenocarcinoma cells 

Elizabeth Meza

CREATIVE 

1

Abandoned Barn 


2

Butterflies 


3

4 

Colorado 

Olivia Brookshire

5 

Distance 

Olivia Brookshire

6 

Hidden Cave 

Olivia Brookshire

7 

Spring Bees 

Olivia Brookshire

8 

Sunset Feels 

Olivia Brookshire

Reflections 

Blair Baumann 

9

Cobalt 

Katelyn Garst 

10

Colorado Waterfall 

Anna Hammond 

11

It’s a Florida Orange Sunrise 

Anna Hammond 

12

13 

Looking Back 

Anna Hammond

14 

Ribbon of Water 

Anna Hammond

Thriving in Hard Places 

Anna Hammond 

15

Pink Sunset 

Emma Lane 

16

Through the Window 

Emma Lane 

17

Yin and Yang 

Emma Lane 

18

Girl in the Blue Hat 


19

Spiraling 


20

21 

Roses & Time 

Addison Stone

Hilltop Embers 


22

Hilltop Embers No. 2 


23

Lighthouse Eyes 

Sophia Vignovich 

24

25 

The Start of Forever 

Victoria Wilburn

The Girl Who Controlled Emotion: A Modern Myth 

Jianna Covarelli 

To all who feel 

I had often walked the streets alone. Loneliness never 

being something I felt. Okay, not something I felt often. 

Shadows of the trees’ bare limbs danced as moonlight 

trickled down upon the pavement. The array of plants along the 

sidewalk whose flower petals are all closed up for the chilly 

night. Monotonous shops’ signs turned “closed” door after 

door. I now stand at the window in my Albany apartment, 

looking at the world I ran away from. I am alone in a city that I 

have become numb to. It has been this way since my Aunt’s 

dog died last month--the last part of my Aunt that held any 

form of life. She had found Trix on the streets as an abandoned 

pup--she had a habit of taking things in. It was the same week I 

went to live with her. That week was 17 years ago, today. 

Today is also my 21st birthday. 

My Aunt had been 43 when she took me in, and six 

months ago the world took her the same way it took my 

parents. She had been driving to the family home in the hills on 

her 60th birthday. Supposedly, the “brakes failed and the car 

went over the side of the curved cliff, but no car or body was 

found.” The same wording as for the accident that took my 

parents. There are now two separate sets of mysterious tire 

tracks on that curve. 

So I’ve hidden myself from the world and all of its 

emotions, because something happened the day of her funeral. 

This something had happened before, but never on the same 

scale. I never asked my Aunt about it while she was alive. I 

regret that decision now. Sometimes I felt I had been given a 

gift--other times it felt more like a curse. This cursed gift 

entangled me with others’ emotions, so I hid from the world 

and all of its feelings. 

It happened 5 months ago, after the funeral. The 

ceremony was perfect for my Aunt: beautiful, uplifting, set on 

the beach...but then there was the family-only reception. All 

26

masks came off of the high and lofty Reyes family at the 

reception. Being the only single member of the family, I arrived 

first. The others dropped their kids off with nannies and my 

grandparents bickered about where they parked the car. The 

house was calm, a gentle coastal breeze ruffled the curtains of 

open windows: the atmosphere was peaceful. I was able to sit 

in my calm thoughts and accept the death of my Aunt. That was 

until each member of the family arrived, and my lightness of 

spirit was slowly attacked. 

The first to arrive, and thus the first masks to fall, were 

my Grandparents: my father and aunt’s parents. My 

Grandmother disappeared into one of the back bedrooms, her 

sobs echoing down the hall. Giving no notice to me, my 

Grandfather walked to the drink cart and poured himself a 

scotch. Ten minutes of gut wrenching sobs and 3 scotches later, 

my other Aunts and Uncles arrived in a whirlwind: one aunt 

was seething, another sank into the sofa as she was spiraling 

into a deep melancholy, while the three uncles joined my 

grandfather for a drink: 2 scotch and a whisky. My 

Grandmother’s violent sobs still echoed from the bedroom. 

I stood in the adjoining dining room--observing. The rich 

colors, leather chairs, and nairy a throw pillow in sight reeked 

of money; I stared at myself in the mirror wall with lattice 

woodwork--where in this mess of money did I fit? 

“They weren’t even true Reyes! Do we really wonder 

why they are dead?” my seething Aunt announced. 

“Your brother and sister were members of this family 

long before you were, so sit down Narcissa!” my Grandfather’s 

voice roared, with moments of slurring, “though they come 

from Homeland, and not of our blood matters not--they were 

Reyes through and through.” 

“Thank you, Grandfather,” I spoke up, but instantly 

regretted it. 

“OH!” frightened my Grandfather spilled his scotch (by 

now I’ve lost count), “Girl! When did you arrive?” 

“Before you and Grandmother,” seeing the multitude of 

expressions dance across his face, I sensed that was a wrong 

27

answer. Yearning to clep out of the conversation, I backed up 

bumping into a dining chair. Huffing, my Grandfather shook 

his head and turned his back to me. 

I stayed in the adjoining room, alone. A wave 

washed over me. Emotions, pains I have no way of describing; 

nor had I ever experienced the depth of these feelings before. I 

attempted to pull out the chair next to me, right before I 

blacked out. My mind was dark, but my sight distorted-- 

thoughts that were not mine floated through my head like 

colors. Heartbreak screamed at me in crimson, bitterness and 

insufficiency roared with a twinges of green, denial bit at me in 

shades of burnt orange, and a purple so black washed over it all 

as despair dragged me down a road towards guilt, resentment 

and hatred. I battled each with my own conscience, completely 

unaware of where this had come from. 

My mind finally awoke, and I felt myself once more; I 

opened my eyes to find my Aunt had gotten up off the couch 

and my head now lay in her lap, her husband standing over her. 

As I looked around, I found the entire family watching me, 

including my Grandmother, but the atmosphere was not the 

same: the intense emotions were gone, and horror showed on 

their faces. Panicked, I stood. Swaying, I grasped the back of 

the chair I had attempted to pull out. 

“Careful!” my Aunt called looking up from where I left 

her on the floor, “you were out for a while.” 

My uncle stretched out a hand to steady me, but I shook 

my head. Doing so I caught a glance of myself in the mirror 

across the room. Instantly, my body went rigid in horror as 

well. My hands flew to my face, hot tears streaming down, as I 

stumbled to the bathroom and locked the door behind me. I 

hesitated to look up at my own reflection, and when I did--I 

wished I hadn’t. I had lines of stress and crinkles from anguish; 

I had streaks of grey in my hair--which was wild and untamed 

as if I had been running my hands through it. My eyes were 

puffy and bloodshot. I was 20 years old, yet my body looked 

like a 70 year old who had the weight of the world on her back. 

My mind went back to the serenity of the family when I woke. 

28

My Grandmother: calm, no more relentless sobs, not even 

bloodshot eyes; the sober eyes of my Grandfather and Uncles; 

and my Aunts at peace. 

My body shook as I grasped the sink, knuckles white. I 

tried scrubbing my face only to look up, water dripping off my 

chin, and see I was melting. Well, not melting per se, more like 

molting--the grey hair was falling out, and a layer of my skin 

was peeling off my face. 

There was a knock on the door, just before I heard the 

concerned voice of one of my Aunts, “You okay in there?” 

“Go away!” my rage surprised myself, “You never 

accepted me or my family as a Reyes anyhow!” 

I sat sobbing until I heard raised voices from the living 

room, I cracked open the bathroom door just as a vase came 

soaring through the air, colliding with the wall right next to my 

head. I slammed the door shut and slid my back down it. 

That is why I resorted to isolation; this is my tale--a 

mystery. Mystery that is until today when I received my Aunt’s 

letter: 

Ancora, 

I should tell you in person, but circumstances sometimes 

force your hand. In following tradition you wouldn’t find out 

until your 21st birthday; however, I do not know if I will be 

here to see that day. I will just come out with it. 

Your father and I are the last of the long line of Yelelns-- 

the family name--that is, until you came along. Our parents, 

your true grandparents, brought peace to the war torn nations, 

but that made enemies. Those who fed off of the destruction 

caused by war swore to destroy us. You see, the family has a 

gift; our last name is an anagram for Elnyel, latin for “absorb”. 

We cultivate our gift to decrease the emotions of discord 

among people, and insert those of harmony. I warn you now, 

with this comes the power for the opposite: you will also be 

able to create discord and form wedges between peoples. 

Honing your craft will take time, but it will eventually come 

when you learn peace on your own, my dear. You cannot give 

29

others what you yourself do not have. 

Yelelns have existed for as long as there has been strife, 

and for that same amount of time we have been long hated by 

our opposers, the Vigextiums--another anagram for: viget in 

exitium, again latin for “thrives on destruction”. 

We come from a place only known as “Homeland”, as 

did all mortals. The journey made after creation decided fate on 

this realm, and our original ancestors excelled in empathetic 

encouragement and guidance of those journeying with them; 

meanwhile, the Vigextiums thrived on those who, well, those 

who could not endure the journey. The Designer saw those of 

us (more than just our two families) who had any kind of an 

effect on the other mortals, and marked us. We were given a 

layout of how we were the guardians of this realm and told that 

we were to maintain balance. 

Well, 3 generations back, the Vigextiums did not take the 

defeat of Germany and the Axis powers so well, and there has 

been war between our families ever since. Yelelins’ natural 

gifting being for peace drove us into hiding, eventually leading 

to the overrun of the Vigextiums. Their bloodline became so 

twisted we no longer know mortal from Vigextium. Quickly, 

our hiding places would be discovered and our people perished 

at the hands of the Vigextiums; our parents, your grandparents, 

found a passage from this realm and into the next in a void just 

over the cliff in the hills, the void only permits those marked by 

The Designer to pass through. 

Ancora, your father named you that with purpose. You 

quite literally are this realm’s final hope in balance. Protect 

yourself. 

Much love my dear niece, 

Aunt Adjúta 

I never asked for this, yet, ironically, I feel this was to be my 

path all along. 

30

Be the $100 Tip 


During the Christmas season, we get a handful of crazygenerous 

tippers at Olive Garden — the restaurant where I 

waitress. It seems like every day at least 1 waiter gets a $100 

tip. In fact, just last week someone left $300 for their server. 

After a brief round of applause for those ballers, I gotta 

say this has taught me something. 

The more I heard these happy waiter stories, the more I’d 

think, “Where’s my crazy-generous tip?? When am I hitting it 

rich?” 

On Christmas Eve, my hopes for an epic payout were at 

the forefront of my mind. So I almost got tears in my eyes 

when one guy spent $50... and left me $2.50. And honestly? 

The rest of the night was more of the same. 

Until my second-to-last table. 

It was a sweet family of four. When I offered to bring togo 

boxes, they asked if they could take their salad home. 

“We just love it!” The mom told me. 

“Hmm,” I said, looking down at the lettuce and 

croutons that were damp with dressing, yet they still wanted to 

take because they liked it so much. 

“I think it’s gonna be a good Christmas for you guys,” I 

said, in a conspiring tone. “I’ll be right back.” 

When I came back with two fresh, full-sized salads I’d 

packaged to-go, their eyes lit up and they were so happy. The 

mom told me their entire Christmas dinner menu, happily 

adding how the salad would fit perfectly. (And this fam doesn’t 

play, it was a legit five-course meal.) 

And I realized how often I miss opportunities to bless 

others, because I’m waiting for what other people can give me. 

I didn’t get outstanding money from that family; instead I 

received something better. 

I’d gotten to give them something they hadn’t expected 

that had blessed them a lot. 

31

My takeaway life motto here? Instead of waiting for your $100 

tip... 

Be the $100 tip. 

Be the one who makes that unexpected gesture of 

kindness that turns someone’s day upside down — 

Rather than waiting for it to happen to you. 

Because while I needed people to set examples of 

kindness when I was a kid, so I’d learn to show kindness to 

someone else, I’m an adult now. And it’s time for me to do the 

inspiring. 

32

When You Want to Be a Masterpiece but Instead You’re A 

Disasterpiece 


You know those pictures you look back on after a glowup? 

Where you think, “Man. I was ugly.” You’re not insulting 

yourself; you’re just stating a fact. You probably don’t even 

resent that those pictures were taken, because hey, now you 

have a souvenir from the past. 

These kinds of photos are easy to spot. They feature illfitting 

clothes that either you picked out (against the advice of a 

good-intentioned parent) or were forced to wear (by a goodintentioned 

parent). There’s usually some kind of hair disaster; 

let your imagination run wild on that one. And you probably 

haven’t fully grown into your limbs yet, so the art of posing is 

still under development. Add an awkward smile, and boom: 

you have what I call a pre-glow-up photo. 

For most of us, the hope is that we leave these photos 

behind in our teens. 

So it’s kind of demoralizing when you take one in your 

twenties. 

The other day, while looking back at the photoshoot of 

my 21-year-old self, I was forced to confront the undeniable 

truth. 

These are pre glow-up photos. 

My other fear is that they’re actually not, and this is as 

good as it gets, but dear God, let us not descend into that realm 

of horror. 

To set the record straight, before I give you the 

backstory: 

My photographer did a wonderful job. This disasterpiece 

was no one’s fault but mine. 

I was the one who picked my outfit, in what is best 

described as a fit of rebellion. I’d never worn such a short, 

skintight dress, but I was tired of seeing everyone else get to 

wear what they wanted, while I had to abide by the more 

conservative rules of my household. I looked like a teenager 

33

loosed on her mother’s wardrobe, if her mom was into the bar 

scene. I am also a ginger who chose to ignore the fact that my 

hair would go into Merida mode the second I went outside. 

You may be wondering, if the rules of my household are 

that strict (which they’re really not; I am a drama queen) — 

how did I escape with that dress in the first place? Well. Strap 

in for this one. 

I’d gone shopping to prepare for the session. After 

discovering the dress in question, then having the kind of mild 

existential crisis that would motivate this type of purchase, I 

bought it and stashed it at home. I kept the overlarge shopping 

bag: it was the perfect size to double as a mobster briefcase. 

And in the predawn hours before my sunrise photoshoot, this is 

exactly what I used it for. On the surface: casual stuff, like my 

purse, extra coat, and change of shoes. Nothing to see here. But 

secretly, squirreled away inside the coat, was the contraband. 

Looking back on this, I’m almost like, where was this 

inner deviant hiding all this time? 

I hardly ever broke the rules. But now, my life felt like 

the classic Batman monologue: either you die a hero, or you 

live long enough to see yourself become the villain. At a ripe 21 

years of age, I had lived long enough to see myself sneak a 

stripper dress out of the house. 

Lastly, I slung three sweaters over my shoulder. I did not 

plan on wearing them; this was a distraction tactic. 

I knew from experience that my sweet mom would be 

awake, which she was; and that she’d want to inspect what I 

was bringing, which she did. To be clear, this was because she 

cared, and wanted to make sure I had enough snacks and warm 

layers. She also helped me revise this piece, after a very 

interesting conversation. I hope she knows that she is amazing 

for tolerating who I am as a person. 

I got in the car, then drove to the park my friend had 

chosen. As I approached, I was astounded: I hadn’t expected so 

many trees, or the giant exercise facility fronting the grounds. 

The place was like a freakin’ resort. 

I’d left the house in jeans and a jacket. After parking 

34

where I thought no one would see me, I took off my jacket and 

pulled my maroon dress over my head. Then I got out of the 

car, intending to pull off my jeans while pulling my dress over 

my butt in one fell swoop. Except that wasn’t gonna work, 

because this dress was not only skintight, but also not my size. 

As my friend approached, I asked her to turn around; then, 

casting a frantic glance to make sure no one was watching, I 

rapidly yanked off my pants and then shimmied the dress 

down. Hopefully I didn’t flash anybody on the way to their 

morning elliptical. 

And then we started walking. My friend would ask me, 

several times, how the heck I wasn’t freezing to death. It was 

50 degrees outside. I kept telling her I was fine, and that cross 

country had trained me to tolerate inclement weather. 

The real reason I survived the cold? That’s because 90% 

of the time, I’m an authority-pleasing rule-follower. So the fact 

that I’d successfully snuck out with this dress made me so 

hopped up on adrenaline, I was practically vibrating. The dress 

literally made me feel hot; just not the way I’d expected when I 

looked at myself in the fitting room mirror days before. 

And so we marched towards our destination, the wheat 

fields. To get there, we had to pass by this majestic mirror lake. 

We snapped a few pictures in front of the water, or at least we 

tried to, until my friend deemed the lighting too dark. 

But in real life, the scene was beautiful. The sun was just 

coming up. Steam rose off the cooling waters, creeping up the 

edges of the lakeside. Fingers of mist ran themselves through 

beams of sunlight as if through golden hair. As a runner jogged 

by, her clouds of breath caught the light and cradled it, leaving 

a trail like hazy fireflies. And the lake mirrored the rising sun 

perfectly. With the mist scuttling over it, like a slow-moving 

cloud, it could have been an inverted sky. As we enjoyed the 

view, hot air balloons spontaneously emerged from the trees, 

their doubles cast in the reflection. 

At first, when we reached the wheat fields, I thought they 

were covered in frost. Yet what looked like frost from afar was 

actually dew, reflecting the blue sky so clearly it looked like 

35

ice. The grass was waist height, and I dove right in, because 

how many times does one get to walk through a giant wheat 

field and get covered in dew? 

By the end of the shoot, my legs were covered in bits of 

grass and leaves — and soaked in freezing water. They felt like 

blocks of ice. I wondered, deliriously, how I’d made it through 

an hour in the cold in this outfit. 

Maybe I put myself through it because there was a lot 

riding on this photoshoot — at least, I thought so at the time. 

Recently, a guy had DM’d me saying that my friend, who’d 

appeared on my stories, was beautiful, and that he wanted to go 

out with her. Mostly, I was happy for her. But this guy had 

known me for a long time. He had seen all my pictures, yet 

never once had he expressed the same thoughts about me. Part 

of me felt like a loser. 

Just once, I didn’t want to feel like the accessory friend. I 

wanted to look good enough to feel like I mattered. 

I’d worried, at the start of the shoot, if this mindset would 

ruin the experience. Would I spend the whole time agonizing 

over whether we’d gotten good pictures, and forget to enjoy 

myself? 

Luckily, I had a great time. I even enjoyed the coldweather 

endurance stunt, because it reminded me of cross 

country. And it made the memory more visceral, so that when I 

think of those awesome views, I remember what it felt like to 

be there. 

I’m pretty sure my wardrobe choices, as well as my hair 

and makeup routine, are still en route to a glow up. (Not that 

you need those things to be pretty.) But I’m glad that my 

mentality was already in the right place. Despite my fears, I 

knew the best strategy was letting go of expectations and just 

having fun. And that’s a great reminder for me. It’s easy to 

believe that how good you look is what makes you matter — 

and that therefore, half the purpose of a social outing is to take 

good pictures. I still catch myself thinking, well yeah. If I don’t 

have a portfolio of photos on Instagram showing the world how 

attractive I am, how else will guys decide that they like me? 

36

This ideology is horrible, on so many levels, yet subversively 

tempting to believe. 

I hope that one day, all of me — not just part of me — 

stops believing that. 

Because frankly, there’s a little voice in my head that 

says this is the only real glow up that needs to happen. 

(Quick comment, by the way: remember those photos we took 

at the lake? Which we thought would get scrapped because the 

lighting was bad? They turned out to be the most amazing 

pictures I’ve ever seen. And I’m barely even in them — just a 

silhouette in the foreground. Which is pretty funny, when you 

think about it.) 

37

Outstanding Creative Submission 

9:48 pm, Central Time. 


At night, the hills and sand traps of our neighborhood golf 

course are cast in black. They look like the rumpled, unmade 

sheets of some giant creature’s bed. And once the sun sets, the 

sprinklers switch on, their rhythmic rotations like the dancing 

figure in an old music box. 

Nowadays, I’m usually too distracted to make these 

observations. I get sucked into work, school, and — sometimes 

while at work and school — my phone. 

Maybe that’s why moments like this one are so memorable, I 

remember exactly what time it happened. 

9:48, that is. I’d just gotten home from work. My hair was wet 

from showering, and I had mascara stains like thumbprints 

stamped under my eyes. And yet, when my dog wanted to go 

outside, I felt compelled to follow him. 

I walked into the temperate darkness, the curtains parting to 

an invisible orchestra. The sprinklers were a hissing veil of noise, 

softening the chirps of crickets and frogs. Out of nowhere, I felt 

this need to experience it all — the sound, the view, and whatever 

else that 9:48 pm had to offer. Almost like life itself was a 

member of foreign royalty receiving me for dinner. If I didn’t try 

every dish on the table, I’d risk disrespecting my host. 

Which kind of fits, because another way I could describe this 

feeling was that my senses were hungry. I wanted to cross my 

yard, open the gate, and run under the sprinklers; and I wanted to 

feel the short, prickly grass that had given me friction burns when 

I was a kid, rolling down the hills for fun. 

I blinked out at the golf course, to the protest of my dry 

contacts, and contemplated whether my parents would think I was 

crazy. But — was that rain splatter I heard? 

The sprinklers were truly giant, and their peaks diffused into 

the night, so I couldn’t tell how far they reached. But judging by 

the noise, the nearest one was passing over my neighbors’ 

backyard. 

38

And then, the thudthudthud of the sprinkler hitting our 

wooden fence, getting closer. I stepped off the porch and onto the 

grass, giggling like a child as the tiny, secret trespassers showered 

over me. The droplets made the night colder, but I just laughed. 

Past the hills, the horizon was slightly lighter than the rest of 

the sky, like a blush that only reddens the tips of your ears. Maybe 

the light came from the city; or maybe it was the last trace of the 

sunset. Actually, I like the second explanation better. Then the sky 

could be blushing with flattered anticipation, like when a guy says 

this date was great, are you free tomorrow? With one last look 

into the night, I wanted to say some version of the same thing. 

When I went inside, I was almost sad. The human memory 

can’t hold everything, and it doesn’t prioritize moments like this. 

Soon, I’d forget this snapshot in time, and a tiny part of me 

lamented the loss. It probably doesn’t make sense — like skipping 

a rock across a lake, then looking down at the millions of other 

rocks beneath your feet, and missing the one you skipped. Or 

maybe that’s not so crazy. There might be a million more rocks, 

but they still aren’t infinite. Maybe that’s why I needed to 

experience 9:48 pm for all it had to offer. I had a lot of 9:48 pm’s 

left, but not an infinite number of them. 

This would all sound poetic if I ended there (which kind of 

makes me cringe. Poetic is usually overrated to me. I’d rather read 

stories that sound like they’re just the transcribed audio of normal 

people, telling you about their lives while untucking their work 

clothes and leafing through the fridge.) 

Anyway — I’ll sacrifice the mystical resonance to add one last 

thing. What put me in an observant state of mind, that day, was 

the fact that I’d been reading more books and spending less time 

on social media. A real shocker, I know. But I think this serves as 

a helpful reminder for me — that constant distraction dulls my 

sense of wonder. If I’m always thinking about work and school, 

and I spend heaps of time on social media, I’m unobservant and 

unintentional with my life. It’s insane, how often I forget that. 

39

POETRY 

40

Immigration Healthcare 

Shachar Albalancy, Angel Rivera Rojas, Sara Yoon 

This song was written as a project for the Music in 

Therapy I class with Dr. Lauren DiMaio. Angel, Sara and I 

were tasked with writing a song that depicts the effect of 

immigration on healthcare. The three of us have each 

experience with immigration: Angel and I are both immigrants 

and Sara is a first generation American of immigrant parents. 

Each of us wrote a verse detailing our personal experiences 

with the medical world as immigrants. 

The heavier lyrics are contrasted by a lighter melody and 

chord progression. We did this so the stark reality of the words 

is “easier to swallow”. The melody is catchy, leaving the song 

in the listener’s ear long after they have finished listening to it. 

We hoped that this would cause the listener to reflect on what 

their experiences are in the medical worlds - whether or not 

they are immigrants. Use the QR code to listen along. 

Chorus: 

What’s it like to have a yearly check up 

What’s it like to know your doctor by name 

Haven’t stepped foot in a clinic in years 

Suck up my pain and my tears 

And my tooth aches? Oh what a shame 

Verse 1: Sara 

I’m a model minority, as you can see 

Lost in translation, my family and me 

Back home it was cheaper, 

But the States, bills are steeper 

Health insurance, no guarantee 

Chorus: 





41


Verse 2: Shachar 

My name looks strange and different on the page; 

It feels like no one can say it right. 

Doctors make me feel like a stranger, 

And if I was in any danger 

They would help me because I look white 

Chorus: 






Verse 3: Angel 

They say everyone is guarantees good care 

But without money it's just not fair 

They don't tell the fine print 

They say good luck on the 

Other side here’s a free mint 

Chorus: 






42

The Lions 

Ryan Atbin 

“Until lions write books, history will always glorify the hunter” 

- South African Proverb. 

When I was little, 

My home was full. 

Traditions, culture, and memories, 

They all flowed free. 

Now I am older, 

My home is lost. 

Our land was taken over, 

Our savagery all gone. 

Those people came, 

Their idea was simple. 

Everyone was equal. 

Once everyone was the same. 

Our history disappeared, 

As it was not theirs. 

But I remember, 

And I wish they had cared. 

43

Devil’s Water 

Katelyn Garst 

Marriage is not a boulder to be moved or eroded over 

time - but marriage is a long, persistent stream of familiarity that 

roars through canyons and gullies... gurgling and still in some 

spots, other times rushing and crashing. 

I asked you to enter my stream, lending a camera and a 

nice view, but you took me by surprise and waded into a cove of 

stillness... naked, lurking, and unafraid. 

You caressed my still, smooth waters with experienced 

hands, and began to splash about when I took pleasure in it. 

You formed rapids out of fantasies – which you retrieved 

ex post facto – and flooded my mind with sensuous suggestions. 

I lapped up your offers and hugged the crevices of your 

vulnerability with enchantment and ease. 

You’re a fisherman who lost sight of his love for fish, 

swooned by the lake and its glassy ideals. Now you cast your 

line in frustration, because the sea doesn’t bite back. 

I, your secret siren, carried you in on a piece of 

driftwood, but these waters are uncharted - and this brackish 

delta, I do not own. 

The view you were looking for is under the surface. Your 

unfortunate plight, though, is that you don’t have gills. 

We both know it, yet we keep kissing and missing and 

wishing you were in my wake. Your underwater screams only 

echo back in your ears - I can’t hear them. You’re losing air fast, 

but you keep grasping, as if for breasts in a warm bed, alone. 

I urge you to pick your head back up and breathe clean 

air before our only touch is on the surface - me carrying your 

lifeless body like guilt... floating down my stream. What I give 

isn’t mine to share. 

44

COVID in College 

Abbey Harrison 

Adapted from Clement Clarke Moore’s ‘Twas the Night Before 

Christmas 

'Twas the week of the coronavirus, 

when all through the campus 

not a creature was stirring, 

Nor bothered to check Canvas 

The students were nestled all snug in their beds, 

while visions of the first spring break danced in their heads. 

More rapid than eagles, the news reports came, 

Rising cases, in nations, by name: 

Italy, France, and Spain, 

Not to mention China, 

When my boyfriend leaned in for a kiss, 

I yelled “Keep your saliva!” 

From the top of the world to the southmost pole, 

Corona reached all continents, 

And the CDC kept a rising toll 

Warnings were hung ‘round TWU with care, 

in hopes that COVID wouldn’t soon be there. 

When in my inbox there arose such a clatter, 

I sprang up to see exactly what was the matter 

Away to my laptop I flew like a flash, 

Tearing open my PC in quite the mad dash. 

Unfortunately school had resumed online... 

My cat reclined across on my desk 

Can you believe I wore pajamas all through this mess?! 

45

The moon on the breast of the new world order 

Gave luster to protesters at the courthouse border, 

Who in their right mind wouldn’t take precaution? 

I asked myself this question in an angry fit 

As I stepped out of my car to retrieve TP, 

I soon felt a breeze upon my lip 

...and I whispered, “Oh S__T!” 

Walking into the store, 

what to my wondering eyes should appear, 

A madhouse devoid of manners although 

Plenty of hand sanitizer stood near. 

“We’re in this together,” grew popular on social media 

As did rise my hyperglycemia 

My throat itched, and I struggled for breath, 

I wondered, could it be? 

I pondered, 

Was it merely an allergy? 

As the leaves turned green and the sun grew hot 

Surely the virus will die off, we thought 

Later as autumn leaves flew, 

We hoped for a vaccine, too. 

And then, from the grapevine, I heard on the street 

the prancing and dancing drops of winter sleet. 

When we social distanced things were seemingly sound 

But up went infections with an unfortunate bound 

“Could you just wear a mask?!” I shouted 

Onto the soapbox I steadily mounted 

46

“It covers your mouth and nose, it circles both ears!” 

I hugged loved ones virtually and 

As the holidays drew near 

I found deeply buried cheer 

(Did I mention it was an election year?) 

What’s the meaning of all this? I pleaded 

It’s not what we asked for, 

But it might be what we needed 

In order to love one another 

In a unique season 

47

06-21-18 

Emma Lane 

There’s a hole in my heart where you used to be 

I keep expecting to hear the pitter patter of your little feet 

Or the clanging of your bowls when you want to eat 

I keep expecting to hear the jingle of your little tag 

Or see you waiting at the door when I put down my bag 

I just want to feel you laying at my feet 

There’s a ghost of you where you used to be 

Towards the end I know I wasn’t always there 

I hate to think that you thought I didn’t care 

48

A Year to Remember 

Emma Lane 

I stand here on this shaky ground 

What day is it? 

There’s no one around 

I used to hate the crowd 

But now I miss the sound 

I see people but they’re out of reach 

Only through a window 

Only through a screen 

But now they’re marching in the streets 

Fighting for something bigger than me 

Black Lives Matter is what they say 

And maybe things will change one day 

I hope that I am alive to see it that way… 

49

i’d like to be alone again 

Marjorie Lim 

i’d like to be alone again. 

but a baby girl gurgles happily as she clutches my bag 

i am sitting in the playroom of the apartment complex 

my mother’s cousin uses in between flights 

from manila to cebu city to zamboanga del sur 

undesirable as company may be at the moment 

fresh from a fault line familial lecture 

it is the only place with remotely accessible WiFi 

and i’m halfway through a beatles song 

so i smile at this curious little creature 

victim of happenstance and vulnerability 

who’s yet to experience object permanence 

her mother, understandably hesitant 

to cater the whims of strangers 

hustles her away from me and my borrowed, 

admittedly ratty dark teal hoodie 

(i wasn’t exactly prioritizing finesse as i retreated) 

my slouched demeanor paints a striking contrast 

to her poised pearlescent accessories 

(they gleam to underscore the effect) 

as she begins an hour long call to her husband, 

and the inane details of their exchange 

become pressingly difficult to ignore 

he is an australian software engineer, 

looking for office space in, i kid you not, dallas 

who is also unforgivably impatient 

evidenced in his dismissal of the baby girl 

just learning to say the word daddy 

she babbles the word repeatedly 

as their conversation crescendos into an argument 

the sour sentiment he utters 

50

after learning his wife isn’t as familiar with instagram 

in comparison to her supposed facebook prowess 

induces a prolonged eye-roll from me 

she mistakes the direction of my pointed annoyance 

perhaps at the volume of their raised voices 

rather than the absurdity of their phrases 

(how can someone stand to be regarded that way?) 

giving me a quick glare in embarrassment, 

she forces her daughter to part with my bag 

(how did she make her way over there again?) 

and dramatically stomps off as the baby cries 

the door still stalling to click shut, cutting off the sound 

(how is that little girl going to grow up?) 

i find myself alone again. 

51

Divine Design 

Cambria Washington 

Didn't you know!? 

Gentlemen, I was created 

From the stars. 

Hand crafted and ordained by 

The Creator Himself. 

Carved from this heavenly body 

And twice bathed in His fervent 

Fire, for that is how I obtain 

My natural glow. And, you see, that 

Fine light and I do go way back. 

I welcome the warmth he basks 

Over my body to convey a love 

Which has transcended time. 

In return, he cascades a 

Radiance over the jewels 

Of my crown illuminating its 

Majesty in his rays. 

You see, I was and always will 

Be. Till my Father calls 

Me home. 

Which is why, kind sirs, 

I was placed in this wasteland. 

Expected to lie in wait 

For my nova to die. 

But little do they know: 

Everything I touch is made 

Alive. Chains cannot hold me. 

Never have never will, for 

My wisdom stretches back 

Over 2000 years. And when 

I turn to freedom within myself, 

I'll take flight. Soaring with 

Seraphs to a land of riches. 

52

But, you see, I was blessed 

With the heart of my Father 

And His power of life was 

Entwined with my design. 

Therefore, these gifts are 

Not my own. My purpose too 

Great for haste made flight. 

So, gentlemen, now you see 

Why I am here and 

The reason behind my 

Divine design. 

53

Skin 

Dana Willis 

Everyday I wake up in this skin 

An inseparable bond is shared between us since birth 

It is inescapable 

It is my protection 

It radiates in the light, 

But the sun can never do it enough justice 

As it inevitably changes, my love for it will stay the same 

Everyday I wake up in this skin, 

And I don’t regret a single second of being in it. 

-written for the purpose of showing how as a black woman, I 

have found joy in the skin that chose me. 

54

Outstanding Freshman/Sophomore Submission 

Cambiat 

Christian Fulenwider 

As I lay my hand upon the grass, 

I feel the soul of the earth, ailing. 

And the menace of man is gross, 

And the light of the sun is failing. 

I reflect on my effect here, 

And I’m proud of where I stand. 

But the dirt beneath my weary feet, 

Has made me who I am. 

I am grateful for the gift of life, 

And the memories I hold. 

Wise in words have I been, 

Beholden young yet old. 

On the cusp of the world, 

I feel the crisp cold breeze. 

And in my heart, I know 

The wind blows for me. 

The sun rises on my right, 

And the sky begins to shine. 

The golden rays shower down, 

I know my life is mine. 

Across the open land I’ve tread, 

I see the towering peaks, 

And the barren moor ahead of me 

Keeps me from what I seek. 

55

In that sunny yet sullen place, 

Looms the thing I fear the most. 

In that bright yet barren place, 

Is a pale and icy ghost. 

There’s a pond by a tree, 

And it freezes in the cold. 

It reflects the light into the night, 

And blunders even the bold. 

I feel the icy hold 

Of my reflection in the water. 

I see my changéd face, 

Afearing of the Father. 

The wind, it howls loud 

As it blows so fast and free. 

It carries the ring of a bell, 

A bell that tolls for me. 

56

Outstanding Junior/Senior Submission 

Blueberry Pie 

Amber Gaudet 

My grandmother was always baking 

I remember hot Georgia afternoons 

Spent plucking plump berries from the bushes in my 

grandparents’ yard 

And delivering them, gritty with brown dirt, 

To my grandma’s kitchen 

Where I would sift them under the cool water before being sent 

out to wait 

with a child’s willful impatience 

For a plate heaped high with cobbler and vanilla bean 

The warm berries ripe with sweetness 

As they ran down my chin 

I visited my grandparents’ house last week 

A ghost lives there now 

She doesn’t bake anymore 

Too shrunken to reach the cherry wood cabinets that held the 

silver sifter, 

the flour jar made of bone white china 

The recipes have all been forgotten 

She can’t even paint anymore 

but she still smiles at me, half remembering 

The girl who stained her Formica counters with sticky fingers 

Her kind hands, soft with age, wrap me in a hug that feels like 

the last 

The branches in the backyard are heavy with another summer’s 

bloom 

Nature making a mockery of our fragile bodies 

Of all the places I imagined life would take me 

Standing in my kitchen, crying over a pie that tastes like my 

childhood 

While I wait for my grandmother to die 

Was not one 

57

RESEARCH 

58

The Social Effects of Menopause on Perimenopausal and 

Postmenopausal Women 

Shachar Albalancy 

Abstract 

In this literature review, the social effects of menopause 

are discussed. Menopause is an event experienced by middle 

age women and signals the end of their reproductive 

years. Menopause is largely seen as only a physical event, 

however this is not entirely true. It can also become an event 

with social repercussions. Menopause affects many 

relationships in a woman’s life, including: spousal, familial, 

and friendship. In addition, menopause can also affect a 

woman’s role in society. This can be defined as a mother or a 

working woman. Additionally, how aging is viewed in society 

plays a large role towards attitudes of menopause. In Western 

culture, aging is largely viewed as disgraceful and the end of 

life. This attitude is even stronger when associated with 

women. The beginning of menopause is heavily associated with 

a woman aging, and is viewed negatively. Menopause has been 

found to have a general negative effect on a woman. Because of 

the social stigma around menopause, women often feel 

ashamed and hide their experiences. This leads to strained 

relationships with significant others, resentment towards female 

friends and mothers for not opening up about their experiences, 

and strain in social status. 

Keywords: menopause, perimenopausal, 

postmenopausal, relationships, social, women 

Introduction 

As women approach their midlife, they begin to face a 

new type of stressor: menopause. According to Rees (2011), 

menopause is the “permanent cessation of menstruation” that 

accompanies the loss of ovarian activity. This loss of activity 

affects a woman’s hormone levels and causes a wide range of 

symptoms. In addition, there is also the distinction of 

perimenopausal and postmenopausal, which are the period 

where the first symptoms of menopause are seen and the date 

59

of the last menstrual period respectively (Rees 2011). While 

menopause is primarily seen as a biological event, it is also a 

psychological and social event. This discussion will primarily 

focus on how menopause affects the social aspects of a 

woman’s life. The social aspects of menopause are defined as 

the relationships a woman has with her spouse, family, and 

friends. In addition, it also includes a woman’s role in society 

and how menopause leads to a change in it. 

Review of Literature 

Menopause and Spousal Relationships 

A key relationship in a woman’s life is the one with her 

significant other. In most articles, a spouse is defined as a 

husband with a large focus on how heterosexual relationships 

are affected by menopause. Due to the hormonal changes that 

occur during menopause, mood changes and irritability may 

develop in women. According to an in-depth interview of 

twenty-one women conducted by Dr. Carolyn Ambler Walter 

in 2000, women felt that their significant others were “critical 

in response” to these changes that occurred. In one case, this 

disapproval even led to the separation of a couple. In addition, 

the husbands have implied that menopause is something their 

wife needs to “control”, according to Dillaway (2008). This 

incorrectly implies that menopause is a disease that a woman 

can control or even treat, instead of a normal process that 

occurs at the end of menses. This sentiment leads menopausal 

women to try to appease their husbands’ ideas of menopause by 

seeking out medical solutions such as hormone therapy 

(Dillaway 2008). In a quote from Dillaway’s interviews (2008) 

of menopausal women, one woman said: 

“[It] was really my family and my boyfriend . . . who 

pushed me towards [HT]. Basically because my 

boyfriend said, you know, "Please quit biting my head off 

and trying to kill me. Please get something done because 

I love you and I want to stay with you." Unfortunately, he 

[felt] the brunt of all this! (laugh) [He said,] "I love you 

honey, but…”. 

60

In the quote above, it is apparent that the woman’s 

menopausal symptoms are seen by her boyfriend as disruptive 

to their relationship. Instead of wanting to understand what his 

girlfriend is experiencing, the significant other is blaming the 

woman for changing. By doing this, the spouse inadvertently 

and perhaps unconsciously defines menopause as “abnormal 

and negative” (Dillaway 2008). 

In addition, menopause is often considered a secret 

between significant others and many spouses were uninterested 

in learning about the condition. The inability for a woman to feel 

that she can be open with her spouse can cause a disconnect, 

leading to a weakened relationship. Most of the women Walter 

questioned did not discuss their journey with menopause with 

their husbands at all. Despite this, many women echoed the 

sentiment that having a partner to face the challenges of 

menopause made it easier to manage the physical changes they 

endured (2000). Some women in both Dillaway’s (2008) and 

Walter’s (2000) interviews reported having supportive spouses. 

One woman explained that her husband was her “hot flash 

coach”, helping her to relax when she experienced them 

(Dillaway 2008). This support was noted as irregular and even 

confusing to some women, as they had not expected their 

husbands to be interested in their menopausal experiences 

(Dillaway 2008). 

Lastly, menopause also impacted the sexual relationship 

between spouses. In a 2015 study of menopausal Taiwanese 

women by Yang et. al, women reported to have less interest in 

sexual intercourse with their partner due to physical symptoms 

such as vaginal dryness. This led to one woman feeling “useless 

and unnecessary” in her marriage, while another woman’s 

vaginal dryness led to her “questioning her role in her husband’s 

life” (Yang et. al 2015). Because of the physical symptoms of 

menopause, the sexual relationship of marriage took a toll. 

Menopause and Familial Relationships 

A common theme that arose in Walter’s interviews was 

the desire for menopausal women to speak with their mothers 

61

about their experiences, whether they were alive at the time of 

the interview or not (2000). By opening a dialogue about 

menopause, the interviewed women hoped it would “clarify 

some of the mystery of menopause” (Walters 2000). Within the 

group that did discuss menopause with their mothers, a few 

noted that their mothers were uncomfortable with the 

discussion and thought that it was a “taboo subject” (Walters 

2000). In addition, several women mentioned that menopause 

and women’s health was not discussed within their family, with 

one woman’s mother getting a hysterectomy and keeping it a 

secret for decades (Walters 2000). This secrecy around the 

natural experience of menopause left many women feeling as 

though they had unanswered questions they wanted to express 

to their mothers. 

Another definition of familial relationships is between a 

woman and her children. Menopause usually occurs at the same 

time as a woman’s children begin to leave the house, according 

to Deeks (2003). Within the first five years after menopause, 

women have reported wanting to change the relationship and 

amount of contact they have with their children. Interestingly, 

after those first five years, post-menopausal women report 

being satisfied with the relationships with their children (Deeks 

2003). One interesting trend that arises, however, is that 

children seem to be returning to the home. There is no current 

evidence on how this affects the relationship between mother 

and child (Deeks 2003). 

Menopause and Friendships 

According to Walters, there were mixed findings in how 

friendships were affected by menopause (2000). Some 

respondents found that discussing their experiences with their 

friends helped to cope with their symptoms, while some 

reported pulling away from their friendships due to menopause 

(Walter 2000). This pulling away was due to the respondent 

feeling as though their friend could not accept that [she] was 

experiencing menopause” (Walters 2000). In addition, some 

women found it easier to discuss their symptoms with their 

older friends who had already experienced menopause (Walters 

62

2000). However, one 55-year-old woman described that while 

she met with a group of those her own age to talk with one 

another about their lives, they “never discuss menopause” 

(Walters 2000). This woman described the situation: 

“the people I am closest to are similar ages and so 

are all going through different phases of this. When we 

talk about it we talk on a very light basis, like ‘‘Am I 

having hot flashes or is it just hot in this room?’’ I have a 

couple of very close friends and most of them who are 

taking estrogen are going through the same things. I’ve 

shared it with them but not in detail. Not, ‘‘Do you go 

through anxiety? Is this just me, or is this where you’re 

coming from too?’’ (Walters 2000). 

While it seems that many women in Walter’s study want 

to discuss their experiences, there does not seem to be much 

effective dialogue about their daily lives. According to Walters, 

there still seems to be a “shroud of secrecy” (Walters 2000) 

surrounding menopause. 

While there are mixed findings on how friendships are 

affected by menopause, socializing with friends is proven to 

keep women from becoming depressed, as well as more likely to 

be positive about menopause (Deeks 2004). 

Menopause and Their Roles in Society 

For most women, the onset of menopause comes at a 

time of dramatic role change in their society. As the children 

leave the home, the role of a woman changes and she is no 

longer needed as a mother. According to a study conducted by 

Deeks and McCabe, 86% of the women they interviewed 

identified with the role of a mother (2004). Because menopause 

means the ceasing of menstruation (Rees 2011), women who 

reach this stage can no longer have children and become 

mothers. While married women with children are not as heavily 

affected by this, single women and even women who decided 

not to bear children feel the loss of their choice to be mothers 

(Walters 2000). One single woman in Walter’s interview 

stated: 

“ I have been single and I don’t have children and 

63

all of a sudden your body is at a point where you can’t 

have them, you no longer have that choice. I have never 

had this burning maternal desire, although I think I am a 

maternal person . . . but there is a final awareness when 

you go through Menopause that (having children) is no 

longer an option for you” (2000). 

No longer having the option to have children left 

women feeling that they were no longer womanly. In fact, some 

women felt that their loss of menstruation meant that they were 

losing their womanhood (Yang et. al 2015). However, 

according to Walter, many of the participants interviewed did 

not feel as though menopause affected their femininity (2000). 

Menopause is also associated with a woman 

aging. In Western society, aging is generally seen as a negative 

experience. Approaching and being in middle age is associated 

with a period of decline, as well as increased dependency on 

others (Hofmeier et. al 2017). In addition, Western society 

emphasizes looking a certain way as a woman - “youthful, thin, 

unwrinkled, and non-gray-haired” (Hofmeier et. al 2017). Due 

to this, the physical effects of menopause and aging cause a 

woman to feel as though she is “grieving the loss of [her] 

younger body” (Hofmeier et. al 2017). This can lead to body 

and self-image issues, as explored in Deeks’ 2004 case study of 

a woman named Jenny. Jenny could no longer “undress in front 

of her husband” because she did not like the way her body had 

changed through menopause (Deeks 2004). This led to her 

trying multiple diets to reduce the size of her waist and was 

becoming “more distressed with each failed attempt” (Deeks 

2004). Societal pressures for women to look a specific way 

may worsen as a woman ages. They may feel as though their 

body is incongruent with how they feel, where they may look 

older on the outside than they do on the inside (Hofmeier et. al 

2017). 

There is also a difference in how menopause 

affects employed versus unemployed women. This is important 

as there is a growing number of middle age women who are 

still employed (Jack et. al 2016). According to Jack et. al, 

64

working women tend to report fewer and less severe symptoms 

(2016). In addition, they also reach menopause later and have 

better knowledge regarding menopause (Jack et. al 2016). In 

addition, part time and unemployed women had more severe 

hot flashes and developed more “somatic complaints and 

anxiety disorders” (Jack et. al 2016). Lastly, women who are 

employed are more likely to engage in hormone replacement 

therapy to help with menopause (Jack et. al 2016). However, 

menopause can also negatively affect the working woman. Due 

to the physical symptoms of menopause - such as hot flashes - a 

woman may feel decreased work satisfaction (Jack et. al 2016). 

This is due to respondents reporting that their symptoms 

actually affect their work environment. In fact, 30% of women 

stated that menopause negatively affected their work 

environment (Jack et. al 2016). 

Lastly, women experiencing menopause often 

discount their needs and feel stigmatized for going through 

menopause. As discussed previously, some spouses of 

menopausal women felt as though they needed to “do 

something about [their] problem” of menopause (Dillaway 

2008). This delegitimizes a woman’s experience of menopause 

by turning it into a temporary issue that can be easily solved, 

rather than a natural issue. Unfortunately, this can translate to a 

societal pressure to remain silent about menopausal 

experiences. According to a study by Nosek et. al (2010), there 

is a lot of shame surrounding the experience of menopause. 

Many of the women interviewed by Nosek et. al expressed 

feeling embarrassed, especially when they would show signs of 

hot flashes (2010). One woman expressed this anxiety over 

“being publicly exposed while having a hot flash” (Nosek et. al 

2016) and having attention called to her menopausal symptoms. 

Because of this, women tend to remain silent about their 

experiences with menopause. 

65

Discussion 

Throughout all the literature examined, it seemed the 

most common feelings towards menopause were shame and 

secrecy. Women did not feel comfortable sharing their 

experiences and had little discussion with those around them 

about menopause. In addition, most relationships with spouses 

seemed to be negatively impacted by menopause, as husbands 

were not open to understanding what their wife was experiencing 

and would not accommodate it. Similarly, we rely on technology 

to reinvent ourselves. Notifications of a text message or “likes” 

on a picture will give us momentary bursts of dopamine. Thus, 

we become addicted to having that instant gratification. From 

Cullington’s point of view, she refutes the idea that “those who 

favor texting explain 

Limitations 

Most of the women interviewed in the studies were Caucasian 

and heterosexual relationships. The only studies where it was 

specified that there were homosexual couples was in Walters’ 

and Dillaway’s studies, with one and two lesbians responding 

respectively. This limitation to heterosexual females limits the 

findings about how menopause affects spousal relationships. 

This makes it hard to generalize the findings to all women. In 

addition, the mainly Caucasian respondents to most studies limit 

the view of menopause to one race. There could be racial 

differences in how menopause is viewed. Lastly, all but one 

study - Yang et. al’s study - focus on the Western narrative of 

menopause and how women are viewed in society. This makes it 

hard to generalize findings in anywhere but Western cultures, as 

well as offers a narrow view of how menopause is viewed. 

Works Cited 

Deeks, A. A. (2003). Psychological aspects of menopause 

management. Best Practice & Research Clinical 

Endocrinology & Metabolism, 17(1), 17–31. doi: 

10.1053/ybeem.2003.232 

Deeks, A. A. (2004). Is this menopause?: women in midlife- 

66

psychosocial issues. Australian family physician, 33(11), 

889. 

Deeks, A. A., & Mccabe, M. P. (2004). Well-being and 

menopause: An investigation of purpose in life, selfacceptance 

and social role in premenopausal, 

perimenopausal and postmenopausal women. Quality of 

Life Research, 13(2), 389–398. doi: 

10.1023/b:qure.0000018506.33706.05 

Dillaway, H. E. (2008). “Why can’t you control this?” How 

women’s interactions with intimate partners define 

menopause and family. Journal Of Women & Aging, 20(1– 

2), 47–64. 

Hofmeier, S. M., Runfola, C. D., Sala, M., Gagne, D. A., 

Brownley, K. A., & Bulik, C. M. (2017). Body image, 

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67

Race Relations at Texas Woman’s University 

Kathryn Fazi 

Abstract 

This study’s purpose was to determine the state of 

current race relations at Texas Woman’s University by gaining 

an understanding of students’ thoughts, opinions, and 

experiences with symbolic racism, traditional racism, and 

between-group social distance. The basis of this study was the 

history of Quakertown and the data acquired from this study 

was used to determine if race relations in Denton, Texas have 

improved since the early 1900s. This study suggests that Texas 

Woman’s University students have a positive perception of race 

relations and showed low levels of both symbolic and 

traditional racism across both White and Black participants. 

Significant differences due to race did occur in response to 

between-group social distance questions but were not severe. 

These results indicate that the majority of Texas Woman’s 

University students do not endorse ideas consistent with 

symbolic racism and that race does not impact their perception 

of race relations on campus. 

Introduction 

Texas Woman’s University has a nationally known 

reputation of diversity. According to College Factual (2019), 

Texas Woman’s University is ranked in the top ten percent for 

ethnic diversity among all colleges and universities in the 

United States. However, the history of the area surrounding 

Texas Woman’s University was not always accepting 

of diversity. From the late 1800s to the early 1900s, 

Quakertown was founded. Prior to the mid-1900s, Quakertown 

had been destroyed due to racist actions supported by the 

surrounding community, specifically Texas Woman’s 

University. Aware of Quakertown’s and Texas Woman’s 

University’s history, this study was conducted to learn of the 

experiences of current students on campus and their opinions 

on race relations among those attending Texas Woman’s 

University. It may seem apparent that Denton no longer 

68

condones active racism, such as removing all the residents of 

Quakertown, but what is not as apparent, is how prevalent 

symbolic or other types of racism could still be, specifically 

among college students. This study looked into how different 

races experience racism on campus, students’ perceptions of 

the racial climate, and their individual experiences with other 

races and their thoughts toward those races. 

History of Quakertown 

In 1875, a neighborhood called Quakertown began to 

form in Denton, Texas (Odintz, 2010). This neighborhood was 

comprised mainly of African-American families who moved 

from Freeman Town due to the opening of the Fred Douglass 

School, a school that would provide education for African- 

American children, in Denton (Fred Douglas History / History, 

n.d.). The families of Quakertown worked throughout Denton, 

attended church, sent their children to school, and, overall, had 

a positive impact on the community of Denton. In the early 

1900s, with the establishment of the Girl’s Industrial College of 

Texas, now known as Texas Woman’s University, Quakertown 

began to be viewed unfavorably. The college was hoping to 

expand and be accredited by the state but there was an obstacle 

in the way: Quakertown. 

The president of the Girl’s Industrial College of Texas 

made the case it was unseemly for an all-female, all-white 

college of young women who lacked parental supervision to be 

in such close proximity to a community of African-Americans 

(Treat, 2013). A petition to purchase all the property of 

Quakertown through the use of bonds was passed in 1922 and 

the city of Denton began purchasing properties from the 

residents of Quakertown or offering to move their homes to the 

East side of Denton. When some of the Quakertown 

community refused to comply, the Ku Klux Klan terrorized the 

area. Less than a year after the petition was passed, all the 

residents of Quakertown had been forced out of the area and 

construction for a new park began as a means to create a safer, 

more appropriate place for the white women and children in 

Denton. 

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Forty years after the removal of Quakertown, in 1961, 

Texas Woman’s University accepted their first African- 

American student, with six more African-American women 

enrolling the following year (Treat, 2013). Since then, Texas 

Woman’s University has become well-known for its diversity, 

with sixty-five percent of the student population being 

comprised of non-whites. 

Critical Race Theory 

In this study, all research was viewed through the lens of 

the Critical Race Theory. Critical race theorists, as defined by 

Derrick Bell (1995), are “ideologically committed to the 

struggle against racism, particularly as institutionalized in and 

by law”. This theory assists researchers in visualizing how 

people, affected by systemic racism, have to fight against 

cultural perceptions of their race, while also being aware of 

ways to counter prejudice (Purdue Writing Lab, n.d.). A large 

component of this theory involves individuals sharing their 

personal experiences and learning how the intersectionality of 

their identities affects their daily interactions (Purdue Writing 

Lab, n.d.). According to Purdue Writing Lab (n.d), scholars 

who utilize the Critical Race Theory are helping to shift the 

way people think and understand “race, racism, and power”. 

It was important to utilize this theory, given the best way 

to gain a well-rounded understanding of the racial climate on 

campus and the current race relations was to ask those 

experiencing these relationships. This theory was the basis for 

the chosen measures and areas of focus because this study 

analyzed different forms of racism within the college 

community and asked for insight from those experiencing it 

firsthand. The purpose of this study was to examine the current 

race relations and levels of racism occurring at Texas Woman’s 

University in the current day. 

Modern-Day Racism 

When people hear the word racism, they may think of it 

as an antiquated term referring to outright acts of aggression 

toward people of another race. However, over the years, racism 

has morphed and become an subconscious way of thought. On 

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college campuses today, the fight for racial equity and equality 

exists, but is often intermingled under a larger, more general 

umbrella focusing on diversity (Buck & Patel, 2016). Modernday 

racism, or aversive racism, has dramatic impacts on 

African-Americans’ quality of life, spanning from social 

impacts to economic impacts (Fairchild, 2019). Racism today is 

insidious, oftentimes appearing as opposing programs with the 

goal to undo the history of discrimination or denying policies 

benefitting those who are not White (Fairchild, 2019). 

A type of modern racism which is more modern and 

considered controversial by some is symbolic racism. 

According to Brandt and Reyna (2012), symbolic racism occurs 

due to “both Black individualism and anti-equality attitudes” 

meaning symbolic racism is a new form of expressing racism, 

yet can also be seen as a “legitimizing ideology”. Some 

researchers have noted how, at a time when traditional racism 

seems to be declining, a new form of racism is beginning to 

steadily emerge. Symbolic racism occurs mostly within the 

ethnic majority, due to a feeling African-Americans are 

making unnecessary requests for social equity (McConahay & 

Hough, 1976). This form of racism focuses on the idea that 

African-Americans are failing due to their own personal 

lacking and not due to societal standards (McConahay & 

Hough, 1976). This study was conducted with the students of 

Texas Woman’s University to measure specifically the amount 

of Symbolic Racism present among students. 

Looking for a Change 

The purpose of this study was to determine racism is not 

prominent at Texas Woman’s University and to show how 

attitudes and beliefs have changed in Denton since the removal 

of the Quakertown community. 

Methodology 

This study attempted to measure the racial climate on 

Texas Woman’s University’s campus and gain insight into the 

current race relations between students. To gain this insight, a 

convenience sampling of Texas Woman’s University students 

responded to measures asking about their own observations and 

71

experiences with racism in two forms, traditional and symbolic, 

as well as between-group social distance. Texas Woman’s 

University’s history is rooted in racism against African- 

Americans and this study sought to determine how the climate 

of the campus and the relations of those living in this area have 

changed since the early 1900s. 

This study utilized two methods to determine the current 

race relations and state of racism on campus, and the results 

were compared to the past racial interactions. First, the study 

examined the differences between responses based on race, 

specifically differences between responses from Black 

participants and White participants, to determine whether 

inconsistencies occurred in how specific races perceive the 

racial climate on campus compared to other races. Secondly, 

associations with student’s current opinions toward race 

relations in comparison to the experiences they have had with 

racism, traditional and symbolic, on campus, as well as their 

between-group social distance were investigated. Thirdly, 

students’ knowledge of the Quakertown community was 

assessed. Finally, the overall levels of racism were compared to 

the experiences and racist encounters which occurred in 

relation to Quakertown. 

Design and Sample 

The data for this study was collected through an online 

survey distributed via PsychData. This survey was sent to 

undergraduate students currently enrolled at Texas Woman’s 

University in early Spring 2020. The demographics of Texas 

Woman’s University’s student body for the 2019-2020 school 

year of the 10,591 enrolled undergraduates were as follows: 

80.2% of first-year students lived in on-campus housing, while 

24.6% of all undergraduates lived on campus. Women made up 

a majority of undergraduate students, with only 13% of 

students identifying as men. 36.5% of undergraduate students 

were White, 31.4% were Hispanic/Latino, 16.7% were Black or 

African-American, 9% were Asian and 6.4% were another 

race/ethnicity. The study was reviewed and approved by the 

Institutional Review Board. This study used multiple-choice 

72

questions about experiences, opinions, and perceptions 

involving race and personal interactions occurring on campus 

between racial groups. 

This study was dispersed to undergraduate Texas 

Woman’s University students by Student Research 

Participation (SONA). Students were given the option to take 

this survey and earn extra credit for a class. The survey was 

also emailed to various undergraduate students and shared on 

social media, such as Facebook and Instagram, for students to 

access. 

Participants 

A total of 209 participants completed this study, 

including 12 men, 195 women, and 2 who identified as other. 

There were some participants who did not finish the survey, 

so their data was removed from the study. 40% of participants 

were White, 20% of participants were Black, 14% were Asian, 

3% were Native American, 6% were Mixed Race, and 16% 

identified as “other” for their race. 97% of participants were 

between the ages 18 and 25. 87% of participants primarily grew 

up in Texas and only 9% of participants primarily grew up 

outside of the Southern United States. 42% of participants 

reported their family’s income to be average in comparison to 

the general American family and 40% of participants reported 

living in a suburb of a medium to large city before entering 

college. 

73

74

Measures 

The dependent variable in this study was what the current 

race relations on Texas Woman’s University’s campus were, 

which was measured using a four-item index of moderate 

reliability (alpha = .76). Participants were asked to assess race 

relations on campus using a 7-point scale; asked how often they 

thought typical Black students experienced racism on campus 

using a 6-point scale; asked how recently they had heard a 

racist comment or slur on campus; and asked if they thought 

racism was a problem on campus using a 7-point scale. 

Calculations were done by using an average standardized score 

for each participant. A score indicating positive race relations 

on campus would was be scored high and indicated that student 

experienced little to no racial discrimination on campus. 

The dependent variables in this study looked at were 

levels of symbolic racism, traditional racism, and amount of 

between-group social distance desired. The independent 

variable was race, breaking it down to two levels, Black and 

White. The measures used in this study were adapted from a 

study completed at the University of Alabama, which were 

chosen from the American National Election Surveys (ANES) 

and the General Social Survey (GSS). 

Symbolic racism was measured with an index of five 

items to show whether a participant associated lower 

socioeconomic status (SES) in the African-American 

community to historical conditions rather than individual 

actions. The following four items were asked utilizing a 5-point 

scale of agreement (agree strongly to disagree strongly): (a) 

“Generations of slavery and discrimination have created 

conditions that make it difficult for African Americans to work 

their way out of the lower class”; (b) “Irish, Italians, Jewish, 

and many other minorities overcame prejudice and worked 

their way up. African Americans should do the same without 

any special favors”; (c) “It’s really a matter of some people not 

working hard enough; if African Americans would only try 

harder they could be just as well off as Whites”; and (d) “Over 

the past few years African Americans have gotten less than 

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they deserve”. The final item was asked using a 4-point scale (a 

lot to not a lot): (e) “How much does racial discrimination 

today limit African Americans’ chances to get ahead?” 

Students’ knowledge of Quakertown was measured with 

one free response question and three multiple choice questions. 

The free response question asked “In your own words, define 

Quakertown and share what you know of Quakertown”. The 

multiple choice questions asked if students had heard of 

Quakertown before this survey, when they had first heard of 

Quakertown, and if they felt Texas Woman’s University had 

negatively impacted Quakertown. These questions were created 

to gauge the level of knowledge students had about 

Quakertown in Denton, Texas. 

Results 

The results of this study showed low levels of symbolic 

racism on campus and race relations were viewed favorably by 

students with no difference between races. Students generally 

felt comfortable with Hispanics, Asians, African Americans, 

Muslims, Whites, illegal aliens, White Northerners, and people 

on welfare, rating them on average at 90 degrees on the feeling 

thermometer. The group of people who students felt least 

comfortable with was White Southerners, rating them at 77 

degrees on the feeling thermometer. Despite slight differences 

between the groups, all of these fall in the “warm and 

favorable” rating, showing Texas Woman’s University students 

on average did not allow these characteristics to impact how 

they felt about groups of people. 

Between-group social distance was measured by 

asking participants to rate how likely they were to interact with 

a person of a different race on various levels, ranging from 

sitting next to them in class to dating them. A one-way 

ANOVA was conducted to determine whether race had an 

effect on how much the amount of social distance a participant 

desired. There was a significant difference among Black 

participants and White participants in a desire for social 

distance in five areas: double-dating F(5, 201) = 5.68, p < .05, 

η 2 = 0.12; having the opposite race as a roommate F(5, 201) = 

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5.25, p < .05, η 2 = 0.12; in dating F(5, 201) = 3.31, p < .05, η 2 = 

0.08; in hanging out as friends F(5, 201) = 3.10, p < .05, η 2 = 

0.07; and in being in student clubs F(5, 201) = 2.56, p < .05, 

η 2 = 0.06. Post-hoc comparisons were made using a Bonferroni 

test and indicated that Black participants (M = 2.17, SD = 1.24) 

desired more social distance than White participants (M = 1.4, 

SD = 1.03) for double-dating, Black participants (M = 2.00, SD 

= 1.10) desired more social distance than White participants (M 

= 0.93, SD = 0.10) for roommates, Black participants (M = 

2.31, SD = 1.25) desired more social distance than White 

participants (M = 1.75, SD = 1.26) for dating, Black 

participants (M = 1.73, SD = 0.92) desired more social distance 

than White participants (M = 1.20, SD = 0.69) for hanging out 

as friends, and Black participants (M = 1.73, SD = .99) desired 

more social distance than White participants (M = 1.23 , SD = 

0.78) for being in student clubs. 

The results showed there was no significant difference 

between the space desired by different races for attending class 

with them, sitting next to them in class, walking with them on 

campus, eating with them, and working with them on a group 

project. However, there was a significant difference between 

the space the desired by different races for double-dating them, 

having them as a roommate, dating someone in the group, 

hanging out with them as friends, and being in student clubs 

with them. When comparing answers from White participants 

to answers from Black participants, the data showed Whites, on 

average, desired less social distance than Black participants in 

the significant areas described above. 

In regards to participants’ perceptions of White 

and Black people on the four characteristics of being hardworking, 

intelligent, violence-prone, and rich, there was no 

significant difference in responses between Blacks and Whites. 

Both Black and White participants perceived African- 

Americans as hardworking, intelligent, not violence-prone, and 

neither rich nor poor. For the perception of Whites, the scores 

for both Black and White participants stated a perception of 

Whites being hard-working, intelligent, not-violence prone, and 

77

neither rich nor poor. These results showcase how Texas 

Woman’s University students do not hold negative perceptions 

of Whites or African-Americans, which is a positive result 

indicating low levels of racism among Texas Woman’s 

University students. 

A one-way ANOVA was conducted to determine 

whether race had an effect on a participant’s perception of race 

relations at Texas Woman’s University. There was no 

significant difference in perception of race relations at Texas 

Woman’s University between races, F(5, 201) = 1.63, p > .05, 

η 2 = .04. Participants, both Blacks and Whites, responded, on 

average, with an assessment of race relations on campus being 

a 5.5 out of 7, with 7 meaning “race relations are very good”. 

White and Black participants both responded to the question 

“Do you think racism is a problem on campus?” on average 

with a 2.2, where a 1 means “not a problem at all”. For all 

questions pertaining to participants’ perceptions of race 

relations at Texas Woman’s University, race caused no 

difference in response choice. 

To determine whether race had an effect on a 

participant’s score on the symbolic racism scale a one-way 

ANOVA was conducted. The results showed White participants 

to have a significant difference in their responses for three 

questions: (a) Generations of slavery and discrimination have 

created conditions that make it difficult for African Americans 

to work their way out of the lower class, (b) Over the past few 

years African Americans have gotten less than they deserve, 

and (c) Racial discrimination limits the chances for African 

Americans to get ahead. A one-way between-subjects ANOVA 

was conducted to determine whether race had an effect on a 

participant’s score on the symbolic racism scale. There was a 

significant difference among Black participants and White 

participants in symbolic racism for question (a), F(5, 201) = 

2.19, p > .05, η 2 = 0.05, question (b), F(5, 201) = 4.29, p < .01, 

η 2 = 0.10 and question (c), F(5, 201) = 2.42, p < .05, η 2 = 0.06. 

Post-hoc comparisons were made using a Bonferroni test and 

indicated that for question (a) White participants reported 

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significantly higher scores (M = 2.06, SD = 1.13) than Black 

participants (M = 1.44, SD = 0.74). Post-hoc comparisons were 

made using a Bonferroni test and indicated that for question (b) 

White participants reported significantly higher scores (M = 

2.27, SD = 1.08) than Black participants (M = 1.49, SD = 0.89). 

Post-hoc comparisons were made using a Bonferroni test and 

indicated that for question (c) White participants reported 

significantly higher scores (M = 1.82, SD = 0.91) than Black 

participants (M = 1.36, SD = 0.73). 

There was a significant difference between responses by 

Black participants and White participants on these three 

questions measuring for symbolic racism and a Bonferroni 

post-hoc test revealed these differences were due to race and 

not chance. While the average score was low for all 

participants, indicating a low level of symbolic racism, Whites 

were slightly higher in their responses. Higher scores on this 

scale indicate higher levels of symbolic racism. The average 

score on the symbolic racism scale for White participants was 

13.05 out of 30. For Black participants, the average score was 

10.27 out of 30. Both scores are low, with the lowest possible 

score being 6, and this shows symbolic racism among Texas 

Woman’s University students was relatively low. 

Finally, a one-way ANOVA was conducted to 

determine whether race had an effect on a participant’s 

knowledge of Quakertown in Denton, Texas and indicated race 

did not have a significant effect F(5, 201) = 1.89, p> .05, η 2 = 

0.04. For 65% of participants, this survey was the first time 

they had heard about the Quakertown community in Denton, 

Texas. Eighty-four percent of participants responded “I’m not 

sure” to the question “Did Texas Woman’s University ever 

have a negative impact on the Quakertown community?”. The 

responses to these questions demonstrated the majority of 

current Texas Woman’s University students were not aware of 

the Quakertown community that once thrived so close to 

campus. This data also indicated race played no part in 

students’ awareness of this community and Texas Woman’s 

University’s impact on it. 

79

Discussion 

The purpose of this study was to look at the race relations 

occurring between students who attend Texas Woman’s 

University. Participants responded to an online survey 

primarily sent to students in undergraduate psychology classes. 

This survey asked questions pertaining to symbolic racism, 

systemic racism, an assessment of campus race relations, and 

knowledge of the Quakertown community that once thrived in 

Denton, Texas. This study had a broad goal of simply gaining 

perspective on the racial climate at Texas Woman’s University, 

specifically focused on the relationships between Blacks and 

Whites on campus. The hypothesis was that it would be shown 

students today were not exhibiting the racism shown by Texas 

Woman’s University in the early 1900s when they evicted the 

residents of Quakertown due to their race. The results support 

this hypothesis and demonstrates that today’s Texas Woman’s 

University students displayed low levels of all forms of racism 

tested and held positive perceptions of campus race relations. 

However, there were two areas where improvement 

among the Texas Woman’s University community could occur: 

between-group social distance and symbolic racism. There was 

a significant difference in Blacks’ desire for between-group 

social distance compared to Whites’ responses showing that 

Blacks desired more social distance than Whites. For symbolic 

racism, there were three questions where responses from White 

participants indicated significantly higher levels of symbolic 

racism in comparison to responses from Black participants. 

Limitations 

This research contained a few limitations. The first major 

limitation came from the length of the survey possibly causing 

fatigue in the participant. This fatigue could lead to satisficing 

answers rather than thoughtful and honest ones. The length of 

the questions also could have contributed to people skimming 

the questions and not fully understanding before responding. A 

second limitation was the lack of male responses due to Texas 

Woman’s University being primarily composed of females. 

Finally, a third limitation of this study was focusing solely on 

80

the racial relations between Blacks and Whites. This did not 

allow for a holistic understanding of the campus given the 

diversity that existed at Texas Woman’s University. 

Future Research and Conclusion 

Future research on this topic should explore measuring 

the racial relationships between other races on Texas Woman’s 

University’s or at other universities. It is important researchers 

remember to include everyone to gain a better understanding of 

the racial climate on a campus. To make the research 

generalizable, it would be wise to complete this study at a 

larger university with a population which is not predominantly 

female. By completing this study at a larger university, the 

distribution of male and female respondents will be more 

aligned with the general population, averaging to about fifty 

percent female and fifty percent male (U.S. Census Bureau 

QuickFacts: United States, 2019). 

For future research within Texas Woman’s 

University, retesting the students in five year increments would 

provide a different viewpoint. This original study could be 

considered a baseline for future research to study modern 

changes in the racial climate and race relations. It would be 

wise to expand the study to incorporate other races and not 

focus solely on Black and White relations as well. 

This research study was the not the first to look at 

race relations on a college campus and it should not be the last. 

As new generations enter college and graduate, it is important 

to be aware of how students are interacting with one another. 

History is easily forgotten, especially uncomfortable history, as 

evidenced by the lack of knowledge about the Quakertown 

community. People need to be aware of their actions and how 

they affect those around them. This study caused students to 

acknowledge how they interact with others and helped students 

recognize how their actions could feed the underlying racism 

which still exists around the world. Hopefully future studies 

will help measure the levels of racism across all races to allow 

for improvement in all areas of race relations on campus. 

81

Works Cited 

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Illinois Law Review 4 (1995): 893-910. 

Brandt, M., & Reyna, C. (2012). The Functions of Symbolic Racism. Social 

Justice Research, 25(1), 41–60. 

Buck, L. & Patel, P. (2016). The Roots are Racism: Historical and Current 

Racial Bias on College Campuses and Their (Unintended) Push on 

the Diversity Agenda. 10.1108/S1479-364420160000019010. 

College Factual. (2019). TWU Highlighted in Ethic Diversity Ranking. 

Retrieved January 24, 2020, from 

https://www.collegefactual.com/colleges/texas-womansuniversity/news/texas-womans-university-2019-college-diversityethnic-ranking/ 

Fairchild, H. (2019). Modern-Day Racism Masks Its Ugly Head. Peace and 

Conflict: Journal of Peace Psychology, 25(2), pp.213-215. 

Fred Douglas History / History. (n.d.). Retrieved from 

https://www.shermanisd.net/domain/216 

McConahay, J. B., & Hough Jr., J. C. (1976). Symbolic Racism. Journal of 

Social Issues, 32(2), 23–45. 

Odintz, M. (2010). QUAKERTOWN, TX. Retrieved from 

https://tshaonline.org/handbook/online/articles/hrqgk 

Purdue Writing Lab. (n.d.). Critical Race Theory // Purdue Writing Lab. 

Retrieved January 17, 2020, from 

Quakertown, Denton (Denton County). (n.d.). Retrieved from 

omeka.library.unt.edu/s/stjohns/page/quakertown. 

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https://www.census.gov/quickfacts/fact/table/US/SEX255218 

82

New media, New Journalism: How literary techniques in The 

New Yorker’s ‘Vivian Gornick is Rereading Everyone, 

Including Herself’ are heightened in digital spaces 

Amber Gaudet 

Prior to the 1960s, objective journalism – referred to by 

industry critics as "the view from nowhere" – was the 

dominant and largely the only form of popular journalism. In 

the decades that followed, however, journalists like Norman 

Mailer and Tom Wolfe began to take more aesthetic 

approaches to news as reflections of broader cultural change, 

“guiding audiences to democratic possibilities” (Berning 2). 

These journalists employed literary techniques to narrative 

journalism in what came to be known as New Journalism, a 

hybrid of literary prose and traditional news media. Today, 

narrative journalists are again embracing New Journalist 

techniques and, when combined with the democratic 

interactivity between reader and writer online, creating a 

hybrid form of news that establishes truth through subjective 

interpretation. In Alexandria Schwartz’s online article for 

The New Yorker, “Vivian Gornick is Rereading Everyone, 

Including Herself,” literary techniques such as chronology, 

first- and third-person narration, and scene-by-scene 

construction are enhanced through the hypertextuality and 

multimodality of the web, situating texts not as objective 

reports but as subjective negotiations between authors and 

readers and creating a new New Journalism of the 21 st 

century. 

At the narrative's opening, Schwartz uses a passage 

from Gornick’s memoir “Fierce Attachments” to describe 

Gornick as a little girl, the daughter of socialists who 

inherited their passion for revolution. 

And I would say, “Wouldn’t it be wonderful if there 

was a flood or an epidemic or a revolution, and even 

though I’m this little kid they find me and they say to 

me, ‘You speak so wonderfully you must lead the 

people out of this disaster.’” I never daydreamed about 

love or money, I always daydreamed I was making

eloquent speeches that stirred ten thousand people to 

feel their lives, and to act. (Gornick, as quoted by 

Schwartz) 

The excerpt from Gornick’s book begins to establish 

characterization from the outset of the article, painting a picture of 

Gornick as a revolutionary of the political and literary worlds. 

Following this passage, Schwartz gives the reader a brief, 

chronological overview of Schwartz's life since her girlhood over 

the next two-and-a-half paragraphs. She then embarks on a firstperson 

description of Gornick’s apartment, which she visits for an 

interview with the 84-year-old author. In both her stylized account 

of Gornick’s life and her commentary on Gornick’s home, 

Schwartz establishes a dual chronology that she weaves 

throughout her article: one which traces Gornick’s development as 

an author and personality throughout her lifetime, and another 

which offers observations of Gornick through Schwartz. 

According to two-time Pulitzer Prize-winning journalist Jon 

Franklin, the literary technique of chronology in narrative 

purposefully guides readers from one point to the next, taking 

them on a journey that maps out the events of the story. Berning 

suggests this use of multiple narrators lends credibility to 

narratives, triangulating truth through diverse vantage points: 

“The third- and first-person narrators complement one another, 

resulting in a multi-perspectival narrative. Moreover…the two 

perspectives reinforce one another to strengthen the story's 

internal logic and exhibit verisimilitude.” Schwartz’s chronology 

offers readers with a comforting, inviting form employed in 

novels, providing a beginning, middle, and end that invites readers 

to stick with the story through its conclusion. 

Through Schwart’s first-person musings, she participates in 

a literary technique founder Tom Wolfe cites as being frequently 

employed by New Journalists: scene-by-scene construction 

(Berning, 3). Schwartz describes Gornick’s apartment both in 

terms of contextualizing the interview – thereby inserting herself 

in the story – and as a tool for building a perception of Gornick for 

the reader. “…her home, like her prose, is straightforward in style, 

unfussy, minimally adorned. The table, couch, and chairs are there 

to be used by the body, not enjoyed by the eye” (Schwartz). 

Schwartz pulls the reader into the story with these subjective 

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observations, providing sensory details to facilitate immersion, 

and employing character-building techniques often found in 

fiction writing. By inserting herself in the article early on, 

Schwartz connects with her audience, establishing herself as a tour 

guide who is, through the facilitation of Gornick’s story, 

negotiating meaning through observation and conversation with 

the author. This admission of sorts can, among readers, foster trust 

and comradery, as the audience finds the vulnerability of 

subjective authorship more authentic and relatable than traditional 

journalistic models of authoritative objectivity. 

Schwartz uses a mix of present and past tense to situate the 

reader in the story as it unfolds, building chronology, and giving 

the story a sense of omnipresence. This style of using the present 

contrasts with hard news stories which use the past tense to favor 

fact-based, objective prose. Though journalists often use the 

present tense in features, Schwartz negotiates two timelines 

throughout the narrative, shifting between scenes from Gornick’s 

past, earlier portions of the interview, and the interview as 

happening in the present. 

I asked Gornick how she knew that literature was something 

worthy of study. She looked at me as if I had asked how she 

knew that clean water was good to drink. I felt ashamed. 

Like her mother, I was thinking in terms of the market, and 

she in terms of the soul. (Schwartz) 

Schwartz's use of the past tense allows her to insert her own 

feelings into the story, providing the audience with another 

perception of Gornick through Schwartz's meaning-making and 

continuing to build characterization. 

Throughout the narrative, Schwartz uses a modified form of 

extended dialogue to give considerable weight and voice to the 

subject. As in fiction writing, extended dialogue provides a backand-forth 

between two subjects, conveying a particular message to 

readers not possible through monologist form. Though highly 

unusual in traditional journalism, the technique can be used in 

narrative journalism with similar effects. Schwartz, rather than 

directly quoting herself, paraphrases her contributions to the 

conversation but lets Gornick’s words stand alone. 

…when, in our conversation, I offhandedly called Colette a 

feminist—after all, hadn’t she made her way in the world by 

85

her pen, writing about women’s experience? —Gornick shut 

me down. “It’s all in service of erotic passion as the central 

experience of a life. I can’t go with that,” she said. (Still, she 

liked the Keira Knightley bio-pic from 2018 as much as I 

did.) 

In this way, Schwartz negotiates her position as a facilitator 

of Gornick’s message and a subjective participant in the narrative she 

creates. 

These literary techniques – though present in both print and 

digital versions of Schwartz’s article – have different effects online. 

In the digital world, Schwartz’s storytelling techniques combine with 

new modalities to renegotiate the authenticity of her prose. In 

electronic spaces dominated by democracy, two-way communication, 

and authorial transparency, meaning is contrived in a manner more 

akin to the negotiated approach between novel writers and readers 

than the top-down, authoritative methods of traditional journalism. 

Berning references a similar phenomenon: “By publishing their 

literary reportages online they embed them in an ever-changing 

electronic environment. Consequently, online literary reportages 

become landmarks of the intertextual system that New Journalists 

used to spell out, and according to which readers and texts become 

partners in the interpretive process" (Berning 2). Using tactics 

employed across journalistic genres in digital spaces, Schwartz’s 

article achieves a heightened authenticity that, contrary to traditional 

notions of objectivity as truth, arrive at meaning through a hybrid 

form of subjective analyses and reader immersion. 

The first method Schwartz, like most journalists, employs, is 

hypertextuality. Woven throughout the narrative are hyperlinks to 

Gornick’s work and other subjects that arise in the course of 

Schwartz’s interview with the author. By providing hyperlinks, 

Schwartz allows readers to use outside resources to supplement her 

narrative. In doing so, Schwartz situates her text in the wider 

dialogues of the internet and heightens the readers' involvement in 

interpreting the story. As Berning described of an article by national 

correspondent Mark Bowden, the digital act of hypertextuality 

changes the relationship between the reader and author and enhances 

the effect of literary techniques. “In the eyes of the author, one of the 

consequences of this is that the reader becomes a co-author of the 

text. […] Bowden’s use of hypertextuality allows for nonlinear 

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storytelling and thus enhances the New Journalism technique of 

scene-by-scene construction.” In this way, Schwartz's digital 

narrative exists independent of its print counterpart, as part of a 

larger body of voices surrounding the subject and as a text more 

immediately vulnerable to audience verification and scrutiny. 

Schwartz’s digital text is also inherently multimodal, 

allowing users to listen to the article (through an Audm embed on the 

page) rather than read it. Though not as multimedia-rich as some of 

its digital counterparts – The New Yorker employs a deliberately 

understated style – the presence of an audio rendering of the 

narrative changes the text’s relationship to the reader. Like other 

digital texts, multimodality and multimedia serve several functions. 

First, multimodality enhances accessibility and convenience for a 

diverse audience. The text’s housing on the web itself is navigable in 

ways that print is not, adapting to fit many screens and be accessible 

across devices. Readers can zoom in, adjust the font size in their 

browser, and more. Secondly, multimodality creates enhanced 

opportunities for meaning-making. Auditory elements such as voice, 

tone, pacing, cadence, and style can play a significant role in creating 

meaning, as messages and intent can become ambiguous through text 

alone. Auditory elements also create subjectivity and connection with 

the reader and allow for more passive participation, as audiobooks do 

for novel readers. This multimodality allows readers to interpret the 

text differently based on their consumption of it, enhancing narrative 

journalism's reliance on subjective reasoning and authenticity to 

arrive at truth. 

Authorial voice and point-of-view are also enhanced in online 

spaces. Rather than favoring the third-person objectivity of print 

journalism, online spaces have seen a growth in the use of firstperson 

reporting, according to Susan Jacobson in “Emerging Models 

of Multimedia Journalism: A Content Analysis of Multimedia 

Packages Published on nytimes.com.” Jacobson finds that “Firstperson 

address has the effect of creating a sense of intimacy between 

the reporter and the Web audience, even if the reporter is speaking as 

an objective observer of events” (69). In employing this literary 

technique, then, journalists foster trust among online audiences, a 

trust likely enhanced by the greater interactivity of the web as 

compared to the one-way communication of print. 

Schwartz’s narrative exemplifies how today’s digital 

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journalists combine literary techniques popular in New Journalism 

with digital standards of hypertextuality and multimodality to create 

a hybrid form of narrative journalism. Schwartz uses dual forms of 

chronology and point-of-view found in traditional fiction writing to 

establish the setting and characterization of her subject through firstperson 

observation and third-person omniscience. Schwartz uses a 

modified form of extended dialogue to negotiate her position as both 

an objective, journalistic observer, and subjective, literary story 

builder. Taken together, the literary techniques Schwartz employs are 

given new meaning in digital spaces. Hypertextuality heightens 

Schwartz's scene-by-scene construction of Gortz's apartment by 

creating a nonlinear text that exists as part of a broader web-based 

dialogue. Multimodality created by an audio version of the story 

allows readers several avenues to interpret the text and makes it 

available to a wider audience by enhancing accessibility. Schwartz’s 

article exemplifies how, renegotiated by digital mediums, literary 

techniques of New Journalism are enhanced to prioritize authenticity 

and emphasize truth not as an objective, one-way dissemination of 

information but as a subjective negotiation between author and 

reader, reflecting the collaborative nature and democracy of native 

web environments. 

Works Cited 

Berning, Nora. “Narrative Journalism in the Age of the Internet. New Ways to 

Create Authenticity in Online Literary Reportages.” Textpraxis, vol. 2, 

no. 2, 2011, pp. 1-15, https://primo-tcna01.hosted.exlibrisgroup.com/permalink/f/110i679/TN_doaj_soai_doa 

j_org_article_682f29a0938a4b24ac22ff21cb41dc0e. Accessed 9 March 

2020. 

Jacobson, Susan. “Emerging Models of Multimedia Journalism: A Content 

Analysis of Multimedia Packages Published on Nytimes.com.” Atlantic 

Journal of Communication, vol. 18, no. 2, 2010, pp. 63–78. 

https://primo-tcna01.hosted.exlibrisgroup.com/permalink/f/110i679/TN_informaworld 

_s10_1080_15456870903554882. Accessed 11 March 2020. 

Schwartz, Alexandra. “Vivian Gornick Is Rereading Everyone, Including 

Herself.” The New Yorker, Condé Nast, 3 Feb. 2020, 

www.newyorker.com/magazine/2020/02/10/vivian-gornick-isrereading-everyone-including-herself. 

88

Sula, The Holy Bible, and Literary Trauma 

Emily Gentry 

Trauma is difficult to define. In terms of psychoanalysis, 

there are two major trains of thought: one born from Sigmund 

Freud and one born from Bessel van der Kolk and Onno van der 

Hart (Barnaby 119). The Freudian approach views trauma through 

its victim’s active repression of traumatic memories, whereas 

Bessel van der Kolk and Onno van der Hart view trauma through 

its victim’s incapability to remember the trauma they have faced 

(Barnaby 119). While one psychologist asserts that victims of 

trauma intentionally repress their traumatic memories and the 

other psychologists assert that the overwhelming nature of trauma 

forces traumatic memories into “an alternate stream of 

consciousness,” both psychoanalytic approaches rely on the 

notion that trauma refers to an event that is not inherently 

traumatic; rather, the remembrance of the event is what causes the 

trauma (qt. in Barnaby 120). These theories of trauma, while 

originally applied only to the individual, have been applied to 

view the traumas of different cultural groups and major traumatic 

events in history. In viewing the traumas of these groups, literary 

trauma theory has provided a lens to help analyze how each of 

these groups expresses, consolidate, and grapple with these 

traumas. As Cathy Caruth, a pioneer in the field of literary trauma 

theory, posits, an event is traumatic in memory and these 

memories follow traumatized groups throughout history; 

therefore, literature is one of the primary avenues for these 

traumatic memories to manifest (Hirth 346). Literary trauma 

theory asserts the importance of its analysis, not only because of 

its ability to manifest traumatic memories but also because of the 

repercussions these traumatic events have for the groups said 

trauma has impacted if left unexplored. As stated in research 

about interrupting the process of intergenerational trauma, “Each 

generation stands to receive these past traumas… and experience 

new ones as a result of them” (Gobodo-Madikizela 14). In 

acknowledging the traumas that are passed intergenerationally 

through culture, it is evident that repetition and symbolism 

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embodied through the remembrance of trauma are important 

factors to identifying, making meaning, and understanding the 

cycle of cultural traumas and their respective texts. The cyclical 

nature of trauma as represented by intergenerational trauma and 

explored through literary trauma theory is evidenced in a 

multitude of works from different cultural groups; however, this 

concept is especially apparent in Toni Morrison’s 1973 novel, 

Sula. Sula illustrates the notion that trauma follows a cycle which 

African Americans continuously endure through its repetitious 

symbolism and its ironic allusions to the power structure of 

religion. 

Sula tells the story of two African American women in the 

early 1900s: Nel and Sula. Sula and Nel are best friends whose 

experiences as African Americans shape both their childhood and 

futures. The two women come from deeply dysfunctional 

households. Nel, whose mother hates the color of her skin, is 

explicitly taught that she is not good enough unless she acts as a 

white woman; at one point, her mother even tells her that she 

“could be pulling her nose,” in an attempt to assimilate to 

whiteness (Morrison 28). Sula, on the other hand, comes from a 

line of strong women whose use of sex to gain power left little to 

no room for the traditional notion of love. As the story develops, 

it becomes abundantly clear that the trauma of both women and 

the entire community face follows a cycle. To illustrate this cycle, 

the novel utilizes fire as a central symbol to explore trauma within 

the African American community. The visceral image of fire is 

present throughout the entirety of the novel, as though the image 

of fire stands to illustrate trauma as a phoenix; fire marks the end 

of trauma until the trauma is revived in a new generation. This is 

evidenced as fire marks the narratives of different characters’ 

traumas within the novel. One of the first moments the novel 

literally experiences fire occurs within Sula’s family history. 

Sula’s grandmother, Eva, was a hardworking woman whose 

husband left early in her children’s lives. After he left, Eva could 

barely take care of her own children, because she had no money. 

One day, after using the last bit of lard she owned to remove her 

starving son’s bowel movement by hand, Eva realized she had to 

become an independent woman and take charge of her own life 

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(Morrison 34). Eva’s marriage ending, forcing her to become 

independent, marked the beginning of one cycle of trauma. Years 

later, Eva’s son Plum comes home from the war. In an effort to 

cope with the horrors of World War I, Plum turns to drugs and 

begins to slowly kill himself through his addiction (Morrison 45). 

Just as Eva had done years prior when she put her baby out of his 

misery through an uncomfortable act, she realized that she had to 

do it again. This time, she held her grown son for some time 

before setting his room on fire and letting him die; for Eva, she 

was ending the cycle of trauma Plum had been enduring since his 

father left (Morrison 48). 

Eva and Plum’s relationship illustrates one of the central 

arguments the novel makes: the person telling the narrative has 

the ability to change your perception of the story. When reading 

the novel, it is evident that Eva kills her son in an attempt to end 

his suffering - she does so out of love. Yet, when viewing Plum’s 

murder through the lens of the oppressor, it is evident that her 

notion of love does not mirror what the power figures in society 

say love is. The misrepresentation of black narratives in order to 

favor the oppressor’s perspective has occurred throughout history. 

Sula, however, distorts the narratives that the oppressors of 

African American culture have created in order to speak the truth 

about African American traumas. Specifically, Sula explores 

ironic interpretations of Christian stories as a means of viewing 

oppressive narratives through satire. Eva and Plum’s relationship 

ironically reflects the story of Rizpah, a biblical mother whose 

sons were hanged unjustly. Rizpah, a concubine, was forced to 

sleep with her husband’s friend; however, because this made her 

an adulterer, her sons were hanged (New International Version, 2 

Sam. 21.1-9). After her sons were hanged, Rizpah stayed with 

their bodies for nearly a year until they received a proper burial (2 

Sam. 21.10-14). In Eva and Plum’s story, Eva murders her own 

son and immediately retreats back to her room, whereas Rizpah 

watched others murder her children and she stayed with them 

until they were treated with honor and proper burial (Morrison 

48). Eva and Plum’s story reflects a mother who loves her son so 

much that she must put him out of his misery, while Rizpah’s 

story reflects a mother who loves her sons so much that she must 

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put herself through misery in their honor. As the narrative of the 

Bible has been distorted by the oppressor to gain power over the 

oppressed, the story of Eva and Plum has been told by the 

oppressed to illustrate the oppressor’s distortion of African 

American humanity. 

The allusions to Christian lore do not end with Eva and 

Plum. There are numerous instances within Sula that reference 

biblical stories and Christianity as a whole, reflecting the African 

American narrative as oppressors have written it. In fact, within 

the first five pages of Sula, the novel references Christianity as a 

means to create the setting for the story. Sula takes place in 

Medallion, Ohio, in the 1900s. While Sula and Nel live in 

Medallion, their story takes place in an African American 

community within the town: the Bottoms. As Sula notes, the 

Bottoms were born from a white farmer who promised his slave 

freedom and land. The farmer convinced his slave that the land in 

the hills was what God considered “the bottom of heaven,” and as 

such, rather than taking the fertile land in the valleys, the slave 

established the African American community at the top of the 

hills of Medallion (Morrison 5). As the setting is established with 

reverence to the Christian faith, the central idea of the Bottoms as 

a community becomes clear: the narrative the oppressors have 

created is one that is meant to oppress and take advantage of 

African Americans - similarly to the story of Eva and Plum. 

Beyond the Bottoms, Sula alludes to another biblical narrative 

through the relationship between Sula and her mother, Hannah. 

Within the novel, Hannah’s relationship with Sula as a mother is 

conservative - at one point, Sula even overhears her mother say, 

“... I love Sula. I just don’t like her” (Morrison 57). This is 

partially a reflection of the relationship that Hannah had with her 

own mother, Eva, of which Hannah asked, “Mamma, did you ever 

love us?” (Morris 67). In Eva’s response, she asserts that love can 

be represented in many ways; taking care of your children by 

clothing them, feeding them, and providing them shelter is love 

enough (Morris 67, 68, 69, 70). As Eva and Hannah’s relationship 

illustrates, Hannah’s relationship with family and love is 

distorted. However, even more interesting than Hannah’s 

relationship to Sula and Eva is the biblical echo that Hannah’s 

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character has to the Hannah of Christian myth. Hannah, in the 

Bible, was a woman who could not bear a child. She prayed 

endlessly to be able to become pregnant and one day promised 

that if she were to bear a son she would do so in the name of God, 

giving Him all the glory. Hannah, after praying enough, gives 

birth to a son and names him Samuel (1 Sam. 2.1-11). Sula’s 

Hannah does not love Sula in the same way the biblical Hannah 

loves Samuel. The Bible’s Hannah experienced deep anguish and 

heartbreak when she was unable to conceive her child, whereas 

Sula’s Hannah conceived Sula with ease and seemingly took her 

child for granted. The dichotomy between Sula’s Hannah and the 

biblical Hannah serves to represent another ironic commentary on 

the narrative of African American trauma as it is characterized by 

white oppressors. Just as explored with the relationship between 

Plum and Eva, Hannah and Sula’s relationship is defined by a 

lack of humanized love. Within the Bible, both Hannah and 

Rizpah represent the Christian idea of righteousness, wherein 

these women are just and right with God. However, Eva and 

Hannah are evidently sinners in their own right - Eva a murderer 

and Hannah an exploiter of the power of lust. The contrastive 

nature of these characters and their biblical counterparts reflects 

the dehumanization that the African American community faces 

when viewed by its oppressors. The concept of love illustrated 

within Sula’s relationships does not follow the love given 

throughout the Bible, because the oppressive nature of African 

American trauma has stripped away the humanity oppressors give 

to that community. The cycle of trauma within Sula follows the 

ironic couplings of biblical figures to African American 

characters within the novel. As such, the stripping of one’s 

humanity provides for love that is deemed immoral. However, as 

the novel asserts, love cannot follow morality when one’s 

humanity is gone. 

The cycle of dehumanization and its translation to the 

definition of love is one illustration of the cyclical nature of 

trauma and is further evidenced in Hannah’s fate within Sula. As 

her humanity is stripped by a lifetime of oppression, Hannah is 

murdered by her own daughter, Sula, engulfed in a fire (Morrison 

78). Hannah’s death seemingly acts as a result of her inability to 

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love Sula within the confines of righteousness and morality. 

Furthermore, the occurrence of her murder in fire reflects another 

African American trauma rooted in oppression: church and cross 

burnings. A fire has been used as a tool of intimidation and fearmongering 

in the African American community for years - 

particularly, in conjunction with the Christian church. Take, for 

example, the 1963 church bombing in Alabama, where four girls 

were murdered after the church’s service (Carter 62). The event 

represented a major blow to the morale of the civil rights 

movement and added to the trauma of African American 

communities, specifically due to the violent nature of the attack, 

as well as the location of the attack: an African American church. 

Overall, the black Christian church has represented a pillar of 

support and has largely been “considered the heartbeat of the 

African American community” from the very first African 

Americans who were enslaved in the United States (Carter 63). 

The degradation of an institution as integral to the African 

American community’s coping mechanisms as religion reflects 

the inherently traumatic nature of church and cross burnings 

throughout American history. Sula’s affinity with fire in 

conjunction with the historical context of the trauma that it 

represents further illustrates the irony of the novel’s allusions to 

religion. As religion is viewed as an important part of the African 

American community’s coping mechanisms, the perversion of the 

institution through the symbol of fire speaks to the oppression 

African Americans are continually subjected to. This is extremely 

apparent through the first character Sula introduces Shadrack. 

Within the novel, Shadrack is a man who is sent back to 

Medallion, Ohio, after sustaining an injury in World War I 

(Morrison 10). In an effort to cope with the horrors of war and the 

uncontrollable nature of death, Shadrack invents “National 

Suicide Day,” the third day of the year wherein, Shadrack parades 

around the Bottoms, asking all those who would like to commit 

suicide to join him in doing so (Morrison 14). Of course, 

Shadrack never commits suicide; in fact, the day begins to gain a 

following in superstition as the community labels it a holiday and 

a day to be wary of celebrations like weddings (Morrison 16). 

Shadrack’s character represents an interesting interpretation of 

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trauma from his biblical counterpart - Shadrach. The Christian 

story of Shadrach follows a man who, when asked to bow down 

to a king and deny God, refused. Thus, the element of fire is 

introduced as Shadrach was thrown into a fiery furnace (Dan. 3.1- 

30). Yet, the biblical Shadrach escaped the fire unscathed. In the 

bible, Shadrach represents the idea of standing in the face of 

authority in order to do what is right. A person who would rather 

die than bow down to a king or an oppressor. Sula’s Shadrack was 

in the fiery pits of the war, but because he played into the 

oppressor’s game - that is, fighting in a war of freedom for a 

country that did not value his own freedom, likely in a segregated 

cohort - he left with the trauma of the uncertainty of death and the 

hurt of war. Shadrack’s invention of suicide day showcases an 

ironic interpretation of this biblical message. Suicide Day reflects 

Shadrack’s attempt to have the rest of the world stand in the face 

of authority the way he wished he had - Shadrack did not stand 

against fighting a war that was designed to kill him and his 

people. If everyone were to participate in suicide day, he would 

no longer be alone in his trauma - he would be able to experience 

the fire as part of a community of traumatized individuals, rather 

than lamenting about his inability to experience said trauma as an 

individual. Beyond this, Shadrack’s suicide day represents a 

means of control. Shadrack, and the rest of the community, no 

longer have to fear the unknown of death; rather, through suicide 

day, they have control of their own destiny. Taking control 

through the morbid act of suicide alludes to a significant example 

of African American trauma: the Middle Passage. From the early 

1700s through the last days of slavery in the United States, the 

Middle Passage represented “the slaves’ resistance to their 

captivity by way of individual or personal battles against their 

enslavers” (Bly 181). Slaves would come together to mutiny the 

captain’s rule on a ship, fight back against their captors, and even 

jump off of the ships that were transporting them from their 

homeland to the United States (Bly 180). Beyond this, another 

important facet of Shadrack’s characterization comes from the 

Bottoms’ collective agreement to place superstition around a 

holiday born from trauma. The superstitious elements of Suicide 

Day connect the Bottoms back to their African heritage. African 

95

tradition, passed from generation to generation, often focuses on 

the spirituality of superstition as a religious institution (Tagwirei 

25). As such, the trauma that this holiday represents is passed 

through the cycle of trauma throughout the generations, affecting 

each African American in the community. Understanding Suicide 

Day’s representation of both Shadrack’s trauma with war, fire, 

death, and their reflection of the Middle passage are imperative to 

understanding the Bottom community’s acceptance and 

superstitions concerning the holiday. While the events of the 

Middle Passage do not directly affect African Americans today, 

Shadrack’s invention of Suicide Day illustrates the same trauma 

in a new generation as coping mechanisms for the traumas 

African Americans were forced to endure and are continually 

faced with within each generation. Shadrack’s story within Sula is 

reflective of the cyclical nature of cultural traumas through the 

illustration of major African American traumas like the Middle 

Passage and its allusions to the symbolic irony of fire within the 

bible. 

Analyzing Sula through the lens of literary trauma theory 

illustrates the notion that trauma follows a cycle that is passed 

down intergenerationally. Through the repeated use of fire as a 

symbol to convey trauma and ironic allusions to Christian lore, 

Sula asserts that the cyclical nature of trauma continuously 

dehumanizes African Americans and lends itself to the power 

dynamics between oppressors and the oppressed. Themes of 

trauma through death and inequality are thoroughly illustrated 

through Sula’s character relationships, backstories, and 

personalities. Above all, Sula’s exploration of trauma challenges 

the reader to reinterpret the narratives that oppressors have given 

about the oppressed and analyze said narratives to evaluate their 

contribution to the systems of inequality that affect African 

Americans today. 

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Works Cited 

Barnaby, Andrew Thomas. "Coming Too Late: Freud, Belatedness, and 

Existential Trauma." SubStance, vol. 41, no. 2, 2012, pp. 119-38. 

Bly, Antonio T. "Crossing the Lake of Fire: Slave Resistance during the Middle 

Passage, 1720-1842." The Journal of Negro History, vol. 83, no. 3, 

1998, pp. 178-86. 

Carter, Carolyn S. "Church Burning in African American Communities: 

Implications for Empowerment Practice." Social Work, vol. 44, no. 1, 

1999, pp. 62-8. 

Gobodo-Madikizela, Pumla. Breaking Intergenerational Cycles of Repetition - 

A Global Dialogue on Historical Trauma and Memory. Opladen; 

Berlin; Toronto: Verlag Barbara Budrich, 2016. 

Hirth, Brittany. "Unclaimed Experience: Trauma, Narrative, and History by 

Cathy Caruth." Canadian Review of Comparative Literature / Revue 

Canadienne de Littérature Comparée, vol. 45, no. 2, 2018, pp. 345-8. 

Morrison, Toni. Sula. New York, Vintage Books, 2004. 

Tagwirei, Cuthbeth. "The "Horror" of African Spirituality." Research in African 

Literatures, vol. 48, no. 2, 2017, pp. 22-36. 

The Bible. New International Version, Biblica, 2011. 

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Letter Knowledge: Effective Pedagogical Practices for 

Implementation in the Classroom 

Regan Goodchild 

In early literacy development, letter knowledge is crucial. 

Letter knowledge is the ability to identify letter names, letter 

sounds, and how to form letters. While letter knowledge appears to 

be easy to learn, it is “exceedingly complex” (Kaye, E.L. & Lose, 

M.K., 2019, p. 609). It takes a lot of time and attention from the 

teacher in order to understand how to properly assist the student in 

their learning. Despite the fact that it can be time consuming, it is 

vital that teachers spend the necessary time creating effective 

lessons for their classes. “Children’s knowledge of letter names 

and shapes is a strong predictor of their success in learning to 

read” (Texas Education Agency, 2018). While letter knowledge 

may vary from student to student, in terms of how much they 

know, it is an essential part of the child’s literacy development and 

ability to understand reading and writing. Therefore, teachers need 

to ensure that they are teaching lessons that incorporate multiple 

aspects of letter knowledge and meet the needs of every student in 

the classroom. Additionally, the knowledge of letter-sound 

associations, or to match a letter to the correct sound, directly 

correlates to the ability to sound out and spell words (Dougherty 

Stahl, Katherine A., 2014, p. 261). Without these foundational 

skills, the students will be highly disadvantaged in their later 

schooling. This is why the teacher's ability to implement effective 

teaching practices in the classroom heavily influences how 

effectively a student will be able to read and write in the future. 

Since letter knowledge is such an important aspect of 

developing reading, writing, and speaking skills, there are many 

strategies that have been created to assist in teaching letter 

knowledge, or alphabetic principle, in the classroom. However, it 

is critical that the teacher “themselves be aware of speech sounds 

and how they differ from letters” in order to effectively teach the 

material to their classes (Learning First Alliance, 2013). If the 

teacher is not knowledgeable about the material they are trying to 

teach, every strategy will be rendered ineffective. The teacher 

needs to be able to teach the material correctly as well as looking 

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for the “best practices for teaching reading and writing” skills 

(Shanahan, 2018). It is important to consider multiple factors 

before implementing strategies in the classroom. Effective and 

efficient teaching practices, in regard to letter knowledge, can help 

expand the literacy comprehension of every student (Dougherty 

Stahl, Katherine A., 2014, p. 265). As a teacher, it is important to 

plan lessons that focus on the essential skills related to letter 

knowledge. While the teacher can create their own lesson plans, 

there are methods that assist the teacher in creating effective 

lessons for all of their students. Enhanced Alphabet Knowledge 

instruction (EAK) is a practical method of instruction “that early 

childhood teachers can use to organize, plan, and teach the 

essential skills of alphabet knowledge” (Clark, S. K., Jones, C. D., 

& Reutzel, D. R., 2012). Additionally, it is important to implement 

strategies, within this framework, that are effective for every 

student. 

While there are a lot of different strategies available, not all 

of them are effective for every student when it comes to learning 

letter knowledge. The teacher must use their knowledge of the 

content to implement effective lessons that are meeting the needs 

of every student in the classroom. EAK provides guidelines to help 

teachers develop effective lessons while allowing them the 

freedom to use the strategies that they like the most. Three 

effective teaching practices that can be used to teach letter 

knowledge, within the framework of EAK, include singing the 

alphabet, the own name advantage, and implementing small 

groups. These strategies help the teacher provide appropriate 

instruction that will promote the student's knowledge of letters and 

letter sounds. Teachers need to have mastery of the content, as 

well as, effective strategies so they can create comprehensive 

lessons that advance the students’ understanding of letter 

knowledge. Through the EAK framework, there are three practices 

that encompass a large portion of the instructional cycles. These 

practices are singing the alphabet, the own name advantage, and 

implementing small group instruction. By using these practices in 

the classroom, the teacher can create effective, efficient, and 

practical lessons that help students develop mastery of letter 

knowledge. The strengths of the EAK framework are more aligned 

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with contemporary educational research than other strategies that 

are sometimes applied in a classroom setting like the ‘letter a week 

strategy’. 

Critique of a New Letter Each Week 

One letter each week is an instruction strategy where the 

teachers “introduce a new letter or set of letters each day in 

multiple cycles of repeated practice” (Dougherty Stahl, Katherine 

A., 2014, p.263). Many of the articles argue that teaching one 

letter each week is not an effective teaching practice. According to 

Kaye, one letter a week forces some students to spend weeks or 

months unnecessarily learning letters that they are already 

proficient in (p. 601). This method is so harshly critiqued because 

it does not provide every student with the knowledge they need to 

successfully use their letter knowledge in reading and writing. It is 

pivotal to the student’s development of letter knowledge that they 

are not spending essential class time learning skills that they have 

already mastered which creates a major drawback in the 

application of the ‘new letter’ strategy. 

This strategy focuses equal time on every letter in the 

alphabet. However, each student learns at a different rate, so this 

does not allow the teacher to differentiate instruction for each 

student. While this strategy does incorporate aspects of the 

effective methods also applied within the EAK framework, it 

negates all of the parts that make those activities effective 

strategies for teaching letter knowledge (Dougherty Stahl, 

Katherine A., 2014, p.263-264). For example, this strategy 

incorporates the traditional alphabet song, ABC’s, so students are 

not as familiar with the letters in the middle of the alphabet as a 

result. Students remember the beginning (a, b, c) and ending (x, y, 

z) of the alphabet better than they remember the middle, therefore, 

this strategy reinforces the letters that they already know instead of 

teaching them unfamiliar letters (Dougherty Stahl, Katherine A., 

2014, p.263-264). In addition, this strategy integrates the own 

name advantage practice, like the EAK strategy does, into one 

instructional cycle. While the own name advantage is an effective 

teaching practice within the EAK framework, the way it is used in 

tandem with the new letter a week strategy nullifies its 

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effectiveness. For the own name advantage practice within the new 

letter a week strategy, they only teach students the initial letters of 

each students’ name in the class (Dougherty Stahl, Katherine A., 

2014, p.263). As a result, they are relearning letters that they 

already have mastery of instead of learning the sounds and names 

of unfamiliar letters. Additionally, it is ineffective to only teach the 

initial letter sound and name for each student's name in the class 

because the teacher is likely to have multiple students with the 

same initial letter. So, students are possibly not learning any new 

information and are being taught letters that they have already 

mastered. It is exceedingly important for teachers to think 

critically about the strategies they are using in the classroom and 

the methods that they are using to teach them. 

Methods such as Enhanced Alphabet Knowledge instruction 

can help the teacher develop practical instruction that incorporates 

all of the effective aspects of the methods introduced. Since EAK 

provides support for teachers and students, as well as, flexibility to 

tailor instruction to each individual student, it is more effective 

than the traditional strategy of teaching one letter a week. The new 

letter each week strategy does not allow for assessment of student 

progress, differentiation, and specialized instruction, whereas 

strategies within the EAK framework utilizes practices that better 

implement these necessary aspects of teaching letter knowledge 

within the classroom. 

Singing the Alphabet 

The first teaching practice is singing the alphabet. Singing 

alphabet songs contributes to student understanding of the 

alphabetical order (a fundamental part of the EAK instructional 

cycle). Letter knowledge is taught primarily during early 

childhood education and K-2 in elementary school. It is important 

to make sure to use strategies that are fun and creative for this 

early age group, so the students remain engaged and stimulated. 

Singing is a great way to maintain the attention of students. 

Additionally, the songs utilize repetition, so students have a harder 

time forgetting the letter names or sounds (ModelTeaching, 2020). 

Songs provide students with an easily accessible reference to go 

back to and allow them multiple opportunities to practice their 

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letter knowledge in a plethora of settings. The most effective way 

to teach alphabet, or letter knowledge songs, as a method is to 

ensure that the songs are being taught slowly. This allows the 

students the opportunity to really pronounce each letter and make 

sure they are not jumbling the letter names and letter sounds 

together (Letter Knowledge, 2012, p. 2). Additionally, singing 

different songs allows for children to become familiar with a 

variety of letters and not just the ones at the beginning of the 

alphabet. When singing or referencing the traditional alphabet 

song, you start with ABC, so children develop more familiarity 

with those particular letters (Piasta, Shayne B., 2014, p. 204-205). 

However, teachers can implement a variety of songs to provide the 

students with opportunities to learn about other letters and letter 

sounds in the alphabet. It is more effective to teach them letters 

they do not already know and to refresh their memory for letters 

they are very familiar with. This is why it is important for the 

teacher to teach a variety of songs in the classroom so students are 

regularly exposed to every letter in the alphabet, offering 

reinforcement for the letters students do not know as well. 

Teachers may also create songs or chants about the student’s 

names and combine two teaching strategies, singing songs and 

own name advantage, bridging aspects of the EAK framework. 

The whole class can chant everyone’s names and, that way, they 

are practicing letters they already know, learning new letters, and 

learning the names of the other children in the class. The great 

degree of flexibility and commensurability with other teaching 

techniques that singing the alphabet offers makes it a cornerstone 

strategy within the EAK framework that I advocate for within this 

paper. Singing the alphabet uses prior knowledge of letters, 

repetition, and engaging lyrics to encourage students to practice 

their letter knowledge. Similarly, the own name advantage uses 

prior knowledge to help students understand letter names and 

sounds that are new and unfamiliar to them. 

Own Name Advantage 

The second cornerstone of the EAK teaching strategy is 

called the ‘own name advantage’. The own name advantage is a 

method where teachers create lessons related to learning the letter 

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names and sounds for the letters in the students’ name. Early in 

their language development, many children learn the sounds and 

names of letters in their name (Dougherty Stahl, Katherine 

A., 2014, p. 263). This method is considered effective because it 

uses the student’s prior knowledge to develop their letter 

knowledge skills. This can be used to the teacher’s advantage. 

Since students are more likely to know the letters and letter sounds 

in their own name, the teacher can determine what letters the 

children already know and what they still need to learn. Therefore, 

this strategy is an effective assessment tool for the teacher to use. 

By assessing each students’ current knowledge of letter sounds 

and names, they can begin teaching them letters they have not yet 

learned. As a result, the teacher can ensure that the focus remains 

on teaching students less internalized letter names and sounds. 

This method helps teachers determine where they need to direct 

the lesson content and what they can review but not focus the bulk 

of their attention on. The own name advantage method is also 

“highly motivating and responsive to young students’ 

developmental needs for constructing self-identity in the 

classroom” (Clark, S. K., Jones, C. D., & Reutzel, D. R., 2012). 

The development of self-identity occurs as students share their 

name with everyone in the class and learn about what the letters in 

their name are called and what sounds they represent. Creating an 

environment where students are comfortable with their names, and 

the names of their classmates, helps the student develop mastery 

over recurrent letters and decoding those letters in words. 

Additionally, teaching strategies like the own name advantage can 

lead to teaching more complex strategies like word-recognition. 

The students will become familiar with certain letter sounds and 

word patterns by looking at the names of students in the class and 

this can help them develop skills related to word recognition 

(Chard, D. J., & Osborn, J., 2018). This practice is effective 

because children are more likely to know the initial sound in their 

name, especially when it is consistent with the letter sound. For 

example, a student named Jessica is more likely to know the letter 

/j/ than a student named Joaquin because of the difference in 

pronunciation (Dougherty Stahl, Katherine A., 2014, p. 263). 

Additionally, children are likely to learn how to write their name 

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efore learning other words in the English language. So, they will 

be more proficient in letter knowledge related to letters in their 

name than unfamiliar words. The children are losing time on their 

in-class learning if they are repeatedly being taught letters they 

already know the name and sound of. Thus, the own name 

advantage is an effective practice in the classroom since it helps 

narrow down what the children need to learn and what they 

already know. Once the teacher has a solid understanding of where 

each student is in their development, they can organize students in 

small groups to help them work on letters they still need more 

assistance learning. 

Small Groups 

The final teaching practice is implementing the use of 

small groups into the classroom. Small groups are an effective way 

to teach letter knowledge because the groups can be divided by 

what the students need to learn. Within the framework of EAK, 

this form of instruction allows the teacher to help students in any 

step of their instructional cycle (Clark, S. K., Jones, C. D., & 

Reutzel, D. R., 2012). Additionally, “small-group differentiated 

instruction that is based on the letter names, letter sounds, and 

phonological awareness of children” is more time-efficient and 

effective when teaching letter knowledge (Dougherty Stahl, 

Katherine A., 2014, p. 263). By introducing small group 

instruction, teachers can spend less time teaching letters to the 

whole class that some students might already know. More time can 

be spent teaching each student the material necessary to continue 

learning and not continually teaching them letters students have 

already internalized. This method also fills gaps within the 

curriculum so the teacher ensures they are not accidentally 

forgetting to teach a letter that the students do not already know. 

In addition to allowing the students to learn letter 

names and letter sounds they are unfamiliar with, it also provides 

them with focused instruction (Kaye, E.L. & Lose, M.K., 2019, p. 

603). Teachers focus on a specific game or activity that can help 

the students learn letter knowledge in a more specialized setting 

than when they are learning letters with the whole class. This 

practice provides teachers with the opportunity to meet the needs 

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of students with disabilities or students who are struggling with a 

specific concept. Teachers can create differentiated instruction and 

develop or provide games that are specifically tailored to meet the 

needs of that particular individual or group. Small groups also 

provide the teacher with an opportunity to really pinpoint where 

each student is struggling so they can move to individual or small 

groups for instruction on that problem. Small groups are one of the 

most effective teaching strategies because they provide specificity 

and help the teacher analyze and determine what the needs of each 

individual student are. This contributes directly to the framework 

of EAK because small groups provide flexible instruction for the 

teacher to help students improve letter knowledge skills that they 

are struggling to understand. 

Enhanced Alphabet Knowledge Instruction 

The final teaching practice is implementing the use of 

small groups into the classroom. 

Enhanced Alphabet Knowledge instruction is a research-based 

strategy for practical instruction that early childhood educators can 

use to teach letter knowledge principles efficiently and effectively 

in the classroom (Clark, S. K., Jones, C. D., & Reutzel, D. R., 

2012). Older instruction methods, such as teaching a letter once a 

week, are no longer the most effective way to teach students about 

alphabetic principles. This framework is laid out into two distinct 

parts, “(1) brief, explicit lessons [and] (2) taught through multiple 

distributed instructional cycles” (Clark, S. K., Jones, C. D., & 

Reutzel, D. R., 2012). In regard to teaching brief, explicit lessons, 

the authors of this article recommend that the teacher make the 

lesson approximately 10 minutes long. Additionally, they provide 

templates to help the teacher create explicit lessons that use 

appropriate language for the age of the students. One 

recommendation is to “use the language ‘the sound this letter 

represents’ rather than ‘the sound this letter makes’” (Clark, S. K., 

Jones, C. D., & Reutzel, D. R., 2012). This is recommended 

because it helps separate the lesson from language they might hear 

when being asked to make animal noises. Also, students might not 

understand that a letter “makes” a sound at all. It is important to 

provide clear instruction and reduce the amount of confusion 

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students experience regarding letter knowledge. 

Within the framework, there are six instructional cycles: (1) 

Own Name Advantage, (2) Alphabetical Order Advantage, (3) 

Letter Name-Letter Sound Relationship Advantage, (4) Letter- 

Frequency Advantage, (5) Consonant Phoneme Acquisition Order 

Advantage, and (6) Distinctive Visual Features Letter Writing 

Advantage (Clark, S. K., Jones, C. D., & Reutzel, D. R., 2012). 

Each of these cycles is intended to provide flexible instruction in 

order to meet the needs of every student in the classroom. In 

addition, they allow the teacher to focus on letters that are 

problematic, or more difficult, for the students to learn and do not 

require the teacher to spend equal amounts of time teaching each 

letter. As discussed when introducing the strategies, this 

framework was established so teachers can create lessons that 

assess the students’ current letter knowledge, as well as, create a 

curriculum that provides support to help them learn the letters that 

they are struggling with or have not been introduced to yet. 

Finally, this instructional format gives teachers the freedom to 

teach a letter multiple times (Clark, S. K., Jones, C. D., & Reutzel, 

D. R., 2012). Students are not likely to learn everything at the 

same pace, some may need additional instruction, and the EAK 

method provides teachers opportunities to differentiate instruction 

and teach it multiple times until the students achieve mastery of 

the letter. The one letter a week model, or the traditional model for 

alphabet knowledge instruction, has a more rigid form of 

instructional delivery. Since students are taught a letter over a 

whole week, there is only time for the teacher to teach that letter 

once during the school year. Therefore, any student who does not 

understand the content at the end of the week will likely fall 

behind in their reading and writing once they advance to another 

grade level. 

The Enhanced Alphabet Knowledge instructional method 

corrects the instructional errors that arise from teaching the 

traditional method. The EAK uses practical application in order to 

ensure that every child in the classroom is mastering each letter in 

the alphabet so they can continue to advance their reading and 

writing skills as they move to upper grade levels. The thorough 

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explanations of instructional content, flexibility for the teacher and 

students, and the explicit lesson templates provided allow any 

teacher to provide effective and efficient instruction of letter 

knowledge to their students. 

Works Cited 

Chard, D. J., & Osborn, J. (2018, November 14). Phonics and Word Recognition 

Instruction in Early Reading Programs: Guidelines for Children with 

Reading Disabilities. Retrieved December 12, 2020, from 

https://www.readingrockets.org/article/phonics-and-word-recognitioninstruction-early-reading-programs-guidelines-children-reading 

Clark, S. K., Jones, C. D., & Reutzel, D. R. (2012, June 6). Enhancing Alphabet 

Knowledge Instruction: Research Implications and Practical Strategies for 

Early Childhood Educators. Retrieved December 12, 2020, from 

https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1403&context 

=teal_facpub 

Dougherty Stahl, Katherine A. ( 2014). New Insights About Letter 

Learning, 68( 4), 261– 265. doi: 10.1002/trtr.1320 

Kaye, E.L. & Lose, M.K. ( 2019). As Easy as ABC? Teaching and Learning About 

Letters in Early Literacy. The Reading 

Teacher, 72( 5), 599– 610. https://doi-org.ezp.twu.edu/10.1002/trtr.1768 

Learning First Alliance. (2013). Teaching Phonemic Awareness, Letter Knowledge, 

and Concepts of Print. Retrieved December 12, from 

https://www.readingrockets.org/article/teaching-phonemic-awarenessletter-knowledge-and-concepts-print 

Letter Knowledge . (2012). Teaching Strategies , 1–4. Retrieved from 

https://teachingstrategies.com/wp-content/uploads/2017/03/TS-CC-Letter- 

Knowledge-Report_11-2013.pdf 

ModelTeaching. (2020, January 5). 4 Engaging Strategies to Teach the Alphabet. 

Retrieved April 15, 2020, from https://www.modelteaching.com/educationarticles/teaching-strategies/4-engaging-strategies-to-teach-the-alphabet 

Piasta, Shayne B. ( 2014). Moving to Assessment‐Guided Differentiated Instruction 

to Support Young Children's Alphabet Knowledge. The Reading 

Teacher, 68( 3), 202– 211. 10.1002/trtr.1316 

Shanahan, T. (2018, August 1). Should We Teach Letter Names? Retrieved 

December 12, 2020, from https://www.readingrockets.org/blogs/shanahanliteracy/should-we-teach-letter-names 

Texas Education Agency. (2018, November 14). The Alphabetic Principle. 

Retrieved December 12, 2020, from 

https://www.readingrockets.org/article/alphabeticprinciple#:~:text=Childrens 

knowledge of letter names,words as sequences 

of letters. 

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Sex Work in a Digital World 

Caitlin Guest 

Sexuality is one of the most universal, and yet controversial, 

concepts to ever arise from mankind. Across the world, everyone 

has some sort of opinion about sexuality and morality issues 

relating to it, whether it be celebratory or critical. For some 

reason, a group that has always been looked down upon are sex 

workers of any kind. Despite the world’s innate stake in sexuality, 

sex workers are commonly shamed for their profession, and are 

even treated as “less than people.” In fact, female sex workers are 

60 to 100 times more likely to be murdered in their profession 

than non-sex worker females (Salfati), and many times their 

deaths are either not brought to justice, or even reported, since 

society views dead sex workers as “less dead” (Higgins). 

Something that has completely changed the game for those 

involved in sex work has been the evolution of social media, and 

the ability to incorporate sex work into a digital format. By 

transitioning pornography, “cam sites”, and membership-based 

platforms to the internet, women and men are able to remove 

themselves from the physical dangers that arise from in-person sex 

work, and make money legally and more safely. This paper will 

explore several facets of digital sex work, how they benefit 

creators and consumers, and how societal views have changed 

about the profession of sex work in general. 

NSFW Digital Content 

One major development that has exploded with popularity in 

the past couple of years is the platform OnlyFans, a membershipbased 

platform accessible through the application Twitter. The 

creator of the site, Tim Stokely, says the site was created “as a 

platform for influencers to directly monetize their content. The 

platform [is] similar to Instagram or Twitter except fans [have] to 

pay a monthly subscription to view influencers’ content and 

interact with them” (Bernstein). Essentially women (and a fair 

amount of men as well) will promote their private OnlyFans 

account on their social media platforms, most commonly Twitter, 

but even on Instagram, Reddit, and Facebook as well. Users who 

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pay the fee gain access to whatever content the influencer desires 

to post, which is frequently suggestive or pornographic material. 

While this may seem vaguely immoral, it actually provides a way 

for sex workers to create their own original, ethical content, and 

capitalize off of it so that they are able to sustain themselves. This 

is far better than previous alternatives, in which women like 

Chanel Santini have been belittled and degraded on pornographic 

scenes and shoots, and conversely are now “pulling in tens of 

thousands of dollars every month just posting content online” 

(Bernstein). OnlyFans is now one of the most popular, and 

arguably safe, ways for everyday people to get involved into sex 

work without too much danger to themselves. This is a significant 

win for all that have ever been involved with the previously very 

dangerous world of sex work, because this platform gives content 

creators autonomy and financial stability in a field that has been 

notorious for its risks in both areas. 

Another area of sex work that has become a hot button issue 

is the ethical creation and use of pornography. The porn industry 

has actually been long criticized for its “serious issues in relation 

to consent and the treatment of women in porn [including abuse 

and coercion, child abuse and trafficking]. (Brinkhurst-Cuff) So 

how does that get fixed? People against the pornography industry 

have always called for the complete eradication of porn, but that 

just simply isn’t realistic. The demand for pornographic content 

has always and will always be present, so getting rid of the 

industry as a whole is impractical at best. Instead, the pornography 

industry needs to be reformed to a point which content is always 

ethically sourced and produced. Now, what is ethical porn? 

Ethical pornography is created legally, with all adult parties 

having consented without coercion, appropriate work/pay 

conditions for actors, and is aligned with feminist ideals. 

According to Patrick Ryan from USA Today, based on his 

interviews with several female porn directors, “key characteristics 

of feminist porn include clear verbal consent, sex positivity and 

inclusive casting of women that encompasses different ages, body 

types, races and ethnicities” (02D) A prime example of a feminist 

pornography site is Bellesa, a site created by women with sex- 

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positive content for women. The site even has “erotic stories 

submitted by community members, feature articles about powerful 

women influencing the industry, sex education, politics, and 

culture” (Danger) The essence of all of that means this: ethical 

pornography benefits both creators and consumers of the industry 

by realigning its values to a more moralistic standard for 

everyone. 

Let’s Talk About Sex, Baby! 

As mentioned in the introduction of this paper, societal 

perceptions of sex work have always been broadly distributed. 

There are many that are against the industry for moral or religious 

reasons, and these people typically also raise their children to also 

be against it. There is absolutely nothing wrong with having moral 

convictions that get passed on from generation to generation, but 

the issue in this case lies on the grey line between abstinence-style 

sex education and the unrealistic and harmful sexualization that 

can occur in media. In an interview with Peggy Orenstein about 

her book, Girls & Sex: Navigating the Complicated New 

Landscape, in which Orenstein conducted interviews of several 

teenage girls of diverse backgrounds, Orenstein discusses the 

affects of social media and pornography on the way girls think 

about and experience their own sexuality. She mentions that “the 

porn industry, the occasional feminist porn site aside, is selling a 

distorted vision of not only female bodies, obviously, but female 

sexuality. It eroticizes humiliation, it eroticizes degradation, and 

that gets normalized for kids who are watching it, so they begin to 

want to act out what they're seeing in porn in their intimate 

relationships” (L1) This circles back to the call for feminist 

pornography sites to become the norm. Currently, the norm in 

pornography is content that is created for the “male gaze,” which 

makes sense when one learns that roughly three-quarters of users 

on industry dominating sites like Pornhub identify as male. This 

creates a skewed perception of sexuality that then gets instilled in 

the brain and reenacted in personal life. Certainly, people under 18 

are not technically allowed to use pornography sites, but the fact 

of the matter is that teens do use the sites, no matter what the 

restrictions are. This means the sites either need to restructure 

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their accessibility, or they need to reform their content so that it is 

less damaging to consumers of any age. The flip side of the coin is 

when youth are kept completely in the dark from any sexual 

content in their lives. This creates a generation of people that 

either have very little knowledge of safe sex, or have to seek it out 

through sites that, as mentioned before, are not yet great examples 

of safe and healthy intercourse. The balance lies in the spread of 

information about healthy sex through the source that the majority 

of the world has some access to: social media and entertainment. 

Sex work is the world’s oldest profession- so why are this 

many people so uncomfortable with it? This paper has already 

discussed the dangers that in-person sex workers face, and the 

injustices don’t stop there. Nearly every person in sex work has 

experienced some kind of harsh judgement or criticism from the 

world outside of the sex work community, and yet, literal billions 

of people all over the world are consumers of sex work, simply 

based on the statistics related to pornography use. The answer 

comes from the concept of “forbidden fruit,” referenced in the 

Bible itself. When people, particularly teenagers, are told that 

something is against the rules, it only creates more of an interest 

or desire for the forbidden item or activity. If society continues to 

postulate the idea that sex is a taboo subject, it will only fuel the 

desire to seek out sexual content, and may even reinforce facets of 

sexuality that really are taboo. Kenneth Weingardt mentions in his 

article in the journal Addiction that if social perceptions about 

pornography change, then perhaps individuals that experience 

moral judgement may get some reprieve, and rates of porn 

addiction may be reduced (507). Exposure to healthy and ageappropriate 

sexual content in social media and entertainment may 

be the key to eradicating this issue. 

Just like politics, the world will never be in complete 

agreement on any one issue, let alone a controversial one such as 

sex work. Nevertheless, since technology has advanced so much 

in the past couple of decades, sex work has in turn made headway 

as well, and it is important to both recognize both the positive 

changes that have come about, and changes that still need to be 

made. So-called ‘adult content’ is unavoidable in many aspects of 

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life, and now society needs to take the opportunity to make this 

content more moral, educational, and ethical through the tools and 

technology present. Social media may not be around forever, but 

the lasting impact of the content that was shared through it might 

influence generations to come, so it’s time to start being 

proactive. 

Works Cited 

Bernstein, Jacob. “The Paywall of Porn.” New York Times, vol. 168, no. 58234, 

10 Feb. 2019. EBSCOhost, 

search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=13462095 

4&site=ehost-live. 

Brinkhurst-Cuff, Charlie. “In Praise of Ethical Porn.” New Statesman, vol. 147, 

no. 5407, Feb. 2018, p. 17. EBSCOhost, 

search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=12821757 

1&site=ehost-live. 

Danger, Danni. “What Is 'Porn for Women?'.” The Daily Dot, 13 Aug. 2020, 

www.dailydot.com/nsfw/reviews/bellesa/. 

Higgins, Alia. “Ignoring the deaths of marginalized groups aids serial killers.” 

The Daily Campus, 2 March 2020, 

dailycampus.com/stories/2020/3/1/ignoring-the-deaths-ofmarginalized-groups-aids-serial-killers. 

MacWhirter, Sarah and Orenstein, Peggy. "(Sex) lives of girls and women." 

Globe & Mail [Toronto, Canada], 28 Mar. 2016, p. L1. Gale In 

Context: Opposing Viewpoints, https://link-galecom.northcenttexascollegelibrary.idm.oclc.org/apps/doc/A447638837/ 

OVIC?u=txshracd2531&sid=OVIC&xid=f7fcfb3f. 

Ryan, Patrick. "Can porn be feminist? These female directors say 'yes'." USA 

Today, June 2017, p. 02D. Gale In Context: Opposing Viewpoints, 

https://link-galecom.northcenttexascollegelibrary.idm.oclc.org/apps/doc/A494782268/ 

OVI 

Salfati, C Gabrielle et al. “Prostitute homicides: a descriptive study.” Journal of 

interpersonal violence vol. 23,4 (2008): 505-43. 

doi:10.1177/0886260507312946. 

Weingardt, Kenneth R. “Commentary on Grubbs et al. (2018): Coming out as a 

Pornography User—could Societal Acceptance Decrease the 

Prevalence of Perceived Addiction?” Addiction, vol. 113, no. 3, Mar. 

2018, pp. 507–508. EBSCOhost, doi:10.1111/add.14104. 

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Survey of the Nutrition Counseling and Dietitian Referral 

Practices of Pediatricians in the Dallas-Fort-Worth Area 

Brandon Kelley 

Abstract 

The 2012 Medicaid Childhood Obesity Prevention Pilot 

Final Report to the Texas Legislature cited pediatricians’ lack of 

interest and referrals as one reason the pilot failed. Studies 

suggest physicians feel their patients would benefit from 

dietitian’s nutrition counseling but have low referral rates. This 

suggests there are barriers to referring patients to dietitians. To 

identify nutrition counseling resources used by pediatricians and 

barriers pediatricians experience when providing nutrition 

counseling and referring patients to dietitians. In this crosssectional 

study, an internet-based survey was administered to 

obtain qualitative and quantitative data about nutrition counseling 

and dietitian referral practices. Participants (n=11) were surveyed 

via a link sent to pediatricians in the Dallas-Fort Worth area (50- 

mile radius). Frequencies were calculated for demographics, 

referral and counseling practices, other pediatrician 

characteristics, and Likert response questions. Qualitative 

analysis included description and summarization of open-ended 

responses. Pearson’s Chi Squared correlations assessed the 

relationship between physician characteristics and referral 

practices. Over half (~54%) of pediatricians reported rarely 

referring patients to dietitians, and ~82% felt there are barriers to 

referrals. Barriers included dietitian-specific barriers such as a 

lack of local or pediatric dietitians in the area (55%) and familyspecific 

barriers (44%) such as finances. Most pediatricians 

(54%) rarely refer new patients to dietitians, but some (36%) 

would prefer the referrals over providing nutrition information 

themselves, even though most pediatricians (72%) are extremely 

comfortable with discussing nutrition or weight issues with 

patients. Responses indicate pediatricians’ barriers to providing 

nutrition counseling or referring patients to dietitians is not due to 

a lack of interest on the pediatrician’s part. Rather, the barriers 

relate to local availability or specialty of dietitians or to 

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perceptions that families will not follow-up with referrals due to 

cost or added inconvenience. 

Introduction 

Obesity was declared a disease by the American Medical 

Association in 2013, meaning more efforts in the American 

healthcare system are needed to reduce the growing obesity 

epidemic. Obesity is often measured using Body Mass Index 

(BMI), which is a calculation based on weight and height. For 

adults, a BMI of greater than 30 is classified as obese; children 

are classified as obese if they meet or exceed the 95 th percentile 

for BMI for age. 1,2 In 2011, the Behavioral Risk Factor 

Surveillance System suggested adults in the United States had a 

median obesity percentage of 27.7% prevalence, with Texans 

having a 30.4% prevalence. 3 In 2018, the obesity prevalence 

across the United States rose to 30.9%, and in Texas rose to 

34.8%. 3 In 2001, the Youth Risk Behavior Surveillance System 

suggested prevalence for childhood obesity across the United 

States was 10.4% and was 14% in Texas. 4 In 2017, the 

prevalence of childhood obesity across the United States 

increased to 14.8% and in Texas increased to 18.6%. 4 So 

although obesity was declared as a disease in 2013 by the 

American Medical Association, the prevalence is increasing 

instead of decreasing, suggesting a failure of the current 

healthcare model to mitigate the issue. 

The increasing obesity rate in Texas even encouraged the 

state legislature to try to curb the obesity epidemic with a Texas 

Obesity Prevention Pilot Program in 2009. 5 The Obesity 

Prevention Pilot Program’s was to investigate the potential costeffectiveness 

and efficacy of using primary care providers to 

increase physical activity and improved diet. Methods included 

nutrition classes, physical activity opportunities, educational 

materials, visits to fruit and vegetable stands, fitness sessions, 

nutrition lectures, cooking demonstrations, one on one coaching, 

etc. 5 In addition, the Texas Pediatric Society (TPS) developed 

an Obesity Toolkit on their website to help “aid pediatric 

practitioners in the prevention, early recognition, and clinical 

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care” of children or adolescents that are battling issues with 

excessive weight or obesity. 1 The Texas Obesity Toolkit is 

heavily based upon the 2007 TPS Nutrition and Health 

Committee recommendations and is periodically updated to 

reflect current American Academy of American Pediatrics (AAP) 

guidelines. 1 Included in the Obesity Toolkit was a four-stage plan 

for physicians to use in treating obesity in children. The first 

stage suggested by the TPS is primary prevention. The primary 

prevention stage includes factors such as considering the family’s 

“current behaviors, cultural values, financial situation, and family 

functions and schedules” and includes working on step-based 

behavior modification. 1 The second stage for treating overweight 

or obese patients is structured weight management and includes 

healthcare staff trained in behavioral change techniques, eating 

plans provided by a physician trained in nutrition or by a 

registered dietitian and possibly referrals to counseling or 

therapists for the family. 1 In addition, it is suggested that 

physicians would “benefit from developing a referral/resource 

list. 1 ” 

However, although the TPS suggests physicians utilize 

referrals to registered dietitians, there may be barriers revolving 

around making the referrals. Unfortunately, the Obesity 

Prevention Pilot program was cited as a failure due to low 

enrollment numbers and inconsistent data. One cited reason for 

its failure was a “lack of interest” from physicians on enrolling 

patients into the program. 5 Due to the ‘lack of interest’ of 

physicians referring their patients to an obesity prevention 

program, further research is needed to understand the nutritional 

counseling and practices of pediatricians, and why they may not 

have made referrals. 

Nutrition counseling is undoubtedly time-consuming, and 

physicians must deal with a multitude of health issues, not just 

nutrition during each visit. In contrast, registered dietitians’ entire 

scope of practice revolves around nutrition education and 

intervention. Although there are some Texas-wide and countrywide 

surveys of physicians’ attitudes towards dietitians, there 

seems to be a gap in data concerning pediatricians. Initial studies 

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have included questions concerning the time that physicians feel 

they have to practice. In 2018, the Physicians Foundation 

conducted a study of 8,774 physicians, and results suggested that 

in 2018, 55.6% of physicians felt they were at “full capacity.” 6 

Almost twenty-four percent felt they were overextended and 

overworked, and only 20.5% felt they had time to see more 

patients or assume more duties. 6 The Physicians Foundation 

study also suggested that the average number of patients that a 

physician sees is ~20 per day. 6 So there is a possibility that with 

an average of 20 patients per day, a majority of physicians may 

be at full capacity with patient load and time. 

Previous studies of adult physicians suggest that 

they might be open to using dietitians. A 2017 study of 

Washington D.C-based physicians received responses from 240 

physicians concerning their attitudes towards registered 

dietitians. 7 The study suggested that 86.1% of physicians thought 

their obese patients could benefit from being referred to a 

registered dietitian. 7 Only 18% always referred their obese 

patients; yet, 42.1% felt that their practice would benefit greatly 

if they employed a registered dietitian on their staff. 7 A 2018 

study in Huntington, West Virginia, surveyed 38 physicians 

regarding barriers to nutrition counseling. 8 In this study 30 

physicians cited time constraints, and 14 physicians suggested 

that the patient’s lack of interest in nutrition topics were the 

biggest barriers to nutrition counseling. 8 Based off of these two 

studies, an overwhelming majority of physicians believe a 

dietitian referral would be beneficial, in addition to the benefits 

of employing a dietitian on site, yet there are few referrals made 

to dietitians. Although time constraints would be a barrier 

towards physicians providing nutrition counseling, the studies 

suggest that physicians also believe there may be barriers in 

patient compliance. 

The 2018 study in West Virginia suggested that patients 

were not interested in nutritional topics, which may be partially 

explained by two small studies. A study from 1994 surveyed 

26 overweight people on their attitudes towards physicians and 

dietitians. 9 All 26 participants stated that they did not want to 

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eceive diet sheets or low calorie recipes because they knew what 

to eat and did not want to be told to eat salad. 9 Concerning 

physical activity, patients know that they need to exercise but 

find an excuse not to. In addition, food texture was extremely 

important and had to be enjoyable. 9 In contrast, a 2006 study at 

an outpatient internal medicine resident continuity clinic in the 

Bronx, New York suggested that out of 42 patients, 64% wanted 

a referral to a dietitian, but 62% also held the belief that the 

physician can help with weight loss. 10 The 1994 study suggests 

patients may be resistant to certain nutrition counseling. The 

2006 study suggests that patients actually want to see a registered 

dietitian, but regardless, still believe their physicians are 

competent to provide nutrition information. 

A 2016 study surveying physicians found that out of 54 

respondents, 70% of physicians usually/always see patients who 

require nutrition education, yet only 46% of physicians 

usually/always will talk to their patients about nutrition. 11 

Seventy-four percent of physicians are somewhat confident in 

their nutrition knowledge, while 11% are not at all confident. 11 

However, 35% never/rarely refer their patients to registered 

dietitians, 48% will sometimes refer their patients, and only 17% 

usually / always refer their patient to registered dietitians. 11 This 

study suggests that although a majority of patients could use 

nutrition counseling, there is a disconnect between how 

frequently physicians will refer their patients to dietitians and 

how frequently the physicians feel the patients could benefit from 

nutrition counseling. 

Thus, it appears as if patients want to be referred to a 

registered dietitian, but equally feel confident that physicians can 

help them too. A majority of the time, physicians appear to see 

patients that could benefit from receiving nutrition information 

and are also somewhat confident in their ability to provide that 

information, while a large percentage of physicians rarely refer 

patients to dietitians. Insufficient data has been published about 

how likely pediatricians are to provide nutrition counseling to 

their patients, refer them to dietitians, or how comfortable they 

are with either practice. Children are a unique population who 

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- 

rely on their caregivers for healthcare visits and many diet or 

lifestyle choices. Pediatricians’ counseling is not directed solely 

to the child since it also requires the participation and 

involvement of the caregiver as well. As a result, the barriers that 

may usually be present in adult counseling may or may not be 

present in pediatric counseling. Thus, the purpose of this study 

was to survey local pediatricians to determine their nutrition 

counseling practices, dietitian referral practice, and barriers to 

both. 

Methodology 

Design and Participants 

This Internet-based survey was targeted towards practicing 

pediatricians within a 50-mile radius of the Dallas-Fort-Worth 

area. The purpose of the survey was to determine the following: 

• How often do pediatricians provide nutrition counseling on 

weight to their own patients? 

• How comfortable are pediatricians with providing nutrition 

counseling on weight? 

• What resources do pediatricians use for nutrition 

counseling, and how satisfied are pediatricians with those 

resources? 

• How often do pediatricians refer to dietitians for nutrition 

counseling? 

• What barriers to referral do they experience? 

• Are any pediatrician demographics or practice 

characteristics correlated with referral likelihood? 

The survey was developed by the nutrition student in 

consultation with a nutrition faculty member. It was piloted 

with a pediatrician who provided feedback to make it easier to 

read. Then it was administered via PsychData (State College, 

Pa). A link to the PsychData survey was sent to pediatricians 

via email and could be taken on the pediatrician’s own device. 

No mailing list from pediatrician groups were provided, so the 

survey was sent out to numerous pediatrician individuals, 

businesses, and pediatrician organizations. No incentives were 

provided for completing the survey. 

The survey was organized in a multipage format. The first 

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page provided the introduction and overview of the survey, 

including agreement to participate, confidentiality, 

risks/benefits, consent, and contact information. The survey was 

reviewed and approved by the Institutional Review Board at 

Texas Woman’s University. The next two pages each had one 

screening question to confirm that the participant was a 

pediatrician, and that he/she practiced within a 50-mile radius 

of DFW. Next, pediatricians were asked about the average 

number of patients seen per day, average length of patient 

consultations, and average percentage of overweight or obese 

patients seen per day. Next, an open-ended question asked the 

pediatrician to list nutrition resources used. A question using a 

five-point Likert scale asked about satisfaction with resources, 

comfort level with discussing weight related questions, and 

frequency of discussing weight-related diseases with 

overweight or obese patients Next pediatricians were asked two 

open-ended questions. The first question asked pediatricians to 

describe their preferred method of providing nutrition 

information. The second question asked them to describe any 

possible barriers when discussing nutrition or weight issues 

with patients or their families. The third page asked about how 

frequently the pediatrician referred to dietitians and what 

barriers in making referrals were experienced. Finally, 

pediatricians were asked about their demographic factors and 

practice characteristics. 

The results of the survey were downloaded from Psych Data 

in Microsoft Excel format. An SPSS Pearson Chi Squared 

analysis was performed to assess the relationship between 

pediatrician demographics and practice characteristics and 

referral practices. Frequencies were determined for Likert 

scored questions. The open-ended question responses were 

analyzed, then summarized and compared across other question 

metrics. 

Results 

Pediatricians and Their Patients 

In total, 13 pediatricians began the survey, but three 

respondents did not finish the survey. However, one respondent 

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completed the questions up until the pediatrician demographics 

(Table 1), so the data was included in the analysis. The other 

two respondents only partially completed the survey and did not 

complete any short answer question, so the data was excluded 

from the analysis. Thus, 11 respondents’ data was included in 

the analysis (n=11). The majority of pediatricians were female 

(70%) and operate in private practice (70%). The ages of the 

pediatricians was evenly split between the 31-45 and 46-65 age 

ranges. Most pediatricians have been practicing medicine for 21 

years or more (40%) followed by 6-10 years (30%). 

When asked about their patients and practice (Table 2), 

seven pediatricians reported seeing “more than 20” patients in 

an average day and two of these pediatricians have an average 

patient consultation time of “less than 10 minutes” with the rest 

having an average of “10-20 minutes.” Two pediatricians that 

saw an average of “6-10 patients” spent “more than 20 minutes” 

on their patient consultations. For the two pediatricians with an 

average of “11-15 patients” per day, one had an average patient 

consultation of “10-20 minutes” and the other “more than 20 

minutes.” 

Of the six pediatricians who answered that an average day 

has “21-40%” of overweight or obese patients, four stated their 

average consultation length was “10-20 minutes” and two of the 

responses said their average consultation length was “less than 

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10 minutes.” Of the two pediatricians who answered with an 

average of “61-80% of overweight or obese patients, one 

pediatrician had an average consultation length of “more than 

20 minutes,” and the other pediatrician had an average patient 

consultation time of “10-20 minutes.” 

Pediatricians’ Nutrition Resources and Counseling 

The first open-ended response asked the pediatricians to list 

any resources they use to provide nutrition information to 

patients. There were seven responses that listed either the AAP 

itself or their website: healthychildren.org. Four responses 

specifically mentioned the use of handouts or infographics. 

Four responses mentioned other external resources such as the 

Scottish Rite sports medicine handout, the AHA child diet, the 

CHOP CHOP recipe book, and one response that cited multiple 

infographics / resources such as “Choose my plate fruits/vegs 

fun, growing healthy, eat smart, health active families. WIC 

Eat, play, grow Slow, whoa, go 5, 2, 1, 0 hand method for 

portion sizes FDA colorful plate posters.” Four responses 

mentioned various nutritional counseling methods such as the 

discussion of portion size, meal choices, specific foods, reward 

systems or dietary habits. Two responses included the 

discussion of exercise. One response listed the use of an inhouse 

registered dietitian. 

Next, the pediatricians were asked to rate their satisfaction 

with nutrition resources available, comfort level with nutrition 

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discussions with patients/families, and frequency of weightrelated 

diseases discussions with patients (Table 3). For the 

seven respondents that were “somewhat satisfied” with 

resources available to help counsel obese or overweight 

patients, all seven either used information from AAP or other 

handouts. The one participant who was “neutral” about 

resources available reported the use of AAP literature as well as 

handouts. Out of the two “somewhat dissatisfied” with 

resources available, one respondent reported the use of AAP 

literature, and the other reported they “give verbal counseling 

after assessing their dietary habits.” Of the one “very 

dissatisfied” on resources available, they do not use any 

handouts and preferred in-depth verbal consultation such as 

discussions to avoid drinking calories, the use fruits or 

vegetables as snacks instead of chips or crackers, and to avoid 

eating out. 

The four pediatricians that reported discussing weightrelated 

risk of disease “every time” all saw less than 15 patients 

a day on average, and of these four pediatricians, two saw “6-10 

patients” a day, and two saw “11-15 patients” a day. In 

addition, the four pediatricians included three whom spent 

“more than 20 minutes” on average for patient consultation, and 

one with an average time of“10-20 minutes.” For the six 

pediatricians that discussed weight-related risk of disease “most 

of the time” and the one that discussed it “sometimes,” all saw 

on average more than 20 patients a day. Of the previously 

mentioned six pediatricians that selected “most of the time”, 

four had an average patient consultation of “10-20 minutes” and 

two had an average consultation of “less than 10 minutes.” The 

one pediatrician that “sometimes” discussed weight-related risk 

of disease regardless of the reason for visiting had an average 

patient consultation of “10-20 minutes.” 

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The second open-ended response question asked 

pediatricians to describe their preferred method of providing 

nutrition information. One response cited “handouts” and did 

not include a verbal component, but four responses included 

handouts in addition to a verbal component such as counseling, 

discussions, or verbal instruction. Two responses specifically 

cited a verbal method without mentioning the use of handouts. 

A total of four responses included a specific type of nutrition 

counseling component such as discussion of nutrition and good 

eating habits, meals/snacks, portion sizes or healthy food 

alternatives. Three responses included goal-setting discussions 

and two responses included discussion of exercise 

The third open-ended response question asked pediatricians 

to describe any possible barriers they experience when 

discussing nutrition or weight issues with their patients or 

families. Seven responses indicated familial barriers such as: 

family history of obesity or poor habits, concern of offending 

the family or weight-shaming, financial stresses or multiple 

caretakers in the family, family resistance or denial of problem, 

defensiveness concerning food or portion sizes, and 

misperception of healthy food prices. Two responses indicated 

cultural or language barriers. Two responses indicated a desire 

of quick results or magic fix. One response indicated 

delicateness of young persons’ self-esteem and importance of 

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not encouraging anorexia. One response cited a lack of ageappropriate 

handouts, and one response cited difficulty in 

changing behavior. 

The longer a pediatrician had been practicing, the more 

likely they were “extremely comfortable” when discussing 

nutrition or weight issues with patients and families (r = 0.758. 

p = 0.011). The older the pediatrician, the more likely they were 

to “rarely” refer patients to dietitians (r = 0.778. p = 0.008). 

Female pediatricians were more likely to spend either “10-20 

minutes” or “more than 20 minutes” with patients, compared 

with males (r = 0.690. p = 0.027). 

Pediatrician Referrals 

The last block of questions evaluated the frequency of 

pediatrician referrals to dietitians and whether the pediatrician 

felt there are barriers to making referrals to dietitians Next, an 

open-ended response question to explain any barriers when 

making referrals to dietitians. Lastly, the pediatrician’s 

preference of providing nutrition information themselves vs 

referring to a dietitian (Table 4). 

Nine pediatricians indicated that they felt there are barriers 

when referring patients to dietitians. The pediatricians were 

then asked to explain what those barriers may be in an openresponse 

question. Four responses cited familial barriers and all 

four included either cost, financial or insurance related barriers, 

in addition to barriers caused by motivation, transportation, or 

scheduling for the family. Five responses cited barriers based 

on the dietitian, such as two responses that cited a lack of 

enough dietitians with expertise or pediatric dietitians, and three 

responses that indicated a lack of available or known local 

dietitians. 

The barriers that the three pediatricians who stated they 

were “somewhat comfortable” discussing nutrition and weight 

issues with patients included one response that cited a concern 

of offending the family. One stated that parents appear to be 

defensive when discussing some food habits, and one stated that 

some families have multiple caregivers. Two of these 

pediatricians that selected “somewhat comfortable” indicated 

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they would prefer “referring the patient to a registered 

dietitian,” and the third pediatrician “would refer a patient to a 

dietitian, but not before providing nutrition information 

myself.” 

The pediatrician that selected “every time” to referring new 

overweight or obese patients to dietitians utilizes a dietitian inhouse 

at their clinic and answered that they do not feel as if 

there are barriers to making referrals to a dietitian. The four 

pediatricians that selected “sometimes” to the frequency of 

dietitian referrals all utilize AAP materials in either handouts or 

verbal discussion with patients, and one of those pediatricians 

did not indicate feeling there were barriers to making referrals 

to a dietitian. 

When asked if the pediatrician preferred providing in-house 

nutrition information themselves or referring to a dietitian, five 

pediatricians “preferred to provide the nutrition information” 

themselves, four preferred “referring to a dietitian,” and two 

selected “other.” The “other” option provided a write in 

response and the two responses were: One utilizes an in-house 

dietitian, and one would not refer their patient to a dietitian 

without providing the patient with nutrition information 

themselves. Of the four that would prefer referring to a 

dietitian, two responses had previously said they do not believe 

there are any barriers to referring patients to dietitians. The 

other two had each cited lack of resources, and lack of pediatric 

specialty, respectfully. 

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Discussion 

Although most pediatricians (~55%) rarely refer their 

patients to a dietitian, many (~36%) would prefer to refer their 

patients to a dietitian for nutritional counseling. It appears that the 

reasoning is tied to the fact that many pediatricians do believe 

there are barriers to referrals of dietitians. There are two main 

barriers, one is from the patient’s side, and the other is from the 

dietitian side. For patients, pediatricians acknowledge that the 

added costs of visiting a dietitian is a hinderance to the family. In 

addition, the inconvenience of scheduling an additional 

appointment can also be a barrier. On the dietitian side, 

pediatricians feel as if there are a lack of local or pediatricspecialty 

dietitians. 

There is also a correlation between time spent in practice 

and counseling behavior. The longer that a pediatrician has been in 

practice, the more comfortable they are with discussing nutrition 

or weight issues with their patients. Further, there is a correlation 

that the older and longer-practicing (more than 21 years) 

pediatricians rarely refer patients to dietitians. A likely explanation 

for this correlation may be due to the small number of available 

dietitians in 1999 or earlier. In 1999, there were less than 66,000 

dietitians, down to just ~55,500 dietitians in 1991. 13 From 2000 to 

2015, the number of dietitians increased from ~67,000 to 

~94,000. 12 Since one of the barriers that some pediatricians 

experience when making referrals is the lack of specialized or 

local dietitians, this small amount of dietitian availability is 

problematic. 

Secondly, most pediatricians appear to use literature from 

the American Academy of Pediatricians to assist in nutrition 

counseling. Although pediatricians did not specifically indicate 

they used resources from the Obesity Toolkit, it does seem that the 

information pediatricians provide to patients and their families is 

comparable to the information provided in the Obesity Toolkit. 

Many pediatricians address the lifestyle changes that patients may 

need to modify such as eating or exercise habits, and the 

implementation of SMART goalsetting. Some of the pediatricians 

utilize in-depth counseling, but most provide literature handouts to 

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assist the patients achieve their goals. 

Thirdly, most of the pediatricians spend “10-20” minutes 

with patients and most pediatricians have an average of 21-40% of 

patients who are overweight. However, the two pediatricians with 

an average of 61% of overweight patients spend more than 20 

minutes with their patients. The average time of spending 10-20 

minutes with patients is on par with the industry average, 

considering most of the pediatricians see an average over 20 

patients each day. However, the time spent with patients was only 

an average and did not reflect the time spent specifically with 

overweight patients. Although the survey did not directly ask the 

pediatrician if they felt at full capacity with patient load or not, 

none of the pediatricians listed any sort of “insufficient time with 

patient” as a barrier to nutrition counselling. 

The results seem to be comparable to previous studies 

involving physicians who provide adult care. Most pediatricians 

are very comfortable when discussing nutrition and weight issues 

with patients. Most pediatricians are also somewhat satisfied with 

the resources available to use in counseling patients. The results of 

this study are somewhat different from the results of the 2016 

survey of Texas physicians on their nutrition counseling. Although 

the questions were worded different, most pediatricians were 

extremely comfortable discussing nutrition or weight issues (72%), 

than physicians in 2016 were confident in performing nutrition 

counseling (15%). 11 However, in the 2016 survey, a much larger 

percent of physicians had less than 10 years of experience. In 

addition, the pediatricians are more likely to rarely refer patients to 

a dietitian, than the physicians were in the 2016 survey. 11 

The biggest limitation of the study is the incredibly small 

sample size. Due to the sample size, it is not an accurate 

representation of pediatricians in Dallas-Fort Worth and introduces 

difficulties when comparing results to other Texas pediatrician or 

physician surveys. In addition, out of respect for pediatrician’s 

time during the covid-19 situation, the survey was designed to be 

short and completed in under five to ten minutes. The biggest 

strength of the survey was the open-ended responses that focused 

on resources used, perceived counseling barriers, and perceived 

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dietitian-referral barriers. The open-ended format allowed 

pediatricians to explain their thoughts on barriers and counseling 

techniques with minimal answer-selection bias. 

There are several future-research topics that could be 

investigated as a result of this survey. After understanding that the 

cost or inconvenience of scheduling is a barrier for patients, future 

research can investigate the incorporation of dietitians as part of 

the pediatric offices. There is a potential to investigate if 

pediatricians prefer providing nutrition counseling themselves over 

referrals because of the patient-dietitian barriers, or for other 

reasons. In addition, the issue of the lack of pediatric-specialized 

dietitians or availability of dietitians in needs to be explored with 

the Academy of Nutrition and Dietetics for potential solutions. 

The Obesity Toolkit provides a Family Readiness 

questionnaire to help pediatricians evaluate how likely families are 

to be supportive and proactive in a family-based weight loss 

strategy. There were no pediatrician responses that included tools 

or resources used to address family readiness. Therefore, future 

research could focus on how pediatricians evaluate family 

readiness and willingness of participation in weight loss or 

likelihood of family resistance to weight loss efforts. In addition, 

discovering what tools or resources pediatrician’s would prefer. 

Lastly, future research could investigate at what growth percentile, 

or stage of obesity would the patient be that would make the 

pediatrician more likely to attempt a referral to a dietitian. 

Conclusion 

Ultimately, it is likely that a low preference for dietitian 

referrals from pediatricians is not due to a lack of interest. There 

are barriers to the referrals such as added costs or inconvenience 

for the patient, or a lack of specialized or available local 

dietitians. The perceived barriers of dietitian availability or 

specialization will have to be addressed to increase the inclusion of 

dietitians in the healthcare model. Further, pediatricians should be 

consulted to determine what sort of resources to use in nutrition 

counseling would be most beneficial. Although most pediatricians 

were comfortable with discussing nutrition or weight-related risks 

with patients, the survey included mostly pediatricians with over 

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21 years of experience and is not reflective of the newest 

generation of pediatricians. Despite the small sample size, this 

study can ultimately serve as a starting-platform that can lead to 

further focus and investigation into how we can expand resources 

available for pediatricians to use and how these barriers to dietitian 

referrals can be overcome. 

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The Relationship between Vegetarian Diets 

and Eating Disorders: Does It Exist? 

A Systematic Review 

Amanda Putnam 

Abstract 

Background: A common assumption that vegetarian diets are 

linked to eating disorders (ED) has not been proven. The results of 

previous studies are conflicting and have led to inconclusive 

findings on whether a relationship exists and the nature of such a 

relationship. Objectives: The objective of this systematic review is 

to determine if there is a relationship between consumption of 

vegetarian diets and prevalence of eating disorders. Methods: The 

Academy of Nutrition and Dietetics’ Evidence Analysis Process 

was used to conduct this systematic review. The research question 

was established using PICO format and a literature search was 

performed using PubMed (January 2012-October 2020) to retrieve 

articles for review. Articles were systematically removed according 

to inclusion and exclusion criteria and noted in PRISMA format. 

Articles remaining for qualitative analysis were organized, 

evaluated, and compared using the Evidence Analysis Library 

Worksheet Template and Quality Criteria Checklist (QCC). 

Results: Searches on PubMed resulted in 29 studies for screening, 

25 of which were excluded, leaving 4 cross-sectional studies for 

qualitative analysis. Each of the four studies earned a neutral rating 

based on the QQC. Two studies found healthier food attitudes and 

behaviors in vegans (p≤0.01). The other two studies found that 

patients with ED had greater prevalence of vegetarianism compared 

to individuals without ED (p≤.05). Semi-vegetarians scored higher 

than omnivores on several ED-related questionnaires (p≤0.02), 

while vegans scored similarly or lower than omnivores (p≤0.01). 

Conclusion: This systematic review does not provide strong enough 

evidence to suggest a relationship between vegetarian diets and 

eating disorders, but it cannot be ruled out without more studies. 

The nature of such a relationship, also cannot be determined due to 

inconsistencies in the classification of vegetarian diet, reason for 

adhering to the diet, and date of starting the diet compared to the 

onset of ED symptoms. 

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Indroduction 

The notion that vegetarian diets are linked to eating disorders 

is common among both healthcare workers and the general public, 

despite a lack of strong evidence. Findings from several studies 

indicate that patients with an eating disorder (ED) are more likely 

to follow a vegetarian diet. 1,2,3 Similarly, studies have shown that 

the rate of eating pathology is higher in vegetarians compared to 

non-vegetarians. 4,5,6 Other studies have found no correlation 

between vegetarianism and eating disorders or have only found an 

association with specific subsets of vegetarianism. 4,7,8,9 However, a 

number of these studies were conducted over a decade ago, outside 

the USA, and did not include large sample sizes. In addition, they 

have been limited by inconsistencies in the type of vegetarian diet, 

reason for adhering to a vegetarian diet, and method of assessing 

eating pathology. Thus, it is important to explore in detail if a 

relationship exists between vegetarianism and eating disorders. 

There is also significance in determining whether vegetarianism 

leads to ED or whether following a vegetarian diet should prompt 

screening for possible ED. 

In the context of this review, eating pathology includes eating 

disorder-related attitudes and/or behaviors such as fasting, binge 

eating, self-induced vomiting, laxative use, excessive exercise, 

unhealthy dieting, etc. 10 These attitudes and behaviors can be 

measured using several questionnaires including, but not limited to, 

the Eating Disorders Examination Questionnaire (EDE-Q) and its 

shape concern, eating concern, and restraint subscales; the Eating 

Attitudes Test-26 (EAT-26); the Dutch Eating Behavior 

Questionnaire (DEBQ) and its restraint, emotional, and external 

subscales; and the Eating Disorder Inventory (ADI) “drive for 

thinness” subscale. 1,2,4,7 

Vegetarianism has been defined several ways. In this paper, 

vegetarian diets include lacto-ovo vegetarian diets, ovo-vegetarian 

diets, lacto-vegetarian diets, vegan diets, and semi-vegetarian diets. 

Lacto-ovo vegetarian diets exclude meat, poultry, and fish, but 

include foods of animal origin such as eggs and dairy products. 1,2,4,7 

Ovo-vegetarian diets, include only plant foods plus eggs, and lactovegetarian 

diets, include only plant foods plus dairy. 1,2,4,7 Vegan 

diets, also referred to as strict vegetarians, exclude all animal 

products: meat, poultry, fish, eggs, and dairy. 1,2,4,7 The definition of 

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a semi-vegetarian diet differs slightly between studies, but there is 

a consensus that semi-vegetarian diets exclude red meat, while 

limiting the consumption of poultry and/or fish. 1,4,7 The majority of 

studies include pesco-vegetarian diets in the semi-vegetarian 

group. 1,4 Pesco-vegetarian diets exclude meat and poultry, but 

include fish, milk, and eggs. 1,2,4,7 Non-vegetarian, omnivorous, diets 

do not exclude meat, poultry, fish or any other animal products. 1,2,4,7 

The significance of these criteria is observed in the differences of 

the study results. In this review, individuals who follow a vegetarian 

diet, vegan diet, semi-vegetarian diet or non-vegetarian/omnivorous 

diet, are referred to as vegetarians, vegans, semi-vegetarians, and 

non-vegetarians/omnivores, respectively. The purpose of this 

systematic review of the literature is to determine if a relationship 

exists between vegetarian diets and eating disorders, to provide 

awareness and application to practicing health care professionals 

and establish focus areas for future research. 

Methods 

This systematic review of literature follows the Evidence 

Analysis Process of the Academy of Nutrition and Dietetics. 11 

Before beginning any searches, a number steps were taken to reduce 

the inclusion of irrelevant studies and possibility of bias in choosing 

studies to review. The research question was created using the PICO 

format, taking into account the pertinence of the topic and possible 

applicability of the results: Is there a relationship between 

consumption of vegetarian diets and prevalence of eating disorders 

in adult women ages 18-40? 

The inclusion and exclusion criteria for this systematic 

review are presented in Table 1. The inclusion criteria required that 

study participants be adults, ages 18-50 years, with children and 

older adults being excluded. Because the research question targets 

females, all studies had to have female participants as the majority 

sex. The nutrition problem/condition established for this review 

included any suspected or diagnosed eating disorder: anorexia 

nervosa, bulimia nervosa, binge eating disorder, etc. The 

intervention/exposure from the studies was adherence to a 

vegetarian diet, which could be vegan, lacto-ovo vegetarian, ovovegetarian, 

lacto-vegetarian, or semi-vegetarian. The comparison 

was any non-vegetarian diet, such as an omnivore or pescatarian. 

For the purpose of avoiding secondary and irrelevant data, only 

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observational studies or randomized control trials were included in 

the search, with literature reviews being excluded. Each study 

needed to have at least 40 participants to obtain sample sizes large 

enough for statistical significance. In addition, studies had to have 

over 20 participants following some type of vegetarian diet, and 

over 20 participants following a non-vegetarian diet. Any studies 

with less than those sample sizes were excluded. There are several 

studies concerning the research topic from decades ago; however, 

to obtain the most recent and updated research, articles had to have 

been published between 2012 and 2020. The articles had to be 

published in English and no other language was accepted. After 

completing the first search, criteria were added to narrow down the 

studies further. The additional criteria was that the studies must 

have taken place in the United States of America, with all other 

study locations being excluded. The average age range was also 

decreased slightly, to 18-40 years of age. 

PubMed was the database used to search for articles. A filter 

was used to select full-text articles published between January 2012 

and October 2020. Three searches were completed in October 2020, 

with the following search terms: search #1 female, eating disorder, 

vegetarian diet; search #2 female, adult, eating disorder, 

vegetarian; and search #3 female, eating disorder, adult, vegan. 

From these three searches, a total of fifty-nine hits were located, as 

outlined in Figure 1. Four additional articles were identified through 

the references of those articles. Next, duplicates were removed, 

yielding twenty-nine articles for screening. The screening process 

involved reading abstracts and removing articles based on the 

original criteria, most notably sample size, language, 

intervention/exposure, study design, and lack of access to full-text. 

The screening phase removed twenty articles and left nine for 

further review. After adding the new criteria mentioned above, five 

more articles were excluded. Three studies were excluded for being 

conducted outside the U.S.. 12,13,14 Two studies were excluded for a 

focus on a screening tool rather than the research question. 15,16 After 

the removal of those five articles, four articles remained for 

qualitative analysis. 

Data was extracted and organized for each of the four articles 

using the Academy of Nutrition and Dietetics EAL Worksheet 

Template. This method gathered information directly from each 

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study related to the design, purpose, criteria, protocol, sample size 

and demographics, results, conclusions, and funding source. The 

studies were then critically analyzed using the Quality Criteria 

Checklist (QCC) for primary research. In doing so, ratings were 

given to each study based on their applicability and validity. 

Results 

The four research articles included in the qualitative synthesis 

were cross-sectional in design, with varying sample sizes and 

population groups. 1,2,4,7 Two of the studies had sample sizes 

between 150 and 250, which included only females. 1,2 The other 

critically reviewed studies had between 450 and 600 participants, 

most of which were females, but also included males. 4,7 The 

demographic data and BMI of the participants in each study were 

comparable. 1,2,4,7 The self-reported ethnicity of each sample group 

from all four studies was 80%-94% White/Caucasian. 1,2,4,7 The 

average BMI for groups in each study were in the normal weight 

range of 18.5-25 kg/m 2 . 1,2,4,7 The recruiting process for the groups 

in each study differed; methods consisted of online web pages, 

social media posts, psychology classes, flyers on college campuses, 

restaurants, and grocery stores, as well as from eating disorder 

treatment centers. 1,2,4,7 Location within the United States also 

differed between studies, taking place online and/or in-person in 

Missouri, New York, Pennsylvania, and Southeastern U.S.. 1,2,4,7 

The QCCs completed for the studies resulted in a similar 

quality rating. Each study was ultimately given a neutral rating 

using the QCCs. 1,2,4,7 The primary reason for not giving a positive 

rating was the lack of descriptions as to how the questionnaires were 

provided and overseen. Many of the questionnaires were completed 

in an online format and only one study involved the assistance of 

medical providers in gathering data. 2 In addition, due to the 

observational design of the studies, many of the criteria for a 

positive rating were not applicable. 

Keeping in mind the neutral quality rating of the studies, the 

data of significance for this review are noted below, with more 

comprehensive summaries presented in Table 3. The study 

conducted by Bardone-Cone AM, et al. looked at the rates of past 

and current vegetarianism in participants with and without an eating 

disorder. 1 The study consisted of only females, 96 having a 

diagnosed ED and 67 not having an ED. 1 Strict vegetarians 

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(vegans), vegetarians, and semi-vegetarians were included in the 

vegetarian group, with the main reason for adherence being weightrelated 

in the ED group, but not the control group. 1 Individuals with 

an eating disorder were more likely to have been or were currently 

vegetarian. 1 In addition, the rate of current vegetarianism was 

highest among the patients with active eating disorders, and lowest 

in the fully recovered eating disorder group. 1 

The study completed by Heiss S, et al. compared eating 

behaviors and attitudes, disordered eating behaviors, and non-eating 

health outcomes of vegans and omnivores. 7 The sample population 

consisted of 114 males and 463 females with 357 self-reported 

vegans and 220 self-reported omnivores, and the main reason for 

veganism being “ideological” reasons. 7 Vegans had lower scores 

than omnivores on the EDE-Q “restraint”, “eating concern”, “shape 

concern”, and “global” scales. 7 In addition, vegans had slightly 

healthier eating attitudes and behaviours. 7 In contrast to previous 

studies of vegetarians, this study indicates that vegans do not 

experience greater eating-related pathology than omnivores. 7 

Another study, (Timko CA, et al., 2012) examined the 

differences in eating attitudes and behaviors between true 

vegetarians, semi-vegetarians, and omnivores in two studies. 4 The 

first study involved 111 males and 374 females, of which 35 were 

vegan, 11 were true vegetarian, 75 were semi-vegetarian, and 265 

were non-vegetarian. 4 The second study included 117 females, with 

44 semi-vegetarians and 74 omnivores. 4 Ethical reasons were the 

primary reason for adhering to the vegan, vegetarian, or semivegetarian 

diet in the first study group. 4 In contrast, the semivegetarians 

in the second study group stated their main reason for 

avoiding meat to be “sensory factors/taste.” 4 The data from a large 

set of questionnaires completed by the participants showed that 

omnivores had the highest score on the drive for thinness scale. 4 

Semi-vegetarians had a more disordered eating pattern than other 

groups based on higher levels of restraint, external eating, hedonic 

hunger, and avoidance of food cues. 4 Vegans had the healthiest 

attitudes towards food, closely followed by vegetarians, with 

omnivores resembling most closely to semi-vegetarians, without the 

distorted attitudes. 4 Similar questionnaires were completed by the 

second study group, leading to further evidence that semivegetarians 

had higher dietary restraint than omnivores, in addition 

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to higher scores on the eating concerns subscale of the EDE-Q. 4 

The final study (Zuromski KL, et al., 2015) determined the 

prevalence of and variables related to vegetarianism in three groups 

with increasing severity of eating pathology. 2 The study population 

consisted of 209 females with 73 nonclinical, 136 subclinical, and 

69 clinical ED participants. 2 The results of the EDE-Q, vegetarian 

questionnaire, lifetime disordered eating items, and demographics 

revealed that the prevalence of self-identified, lifetime 

vegetarianism was lowest in the non-clinical group and highest in 

the clinical group. 2 In addition, former vegetarians in the clinical 

group noted that their discontinuation of vegetarianism was related 

to their eating disorder, as a means to improve recovery status. 2 

Discussion 

In this systematic review of the relationship between 

vegetarianism and eating disorders, there was insufficient evidence 

to provide a strong conclusion. The studies reviewed did not lead to 

the same conclusions, and overall, the evidence does not suggest a 

relationship between vegetarianism and eating disorders in 18-40 

year old females; however, a relationship cannot be ruled out 

without more studies. 1,2,4 When the various types of vegetarian diets 

were considered, semi-vegetarians had the greatest eating 

pathology. 1,2,4 Two studies of large groups of vegetarians and nonvegetarians 

found healthier attitudes towards food in vegans. 4,7 Two 

studies of patients with ED comparing them to patients without ED 

found greater prevalence of vegetarianism among the ED group. 1,2 

While vegetarianism itself may not be associated with development 

of an ED, patients with ED are more likely to follow a vegetarian 

diet. Thus, there may be justification to screen patients following a 

vegetarian diet for ED pathology. 

Each study provided unique evidence based on their focus. 

One of the main discrepancies among the studies was the reason for 

adhering to a vegetarian diet as part of the relationship with eating 

disorders. In two studies, undesirable taste was the main reason for 

avoiding meat in participants who also had the highest eating 

pathology; however, in another study, ideological reasons were 

most common, and yet in another study, weight-related reasons 

were found in the majority of participants with a diagnosed or 

predicted ED. 1,2,4,7 Another major difference between the studies is 

the type of vegetarian diet included in the vegetarian group. In one 

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study, only vegans were classified in the meat-free diet group, while 

in two other studies, the vegetarian group included vegans, 

vegetarians, and semi-vegetarians. 1,2,4,7 Another study included 

lacto-ovo- and pesco-vegetarians as part of the vegetarian group. 2 It 

is clear from the results of this review that differentiating the types 

of vegetarian diets can lead to differences in results and using a 

standard definition should be emphasized in future research. 

In addition to the type of vegetarian diet, the reason for 

adhering to a diet may have had an effect on study results. In 

general, the studies divided reasons for following a particular diet 

mainly into “sensory/taste,” “weight-related,” “ethical/ideological,” 

and “health” reasons. 1,2,4,7 The “sensory/taste” reason indicates a 

dislike of meat and/or dairy products due to the flavor, texture, 

smell, etc. 1,2,7 The “weight-related” reason refers to cutting out meat 

and/or dairy to lose or maintain body 

weight. 1,2,4,7 “Ethical/ideological” reasons involve concerns about 

animal welfare, environment, or for religious reasons. 1,2,4,7 Lastly, 

adhering to a vegetarian diet due to “health” reasons did so out of 

desire for a healthier diet and due to belief that it is healthier not to 

eat meat/certain kinds of meat. 1,2,4,7 These reasons were not 

classified exactly the same in each of the four studies, but they were 

grouped similarly enough that a significant difference in results 

would not be likely. Despite similar categorizing of reasons, there 

was a lack of overall association between a particular reason for 

choosing vegetarianism and eating pathology. 1,2,4,7 This finding 

suggests the need for further research exploring what, if any, 

reasons for vegetarianism are linked to greater eating pathology. 

Although the totality of the evaluated evidence does not 

equate to a strong conclusion, the findings still suggest the 

incorporation of several practices into healthcare professions. 

Clinical implications associated with the results include the need for 

practitioners to be aware of an individual’s reasons for starting and 

maintaining a vegetarian diet, especially if altered eating attitudes 

and behaviors are already present. 1 In addition, clinicians should 

take into account that both omnivores and vegans are similarly at 

risk for eating pathology and each patient should be evaluated based 

on individual eating attitudes and behaviors. 7 The results may even 

emphasize the need for clinicians to recognize possible benefits of 

vegan diets in protecting against developing disordered eating. 4 

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Clinicians should instead be particularly concerned with patients 

following a semi-vegetarian diet, as this may be indicative of 

pathologic eating attitudes and behaviours. 4 These findings add to 

the small amount of research exploring eating disorders and 

vegetarianism, and suggests that vegetarian diets may be an 

important risk identifier for disordered eating and its development. 2 

Therefore, practitioners should be aware that reverting back to 

vegetarianism after eating disorder recovery may indicate 

incomplete treatment or relapse. 

Conclusion 

The concluding statement, presented in Figure 2, ties together 

the evidence from each study in the qualitative analysis. These 

studies were systematically chosen to be used in the review based 

on their design and relevance to the research question. Because of 

this, the similar data from the studies yields reliable results that can 

be applied in professions related to psychology, dietetics, and 

overall healthcare. The evidence provided in this systematic review 

suggests that vegetarianism may or may not be associated with 

eating disorders. 1,2,4,7 However, this statement is not complete 

without further explanation due to the complexity of the study 

designs. It is clear that when all types of vegetarian diets were 

included in the same study group and compared to omnivores, 

vegetarians had lower scores on the questionnaires, indicating 

higher eating pathology. 1,2 Despite these findings, when the type of 

vegetarian diet was taken into consideration, there were mixed 

results. 4,7 When looking more closely, semi-vegetarians had greater 

eating pathology than omnivores, while vegans had less eating 

pathology than omnivores. 4,7 

These results point to a need for further research looking at 

the type of vegetarian diet in association with eating disorders. If a 

relationship is to be confirmed or denied in future studies, a 

vegetarian diet cannot be used as a broad, all-encompassing term. 

Instead, the types of vegetarian diet need to be studied separately. 

In addition, because of the lack of significant evidence for an 

association between motivation for a vegetarian diet and eating 

disorders in this review, future studies should prioritize such reasons 

to gain greater understanding of the association between vegetarians 

and eating disorders. Despite a slightly higher prevalence of 

vegetarians in the eating disorder community, current research does 

139

not provide data on whether eating disorders lead to vegetarian diets 

as a means of greater restriction, or if vegetarian diets predispose 

individuals to the development of eating disorders. 1,2,4,7 Therefore, 

prospective and longitudinal studies should be employed to 

determine the cause of this possible relationship and offer more 

accurate and applicable recommendations for professionals to 

provide to the general public. 

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2. Zuromski KL, Witte TK, Smith AR, Goodwin N, Bodell LP, Bartlett M, 

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5. Klopp SA, Heiss CJ, Smith HS. Self-reported vegetarianism may be a 

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1;118:129-135. doi: 10.1016/j.appet.2017.08.001. 

8. Forestell CA, Spaeth AM, Kane SA. To eat or not to eat red meat. A 

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15. Heiss S, Coffino JA, Hormes JM. What does the ORTO-15 measure? 

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Exploring the Relationship Between Violent 

Video Games and Aggression 

Katheryne Ricardo 

Abstract 

Video games are a large and important part of the lives of 

many, so it is to no surprise that a lot of speculation about how 

video games may affect players has come up. A particular area of 

concern is violent video games and their association with 

aggression in their players. This topic has brought about a 

significant amount of research, but there is little to no agreement 

on whether a relationship exists and if so, how it works. The most 

discussed explanation is the Generalized Aggression Model, 

which proposes that repeated exposure to violent media such as 

violent video games engages with the players’ aggression 

schemas and over time fosters aggressive behaviors and even 

aggressive personality traits in the players. However, this model 

is highly contested by several studies with results that do not 

align with the model. Instead, there have been other models 

proposed in place of the Generalized Aggression Model. Despite 

the great amount of research that has been conducted, there are 

still no cohesive model that explains the relationship between 

violent video games and aggression, but several different 

components that contribute to the relationship have been 

discovered such as character preferences, reward structures, and 

narrative structures. 

Video games have become a significant and important part 

of the lives of many, especially young people. More than 90% of 

American children play video games, and 97% of American 

children from ages 12-17 play them (American Psychological 

Association, 2015). Not only do most children play video games, 

most of them play video games for multiple hours on a daily 

basis; children under 8 report spending a daily average of 69 

minutes on handheld console games, 57 minutes on computer 

games, and 45 minutes on mobile games (American 

Psychological Association, 2015). In addition, more than 85% of 

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the video games on the market contain some form of violence 

(American Psychological Association, 2015). Due to the 

significance of video games, violent video games (VVGs) have 

become a topic of concern for many, especially regarding how 

they affect their players. Several media sources like newscasters 

often blame video games as causes or training for acts of violence 

such as the mass shootings of Columbine High School (American 

Psychological Association, 2015). Interest in the topic of VVGs 

has also sparked a significant amount of research on their 

psychological effects with a large focus on testing whether VVGs 

and aggression are associated. 

Due to the interactive component of video games, 

researchers have suggested that video games may have a stronger 

influence on outcomes such as aggression than other more 

passive forms of media such as TV or movies (Coyne, 

Warburton, Essig, & Stockdale, 2018). According to the 

American Psychological Association (APA), multiple metaanalyses 

of the research on video games and violence have been 

conducted, and they have found a direct association between 

VVG use and aggressive outcomes (American Psychological 

Association, 2015). However, despite the similarity of the effect 

sizes of these studies, many differ in their interpretations of these 

results (American Psychological Association, 2015). 

Furthermore, a cohesive model to explain the effects of VVGs 

and aggression has yet to be agreed upon. Though models such as 

the Generalized Aggression Model (GAM) have been proposed, 

several studies do not fall in line with the models or directly 

contradict them while proposing other models. Therefore, more 

research must be done on the subject before definitive claims on 

the association between VVGs and aggression can be made. 

Aggression is any behavior intended to harm another who 

does not wish to be harmed, and violence is aggression that has 

extreme physical ham (Principles of Social Psychology, 2015). 

There are several variables that can influence levels of 

aggression, including biological and emotional factors, but social 

situational factors will be looked at in order to explore the role 

that VVGs might play into aggression (Principles of Social 

Psychology, 2015). The great amount of debate over the abundant 

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evidence stems from issues that present themselves when 

conducting research on this topic (Breuer, Vogelgasang, Quandt, 

& Festl, 2015). For example, experimental studies, though having 

the ability to test the direction of the association, can only report 

on the short-term effects following exposure to VVGs (Breuer et 

al., 2015). Though cross-sectional research has larger samples 

and is therefore more externally valid than experimental studies, 

they are unable to assess the direction of the association (Breuer 

et al., 2015). In addition, though longitudinal studies use large 

samples and can figure out which variable precedes the other, 

only controlled experiments can actually prove causality, and 

furthermore, there are far fewer longitudinal studies that have 

been done on this topic than experimental or cross-sectional 

studies (Breuer et al., 2015). Moreover, most of the longitudinal 

studies that have been conducted rely on convenience sampling 

methods, which limits their external validity (Breuer et al., 2015). 

In addition to the structure of the study, the method of obtaining 

measures for aggression also presents issues. One of the problems 

with relying on explicit measures for aggression is that they rely 

on individuals’ ability to introspect and accurately report on their 

inner states, which is not always reliable and is often biased 

by factors such as demand characteristics, social desirability, or 

intentional faking (Květon & Jelínek, 2019). These obstacles in 

conducting research on the association between VVGs and 

aggression contributes to the disagreement on the topic, and this 

disagreement is reflected in the variety of theoretical frameworks 

that aim to explain it (Květon & Jelínek, 2019). 

One of the most discussed models, the GAM, posits that 

repeated exposure to violent content can lead to the development 

of an aggressive personality which consists of aggressive attitudes 

and beliefs, perceptual schemata, expectation schemata, behavior 

scripts, and desensitization (Květon & Jelínek, 2019). The GAM 

claims that exposure to violent content such as VVGs leads to 

short-term increases in aggression; furthermore, if the exposure 

continues on a consistent basis, then the content favors a more 

aggressive personality in the player because increased 

accessibility of aggressive thoughts evokes aggressive behavior 

(Delhove & Greitemeyer, 2018). Several studies that have been 

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conducted on VVGs and aggression show support for the GAM. 

For example, a study measured the voice stress of individuals 

playing VVGs and non-VVGs, finding that VVG players had 

higher voice stress than non-VVG players (Hasan, 2017). A 

product of emotional distress is vocal stress which is measured by 

disturbances in vocal responses caused by tension on the vocal 

cords (Hasan, 2017). The study also showed that playing VVGs 

leads to increased physiological arousal such as increased heart 

rate, cardiac coherence, blood pressure, skin conductance, and 

release of stress-related hormones (Hasan, 2017). Therefore, the 

results of this study indicate that VVGs produce physiological 

arousal in their players (Hasan, 2017). The results of this study 

support the GAM through establishing a measurable increase in 

physiological arousal associated with aggressive schemata in 

VVG players than non-VVG players. 

Another study that supports the GAM is Coyne, Warburton, 

Essig, and Stockdale’s longitudinal study regarding exposure to 

VVGs during adolescence, which found that early exposure to 

video game violence was indirectly associated with decreased 

levels of benevolence, ultimately leading to a reduction in 

prosocial behavior (2018). This suggests that early exposure to 

VVGs erodes an individual’s moral orientation toward helping 

others (Coyne et al., 2018). In addition, the study found that early 

exposure to VVGs was also associated with higher levels of 

externalizing behavior such as social deviance, unmanageability, 

hyperactivity, disruptiveness, noncompliance, antisocial 

behaviors, and delinquency (Coyne et al., 2018). VVGs display 

both aggressive acts as well as externalizing behaviors such as 

rule-breaking, theft, and vandalism (Coyne et al., 2018). 

Therefore, if an individual is exposed to VVGs that display 

externalizing behaviors, they may be inclined to believe that these 

behaviors are normative (Coyne et al., 2018). Following the 

GAM, frequent exposure to VVGs can lead to formulation, 

rehearsal, and reinforcement of beliefs and attitudes that 

normalize externalizing behavior and decrease barriers to 

externalizing behavior by emotionally and cognitively 

desensitizing players to the suffering of others (Coyne et al., 

2018). Furthermore, VVG exposure can lead to a hostile 

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attributional bias, which may increase the likelihood that an 

individual interprets the behavior of another as hostile when no 

hostility was intended, and this increases the chances that the 

individual will reciprocate the perceived hostility (Coyne et al., 

2018). Also, the study showed that players are likely to imitate 

the behavior seen in VVGs if the character performing the 

behavior is admired, high in status, powerful, or is rewarded for 

that behavior (Coyne et al., 2018). The results of this study are 

also applicable to the GAM because they show that repeated 

exposure to VVGs effects the players’ personalities to be less 

prosocial and more aggressive (Coyne et al., 2018). 

Also, a study by Delhove and Greitemeyer explored the 

relationship between video game character preferences and 

aggressive and prosocial personality traits (2018). Typically, a 

player’s choice of role impacts their approach to the game. For 

example, “support” and “tank” characters that have prosocial 

abilities such as healing other players are likely to encourage the 

players to focus on those actions which foster more prosocial 

traits; in contrast, players who choose characters that have more 

attack-centered roles such as “offense” and “defense” are 

encouraged to damage other players and therefore foster more 

aggressive traits (Delhove & Greitemeyer, 2018). Delhove and 

Greitemeyer found that preferences for attack characters were 

positively associated with trait aggression while being negatively 

associated with empathy and agreeableness; this is in contrast to 

players with preferences for support characters, which showed 

positive correlations with empathy and agreeableness and 

negative correlations with trait aggression (2018). The results of 

this study support the GAM in that players who chose more 

aggressive characters had more aggressive personalities. 

However, the study also found that prosocial characters exist in 

some VVGs, and this complicates the argument of the GAM 

because it introduces the role of character modulating the player’s 

aggression within VVGs. 

Similarly, another example of a study that contradicts the 

GAM is Greitemeyer’s study on the police officer’s dilemma and 

VVG exposure. This study found that people who habitually play 

VVGs had faster processing skills without limiting accuracy in 

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the Correll shooting paradigm (2019). The Correll shooting 

paradigm consists of a participant playing the role of a police 

officer making rapid decisions on whether to shoot an individual; 

participants are to shoot armed individuals and refrain from 

shooting unarmed individuals, so participants must make the 

distinction between an armed individual and an unarmed 

individual within seconds. Followers of the GAM would predict 

that players of VVGs would have more aggressive results 

consisting of shorter reaction times as well as increased errors of 

shooting an unarmed target due to the increased accessibility of 

aggressive thoughts (Greitemeyer, 2019). However, the study’s 

results showed that playing VVGs reduced reaction time and did 

not decrease accuracy (Greitemeyer, 2019). These results support 

the idea that VVGs such as first-person shooters can help develop 

the player’s ability to rapidly process sensory information and 

make decisions under time constraints, showing that the nature of 

VVGs does not necessarily correlate with aggression but rather 

with specific skills that are required to be successful in these 

games (Greitemeyer, 2019). 

In the same vein, one study found that reward structures 

selectively affected in-game aggression, and narrative context 

selectively affected post-game aggression (Sauer, Drummond, & 

Nova, 2015). The study found that manipulating the reward 

mechanism by rewarding in-game aggression did not generalize 

to post-game aggression (Sauer et al., 2015). This contradicts the 

GAM because increasing in-game violence did not necessarily 

lead to increased post-game aggression (Sauer et al., 2015). In the 

study, the narrative structure of the game either portrayed the 

protagonist as heroic or antiheroic, and the participants that 

played as the heroic protagonist were less aggressive in the postgame 

aggression measure than participants who played as the 

antiheroic protagonist (Sauer et al., 2015). This indicates that the 

context in which violence is portrayed in VVGs influences postgame 

aggression in players more than the violent behaviors 

enacted by the player in the game (Sauer et al., 2015). This study 

supports the concept that modeling behavior involves complex 

and abstract reasoning in which individuals model behavior only 

when the context in which the action was observed is 

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appropriately similar (Sauer et al., 2015). 

Because a significant amount of research on VVGs and 

aggression do not fall in line with the GAM, other models have 

been proposed in its place. For example, the Catalyst Model 

asserts that aggressive behavior is caused mainly by genetic and 

proximal social factors such as family and peers, and violent 

media is a catalyst instead of a source of aggression (Breuer et al., 

2015). Therefore, individuals who are already prone to aggression 

may model the violent acts portrayed by VVGs, but VVGs alone 

are not a sufficient cause for aggressive behavior (Breuer et al., 

2015). A one-year longitudinal study done on German gamers 

ages 14-21 that tested the association between use of VVGs and 

physical aggression found that use of VVGs is not a substantial 

predictor of physical aggression (Breuer et al., 2015). Though the 

VVG portrayed physical aggression, there was no change in the 

levels of physical aggression among the participants (Breuer et 

al., 2015). This falls in line with the Catalyst Model because the 

VVG was not enough to affect the preexisting aggression levels 

of the participants (Breuer et al., 2015). 

Likewise, another proposed model is the Dual-System 

Model of Media Reality which claims that individuals process 

media based on two distinct information processing systems that 

operate in parallel during exposure such as automatic and 

controlled processes; the interaction between those two processes 

influences the experience of the game (Krcmar & Eden, 2019). 

The automatic processes in which information is processed 

quickly, effortlessly, and unconsciously contribute to the feeling 

of realism in the game and are likely to be engaged when the 

player has to make quick judgements, form impressions, and 

experience emotional responses to the game (Krcmar & Eden, 

2019). The controlled processes in which information is 

processed slowly, effortfully, and consciously are likely to be 

engaged while the player is trying to make sense of the game such 

as understanding plot information, character motivation, and 

utilizing environmental and spacial information (Krcmar & Eden, 

2019). In video games that cause the player to act in a way that 

produces guilt for their in-game actions, the automatic process 

would produce automatic feelings of guilt, but if the player has 

150

the motivation to feel entertained and maintain a positive mood 

while playing the game, the controlled processes would override 

the automatic feelings of guilt by reminding the player that it is 

just a game (Krcmar & Eden, 2019). However, if the controlled 

processes are overtaken by cognitive load, then they can not 

monitor and suppress the automatic processes, so the automatic 

processes would become more prevalent in the interpretation of 

events (Krcmar & Eden, 2019). Krcmar and Eden found that 

higher levels of cognitive load in players of VVGs had lower 

levels of in-game aggression and higher levels of 

anthropomorphism of the characters and guilt for their in-game 

behavior (2019). This shows that the cognitive load of VVGs also 

factors into the relationship between VVGs and aggression. 

In conclusion, more research must be done to create a 

cohesive model to explain the effects of VVGs and aggression. 

Though many studies have already been conducted on the topic, 

there is still much disagreement on whether a relationship exists 

and how that relationship works if it does exist. Regardless of the 

current state of disagreement over the correlation of VVGs and 

aggression, many studies have discovered interesting components 

to the relationship such as reward structures, character 

preferences, and cognitive load. Though there is no definitive 

answer yet, this is just the beginning of research on VVGs, and 

the possible explorations of the future are promising. 

Works Cited 

American Psychological Association. (2015). Resolution on Violent Video 

Games. Retrieved from: http://www.apa.org/about/policy/violentvideo-games.aspx 

Breuer, J., Vogelgesang, J., Quandt, T., & Festl, R. (2015). Violent video 

games and physical aggression: Evidence for a selection effect among 

adolescents. Psychology of Popular Media Culture, 4(4), 305–328. 

https://doi-org.ezp.twu.edu/10.1037/ppm0000035 

Coyne, S. M., Warburton, W. A., Essig, L. W., & Stockdale, L. A. (2018). 

Violent video games, externalizing behavior, and prosocial behavior: A 

five-year longitudinal study during adolescence. Developmental 

Psychology, 54(10), 1868–1880. 

https://doi.org/10.1037/dev0000574.supp (Supplemental) 

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Delhove, M., & Greitemeyer, T. (2018). The relationship between video game 

character preferences and aggressive and prosocial personality traits. 

Psychology of Popular Media Culture. 

https://doi.org/10.1037/ppm0000211 

Greitemeyer, T. (2019). The police officer’s dilemma: The relationship between 

violent video game play and responses in a first-person shooter task. 

Journal of Media Psychology: Theories, Methods, and Applications. 

https://doi.org/10.1027/1864-1105/a000260 

Hasan, Y. (2017). Violent video games increase voice stress: An experimental 

study. Psychology of Popular Media Culture, 6(1), 74–81. 

https://doi.org/10.1037/ppm0000083 

Krcmar, M., & Eden, A. (2019). Rational versus intuitive processing: The 

impact of cognitive load and moral salience on in-game aggression and 

feelings of guilt. Journal of Media Psychology: Theories, Methods, and 

Applications, 31(1), 2–11. https://doi.org/10.1027/1864-1105/a000215 

Květon, P., & Jelínek, M. (2019). Frustration and violence in mobile video 

games: An experimental evaluation of their effect on implicit 

aggression. Swiss Journal of Psychology. https://doi.org/10.1024/1421- 

0185/a000236 

Principles of Social Psychology. (2015). University of Minnesota Libraries 

Publishing. https://doi.org/10.24926/8668.2001 

Sauer, J. D., Drummond, A., & Nova, N. (2015). Violent video games: The 

effects of narrative context and reward structure on in-game and 

postgame aggression. Journal of Experimental Psychology: Applied, 

21(3), 205–214. https://doi.org/10.1037/xap0000050.supp 

(Supplemental) 

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Fostering Creativity in Children 

Yelena Sorensen 

For my Touchstone Honors Project, I created a pamphlet 

with the help and guidance of Dr. Peggy S. Lisenbee, TWU 

professor in the College of Professional Education. My objective 

was to create a bright and colorful pamphlet that would help 

parents understand the importance of fostering creativity in their 

children and also would give them practical suggestions and 

ideas about how to do that through guided play activities. This 

pamphlet is especially relevant at this point in time given the 

impact of the COVID-19 pandemic on children, their families, 

and their schools. Virtual school is relatively common now, and 

there are far fewer opportunities for play in schools. Even before 

2020, the emphasis in schools had shifted strongly to a focus on 

the core curriculum. That resulted in far less emphasis on 

constructive play activities. As a result, it is more important than 

ever for parents to do more in fostering constructive, creative 

play with their children. It is difficult to overstate the importance 

of a parent’s role in fostering creativity. I would hope for this 

pamphlet to make that job a little easier for parents. For those 

who may be interested, this pamphlet includes a QR code for 

easy access to the references for the infographic. 

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Brainstem Research 

Haley Tate 

The brainstem is located superiorly to the spinal cord and 

inferiorly to the cerebrum. The brainstem sits at the inferior portion 

of the brain-the bottom or base of the brain. Although, it is 

continuous with the brain and the spinal cord. The brainstem is 

made up of three parts; the midbrain, the pons and the medulla 

oblongata, therefore all of their functions are the functions that 

make up the brainstem. The brainstem has many vital functions, 

these vital functions consist of; movements of the eyes, mouth, 

involuntary movements of the muscles, and regulation of 

respiration, consciousness, heart rate, and relays sensory 

information and other bodily functions such as sneezing, 

swallowing, vomiting and coughing. The Brainstem is an important 

structure of the brain, because it has many functions, parts, 

innervation of cranial nerves and when damage occurs to the 

brainstem there can be terrible effects. 

The brainstem is made up of three parts; the midbrain, the 

pons, and the medulla oblongata. These three parts of the brainstem 

have a variety of vital functions that each one controls. According 

to Medicine LibreTexts, it states, “The brain stem also plays an 

important role in the regulation of cardiac and respiratory function. 

It regulates the central nervous system (CNS) and is pivotal in 

maintaining consciousness and regulating the sleep cycle 

(LibreTexts, 2020).” The midbrain is important for other vital 

functions such as vision, hearing, consciousness, alertness and 

regulation of body temperature, as well as controlling bodily 

movements and is a relay station for the vital function’s 

information. The midbrain is located most anteriorly to the pons, 

posterior to the thalamus. The pons functions consist of controlling 

the movement for the eyes and facial muscles, processing motor 

information. The pons is located posteriorly to the midbrain and 

superior to the medulla oblongata. The medulla oblongata regulates 

involuntary functions; of the heart (heart rate) and lungs 

(respiration) and blood pressure, the medulla also controls 

movements of the eyes and head, coordinates swallowing and 

regulates visceral activity of the autonomic nervous system. The 

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medulla oblongata is located posteriorly to the pons and anteriorly 

to the cerebellum, superior to spinal cord. To go slightly further in 

depth on these parts will identify other important structures on the 

brainstem, such as the pyramids and the olives of the midbrain. 

There are other important structures associated with the 

medulla oblongata, these are known as the pyramids and olives. 

The pyramids and olives are important for controlling the 

voluntary muscles of the body and face. According to Teach Me 

Anatomy, it states that, “the neurones converge, and descend 

through the internal capsule... This is clinically important, as the 

internal capsule is particularly susceptible to compression 

from haemorrhagic bleeds, known as a ‘capsular stroke ‘. Such an 

event could cause a lesion of the descending tracts (Jones, 2018).” 

The pyramids are located anteriorly of the medulla and are made of 

white matter that are ridge-like and their function is to transmit 

motor signals through the two tracts that are contained in the 

pyramids. These two tracts are called the corticospinal tract and the 

corticobulbar tract, they regulate activity of the ascending tracts 

and control muscles in the head, neck and body. Therefore, damage 

to the pyramids and olives on the midbrain, can lead to the inability 

to control the muscles in the head, neck and body. Just lateral to 

each pyramid is another part of the medulla called the olives these 

look like two small bulges or lumps; their function is to transmit 

sensory information and proprioceptive information. It is important 

to know and understand all of the functions that occur in certain 

aspects of the brain, particularly the brainstem, because there are a 

variety of damages, injuries, and disorders that can be associated 

with the brainstem that can be traumatic. 

Since the brainstem is important for vital functions of the 

body, if something were to cause damage to any part of the 

brainstem there could be severe effects leading to disorders or 

diseases of the brainstem. If a part of the brainstem were to be 

damaged, the worst-case scenario would be death, by irregular 

regulation of the heart rate and respiration. According to Dolman 

Law Group, “In acute cases, there may be personality changes and 

memory loss. In severe cases, the result can be loss of 

consciousness, coma and paralysis. A victim may remain in a 

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vegetative state for life, or death can suddenly occur from heart and 

lung failure as a result (Dolman Law Group, 2019).” Other injuries 

can result in traumatic events such as a stroke, can be from broken 

vessels or swelling of the area. These damages can impact speech, 

breathing, sleep and the ability or swallow. Since the brainstem is 

located inferiorly to the cerebrum, this makes it very difficult to 

operate on damages and injuries to the brainstem, therefore it is 

difficult to treat. Damage to the brainstem can be from infections, 

tumors inflammation or damage to the many cranial nerves and 

demyelination in the area. Other disorders can arise from injury to 

the brainstem, for example a disorder known as Locked In 

Syndrome. 

Locked In Syndrome is a disorder associated with damage to 

the pons of the brain stem, this damages the nerve fibers that relay 

important information from cerebrum to the cerebellum. Damage 

to the pons can cause a loss of that relay information, resulting in a 

loss of the ability to produce bodily movements leading to 

paralysis of the voluntary muscles that are controlled by the pons. 

According to the National Organization for Rare Disorders, “In 

locked-in syndrome there is an interruption of all the motor fibers 

running from grey matter in the brain via the spinal cord to the 

body’s muscles and also damage to the centers in the brainstem 

important for facial control and speaking (Pistoia and Laureys, 

2018).” Locked in Syndrome is very rare and typically from lack of 

blood flow or bleeding of the brainstem, the individual with this 

disorder is completely paralyzed and only has the ability to control 

the voluntary muscles of the eyes, can move the eyes up and down 

as well as blink. The individual is conscious but cannot speak, 

therefore the individual communicates through eye movements. 

Cognitive function of the individual is not affected and the person 

is alert, the person can hear, see and comprehend communication 

to them, but are reliant on a care taker since the individual cannot 

move, chew, swallow or speak. Damage to the brainstem can also 

occur to the cranial nerves that innervate the brainstem. 

The brainstem contains ten of the cranial nerves, cranial 

nerves three through twelve. These cranial nerves innervate the 

face and neck, and provide motor and sensory information. 

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According to Medicine LibreTexts, it states, “Though small, it is 

an extremely important part of the brain, as the nerve connections 

of the motor and sensory systems from the main part of the brain 

that communicate with the peripheral nervous system pass through 

the brainstem (LibreTexts, 2020).” Majority of the nerves are 

motor nerves, only the Vestibulocochlear nerve is completely 

sensory and the Facial nerve, Glossopharyngeal nerve, and Vagus 

nerve are mixed with motor and sensory function. The cranial 

nerves (three through twelve) that innervate the brainstem are the 

Oculomotor nerve, Trochlear nerve, Trigeminal nerve, Abducens 

nerve, Facial nerve, Vestibulocochlear nerve, Glossopharyngeal 

nerve, Vagus nerve, Spinal Accessory nerve and the Hypoglossal 

nerve. The cranial nerves connect to the brainstem via the midbrain 

are; the Oculomotor nerve and Trochlear nerve. The cranial nerves 

that connect to the pons are the Trigeminal nerve and the ones that 

are between the pons and the medulla are the Abducens nerve, 

Facial nerve, and the Vestibulocochlear nerve. The cranial nerves 

that connect to the medulla are the Glossopharyngeal nerve, Vagus 

nerve, and the Hypoglossal nerve. The only cranial nerve that 

connects to the medulla and the spinal cord is the Spinal Accessory 

nerve. The cranial nerves are fragile and can easily be damaged, it 

is important to know what each nerve is responsible for in case of 

damage from either stretching, pressure or lesions. 

Once cranial nerves have been damaged, there is no way to 

technically treat or repair the damage to the nerve. Damage to the 

cranial nerves can present as many different symptoms, some of 

the most common symptoms can be; loss of sensation and 

weakness are typically seen in damage to nerves. According to 

UPMC, it states that symptoms of cranial nerve damage can be, 

“Intermittent attacks of excruciating facial pain, Vertigo 

(dizziness), Hearing loss, Weakness, Paralysis, Facial twitch 

(UPMC, 2020).” The Oculomotor nerve function is to move the 

eyes up and down, medially and to elevate the upper eyelid, to 

constrict the pupil and adjust the eye lens. Damage to this nerve 

will produce ptosis and diplopia. The function of the Trochlear 

nerve is to move the eye medially and down. Damage to this nerve 

will cause double vision. The function of the Trigeminal nerve is 

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the ability of the blinking reflex, providing sensation from face and 

the temporomandibular (jaw) joint, and is responsible for the 

muscles that allow an individual to chew. Damage to this nerve 

will produce trigeminal neuralgia. The function of the Abducens 

nerve is to move the eyes laterally. Damage to this nerve will 

produce double vision. The function of the Facial nerve is also the 

ability of the blinking reflex, as well as the ability to produce facial 

expressions, salivation and tear production, and the ability to taste. 

Damage to this nerve will cause Bell’s Palsy. The function of the 

Vestibulocochlear nerve is the ability to sense the head position 

relative to gravity and head movement, as well as the ability to 

hear. Damage to this nerve will cause conductive deafness and 

sensorineural deafness. The function of the Glossopharyngeal 

nerve is the ability to taste, the gag reflex and ability to swallow 

and produce saliva. Damage to this nerve will interrupt the gag and 

swallowing reflex and decreased production in saliva. The function 

of the Vagus nerve is to control the motor limb of the gag reflex 

and swallowing, production of speech and regulation of visceral 

organs. Damage to this nerve will also interrupt the gag and 

swallowing reflex, produce poor digestion and difficulty in 

speaking. The function of the Spinal Accessory nerve is the elevate 

the shoulder and to turn the head. Damage to this nerve will cause 

paralysis of shoulder and head muscles, the sternocleidomastoid 

and the trapezius muscles. The function of the Hypoglossal nerve 

is to move the tongue via the tongue muscles. Damage to this nerve 

will produce a difficulty in speaking and swallowing as well as 

atrophy of the tongue. The cranial nerves listed are important 

nerves located on the brainstem, damage to one of the cranial 

nerves can cause a loss of many crucial functions. 

The brainstem is a very crucial part of the brain, since it 

contains almost all of the cranial nerves in the brain and regulates 

heart rate and breathing it is also an important part of the human 

life. Any slight injury to the brainstem area can result in traumatic 

events, such as a stroke, loss of multiple functions, or even 

paralysis and death. Damage to the brainstem can result in a very 

rare disorder known as Locked In Syndrome, this is not the only 

disorder that can arise from an injury to the brainstem. The 

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Brainstem is an important structure of the brain, because it has 

many functions, parts, innervation of cranial nerves and when 

damage occurs to the brainstem there can be terrible and traumatic 

effects. 

Works Cited 

Pistoia, Francesca, MD, PhD, and Laureys, Steven, MD, PhD,. “Locked In 

Syndrome.” NORD (National Organization for Rare Disorders), 12 

Mar. 2018, rarediseases.org/rare-diseases/locked-in-syndrome/. 

Davis, Larry E., and Sarah Pirio Richardson. “Disorders of the Brainstem and 

Cerebellum.” SpringerLink, Springer, New York, NY, 1 Jan. 1970, 

link.springer.com/chapter/10.1007/978-1-4939-2359-5_8. 

Dolman Law Group |. “What Are the Causes and Effects of Brain-Stem 

Injuries?” Clearwater Personal Injury Attorneys Near Me, 6 June 2019, 

www.dolmanlaw.com/brain-stem-injuries/. 

“Anatomy of the Brain.” Johns Hopkins Medicine, 2020, 

www.hopkinsmedicine.org/health/conditions-and-diseases/anatomy-ofthe-brain. 

Libretexts. “11.4A: Functions of the Brain Stem.” Medicine LibreTexts, 

Libretexts, 14 Aug. 2020, 

med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book:_Anat 

omy_and_Physiology_(Boundless)/11:_Central_Nervous_System/11.4: 

_The_Brain_Stem/11.4A:_Functions_of_the_Brain_Stem. 

Micheau, Dr. Antoine, and Dr. Denis Hoa. “Pyramid.” IMAIOS, IMAIOS, 31 

July 2020, www.imaios.com/en/e-Anatomy/Anatomical- 

Parts/Pyramid. 

Jones, Oliver. “The Descending Tracts.” TeachMeAnatomy, 2 Jan. 2018, 

teachmeanatomy.info/neuroanatomy/pathways/descending-tractsmotor/. 

UPMC. “Cranial Nerve Disorders.” UPMC, 2020, 

www.upmc.com/services/neurosurgery/brain/conditions/cranial-nervedisorders. 

161

Chair Yoga 

Haley Tate 

The origins of yoga is unknown but it is dated to ~5000 years 

ago and rooted in Indian philosophy. Seals and fossils from the 

Indus Saraswati Valley Civilization were found with Yogi motives 

and figures performing yoga. The story: Shiva, a deity of 

Hinduism, was the first yogi. He shared his knowledge with the 

Saptarishis (“seven sages”) who carried it to different parts of the 

world. 

Yoga comes from the Sanskrit word ‘yuj’ meaning to unite. 

Yoga is about the perfect harmony between the mind and body and 

does not adhere itself to any particular religion or community. 

Enlightenment can be reached through different types of yoga (e.g. 

hatha, Iyengar, ashtanga, vinyasa, bikram) although, each may 

have their own approaches and techniques. There are many aspects 

of yoga, focusing on the mind, body, spirit, and soul, but as it 

became more widespread in the 1930s, emphasis was put on 

exercise, flexibility, breathing and strength. Yoga practiced in the 

U.S. typically emphasizes physical postures, breathing techniques 

and mediation. 

Equipment includes; a yoga mat, a block, a strap, a blanket 

and/or a bolster. Types of Yoga consist of; Hatha, Vinyasa, 

Ashtanga, Iyengar, Kundalini, Bikram, Jivamukti, and 

Yin/Restorative. Forms of Yoga can include: Aerial Yoga, Aquatic 

Yoga, Paddle Board Yoga, Acro Yoga, and Hip-Hop Yoga. A brief 

description of the types of Yoga are included below. 

Hatha is a combination of breathwork with physical postures, 

an introduction to basic yoga postures with a relaxed style, upon 

completion you feel more relaxed and stretched out. Vinyasa is a 

combination of rhythmic breathing with a series of flowing 

postures for a vigorous mind and body workout. It links breath to 

movement and flows with quick pace, this is a more athletic and 

dynamic workout. Ashtanga is similar to Vinyasa yoga; links 

breath to movement, although it is more structured and follows a 

specific sequence of poses in an order and when perform this type 

of yoga you should expect it to be hot, sweaty, and physically 

demanding. Iyengar emphasizes proper form by the use of props 

162

such as; blocks, straps, bolsters, and blankets. This type of yoga 

can help with proper alignment and ease tension, it is performed at 

a slower pace to allow people to go deeper into the postures and 

hold them for longer. This type of yoga is best for people with an 

injury or chronic condition. 

Kundalini focuses on repetitive movements synchronized 

with the breath, it involves chanting and meditating. This type of 

yoga really focuses on awakening the energy at the base of the 

spine in order to draw it up through each of the seven chakras 

through the practice of very simple poses to focus energy on 

awareness of both body and mind. Bikram includes only 26 poses 

that are performed in a specific order, the room is heated to 105°F. 

To prevent fluid and electrolyte imbalances; pre-hydration, posthydration 

along with electrolyte replacement is very important due 

to the increase in heat. Be careful to not over-strain muscles or 

joints due to the increased flexibility that comes with the heat. 

Jivamukti includes a Vinyasa-style flow through movement along 

with weekly themes that involves Sanskrit chanting, meditation, 

readings and affirmations. This type of yoga has a specific warmup 

sequence, you will always learn something new: focus on a 

particular (pose) or discussing an ancient yoga teaching when 

participating in this type of yoga. Jivamkti is highly meditative and 

very physically challenging to perform. Yin/Restorative has a 

slow-paced style that includes meditative and relaxing passive 

poses that are held for multiple minutes. It includes the use of 

props to Improve flexibility and circulation in joints and the focus 

is to lengthen the connective tissue; tendons, fascia, and ligaments. 

After participating in this type of yoga you will feel rejuvenated 

and relaxed. 

Chair Yoga was discovered by Lakshmi Voelker, she created 

Chair Yoga in 1982. Lakshmi Voelker created Chair Yoga because 

one of her students had arthritis and could not get on the floor to 

participate in yoga anymore. Lakshmi Voelker certifications and 

memberships include; Kripalu Yoga instructor, Member of the 

Yoga Alliance, and International Association of Yoga Therapists, 

and other certifications. Lakshmi Voelker stated that, “She was 

able to bring adaptive fitness and exercise programs to those who 

163

could not benefit from traditional activities due to age or limiting 

physical/mental conditions or environment/location. 

Anyone can benefit from Yoga even people that have these 

injuries or diseases can benefit from yoga; Chronic Pain, Carpal 

Tunnel Syndrome, Osteoporosis, Osteopenia, Multiple Sclerosis, 

Arthritis, Diabetes, Heart Disease, Disabled Individuals, Scoliosis, 

elderly and people that have trouble with up and down movement, 

allows stabilization. Getfitwhereyousit stated that, “Disabled 

people who are wheelchair bound begin to enjoy life and become 

more playful with weekly chair yoga classes. This is especially 

true for children. Turning your yoga practice into fun breathing 

and moving games on the wheelchair has proved successful. Your 

confidence begins to build and as times goes on you will want to 

lead the weekly classes.” 

Benefits of Yoga can include improved strength, flexibility, 

proprioception, stress and pain management, mental-state, and 

improved lung capacity of breathing. Other benefits of Yoga 

include a reduction in stress and improved mental clarity, provides 

the opportunities to meet people and socialize and weight-loss. 

Examples of Yoga Poses that can be performed on a chair: 

• Candle Pose: 

• Inhale, lengthen spine and raise hands above head. 

• Exhale, bring palms of hands together. 

• Raised Hands Pose: 

• Stretches stomach, shoulders and improves digestion. 

• Inhale, lengthen spine, raise hands above head palms 

facing each other. 

• Exhale and repeat as needed. To make more difficult, 

on inhale raise legs when you raise arms. 

• Forward Bend: 

• Massages the intestines, helps with digestion, and 

lengthens the spine and stretch's the back muscles. 

• Extend spine, and simply fold over your legs. Can 

start with hands resting on thighs and slide them 

down your legs as you fold for a little extra support. 

164

Can keep arms at sides as you work toward laying 

your torso on your thighs. 

• Inhale, lift torso back to an upright position. 

• Extended Side Angle Pose: 

• Releases stiffness in shoulders and back. Perform 

steps as Forward Bend Pose. 

• Raise one hand in the air and turn towards side of 

hand raised. (Example: raise right hand, turn to the 

right side). Keep opposite hand by side. Switch sides 

and repeat. 

• Shoulder Stretch/ Reverse Arm Hold: 

• Stretches the shoulders and opens up chest, helps 

with posture, stress, and if difficulty breathing. 

• Inhale, stretch both arms out to your sides, palms 

down. 

• Exhale, roll shoulders forward slightly, this will cause 

the palms to roll and face behind you. Bend elbows, 

let your hands swing behind your back. Clasp hands, 

can be by fingers, hands, writs or elbows depending 

on how flexible the joint is. If you grip past the 

hands, take a mental note of which arm you grabbed. 

Gently pull hands away from each other without 

releasing hold. After a few breathes, re-clasp the 

other wrist or elbow and hold for a couple breaths. 

• Table Pose: 

• Stretches front side of the body, core and arms. 

Improves posture and balance, relieves feelings of 

fatigue or stress and restores balance to body after 

any forward-facing actions or motions. 

• Extend legs, place arms by side, slide to end of seat. 

• Inhale, place hands slightly behind body, feet flat on 

the floor and press against chair to lift body up 

• Exhale, hold and on last exhale slowly release 

position and return to sitting with hands by side and 

legs bent at 90 degrees. 

• Spinal Twist: 

165

• Twisting: helps release lower back pain, aids in 

digestion and circulation. It is referred to as a detox 

pose. 

• Do not want to use the chair to pull yourself into a 

deeper twist, the body has a natural stopping point, do 

not force it by pulling with your hands. Forcing a 

twist can cause serious injury. 

• Inhale, extend the spine and raise arms out to the 

sides and up. 

• Exhale, gently twist with upper body and lower your 

arms. Hand (for side you are twisting to) will rest on 

top of chair back and help to gently twist, opposite 

hand will rest by side. Look over shoulder. Use your 

grip on the chair to help stay in the twist but not to 

deepen it. After a couple breaths, release twist and 

return to facing the front. Repeat on other side. 

• Star Pose: 

• Stretches body in all directions, aligns spine, improve 

posture and reduces pain in back and shoulders. Uses 

every muscle in the body. Strengthens the legs, 

ankles, abdomen, and back. Reduce the effects of 

sciatica and flat feet, improves circulation and 

respiration. 

• Perform same steps as the Raised Hands Pose: 

• Inhale, lengthen spine, raise hands above head palms 

facing each other and raise legs when you raise arms. 

• Exhale, move arms and legs out, away from body, 

around 45 degrees, maintain pose and continue to 

inhale and exhale. On last Exhale slowly bring limbs 

back toward body. 

• Seated Side Bend Pose: 

• Stretches the abdominal muscles and digestive 

organs, also stretches the muscles between the ribs; 

improves breathing capacity. Relieves respiratory 

conditions, such as asthma, allergies, and colds. Aids 

and regulates digestion, elimination, and metabolism. 

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• Inhale, raise hands above head. 

• Exhale, lower one hand to side and place beside legs, 

lean towards that side. Repeat and switch sides. 

• Seated Mountain: 

• Inhale, lift your arms out to the sides, then raise 

hands up to meet above your head. Lace fingers 

together, keep pointer fingers and thumbs out. 

Pointing at the ceiling directly over your head. 

• Exhale, roll shoulders away from ears, letting 

shoulder blades slide down your back. This will 

engage the shoulder joint muscles. Continue to take 

deep breaths. On last exhale, release clasped hands 

and let arms gently float back to your sides. 

• Warrior 1: 

• Strengthens the arms and legs, opens the hips and 

chest. Develops concentration, balance and 

groundedness. Improves circulation and respiration 

and energizes the entire body. Can be modified by 

raising hands up and sitting forward, the Raised 

Hands Pose. If you are able to use the lower body, 

you can advance the Raised Hands Pose to this pose. 

• Start in lunge position, inhale, lengthen spine, raise 

hands above head palms facing each other. Exhale 

and hold. To go deeper; bring the palms together and 

carefully arch back, look up towards the ceiling. 

• Eagle Pose: 

• Relaxes shoulders and upper back, stabilizes and 

flexes your shoulder joint. 

• As you inhale, stretch your arms out to your sides. 

• As you exhale, bring arms in front of you, swinging 

your right arm under your left and grabbing your 

shoulders with the opposite hands, giving yourself a 

hug. If you have more flexibility in your shoulders: 

release grip and continue wrapping your forearms 

around each other until your right fingers rest in your 

left palm. 

167

• Inhaling, lift your elbows a few inches higher. 

• Exhaling, roll your shoulders down, relaxing them 

away from your ears. 

• Cat and Cow Pose: 

• Flexibility to the spine; stretches the back, torso and 

neck. Develop postural awareness, balance 

throughout the body, brings spine into correct 

alignment and can help prevent back pain. Stimulates 

and strengthens the abdominal organs. Opens the 

chest, stimulates the kidneys and adrenal glands. 

Coordinating with breathing to relieve stress and 

calm the mind. 

• Place hands on thighs, center your head into a neutral 

position, slowly look downward. 

• Start with the Cow Pose: Inhale, flex the spine, torso 

moves forward, lift your chin and chest, and look 

straight ahead or toward the ceiling. Draw shoulders 

away from the ears. Exhale and continue to hold pose 

as needed. 

• On last exhale, move into Cat Pose: draw torso in, 

round the spine, (the pose should look like a cat 

stretching its back). Move your head towards the 

floor or downwards, do not force the chin to touch the 

chest. Continue to breathe as you hold the pose. Can 

alternate between the poses or do one pose and move 

into the other. If alternating, you would need to inhale 

to form the Cow Pose and then exhale as you return 

to Cat Pose. 

• Single Leg Stretch 

• Sit on edge of seat, sit tall, stretch one leg out and 

place the heel on the floor, toes pointing up. Place 

hands on outstretched leg. The closer to the edge of 

the seat you are, the straighter your leg can get, BUT 

pay attention to how supported you are before folding 

forward. 

• Inhale, raise up through spine. Exhale, bend over leg 

168

and slide the hands down as you go down. Go deeper 

each time you breathe. On last inhale, slowly rise up 

and repeat with other leg. Stretch as far as you like, 

do not strain or force anything, continue to feel 

supported by the chair and by your hands. 

Works Cited 

“Types of Yoga: The Eight Most Popular Styles Of Yoga: Andrew Weil, M.D.” 

DrWeil.com, 26 Jan. 2018, www.drweil.com/blog/spontaneoushappiness/the-8-most-popular-types-of-yoga/. 

Kravetz, Richard. “6 Benefits Of Chair Yoga + 8 Poses To Get You Started.” 

DOYOU.COM, 5 Sept. 2014, www.doyou.com/6-benefits-of-chairyoga-8-poses-to-get-you-started/. 

Blasi, Elizabeth. “What Is Chair Yoga? Benefits, Poses & More!” Aaptiv, 

Aaptiv, 24 June 2019, aaptiv.com/magazine/chair-yoga. 

“About Lakshmi Voelker.” Chair Yoga, Chair Yoga Fitness, Chair Yoga 

Exercises, Chair Yoga Poses - Get Fit Where You Sit, 

getfitwhereyousit.com/about-lakshmi-voelker-fitness-exercise/. 

Tran, Phuoc. “How to Do Star Pose in Yoga.” YogaOutlet.com, 

YogaOutlet.com, 18 Sept. 2013, 

www.yogaoutlet.com/blogs/guides/how-to-do-star-pose-in-yoga. 

Kravetz, Richard. “6 Benefits Of Chair Yoga + 8 Poses To Get You Started.” 

DOYOU.COM, 5 Sept. 2014, www.doyou.com/6-benefits-of-chairyoga-8-poses-to-get 

you-started/. 

McDonald, Lois. “Warrior I Pose (Virabhadrasana I) Instructions & Photos • 

Yoga Basics.” Yoga Basics, 29 Mar. 2019, 

www.yogabasics.com/asana/warrior-i/. 

Tran, Phuoc. “How to Do Cat-Cow Pose in Yoga.” YogaOutlet.com, 

YogaOutlet.com, 12 Apr. 2015, 

www.yogaoutlet.com/blogs/guides/how-to-do-cat-cow-pose-in-yoga. 

169

The Sound of Silence: A Look Into Noise-Induced 

Hearing Loss 

Rhea Tibrewal 

Noise-induced hearing loss (NIHL) is a category of 

sensorineural hearing loss that stems from an excess amount of 

exposure to intense sound, typically over an extended duration. 

This type of hearing loss can occur to any demographic as it does 

not discriminate between race, age, or gender. NIHL can be caused 

by either a one-time exposure to a powerful sound or by chronic 

exposure to loud noises (Noise-Induced, 2019). In the age of 

technology, this form of loss has become increasingly prevalent as 

it can come through numerous sources, such as personal music 

devices and workplace environments; both elements of life 

contribute to our society’s daily experiences. It can be particularly 

insidious as it accumulates, usually unnoticed, over a period of 

many years of exposure to noise on a daily basis (Pope & Rall, 

1995). Nevertheless, it can be easily prevented through proper 

hearing healthcare and education. 

Noise-induced hearing loss was first recorded during the 

Industrial Revolution in the late 1700s to the early 1800s. During 

this period, many occupational workers experienced NIHL due to 

the loud machinery they were surrounded by (Harvard, 2007). In 

fact, this hearing loss was so rampant that it became known as 

boilermakers’ disease due to the fact that the workers who created 

boilers were especially susceptible to developing NIHL (Harvard, 

2007). Though the name has changed, the effect of loud 

occupational environments certainly has not. Indeed, it has become 

even more relevant in today’s society, especially when combined 

with recreational NIHL. 

Currently, noise-induced hearing loss is the second most 

common cause of sensorineural hearing loss after presbycusis, 

hearing loss resulting from the natural aging process (Rabinowitz, 

2000). In a 2011-2012 National Health and Nutrition Examination 

Survey published by the Center for Disease Control (CDC), it was 

found that around one in four U.S. adults aged 20-69 had aspects of 

noise-induced hearing loss in one or both ears. This indicates that 

170

as many as 40 million adults may have NIHL (U.S., 2017). 

Furthermore, the World Health Organization (WHO), has stated 

that 1.1 billion young people from ages 12-35 are at risk of 

developing NIHL in recreational settings (World, 2020), and the 

CDC has reported that approximately 5.2 million U.S. children 

aged 6-19 have suffered permanent ear damage due to excessive 

noise (Center, 2020; Niskar, Kieszak, Holmes, Esteban, Rubin, & 

Brody, 2001 ). This can most definitely be attributed to the severe 

expansion of noisy environments surrounding children and adults 

today. 

Music can be considered one of the most often causes of 

NIHL, especially through the use of headphones. Headphones 

allow the user to increase his or her volume level to a range of 

about 85-110 decibels (dB) (Brinson, 2016). Decibels are units in 

which sound is measured. Sounds at or below 70 dB are considered 

to be safe levels of noise and are unlikely to cause any damage to 

hearing; however, sounds 85 dB and higher can be detrimental to 

hearing, especially if the sound is consistently playing at those 

frequencies (Noise-Induced, 2019). Thus, the fact that users can 

turn their headphones up to 110 dB is greatly problematic and is a 

high cause for concern. Furthermore, as the distance between the 

headphones and the eardrum is short once the headphones are put 

into the ears, the amount of noise going to the eardrum is far 

greater than necessary and can cause everlasting negative effects to 

the user’s hearing levels. NIHL due to music can be found in 

young adults worldwide. In a Scandinavian study, 15% of the 538 

teenage boys tested had a hearing loss due to noise exposure. 

Additionally, clinical data in Germany found that one in ten young 

adults has some degree of NIHL from recreational noise. In China, 

14% of 120 young users of personal music devices had impaired 

hearing. And in France, an audiometric survey of 1364 young 

adults found evidence of hearing problems in 66% of subjects who 

often attended concerts or used personal music devices (Harrison, 

2008; Axelsson, Jerson, Lindberg, & Lindgren 1981; Zenner, 

1999; Peng, Tao, & Huang, 2007; Meyer-Bisch, 1996). Table one 

shows a comparison of the average intensity levels for various 

171

sounds (Rabinowitz, 2000). 

In addition to consideration of the level of noise, the duration 

of exposure is also a critical determining factor. As seen in the 

figure above, an eight-hour time limit of exposure appears starting 

from 85 dB. Though not explicitly shown, this limit decreases as 

the loudness increases as the more exposure one has to louder dB, 

the greater the chance that permanent noise-induced hearing loss 

may occur. 

Moreover, workplace exposure can also play a role in 

attaining NIHL. Many physically demanding careers, such as 

construction or the Army, unfortunately coincide with consistently 

being exposed to loud noises. In a study from the Building Trades 

National Medical Screening Program it was found that among 

construction workers examined between 1996 and 2010, 58% had 

significant abnormal hearing loss due to noise exposures at work 

(McGarvey, 2018). This is quite shocking as it can be plainly seen 

that more than half of construction workers develop NIHL. 

172

Similarly, individuals in the Army are at great risk of developing 

hearing loss because of their constant exposure to loud noises from 

objects such as guns, bombs, and utility vehicles. In fact, in a 2008- 

2012 analysis by the U.S. Army Public Health Command, it was 

found that approximately 60% of active-duty members in the Army 

developed NIHL (Helfer, T., Beamer, S., Deaver, K., & Hall, S., 

2014). As these personnel are regularly surrounded by unusually 

high levels of noise in their environment compared to civilians, it is 

no great concept to imagine that they will experience NIHL faster 

than non-Army persons. 

NIHL can be physically seen once an individual gets his or 

her hearing tested by an audiologist. This test will then produce an 

audiogram, which will show the hearing levels the individual has 

based on dB and Hertz (Hz). dB constitute the loudness of a sound, 

while Hz represents the frequency of that sound. A normal hearing 

person typically has the ability to hear from 250-8000 Hz at 0 dB. 

A person with NIHL, however, has limitations to that range of 

hearing, as they have selected hearing loss frequencies at 3000, 

4000, and 6000 Hz and at higher dB (U.S., 2017). Visually, this 

can be seen as a notch in the audiogram. Figure 1 shows an image 

of an audiogram of a normal hearing person and of a person with 

bilateral NIHL (Pope & Rall, 1995). 

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In this figure, the individual with normal hearing is 

represented through dashed lines, while the individual with 

bilateral NIHL is represented through solid lines. As seen in the 

figure, the individual with NIHL has a notch in his or her hearing 

portrayed by the sudden downward spike. This notch can 

complement the inability to hear certain speech sounds, such as /t/, 

/f/, and /s/, as these sounds coincide with frequencies of 3000 Hz, 

4000 Hz, and 6000 Hz respectively (U.S., 2017). Mr. Howard J. 

Hoffman, the director of the National Institute on Deafness and 

Other Communication Disorders’ (NIDCD) Epidemiology and 

Statistics Program, stated that “When hearing loss is found in both 

ears, the presence of the audiometric notch is more closely 

correlated with loud noise exposure than when the notch is found 

in only one ear. However, notches may be caused by noise and a 

variety of other factors,” (U.S., 2017). Furthermore, in the 

aforementioned 2011-2012 study published by the CDC, Hoffman, 

a coauthor of the paper, found that “...19% of young adults aged 

174

20-29 had either unilateral or bilateral audiometric notches, with 

4% having noise notches in both ears,” (U.S., 2017). This proves 

that young people are also at risk of developing NIHL, most likely 

through music, and that this form of hearing loss is not limited to 

the workplace environment. 

Sound is first produced when sound waves go through the 

ear canal to the eardrum. The eardrum then vibrates and sends 

those vibrations to the three bone ossicles in the middle ear. These 

bones turn the sound vibrations into fluid vibrations in the cochlea 

and travel to the basilar membrane in the inner ear where the 

stereocilia sit. The stereocilia are used to convert the fluid 

vibrations of sounds produced from the cochlea into electrical 

signals that are carried to the brain through the auditory nerve. This 

occurs when the stereocilia bend and create channels to open up, 

thus allowing chemicals, mostly potassium, to rush into the cell. 

The auditory nerve will then take those signals to the brain, which 

translates it into a recognizable sound (Noise-Induced, 2019). 

However, when the stereocilia are damaged due to overexposure to 

noise, this process is impeded and the fluid vibrations are no longer 

able to convert to electrical signals, creating noise-induced hearing 

loss. Over time, sounds will gradually become more muffled and 

difficult to understand (Noise-Induced, 2019). Unfortunately, due 

to their place in the inner ear, once the stereocilia are damaged, 

there is no way to repair them and there is a permanent loss of 

hearing. Figure 2 shows images of stereocilia that are both normal 

and damaged to see the difference between them (Harrison, 2008). 

175

In this figure, the top left corner shows an image of what 

stereocilia normally look like. Notice how they are all neatly linked 

together. In contrast, the right image shows what damaged 

stereocilia resemble. The bottom left image depicts an anatomical 

diagram of the structure of normal stereocilia. It is notable in the 

right figure that the stereocilia appear to be frayed and broken. 

When this occurs, the stereocilia can no longer open the channels 

that allow the chemicals to come in. This in part causes the 

stereocilia to self-destruct (Harrison, 2008). 

Hearing loss due to noise exposure can be separated into 

various categories including, acoustic trauma, temporary threshold 

shift (TTS), permanent threshold shift (PTS), and tinnitus (Pope & 

Rall, 1995) (Harrison, 2008). Acoustic trauma can usually be 

caused by a single, intense noise followed by tinnitus and a change 

in hearing threshold. This can either improve over time, or, if loud 

enough, create a PTS (Pope & Rall, 1995). TTS can be defined as a 

temporary hearing loss that can fully recover over time (Harrison, 

2008). However, it is agreed upon that repeated experiences of 

TTS can end in permanent damage due to TTS altering the 

cochlea’s function and loosening the stereocilia linkages (Harrison, 

2008). TTS is probably the most harmful form of noise-induced 

176

hearing loss as it slowly progresses, usually without the knowledge 

of its victim. 

Tinnitus is commonly known as the slight ringing in the ear 

after exposure to loud noises. Though tinnitus may recover after a 

brief period, chronic tinnitus does exist and warns of cochlear 

injury caused by stereocilia self-destructing (Harrison, 2008). This 

then causes the stereocilia to produce a neural injury discharge and 

break down the cell membrane, thus beginning the process of 

depolarization and the uncontrollable release of neurotransmitters 

(Harrison, 2008). This contributes to hearing loss due to noise 

exposure. Tinnitus due to NIHL has been widely documented. In a 

German study, data was collected from 531 patients who suffered 

from chronic tinnitus. Of those patients, it was found that 83% of 

them had a high-frequency hearing loss due to NIHL (Mazurek, B., 

Olze, H., Haupt, H., & Szczepek, A. J., 2010). In Sweden, 

researchers in a 1991 study found that noise exposure and NIHL 

were the most common cause of tinnitus (Axelsson & Prasher, 

2000; Axelsson & Barrenas, 1991). Furthermore, regarding 

occupational NIHL, 33% of the 400 tinnitus patients observed were 

found to have been exposed to occupational noise (Axelsson & 

Prasher, 2000; Axelsson & Barrenas, 1991). Tinnitus was also 

found to affect frequencies from 2000-8000 Hz, which corresponds 

to the frequencies lost due to NIHL, therefore, it can be considered 

that the aspects that hinder the sense of hearing also affect the 

presence of tinnitus (Axelsson & Prasher, 2000). 

As noise-induced hearing loss cannot be repaired, the only 

way to combat it is to take preventative measures. Fortunately, 

there are several ways that that can be achieved. One avenue that 

can be taken is to measure the sound level in a given setting, such 

as the workplace. The American National Standards Institute 

(ANSI) provided guidelines for industries and government 

agencies about workplace safety, including hearing protection. 

Consistent monitoring, and adhering to the guidelines of ANSI, 

will greatly lower the risk of acquiring NIHL as well as informing 

the individual about hearing protection in the workplace (ANSI’s, 

n.d.). There are two main devices that are widely used to determine 

177

the amount of noise exposure: sound level meters (SLMs) and 

noise dosimeters (Levey, Fligor, Ginocchi, & Kagimbi, 2012). 

SLMs are handheld devices that use a microphone and signal 

processing hardware and are calibrated to instantaneously show the 

sound level in the environment. SLMs are easily obtained and used 

and may even be found in the form of phone apps. Noise 

dosimeters, on the other hand, report sound in intervals of time and 

show the average sound exposure over the course of hours (Levey 

et. al., 2012). They also attach to an individual’s clothing, such as a 

belt, and utilize a small microphone that fastens to the person’s 

shirt collar, so that it is close to their ear. It is more useful to people 

who change locations frequently (Government of Canada, 2014). 

Figure 3 shows an example of a noise dosimeter reading 

(Seneviratne & Phoon, 2006). 

As can be seen in the figure, over the course of the 

individual’s shift, the noise level that he was surrounded by was 

almost always above 85 dB. This recording is particularly 

important as it tells the individual that he is at risk of developing 

NIHL if he continues to work in this environment without the 

usage of preventative equipment, such as earplugs. 

NIHL can greatly affect an individual’s quality of life. Sadly, 

losing one’s hearing can create strong negative feelings of anger, 

frustration, and depression. This may be traced to the idea that the 

individual now believes that he is disabled and can no longer be 

178

freely independent. This can be exceptionally problematic in young 

adults, who may feel that they have a more difficult time 

communicating in noisy environments. These thoughts can then 

lead to a feeling of social isolation which, in extreme cases, can 

lead to emotional and mental health issues (Harrison, 2008). If 

hearing aids are needed, adolescents may also feel self-conscious 

about the appearance of the technology. The consequences of 

NIHL may also affect future career goals due to some employers 

feeling hesitant about employing an individual with a hearing loss. 

This can end in massive quality of life implications. 

Fortunately, it is quite easy to impede the development of 

noise-induced hearing loss. Simple measures including wearing 

earplugs, earmuffs, or noise-cancelling headphones will greatly 

reduce the attainment of NIHL. And, if those are not available, 

merely avoiding loud settings would also be acceptable. Turning 

down the volume on personal music devices is also useful, 

especially if using headphones. This action should not be too 

difficult to perform as most smartphones have a feature that 

notifies the user if the volume is too loud. Furthermore, it is 

important to be self-aware and get tested if there is any sign that 

hearing loss may occur. The most important thing, however, is to 

make sure proper hearing education is being taught. The best place 

to do this is in schools where students can learn how to take care of 

their ears from an early age. This will greatly reduce the cases of 

NIHL in the future as these children will grow up knowing how to 

take efforts against NIHL and the damage it can do. 

Summary and Conclusion 

NIHL is a form of hearing loss that is highly prevalent in 

both young adults and adults. With constant access to loud noises 

through personal music devices or workplace machinery, it is 

easier than ever for anyone to start developing aspects of NIHL 

without their knowledge. As it typically grows gradually, most do 

not even realize their hearing is being impaired until it is too late. 

As NIHL affects the stereocilia in the inner ear, damage to hair 

cells result in permanent hearing loss. However, there are 

preventative measures that can be taken to prohibit NIHL from 

179

appearing in the first place. Through protective devices such as 

earplugs and noise-cancelling headphones, the risk of losing 

hearing greatly reduces. Further, staying away from environments 

that are loud, if possible, and turning down the volume of personal 

music devices also inhibits NIHL. In order to truly combat NIHL, 

it is imperative that people know about the existence of this 

disorder and the consequences that can arise from it. Merely taking 

precautions when in the presence of loud noises can considerably 

diminish the number of cases that currently stand and will achieve 

a greater quality of life for all. 

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Helfer, T., Beamer, S., Deaver, K., & Hall, S. (2014). Active Duty – U.S. Army 

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Mazurek, B., Olze, H., Haupt, H., & Szczepek, A. J. (2010). The more the 

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McGarvey, S., Booker, B., & Cain, C. T. (2018). Noise-Induced Hearing Loss 

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shifts among children 6 to 19 years of age: The third national health 

and nutritional examination survey. 1988-1994, United States. 

Pediatrics;108:40–43. 

“Noise-Induced Hearing Loss.” (2019). National Institute of Deafness and 

Other Communication Disorders, U.S. Department of Health and 

Human Services, 

Pope, A. M. & Rall, D. P. (1995) "Case Study 52: Behavioral and Audiologic 

Manifestations of Noise-Induced Hearing Loss." Institute of Medicine. 

Environmental Medicine: Integrating a Missing Element into Medical 

Education. Washington, DC: The National Academies Press. doi: 

10.17226/4795. 

Rabinowitz, P. M. (2000). “Noise-Induced Hearing Loss.” American Family 

Physician, American Family Physician. 

The Center for Construction Research and Training. Noise-Induced Hearing 

Loss in Construction and Other Industries. The Construction Chart 

Book. 

Seneviratne, M. & Phoon, W. (2006). Exposure Assessment in SMEs: A Low- 

Cost Approach to Bring OHS Services to Small-Scale Enterprises. 

Industrial health. 44. 27-30. doi: 10.2486/indhealth.44.27. 

“U.S. Adults Aged 20 to 69 Years Show Signs of Noise-Induced Hearing 

Loss.” (2017). National Institute of Deafness and Other 

Communication Disorders, U.S. Department of Health and Human 

Services. 

World Health Organization. (2020). Deafness and hearing loss. World Health 

Organization. 

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182

Cultural Expression Through the Haka Dance 

Analisa Trevino-Contreras 

Haka is a traditional dance form created by the Maori people 

of New Zealand. The dance form originated as a war dance done 

before battle to energize the warriors before they head out to battle 

as well as to intimidate the opposition on the battlefield to increase 

their chances of success ("History of the All Black haka"). The 

dance form evolved and was later integrated into many different 

features of Maori life, this includes weddings, funerals, traditional 

ceremonies, as well as welcoming guests into their tribe’s land 

(Williams, 2017). Along with all these different features of Maori 

life being influenced by the dance practice, there came many 

different forms of the dance that was then performed at these 

different events. However, due to the fact that the many different 

forms of the dance share the same origins of the war dance, they all 

share the same intense and powerful movements as the war dance, 

to assert their dominance and strength in all aspects of life. The 

great pride of the Maori people of New Zealand has major 

influences on the traditional dance Haka, further illustrated through 

the strong and percussive movements used in the various forms of 

the dance. 

One of the original influences on the creation of the dance 

came from the Maori legend of the sun god Tama-nui-te-ra and one 

of his two wives, Hine-raumati who contains the essence of 

summer in god form, and their child together named Tane-rore. It 

is said that the trembling and fluttering presence of the air on a hot 

summer day is created by Tane-rore who dances for his mother 

(Alves, 2017). This is what all the swift and light movements used 

in all the forms of Haka are derived from, with emphasis on the 

quivering hands and fingers that the dancers always utilize in the 

different forms to represent the god’s dance for his mother 

(Cunningham, 2019). The swift and light movements allow the 

dancers to add a sense of power behind their movements to assert 

their strength wherever the dance is performed, the battlefield, 

183

ceremonies, celebrations, and welcoming guests. In all of these 

different occasions, the Haka is executed as a group to express the 

unity of the tribe. The group must also have a leader who is very 

experienced in the dance art and who has the capability of 

influencing his team’s performance “by the timing of voice and 

movement” (Smith, 2017). The other participants of the group 

can’t just be anybody, they must also be well-versed in the art of 

the dance, not necessarily as much as the leader, this is because the 

Maori tribes take great pride in their people and their works, if a 

performance is executed poorly, especially when welcoming a 

guest to their land, this could “greatly damage the tribe’s 

reputation” (Alves, 2017). 

The term “Haka” is a general one used to encompass the 

many different forms of the dance that originated from the war 

dance. Some of these different forms include “haka taparahi,” a 

ceremonial haka performed without the use of weapons, “haka 

peruperu,” war hakas performed with weapons, and “haka 

powhiri,” a welcoming for guests (Williams, 2017). Even though 

the different hakas are performed upon diverse occasions, the fact 

that they share the same origins means that they share similar 

movements, the fact that they all look so similar is why so many 

people are unfamiliar with the fact that there are indeed many 

different forms of the dance. The movements that are used in the 

different forms of the dance include stomping the ground, 

quivering hands and fingers, slapping the thighs and chest, having 

the eyes wide open, thrusting the tongue out and having the legs 

spread far apart (Cunningham, 2019). It is said that while 

performing, one must give everything they have into the 

performance if in the end they still have any amount of energy or 

strength left, they didn’t do the performance right and the 

reputation of their tribe may suffer (Higgins & Loader, 2017). All 

of these movements combined to make a very ferocious sight to 

behold, especially when paired with the chanting in their native 

Maori tongue that has a rather harsh tone to it. When performing 

the war dances, the intention of the dance is to energize the 

warriors to win the battle as well as to terrify their enemies into 

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submission, the ceremonial hakas can include performances at 

weddings, funerals, preparing to sail to sea and welcoming hakas, 

the ferociousness of the dance is meant to “excite the audience and 

seduce them into the performance” and as for the welcoming of 

guests, it is also meant to excite them as well as assert that their 

tribe is not inferior (Smith, 2017). There are more recent renditions 

of the Haka that were created in the early nineteenth century by a 

Maori chief by the name of Te Rauparaha who constructed the “ka 

mate haka” while fleeing an enemy and performed it as a 

celebration of his survival and this form of haka was later adopted 

by the New Zealand rugby team the All Blacks who began 

performing it before matches to intimidate their opponents, a 

similar intention as the original war haka, to make the opponents 

uneasy and increase their chances of success (“History of the All 

Black haka”). 

The clothing worn while performing a majority of the 

traditional Hakas includes the traditional clothing of the Maori 

people. The traditional clothing mostly consists of shoulder and 

waist garments made from a variety of sources, mainly plants and 

animal skins and while performing there were no shoes worn to 

make the dancers feel more connected to the earth. The traditional 

clothing also consisted of neck, ear and hair accessories. The 

clothing and accessories one wear was a reflection of their status, if 

they had many accessories and clothing made of the more prized 

animals and rarest plants, that reflected the high status of an 

individual. Thus, while performing, especially when the audience 

includes outsiders, the dancers would wear the clothing that 

reflects a higher status as the Maori people maintain a “strong 

sense of collective identity,” if their dancers’ clothing reflects a 

high statues then that further displays the higher status of the tribe 

as a whole, which is essential to the tribe as they take great pride in 

themselves and their people (Coates, 2018). However, in regards to 

the relatively newer form of haka, the ka mate, due to the fact that 

it is being performed before a rugby match, the dancers who are 

also the team members, wear the uniform of their team which is a 

black shirt and pants, also meant to intimidate their opponent, with 

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their fierce movements, chanting and all-black attire. 

As someone who has never experienced a dance of this style 

before, I was very intrigued which partially contributed to the 

reason why this topic was chosen. Until reading about this dance 

and watching videos of it, I had never seen a war dance, a dance 

that shows such ferocity, which intrigued me. I also find it so 

beautiful that this dance had such a grip on the development of the 

culture that it was able to evolve and ingrain itself in the different 

aspects of Maori life. I have research and seen dances that have 

evolved through time and were integral to the culture, but never 

have I heard of a dance that was able to develop into multiple 

versions to allow it to be applied to so many different aspects of 

life, war, peace, welcome, mourning and celebration. As someone 

who is very timid, seeing the dancers be able to keep such a fierce 

face while doing such powerful movements and chants was very 

empowering, especially because the dances that were to be 

performed by only women showed the same fierceness as those 

done by only the men, which I thought was very empowering for 

the Maori women, showing how they can have the same strength as 

their male counterparts. I felt very much like an outsider when 

attempting to apply this research to my own life because even on 

my best days I would never be able to embody the same strength 

and intensity the dancers' display. Although I feel like an outsider 

while reading about and watching these performances, the fact that 

this dance form is so culturally rich and deeply engrained in their 

history, that just makes the dance even more appealing. To have a 

part of your history passed down through the generations and be 

able to have your grandparents teach you about it after they learned 

it from their grandparents, and it hasn’t been polluted by the 

influence of many different cultures, making it all the more unique 

to their culture alone makes the art all the more extraordinary. 

There was a video I watched of a wedding of a couple in New 

Zealand and a group of attendees began to dance the Haka during 

the reception and the couple was so touched it brought them to 

tears before joining in the dance and while I do appreciate the 

beauty and strength displayed during performances of the dance, I 

186

would never be able to fully comprehend and partake in such a 

culturally rich and powerful dance (Westone Productions Limited, 

2016). 

In conclusion, the great pride of the Maori people of New 

Zealand has major influences on the traditional dance Haka, further 

illustrated through the strong and percussive movements used in 

the various forms of the dance. The dance’s origins come from the 

Maori legend of the sun god and his wife whose son dances for her 

through the heat waves in the summer, which inspired an integral 

part of the dance, the dancer’s trembling fingers and hands. The 

dance began as a war dance to energize the warriors before battle 

and to terrify the enemy into submission, the dance was so integral 

to the Maori way of life that it later evolved and became ingrained 

into the many different aspects of their life which gave birth to the 

many different forms of Haka which are to be performed at many 

different occasions including war, peace, welcome, mourning and 

celebration. The clothing worn by the dancers consists of the 

traditional Maori clothing, however, it is that of a tribe member 

with higher status to show to the other tribes that may be in 

attendance of the performance, that their tribe as a whole has a high 

status. Despite the fact that there are many different instances for 

the different variations of the dance to be performed, they all share 

the same power, and ferocity through their strong movements and 

stances and forceful chanting. The differing occasions for the 

performance of the dance style all share one similar intention, 

pride. They take pride in their strength of the dancers and the 

leader, in the unity of the group which further represents the unity 

of the tribe as a whole and in the dominance the tribe has over all 

others. 

Works Cited 

Alves, T. (2017, June 22). The Haka: New Zealand's Maori War Dance. 

Retrieved from https://theculturetrip.com/pacific/newzealand/articles/what-is-the-haka-new-zealands-maori-war-dance/. 

Coates, J. (2018, April 30). A Guide To Traditional Maori Dress. Retrieved 

from https://theculturetrip.com/pacific/new-zealand/articles/a-guide-to- 

187

traditional-maori-dress/. 

Cunningham, J. M. (2019, August 22). Haka. Retrieved from 

https://www.britannica.com/art/haka. 

Higgins, R., & Loader, A. (2017, June 8). Haka taparahi. Retrieved from 

https://teara.govt.nz/en/video/44228/haka-taparahi. 

History of the All Black haka. (n.d.). Retrieved from 

https://media.newzealand.com/en/story-ideas/history-of-the-all-blackhaka/. 

Smith, V. (2017, May 26). Kapa haka – Māori performing arts. Retrieved from 

https://teara.govt.nz/en/kapa-haka-maori-performing-arts/page-1. 

Westone Productions Limited. “EMOTIONAL WEDDING HAKA (Original 

Video) HD” YouTube. Video. 21 Jan 2016. Web. Accessed 6 Nov 

2019. 

Williams, A. (2017, October 4). The History of the Traditional Maori Haka in 

New Zealand. Retrieved from https://www.dangerous-business.com/kamate-ka-mate-ka-ora-a-haka-history-lesson/. 

188

Coronavirus and Climate Change: An Analysis 

Anna Whitaker 

When we put the terms ‘COVID-19’ and ‘climate change’ 

together, our first thought is that this pandemic, as horrible as it is, 

has actually been beneficial for climate change due to lockdowns 

and sharp reductions in emissions. However, there’s also been 

quite a few surprising downsides. Meehan Crist, writer-inresidence 

in the biological sciences department at Columbia 

University, seeks to uncover these positives and negatives in her 

March 2020 opinion article for The New York Times. I’ll be 

analyzing her arguments and evidence to help us see just how well 

she answers the question she herself poses: “In the longer term, 

will the virus help or harm the climate?” (Crist) 

Let’s start with the positives. Because of measures set in 

place to prevent virus spread, travel has been drastically limited. 

Fewer planes are flying and the streets are emptier. Factories and 

other manufacturers that use fossil fuels have dropped their 

production amounts. Crist writes that in February, China reported a 

“drop in carbon emissions of an estimated 25 percent….more than 

half the annual emissions of Britain.” This number is staggering, 

something we’d all love to see in our day-to-day lives outside of 

the pandemic. There’s also the idea that the slow-down of the 

consumerism lifestyle will stick around once we’ve moved past the 

pandemic. Things we considered necessary before may now seem 

less important, such as driving twenty miles to your workplace 

instead of just joining a Zoom call from your living room. While 

these things do help in efforts to be more environmentally 

responsible, these small actions aren’t what have made the biggest 

impact on our climate. “It was the abrupt halt of industrial 

manufacturing.” (Crist) 

The accommodations that manufacturers have made for the 

coronavirus may end up doing more harm than good for the 

environment once the pandemic is over. Though emissions are 

lower now (emissions usually trend at the same rate as the 

economy does - more supply and demand equals more fossil fuel 

189

usage), they’re unlikely to stay this way, as we’ve seen throughout 

all recessions. Crist writes that “in response to the need for 

economic stimulus, China has indicated they will relax 

environmental supervision of companies to stimulate its economy” 

post-shutdown. This means that, post-pandemic, we could and 

most likely will end up seeing an explosion in emissions rates 

because of temporary environmental deregulations used in an 

attempt to kickstart industries and economies. Crist goes on to talk 

about how COVID-19 and the implementation of social distancing 

has led to the grinding halt of research efforts. In-person fieldwork 

for climate change research has been stopped, and meetings where 

world leaders can gather and discuss climate change and measures 

to combat it have been postponed, if not altogether cancelled, 

which is delaying vital conversations. Public activism and 

advocacy has been forced onto online platforms, which is much 

easier for those who are being lobbied to take steps against climate 

change to ignore. The manufacturing of solar panels, wind 

turbines, and other clean energy products has been slowed as well. 

The focus within the American government right now is, 

unfortunately, not on the future. Current stimulus bills are centered 

on helping sick unemployed American citizens and bailing out 

businesses that are pillars of the economy, not on giving aid to 

already-struggling clean energy industries. To politicians and 

businessmen, the urgency to get industries such as oil and gas 

running again, whose prices dropped low over the summer, is more 

pressing than the future effects of climate change. 

So what about solutions? How do we ensure that we’re not 

amplifying the climate crisis during or after this global pandemic? 

Crist writes, “There is another world in which policymakers and 

politicians planning for economic recovery decide to make 

building a carbon-neutral society a priority.” We’ve seen a lot of 

red tape be cut away over this year in attempts to rush stimulus 

bills through Congress so that America and its industries and 

people can stay afloat. Politicians focused on climate change could 

utilize this expedited process to begin laying the groundwork for 

the transition to clean energy. In her article, Crist introduces a 

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possible, immediate solution to the unemployment America is 

currently seeing. “In this [potential clean-energy-prioritized] world, 

governments would create meaningful jobs in areas such as 

education, medical care, housing, and clean energy, with an 

emphasis on “shovel-ready” projects that put people to work 

immediately.” (Crist) What this means is that upcoming stimulus 

bills would include funding and framework for new or continuing 

projects focused on clean energy, such as the creation of more solar 

power plants. This plan would kill two birds with one stone: 

simultaneously helping bring people back to work with new jobs 

while moving the necessary transition to clean energy forward. 

There are other, much more ‘radical’ ideas bouncing around 

the heads of those invested in climate change. The drop in the 

current usage of oil and gas gives opportunities to start the fade of 

those products entirely, replacing them with ‘green’ alternatives. 

There is also potential for a 32-hour workweek as opposed to the 

current 40-hour one, which would reduce emissions as well as 

possibly improving American life overall. Of this, Crist writes, 

“It’s unlikely we will see a four-day workweek anytime soon, but 

the profound disruptions of the pandemic provide a rare 

opportunity, even in the midst of great suffering, for rewiring our 

sense of what is possible in American society.” This pandemic has 

taken all of us for quite a ride and shown us what we as a society 

are really capable of going through and surviving with and without. 

There’s not much reason to think that a bit of radical change 

shouldn’t be implemented, especially at the time when we need it 

most. 

Crist’s article provides a wealth of insight into how the 

COVID-19 pandemic has both positively and negatively affected 

climate change and the efforts to combat it, a topic that I had never 

considered before finding this article. Our Earth is in danger, and 

our responses to the pandemic could be jeopardizing it even 

further. A vital piece to what Crist has written is the solutions she 

gives: those that are realistic and tangible, and those that are more 

far-fetched but still attainable, should we work hard enough to 

reach them. She concludes by hitting the true crux of this issue and 

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wrapping back around to the question she posed in the beginning: 

asking us, the inhabitants of this planet, what we’re going to do 

about this situation. “Perhaps the real question is not whether the 

virus is “good” or “bad” for the climate, or whether rich people 

will take fewer airplane flights, but whether we can create a 

functioning economy that supports people without threatening life 

on Earth, including our own.” (Crist) 

Works Cited 

Crist, Meehan. “What the Coronavirus Means for Climate Change.” The New 

York Times, 27 March 2020, 

https://www.nytimes.com/2020/03/27/opinion/sunday/coronavirusclimate-change.html. 

Accessed 24 October 2020. 

192

Sarah McIntire Award 

for Outstanding 

Capstones 2020 

Vesicular proteins associated with HDAC8-H1.3 novel protein 

complex in MCF-7 breast adenocarcinoma cells 

Elizabeth Meza 

Abstract 

A novel protein complex, named HDAC8-H1.3 complex, was 

discovered in our lab. Both of the proteins within this protein 

complex are known to be involved in chromatin compaction and 

transcriptional repression. However, this complex was observed to 

associate with cycling vesicle in the cytoplasm of MCF-7 breast 

cancer cells. Though the function of this complex is still largely 

unknown, previous studies indicated that the HDAC8-H1.3 

complex is possibly associated with vesicular proteins such as 

COPA. Our immediate goal was to corroborate whether COPA is 

part of the HDAC8-H1.3 complex using immunoprecipitation 

followed by Western blotting. Our long-term goal is to determine 

the functional role of this complex in vesicular trafficking, which is 

an important component of many biological processes, such as 

endocrine secretion and neurotransmission. The results of this 

project demonstrate the optimal conditions for 

immunoprecipitation and Western blotting of HDAC8 and COPA, 

however, further research must be conducted to determine whether 

or not COPA is associated with the HDAC8-H1.3 complex. 

Introduction 

Society, as of 2019, there will be an estimated 1.7 million new 

cancer cases diagnosed and 606,880 cancer deaths in the United 

States. 1 Although there are myriad of causes for cancer, one 

193

process that can be critical is cell trafficking. Cell trafficking 

involves the movement of various vesicles containing different 

proteins throughout the cell. 2 Trafficking of these vesicles is 

important in packaging proteins and shuttling them in and out of 

the cell. 3 This process is essential in the communication between 

the cell and its environment. 3 If vesicular transportation is 

interrupted, it can lead to uncontrollable cell growth and metastasis 

of tumors throughout the body. 2 Chromosomes are organized into 

ordered structures consisting of DNA and associated proteins, 

called chromatin. 3 These associated proteins are called histones. 

DNA and histones are organized into repeating units, called 

nucleosomes. 3 One particular histone, histone type H1, is not part 

of the nucleosome core particle, but rather binds to part of the 

linker DNA that connects one nucleosome core particle to the next, 

and to the DNA at the dyad axis, as depicted in Figure 1. 3 For this 

reason, histone type H1 is referred to as a linker histone. Histones 

play a major role in the regulation of cellular processes such as 

transcription, replication, recombination, and repair. 3 Histone 

proteins can undergo modifications that have important epigenetic 

functions. Histone acetylation by the enzyme histone 

acetyltransferases, otherwise known as HATs, is a common histone 

modification that results in the addition of an acetyl group to the 

protein. 4 High levels of acetylation result in the loosening or 

opening up of the chromatin fiber. 4 The opening up of the 

chromatin allows for gene transcription. Conversely, enzymes 

known as histone deacetylases, or HDACs, functions to remove 

acetyl groups from histone proteins. This allows for tighter 

compaction of the DNA molecule and results transcriptional 

repression. 4 

194

In our lab, we have found a complex, known as HDAC8-H1.3, 

localized in the cycling vesicles of MCF7-cells, a breast cancer cell 

line. Both HDAC8 and H1.3 have functions in chromatin 

compaction and transcriptional repression. HDAC8 belongs to 

class I of the HDACs. HDACs refer to histone deacetylases, whose 

function is to aid in DNA compaction. 6 Previous studies have 

supported that upregulation of HDAC8 is related to advanced stage 

neuroblastoma, which is a type of cancer found in developing 

nerve cells in an embryo or fetus. 7 Additionally, mutations in 

HDAC8 contribute to Cornelia de Lange syndrome, whose 

symptoms include mental retardation and facial dysmorphism. 8 

The other player of the HDAC8-H1.3 complex is H1.3. H1.3 is a 

subtype of linker histone commonly referred to as H1, which aids 

in the packaging of DNA into the structural unit known as the 

nucleosome. Studies have shown that H1 phosphorylation can 

serve as potential clinical biomarker for breast cancer across 

different cell lines. 9 

Previous studies have indicated colocalization of the complex with 

Rab6 and partial colocalization with Rab7, which narrowed down 

the HDAC8-H1.3 complex localization to trans-Golgi vesicles and 

195

late endosomes. 10 Mass spectrometry suggested that the HDAC8- 

H1.3 complex is associated with the vesicular proteins COPA, 

Sec23A, Sec23B, Sec22B, and clathrin heavy chain 1. 10 The 

function of the HDAC8-H1.3 complex is still largely unknown. 

Since HDAC8 and H1.3 independently can contribute to various 

aspects of multiple diseases, it will be noteworthy to demonstrate 

how this complex operates in order to provide a better 

understanding of its overall impact. The purpose of my project will 

be to focus on the protein COPA, which has been shown to be 

potentially associated with this complex and determine whether the 

protein COPA interacts with HDAC8 using immunoprecipitation 

followed by Western blotting. Our long-term goal is to determine 

the functional role of this complex in vesicular trafficking, which is 

an important component of many biological processes, such as 

endocrine secretion and neurotransmission. Furthermore, we hope 

to explore possible methods to manipulate the HDAC8-H1.3 

complex for cancer therapy and anti-cancer drug treatments. 

Materials and Methods 

Cell Culture Methods 

The protein complex was studied in MCF-7 breast adenocarcinoma 

cells. This cell line was grown and maintained in Dubelco’s 

Modified Eagle’s Medium (DMEM). The media was supplemented 

with 10% heat-inactivated fetal bovine serum (FBS), 1% penicillin, 

and 1% streptomycin. The cells were maintained at 37 ℃, 100% 

humidity, and 5% CO2. Through the use of cell growth curves and 

cell counts, cells growth stages were determined, and the cells were 

harvested during the exponential stage of cell growth. 10 

Immunoprecipitation 

Cells were grown until they reached the exponential phase of cell 

growth. The cells were lysed by the utilization of Radio 

Immunoprecipitation Assay (RIPA) buffer. While on ice, cell 

lysates were broken up by passing the cell lysates through a 21- 

gauge needle ten times. The cell lysates were then incubated on ice 

for thirty minutes and centrifuged at 10,000 g for twenty minutes at 

4 ℃. After centrifugation, the separated supernatant was removed 

and used to determine the cell lysate protein concentration. Protein 

196

concentration was determined using the Pierce 660 nm protein 

estimation kit. For immunoprecipitation, cell lysates were 

precleared with 1 μμμμg nonimmune IgG and 20 μμμμl protein A/G or 

L agarose beads for an hour at 4 ℃. The non-immune IgG and 

agarose beads were removed from the lysates by centrifugation at 

1000 X g for five minutes. The protein of interest was precipitated 

from the precleared lysates using 1-5 μμμμg of antibody or 20 μμμμl 

protein A/G or L agarose beads in 4 °C while rocking overnight. 

Non-immune IgG or A/G or L agarose beads were utilized as 

negative controls for each IP. The non-immune IgG was of the 

same species as the specific antibody against the protein of interest 

for each experiment. Immunoprecipitated complexes bound to the 

agarose beads were collected through centrifugation at 1000 X g 

for five minutes. The beads were then washed twice with 1X RIPA 

buffer. The protein was denatured using 35 μμμμl 1X SDS Laemmli 

buffer and incubation at 95 °C for five minutes. Collected protein 

samples were then resolved on SDS-polyacrylamide gel 

electrophoresis (SDS-PAGE) gels. Protein amounts were then 

analyzed through Western blot technique. Cell lysates containing 

SDS Laemmli buffer were utilized as positive control inputs. 

Antibodies utilized in Western blot were of a different species than 

the species of the antibody utilized in immunoprecipitation. Table 

1 lists the antibodies utilized throughout each experiment. 10 

197

SDS-PAGE and Western Blot Protein Detection 

Whole cell extracts were prepared by lysing the cells with 1 X SDS 

Laemmli buffer. The protein concentrations of the 1 X SDS cell 

extracts were determined using Pierce 660 nm protein estimation 

kit. Proteins from cell extracts and immunoprecipitation 

experiments were separated by their molecular weight using 

electrophoresis on an 8% or 10% SDS-polyacrylamide gel with the 

use of tris-glycine SDS running buffer. The proteins were then 

transferred from the polyacrylamide gel to a Polyvinylidene 

difluoride (PVDF) membrane for two hours. The membranes were 

then incubated in blocking buffer for forty-five minutes at room 

temperature. The membranes were incubated in primary antibody 

against the protein of interest overnight. The membranes were 

washed with Phosphate Buffered Saline (PBS) three times for ten, 

five, and five minutes. The membranes were then incubated in 

secondary antibody, which is capable of detecting the primary 

antibody, for an hour at room temperature. Membranes with 

antibody bound protein bands were visualized on Li-COR Odyssey 

imager or Bio-Rad ChemiDoc imager. 10 

Results 

Optimizing the conditions for HDAC8 immunoprecipitation and 

Western blotting 

Immunoprecipitation and Western blotting of HDAC8 were 

conducted in order to determine the optimal conditions. HDAC8 

was immunoprecipitated from MCF-7 cell lysate. HDAC8 was 

resolved by means of SDS-PAGE and subsequently detected by 

Western blot analysis. Agarose beads were used as a negative 

control for this experiment. The negative bead control precipitation 

was blotted with anti-HDAC8 antibody, as represented by lane 3 in 

Figure 2. The negative bead control precipitation only 

demonstrated nonspecific binding at a molecular weight not 

consistent with HDAC8. This result was expected because of the 

use of the same antibody and therefore the same species in both the 

immunoprecipitation and Western blotting techniques in this 

experiment. The results from this experiment indicated a strong 

signal, therefore 5 μμμμg of the anti-HDAC8 antibody provided for 

198

optimal imaging. 

Immunoprecipitation and Western blot to optimize conditions for 

COPA 

Immunoprecipitation and Western blot of COPA were conducted 

in order to determine the optimal conditions for COPA. COPA was 

immunoprecipitated from MCF-7 cell lysate. COPA was resolved 

on SDS-PAGE and subsequently detected by Western blot analysis 

with antiCOPA antibody. Agarose beads were used as a negative 

control for this experiment. The results from this experiment 

indicated weak COPA signals for both 2 μμμμg and 5 μμμμg of the anti- 

COPA antibody. The negative bead control precipitation (lane 5) 

demonstrated specific binding at the molecular weight somewhat 

lower than COPA. At the negative control lane, there should not be 

a band present at the molecular weight consistent with COPA. 

199

Western blots to optimize conditions for COPA 

Multiple Western blots of COPA were conducted in order to 

determine the optimal conditions for COPA. COPA was resolved 

by means of SDS-PAGE and subsequently detected by Western 

blot analysis. In the experiment depicted by Figure 4, different 

amounts of the cell lysate input were loaded in order to determine 

the optimal concentration of input needed for further experiments. 

The results from this experiment indicated weak signals similar to 

the previous experiment in Figure 3. However, a concentrationdependent 

increase in intensity was observed between the varying 

amounts of cell lysate input resolved on the gel. It was determined 

that these weak signals were most likely due to a reduction in 

activity of the primary antibody for antiCOPA. 

200

The purpose of the Western blot experiment depicted in Figure 5 

was to determine the concentration of the primary antibody for 

anti-COPA needed for subsequent experimentation. The membrane 

was cut in half and both halves were incubated in different 

concentrations of the primary antibody. A new primary antibody 

for anti-COPA was utilized in this experiment which allowed for 

the visualization of bands indicating the presence of COPA. The 

results of this experiment demonstrated that the concentration of 

primary antibody that provided the best signals was 0.5 μμμμg/mL. 

This is half the concentration recommended by the manufacturer, 

however proved to produce the best results. 

201

The Western blot experiment depicted in Figure 6 was conducted 

in order to determine which concentrations of MCF-7 1 X SDS 

extract and RIPA extract were optimal for Western blot. The 

previous experiment indicated bands of similar intensity between 

the MCF-7 1 X SDS extract concentrations of 80 μμμμg and 120 μμμμg. 

After a correction in the calculations for the protein estimation 

standard curve of the MCF-7 extracts from 2/27/2019 and 

6/5/2019, it was determined that the amounts of extract were 

actually 73 μμμμg and 111 μμμμg, as opposed to 80 μμμμg and 120 μμμμg. 

The results of this experiment demonstrated that the activity of the 

new antibody is much higher than the older antibody and 111 μμμμg 

seemed to provide a band of higher intensity and quality. The 

optimal amount of extract to be utilized in further Western blot 

experiments is 111 μμμμg. 

202

Immunoprecipitation and Western blot to optimize conditions for 

COPA using Nonimmune IgG 

Immunoprecipitation and Western blotting of COPA were 

conducted in order to determine the optimal conditions for COPA. 

COPA was immunoprecipitated from MCF-7 cell lysate. COPA 

was resolved by means of SDS-PAGE and subsequently detected 

by Western blot analysis. The purpose of this experiment was to 

determine the concentration of primary anti-COPA antibody 

needed for subsequent immunoprecipitations. Immunoprecipitation 

and Western blot of COPA had been conducted prior, however, 

due to the reduced activity of the primary antibody, no bands were 

visualized. Non-immune IgG antibody was used as a negative 

control for this experiment. The negative control precipitation was 

blotted with anti-COPA antibody, as represented by lanes 5, 6, and 

7 in Figure 7. The non-immune IgG antibody used in the Western 

203

lot experiment was of the same species as the experimental IP 

antibody. The negative control non-immune IgG precipitation only 

demonstrates nonspecific binding at a molecular weight not 

consistent with HDAC8. This is expected and is a result of the use 

of an antibody of the same species in the immunoprecipitation and 

Western blot experiments. The results from this experiment 

indicated no signals at the molecular weight consistent with COPA 

in experimental lanes 2, 3, and 4. The lack of signal in the 

experimental lanes is most likely due to an error in the 

immunoprecipitation portion of the experiment or can be attributed 

to the samples not being temperature stabilized as a result of a 

mechanical malfunction. A band was detected in the input lane 

(lane 8), which contained cell lysate. 

204

Results 

Immunoprecipitation and Western blot of HDAC8 were conducted 

in order to determine the optimal conditions for HDAC8. The 

negative bead control precipitation only demonstrated nonspecific 

binding at a molecular weight not consistent with HDAC8, as is 

depicted in Figure 2. This is expected and is a result of the use of 

the same antibody and, therefore, the same species in both the 

immunoprecipitation and Western blot techniques of this 

experiment. The results from this experiment indicated a strong 

signal. Five μμμμg of the anti-HDAC8 antibody provided for optimal 

imaging. For further experimentation to test the interaction 

between HDAC8 and H1.3, 5 μμμμg of the anti-HDAC8 primary 

antibody will be used in the immunoprecipitation portion of the 

experiment. Figure 3 shows the immunoprecipitation and Western 

blot of COPA conducted in order to determine the optimal 

conditions for COPA. We suspect that the band present in the 

negative bead control precipitation demonstrated non-specific 

binding at a molecular weight slightly lower than the molecular 

weight of COPA. Thus, this band is not indicative of COPA 

binding. The negative control lane should not demonstrate a band 

at the molecular weight of the protein of interest. Despite the 

band’s weight similarity to COPA, it is not COPA specific binding. 

The negative bead control precipitation demonstrated specific 

binding at the molecular weight consistent with COPA. As the 

negative control lane, there should not be a band present at the 

molecular weight consistent with COPA. The results from this 

experiment indicated weak signals for both 2 μμμμg and 5 μμμμg of the 

anti-HDAC8 antibody. Due to the presence of a band 

demonstrating specific binding at the molecular weight consistent 

with our protein of interest COPA, this experiment cannot be relied 

upon to determine the optimal conditions for COPA. Additionally, 

this experiment produced a fairly weak signal for even the highest 

antibody concentration of 5 μμμμg. From this experiment we began to 

suspect that either one or multiple steps in the immunoprecipitation 

or Western blot processes were not executed properly and thus 

resulted in subpar visualization. Additionally, the low intensity 

205

ands could be a result of ineffective reagents. Further testing was 

required in order to determine the source of error. Multiple 

Western blots of COPA were conducted in order to determine the 

optimal conditions for COPA. The experiment in Figure 4 was 

conducted in order to determine the optimal concentration of input 

needed for further experiments. The results from this experiment 

indicated weak signals similar to the previous experiment in Figure 

3. However, a concentration-dependent increase in intensity was 

observed between the varying amounts of cell lysate input resolved 

on the gel. It was determined that these weak signals were most 

likely due to a reduction in activity of the primary antibody for 

anti-COPA. This antibody was repurchased and immediately 

aliquoted in order to increase its longevity. Aliquoting temperature 

sensitive antibodies is standard practice as these antibodies will 

begin to lose their activity after three freeze-thaw cycles. The 

purpose of the Western blot experiment depicted in Figure 5 was to 

determine the concentration of the primary antibody for anti-COPA 

needed for subsequent experimentation. Two concentrations were 

tested for primary antibody incubation. The new primary antibody 

for anti-COPA was utilized in this experiment, which allowed for 

the better visualization of bands indicating the presence of COPA. 

The results of this experiment demonstrated that the Meza 12 

concentration of primary antibody that provided the best signals 

was 0.5 μμμμg/mL. This is half the concentration recommended by 

the manufacturer, however proved to produce the best results. This 

optimization is important in obtaining the best scans with bands of 

the highest intensity and saving antibody to be used for other 

experiments, rather than relying on the manufacturer’s 

recommendations. The Western blot experiment depicted in Figure 

6 was conducted in order to determine which concentrations of 

MCF-7 1 X SDS extract and RIPA extract that were optimal for 

Western blot. The previous experiment indicated bands of similar 

intensity between the MCF-7 1 X SDS extract concentrations of 80 

μμμμg and 120 μμμμg. After a correction in the calculations for the 

protein estimation standard curve of the MCF-7 extracts from 

2/27/2019 and 6/5/2019, it was determined that the amounts of 

206

extract were actually 73 μμμμg and 111 μμμμg, as opposed to 80 μμμμg 

and 120 μμμμg. The results of this experiment demonstrated that 111 

μμμμg seemed to provide a band of higher intensity and quality. One 

hundred and eleven μμμμg is the optimal amount of MCF-7 1 X SDS 

extract to be utilized in further Western blot experiments. This 

amount will be used as the positive control input. Additionally, the 

loading of the MCF-7 RIPA extracts confirm the presence of the 

COPA protein within the cell lysate. This indicated by the presence 

of a strong band in lanes 6 and 7. Immunoprecipitation and 

Western blot of COPA were conducted in order to determine the 

optimal conditions for COPA. The purpose of the experiment 

shown in Figure 7 was to determine the concentration of primary 

anti-COPA antibody needed for subsequent immunoprecipitations. 

This experiment had been conducted prior, however, due to the 

reduced activity of the primary antibody, no bands were visualized. 

The negative control non-immune IgG precipitation only 

demonstrates nonspecific binding at a molecular weight not 

consistent with HDAC8. This is expected and is a result of the use 

of an antibody of the same species in the immunoprecipitation and 

Western blot experiments. The results from this experiment 

indicated no signals at the molecular weight consistent with COPA 

in experimental lanes 2, 3, and 4. A band was detected in the input 

lane 8, which contained cell lysate. Due to the presence of a band 

in the positive control lane and the lack of a band in the negative 

control lanes at the molecular weight of COPA, it can be concluded 

that the Western part of the experiment was executed properly. The 

lack of bands within the experimental lanes could be due to not 

enough RIPA extract utilized in the immunoprecipitation portion of 

the experiment. The next COPA immunoprecipitation experiment 

to be conducted would be to repeat the experiment using 2 mg 

RIPA extract, which would hopefully be enough to visualize 

specific binding. 

Conclusions 

It was discovered that 5 μμμμg is the optimal amount of primary anti- 

HDAC8 antibody to use in immunoprecipitation experiments. 

Additionally, we found that a lower concentration of primary anti- 

207

COPA antibody used in the incubation portion of the Western blot 

technique provided for bands of higher intensity when compared to 

the manufacturer’s recommendation of 1 μμμμg/mL. One hundred 

and eleven μμμμg of MCF-7 1 X SDS extract provided for the highest 

strength band. The MCF-7 RIPA extract, when loaded with 1 X 

SDS in SDS-PAGE, demonstrated a band of high intensity 

indicating a high level of antibody-bound COPA protein. After two 

immunoprecipitations and Western blots against COPA, both 

resulting in weak signals, we concluded that another protein other 

than COPA should be immunoprecipitated. Therefore, the next 

experiment I will conduct will involve the immunoprecipitation 

against HDAC8 and the subsequent Western blot against COPA. 

We hope that this combination will allow for the visualization of a 

possible interaction between these two proteins. Should an 

interaction be observed, further experimentation with H1.3 can be 

conducted to determine whether or not COPA is associated with 

the HDAC8-H1.3 complex. 

Acknowledgements 

I would like to acknowledge those who have contributed most to 

my success and continue to push me to accomplish my goals. First 

and foremost, I would like to thank my mentor Dr. Bergel, who put 

his faith in me as a researcher and helped me to realize how much I 

am capable of. The knowledge I have obtained from Dr. Bergel is 

invaluable and I will forever be grateful for the opportunity to 

work with such an incredible individual. I would also like to 

acknowledge my family for being so supportive throughout my 

undergraduate research career. Without the understanding and 

encouragement I received from my family, I do not believe I could 

have accomplished what I did. I would like to thank the members 

of Dr. Bergel’s lab, former and present graduate and undergraduate 

students. I would like to thank Thu Autumn Doan and Dr. Carrie 

Wilks for personally training me on the techniques I implemented 

throughout my project. I would like to thank Dr. Amon Gekombe, 

Rituparna Sinha Roy, and Karen Underbrink, all of which were 

graduate students who took the time to train me in different 

techniques that were essential to the completion of my project. 

208

These individuals could not have been more supportive in all my 

endeavors, research and otherwise. I would like to thank the 

remaining members of Dr. Bergel’s lab, which is composed of my 

peers of undergraduate researchers, for their help and advice. 

Finally, I would like to acknowledge the Experiential Student 

Scholar Program for funding my project throughout its course. 

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Email: honors@twu.edu 

www.twu.edu/honors 

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