Abstract
Children from disadvantaged backgrounds have an elevated risk for poor health and developmental outcomes. Families are less likely to participate in interventions if they feel they have been targeted because they fit a particular demographic profile. There is a need for interventions that can engage families from low-socioeconomic backgrounds. Community-based music enrichment (CBME) programs support a strength-based approach by drawing upon family behaviors like listening to music and singing with their children. Currently, little is known about the extent to which families from low socio-economic status (SES) backgrounds would be interested in or have access to CBME programs. The aims of this study were to (1) understand the home music environment of families from low SES backgrounds, (2) investigate family interest and perceptions of developmental benefits in CBME programs, and (3) identify perceived barriers to CBME programs. This study used 15 semi-structured interviews with parents of children 2-years old or younger from low-SES backgrounds. Qualitative coding and thematic analysis revealed that parents use music with their children at home, and are interested in and believe music programs can benefit their children. Location and schedule are major barriers that prevent families from engaging in music programs. Based on current findings, novel program development ideas are discussed.
Introduction
Birth to 5 years is a critical period of development in language, cognitive, social, emotional, and physical skills. Children from lower socio-economic backgrounds have a particularly heightened risk for developmental difficulty across multiple domains. Research shows there are numerous reasons that prevent or reduce the likelihood that lower SES families will participate in early intervention programs. Despite substantial United States (US) national and local investment in early intervention and prevention programs for low SES populations, participation remains limited. Low enrollment and poor program completion rates undermine the potential benefits of these initiatives (Finan et al., 2018). Poor enrollment and completion may be due to demanding parent schedules and inconvenient program locations (Ingoldsby, 2010; Sanders et al., 2009). Parents’ perceptions of the program’s relevance to their child’s needs also influence enrollment (Caspe and Lopez, 2006; Pote et al., 2019). Positive parental perceptions are associated with greater program uptake (Justice et al., 2015; Mendez et al., 2009; Morawska and Sanders, 2006). Social stigma including feeling targeted for their demographic profile or judged for their parenting can discourage families from attending (Vanobbergen et al., 2010; Winkworth et al., 2010). Thus, families who stand to gain the most from intervention engagement face the greatest enrollment challenges. There is an urgent need for interventions that can successfully engage families from low SES backgrounds (Porterfield and McBride, 2007).
One avenue with great potential for engaging families from low SES backgrounds is through music programs. In the US, community-based music enrichment (CBME) programs are common in many communities and are a popular activity among families with young children. Music activities are ubiquitous during early childhood and can provide non-threatening and enjoyable contexts for parent-child interaction. It has been demonstrated that parents across all ethnicities and demographics sing to their infants (Yan et al., 2021), yet family characteristics are associated with differing styles of parent-child interaction. Participating in a CBME program has been associated with reduced parent intrusiveness and improved quality of language interactions in a sample of middle-to high-income families in the US (Smith et al., 2023, 2024). In Australian families from low SES backgrounds, a pilot study of participation in a short-term music program yielded positive results for observed parent responsiveness (Teggelove et al., 2019). Additional research with low SES families in the US is needed to understand if CBME programs can provide an avenue to overcome barriers to participation in traditional early intervention programs. Because music is a common activity among families from all cultures and backgrounds, music programs may naturally support a strength-based intervention approach by drawing upon current family practices (Fenton et al., 2015). Additionally, because CBME programs are designed to benefit all children, they may bypass the social stigma often associated with targeted early intervention programs.
Although music is perceived as a universal aspect of early parent-child interactions, the ways in which music is practiced with infants varies across cultures (Garfias, 1990). Level of parent education is associated with the amount of parent-child music interaction. It has been reported that parents with higher education are more likely to sing with their child (Custodero and Johnson-Green, 2003). Integration of music into parenting behaviors also intertwined with a parent’s own past music experiences and beliefs about the role of music during childhood (Custodero and Johnson-Green, 2003). Parents who have taken music lessons and have memories of being sung to by their parent provide more musical interactions with their own infants (Custodero and Johnson-Green, 2003). Parent views regarding the importance of music influence their child’s participation in music at school (Wills, 2011). Families of typically developing children (TD) and children with autism spectrum disorder (ASD) more motivated to sign up for a music class when they perceived that their child had an interest in music (Lense et al., 2022). Another study found that for low-SES families, opportunities for child socialization and child learning were the main motivation for a parent’s decision to enroll in a music program (Kong et al., 2024). Understanding how previous music experiences and views shape current parenting behaviors, and what parents value as import to their child are critical to the development of music programs that can engage diverse communities.
Many CBME programs do not consistently reach families from lower SES backgrounds in part due to limited access or availability of these types of programs in under resourced communities. Little is known about the extent to which families from low SES backgrounds would be interested in CBME programs or how parents’ prior music experiences may influence their attendance of music classes with their infant. Therefore, the aims of this study are to (1) understand the home music environment of families from low SES backgrounds, (2) investigate family interest and perceptions of developmental benefits in CBME programs, and (3) identify perceived barriers to CBME programs. Involving families as key informants is a critical step toward creating ecologically valid, strength-based music interventions that can successfully engage the community of interest.
Method
We conducted individual interviews using a semi-structured interview guide from September to November 2023. To qualify for the study, parents had to have at least one child who was 2-years old or younger and have a household income which qualified for the Women, Infants, and Children’s (WIC) program. Recruitment was conducted at an urban primary care pediatrician office that serves low SES families as well as from e-mails sent to parents who previously indicated an interest in participating in research studies in the Baby Health Behavior Lab at Children’s Mercy Hospital. Families were excluded if their child had chronic health or developmental diagnosis. Recruitment and interviews continued until saturation was reached (n = 16).
A.R.S. conducted all parent interviews. Participants were given the option to complete the interview in their home or come to the laboratory. Most parents had at least one child present for the interview, and the child was provided with toys and a snack during the interview. After the consent procedure, each interview was audio-recorded on a digital voice recorder. The semi-structured interview guide included a series of open-ended questions designed to stimulate conversation relating to the study aims (Table 1).
Excerpt of interview guide questions.
Immediately following the interview, the first author journaled about the interview to indicate initial thoughts and participant demeanor not captured on the audio-recording. Trained research assistants conducted word-for-word transcriptions of each audio-recording. Participants were assigned ID numbers to protect confidentiality. For their involvement in the study, participants received a $50 payment card upon completion of the interview.
We coded the transcribed interviews using the inductive approach of thematic analysis outlined by Clarke and Braun (2017). Multiple steps were taken to ensure precise interpretation during the coding process. To begin, each transcript was read several times and annotated. Then, each transcript was individually coded based on each of the study aims using a codebook that was developed while coding transcripts. After all transcripts were coded by the first author, discussed with co-authors to check accuracy, re-coded where necessary, and the prominent themes were evaluated. Finally, we grouped codes into the larger themes and identified participant quotes that embodied each theme.
Results
We conducted a total of 16 interviews and 15 interviews were included in the final analysis. After interview completion, one parent was excluded due to concerns over the child’s development. A participant flow chart is presented in Figure 1. The sample consisted of primarily Black (53%) and multi-racial (20%) families who reported an annual income below the 2023 poverty threshold for the number of family members living in the home (73%). Most participating parents were mothers (94%), single (73%), and had a high school education or lower (87%; Table 2). Interviews lasted between 25 and 45 minutes (mean duration, 31.2 minutes).
Participant flow chart.
Participant demographics.
SD: standard deviation.
Aim 1: The home music environment of families from low SES backgrounds
Theme 1: Parent music background influences current music choices
During the interviews parents were asked about their own musical backgrounds and what types of music they currently listened to. Many families did not recall musical traditions from their own upbringings, or they recalled negative childhood memories associated with music experiences. For example, when asked about memories of music from her childhood, one parent said, “I don’t have positive memories cuz like my parents, they listened to like Spanish cartel music, and that’s not something I want to introduce my children to, I’m trying to break chains.” Even though many parents did not recall memories related to musical traditions in their family, several parents did participate in band or choir in school or at church. One parent described making the choice to participate in the church choir when she was old enough, “as I got older, I was able to sing in the church choir and I chose to do that because I just really had a good time singing, it was sometimes the best part of my week.” Parents reported a wide variety of musical styles and genres that they currently listened to (Table 3). Often, the music parents chose to listen to was related to wanting to expose their child to certain types of music over others. For example, “I want to expose them (children) to positive music, you know, not music about shooting and things like I heard, I want to break that chain,” and “I’m just starting on a spiritual path now and so I listen to a lot of gospel and Christian music, I want my kids to hear that too.”
Parent descriptions of recorded music they play for their infants.
Theme 2: Parents choose specific music just for their children
In addition to parents’ preferred music, parents were asked to talk about any music they select that is specifically for their children. A few parents commented that they only played their own preferred music and not children’s music, “We listen to like country, and R&B, and hip-hop, but not like kids music really.” Most often, parents described traditional children’s songs as the music they played for their children and indicated that those were their child’s favorite songs. For example, “he loves patty cake, so um, we do patty cake a lot. I would typically say we sing a lot of nursery rhymes” and “she loves the Itsy-Bitsy Spider, she is obsessed with it, that’s her favorite thing, that and The Wheels on the Bus.” Internet streaming programs were one of the primary ways parents exposed their children to music at home; Toddler learning videos, were mentioned most often by parents as sources of music for their children. Disney music and TV theme songs, especially Bluey, were also sources of children’s music that parents played for their children. Parents also mentioned how traditional songs have been remade to sound more updated by some popular music artists. For example, “Doggyland,” is a children’s music show created by the artist Snoop Dogg that includes hip hop or rap remixes of traditional songs such as “The Wheels on the Bus.” Parents expressed how they like the sounds of the remixed songs, “they (Snoop Dogg) sing like really good songs cuz he sings all the nursery rhymes but he kinda changes it so it’s very interesting for the kiddos. They are very catchy to me, I watch with him too and I start to sing along. There is this song (sings a line of the song), and it’s so catchy! I’m like, okay, I really like this song.” Overall, families were familiar with and utilized many traditional children’s songs and especially enjoyed when those songs were remixed by popular artists.
Theme 3: Parent child musical interactions
Finally, regarding the home music environment, parents were asked about interactions they have with their children that involve music. Parents primarily mentioned interactions that involved singing along with recorded music while doing things around the house or in the car with their child present. For example, “I’ll be doing something around the house and then singing a part of a song that comes on [the radio] to him. It’s nothing like that I’m sitting in front of him and singing to him, it’s just that the music is on and he is there too,” and “If I sing songs to her, I sing like, along with the Gracie’s Corner songs, like especially if I’m trying to have her do her numbers or make the alphabet sounds.” Sometimes parents mentioned singing nursery rhymes and other songs to their child without a recording, saying, “Oh yes, I sing. We sing the ABCs, or I’ll sing something that they sing on there (music program), or I sing one of my songs, like Christian songs he really likes.” A few parents also mentioned making up songs to sing to their children and singing whatever came to mind.
As far as when parents have musical interactions with their child, most parents talked about singing to their child at nap or bedtime, saying, “I usually sing to her when she’s about to go to sleep.” Another time parents talked about singing with their child was when they were trying to teach something like counting or letter sounds. This was best described as, “I sing to him all the time, I sing the ABCs and stuff, like trying to get him to understand the ABCs and 123s.” Another common time that parents talked about singing was when their child was fussy, “I started singing Head, Shoulders, Knees and Toes when they were like in my stomach, so like now I can calm them down with that song, and the ABCs” and “if he gets upset, we will literally sing the ABC song and he will calm down.” Parents also reported singing songs that are related to the activities they are doing while out and about in the community. For example, one parent described, “when we go to the zoo, J loves the zoo, and I sing that walking at the zoo song (sings part of the song) while we are walking along, it helps him retain the memory of the different animals.”
In summary, the home music environment is largely shaped by parent musical backgrounds and beliefs that music plays an important role in child development. Overall, parents we interviewed are mindful of creating positive music experiences for their children, even when their own past experiences with music are negative. Parents rely on the multitude of children’s programming available on the internet to provide fun and educational experiences for their children. When characters reflect the family’s own ethnicity (e.g. Gracie’s Corner) or songs mimic music genres parents prefer (e.g. Doggyland), parents enjoy the programs and participate along with their child. Most parent-child music interactions throughout the day involve recorded music or music shows, although some parents do sing at other times when recordings are not present. Parents most commonly sing to their child when they are fussy or going to sleep and it is less common that parents sing to their children during playtime.
Aim 2: Parent interest and perceptions of developmental benefits in CBME programs
Theme 1: “Wanting to do better for my child.”
Parents consistently stated that they wanted their children to have better experiences/opportunities growing up than they did and that this was a primary motivator behind the decisions they make as parents. This theme is best represented by one parent who said, “I look back to my childhood, I can’t really tell you like, really anything good that came from, my parents, like, as far as like, nurturing, so I’m, I’m really trying to take it to another level with my kids.” Many parents said a priority was seeking out community resources that provide developmental and educational experiences for their child. Some talked about community programs such as the Parents as Teachers program, “they are a really good help, they come to the home and give helpful tips and guide us on those little things to help our child.” Parents also endorsed using online and social media resources to get ideas about enriching experiences for their children. Parents said, “I google pretty much everything,” and “I find a lot of ideas and activities on TikTok, like, what did we do before social media?” Although the parents we interviewed were unfamiliar with CBME programs in their neighborhood, once they were informed about CBME programs, many expressed high levels of interest in attending with their child by saying, “I would wanna get him into a class like that, he loves music and I could see him really enjoying something like that,” and “Anything where she can be musically involved would be right up her alley.”
Theme 2: Parents are interested in CBME to meet developmental needs
Parents were very in tune with wanting to provide opportunities targeting specific developmental skills that they perceived as important. For example, social interaction was a primary developmental concern of parents. One parent said, “I just like for him to do stuff around other kids, at home he is just around me and doesn’t get to you know, develop socially, like with kids his age.” Other parents were interested in the cognitive benefits, “I would like him to do classes where he, um, is probably more like learning things like reading and ABC’s and stuff”; or gross motor development, “I know I want to give him opportunities to learn how to walk, cuz he’s standing up and I feel like if he’s in a class with other kids walking and running around he will learn too.” When asked specifically about CBME programs, parents again were most interested in the social benefits of a music class, “it would be important that he got to interact with other babies,” followed by learning, “it would be nice to incorporate some learning, like numbers and colors, stuff like that with the music.”
Theme 3: Parents value music for their child
The final theme that emerged regarding parents’ interest in CBME programs was related to what they value about music for their child. In general, parents valued music in their daily lives as entertainment, for stress relief, for expression, and because they felt like their child enjoyed it. For example, about stress relief, a parent said, “you know, music helps with stress, you just sing or listen to music and it helps me and him calm down.” Regarding entertainment one parent said, “it’s a big part of entertainment for our family life. It makes them (children) and me happier when they listen to music.” When parents were asked about how they see music helping their child, two primary reasons emerged. First, “because music helps calm my baby down,” and second, “I see him learning new things.” Parents shared that they especially appreciate children’s music shows (Gracie’s Corner) because they observe their child learning new skills. Some examples include, “it (Gracie’s Corner) helps her a lot, it like, she knows the sounds of certain letters and I think that show helped her a lot. She knows how to say words now too” and “he has learned to clap from watching Ms. Rachel, he loves to clap along with the music.”
In summary, parents’ desire to “do better” for their child is a strong motivator for selecting activities for their child to participate in. Parents seek out community and online resources that can help them provide educational opportunities for their child. Social development is a primary concern of many parents and a reason they would be interested in community-based programs. Additionally, parents we talked to were very interested in community-based programs that could provide their child with opportunities for academic learning. Parents notice that their child learns new skills by watching music shows online like Ms. Rachel. They see that as a major benefit of engaging in music at an early age.
Aim 3: Perceived barriers to CBME programs
Theme 1: Parents are unfamiliar with CBME programs in their community
The interviews revealed that parents were largely unfamiliar with parent-child classes, including CBME programs, in their communities. Parents said “I don’t know about any (mommy and me) music classes around here. I’ve been trying to look into something like that though” and “no (I’m not familiar) but that’s what I want, I want her to do that.” A small number of the 15 parents mentioned that they had heard of programs like story time at the library or classes at a local YMCA, “I think the community center or YMCA does something like mommy and me, but I don’t think it’s a music class.” Even though some had heard of parent-child classes in their community, very few parents had ever attended with their child, “I’ve heard about those (mommy and me classes), but I’ve never really um, looked into ‘em.”
Theme 2: Parent perspectives on barriers to attending CBME programs
Parents perceived location as a significant barrier to attending CBME programs, saying “well, some stuff is just way out yonder, and by the time I get there, do the activity, try to beat traffic, and get back in time to get my son off the bus, it’s just too stressful.” For some parents a lack of reliable transportation was the primary barrier. One parent said, “right now, well, my car doesn’t work and that just happened out of nowhere. I don’t know when it will be fixed.” Public transportation was also viewed as a challenge as one parent shared, “well, the bus is good, you know cuz it’s free, but it’s a lot of work with three kids . . . you’re managing kids that are mobile plus trying to mess with the stroller on the bus.” Costs related to transportation and program enrollment were perceived as a barrier by many parents. One parent talked about the financial barrier of being a single parent, “you know cost is a big thing, as a single parent household, we have very limited income, there are some things that just aren’t feasible.” Parents also talked about personal life barriers such as lack of time due to work schedules, parenting demands, and health challenges. For example, one parent talked about how her fatigue related to working multiple jobs prevented her from attending extra programs with her child, “I’m always tired when I get home from work. Like, I’m super tired, I get up at four o’clock in the morning, I work two jobs, there just isn’t any extra energy left.” Other parents shared the demands of having multiple children and not having enough time, “Right now I have three kids that all need something different and I only have enough time to do what needs to be done, I can’t do everything.” Multiple parents also mentioned managing child custody schedules with another parent, “Right now my situation is just messed up with the custody issues and it’s like changing all the time.”
In summary, the families we interviewed were facing multiple SES related adversities that are potential barriers to enrollment in CBMEs. Financial, transportation, family, and health are some of the barriers mentioned that prevent families from considering participating in these programs. Furthermore, CBMEs are rarely offered in areas that are easily accessed by the families we interviewed. None of the 15 parents interviewed in this study was aware of a CBME in in their community or had attended any kind parent-child program offered in their community.
Discussion
Parents in this study expressed high levels of interest in attending CBME programs, which highlights the potential for CBME programs to address a critical lack of intervention uptake among low SES communities. Positive parental perceptions about program components meeting their specific concerns are associated with greater program enrollment (Mendez et al., 2009; Morawska and Sanders, 2006). The parents we interviewed expressed two specific concerns that motivated their interest in CMBE programs: (i) wanting to be a better parent for their children and (ii) providing opportunities for their children to participate in social activities with other children. Similarly, Kong et al. (2024) reported that families with low SES who attended a weekly music enrichment class stated that the opportunity to engage in something new with their child was a primary reason for their enrollment. Unlike other early intervention programs that target developmental or parenting concerns, community-based music classes are poised to provide rich social opportunities for young children. Participation in CMBE can have the potential to benefit parenting and social concerns of families from low SES backgrounds. Emphasizing how CBME programs meet specific parent expectations may be a powerful motivator to engage families from low SES backgrounds.
From the field of positive psychology, strength-based interventions emphasize individual parent strengths that may confer protections against environmental risk factors (Bates et al., 2023). Increased understanding the home music practices of diverse families will aid in developing CBME programs that align with family values and leverage parent strengths. Coming from a low SES background is often viewed as a disadvantage that incurs additional vulnerabilities for children (Kraus and Stephens, 2012). Yet, many people from low SES backgrounds gain unique strengths based on their own past experiences that can influence their ability to overcome adversity (Spencer and Tinsley, 2008). Prior research has shown a positive association between being sung to as a child and later singing to one’s child as a parent (Mehr, 2014). In contrast, many parents we interviewed shared negative memories related to music from their own childhood which motivated them to provide better music experiences for their children. Parents talked about selecting music that they viewed as appropriate, and providing music experiences that specifically assisted their child’s development. A key component of CBME programs is the use of child-centered music with a mix of familiar and new songs and styles. Infant-directed singing is strongly associated with early learning and access to program music at home has been shown to increase music engagement (Franco et al., 2022; Steinberg et al., 2021). Active music experiences are linked to enhanced language skills, social, cognitive, and motor skills in infants and children (Betancourt and Hernandez, 2012; Gerry et al., 2012; Smith et al., 2024). In this way, CBME programs leverage a parent’s current music practices and enhance the home music environment. Families learn new interactive music ideas during class through teacher modeling and feedback and are provided materials for home use. Emerging evidence suggests that music enrichment programs help to increase the amount of parent-child music engagement at home, however, more research is needed to investigate this transfer (Steinberg et al., 2021).
Parents in this study reported that their children learned new skills by listening to music, watching music shows for children, and engaging in music interactions together with their parents. From the field of positive psychology, strength-based parenting refers to a parenting approach that deliberately aims to notice and cultivate strengths in one’s children (Sheely-Moore and Bratton, 2010). Strength-based interventions also emphasize individual parent strengths, such as warmth and responsiveness that confer protections against environmental risk factors (Bates et al., 2023). Based on the interviews, parents were often attuned to how music activities benefit their children’s development. Participation in CBME programs can reduce parent intrusiveness during everyday activities such as mealtime (Smith et al., 2023). Since music is deeply rooted in culture and traditions that frequently play an important role in day-to-day family activities (Custodero, 2023; Doja, 2014), CBME programs may boost this strength of parents from low SES backgrounds and offset additional environmental risks associated with childhood adversity. To maximize the strength-based potential, CBME programs should include components that are familiar to families, such as short video clips of program activities the parent and child can watch together at home. Using a strength-based framework that builds upon a family’s current routines may help reduce negative perceptions about participating in an intervention. This approach can in turn, increase enrollment, engagement, and follow through by historically under resourced families (Waters and Sun, 2016; Winkworth et al., 2010).
Parent singing is associated with improved child language ability, child regulation, and reduced parent stress (Cirelli et al., 2020; Fancourt and Perkins, 2018; Gerry et al., 2012). Helping parents to build a repertoire of songs and music activities to incorporate into their daily routines is a key feature of CMBE programs. Increasing shared music experience at home may enhance the quality of parent-child interactions. Parents who were interviewed noted that their children were most often exposed to recorded music and music programs from streaming services. While many parents mentioned singing to their children, they were often singing along to recordings. When parents enjoyed the children’s songs, they often sang along with the recording and could remember the songs to sing to their children without the recording. In this way, the type of music used in a CBME program could increase parent use of music activities in the home environment, and lead to enhanced intervention effectiveness. For example, many participants expressed interest in updated versions of well-known children’s songs by popular artists. To our knowledge, the relationship between music preference and parent participation/engagement at home or during structured classes has not been investigated. Understanding how music choices relate to program effectiveness will be an important next step.
Finally, previous research with various types of intervention programs for parents and young children have reported that personal life factors strongly influence participant attendance and engagement in intervention activities (Hoff, 2003; Whittaker and Cowley, 2012). The format of most CBME programs includes regularly scheduled classes for multiple weeks in a row. This may not be feasible for families who have an unpredictable weekly schedule due to inconsistent work schedules, health difficulties, or other personal reasons. Offering flexible intervention times and locations can reduce these barriers, however, this can be a challenge for group-based interventions (Smith et al., 2015). To address this concern, approaches such as multi-modal delivery methods that combine less frequent group meetings with other asynchronous activities that are mobile app- or text messaging-based could be considered. However, additional feasibility studies are needed to evaluate parent engagement and effectiveness for this type of multi-modal/hybrid delivery. Community centers and libraries can incorporate music activities into their educational programs free to families, especially those in under resource communities. Community organizations may seek partnerships with local music teachers, and music therapists to offer music programs. Organizations that regularly serve low SES communities can encourage parents to sing with their children at home by providing suggestions of popular children’s songs and activity ideas for everyday routines such as singing during bathtime.
In this study we aimed to understand the home music environment, parent interest in and perceived barriers to attending CBME programs among families who have SES related disparities that may negatively impact child health and development. Our findings suggest that families from low SES communities are highly interested in CBME programs and are especially motivated by wanting to be a better parent. Engaging families with low SES as key stakeholders in intervention development is a critical step in developing ecologically valid interventions that are accessible to the target population. Using a strength-based framework for intervention development and novel intervention delivery will critically address the current access gap for families from low SES communities and boost program barriers such as attendance, activity engagement, and home practice that indirectly enhance the intervention effectiveness.
Footnotes
Acknowledgements
We acknowledge the Formative Research Team at the Children’s Mercy Research Institute for their guidance during this research study’s development. We thank Catherine Serwatka and Hideko Engle, Research Assistants in the Baby Health Behavior Lab for their help with recruitment and participant scheduling, Melissa Carlson and Jacee Weber, medical student volunteers for their transcription assistance.
Author contributions
Amy R. Smith: Conceptualization, Methodology, Investigation, Analysis, Original draft preparation. Delwyn Catley: Methodology, Writing – Review and Editing, Supervision. Ann Davis: Methodology, Writing – Review and Editing, Supervision. Kai Ling Kong: Conceptualization, Writing – Review and Editing, Supervision.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a CTSA grant from NCATS awarded to the University of Kansas for Frontiers: University of Kansas Clinical and Translational Science Institute #TL1TR002368; and NCATS awarded to Vanderbilt University Medical Center: Vanderbilt Institute for Clinical and Translational Research #TL1TR002244.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.