Abstract
Background and Objectives
Rural and underserved communities face persistent health workforce shortages driven partly by limited early exposure to health careers and educational pathways. Area Health Education Centers (AHECs) support workforce pipeline programs, but multi-year outcome data remain limited. This study evaluated short-term educational outcomes associated with participation in a regional Michigan AHEC Health Careers Pipeline Program (HCPP), a nine-session curriculum for high school students.
Methods
Multi-year cross-sectional pre/post evaluation using independent (unpaired) samples among students aged 14–16 at two Mid Central Michigan AHEC sites (Mount Pleasant, Saginaw). Surveys assessed four single-item outcomes on a 1–5 Likert scale: understanding of health careers, knowledge of educational qualifications, awareness of school-based resources, and confidence reaching out to health professionals. Because individual identifiers were not collected, pre- and post-program responses could not be linked. Unpaired comparisons used Mann–Whitney U tests with Benjamini–Hochberg false discovery rate (FDR) adjustment.
Results
Between 2020 and 2025, 347 students participated in the HCPP, with the primary analysis drawing on five cohorts (Mount Pleasant 2023–2025; Saginaw 2024–2025). Understanding of health careers and knowledge of educational qualifications reached significance in every cohort, while awareness of school-based resources reached significance in three of five cohorts and confidence reaching out to health professionals in one of five. Effect sizes ranged from r = 0.31 to 0.64, and program satisfaction remained consistently high across sites and years (mean ratings 4.6–5.0).
Conclusions
HCPP participation was associated with consistent end-of-program differences in health career knowledge and educational pathway awareness across multiple cohorts and two regional sites. Because responses could not be linked at the individual level, these findings reflect group-level differences rather than within-student change or causal effects. While encouraging, these short-term outcomes warrant longitudinal follow-up to determine whether early participation translates into eventual entry into the health professions workforce.
Keywords
Introduction
Recent United States (U.S.) Census data suggests that approximately 20% of the population live in rural areas.1,2 Residents of these areas face inequities that result in worse healthcare and medical outcomes compared to urban and suburban residents, making healthcare improvement strategies important. 3 These disparities are driven in part by health workforce shortages that span multiple professions. Rural areas have fewer primary care physicians (∼55.1 per 100,000 vs. ∼79.3 per 100,000 in urban areas), but shortages also extend to nursing, dentistry, mental health, and allied health professions.4,5 Among U.S. rural counties, 65% lack adequate numbers of health professionals, and with the exception of licensed nurses, the supply of every type of health professional is lower in rural than urban areas. 6 These workforce gaps contribute to higher all-cause mortality and reduced access to care for rural patients.4,5
To address the longstanding health workforce shortages in rural areas, multiple federal and state initiatives have been developed, including the National Health Service Corps (NHSC), Rural Residency Planning and Development (RRPD) Program, and State Loan Repayment Programs (SLRP). While the participation and retention rates of these programs vary, they provide increased support frameworks for pipelining health professionals into these underserved areas, and are an important step towards decreasing rural workforce disparities. 7
Federal appropriations for these rural workforce programs continue to fluctuate, and Title VII training initiatives face continued challenges.8-10 Rural health leaders caution that reductions in pipeline funding could exacerbate provider shortages for decades, given the well-established relationship between pipeline programs and eventual practice in underserved areas.11-13 Evidence from a systematic review of training program effects found that rural background was positively associated with rural practice across 22 studies, with adjusted odds ratios ranging from 2.80 (95% CI 2.09–3.74) to 4.02 (95% CI 2.17–7.74). Participation in rural training tracks was associated with more than double the likelihood of matching into family medicine (RR = 2.6; 95% CI 1.5–4.4), and over 57% of rural track participants chose a rural location for their first practice. 14 Understanding the measurable benefits of these programs has therefore become increasingly important among a quickly changing federal funding landscape.
One program that aims to facilitate health professions employment in rural communities without providing direct financial incentives to participants is the Area Health Education Center (AHEC) network. Primary funding for these centers comes from the HRSA (Health Resources and Services Administration), which supports statewide AHEC programs that distribute funds to regional centers. This federal funding is often supplemented by state appropriations, host institutions, grants, contracts, and program revenue to support health workforce pipeline and training activities. Their statutory purpose is to “improve the supply, distribution, diversity, and quality of the health professions workforce serving underserved populations”, and it has been well-documented in peer-reviewed evaluations of the AHEC infrastructure.15,16
Originally developed by Congress in 1971 to recruit, train, and retain a health professions workforce committed to underserved populations, there is now a network of more than 300 AHEC program offices and centers that serve over 85% of United States counties across the nation. 17
Michigan’s AHEC network consists of five regional centers distributed across the state: the Upper Peninsula, Northern Lower, Western Community Consortium, Southeast, and Mid Central Regional Centers (Figure 1). The Mid Central Regional Center was created in 2010 in partnership with Central Michigan University to serve a multi-county region in central Michigan, including the communities of Mount Pleasant and Saginaw.
18
Recent needs assessments conducted by the Wayne State Center for Urban Studies indicate that across the region, 37–44% of residents live below 200% of the federal poverty level, more than 25% of children live below the poverty line, and 17 of the region’s 19 counties are designated as primary care Health Professional Shortage Areas (with 18 of 19 carrying at least one HPSA designation across primary care, dental, or mental health disciplines), highlighting structural barriers to healthcare access and early exposure to health career pathways.19,20 Michigan’s AHEC regions
In alignment with the broader AHEC mission, the Mid Central Regional Center developed a Health Careers Pipeline Program (HCPP) designed to introduce high school students to healthcare professions through structured exposure, skill-building activities, mentorship, and facilitated engagement with local community leaders. The program serves students from both rural and urban underserved communities in the region. The program seeks to strengthen the future healthcare workforce by (1) increasing early awareness of health career pathways, (2) improving students’ navigational capacity regarding educational requirements and community resources, and (3) cultivating local identity and sustained engagement within rural and underserved communities.
The purpose of this study is to evaluate whether participation in the Mid Central Regional AHEC Health Careers Pipeline Program (HCPP) is associated with short-term pre/post differences in students’ knowledge of health careers, understanding of educational pathways, awareness of school-based resources, and confidence in contacting healthcare professionals. By analyzing pre- and post-program survey data collected across multiple cohorts and two program sites, this analysis aims to contribute to the growing evidence base regarding the measurable outcomes of AHEC pipeline programs and inform future program design and investment.
Methods
Study Design
This study is a descriptive, multi-year program evaluation of the HCPP using a cross-sectional pre/post design with independent (unpaired) samples and routinely collected program survey data. Individual participant identifiers were not collected; therefore baseline and end-of-program responses could not be linked at the individual level, and analyses compare aggregate response distributions between the two time points. The HCPP is a regional initiative designed to enhance students’ exposure to healthcare professions. The annual program was delivered in the Mount Pleasant region during the fall and in the Saginaw region during the spring of each academic year with participants from 19 high schools across the region. The same core curriculum was delivered across all participating high schools at each site, with minor logistical variations based on weather, speaker availability, or school scheduling.
All study procedures were reviewed and deemed exempt by the Central Michigan University Office of Research Compliance and IRB (submission number 2025-872; January 23, 2026). Written guardian consent and student assent were obtained from all participants prior to enrollment in the program.
Participants
Health Careers Pipeline Program: Participant Enrollment, Curriculum Structure, and Session Format
Note: Panel A values represent the maximum number of high school student respondents per year at each site. When both pre- and post-program surveys were available, the higher respondent count is reported. Saginaw participation prior to 2024 reflects pilot or non-standardized program offerings and was not included in the primary pre-post inferential analyses. Panel B shows an example of the fall semester curriculum. Panel C illustrates a typical 90-minute evening session structure.
Intervention
The program consisted of a structured, multi-session curriculum that included hands-on clinical skills practice, interdisciplinary career panels, simulation laboratory experiences, and structured discussions about educational pathways. Sessions were held both in person and online due to speaker accessibility or scheduled school breaks, while all sessions were delivered by faculty, health professionals, and trained volunteers. Each session lasted approximately 90 minutes. At the conclusion of the last scheduled session each student received a certificate of completion. An example of the weekly and nightly schedule is shown in Table 1; Panels B & C.
The curriculum was organized around four core learning objectives such that, by program completion, participants would be able to: (1) describe a range of health professions and the day-to-day work of practitioners in those fields, (2) identify the educational pathways and qualifications associated with selected health professions, (3) recognize school-based and community resources available to support pursuit of a health career, and (4) practice direct communication with health professionals through mentor and panel interactions.
In addition to the didactic curriculum, the program incorporated a structured mentorship component in which students were paired with local health professional mentors who facilitated small-group discussions and served as accessible points of contact throughout the program. Mentors were recruited locally and received an orientation prior to the start of each cohort that reviewed program goals, mentee engagement expectations, and professionalism. Across the five analyzed cohorts, mentor cohort sizes ranged from 10 to 12 mentors per cohort, yielding small mentor groups of approximately two to three high school students per mentor depending on annual enrollment. The same nine-session core curriculum was used across cohorts and sites, with session-level content modestly updated each year to reflect speaker availability, simulation-laboratory scheduling, and student feedback.
The program facilitates early engagement and network building for high school students in the Mount Pleasant and Saginaw regions of Michigan. These regions include both rural and urban communities that are medically underserved and experience ongoing economic challenges and healthcare workforce shortages. 19
Survey Instrument
Students voluntarily completed surveys at the start (baseline) and at the conclusion of the program (Supplementary Appendix). Both surveys used identical wording and response anchors, and each assessed the same four core constructs with a single Likert-scale item rated on a 1–5 scale (1 = “Not at all,” 5 = “Extremely”). The four core items were worded exactly as follows: (1) “How well do you understand various health careers available to you after high school?”; (2) “How well do you know the educational qualifications needed for the health careers you are interested in?”; (3) “Are you aware of resources or programs at your high school that provide information about health careers, educational pathways, and financial aid assistance?”; and (4) “How confident are you in your ability to reach out to individuals working in the health field for advice or questions about pursuing a health career?”
The post-survey was administered upon program completion and included items assessing whether participation influenced students’ career goals and whether the program supported their interest in a health career. Students also provided global ratings of overall program quality, technology platforms, and each individual session.
All survey items were developed by program faculty and staff, informed by prior health workforce pipeline literature, and were reviewed by program faculty to support content validity.
Outcomes
Primary outcomes included the four core Likert survey items described above, each analyzed individually. No composite indices were constructed. Secondary outcomes included program satisfaction ratings and descriptive post-survey responses regarding career interest and perceived benefit.
Data Management
Electronic surveys are completed by participants and records are securely maintained by Mid Central AHEC.
Statistical Analysis
All analyses were conducted using Python version 3.x, with pandas and NumPy used for data management, SciPy for nonparametric statistical testing, statsmodels for multiple-comparison adjustment, and matplotlib for figure generation. Primary analyses included five cohorts with both pre- and post-program survey data across two program locations (Mount Pleasant 2023–2025; Saginaw 2024–2025). Analyses were restricted to high school respondents. Because participant identifiers were not available to link individuals across pre- and post-program surveys, pre–post comparisons were treated as independent samples. Data were stratified by program site and year rather than pooled because the Mount Pleasant and Saginaw sites serve distinct communities with different socioeconomic profiles and school contexts, and because the program was delivered across academic years during which curricular refinements, facilitator changes, and external factors may have influenced outcomes. Stratification preserves transparency regarding variability in sample sizes and effect magnitudes and allows readers to assess the consistency of program effects across implementation contexts—itself an important evaluative finding.
Mann–Whitney U tests were selected for pre–post comparisons because the outcome data are ordinal (5-point Likert scales), the pre- and post-program groups represent independent (unpaired) samples, and the relatively small within-cohort sample sizes make distributional assumptions required by parametric tests less tenable. Descriptive statistics were calculated for all survey items, including means and medians for Likert-scale responses. Effect sizes were calculated as r from the Mann–Whitney U statistic, with positive values indicating higher post-program ranks. To account for multiple comparisons across the four outcomes within each cohort, p-values were adjusted using the Benjamini–Hochberg false discovery rate (FDR) procedure. All reported p-values are FDR-adjusted, with significance defined as p < 0.05. Post-only survey data from earlier program years were analyzed descriptively without inferential testing to characterize program acceptability and perceived benefit.
Results
Unpaired Pre–Post Changes in Core Learning Outcomes Among Health Careers Pipeline Program Participants by Site and Year
Note: (1) Likert scale ranged from 1 to 5, where 1 = not at all confident and 5 = extremely confident; (2) Effect sizes were calculated with positive values indicating higher post-program scores; (3) Nonparametric testing was used due to ordinal response scales and independent samples; (4) All p-values shown are Benjamini-Hochberg FDR-adjusted values (four comparisons per cohort); raw p-values were used only as inputs to the FDR procedure and are not reported. p-values reported as <0.001 reflect FDR-adjusted values rounded below the third decimal place.
In Mount Pleasant, post-program scores were consistently higher than pre-program scores for “understanding of health careers” and “knowledge of educational qualifications” across all evaluated years, with effect sizes ranging from r = 0.41 to r = 0.64 in 2024 and 2025 (Table 2; Figure 2). In 2023, higher post-program ratings were observed across all three knowledge/awareness outcomes with statistically significant differences for “understanding of health careers” and “knowledge of educational qualifications”, while “confidence reaching out to health professionals” showed smaller and non-significant differences (Table 2; Figure 2). In 2024, “understanding of health careers” and “knowledge of educational qualifications” again showed statistically significant post-program differences, while “awareness of resources” and “confidence reaching out to health professionals” demonstrated smaller differences that were not significant after adjustment (Table 2; Figure 2). In 2025, the largest post-program increases were observed in “understanding of health careers”, “knowledge of educational qualifications”, and “awareness of resources”, all remaining statistically significant after correction, while “confidence reaching out to health professionals” increased but did not reach significance (Table 2; Figure 2). Unpaired pre–post distributions of core learning outcomes among 2023-2025 Mount Pleasant participants. *= Statistically significant
In Saginaw, unpaired pre–post comparisons similarly demonstrated higher post-program ratings across the four core outcomes (Figure 3). In 2024, all four outcomes showed statistically significant post-program increases (Table 2). In 2025, “understanding of health careers” and “knowledge of educational qualifications” showed statistically significant post-program increases with effect sizes ranging from r = 0.37 to r = 0.53; “awareness of resources” showed a smaller but statistically significant increase, while “confidence reaching out to health professionals” showed a smaller increase that did not remain statistically significant after adjustment (Table 2; Figure 3). Unpaired pre–post distributions of core learning outcomes among 2024-2025 Saginaw participants. *= Statistically significant
Across all cohorts with post-program survey data, participants reported consistently high satisfaction with the Health Careers Pipeline Program. At the Mount Pleasant site, mean overall program ratings increased from 4.63 in 2023 to 4.80 in 2024 and 4.97 in 2025, with median scores of 5 in each year. Participants at the Saginaw site reported similarly strong satisfaction in 2025, with a mean rating of 4.89 and a median of 5. Descriptive analyses of post-only cohorts from earlier program years (Mount Pleasant 2020–2022) demonstrated uniformly high satisfaction, with mean ratings generally ranging between 4.5 and 5.0. These findings indicate sustained, high perceived program value across sites and years, even during early implementation before systematic pre-program assessment was introduced. Post-survey responses also indicated that most participants reported increased interest in pursuing a health career after completing the program, though these data were collected descriptively and were not subject to inferential testing. Across the five analyzed cohorts, the most consistent post-program differences were observed for “understanding of health careers” and “knowledge of educational qualifications,” both reaching statistical significance after FDR adjustment in every cohort. “Awareness of school-based resources” reached significance in three of five cohorts, while “confidence reaching out to health professionals” reached significance in only one (Saginaw 2024).
Discussion
Across the five analyzed cohorts, three of the four core outcomes; understanding of health careers, knowledge of educational qualifications, and awareness of resources showed consistent, statistically significant differences between baseline and program completion, with moderate to large effect sizes (r = 0.31–0.64; Table 2; Figures 2 and 3). Differences in confidence reaching out to health professionals were smaller and less consistent but trended positively across cohorts. Descriptive data from earlier post-only years further support sustained program acceptability and perceived benefit.
These findings are consistent with evidence that structured pipeline programs offering career exposure, mentorship, and hands-on activities can enhance career awareness and readiness, particularly among students from underserved communities.22-24 Studies of health career pathways have found that early acquisition of career-specific knowledge and understanding of educational requirements is positively associated with students’ intent to pursue those professions. 25 The consistency of these findings across multiple years and two distinct geographic sites supports the replicability of program effects across implementation settings.
These results contribute to relatively limited but growing evidence base on AHEC pipeline program outcomes. While AHEC programs have operated for over five decades across more than 300 centers nationwide, multi-year outcome evaluations of individual programs remain uncommon.15-17 A recent longitudinal evaluation of another AHEC program found that participation was associated with increased intent to pursue health careers and higher rates of primary care residency match among medical students. 26 The findings extend this literature by documenting consistent short-term educational differences in a younger, pre-college population, a pipeline stage where evidence is particularly sparse. Other AHEC regions and state networks may find these outcome patterns informative for programmatic benchmarking.
These knowledge-based findings align with research demonstrating that targeted educational interventions can narrow information gaps that disproportionately affect students in under-resourced communities.27-29
Another consistent pattern across years was the lesser increase in students’ “confidence reaching out to health professionals”. This finding is consistent with prior research showing that confidence and professional identity in early learners develop more slowly than knowledge, requiring sustained mentorship and repeated authentic exposure to clinical roles.30,31 Pipeline programs incorporating longitudinal mentoring, structured networking, and near-peer coaching demonstrate greater gains in confidence and professional identity. 32 Given these findings, strengthening the HCPP through expanded mentorship infrastructure, greater continuity in student–mentor relationships, and deliberate practice opportunities for professional communication may enhance confidence outcomes.
Several program-specific considerations may also help explain this finding. The curriculum directly targets the three knowledge-oriented constructs through repeated programmatic elements: career panels build career awareness, structured discussions of pathways convey educational requirements, and explicit review of school- and community-based resources. In contrast, the program does not include a structured component requiring students to initiate contact with a health professional outside of program-facilitated interactions, leaving the “confidence reaching out” construct less directly addressed. Embedding a low-stakes outreach assignment, such as a brief required email or follow-up question to a panel speaker, mentor, or community provider, may better align the curriculum with this outcome in future iterations.
Qualitative review of open-response items on post-program surveys was consistent with this interpretation. Students frequently described mentorship and direct interaction with professionals as the most valuable elements of the program, while requesting more one-on-one mentor time, smaller breakout discussions, and longer interactions with each professional. Several students explicitly referenced discomfort with public speaking and professional interaction as a personal growth area highlighted by the program, reinforcing the interpretation that confidence-building and professional communication develop through sustained, repeated authentic interactions rather than through single-session exposure.
The high program satisfaction reported across all years in which it was offered further strengthens the interpretation that participants perceive the program to be valuable, engaging, and relevant. This mirrors national findings that similar programs consistently receive strong acceptability ratings and enhance learners’ interest in health careers. 33 The consistency of these ratings over the program’s tenure, despite annual variation in participants and facilitators, suggests organizational stability and curricular coherence within the Mid Central AHEC model. Features such as the structured multi-week curriculum, integration with university simulation facilities, and pairing of students with local health professional mentors represent program elements that could be adapted by other AHEC regions or similar workforce pipeline initiatives. The HCPP was delivered at an estimated annual operating cost between $4,000-7,000 which was dependent on number of participants, number of weekly sessions, and material costs. As rural health workforce shortages persist and demand for evidence-based recruitment strategies grows, programs demonstrating sustained participant engagement warrant continued investment and broader implementation.
Beyond individual-level outcomes, these findings hold relevance for national efforts to address rural health workforce shortages. While long-term rural workforce outcomes remain unknown due to the program’s infancy and limited longitudinal follow-up due to attrition, evidence indicates that early exposure to health professions and targeted recruitment from rural communities significantly increase the likelihood of long-term rural practice.34-36 Higher end-of-program ratings of career knowledge, educational pathway awareness, and resource navigation documented here represent early markers along this trajectory, addressing the informational and motivational barriers that disproportionately deter rural and first-generation students from pursuing health careers. 28 Pipeline programs like the HCPP focus on cultivating intrinsic motivation and early career commitment through community-embedded approaches: local mentorship, exposure to regional healthcare professionals, and structured engagement with nearby training institutions. These mechanisms may complement traditional financial incentives, whose retention outcomes have been mixed.7,37 As federal appropriations continue to face uncertainty, the pattern of higher post-program ratings observed across these cohorts is consistent with the longstanding congressional rationale for AHEC funding, namely that community-embedded educational interventions may contribute to upstream health workforce pipeline development before students reach post-secondary training.
Limitations
Several limitations should be considered when interpreting these findings. With respect to study design, this evaluation is descriptive and does not test causal associations. Pre- and post-program surveys were collected without participant identifiers, so comparisons were conducted as independent (unpaired) samples rather than paired analyses, which prevents assessment of individual level change. The absence of a non-participating control group further limits causal inference, and the program may attract students who already have interest in health careers, introducing self-selection bias. Sample sizes varied across cohorts and sites, and some post-survey groups were relatively small. The use of self-reported Likert scales also introduces possible response and social desirability bias. Due to the response scale being bounded at 5, ceiling effects are possible. Specifically, pre-program means in some cohorts approached the upper end of the scale which may attenuate observed between-group differences. Although students were drawn from 19 high schools, the analyses did not incorporate school-level clustering or random effects, which could underestimate variability associated with school context. With respect to generalizability and reach, the geographic scope is limited to two sites within a single AHEC region in central Michigan, which constrains generalizability to other settings and populations. Demographic data on race/ethnicity, sex, socioeconomic status, and first-generation college status were not collected, so this study cannot determine whether the program reached specific underserved subgroups. References to “rural and underserved” students describe the program’s catchment region rather than individual participants. Long-term educational and career outcomes were not tracked, and for cohorts prior to 2023 attrition and survey response rates cannot be reconstructed from the available records. Future program iterations could address these limitations through unique participant identifiers enabling paired analyses, systematic collection of participant demographic data, formal tracking of attrition and survey response rates, longitudinal tracking of educational and career milestones, and comparison with matched non-participant cohorts where feasible.
Conclusion
This multi-year evaluation found consistent pre/post differences in health career knowledge, educational pathway awareness, and resource awareness across five cohorts and two regional sites. The replicability of these findings across implementation contexts is an important result and supports the HCPP curriculum as a transferable model for early career exposure. Longitudinal tracking is needed to determine whether these gains translate into health professions career entry; however, the consistency of these short-term outcomes, in a region where 17 of 19 counties are designated as health professional shortage areas, makes a compelling case for sustained investment in community-embedded AHEC pipeline programming.
Supplemental Material
Supplemental Material - Health Career Knowledge Outcomes Among Rural High School Students: A Multi-Year Evaluation of a Regional AHEC Pipeline Program
Supplemental Material for Health Career Knowledge Outcomes Among Rural High School Students: A Multi-Year Evaluation of a Regional AHEC Pipeline Program by Matthew Ruge, Jacob Surma, Jennifer Morneau-Wilson, April Osburn, Christopher Bobier in Journal of Medical Education and Curricular Development.
Footnotes
Presentations
This manuscript has not been presented in any professional setting.
Acknowledgements
The authors thank the Mid Central Regional Area Health Education Center and its staff for their ongoing commitment to the Health Careers Pipeline Program. We also acknowledge the high school students, mentors, and community partners who participated in the program across both sites.
Ethical Considerations
All study procedures were reviewed and deemed exempt by the Central Michigan University Office of Research Compliance and IRB (submission number 2025-872; January 23, 2026). Written parental/guardian consent and student assent were obtained from all participants prior to enrollment in the Health Careers Pipeline Program.
Author Contributions
Mr. Ruge and Mr. Surma contributed to the conception and design of the study; performed the statistical analysis and interpretation of program data; contributed to formal analysis, data curation, and visualization; and drafted and revised the manuscript in its entirety. Mrs. Morneau-Wilson and Mrs. Osburn contributed to the conception and design of the study, oversaw annual program delivery and project administration, maintained the survey data, and critically revised the manuscript. Dr. Bobier contributed to the study design and to the analysis and interpretation of data, provided supervision of the project, critically revised the manuscript for important intellectual content, and approved the final version for publication. All authors contributed to writing, review, and editing of the manuscript, approved the final version of the manuscript, and agree to be accountable for all aspects of the work.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors report no financial conflicts of interest relevant to this article. As a potential non-financial interest, the authors disclose that two authors are affiliated with the Mid Central Michigan Area Health Education Center, the organization that operates the Health Careers Pipeline Program evaluated in this study. Specifically, authors Jennifer Morneau-Wilson and April Osburn are program staff who manage program delivery and survey data collection.
Data Availability Statement
Data supporting the findings of this study are available from the corresponding author upon request. Individual-level survey data are maintained by the Mid Central Michigan AHEC and are not publicly available due to the minor status of participants and the conditions of program enrollment.
Supplemental Material
Supplemental material for this article is available online.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
