Teacher Candidates’ Responses to Examining Personal Privilege: Nuanced Understandings of the Discourse of Individualism in Critical Multicultural Education

Introduction

Critical multicultural education seeks to prepare teachers to dismantle inequitable structures in their own classrooms and more productively attend to inequity in their interactions with children and parents, other educators, and society at large (Gorski, 2009; DiAngelo and Sensoy, 2010; Sensoy and DiAngelo, 2017). One way to encourage students to see their social positionality and larger connections to the institutional and societal structures is to ask them to identify and examine their own privilege. A body of empirical work in teacher education examines aspects of privilege particularly in terms of deepening understanding, shifting discourses, and enlisting commitment to creating more equitable educational environments (Dunlap et al., 2007; Case and Cole, 2013; Flynn, 2015). Scholars have identified discourses and ideologies that students draw on when they grapple with critical multicultural education as they prepare to teach (Van Dijk, 1992; DiAngelo and Sensoy, 2009; DiAngelo, 2010; Coates, 2013). For example, Robin DiAngelo variously describes how the discourses of universality (DiAngelo, 2006) discourses of opinion (with DiAngelo and Sensoy, 2009), of individualism (DiAngelo and Sensoy, 2010), and of White silence (DiAngelo, 2012) all function as “discursive projects of resistance” (2009, p. 443) in social justice-oriented classrooms.

These dominant discourses that all emphasize individualism interfere with teacher candidates' ability to embrace understandings of systemic privilege that emerge in critical multicultural education (DiAngelo and Sensoy, 2009; Gorski, 2009, 2012; DiAngelo, 2010, 2012; Flynn, 2015). The emphasis on individuals as autonomous from the socio-historical forces that shape opportunity reinforces a meritocratic perspective and reduces the visibility of structural inequality, or privilege, in personal experiences. The present study builds on scholarship examining the Discourses of Individualism and asks: How do pre-service teachers in a critical multicultural education course articulate a Discourse of Individualism to explain privilege in their own lives?

Conceptual Framework

Privilege can be defined as “unearned social group advantages” (Case, 2013: p. 2). Scholars note how crucial it is that teachers be taught explicitly about privilege (Weisman and Garza, 2002; Gay and Kirkland, 2003; Dunlap et al., 2007). For example, racism is often thought of as “individual acts of meanness” (McIntosh, 1988, p. 192) instead of patterned, systemic institutional forces that shape our opportunities and social positions. Therefore, a crucial component of critical multicultural education is for students to examine privilege at the structural level (Sleeter and Grant, 2006; Gorski, 2009; Howard, 2009).

Engaging teacher candidates in considering social difference and inequality challenges dominant culture ideologies, including meritocracy, individualism, and the ideal of democracy (DiAngelo and Sensoy, 2009; DiAngelo, 2010; McIntosh, 2013), and is an emotionally laden task (Kelchtermans, 2009; Zembylas, 2010; Case, 2013; Whiting and Cutri, 2015). Research documents that some students actively and passively resist the content of multicultural education and discussions of privilege (Weisman and Garza, 2002; Dunlap et al., 2007; Mueller and O'Connor, 2007; Case, 2013; Case and Cole, 2013). For example, Gay and Kirkland (2003) discuss “maneuvers” that pre-service teachers use to avoid reflecting on privilege or the development of critical consciousness, including diversion away from the topic, focusing on the individual instead of broad inequality, and pleading ignorance (also Case, 2013; Wise and Case, 2013; Sensoy and DiAngelo, 2014, 2017).

The Discourse of Individualism is one prevalent discourse identified as a response to a critical multicultural education content (DiAngelo, 2010). One way that students enact the discourse of individualism in multicultural classrooms is through a discourse of opinion as “a rhetorical device used to resist the call for positionality and to counter claims of inequality” (DiAngelo and Sensoy, 2009: p. 447). In other words, teacher candidates can resist simply by conceptualizing content as opinion rather than socially real. Together the Discourse of Individualism including a discourse of opinion, are used to ease the internal tensions experienced by students as they grapple with critical multicultural education content that challenges dominant ideologies about power by asking students to consider the influence of social position.

Discourses contain and reveal embedded ideologies as “ways of thinking and behaving within a given society which make the ways of society seem “natural” or unquestioned to it's members” (DiAngelo, 2010: p. 3). These discourses and ideologies can be used to make oppressive social systems seem natural or desirable or even invisible. As DiAngelo (2010) explains,

The Discourse of Individualism is a claim that we all act independently from one another and that we all have the same possibility of achievement and are unmarked by social positions, such as race, class, and gender (Bonilla-Silva, 2006)… Because it obscures how social positioning impacts opportunity, the Discourse of Individualism is a dominant discourse that functions ideologically to reinforce and reproduce relations of unequal power (p. 4).

An insistence on individualism leads to the masking of social inequalities and our complicitness in the systems of oppression. In her work, DiAngelo (2010) presents eight dynamics of racism within the Discourse of Individualism. These include; the denial of white privilege and the significance of race, denial of the accumulation of wealth over generations, the denial of socio-historical context, denial of persistent historical patterns of inequalities, denial of collective socialization on influence of mass media on hegemonic ideologies, reproduction of the myth of meritocracy and the myth of color blindness, portrayal of universal human individuality as a mythical norm, and finally it makes collective action difficult.

More empirical work is needed that examines how teacher candidates position themselves in a Discourse of Individualism in their explanations of their privilege. A more nuanced examination of how a Discourse of Individualism is enacted and articulated in the context of critical multicultural teacher education about social privilege is warranted. As we further interrogate the Discourse of Individualism to uncover and better understand student grappling, we can help name, articulate, and critique such discursive moves in ways that position teacher candidates to be prepared and responsive to their future students.

Methods

In our 14-weeks required course we explicitly teach our students to identify their personal unearned privileges by introducing them to constructs, such as the myth of meritocracy, social reproduction, attributional errors, discrimination, and the reality of oppression, among other important multicultural concepts (Sensoy and DiAngelo, 2017). We are challenged to create spaces where students can examine their own positionalities “while simultaneously challenging the mainstream discourses that students invoke in the classroom” (DiAngelo and Sensoy, 2009: p. 451) to avoid the discomfort of critical social justice work. Students are asked to examine their own social positions and privileges and critique the social structures that continue to constrain access to resources and opportunities. We assign coursework and assessments designed to ascertain how students grapple with learning of structured institutional inequality.

Setting and Participants

This study occurred at a private Christian university in the intermountain region of the United States. The Institutional Review Board for Human Subjects (IRB) which considers the ethical implications and procedures of research at our institution approved the study with the stipulation that data be safeguarded for confidentiality and then destroyed after 5 years. After explaining the study purposes and implications, students who were willing to participate in the study signed written consent forms and retained an information sheet indicating that they could withdraw at any time without penalty. Data was analyzed after the course was completed and thus student grades and other outcomes were not impacted by this research process.

The participants were taught by the authors of this paper and all participated in a common curriculum. This curriculum explicitly highlights the concepts of privilege and discrimination as being inherently connected in our social world. We assert that possessing social privileges comes with larger moral obligations to those who do not enjoy those privileges and requires students to grapple with the context of material privilege in their own lives. Assignments are designed to move from careful and critical examination of the self to larger consideration in the community (Allen and Rossatto, 2009), and then critical examinations of larger societal ramifications of privileges and challenges related to race, class, gender, sexuality, immigration, and language.

Our sample included 175 pre-service teachers enrolled in a required multicultural education class. Responses from 77 elementary and 98 secondary pre-service teachers were collected across three semesters. Most students were between the ages of 19 and 25 but there were at least six “non-traditional” students returning to school after significant time away from university to complete their undergraduate degrees. Available demographic data from the larger school population indicate that our sample population comes largely from the dominant White, English speaking, middle class, and Christian population in the United States. Official school statistics boast students from all 50 states. While this is so, only 14% of the undergraduate population identify themselves as a member of any racial minority group. Additionally, almost 99% of students are Christian from a single denomination (School Statistics, 2016). These demographics closely match the majority of pre-service teachers in traditional teacher preparation programs in the US (Quiocho and Rios, 2000; Ladson-Billings, 2005; Platt, 2013). In our analysis, we seek to avoid a reductionistic portrayal of majority culture teacher candidates by acknowledging the nuances in each positionality and the possibilities for all students to work as allies in various contexts (Lowenstein, 2009; Gorski, 2012; Case, 2013).

Data and Analysis

Data came from responses to a short essay question on a final assignment. The question specifically asks students to draw on their learning in critical multicultural education and use a personal experience to illustrate structural privilege by identifying “at least one important personal privilege that you did not ‘earn’ or merit for yourselves and then reflect on and analyze the impact of this in your life.” We consider teacher candidates' responses as articulations of conceptional negotiations between an ideology of individuality and critical multicultural ideologies as they explain their own privileges. As previously presented in our theoretical framework, we are building on work in critical multicultural teacher education that describes discursive moves to resist critical multicultural content which seeks to implicate all people in the social structures of privilege (DiAngelo and Sensoy, 2009; DiAngelo, 2010, 2012).

We used open coding to identify patterns of responses used by pre-service teachers as they describe their social privileges (Miles and Huberman, 1994; Saldaña, 2009). Our recursive process began as both authors analyzed a small sample of data separately, then discussed emerging patterns of teacher candidates' approaches to their own unearned social privileges. Working independently, we analyzed the larger sample, meeting periodically to examine particular samples to confirm our interpretations of data remained congruent with each other. Throughout this process, we sought contradictory and negative evidence of our themes. Once we completed the analysis, we reviewed our data against our patterns and themes to make certain that our data provided clear evidence of our themes (Strauss, 1987; Saldaña, 2009).

Building on our previous analysis of types of privileges articulated by teacher candidates (Whiting and Cutri, 2015), we noted articulations of student stance toward their privileges. We specifically looked for ways that students articulated thoughts within a Discourse of Individualism (DiAngelo, 2010) including the specific opinion discourse identified by DiAngelo and Sensoy (2009) and additional emerging variations of individuality. We identified the stance of students in their written response texts about their personal privilege to determine if elements of the Discourse of Individualism were being used (Johnstone, 2008). We focused on positioning toward others because we recognize that “positionality is a foundation of this type of analysis” (DiAngelo and Sensoy, 2009, p. 456). We then analyzed the nuances of how these articulations made sense of the privilege within the Discourse of Individualism.

Our first pass of the data identified familiar variants of the Discourse of Individualism in critical multicultural education (DiAngelo and Sensoy, 2009; DiAngelo, 2010, 2018). Our second pass through the data looked for new and emerging articulations not previously acknowledged in the literature on individuality discourse in critical multicultural education. We identified the emerging articulations that reflected the ways students position themselves toward their own privilege and the ways that students explain their experiences using a Discourse of Individualism (see DiAngelo, 2010).

Findings and Discussions

We identified three specific categories of articulations within the Discourse of Individualism in students' responses that are characterized by specific ideologies that facilitate a Discourse of Individualism. First, student responses (n = 12) show outright resistance to the reality of unearned privilege. This approach draws on the ideology of meritocracy and personal achievement. Second, student responses (n = 118) articulate privilege as an inheritance which relies on an ideology of luck. Finally, we see student responses (n = 45) that begin to acknowledge privilege as being a part of systemically structured inequality that relies on critical multicultural ideologies.

Personal Achievement and Meritocracy

Seven responses emphasized personal characteristics, such as “I dress well,” or “I am smart.” Although these short responses are hard to analyze for our question, they may reflect a form of resistance, or “not-learning” (Kohl, 1995), of the concepts of privilege and systemic inequality as we presented them. Overall, these responses have a strong emphasis on individual positionality and reflect a denial of privilege as systemic.

An additional five student responses demonstrated articulations of personal achievement to express an active resistance to structured privilege. These critiques exposed a commitment to a rigid ideology of meritocracy. One student wrote about their father's experience to argue that work alone is responsible for inequitable social status and privileges in society. This student references a Discourse of Individualism and ideology of meritocracy explicitly in this segment.

“I believe that it wasn't by chance that we lived in Southern California, my dad didn't have a house given to him, or let alone a job. I believe it is because my dad made a goal for himself, and achieved the goal. This is a perfect example of meritocracy. My dad worked hard and he became what he wanted to be. It all has to do with one person's goal to achieve anything. I know that as we have learned about all these terms, that people who come from different cultures, ethnicities (sic.), those who are immigrants, I honestly believe that if they put their mind to something, despite what others tell them, that they can achieve great things in their lives.”

It is easy to notice the assertions about hard work, lack of being “given” a house or a job. Also, we note the assertion that if others would just do what this student's father did, set goals and work hard they could reach the same outcome—good job and nice house in Southern California.

Other responses displayed more nuanced grappling with having unearned privilege. For example, a Hispanic American student, and one of only two students from racial minorities in our sample, commented:

“This is a hard question for me, because I feel that everything that I have in my immediate life is something that I have worked for. After long analyzing and thought, freedom is one privilege in my life that I have not had to work for and has simply been given to me that has in turn allowed me to work for everything else in my life.”

This response shows the challenges in this task and the teacher candidate could only identify the abstract concept of “freedom.” This response also suggests that for students in marginalized positions, acknowledging their locations of privilege can be especially difficult as achievements are often hard won relative to those more privileged. The struggle to identify privilege occurs in a context of an individual and interpersonal focus that is ingrained in dominant discourses related to individual achievement.

Interestingly, these students openly challenged the stated goals and curricular assertions of the course and the instructors in this final assessment. It appears that they were holding onto beliefs about individual identity and achievement that are based in the Discourse of Individualism and ideology of meritocracy. Although a small number of the overall responses, we consider that these responses may articulate ideas that others were perhaps reluctant to express in the context of a course assignment.

Inheritance and Luck

The vast majority of student responses attributed personal privileges to inheritance and luck in some way. In fact, 118 responses out of the 175 responses analyzed were included in this category. The critical multicultural education curriculum of the course challenges students to think about privilege systemically and to critique the ideology of meritocracy. These responses show students grappling with the institutional level but with a continued reliance on individualistic explanations.

Some responses show teacher candidates working through tensions between the acknowledgment of social position and inheritance and their own sense of their individual work and achievement.

“As we have studied I have realized how hard it is to start from nothing. My privilege has been the result of the economic sacrifice of my family, though not rich, we have had plenty to take care of ourselves.”

This response also reveals a pattern of qualifying inherited privilege. For example, the teacher candidate argues that parent income was a result of the hard work or “economic sacrifice,” coupled with a qualification that the family had vast economic resources. An implication of this response is the idea that privilege is contextualized in an ideology of personal achievement which works to present any privileged positioning as a “deserved” privilege. Similarly, student responses sometimes revealed a related pattern of downplaying privileges connected to articulations of inheritance evident here in the qualification “though not rich.” These patterns permitted students to begin recognizing inequality without completely letting go of the fallacy of meritocracy so deeply embedded in dominant discourses of individuality.

Some student articulations of inheritance began to acknowledge implications of social inequality in terms of historical and institutionalized practices toward certain groups in this country. However, such responses fall short of an acknowledgment of the social structures that perpetuate or reinforce these inequalities. For example, responses that acknowledged race as a privilege tacitly but not explicitly conceded that there is a system of racism, which differentially benefits some over others in terms of status and opportunities. However, many of these teacher candidates did not elaborate on the institutional aspects of this privilege, instead emphasizing personal and passive inheritance and the ideology of luck, or unspecified forces outside of personal control, as illustrated in the following quote.

“I am white. I didn't choose to be white, nor did I certainly earn it in any way. I am just the way I came. because I am a white person I have had many opportunities that I might not otherwise received.”

This student has begun to acknowledge the role of race as a privilege in this society by labeling it, but this remains relatively preliminary and individual. While the response began to connect the experience to the course definition of privilege, this connection is slim and incomplete. It references course requirements and ideas but does not draw on the ideologies or critical concepts presented in the course to elaborate understanding of why or how race functions as a privilege, the role of intersectionality, or providing any critique for the system of privilege.

Similarly, teacher candidates began to name and acknowledge privileges inherited from families and the idea of advantage without a disavowing an individualistic orientation or ideology. One student provided a typical response:

“I have grown up enjoying the privilege of being born into an educated household where a strong emphasis was placed on school…because I was born into the culture of power, I already have many advantages over my peers who were not born with this distinction.”

Although this student drew on and used course concepts to demonstrate recognition of social privilege and positionality, this response did not acknowledge how privilege is also systematically structured in society. This example illustrates an emerging articulation of inheritance, used to acknowledge individual privilege while holding on to dominant culture ideals within a Discourse of Individualism. It also allowed the respondent to avoid a critical perspective that names elements of systemic inequality.

A few responses explicitly named the ideal of meritocracy as taught in the course as they grappled with their own personal privilege. Responses contended that although teacher candidates may have once relied on this ideology to see and understand their world, they are now embracing new perspectives. These responses demonstrated potential critical social justice orientations by implicitly referencing the ideas of inheritance to challenge the meritocracy myth. For example:

“As a younger kid, I felt that I really earned these chances, that others who didn't do the activities I did were just lazy. I realize now that I basically inherited these opportunities—no matter how much work ethic I had, I wouldn't have had these chances if my parents hadn't been wealthy enough to afford them for me. This reminds me of an error of the meritocracy myth—some people believe that you work hard enough, you can have anything you want, you can be anything you want. This just isn't true. My parents' income played a large part in my successes in life. This is a resource that others don't have at their disposal, and it's not because they deserve it less than I did. Some things are just luck. I was lucky enough to be born to a wealthy family, and that aided me in gaining all sorts of cultural capital that I wouldn't have had access to otherwise.”

This response used concepts specifically identifying social position as a child of wealthy parents that has opened up access to “chances,” “successes,” and “cultural capital” to grapple with how social outcomes are connected to how we make sense of what one “deserves,” entitlements, and introduces an ideology of justice. However, once again, the response stopped short of acknowledging the social structures related to this inherited position of privilege, but instead attributed this to luck. The articulations of luck and inheritance, remain grounded in an individual level of thought and focuses attention on interpersonal outcomes rather than larger social justice implications.

Although students are contending with social inheritance and the rejection of meritocracy as a simple fact, their articulations of privilege revealed their resistance to and struggle with acknowledging much complicity in the overall social structure. One response articulated a teacher candidate's learning. This student began to situate their own life experience in a larger context but remained non-committal on the location of power within these forces.

“What this has taught me is that although we may have many choices and experiences that can put us ahead (or behind) in life, a lot of how our life turns out comes from generations before you which you cannot control.”

Articulations of inheritance in such examples show that students are situating themselves as passive heirs. This allows them to recognize their privilege, be grateful and yet still remain shielded from their complicity in continuing advantaged positioning within a structured social system of privilege.

Student reconciliations of their own experiences using the concepts of inheritance and luck show emerging thinking about social position and the implications of privilege. These responses highlight the difficulty inherent in positioning ourselves as active participant's complicitness in the propagation of the system of social privilege. Teacher candidates' responses fell short of situating social privilege as structured in society and they continued to rely on dominant discourses that focus attention to privilege in individualistic positioning. Nevertheless, because our course asks students to fundamentally reexamine who they are in their world, these responses indicate potentially significant shifts for teacher candidates begin to challenge ideas of meritocracy and acknowledge their own privilege relative to others in society.

Acknowledgment of Systemic Inequality

The third analytic theme includes 45 examples of student responses articulating privilege in the context of a broader social structure from which they benefited. Although mostly nascent and emerging, these responses elaborated more specifically about how systemic structured inequality impacted personal experiences. These responses were different than other responses because they showed some reasoning about the social structures explicitly and they began to draw upon an ideology related to social justice.

One example shows a teacher candidate acknowledging race as a privilege and the ways social categories came together for her benefit.

“I think that the fact that I am a white female has given me privilege I did not earn. I grew up in a poor home as the youngest of 9 children. I think being poor should have been a restriction on my education or future, but no teacher treated me poor because I am white.”

This response shows student effort to examine how race, gender, and economic status may intersect. Although we do not know the details of her experience, she appears to be asserting that in her opinion her white privilege was more influential than her social class (or gender) referring to the organization of social privilege outside her experiences in societal structures. She demonstrated an understanding of how privileges can be weighted differently in certain social settings and the institutional forces that are relevant to understanding privilege.

A few students connected their privileges to intersecting and reinforcing social structures taken for granted when in positions of privilege. For example, one teacher candidate linked access to quality health care with a sense of security that led to other social opportunities and privileges.

“All throughout my childhood and adolescence, I have had access to good healthcare… because I had good healthcare I never thought much about my health. I engaged in dangerous activities- skating, rock climbing and football because I was not worried about breaking an arm or leg… because I inherited health insurance from parents, I have never had to consider the cost of treatment. I have never had to worry about not getting the treatment that I needed because I didn't have the money to buy it.”

Although this teacher candidate drew on concepts of inheritance explicitly, in contrast to peer responses, it is without emphasizing the individual level. Instead, by acknowledging positionality in the system of accessing health privilege structured through insurance programs in the US, connections are made between inherited privilege and various other ways privilege is enacted and structured outside an individual personal situation.

Structured inequality is experienced in myriad, overlapping, categories and levels of privilege, intersecting in complex ways. One response articulated a process of exploring personal experiences through the class and learning about how privilege is a part of a larger system of inequality.

“I didn't see my privilege as a speaker of English or as a white person or as a member of the middle class. All of these things allowed me the privilege of believing in the myth of meritocracy. It seemed obvious to me that, since I worked hard and succeeded, others could do the same thing. But this belief itself is a privilege—a privilege of those successful in the system. This sort of naïve idealism put me in a place where I didn't even see my own privilege because I lived under the false impression that I earned everything I received.”

This teacher candidate demonstrated a more critical stance with a recognition that even the belief systems available to make meaning were impacted by positionality in a system of privilege.

This analysis demonstrates three different ways that teacher candidates articulate and justify privilege. These show a range of reliance on individual explanations in contrast to more institutional explanations of privilege in critical social justice discourses. A few student responses actively resisted any critical concept of privilege with articulations based in the ideology of meritocracy. Some teacher candidates articulated that acknowledged systemic structured inequality in which they placed themselves as beneficiaries. However, the majority of the participants in this study articulated a hybrid of these where privileged social positions are acknowledged, but then described as an inheritance from their parents, or luck outside of personal control where students could remain unimplicated in the societal structures of privilege.

Conclusions and Implications

In order to meet the critical multicultural education curricular goals of confronting the systemic and structured aspects of privilege, teacher candidates must be exposed to new critical discourses and be taught to identify the discourses that they rely on for making meaning in their lives. Building on work that establishes the Discourse of Individualism as a typical response to critical multicultural education (DiAngelo and Sensoy, 2009; DiAngelo, 2010, 2018), this study provides additional nuanced understandings of the Discourse of Individualism.

Empirical evidence from this study extends our understanding of the Discourse of Individualism by documenting additional nuances in how students grapple with privilege. These include articulations of active resistance to privilege via an ideology of meritocracy, a passive acceptance of privilege via an ideology of luck, and a more critical stance acknowledging inequitable institutional structures via an emerging ideology of social justice.

Articulations of inheritance emerge as a passive response that is a sort of middle ground between active resistance to the realities of socially structured inequality and a full active acknowledgment of complicit participation in socially constructed inequality that typifies a critical social justice approach. The tendency to speak about passively acquiring privileges in terms of inheritances or luck suggest a strong inclination to hedge or qualify social privilege through positioning oneself into a passive recipient role. This passive stance allows one to deflect direct responsibility in the inequitable structures and forces that shape these inheritances. Yet, when teacher candidates employ the concept of inheritance, they often demonstrate indirect recognition of systemic inequality and other complexities.

We assert that recognizing student grappling through articulations of inheritance that emerges in our study is important because, in addition to representing the largest response from students, it has practical and theoretical implications for teacher educators. The ideology of inheritance or luck, though inadequate as an explanation for social inequity, allows for the reality of social position and structural inequity and opens the door for conversations of ways to understand and enact professional obligations to those who are “not lucky.” This could be a place of imagining for teacher candidates to engage with intellectually and emotionally challenging content as critical social justice ideologies are introduced. More empirical work can explore how entering into this messy middle ground can be a fruitful place for teacher educators to support student learning and facilitate further consideration of critical multicultural discourses that acknowledge privilege as being a part of systemically structured inequality and more critical ideologies.

Identifying a reliance on concepts of inheritance which passively positions students in inequality as one possible response to critical multicultural education curriculum contributes additional theoretical understanding of the Discourse of Individualism. This further theoretical consideration of the Discourse of Individualism will hopefully open and inform a conversation about how teacher educators can support teacher candidates in moving from individualistic understandings of privilege to more systemic ones.

Data Availability Statement

The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher. Please note that the raw data are destroyed after 5 years because of stipulations in the IRB to protect participant privacy.

Ethics Statement

The study was reviewed and approved by the Institutional Review Board of Brigham Young University. Written informed consent was obtained from all participants.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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