Abstract The use of smart phones among young people in Southwestern Nigeria has grown since the early 1990'€™s while traditional healthcare access had continued to deteriorate. HIV care centers have been concentrated in large cities, but earlier studies had shown higher prevalence of HIV in rural areas that constituted a larger portion of the population. However, existing studies had not adequately explored the use of mobile phones to supplement traditional healthcare access. The purpose of this study was to assess the feasibility of telehealth for healthcare access among individuals aged 17-34 with positive HIV status and those at high risk for the disease in Southwestern Nigeria. Using the health belief model (HBM) as theoretical foundation, a sample (n = 2,228) was selected from data collected from six Nigerian southwestern states. Out of 2,228, 910 (40.8%) were HIV positive while 1,318 (59.2%) were HIV-negative but at high risk. 1,459 (65.5%) used mobile phones for their HIV status while 769 (34.5%) did not. A chi-square test of association showed that there was a statistically significant association between mobile phone use and HIV status, with X2(1) = 5.173, p = .023. Spearman'€™s correlation analysis between mobile phone use and weekly HIV counseling sessions which depicted the efforts made to understand, prevent, or manage disease was significant (p < .0005). Findings from this study might present a stronger case for the use of mobile phones to supplement reliance on face-to-face counseling and other treatment in HIV prevalence in Southwestern Nigeria. The implication for social change can be a wider healthcare coverage for people living with HIV and those at risk for it if telehealth can be applied to complement existing traditional healthcare coverage which had been grossly inadequate. Such positive social changes would reduce HIV prevalence.

Despite the increasing interest in preterm birth risk associated with maternal exposure to the current level of fine particulate matter (PM2.5) in Korea, there is little information on differences in PM2.5 exposure and its impact on preterm birth. This study was designed to examine the effects of Korea's air quality on preterm birth, including the possibility of moderation and mediation. This work was also designed to investigate manipulable factors for PM2.5 exposure. The theoretical framework of this quantitative and observational study included the social ecological theory and systems theory. The conceptual framework of this partially ecologic and retrospective cohort study included the social ecological model and Rothman's sufficient component cause model. Data of 19,371 Korean women who gave birth in 2015 were analyzed by logistic regression and multiple regression, including testing for moderation and mediation. An increase in PM2.5 exposure by 10 μg/m3 in the 3rd week before childbirth increased the likelihood of preterm birth by 6.52 times. Moderation and mediation by PM2.5 did not exist between sociodemographic factors and gestational age but existed between socioeconomic and energy policy factors and gestational age. The most influential factor for PM2.5 exposure was unemployment rate at the organizational level. These results show the need for socioeconomic interventions to reduce PM2.5 exposure more effectively. These �ndings indicate that prenatal care should be addressed with a socioeconomic- and energy-policy-sensitive approach to lower preterm birth due to severe air pollution in Korea. This study has the potential to change people's perceptions of threats from PM2.5 exposure, which could lead to behavior changes.

Pregnancy outcomes have improved tremendously in developed countries. Notwithstanding, it is still a huge challenge in developing countries, especially Sub-Saharan Africa. In 2015 in Nigeria, about 145 women died daily from pregnancy-related causes. Similarly, nearly 2,300 children under 5 years were lost in the same year. Nigeria consistently underperformed in some of the critical pregnancy indicators such as maternal and neonatal mortality, second worst only to India in the world. Studies on poor pregnancy outcomes are scarce in Nigeria. The purpose of this quantitative, retrospective cross-sectional study was to use local evidence to ascertain the risk factors that predict poor pregnancy outcomes for women of childbearing age (15-49 years old) in Nigeria. The theoretical framework for this study was the social cognitive theory. Secondary data from 400 pregnant women from Island Maternity Hospital, Nigeria, was used for this study. Five central research questions were analyzed through univariate and multiple logistic regressions. The results indicated moderate to strong statistically significant associations between outcomes of last pregnancy, gestational age at delivery, mode of delivery, and the timing of antenatal care booking with maternal mortality, neonatal mortality, and low birth weight, even after controlling for other covariates. Findings from this study may foster positive social change by further enhancing the understanding of poor pregnancy outcomes, especially in Nigeria. It will help public health practitioners, policymakers, community leaders and other stakeholders to design strategies and interventions that will take advantage of cultural and religious norms and educational status of women of childbearing age in promoting reproductive health in Nigeria.

Global rate of participation in clinical trials is especially low among African Americans in the United States due to social factors identified by research, which adversely impact this group's willingness to participate in clinical trials. The purpose of this cross-sectional quantitative study was to evaluate the role of social influence in the decision-making patterns of African Americans as it relates to clinical trial participation. The theory of planned behavior was used as the theoretical framework to understand an individual's interaction with social factors and how it affects their willingness to participate in clinical trials. The participants in the study were 115 African Americans residing in a greater metropolitan area of Ohio. Data were collected using 1-time questionnaire administered by paper instrument. Regression and correlation analyses were conducted for all 115 collected survey responses. Results of the analyses were statistically significant in proving that social influence is a good predictor of willingness to participate in clinical trials where the research involves minimal risk to the participants (p = 0.047). The results also showed that attitudes and beliefs about clinical trials are good predictors of willingness to participate in clinical trials among African Americans (p = 0.000). The results of this study offer new insight for the development of patient recruitment initiatives within the African American community in the United States and create a path to the development of viable and sustainable intervention.

Current interventional pharmaceutical therapies targeted for depression are not adequate to achieve sufficient remission following treatment. Researchers explored inflammatory biomarkers as a way of understanding why treatment for depression is effective for some and not others. The purpose of this secondary data analysis study was to determine if there was a relationship between inflammatory biomarkers and treatment efficacy in persons diagnosed with depression who have demonstrated a previous lack of remission. Using the immune-cytokine paradigm of depression (POD) allowed depression to be viewed as multifaceted and a potential signal of chronic immune system activation. This secondary data analysis included findings from a clinical trial called, 'A Study of the Efficacy and Safety of CP-601,927 Augmentation of Antidepressant Therapy in Major Depression' ANOVA and linear regression were used to analyze 1 dependent variable: depression remission. The 5 independent variables included adiponectin C-Reactive Protein (hs-CRP), leptin, interleukin 1-β (IL1-β), interleukin 6 (IL6), and tumor necrosis factor-α (TNFα). The 3 mediating variables included age, race, and gender. According to the results of the study, IL6 significantly correlated with and predicted remission outcome, as measured by change in MADRS total score from baseline. None of the other biomarkers significantly correlated with remission outcome. Better remission outcomes for patients suffering from depression would lead to positive social change and improved quality of life.

Childhood obesity is disproportionately higher among children from Hispanic backgrounds. Ethnicity is a social and cultural construct and does not capture true ancestral heterogeneity. Hispanic Americans have a wide variety of genetic admixture proportions of European (EUR), Native American (AMR), and African (AFR) ancestry. The objective of this cross-sectional study was to assess the contribution of ancestral genetic composition to body mass index (BMI), and to evaluate the relationship of obesity risk factors to BMI among 154 2-year-old Hispanic American children. The theory of Evolutionary Developmental Biology was utilized to investigate the relationship between children's growth process and ancestral background. Their genetic admixture was estimated using the ancestry and kinship toolkit and BMI was calculated and evaluated using the Center for Disease Control and Prevention (CDC) BMI charts. Three simple linear regressions assessed the association between standard EUR, AMR, and AFR to BMI. A backward, stepwise, linear regression was performed to evaluate the influence of sex, birth weight, and juice consumption frequency as well as mother's age, BMI, education, and region of birth on the child's BMI. No associations were found between BMI and genetic admixture proportion, and the regression model revealed that only birth weight was positively associated with BMI; higher maternal education was negatively associated with BMI. Contrary to adulthood obesity studies, EUR, AMR, and AFR proportions were not associated with BMI at age 2, which suggests that the influence of genetic composition on BMI may vary by age. This information has the potential to create positive social change by developing preventions that target modifiable risk factors, such as maternal education.

Necrotizing fasciitis infections have high mortality rates especially when treatment is delayed. Despite the abundance of research in many areas of necrotizing fasciitis infection, there are limited and conflicting studies focusing on gender-related outcomes for those diagnosed and died with necrotizing fasciitis infection. The purpose of this study was to determine the association that gender plays on survival time of patients who have been diagnosed with necrotizing fasciitis using a cross-sectional study design. Succeeding the conceptual design of the life course model, the research question tested whether there was a significant difference in survival time between the genders while in the hospital. Additionally, the research questions tested whether gender-related survival was modified by sociodemographic factors or mediated by risk factors for survival of necrotizing fasciitis. Kaplan-Meir method was used to examine survival times between genders. The Cox Proportional Hazards model was used to examine effect modification and mediation. Secondary data from the State Inpatient Databases (SID) and the National Inpatient Sample (NIS) was obtained and used. The result illustrated that there is no difference in survival by gender. However, among men, survival is modified by age. Additionally, diabetes diagnosis tends to affect the survival time for both males and females. The research contributed to social change by increasing the knowledge and understanding of necrotizing fasciitis infections and mortality factors. The results of this study aid in the treatment of necrotizing fasciitis infections for health professionals and inform the health community with a better comprehension of the infection.

Walden University College of Health Sciences This is to certify that the doctoral dissertation by Sando Adetunji has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Chinaro Kennedy, Committee Chairperson, Public Health Faculty Dr. Adebowale Awosika-Olumo, Committee Member, Public Health Faculty Dr. James Rohrer, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2018 Female genital mutilation has been a public health issue in many countries. As a result, researchers across the globe have conducted numerous studies showing that the practice is very harmful toward women's health and safety. Unfortunately, in the northwestern region of Liberia, there have been no recent empirical studies conducted regarding the danger of female genital mutilation on women's reproductive health and safety. The socio-ecological model can guide this study which outlines how environmental variables can impact the experiences of FGM. In this study, a quantitative approach was used to explore whether there were environmental factors such as parental educational attainment, parental wealth (socioeconomic), and location that affect the prevalence of female genital mutilation among girls and women in the northwestern region of Liberia. Secondary data from the 2013 Liberia Demographic Health Survey was used to analyze the multiple determinants that influenced parents and families to join the Sande Bush Society which facilitated female genital mutilation practices in the northwestern region of Liberia. The methods of analysis included chi-square for association and multiple logistic regression. The findings showed that parental wealth and parental education predicted whether females were initiated into the Sande Bush Society, resulting in female genital mutilation practices. There were no significant differences in whether parental region (suburban or rural) predicts the likelihood of initiation into the Sande Bush Society. This study provides additional information to stakeholders, policy makers, and social advocacy groups for developing and implementing laws relevant to female genital mutilation.

Racial and ethnic disparities related to lung cancer treatments and outcomes are not fully understood but may be due to individual or institutional factors. Following established national cancer treatment guidelines may improve patients' quality of life, outcome to treatment, and facilitate the eradication of lung cancer. There are limited data on the real-world treatment of racial/ethnic groups with non-small cell lung cancer (NSCLC) according to clinical practice guidelines, therefore this population-based cohort study examined the receipt of first line treatment for advanced or metastatic NSCLC according to the National Comprehensive Cancer Network (NCCN) practice guidelines. The Social Cognitive Theory served as the framework as it focuses on individual cognitive influences and self-efficacy. A retrospective analysis of NSCLC patients (> 65 years) was conducted using the linked Surveillance, Epidemiology, and End Results (SEER) data linked with Medicare. Logistic regression models were fit to evaluate the relationships between patient race/ethnicity and the receipt of treatment according to the guidelines within various clinical strata (e.g., histology type, stage of disease). There were no significant differences between Caucasians and African Americans in terms of treatment consistent with guidelines after controlling for other factors. One limitation to this study was the administrative nature of the Medicare database and the limited number of Hispanic patients. This research may contribute to positive social change by supporting a deeper understanding of factors that might influence NSCLC treatment selection. Public health initiatives to promote compliance with treatment guidelines can lead to better outcomes following medical treatments, especially for NSCLC.

Primary efficacy endpoints for interventional products targeting travelers’ diarrhea (TD) prevention have been predominately based on stool frequency. However, reliance on stool-based endpoints alone may obscure potentially meaningful differences in illness profiles. A single, standardized scoring system optimized for use in adult travelers is needed to accurately measure TD severity and enable more robust estimates of treatment or intervention effectiveness. The purpose of this quantitative secondary data analysis was to describe the variability in TD signs and symptoms across traditional severity metrics such as stool output, identify which symptoms were significantly associated with a negative impact on activity, and determine whether a TD scoring system that considers other symptomology could be optimized for use in future studies using the IRT and CTT frameworks. Data were obtained from two interventional studies: TrEAT TD, a multi-site TD treatment trial, and OEV-118—a placebo-controlled ETEC vaccine efficacy trial in travelers. Correlation, regression and multiple correspondence analyses were performed across multiple signs and symptoms to assess impact on activity and a TD severity score was established. Conclusions were (a) the new TD score significantly benefits the estimation of impact on activity over any individual sign or symptom, and (b) there was a benefit to reduction in overall TD disease severity when applied to a previously conducted vaccine efficacy trial. The use of a single optimized scoring system may better capture illness severity than commonly utilized metrics and moves the field towards current recommendations for TD management. Additionally, the use of the TD severity score may be an improved efficacy metric than stool frequency for future vaccine trials.