Due to rising veteran suicide rates, the veteran population has become a focus of practitioners, research scientists, and policymakers. Although researchers have studied the relationship between suicidality and the environment, more research is required to evaluate how suicidal behavior, suicidal ideation, and suicide risk are associated with a veteran's use of medical care services within the Veterans Health Administration (VHA). Therefore, this study focused on environmental variables (medical care usage and rurality), and their relationship with suicidal behavior (Manuscript 1), suicidal ideation (Manuscript 2), and suicide risk (Manuscript 3). The social ecological model was used to better understand the interaction between the environmental factors discussed and veteran suicidality. Use of primary care services was found to be significantly associated (negative association at all levels in comparison to the reference level of high use) with each dependent variable: suicidal behavior (p < .001, OR = .074 - .529), suicidal ideation (p < .001, OR = .170 - .490), and suicide risk (p < .001, OR = .154 - .656). Finally, rurality was found to be significantly associated with suicidal behavior and suicidal ideation. A positive association was found between suicidal behavior (p < .05, OR = 8.099) and suicidal ideation (p < .05, OR = 1.892) and urban residence (in comparison to the reference level of highly rural). This study can promote social change by providing insights on how environmental factors influence veterans' propensity to suicide and by leading VHA researchers into further exploring the impact of veterans' use of services on the suicidality of the population.

Intimate partner violence (IPV) among women poses a significant threat to maternal mortality during pregnancy in Nigeria with a prevalence rate of 14% in the southern region versus 43% in the northern region. Early and adequate prenatal care is essential for improving pregnancy outcomes and the reduction of the maternal mortality rate. Previous studies in several countries have demonstrated a unique barrier to healthcare access among women exposed to IPV. This study assessed the association between IPV during pregnancy and prenatal clinic attendance, using a cross-sectional quantitative study design guided by the social learning theory. The modified Conflict Tactile Scale module and the Adequacy of Prenatal Care Utilization index were used to assess 467 pregnant women attending prenatal care at two government hospitals in Abuja, Nigeria. Results showed a 55.2% IPV prevalence among studied pregnant women in Abuja. A significant relationship was not established between IPV and prenatal clinic visits and its early initiation. However, media exposure (p = .016) was positively associated with prenatal clinic visits, while parity (p < .001) and wealth index (p = .017) had significant associations with prenatal clinic initiation using a chi-square test of association analysis. Multiple logistic regression analysis further showed that pregnant women who were exposed to IPV were less likely to have inadequate prenatal visits; however, this was not statistically significant (OR = 0.795, Cl = 0.491-1.287, p = .351). Women in the lower wealth index (OR = 2.297, Cl = 1.101-4.794, p = .027) and those with inadequate media exposure (OR = 1.999, Cl = 1.020-3.916, p = .043) were more likely to have inadequate prenatal clinic visits. The impact of the study on positive social change will guide discussions on the need for standardized IPV abuse screening and evaluation at all levels of healthcare entry for Abuja women.

Coping mechanisms of breast cancer is a public health problem among African females, particularly, the Sub-Saharan African female immigrants. The purpose of this qualitative study was to explore the coping mechanisms of the research group that could be used to develop and implement an intervention program to promote the quality of adaptation to improve the quality of life. The study achieved the objective by the use of 1-to-1 interviews of purposive samples of 2 and 12 using Roy Adaptation Model. Interviewed data were collected from females diagnosed with breast cancer, in treatment, and with remissions. The pilot study (n = 2) result was used to appraise the method of the primary study. The primary study sample (N = 12) data were thematically analyzed using a grounding approach. Summary of the primary copings identified in the study was crying, religion, family support, social support networks, problem-focused, emotion-focused, and relaxation techniques. The rest were positive reappraisal, health insurance/medical staff, and prevention. The findings could not be generalized to the general female immigrant population because of the sample size. However, the study has added to the knowledge and understanding of the coping mechanism of the study population. Coping mechanisms, detecting breast cancer early, and education, constitute the primary interventions that may bring significant social change in the study population.

Sickle cell disease (SCD) is a genetic health condition that has continued to increase globally. SCD is prevalent in developing countries like Nigeria with 20 to 30% of the population living with SCD. The aim of this study was to explore the effect of the socioeconomic and cultural factors that affect the quality of life (QOL) of individuals with SCD in Nigeria. The framework for the study is secondary prevention. Secondary prevention allows for opportunities to improve QOL amongst people living with SCD focusing on the health beliefs, and socioeconomic wellbeing. A phenomenological approach was used to collect in-depth data on the effect of socioeconomic and cultural factors from 30 randomly selected individuals living with SCD in Nigeria. Thematic content analysis of participant responses was the qualitative methodology used for this study. Study results indicated that among individuals living with SCD in Nigeria, socioeconomic and cultural factors of the disease contributed to diminishing QOL. Common themes included limited education and awareness, financial support, and cultural beliefs as impactful on an individual's capacity to manage their SCD, leading to diminished QOL. A potential positive social change of this study is to share study results and recommendations with public health officials to promote public health policy and practices that can encourage increased awareness, and treatment of SCD to stimulate a better QOL of individuals living with SCD.

Lyme disease is the most prevalent arthropod-borne (tick) disease in North America. The disease is more prevalent in some Eastern and Central states than in Western states. The general problem is that, in southern California especially in Los Angeles County, both patients and practitioners fail to recognize the disease, resulting in misdiagnosis and delayed treatment. Consequently, the patient may develop the long-term, chronic Lyme disease (CLD). The purpose of this phenomenological study was to explore the impact of CLD on the health-promoting behaviors of ethnically diverse young adults from similar educational and socioeconomic backgrounds based on their lived experiences. The geographical focus of this study was restricted to Los Angeles County, California, because researchers have demonstrated a general lack of awareness of CLD as well as a gap when it comes to representing CLD clients from diverse ethical and socio-economic groupings. Data were collected from face-to-face semistructured interviews of 9 participants, based on the health belief model constructs on an ethnically diverse group of young adults clinically diagnosed with CLD. Data were coded and explored for themes. Key results of the study include the existence of excellent health prior to CLD, marked declined in health status because of the disease not being recognized or properly treated, and the use of various modalities of treatment including conventional antibiotic treatment and complementary and alternative treatments to combat the disease. Social implications of this study include increased awareness of physicians and the community in the Los Angeles County of Lyme Disease as an emerging epidemic, development of preventive measures against this disease, and generation of rich data and propositions regarding CLD for further research.

Emergency departments (ED) are an integral component of the United States' health care system. The underlying factors related to ED use among Arizona's mentally ill are not fully understood and the patterns necessary to classify patients as frequent users have not been examined. The purpose of this study was to increase the understanding of frequent users and further examine the conditions by which they present to the ED. The theoretical foundation for this study was the fourth version of Andersen's behavioral model (1995) and this model's use to frame this study allowed for an objective analysis of ED use among Arizonans. The sample consisted of Arizona Department of Health Services-Department of Behavioral Services [AZDHS-DBS], ED discharge data, FY2013. The study addressed the gap in the literature using exploratory techniques and was guided by quantitative factor analysis. These multivariate techniques allowed for an analysis of the loading factors for each variable. The major findings from this study revealed a lack of generalizability based on a smaller than anticipated sample size; thus, halting further exploration within the sample for mental disorder, a key component to Research Question 1 and the overall study. Findings from Research Question 2 revealed the factors of race and payer as the best predictors of an ED visit. Study findings revealed ED visitors were most likely White females, 50 years of age or younger, and recipients of Medicaid. These study findings can inform clinical professionals within emergency medicine (EM) in the state of Arizona. This research has provided evidence that can be used by these professionals to promote positive social change and prompt additional primary research study efforts in healthcare utilization among Arizonans.

Alcohol consumption and cervical cancer caught in the early stages are preventive epidemics, though the incidence of cervical cancer has continued to rise in Los Angeles, California. The purpose of this quantitative cross-sectional study was to better understand the association between alcohol consumption and cervical cancer incidence using the theory of relationism. California Health Interview Survey (CHIS) data collected in 2005 was used to investigate alcohol consumption and cervical cancer incidence among women in Los Angeles, California. The CHIS 2005 surveyed 43,020 adults; of those surveyed, 441 participants reported alcohol consumption and cervical cancer out of 25,548 adult women. Chi-square tests of independent and logistic regression were used to determine the strength of association between alcohol consumption and cervical cancer among women in the CHIS dataset. Chi-square results indicate consuming alcoholic drinks 30 days before diagnoses was not a significant predictor of cervical cancer. The logistic regression results suggest the number of alcoholic drinks consume per day was a significant predictor of cervical cancer incidence (p = .000). A major limitation of this study was the small sample sizes. A larger sample size is recommended. Implementing and enforcing awareness program and behaviors modification polices regarding alcohol consumption specifically among women diagnosed with cervical cancer could facilitate the reduction or elimination of alcohol consumption among women alcohol consumer diagnosed with cervical cancer in Los Angeles, California.

A paucity of information exists on the benefits of using radiation therapy for treating women with early cervical cancer detection. The purpose of this cross-sectional study was to investigate the association between early versus late testing of Human papilloma virus (HPV), age, race, radiation therapy, and regions in United States, and survival rates among women diagnosed with early cervical cancer. The epidemiological triad of person, time, and space guided this study to explain the regional spread of cervical cancer, and the effect of early testing. Secondary data from Surveillance, Epidemiology, and End Results (SEER) were used (N= 520,153). Statistical analyses included descriptive statistics as well as binary and multiple logistic regression. According to multiple logistic regression tests early testing for HPV saved more women from cervical cancer death (Odds ratio = .917, CI = .896 - .939, P = .000), and women with radiation therapy had increase likelihood of dying (Odds ratio = 1.646, CI = 1.626 – 1.667, P = .000). Older Women had increased likelihood of dying when diagnosed with cervical cancer (Odds ratio = 1.043, CI = 1.042 – 1.044, P = .000).Whites had a reduced likelihood of dying when diagnosed with cervical cancer (Odds ratio = .735, CI = .722 - .748, P = .000) compared to non-Whites with increased likelihood of dying when diagnosed with cervical cancer (Odds ratio = 1.3605, CI = .722 - .748). Alaskans had a reduced likelihood of dying compared to women living in the Pacific Coast (Odds ratio = .714, CI = .598 -.853, P = .000). Increased awareness among women on radiation therapy for early detection of cervical cancer can improve survival and lead to positive social change.

Medication adherence amongst HIV/AIDS infected individuals can be challenging for many reasons. I examined whether there was an association between mode of HIV transmission, such as sexual intercourse, mother to child, or IV drug use, and medication adherence among HIV+ individuals 18 years and older living in New York City. The theoretical base for this study was the Social Ecological Systems Theory. Logistic regression analyses were conducted on field data obtained from the New York State Medicaid Agency from 2015. Results indicated that transmission mode, age, race, and poverty level all have statistically significant associations with the dependent variable of medication adherence. The individuals most and least likely to adhere to ART were MSM and perinatal groups, respectively. Increased age predicted increased medication adherence rates, while increased poverty level predicted decreased medication adherence rates. Caucasian and Asian/Pacific Islander races had the highest rates of medication adherence, while Hispanics had lowest rates of adherence. Alternatively, there were no statistically significant relationships between New York City borough of residence or gender on an individual's medication adherence rate. This research contributed to filling a literature gap in the HIV field since no published literature to date had examined the association between transmission mode and ART medication adherence. This study's findings can be used to lead to a positive social change by allowing those in the HIV and public health fields to identify the varying needs of populations based on transmission mode, which could help individuals achieve long lasting medication adherence, and which in turn, could result in longer lives for those with HIV/AIDS.

Young children's early language development is strongly related to their school performance, and slow language growth may predict later academic problems. The link between the language quality and amount of speech that children hear and their language development is well documented; however, the factors that impact variability in linguistic input are not well understood. The purpose of this quantitative study was to assess the association between childcare settings and childcare provider education level and toddlers' language environment. The study sample consisted of 29 Bulgarian children. The study used a new technology called Language Environment Analysis, which is the preferred method to assess children's language environment. Vygotsky's theory guided this effort to understand the impact of child caregiver settings and caregiver educational background on the child language environment. Data analysis involved descriptive statistics, percentage agreement, analysis of covariance, and linear logistic regressions. Results showed a significant correlation between the childcare setting and the mean number of adult words spoken around the child, child vocalizations, and conversation turns. However, the educational level of the childcare providers did not have a significant effect on the adult words pronounced by the childcare providers, the number of child vocalizations, or conversational turns. Positive social change may result from improvements in caregivers' practices aimed to advance adult-child daily interaction. Future studies could provide important information to policy makers to improve childcare practices to enhance caregivers' information concerning factors that could greatly influence language and overall child development in countries outside the United States.