Colorectal cancer (CRC) represents a public health issue that may be prevented using the screening strategy. Black people in Africa represent the population with the lowest risk for CRC. However, in Africa as well as the United States, Black people participate the least in CRC screening. Little is known about the perceptions of CRC and CRC screening in the Black, male, African immigrants residing in Baltimore, Maryland. The low participation in CRC screening in this population was the problem addressed by this dissertation. The purpose of this qualitative study was to explore and describe Black, male, African immigrants’ experience with CRC screening in Baltimore. Two research questions focused on understanding the meaning of CRC and describing the experience with CRC screening in this population. The health belief model served as a conceptual framework. The descriptive phenomenological approach was used using semistructured interviews with 8 participants. Data collected from eligible participants in the population of interest were transcribed and analyzed thematically using Colaizzi’s 7-step strategy. Three key findings from this study included the limited knowledge of CRC, the limited perceived barriers to CRC screening, and the high level of trust in health care providers of the participants. Fear of results and negative cultural beliefs about CRC screening were no barriers to the screening. The recommendations for future studies include the consideration of the female population and the inclusion of participants resident in Baltimore for fewer than 6 months. The implications for a positive social change include the improvement of CRC awareness and physician-patient conversations, as well as the development of policies that can facilitate access to health care.

OBJECTIVE: This study investigated the relationship between methamphetamine use and periodontitis among US adults using data from the National Health and Nutritional Examination Survey (NHANES) 2009-2014. METHODS: Data from 7,830 participants age 30 and above who participated in the 2009-2014 National Health and Nutritional Examination Survey (NHANES) were analyzed. Inclusion criteria were undergoing a periodontal examination, and providing answers about drug use (methamphetamine, other drugs (cocaine, heroin), or non-user) and other demographic and risk factor covariates. The outcome was moderate/severe periodontitis vs. none/mild periodontitis based on the CDC/AAP periodontal disease case definition. Chi-square statistics were used to assess bivariate associations of all variables of interest with the exposure (drug use) and with the outcome (periodontitis). Odds ratios (OR) of moderate or severe periodontitis and 95% confidence intervals (CI) were estimated with multivariable logistic regression. Survey procedures and weights were applied. RESULTS: There were higher odds (1.54 ,95%CI=1.05-2.24) of moderate or severe periodontitis among methamphetamine users compared to non-users, whereas other drug users had odds ratio (OR=0.8, 95% CI=0.66-1.16) as compared to non-users. Also, older age, being male, belonging to an ethnic group other than non-Hispanic whites, current and former smoking, having less than a college education, being a nondrinker (relative to moderate drinking), and having fewer than 20 teeth were associated with increased odds of periodontal disease. CONCLUSION: This study suggested a statistically significant positive relationship between periodontal disease and methamphetamine use among US adults. Further studies are needed to investigate the effects of duration and frequency of methamphetamine use on periodontal disease in adults.

Early detection and intervention of breast, cervical, and colorectal cancer improve cancer survival rates. However, ethnic and minority communities including Vietnamese Americans often delay their cancer screening practices. This study will discuss how the Vietnamese Americans' culture and religion influence health beliefs and health practices, to understand the barriers to health care access in the United States. This study reviewed the literature to present the current barriers to screening for breast, cervical and colorectal cancer. Among the studies evaluated, the strongest predictors of cancer screening among Vietnamese Americans included knowledge of cancer and cancer screening, cultural attitudes, financial and structural challenges. These studies highlight the need for better cancer screening promotion and awareness within ethnic and minority populations, while they also call for improvements in healthcare policies, organizations of institutions, and social conditions in neighborhoods and cities.

Inadequate nutrition during infancy and early childhood seriously interferes with brain development, leading to neurological and behavioral disorders. Such effects are detrimental to children under 2 years of age. The purpose of this cross-sectional study was to better understand the quality of nutrition services offered to children and pregnant women in Ntungamo District in southwestern Uganda. The cross-sectional design facilitated comparison of different variables, using a research-question-driven approach, assessing existing secondary data from SPRING Uganda database. Stepwise, backward multiple logistic regression was used to identify the independent variables that influenced the provision of quality nutrition assessment, counseling, and support (NACS) services to clients. Only the independent variables with p < 0.05 were retained in the final model. Odds ratios with 95% confidence intervals were used to estimate the strength of association between the independent variables which are: 1) training of health workers with different nutrition packages, 2) availability of nutrition assessment equipment at varied service delivery points, 3) availability of nutrition supplies for preventing and treating acute malnutrition, 4) availability of nutrition treatment protocols and IEC materials functionality of quality improvement teams, and 5) supervision and motivation of health workers. The dependent variables were indicated by percentage of children and pregnant women who were provided with appropriate NACS in outpatient departments, young child clinics, antenatal clinics, postnatal clinics and antiretroviral therapy (ART) departments in the past 3 months. Statistical analysis was performed with IBM SPSS 25.0. All associations with p < 0.05 were considered statistically significant. All surveyed facilities offer maternal health services, a positive indication that a greater percentage of the facilities in western Uganda realize the importance of nutrition assessment of pregnant mothers and children. Of the sampled health facilities supported by SPRING Uganda, 56.3% had functional nutrition assessment equipment like mid-upper arm circumferences (MUAC) tapes and weighing scales. This study showed that different nutritional services offered to pregnant and lactating mothers and children could either positively or negatively affect the quality of nutrition in Ntungamo District.

Opioid overdoses and overdose deaths have increased significantly throughout the United States. Naloxone distribution has become a harm reduction strategy that has proven effective in reducing opioid overdoses in urban areas through drug treatment centers and needle exchange programs. However, limited research is available on the efficacy and feasibility of these programs in rural locations and other nontraditional settings. Guided by harm reduction theory, the purpose of this qualitative phenomenological study was to address this gap by exploring the feasibility of implementing a take home naloxone program in rural jails. Semistructured interviews were conducted with 6 jail administrators in rural upstate New York to determine their knowledge, attitudes, perceptions, and perceived barriers of a take home naloxone program. Data analysis of the participant interviews concluded 6 themes. The first theme concluded that participants believe naloxone acts as a safety net for drug users. The second theme identified that jail personnel are knowledgeable of opioid overdose and naloxone administration. Theme three confirmed that jail personnel would likely not support a naloxone program. Theme four concluded that naloxone training within the jail would likely be appreciated by inmates. The fifth theme addressed that multiple training barriers exist. In conclusion theme six affirmed that harm reduction programs are not favored by jail administrators. The implications for positive social change include increased knowledge of barriers that surround nonmedical and nontraditional community dispensing models for Naloxone and improved community awareness of a growing public health concern and increases collaboration towards a public health and safety approach to substance use and abuse.

Children between the ages of 6-17 years suffering from childhood attention deficit hyperactivity disorder (ADHD) need constant attention as they are more likely to be accident proned, hospitalized, disruptive, and educationally challenged. The constant attention required for children with ADHD may impose stress on mothers and primary caregivers, yet this stress has not been sufficiently studied. The objective of this study was to fill a gap in literature by studying the stress experienced by African immigrant mothers living in the United States who are living with and caring for a child with ADHD, and then comparing the level of stress reported by African immigrant mothers and African American mothers caring for children with and without ADHD. The study had a quantitative, case-control design, and used the parental stress index-short form (PSI-SF) and a 9-item demographic questionnaire as the survey instruments. One hundred twenty-five African immigrant and African American mothers participated in the study. Data collected from the mothers were analyzed for descriptive. ANOVA and Regression analysis were performed using SPSS version 21. The results showed that African immigrant mothers caring for a child with ADHD had significantly higher stress levels than those not caring for a child with ADHD. African American mothers also caring for a child with ADHD had significantly higher stress than African American mothers not caring for a child with ADHD. African immigrant mothers caring for a child with ADHD had significantly lower stress than African American mothers caring for a child with ADHD. These findings may initiate interventions that would help mothers provide quality care of life for themselves and for their children suffering form ADHD.

The stressful nature of deploying to a disaster makes it necessary for a good emergency manager to be capable of coping in high-pressure situations. When intensified by extended work hours, deployments can often lead to burnout, job strain, and emotional stress, which can have a significant impact on an employee's well-being. The purpose of this study was to examine the effects of burnout and perceived stress amongst emergency managers working for FEMA and to determine if social support was an effective intervention. The theoretical foundation used for this study was the job demands-resources theory, which aided in understanding, explaining, and predicting the well-being of employees, job performance, and organizational outcomes. The key research questions included to what extent do psychological job demands predict burnout, to what extent does the perception of stress lead to feeling burnout, and to what extent does peer support affect burnout. A quantitative correlational design utilizing secondary data from the Work, Family and Health Network was performed (N = 4,776). Results from linear regression found a relationship between psychological job demands and feeling burned out as well as a relationship between perceived stress and feeling burned out, as experienced by emergency managers. The model did not support a significant relationship between peer support and burnout. The social change implications include advancing the understanding of the stressful nature of deployments and stress from the psychological demands of the job that often leads to burnout. This study can be a resource to create and implement training programs for burnout prevention, and as a tool illustrating how to care for and support colleagues while also assisting disaster survivors.

The lack of knowledge of pharmacogenetic testing for cardiovascular disease (CVD), coupled with their increased risk for CVD, may impair nurses' cognitions and attitudes toward pharmacogenetic testing for CVD. The purpose of this quantitative cross-sectional correlational study, conducted with 230 RNs without CVD who worked in acute-care settings in Georgia, was to determine if their years of education, years of experience, and gender significantly influenced their perceived risk for CVD (Questions 1-3) and their perceived knowledge of pharmacogenetic testing for CVD (Questions 4-6), and if their perceived risk for CVD significantly influenced their acceptance of pharmacogenetic testing for CVD (Question 7). Various regression analyses (hierarchical multiple linear regression, multiple linear regression, hierarchical, linear regression) were conducted for hypothesis testing. Results showed that: (a) gender significantly predicted perceived risk for CVD, in that male nurses perceived themselves to be more at risk for CVD than did female nurses; (b) years of education was a significant predictor of knowledge of pharmacogenetic testing for CVD, in that as nurses' education level increased, so did their knowledge; and (c) knowledge of pharmacogenetic testing for CVD, but not perceived risk for CVD, significantly predicted acceptance of pharmacogenetic testing for CVD. This study may act as a catalyst to promote empirical work and inform practice in nurses' CVD health and their knowledge and acceptance of pharmacogenetic testing for CVD.

The purpose of this phenomenological qualitative study was to examine the etiology of water quality perceptions and beverage preferences of Black children and adolescents, which addressed a current gap in the literature on this topic. This study was guided by Festinger's social comparison theory, which supports the notion that children and adolescents' perceptions and preferences are influenced by their social network and those with whom they have a close association. In this study, children and adolescents' water quality perceptions were examined as well as the development and factors affecting those perceptions. Whether social factors such as peer or parental influence have an impact on children and adolescents' beverage consumption were also investigated. The study participants (n = 20) were recruited from two cities in a Midwestern state for semi-structured interviews from which information was coded into themes. Participants who met the inclusion criteria were Black youths between the ages of 9 to 18 years. The data were analyzed using latent content analysis with open and axial coding.The key findings in this study indicated that Black youths had negative perceptions of tap water quality and positive perceptions of bottled water, and stronger preferences for sugar-sweetened beverages than for water. These perceptions and preferences emanated from their parents and were also influenced by their peers, tastes, and the social environment. This study's implications suggest the need for improved health literacy through programs that educate participants in making informed decisions to impact the quality of health; this will also increase the overall health of society in terms of productivity and economic growth.

The custom of female genital mutilation/cutting (FGM/C) is a traditional practice inimical to women's health with profound implications. There is a gap in the literature on the lived experiences of women who have undergone FGM/C and their statuses within their communities. Guided by the social cognitive theory and the ecological model, this qualitative study aimed at explicating the attitudes and perceptions of women in the northwest region of Nigeria towards the practice of FGM/C, to illuminate how the women view themselves in their society and the inspiration for the continued practice of FGM/C. Interview and observation data were gathered from 10 women, ages 18 to 59 who had undergone FGM/C. Participants were voluntarily recruited using purposeful snowball sampling techniques. Data were analyzed through inductive coding techniques to extract and compare recurrent themes and patterns. Four major themes emerged: (a) traditional beliefs; (b) pain, happy, and approval; (c) pain, distress, and disapproval; and (e) ignorance of the law. Results indicated that ethnocultural beliefs, religion, and customs had a strong influence on the decision to undergo FGM/C. Women who viewed themselves as heroes of the practice strongly supported the continuation of FGM/C. The women who viewed themselves as victims of FGM/C disapproved the practice as an instrument to instill fear and control. The potential for social change could improve the knowledge of public health professionals, international organizations, federal, state, and local governments to influence policies on decreasing FGM/C without undermining the culture of communities regardless of any personal belief that sees FGM/C as detrimental to women.