Obesity is a significant global issue, and its incidence has increased over time. A substantial percentage of the U.S. population suffers from this disease with a relatively high prevalence seen in individuals from the Caribbean. The purpose of this phenomenological study was to explore Caribbean women's perception of how migration to South Florida may have impacted the onset of obesity in this population. The social ecological model provided the framework for the study. Data were collected from 1-on-1 interviews held with 12 female participants between the ages of 18 and 35, who previously resided in the Caribbean at a healthy weight but became overweight after migration to the United States. The information collected were analyzed using manual coding to identify 5 themes: consciousness of weight gain, challenges associated with weight gain, factors causing weight gain, attitudes toward weight gain, and efforts aimed at weight loss. Participants reported they felt that migration adversely affected their health by causing weight gain which eventually developed into obesity, caused by a modification to their lifestyle as well as an overall change in attitude towards weight gain. The social change implications of these findings are that they may be used to raise awareness of the risks of obesity among Caribbean immigrant women and to develop interventions to address the issue. Such interventions may result in increased well-being, healthier lifestyles, and prevention of obesity associated morbidity and mortality among this population.

Prescription opioid abuse in the United States is an alarming health issue. In 2015, approximately 2 million people abused prescription opioids, and 12 million individuals misused their prescription opioid pain relievers. The percentage of individuals who died as a result of opiate abuse increased from 22% in 2013 to 76% in 2014. The purpose of this project was to evaluate the influence of an inner-city drug treatment (DTBF) program on opioid users' behavior. The practice question addressed whether knowledge of signs and symptoms of opioid withdrawal obtained from the DTBF program resulted in a significant behavioral change in opioid use in 45 adults ages 18 to 25. The Centers for Disease Control and Prevention framework for program evaluation was used to guide the study. Data were collected using a pretest and posttest with the Clinical Opiate Withdrawal Scale (COWS) over a 6-month period. Results of t-test analysis indicated a significant change in drug use (p = .000). Recommendations to clinic administrators included encouraging all staff to use the COWS in screening individuals and observing them at each clinic visit. The implication of this study for social change is that findings may be used to reduce drug abuse and misuse among prescription opioid users.

The southwest and northwest regions of Cameroon have experienced high rates of intimate partner violence (IPV). Limited information is available about IPV victims' experiences with social support systems. This phenomenological study was aimed at investigating IPV victims' lived experiences with social support systems in Cameroon. Some of these systems are the judicial system, police officers, hospitals and clinics, and domestic violence agencies. The Health Belief Model (HBM) and the Transtheoretical Model of Change (TTM) were used to understand how 8 self-identified victims of IPV were able to discuss their lived experiences with social support systems. The research questions addressed women's experiences with social support systems as victims of intimate partner violence. The study also addressed participants' willingness to use social support systems again if the systems were made available to them. Data were gathered through face-to-face interviews using a purposeful-criterion sample that discussed the themes developed after the interview. The participants were selected with the help of 2 local domestic violence organizations based in the northwest and southwest regions of Cameroon. Study findings, which were generated via inductive analyses, indicated that victims sought the help of social support systems at least 3 times in hopes of changing their situation but were not satisfied with these systems. The study conveys social change by encouraging the need to educate social support systems in implementing and developing culturally-sensitive programs to eradicate IPV in Cameroon.

Obesity or being overweight is a prevalent health concern around the world. Despite the growing problem in developing countries such as Kenya, there is scant literature available on obesity or being overweight among women in rural Kenya. This research study provides information necessary for bridging the gap in understanding the perceptions, beliefs, and knowledge of obesity among women in rural Kenya. This study used the social cognitive theory (SCT) framework to assist in understanding the impact of obesity or being overweight among women living in rural Kenya. Participants were women aged 20 to 45 recruited from a local church in rural Subukia. Using a phenomenological inquiry, in-depth interviews were conducted. Data obtained were analyzed by open coding. Themes that emerged from data analysis showed that less than half of the study participants had an appropriate knowledge of obesity. Participants desired to have big round bodies, as it was perceived as desirable and as being healthy. However, this perception put these women at increased risk of obesity and associated health risks. Implications for positive social change include the use of study findings by policy makers to develop obesity prevention programs. Such programs may promote obesity awareness and obesity prevention strategies. This promotion may include providing education on topics such as healthy nutrition and the importance of physical activity. Policy makers may develop obesity prevention programs aimed at not only educating, but also empowering rural communities to practice healthy lifestyles based on their cultural and social norms. Such empowerment may encourage the adoption of obesity reducing lifestyles and positive behavior change.

Numerous studies have shown a rising HIV/AIDS epidemic among U.S. Hispanics/Latinos. Risky sexual behavior, alcohol, drug abuse, and sociodemographics contribute to Hispanics/Latinos' elevated risk for contracting HIV and other STDs. There is a need for additional research to understand the combination of factors associated with HIV and other STD infection among Hispanic/Latino youth. Based on social cognitive theory, this study examined the influences of peer pressure and relationship knowledge on risky sexual behavior among Hispanic/Latino young adults as measured by the Peer Pressure Inventory (PPI), the Teenage Research Unlimited Survey (TRU), and the Youth Risk Behavior Survey (YRBS). A group of 18-to-24 year olds (n = 173) from the 6 wards of Harris County, Houston, Texas completed the PPI, TRU and YRBS via paper questionnaires. Logistic regression determined a marginally significant association between relationship knowledge and number of lifetime sex partners. The remaining logistic regressions indicated no significant relationships between the variables of peer pressure, relationship knowledge, and risky sexual behavior. Descriptive statistics revealed that a large proportion of participants were engaging in several risky behaviors, including sex without condoms, sex while using alcohol or drugs, and sex with multiple partners. The results of this study also confirmed that Hispanics/Latinos aged 18-24 years are at risk for HIV and other STDs. Implications for positive social change include evidence to inform peer- and community-driven prevention programs targeting Hispanic/Latino young adults living and working in Harris County, Houston, Texas as a means to reduce transmission of STDs and HIV/AIDS in the Hispanic population.

There is a gap in infertility research regarding resource availability within rural communities, yet existing research declares infertility a public health concern. This qualitative study was grounded in the Heggerian phenomenological framework by way of assessing participants' perceptions of and experiences with infertility resources in a rural community. The purpose was to analyze the meaning of those experiences within their world. To accomplish this, Antonovsky's salutogenic theory was applied to investigate the strengths and weaknesses of infertility resources including the availability of resources, participant understanding of, and participants' experiences. Purposive sampling was used and in-depth interviews were conducted with 12 women, ages 24 to 39, who reside within rural communities. Interviews consisted of 60 questions that were designed to examine 13 research questions. Data were analyzed following Ritchie and Spencer's framework, requiring documentation and data classification, through 3 phases: open coding, focused coding, and axial coding. Emerging themes included a need for more resources on infertility, assistance with locating infertility resources, and an association between insurance coverage and use of infertility treatments. Findings from this study indicated a need for additional resources and knowledge regarding infertility in rural areas, also confirming a need for additional research on the topic. Social change implications for this research include developing resources for consumers and health care providers as well as improved provider knowledge. With increased knowledge and resources, these individuals may be able to achieve their goals and cope with the challenges of understanding and dealing with infertility.

Twenty million people in the United States have some form of thyroid disease. In 2014, there were 62,980 new cases of thyroid cancer and 1,890 deaths. Water source is a known risk factor for thyroid disease. Pollutants that are known to alter thyroid function can find their way into water sources. The effect of various water sources on thyroid- related mortality has not been determined in the state of Georgia. The purpose of this correlational study was to investigate whether invasive thyroid disease mortality differs between urban participants who drank municipal water and rural participants who drank untreated water in Southwest Georgia. Using the ecologic systems theory, secondary data from the Georgia Department of Public Health and the Department of Environmental Services were analyzed for 179 cases of invasive thyroid disease mortality and corresponding water source. According to the Wilcoxon-Rank sum test, there was no statistically significant difference in invasive thyroid disease mortality between individuals who consumed municipal water and individuals who consumed untreated well water. However, a disproportionate number of cases came from Dougherty County, particularly within rural areas and among women. The positive social change implication of this study was to discover an area of disparity for thyroid disease mortality in the state of Georgia. Larger studies need to be conducted to determine if there is a correlation between water consumption and thyroid disease and to explore the geographical, environmental, and demographic factors associated with cases in Dougherty County.

The prevalence of autism spectrum disorder (ASD) is estimated to be one in every 150 births. While both genetic and postpartum environmental exposure have been linked to ASD, prenatal maternal weight has not been investigated. The objective of the study is to assess whether overweight or obesity at pregnancy is an important risk factor for the diagnosis of ASD in offspring. A case-control study was designed to answer this question using the public health ecosocial theory. The study population consisted of 70 mothers, who were recruited via the Internet using the viral expansion loop. Multiple logistic regression analysis was used to test the hypotheses. No significant difference in risk of ASD by level of body mass index (BMI) was found after adjusting for covariates. The odds ratio for obese women in comparison to normal or underweight women was 1.19, 95% CI [0.53, 2.66] after adjusting for covariates. Gaining the appropriate amount of weight during gestation, as determined by the Institute of Medicine, was not associated with ASD either, with the odds ratio at 0.67, 95% CI [0.31, 1.48]. The results indicate that BMI category at pregnancy and gestational weight gain were not risk factors for autism in children. The implications for positive social change include a better understanding of maternal prenatal BMI as a risk factor for autism spectrum disorder. Appropriate health information provided to mothers prenatally could result in improved birth outcomes.

The purpose of this investigation was to generate a context- specific model of the lived experience of HIV positive Tanzanian orphans. With the advent of anti-retroviral drugs, Sub-Saharan African populations with high burdens of human immunodeficiency virus (HIV) face annually accumulating increases in the number of HIV positive children, and ultimately adults. Perinatally infected, these children often become orphans while still young. Extended interviews were performed with a purposive sample of 12 HIV infected orphaned children between 9 and 12 years of age. Half of the research participants lived in an orphanage and half were children living with guardians in villages near Arusha, Tanzania. A phenomenological approach to data analysis was employed with the guidance of literature-based constructs of intrinsic traits and developed tools used by children to meet challenging life circumstances. Data demonstrated that disclosure of HIV and orphan status engendered widespread social consequence. The phenomenon also negatively affected the children's physical, material, and emotional quality of life. Even in the face of these challenges, participants demonstrated resilient and self-reliant coping mechanisms. Responses ranging from caretaker education to stigma reduction in the schools will help to meet the needs of these children. In addition, the information generated by this research will be a basis for beginning to examine the social change responses that will be necessary for Tanzanians in the healthcare, social service, and policymaking arenas to successfully integrate this new population group into all levels of society.

The 2001 destruction of the World Trade Center and the subsequent anthrax attacks highlighted the inability of an antiquated public health system in the United States to respond effectively to emergencies. Little documentation exists to define how public health agencies can improve performance. The overarching research question was the extent to which drills and exercises improve performance in public health emergencies. Adult learning theory and deliberate practice theory were explored in this context. The research data were from 50 state public health departments, which were required to report performance information to the U.S. Centers for Disease Control and Prevention. The data were examined using Poisson analysis and logistic regression. Results indicated that drills and exercises had no statistically significant impact on public health performance for the 3 performance measures examined; of all predictors, what explained the most variance in reaching performance targets was the number of real emergencies to which a health department had responded in the past. Performing drills and exercises did not predict the likelihood of reaching performance targets. These findings have implications for positive social change for Congressional leaders and other government representatives. Such public servants could use this information to guide their efforts to redirect public health emergency preparedness funds away from drills and exercises and toward other fundamental public health activities. These more focused efforts could facilitate the improvement of public health laboratory capacity, the training of field epidemiologists, and the advancements in technology for enhanced reporting and surveillance.