Racial disparity is present in deaths attributed to sudden infant death syndrome (SIDS) and unintentional suffocation. The Back to Sleep Campaign that began in 1994 caused an overall decrease in SIDS rates, but the racial disparity has continued to increase. Researchers have analyzed and described various socio-demographic characteristics of SIDS and infant deaths by unintentional suffocation in urban areas yet have not simultaneously controlled for multiple risk factors that may contribute to racial disparity such as race, poverty, maternal education, and number of children born to each mother (parity). The purpose of this study was to determine if there is a relationship between poverty, race, maternal education, parity, and infant sleep-related deaths in the African American population in an urban setting. This quantitative case-control study used secondary data collected from birth certificates and matched birth/death certificates by a Midwestern state health department between 2005 and 2009. The health belief model was used as a conceptual framework. To answer the research questions that asked if there was a relationship between infant sleep-related deaths (dependent variable) and race, poverty, maternal education, and parity (independent variables), chi-square analysis and logistic regression analysis were performed. These analyses suggested that race and poverty have significant relationships with infant sleep-related deaths. The analyses did not suggest a relationship between maternal education or parity and sleep related infant deaths. The social significance of these findings may be that the results could be useful for population-specific modifications of prevention messages that will reduce infant sleep-related deaths.

Although the incidence of breast cancer in women under 40 years of age is somewhat rare, young women tend to present with cancer that is more advanced and with poorer prognostic characteristics. This research will be important to providers, women and their families and those seeking to clarify screening guidelines. The purpose of this quantitative, retrospective, cohort study was to evaluate differences in prognostic characteristics by socioeconomic position (SIP). The cohort was comprised of females aged 18 to 39 with a primary diagnosis of breast cancer. Data were obtained from the Surveillance, Epidemiology and End Results registry for all primary breast cancers reported between 2001 and 2006 (n = 14,696). Hierarchical regression analysis was performed to assess to what extent SEP had an independent effect on tumor size and cancer summary stage upon diagnosis, and overall survival. SEP was found to be a significant predictor of tumor size and summary stage at the time of diagnosis. As cancer summary stage increases by 1 unit, women were .14 times as likely to have a tumor size of less than 2 cm versus a tumor size of greater than 5 cm. As SEP increases by 1 unit, the likelihood of having a tumor size of less than 2 cm versus greater than 5 cm increases by a factor of 1.14. SEP was not a significant predictor of survival time. The results of this study have the potential to promote positive social change by advancing the understanding of breast cancer in young women, as well as raise awareness of socioeconomic, racial and clinical inequalities. In addition, it may assist researchers and policy makers clearly defined formal screening guidelines for young women in higher-risk subgroups based on socioeconomic position.

Children with special health care needs (CSHCN) generally have physical, mental, or emotional conditions that require a broader range and greater quantity of health and related services compared to typical children. Care coordination (CC) and family-centered care (FCC) are necessary in the quality of health care for CSHCN. A gap exists in the literature regarding the impact of CC and FCC on children's functional ability (FA). Previous researchers have focused on met and unmet health care needs, but not on health outcomes or functionality. The purpose of this study was to determine if there was an association between CC, FCC, and FA in CSHCN. The design of this study was a secondary analysis of data from the 2005--2006 National Survey of CSHCN. The study was guided by an adapted socioecological multilevel conceptual framework. Statistical methods included univariate, bivariate, and multiple logistic regression analysis. Results indicated that CC was associated with FA in CSHCN. CSHCN that did not receive CC had a 53% increased risk (OR =1.53, 95%CI 1.21--1.94, p < 0.001) for a limitation in FA compared to CSHCN that received CC, controlling for age, gender, number of conditions, household poverty level, parental educational level, and health insurance. FCC was not associated with a limitation in FA in CSHCN ( p = 0.61). Findings from this study were consistent with the socioecological multilevel framework and the literature on care coordination. This study contributed to positive social change by providing information that can be used by public health officials, health care providers and policy makers in developing policies to assure that care coordination is provided to CSHCN and their families in order to improve their health outcomes and functionality.

Gatekeeper Suicide Prevention Trainings such as Question Persuade and Refer (QPR) are used to increase suicide awareness and teach participants basic suicide intervention skills. Previous researchers showed that QPR training increases knowledge of suicide risk factors and increases participants' willingness to intervene with individuals at risk of suicide. It was hypothesized that completion of QPR would also increase positive attitudes toward the utilization of mental health services and that this outcome would be more pronounced among male participants. The examination of attitudes was rooted in the theoretical framework of Ajzen's theory of planned behavior. The Inventory of Attitudes toward Seeking Mental Health Services (IASMHS) was the instrument used for the study. The study occurred in a rural community college in southern Oregon. Student attitudes were assessed prior to completion of a 1-hour QPR presentation followed by a 3-week post assessment. Analysis of Variance revealed significant effects of QPR training. IASMHS scores were significantly higher at post QPR training. A significant interaction between gender and QPR training showed that women scored significantly higher than men only at pre QPR training. There was no statistical gender difference in attitudes measured by the IASMHS at post QPR training. QPR increased help seeking attitudes in both men and women with the increase being more pronounced in men. Increasing positive attitudes toward help seeking can contribute to positive social change. Practitioners in the field of men's health should consider using gatekeeper suicide prevention training such as QPR as a means of increasing male help seeking.

Obstructive sleep apnea (OSA), a disorder in which the airway intermittently collapses and obstructs during sleep, is associated with increased cardiovascular and cerebrovascular morbidity and mortality, increased risk of motor vehicle accidents, metabolic syndrome, hypertension, and depression. Treatment of OSA attenuates or reverses many of these associated risks. However, most cases of OSA are unrecognized and untreated. The two most recent studies using 1990s data found that only 6.5 - 15.4% of OSA cases, depending on severity, are clinically recognized in mixed gender populations. Based on a conceptual framework of improved physician awareness of OSA, and reduced diagnostic access bias with the increased availability of sleep laboratory services, increased OSA recognition since the 1990s was predicted. Study participants with clinically recognized OSA were identified using the resources of the Rochester Epidemiology Project, while the Berlin Questionnaire OSA high risk classification was used as a surrogate for prevalent OSA in this population. Analysis in a mixed gender population determined that OSA clinical recognition among those with prevalent OSA was 22.7 % (95% CI 19.6 - 25.8%) for mild or greater OSA severity leaving more than 75% of prevalent OSA clinically unrecognized and untreated in this population. Obesity and male gender were associated with increased likelihood of clinical recognition in bivariate and multivariate analyses, though even among obese men only 36.5% of OSA was clinically recognized. In order to support positive social change and address these inequities of OSA clinical recognition, strategies that enhance OSA recognition overall, and more specifically target recognition of OSA among women and the nonobese, should be developed and implemented. Further research regarding such strategies should consider whether they reduce OSA associated morbidity and mortality.

Childhood obesity is a worldwide problem that can lead to adverse health conditions. In several rural Pennsylvania communities, over one third of elementary students are characterized as overweight, having a body mass index above the 85th percentile. The purpose of the study was to investigate educational stakeholders' perspectives about school-based obesity-prevention programs. The conceptual framework focused on cognitive theory, the theory of planned behavior, and the trans-theoretical model of health behavior change, which postulates that an individual's readiness to change is the most important factor of intervention programs. Qualitative interview data were gathered from 18 educational stakeholders. Inductive code-based analysis led to categories and themes. Key findings revealed a variety of barriers that limited and prevented effective student-wellness initiatives: students' physical activity; family dynamics, schedules, and socioeconomic factors; lack of transportation limiting children's participation in physical activities; parental engagement and input on obesity-prevention initiatives; and cafeteria environment and meal offerings. Findings informed the development of a policy recommendation for a research-based nutrition education program for schools and a strategy to communicate students' cafeteria habits to parents. Recommendations include a heightened awareness on factors contributing to obesity, as well as better educator-led planning to make improvements to school-based programs. Implications for positive social change may be the potential to increase awareness of healthy behaviors and improved student health through obesity-prevention methods, exercise patterns, and dietary habits of youth. These healthy habits may reduce adverse health effects in adulthood, which could hold the potential to improve the health of the next generation.

Effective recognition and proper treatment of cardiovascular diseases (CVDs) in Hispanic woman is a public health problem that needs further investigation. Guided by the stress and coping social support theory, the purpose of this cross-sectional survey study was to examine the relationship between attitudes, emotional support, and the perception of success in managing cardiovascular diseases (CVDs) in 335 Hispanic women living in Atlanta, Georgia. Correlations, independent-sample t tests, simple linear regression, and multiple linear regressions showed ethnicity as a moderating variable between the perception of success in handling CVD and emotional support, while emotional support was shown to be a significant predictor of perceived success for all participants. The relationship between the 2 variables was positive for Hispanic women and negative for non-Hispanics women. Diet and exercise also emerged as a significant direct predictor of perceived success in handling CVD when the variable of emotional support was controlled. Key findings also showed that, while Hispanic women had higher scores for perceived success in handling CVD, non-Hispanic women had higher emotional support scores. This study supports positive social change by highlighting the unique needs of Hispanic women to healthcare providers, relative to effective recognition and positive treatment regimens, if cardiovascular disease is suspected. Positive social change will be demonstrated with the recognition of better health outcomes for Hispanic women.

Recent research clearly demonstrates that a decrease of physical activity has occurred among young people. Hence, the purpose of this study was to examine the impact of external motivation on physical activity. Drawn from self-determination theory, the specific research question examined if academic incentives effectively motivated 7th grade students to participate in a 3-week fitness program. A quasi-experimental pre-post design examined treatment and control groups drawn from a sample of 24 students from three physical education classes. The treatment group received academic incentives whereas the control group received no external incentives but were asked to complete the same fitness Program. Independent-sample t-test of the physical activity section of the 2005 Youth Risk Behavior System Survey (YRBS) revealed no group differences on the posttest. Dependent-sample tests indicated little pretest-posttest change in YRBS scores, leading to the conclusion the academic incentive had no major effect on students' motivation to be physically active outside the school environment. This research contributes to positive social change by provided additional insight into what motivates or does not motivate 7th graders to be physically active.

The lack of mentored relationships among nursing educators has the potential to negatively influence perceptions of leadership practices and could decrease the numbers of nursing faculty staying in academia. The purpose of this study was to investigate the perceptions of mentorships and leadership practices of nursing faculty teaching in academia. Watson's caring theory was the theoretical foundation to explain the congruence between mentored relationships, leadership practices, and the association with faculty retention. The first research question focused on differences between mentoring experience, assistance, and characteristics by mentor training type. Question two assessed the relationship between leadership practices by mentor training type. In this cross sectional, research design, a nonrandomized convenience sampling method was used to select 65 masters or doctoral level nursing faculty from one Midwestern state in the United States. The z test statistic measured the perceptions of mentoring experience, assistance, and characteristics by mentor training type; results indicated no significant differences in the perceptions of mentoring experience, assistance, and characteristics by training type. The ANOVA measured the perceptions of leadership practices by mentor training type. Results showed that nursing faculty who reported no mentor scored significantly lower on the perception of leadership practices when compared with nursing faculty who had formal mentor training. Recommendations for action include an exploration of barriers to mentorships and the perceptions of leadership practices within the workplace setting. This study contributes to positive social change by encouraging administrative personal and nursing leaders to focus on developing and maintaining healthy working relationships to potentially offset the nursing faculty shortage.

Researchers have identified inadequate sleep duration as one of the factors contributing to global obesity. The purpose of this study was to test a hypothesis deduced from a new sleep-duration-based evolutionary theory claiming that sleep extension in response to lengthening night duration in early fall evolved into a behavioral marker of an approaching winter; this adaptive trait was theorized to produce adiposity gain in White men in response to sleep extension. The hypothesis was that White Americans would show a greater increase in the age-adjusted fat mass index per unit of sleep duration compared to that of Black Americans. Data were part of the National Health and Nutrition Examination Survey (NHANES) study between 2005 and 2010. The multiple regression analysis did not support the study hypothesis. The results indicated that habitual sleep duration had no effect on the annual rate of adiposity gain in White men, while in Black men, longer sleep was associated with significantly higher annual rates of adiposity gain. Implications for social change include the case for population-specific antiobesity interventions in Black men, including closer monitoring of sleep duration in order to prevent adverse habitual sleep extension and to improve time budgeting for physical exercise.