American Indian and Alaska Native adults are 2.6 times more likely to have adult onset diabetes resulting from higher weight at birth. Pregnant women, providers, and Indian Health Service administrators may benefit from timely information during pregnancy to intervene and prevent Type 2 diabetes. The purpose of this study was to examine the role of birth weight in the development of Type 2 diabetes among Southeast Alaska (SEA) Natives. Guided by the socioecological model, this study examined the extent to which birth weight and gestational age predict the incidence of Type 2 diabetes. The study used a quantitative research design with retrospective analysis of 540 Native children born in SEA whose data were abstracted from birth journals and electronic medical records at ages 43-53. A t test indicated a significant positive correlation between gestational birth weight and incidence of Type 2 diabetes (t(285) = 13.91, p < .001). Birth weight for gestational age was associated with frequency of Type 2 diabetes, where small for gestational age (SGA) had the lowest risk (1.42%), average for gestational age (AGA) at medium risk (8.76%), and large for gestational age (LGA) had the highest risk at 32.25% (x^2(12) = 63.29, p < .0005). Findings indicate that adult Type 2 diabetes among the SEA Native population is due to excess intrauterine fetal weight gain. The positive social change implications include preventing Type 2 diabetes in SEA Natives by controlling weight gain during pregnancy; the findings also suggest using diagnostic risk profiles for those who are LGA at birth for the management of diabetes and prevention of obesity and chronic disease.

Youth violence is a pervasive and ongoing public health concern. Based on the paradigm of resilience, the purpose of this quantitative study was to test the relationship between prolonged (3 or more hours) of non-school related media use and youth violence. Secondary data from the Centers for Disease Control and Prevention (CDC) were utilized for this study. Logistic and multiple regression models were used to test whether exposure to prolonged non-school related media (video games and TV) use was associated with violent behavior, and whether there was a relationship between prolonged exposure to non-school related media use and electronic bullying among urban youth (N = 1228). Prolonged exposure to both types of non-school related media use was associated with violent behavior (carrying a weapon, physical fighting, perpetrating physical bullying), and playing video and computer games 3 or more hours per day was positively associated with electronic bullying. However, 3 or more hours of TV viewing per day was not associated with electronic bullying. Policy makers, constituents, and parents may benefit from a greater understanding of media exposure and urban youth violence. The knowledge gained from this study may promote positive social change within family systems by increasing parental awareness of what youth do in their unstructured free time and how this impacts subsequent behaviors. Public health professionals, community organizations, and social service agencies in urban communities could incorporate the results to create a culture that supports youth leadership programs that focus on limited use of non-school related media and on violence prevention.

Voluntary HIV/AIDS testing and counselling (VHTC) is one of the preventive measures used in many countries to decrease the spread of HIV/AIDS. Archived data from National HIV/AIDS Response Program's (NHARP) raw 2016 dataset were used to identify relationships and to assess significant differences between sociodemographic factors and selected sexual risk behaviours versus VHTC practices among adults 18 years and older who resided in Dominica. The health belief model was used as the framework for this cross-sectional study. The sample comprised 982 participants (40% [394] men and 60% [588] women). Logistic regression analysis was used to assess associations between sociodemographic and sexual risk exposure factors versus VHTC. Findings revealed that, as compared to age group > 65 years, participants in age groups 25-44 years were 5 times more likely--and 45-64 years were 2 times more likely--to have engaged in VHTC (OR = 5.11, 95% CI = 2.03, 12.8 and OR = 2.63, 95% CI = 1.07, 6.49, respectively). The odds not to engage in VHTC were 48% higher for participants from Grand Bay district (rural area) compared to Roseau health district (capital) (OR = .52, 95% CI = .29, .94). The odds of nonengagement in VHTC were 51% higher for participants not having vaginal sex, compared to those who reported having vaginal sex (OR = .49, 95% CI = .26, .92). The implications for positive social change include providing public health practitioners with data to plan and implement educational programs specific to the demographic characteristics in Dominica. This will enhance current efforts to raise awareness regarding HIV/AIDS and may increase VHTC practice among the population that may reduce the incidence of HIV/AIDS.

Clostridium difficile is a frequent cause of healthcare-associated infections (HAI) and is associated with increased risk of morbidity and mortality. Studies suggest environmental and host characteristics increase patient's susceptibility to C. difficile infection (CDI). However, few studies have examined the risk of CDI among those with diabetes or patients in the acute rehabilitation (AR) setting. A case-control study, using secondary data (n = 473), evaluated the relationship between CDI and diabetes and identified modifiable environmental exposures. An ecosocial framework was used to examine the relationship between these two complex diseases among hospitalized patients in an AR setting. Results of the multiple logistic regression showed that patients with diabetes experienced 2.5 times the risk for CDI (p = 0.03) compared to non-diabetic patients. Multiple logistic regression was also used to assess for modifiable exposures among AR patients with diabetes only. Findings from this sub-analysis found the significant exposures in this population were antibiotics (OR = 3.9; p = 0.01) and insulin use (OR = 2.6; p = 0.015), suggesting an effect on the intestinal microbiome. Understanding the relationship between CDI and diabetes among the AR population promotes positive social change through the reduction of CDI associated morbidity and mortality among diabetic patients. Findings from this study support antibiotic stewardship efforts across the spectrum of healthcare delivery and the development of new strategies to decrease the economic burden associated with CDI for individuals, healthcare facilities, and at the national level.

Community coalitions have had successful reductions in adolescent substance abuse, and the legalization of marijuana presents an opportunity for these coalitions to re-evaluate their current methods and messages for preventing adolescent marijuana usage. Using the theory of planned behavior, the purpose of this qualitative study was to determine how legalization of marijuana for recreational purposes affects the methods and messages of coalitions and how the coalition members perceive their efforts to reduce adolescent marijuana usage post-legalization in Colorado. Participants were obtained by recommendations from the executive director in each of four coalitions. A purposive sample of 12 coalition members was interviewed via telephone and recorded. Data from the transcripts were analyzed, coded, and repeated as necessary until themes arose. The major themes suggested that programs alone were inadequate to change adolescents' perception of marijuana, despite the current success of the methods and messages expressed by coalition members. Recommendations included continuing current programs despite legalization, partnering with marijuana retail shops, engaging youth through multiple tactics, developing relationships with youth, and improving parent education to help prevent adolescent marijuana usage. These themes could shape the development of programs that guide adolescents into making better choices, which could ultimately lead to positive social change.

Unsafe abortions pose serious threats to women's health. Medical abortion provides safer abortion access to many. The lengthy interval between misoprostol and mifepristone creates multiple barriers for women and providers. A paucity of research exists about medical abortion protocols that allow single day procedures. The efficacy and the safety of 3 medical abortion protocols of varying lengths were explored in this study. A secondary data set of over 55,000 patients from the United Kingdom was retrospectively analyzed using binomial logistic regression. Efficacy results showed no significant difference between the conventional and the simultaneous protocols; when compared to those, the 6- to 8- hour protocol showed a 79% higher risk (OR = 0.210, 95% CI = 0.178 - 0.246) of failure. Safety of the simultaneous protocol was 48% lesser (OR = 0.524, 95% CI = 0.447 - 0.613) and the safety of the 6- to 8- hour protocol 61% lesser (OR = 0.386, 95% CI = 0.304- 0.489) compared to the conventional protocol. The absolute risk of complications or severe adverse events of all protocols (0.98%, 1.97%, and 2.67%) was very low. The results suggest the simultaneous protocol is a viable alternative to the conventional protocol up to 10 weeks' gestation. The results could promote the adoption of the simultaneous protocol by health systems, give millions more women access to safe and effective single day medical abortions, reduce the need for skilled clinicians, and reduce cost burdens for both women and for healthcare systems overall. Implementation of these social changes could make abortion safer globally.

Traditionally, in Nigeria women play a subservient role in relation to men. While a man can practice polygamy by marrying many wives, women cannot marry more than one husband at a time. Although researchers have documented the effects of polygamy on the spread of HIV/AIDS, little is known about the experiences of polygamy by Nigerian women who stopped practicing polygamy by immigrating to the United States without their husbands. It is important to know the experiences of these women as they pertain specifically to the spread of HIV/AIDS so as to develop a preventive intervention for HIV/AIDS among Nigerian women in polygamy. The purpose of this phenomenological study was to explore the perspectives on HIV/AIDS held by 10 Nigerian women who practiced polygamy in Nigeria before immigrating to the United States. Recruitment was done through purposive sampling at a faith-based organization. Guided by the health belief model, interview transcripts from the 10 women were analyzed to reveal recurrent themes that expressed the women's lived experiences in polygamy with their perspectives on HIV/AIDS. Findings revealed that these women had a basic knowledge of the risk of contracting HIV/AIDS by engaging in polygamy but needed to comply with the terms of sexual encounters as dictated by their husbands; therefore, they were at risk for HIV/AIDS. The results of this study can be used to increase awareness among Nigerian women in polygamy and Nigerian health policy makers regarding the transmission of HIV/AIDS and the preventive measures available for HIV/AIDS. Understanding the experiences of women in polygamy may lead to greater understanding of the impact of polygamy on HIV/AIDS and may help to decrease the prevalence of this disease.

In recent years, many dramatic changes have occurred in the nation's health care delivery system, particularly in health education. The National Consumer Health Information and Promotion Act was enacted in 1976. In response to this legislation, the nation's health education efforts were greatly expanded through the creation of a Bureau of Health Education within the Center for Disease Control and establishment of the Office of Health Information and Promotion in the Office of the Assistant Secretary for Health, Department of Health, Education and Welfare. A National Center for Health Education was also established. Health education was prominently included among the ten national health priorities outlined in the National Health Planning and Resources Development Act of 1974. Concurrent to these developments have been intensified demands among health organizations and the public for an expanded health education component of the health care delivery system. Health education of the hospital patient (or hospital patient education) is a significant aspect of the broader area of health education. This thesis examines the relationship between some of the national health education developments and the patient education responsibilities of small hospitals. Issues inherent in these responsibilities are identified and analyzed in an attempt to develop a philosophy (or concept) of the extent to which small hospitals should provide patient education. For purposes of this study, small hospitals are defined as general, acute-care hospitals of the 100-bed and less category. To facilitate understanding of how patient education hospitals has reached its present position, a brief history of hospital patient education is presented. This history leads to an overview of current hospital patient education activities and the identification of issues and trends in this area relative to the small hospital. This thesis examines some of the current questions raised on the appropriate role of the small hospital in meeting the health education needs of its patients. Specific aspects of hospital patient education are also discussed; for example: philosophies, planning, coordination, methodologies, financing, materials, cost effectiveness, and evaluation. After discussing the above-mentioned issues, this thesis concludes with the presentation of a concept of patient education in the small hospital and some recommendations relating to the small hospitals' patient education activities. The concept presented was based on the conclusion that the philosophical and humanitarian tenets upon which small hospitals provide service demand the provision of maximal patient education which is integrated into routine patient care regimens.

Objective: This study sought to examining the gender-based expectations of an ideal body, for self and opposite gender, among college students. Methods: The study used a qualitative approach using thematic analysis. Common words and phrases were first identified and later grouped into category, through open and axial coding respectively. Next, central theme was identified using selective coding. Results: This study examined a total of 145 student participants responses of which 94 were self-identified women and 51 were self-identified men. The results reveal that men’s ideal body perception for a woman is different than women’s expectations for women. For example, women’s perceptions of ideal body for women were focused on features such as lips, nose, eyebrows; whereas the men’s perception of ideal body for women was considered to be a small body type. Similarly, there was also variation of ideal body expectations for men. Although both men and women considered fit body types to be the most ideal body for men, women also reported personal hygiene as being an important factor. Furthermore, the men’s perception focused more on body types rather than other factors such as hygiene. Conclusion: Our results show unique differences in body image perception based on self-identified gender. These results can aid public health professionals in creating targeted body positivity initiatives.

Every year, about 1 million children are abused in the United States and an average of 4.5 of those children die daily at the hands of caretakers, parents, relatives, or friends. Using the ecological model as a guide, the purpose of this study was to investigate the relationship between family structure and specific types of child maltreatment utilizing cases from an agency in Montgomery, Alabama, in 2012-2013. Approximately 727 cases of child maltreatment were reviewed. Logistic regression results indicate married and common law families' children are 1.83 times more likely to experience sexual abuse than the reference category (single) (OR= 1.834, 95% CI:1.19, 2.81). As it relates to relationship to the offender, children are 2.1 times more likely to experience sexual abuse from an acquaintance; someone who is known by the child but is a non-family member, compared to the reference level (stranger) (OR= 2.1, 95% CI:1.20, 3.65). This research can promote positive social change by providing awareness to the local community about child maltreatment; the findings provide policymakers, public health departments, healthcare officials, health advocates, and communities needed information on the child maltreatment and the specific family structures that are associated.