Dementia is a serious public health concern in the United States, with a prevalence of 5.2 million. There is currently no effective way to prevent or cure dementia, and the precise etiology is unknown, but it appears there are multiple risk factors. Prediabetes (PD) has been identified as a risk factor although the scientific evidence is conflicting. This study is important to those at high risk for dementia and to healthcare professionals who lack substantiated dementia prevention strategies. The purpose of this case control study was to determine whether PD is associated with dementia in adults aged 65-95 years and whether the association varies according to demographic (age, gender, race, and socioeconomic status [SES]) and health (atherosclerosis, body weight, cerebrovascular disease, dyslipidemia, hypertension, and stroke) risk factors. The ecosocial theory was selected to bridge the study findings to life-course exposures and risk factors. Cases (n = 574) and controls (n = 2,157) were sampled from a large ambulatory care dataset, and multivariable logistic regression was used to test the research hypotheses. No unadjusted association between PD and dementia was found (OR 1.08, 95% CI = .854, 1.241, p = .604). The regression analysis revealed no association between PD and dementia; however, atherosclerosis, hypertension, low body weight, and low/average SES were found to be significantly and independently associated with dementia. A stratified analysis revealed that race and SES did not alter the effect of PD on dementia. The implications for positive social change include the potential reduction of incident dementia through initiatives targeted toward demographic and health risk factors including atherosclerosis, hypertension, low body weight, and low/average SES.

Posttraumatic stress disorder (PTSD) is a serious issue for post-deployment United States Marine Corps (USMC) veterans, especially because PTSD can increase the risk of suicide. Marines are screened post-deployment, yet little is known about Marine veterans' perceptions of the PTSD screening process. The purpose of this phenomenological study was to explore USMC male veterans' perceptions of the Post- Deployment Health Reassessment (PDHRA). The social cognitive theory constructs of a triadic relationship among person, environment, and behavior were the framework for understanding this population's perceptions of the PDHRA and potential stigma. Two research questions focused on how people, culture, and behavior affect Marines perception of the PDHRA and PTSD attached stigma. Interviews were conducted with 10 Marine veterans' participants and transcribed interview responses were input into NVivo 11 software to retain a reliable database and Colaizzi's strategy to identify emerging themes. Key findings revealed potential positive social change to military chaplains and veterans' health service providers. This knowledge might inform about the perceptions of Marines through informed understanding and may help develop an updated evaluation tool. Future researchers might focus on the forthcoming answers and treatment of PTSD and the attached stigma among Marines by alleviating repercussions for Marines' answers on the PDHRA. An understanding of the study's findings may elicit strategies for health care administrators to expound on the PDHRA and provide educational programs to assist in future screening environments and processes through Marines perspectives.

Research indicated that depression is now the leading cause of disability globally. Depression and help-seeking experiences among African American men have not been adequately studied. The purpose of this phenomenological study was to explore the help-seeking experiences of African American men with depression. The theoretical framework was Andersen's Behavioral Model of Health Services. Purposive sampling was used to recruit participants. Inclusion criteria were (a) African American men, (b) aged 18 through 65, (c) having a medical diagnosis of depression or symptoms of depression, (d) not currently in treatment, and English speaking. Six African American men with depression or depressive symptoms were interviewed. Coding analysis of data generated two major themes: African American men's perceptions of factors that inhibit help-seeking and African American men's perceptions of factors that promote help-seeking. The 6 sub-themes identified were (a) African American men with depression tend to feel misunderstood and stigmatized; (b) some African American men admit to a degree of self-stigma; (c) some African American men deny their depression or any need for help; (d) African American men who had therapy found it helpful until the therapist was changed, causing feelings of mistrust and inadequate mental health care; (e) African American men fear guilt, fear being a burden to others, and feel they should be able to handle their problems; and (f) it is difficult being depressed and Black in America, which leads to stress, frustration, and perceived racism. Findings may be used by mental health professionals seeking to improve cultural competency, mental health and support services, and treatment regiments for African American men with depression.

Obesity has been identified as a significant risk factor for chronic diseases, contributing to health disparities in minority and vulnerable populations. Though research has identified an increased risk for obesity in the Hispanic immigrant population, there is little or no research on the heterogeneity of obesity predictors in specific immigrant populations in the United States. This study examined the predictors of obesity in the Nigerian immigrant population in the United States. Guided by the social ecological model and the segmented assimilation theory, this cross-sectional study collected primary data from 205 Nigerian immigrants in the United States using the CDC's Behavioral Risk Factor Surveillance System self-administered web-based survey. Spearman's correlation and logistic regressions were used to analyze data through SPSS. The results showed no significant relationship between obesity and the factors education, socioeconomic status, length of stay, and level of physical activity. This study, however, identified a significant association between weekly consumption of alcohol and all obesity (OR 1.78, p = .021), and moderate/morbid obesity (OR 2.46, p = .013). There was also a significant association between gender and moderate/morbid obesity (OR 3.30, p = .031). These findings provide strong evidence to inform the development of targeted culturally-relevant community-based interventions for Nigerian immigrant population in the United States, including health education and targeted screenings for alcohol consumption, and other unrecognized behaviors that increase their risk for obesity. The lack of association between other well-known predictors of obesity and obesity outcomes calls for further investigation into other causes of obesity in this immigrant population.

Cervical cancer is a major public health problem in developing countries. In Guyana, factors associated with increasing cervical cancer cases among Indigenous Amerindian women (IAW), Afro- women (AGW), and Indo-Guyanese women (IGW) have not been fully examined. In this comparative cross-sectional study, 5,800 cervical cancer cases were selected from Guyanese women age 13 and above for ethnicity (Indigenous Amerindian, Afro- and Indo Guyanese women), geographical region, marital status, and year and stage at diagnosis. Secondary data from Guyana Cancer Registry for the 2000-2012 study periods were analyzed using chi-square test, multinomial logistic regression, poisson regression, and relative risk. Geographical region was a strong predictor of cervical cancer cases for all three ethnic groups (p < 0.05). The relative risk for cervical cancer for IAW in Regions 2 (RR = 1.2) and 6 (RR = 1.07) was greater than for IAW in Region 4, the reference group for the study period. Comparatively, the relative risk for cervical cancer for AGW in Region 4 was greater than AGW in all other regions except Region 3 (RR = 1.05). Additionally, the relative risk for cervical cancer for IGW in Region 3 (RR = 1.03) was greater than that of IGW in all other regions. Single IAW (1.05) have a higher risk of getting cervical cancer than their married counterparts as compared to AGW (0.96) and IGW (1.00). Implications for social change include development of tailored programs which utilize a socio-ecological model to address cervical cancer issues at the individual, interpersonal, cultural, and community levels. Future research should focus on understanding the epidemiology of cervical cancer and the social factors among the ethnic groups of women.

In elderly women, discharge after gynecologic surgery is often associated with increased morbidity. Little information exists about elderly women's discharge destination after gynecologic surgery and the outcome of early hospital readmission. The purpose of this study, conceptualized using the quality health outcomes model, was to examine whether post hysterectomy discharge destination is an independent predictor of 30-day hospital readmission in women age 65 and older. Examination of covariates included patient age, race, medical comorbidity and complications of care, as well as surgical anatomic approach and operative technique. This study involved use of a retrospective cohort design and data from 10,598 cases contained in the Healthcare Cost and Utilization Project 2010 and 2011 California State Inpatient Databases. Results of the bivariate analysis showed a statistically significant association between discharge destination after hysterectomy and 30-day hospital readmission. Additionally, the results of multivariate logistic regression revealed the odds of readmission after discharge with home care were 2.99, p < .001, 95% CI [2.29, 3.67] times greater when compared with discharge home for self-care and 5.99, p < .001, 95% CI [4.68, 7.43] times greater with discharge to continuing inpatient care versus home for self-care. This study may lead to positive social change for elderly women by informing health care providers about the odds of early hospital readmission associated with discharge destination after hysterectomy. Further, this information may stimulate development of interventions to improve health care practices for elderly women preparing for hospital discharge after hysterectomy.

Obesity and morbid obesity affect more than 30% of Americans, which emulates the rate of smoking as the leading preventable cause of disease and death in the United States. The prevalence of obesity among adults in the United States increased dramatically between 1980 and 2010 (16% to 36%). The integration of the social cognitive theory (SCT) constructs such as self-efficacy, self-control, environment and expectations in the study instrument allowed identifying the impact of personal, social and economic factors on Registered Dietitians (RDs) counseling behaviors with obese clients. The goal of this quantitative cross sectional study was to investigate the association between RDs counseling behaviors and weight loss of clients using SCT. The sample of 150 RDs affiliated to the American Dietetic Association completed a survey to gather counseling behaviors with weight loss clients and SCT constructs. Data were analyzed using multiple regressions. The study showed a significant relationship between three SCT constructs such as self-efficacy in overcoming barriers, counseling environment and self-control with RDs counseling behaviors. The Spearman's rho correlations analyses between independent and dependent variables showed positive relationships between self-efficacy in overcoming barriers in counseling sessions and RDs counseling behaviors .34. The study adds to the literature on weight loss and RDs' counseling skills and creates the foundation for further research studies to reduce obesity by improving counseling skills among RDs.

Age-related macular degeneration (AMD) is the leading cause of vision loss in individuals aged 50 years and older and is estimated to affect as many as 11 million individuals in the United States. The purpose of this study was to examine the association between vitamin D and AMD disease progression. The life course epidemiology framework model was used to explore how vitamin D level as a risk factor may have an association to AMD disease through time. Data in the 2005-2008 National Health and Nutrition Examination Survey (NHANES) database were collected on vitamin D levels and identified stages of AMD level based on graded fundus eye exams from an available sample size of 5,604 participants. A quantitative cross-sectional study approach was used to address this gap in knowledge. A bivariate analysis was used to examine each independent variable (age, race/ethnicity, smoking status, and diabetes) to the dependent variable AMD from the 2005-2008 NHANES dataset. A multivariate logistic regression analysis was performed with AMD including each independent variable found to be significant. The findings from this study failed to suggest an association between vitamin D levels to AMD, with or without the covariates included in the model. There was not an association found between vitamin D level and presence of AMD. An association was found between age, smoking, and race to presence of AMD in each of the bivariate models. The findings from this study could be used for positive social change by encouraging medical and public health agencies to target screening programs at high-risk age, smoking, and race groups. There remains to be conflicting data in the literature. This study adds to the body of literature suggesting that higher levels of vitamin D are not necessarily beneficial as they pertains to AMD.

Veterans with serious mental illness (SMI) are at high risk of developing conditions such as insulin resistance, obesity, and smoking, which may lead to chronic medical problems. As a result, the morbidity and mortality of people with SMI are high compared to the general population. It appears that integrated care improves the wellbeing of veterans; however, there is a gap in the literature on wellness-based interventions for veterans with SMI. The purpose of this cross-sectional study was to evaluate the association between a wellness intervention for veterans and their perceived quality of life (QOL). Social cognitive theory was the theoretical lens through which this study was conducted. It was hypothesized that there is an association between veterans’ involvement in the wellness component of a program and their perceived QOL. The program is a specialty VA service known as Mental Health Intensive Case Management (MHICM). A total of 112 veterans served by a single MHICM program in the U.S. Southeast completed a validated VA survey that measures health related QOL. A chart audit was conducted to gather information such as years served by the program and type of wellness services received. Regression modeling was used to assess the relationship between a veteran’s involvement in the wellness interventions and his or her perceived QOL. The study results showed that the interventions were not significant predictors of veterans QOL. Two covariates, age and gender, were found to be significant predictors, but each accounted for less than 7% of the variance. The study findings show the need for further research to explore the role of wellness interventions in a veteran’s recovery. Social change may result from encouraging veterans with SMIs to participate in self-rated QOL measures.

Parents' refusal to immunize their children with the measles, mumps, and rubella (MMR) vaccine has resulted in a surge of measles outbreaks in the United States. The purpose of this correlational study was to examine the relationships between parental knowledge and trust of the MMR vaccine, and their trust in government and medical authorities. The theoretical foundation for this study was the health belief model (HBM). This study determined if there was any relationship between general trust in doctors/governments (i.e., the predictor variable) and attitudes toward MMR vaccine (i.e., the sole dependent variable), and whether gender, age group, or level of education moderated that general trust. A Survey Monkey subscriber database and researcher-developed survey was used to identify and email 2,500 parents of immunization-aged children, resulting in 237 respondents who met the required parameters. The analysis revealed a significant, positive relationship between the criterion and predictor variables, R = .32, R2 = .10, F(1, 235) = 26.39, p. < .001, regardless of gender, age, or education, suggesting an association between higher trust and greater likelihood of a parent allowing vaccination. This study offers significant insights for positive social change by providing pediatricians, primary health care providers, and vaccine educators, with information for communicating with vaccine-hesitant parents: It is not enough to address parental concerns of vaccine safety, efficacy, and necessity. It is also not enough to provide evidence-based scientific data, as doing so has been proven to be ineffective "and for some parents counter-productive" when government and medical authorities are sited as the source. What we need to do is start focusing upon the role of parental trust, including how to best establish that trust, and equally important, what steps are necessary to sustain that trust.