More people in the United States are approaching retirement age, a trend which has resulted in increased study on life satisfaction and psychological well-being of the elderly. Previous researchers have focused on the relationship between religious social support and life satisfaction; however, there remains a gap in the literature regarding how race and gender may influence this association. Knowledge of interactions between religiosity, gender, and race will enable counselors working with different groups of religiously inclined clients to develop and implement religious-based interventions specific to their clients. Guided by the social ecological model, the purpose of this study was to examine how gender and race influence religious social relationships and psychological well-being, optimism, and self-rated health among the elderly, using data from the Religion, Aging, and Health Survey. Pearson bivariate correlations and hierarchical linear regression were used to examine multicollinearity among variables and whether the association between the religious variables measured and the psychological well-being of the elderly varied by gender and/or race. All 3 religious constructs significantly predicted positive well-being outcomes. However, only gender and race interactions were significant for the religious-based relationships with others variable. Income and marital status were found to be significant covariats for this study. Also, both income and marital status were significantly associated with the relationship between religious variables and the psychological well-being of the elderly. Findings from this study can aid religious leaders and public health practitioners in developing programs and policies to improve perception of health and psychological wellbeing among the elderly.

Breast cancer is one of the most widespread chronic diseases and a major cause of death among women in the United States. African American women have a higher incidence of breast cancer than their counterparts from other ethnic/racial groups. The purpose of this cross-sectional survey of 126 African American females from the western US metropolitan area was to assess knowledge, attitudes, and behavior with respect to breast cancer manifestation, detection services, and the role of mammography in breast cancer prevention and control. The health belief model guided this study. A 41-item, ethnically sensitive, self-administered, and gender-specific instrument, the Champion Revised Susceptibility, Benefits, and Barriers Scale for Mammography Screening, was used in this study. Analysis of variance, the Scheffe post hoc tests, and Fisher's exact test were used to analyze the data. The results showed that all but three participants (97.6%) reported having had breast cancer screening; almost all of the participants were compliant and answered the knowledge question. The findings also showed that the women with high levels of education reported lower benefits of mammography scores and lower barriers to mammography scores; and higher cues to action scores. Income was not significantly related to attitude toward breast cancer screening. The implication for positive social change is that these results may help to facilitate continued development of intervention strategies to encourage African American women to utilize early breast cancer detection services.

A disproportionate number of African American (AA) women are overweight, obese, and more likely to have weight related health concerns compared with Caucasian (C) women. Previous research indicates perception about health-enhancing behaviors influences AA females' health behavior. A gap exists in the current literature regarding AA women's perception of eating and exercise behavior and the impact social support has on AA women's adherence to USDA recommendations. The purpose of this study was twofold: (1) to examine AA women's weight locus of control, perceived susceptibility to weight related diseases, and perceived barriers to healthy eating and exercise relative to C women; and (2) to assess the impact of social support on adherence to USDA recommendations in AA women utilizing the extended health belief model. Participants were a convenience sample of 76 AA and C women ages 20-75 from churches in northeast Texas. A quantitative cross-sectional survey design was employed. ANOVA and linear regression were used to determine if there was a relationship between race and weight locus of control, perceived susceptibility to weight related diseases, and amount of perceived barriers to exercising/healthy eating as well as between perceived social support for exercising/healthy eating and adherence to USDA recommendations in African American women. Results indicated no signficant difference between AA and C participants in weight locus of control, susceptibility to weight-related diseases, or barriers to exercising/healthy eating. Social support predicted adherence to USDA recommendations in AA women. This enhances social change by providing a basis for future studies aimed towards designing and implementing interventions and strategies to help AA and C women improve their health.

One of the newest teaching modalities in nursing education is the use of human patient simulators (HPS). An HPS simulation scenario creates a software program vignette in which students interact with a manikin to practice caring for critical patients in a risk-free environment. Although used extensively in schools of nursing, there is little research that examines if these expensive simulators improve the clinical decision-making ability of nursing students. The purpose of this experimental differentiated treatment study was to assess if HPS technology leads to increased clinical decision-making ability and clinical performance more than the teaching modality of a paper and pencil case study. Students (n = 133) from practical nursing programs in Pennsylvania were randomly assigned to one of 2 groups learning about the care of a patient with a myocardial infarction: an HPS simulation group or a paper and pencil case study group. One-tailed, independent t-tests were used to measure pre and post treatment exam and clinical performance scores measuring the care of a patient with a myocardial infarction. Results indicated that there was a statistically significant learning gain from the use of HPS technology compared to the paper and pencil case study ( p < 0.001). Students in the HPS simulation group also performed CPR more quickly than students in the case study group (p < 0.001). The research adds a rare control group study to the literature and confirms previous findings about the effectiveness of HPS technology. Nurse educators can benefit as the results validate the use of HPS technology in nursing education. Ultimately patients may benefit from increased quality and speed of care from practical nurses whose training was improved through the use of HPS technology.

Recently, the Centers for Medicare and Medicaid Services (CMS) ranked all hospitals based on Medicare readmission rates for heart attacks, heart failure, and pneumonia. CMS offered subsidies to hospitals ranked in the 4th quartile to develop community support services to reduce the problem of potentially preventable readmissions (PPRs). CMS cited 4 of the 5 hospitals in Prince George's County in the 4th quartile. The purpose of this quantitative research study was to investigate the relationship between community support services and the reduction of PPRs in Prince George's County. The Evans and Stoddart field model of health and well-being guided this study with support from Bertalannffy's general systems theory. This study sought to relate community support services to PPRs in Prince George's County in contrast to other Maryland counties. To evaluate relationships between community support services and the reduction of PPAs, secondary data were provided by CMS in conjunction with the Robert Wood Johnson Foundation and the University of Wisconsin. The data included 26 behavioral community support factors from 53,229 Medicare paid claims in Maryland residents from July 1, 2008 to June 30, 2011. Lack of diabetes screening is a community support factor within quality of care. Using multiple regressions, there was a statistically significant relationship found between diabetic screenings and pneumonia readmission rate. The implication for social change is that reimbursement of key screening recommendations to CMS, local government, and hospitals in Prince George's County may reduce readmission rates, thereby positively affecting patients, improving community health, and decreasing health care costs in Prince George's County.

Limited research exists on the experiences of sedentary women as they transition through menopause. This gap creates difficulty for public health practitioners as they strive to develop resources, implement programs, or influence policy change at the community level for this group of marginalized women. Keeping women healthy throughout the aging process, including menopause, improves their quality of life and decreases the impact aging has on the health care system. This phenomenological study, through in-depth interviews, provided the opportunity for sedentary women to share their thoughts and experiences of menopause. Thirteen sedentary women between the ages of 40 and 60, experiencing at least one sign of menopause and residing within a rural community in Canada, participated in the study. Analysis of the data generated themes to support and describe their experience of menopause. For this group of sedentary women, menopause signaled a significant life change, impacted by a number of internal and external forces over which they articulated varying levels of control. How women reacted to this life change and their perceived amount of control determined whether they described their menopause experience as positive or negative. While the thought of increasing their physical activity level was not appealing, there was a desire for support in numbers. If women were speaking openly about menopause, more opportunities would exist for aging women; participants desired to improve the menopause transition for all women not just women in their circle of friends. Women helping other women, improved public health programs and services, and potential policy change that encourage healthy choices at the group and community level can result in positive social change for menopausal women.

Even with access to well-known breast cancer treatment centers, older African American women continue to have higher breast cancer mortality compared to their European American counterparts. Researchers have theorized relationships among diagnostic delay, socioeconomic status (SES) factors, beliefs, culture, and breast cancer mortality in African American women ages 40 to 64, but these same relationships among African American women ages 65 to 80 have not been investigated. The purpose of this qualitative study was to describe older African American women's experiences with abnormal mammograms. The quality-caring model and critical race theory were used through narration to show the association of structure and process within the context of race. Purposeful, criterion-based sampling was used to select and interview 12 African American women ages 65 to 80 who had an abnormal mammogram result after breast cancer screening (BCS) within the previous 2 years. Through narrative analysis with triangulation it was demonstrated that clinical and social systems within the process of BCS affected the women's perceptions of providers and outcome. Their independence, motivation, health outlook, and spiritualistic beliefs kept them adherent to BCS and longterm follow-up. Health promotion activities were supported by family, friends, and spirituality. Variations in mammography practices and poor provider communication were obstacles to health maintenance. Positive social change is supported through health care providers' understanding of the barriers that impede older African American women's follow-up of abnormal mammogram results. Removing these barriers may assist in the reduction of breast cancer mortality.

Despite decades of important contributions by male nurses, nursing is still viewed as a feminine profession. Moreover, male nursing students continue to experience gender bias and gender-based educational barriers within schools of nursing. This has led to failure and drop-out rates much higher than those experienced by their female counterparts. The purposes of this quantitative survey study were to (a) explore the relationship between perceived gender bias, gender-based educational barriers within nursing education, and resiliency in recent male nursing graduates; and (b) to identify those gender-based barriers that were considered to be most prevalent and most important. A view of gender from a social constructivist approach framed the study. Two previously validated data collection tools, the Inventory of Male Friendliness in Nursing Programs-Short(c) (IMFNPS(c)) and the Brief Resilience Scale(c) (BRS(c)) were used to gather data from recent male nursing graduates (N = 97). The results demonstrated no significant correlation (Spearman rho = 0.1025, p = 0.3178), between mean scores on the IMFNPS and the BRS; however, overall mean resilience scores were high (M = 3.90, SD = 0.62). The gender-based educational barriers identified as being most prevalent and most important included (a) curriculum did not include a discussion of the historical contributions of male nurses, (b) clinical experiences were limited during the obstetrical rotation; and (c) male students feared that they would be accused of sexual inappropriateness when providing nursing care for female patients. Positive social change can occur for male nursing students if the most prevalent gender-based barriers are minimized or eliminated, men are provided with the appropriate skills to care for female patients, and resilience education is included within all nursing curricula.

In recent years, several schools have addressed the No Child Left Behind (NCLB) Act of 2001 by focusing on promoting skill acquisition in reading and math, often overlooking physical education (PE) as a significant part of a child's education. The purpose of this causal-comparative study was to evaluate the effectiveness of an integrated health and physical education (HPE) program on student achievement. This study was grounded in action-based learning theories. The research question examined differences in posttest scores, adjusted for pretest differences, from 204 freshman students enrolled in a Biology-1 class at an urban high school. Students in Group A were enrolled in Biology-1 and an HPE class that incorporates Biology-1 content. Students in Group B were enrolled in Biology-1 but were not in a HPE class; thus, they did not participate in the integrated HPE program. An analysis of covariance (ANCOVA) was used to determine whether the integrated PE program increased student achievement in Biology-1. The findings showed that there was a significant difference between the two groups (p < .05). The Biology-1 students who participated in the integrated HPE program scored significantly higher on the Biology-1 state test than the Biology-1 students who did not participate in the integrated HPE program. These results may influence educational decisions regarding the use of HPE by encouraging serious consideration of an integrated HPE program, which could enhance student achievement, thus promoting positive social change.

Obesity increases risk for heart disease, hypertension and other chronic diseases, and it affects minority ethnic groups disproportionately. However, it is unknown if African American immigrant adults, an increasing segment of the population, are at higher risk for obesity than African American non-immigrant adults residing in the United States. This study examined the association of obesity and immigrant status by comparing African American immigrant adults now residing in the United States to the general population of African American adults. The socio-ecological model provided the conceptual framework for this study. This study used a cross-sectional quantitative self-administered web-based survey to collect primary data on 303 adult African American immigrants and non-immigrants residing in the United States. Data were analyzed using EpiInfo statistical software. It was hypothesized that the risk of obesity in African American adults is associated with immigration status after adjusting for other factors. The data revealed no significant relationship between obesity and immigration status in African American adults. However, binge drinking and other variables were revealed to be risk factors for morbid obesity in African American immigrants. The results impact social change by demonstrating that obesity control programs targeted at African American immigrant communities should incorporate socio-ecological risk factors. Specific interventions that could be implemented should include screening for alcohol consumption.