<p> This study examines the impact adult supervision, role models, and civic engagement has on the health status of adolescents. The dependent variable was health status of adolescents. The independent variables were adult supervision, role models, and civic engagement. The results revealed that adult supervision is related to the health status among adolescents. Specifically, adolescents whose parents were married are more likely to report excellent to very good health. Adolescents who do not live with both parents are more likely to report that they feel hopeless and restless. One of the most consistent predictors of adolescent health status in the area of adult supervision was frequency of an adult around after school hours. Another consistent predictor of health status among this population was gender. Being female was related to worse health status among adolescents. Role model was also a predictor of excellent to very good health status among adolescents.</p>

<p> Human Immunodeficiency Virus (HIV) remains a serious public health issue, and many social factors are involved in virus transmission and treatment. The current conceptualization of how HIV status disclosure and perceived stigma of HIV diagnosis interact is undeveloped. This study was based on social cognitive theory and tested hypothesized positive relations between HIV serostatus disclosure, social support, and self-efficacy. In addition, self-rated HIV stigma was examined as a potential mediating variable. Participants were 109 HIV positive, mostly White gay men recruited via an online bulletin board. They completed the medical outcomes study social support survey, the general self-efficacy scale, the HIV stigma scale, a HIV serostatus disclosure questionnaire, and a demographic questionnaire. Linear regression revealed that social support significantly and positively predicted HIV serotatus disclosure. HIV stigma mediated this relation by lowering the perception of support. Sexual orientation disclosure significantly and positively predicted HIV serostatus disclosure and social support. It is recommended that future research examine the impact of HIV stigma in different groups (racial and sexual minorities, and women). Culturally-sensitive assessments may also be used to measure individual levels of perceived stigma, HIV status disclosure, and social support. Action for social change includes raising general public awareness regarding HIV misconceptions, such as transmission risk; lowering stigma and raising support through public education; and increasing sexual minority status self-identification via outreach in low self-disclosure communities.</p>

<p> The development of new medical treatments for patients is limited by the challenges of recruiting clinical-research participants. In the United States, the Food and Drug Administration regulates the multidimensional approval process for new drugs, biologics, and medical devices to ensure consumer safety. The regulatory approval processes includes complex clinical trials that necessitate either healthy volunteers or patients who are willing to participate. The low enrollment rates of volunteers and patients willing to participate in clinical trials are resulting in significant delays in bringing new treatments to the market and substantially increasing development costs, for which consumers ultimately pay. The available research indicates that young adults and adolescents represent two of the lowest participating groups in clinical trials. Even though they are the next generation of consumers and patients, little to no research has examined the adolescent and young adult populations and their knowledge and perceptions of clinical research or their willingness to participate in clinical trials. Understanding these populations' perspectives and knowledge of the drug-development process and providing education regarding on this issue may have a profound, positive trickle-down effect on medicine, their personal well-being, and the well-being of the general public. </p><p> This study used a simple experimental design consisting of an intervention group and a control group. The intervention was a 10-minute educational video on participation in clinical research. Adolescents and young adults (<i> n</i> = 527) were randomly distributed into the two groups. The knowledge, perceptions, and willingness to participate in clinical research were measured in both groups utilizing a 31-question survey instrument. The findings from this study may be used by educators, health care providers, patient advocacy groups, payers, and the pharmaceutical research and development industry to determine the best methods for educating adolescents and young adults on clinical research and trial participation. </p><p> The study concluded with a discussion of the importance of the role of leadership in social change and the process of igniting and sustaining such change. This process includes how, historically, public and private interests have come together to positively influence important public-health initiatives and, in turn, social change that holistically benefited all of society. Moving forward, leadership for social change could potentially deliver new and improved medical treatments in a timelier manner.</p>

<p> How does a drug with a limited safety and efficacy record become an international blockbuster? In June 2006 the FDA approved and recommended a new vaccine directed against 4 types of sexually transmitted human papillomavirus, associated with 70% of cervical cancer cases and 90% of genital wart cases. Branded as a "cervical cancer vaccine" Gardasil has been met with as much fanfare as controversy, and retains blockbuster status in Merck's portfolio. Sold as a cancer risk-reduction method, Gardasil carries its own risks, with startlingly low efficacy and elevated likelihood of serious adverse events (side effects). Through the lens of risk, this dissertation examines Gardasil's popularity in the face of evidence that it is neither as safe nor as effective as advertised. Through three distinct research projects, I identify (a) five sociological factors responsible for Gardasil's success on the heels of Vioxx, one of the biggest drug scandals in history; (b) how amongst healthy vaccinated girls, cervical cancer is experienced as a "risk object," yet when a young woman experiences a serious adverse event that "object of risk" and her "experience of risk" shift toward Gardasil; and (c) that Gardasil is so trusted among young women, that warnings about potential side effects from others made some girls more likely to get vaccinated and have a positive opinion on the vaccine, suggesting that Gardasil benefits from a broader cultural assumption that vaccines are inherently safe and effective. Physicians and pharmaceutical marketing also play an important role. Gardasil is a risk-reduction drug and vaccine purported to treat risk while it simultaneously creates new risk for further health problems in some consumers. This dissertation contributes to sociological literatures on pharmaceuticalization, pharmaceutical pseudoscience, the social construction of risk, research on regulatory agencies, and the sociology of medicine more broadly.</p>

<p> Obesity and substance abuse are two major public health issues in the United States, especially among low-income individuals. The United States Department of Health and Human Services has set forth the <i>Dietary Guidelines,</i> which encourage a diet rich in fresh fruits, vegetables, whole grains, legumes, lean meat, and low-fat dairy to help Americans obtain a healthy body weight. Substance abusers in recovery are at increased risk of weight gain, as their previous addiction may continue with the substance shifting from drugs or alcohol to sugary or high fat food. Nutrition interventions have been beneficial in recovery by improving outcomes and preventing relapse, however, possible barriers to obtaining fresh, healthy food items have been noted. There is limited research investigating females, especially mothers, in recovery and their access to healthy food items. The current study utilized a demographic survey and multiple Household Food Inventories (HFI) to assess the amount and variety of food items of mothers and their children in a residential substance abuse recovery facility. A sample of 11 mothers in rural, eastern North Carolina completed the survey and two separate HFI, two weeks apart to account for intra-monthly variability. Demographic information was entered into Statistical Package for the Social Sciences [SPSS] while HFI data were coded and categorized in Microsoft Excel. Results included all 11 mothers participated in at least two different federal food assistance programs, stated they face challenges grocery shopping, and seven households were food insecure. Fresh vegetables were slightly more common in households than fresh fruits, and canned, frozen, and packaged fruits (especially fruit juice), vegetables, and legumes, were more prevalent than fresh forms. Cheese was the most popular form of dairy, and most was full fat. The majority of protein was red meat or breakfast meat including bacon and sausage. Whole grain was less common than white, refined grain products. There was an abundance of pre-packaged, convenience food including chips, ice cream, cookies, and cakes. The results indicated that the HFI on two separate occasions was beneficial to explain variability among types and amounts of food items from one assessment to the next, especially among fresh fruits, fresh vegetables, and chicken. The lack of fresh fruits, vegetables, low-fat dairy options, lean meats, and whole grains in combination with copious sweetened, pre-packaged, high-fat food items form a diet associated with obesity and contradictive of the <i> Dietary Guidelines.</i> Possible barriers to obtaining healthier food options may include low or fluctuating income and federal assistance benefits, limited transportation, decreased storage space, infrequent grocery trips, or a lack of nutritional knowledge. Mothers and children in recovery could benefit from nutrition education and improved access to healthier food items. Future research should further investigate the barriers to obtaining fresh, healthy food items, as well as shifts in addiction from substance to food, food choice, disordered eating patterns, and subsequent weight and health issues to guide nutrition interventions for mothers and children in substance abuse recovery facilities.</p>

<p> <b>BACKGROUND:</b> Children with Special Health Care Needs (CSHCN) increasingly live into adulthood, and every year approximately 500,000 American youth transition from pediatric to adult health care system. Health Care Transition (HCT) for Youth with Special Health Care Needs (YSHCN) has emerged as a significant event in the life course of this population. The overarching goal for HCT is to provide high quality, coordinated, uninterrupted health care which is responsive to the needs and desires of the patient. Although improvements have been seen in health care quality of the general population, differences still persist in health care quality among CSHCN in racial and ethnic minority groups. Children with Intellectual and Developmental Disabilities (ID-DD) are an important subpopulation of CSHCN because of their increasing prevalence due to autism and attention deficit hyperactivity disorder, high service needs, cost, and societal impact. A few researchers have focused on transition preparation for all YSHCN, but not on racial and ethnic (e.g., African American, Latino) disparities in health care transition and quality for youth ages 12-17 with ID-DD. <b>OBJECTIVE:</b> The purpose of this study was to explore the racial and ethnic disparities in transition to adult health care and quality of care for youth ages 12-17 with ID-DD. <b>METHODS:</b> The 2009&ndash;2010 National Survey of Children with Special Health Care Needs is a nationally representative sample with 17, 114 respondents (parents of CSHCN) ranging in age from 12 to 17 years old. They were asked about transitioning to an adult provider, changing health care needs, maintaining insurance needs, and increasing responsibility for self-care. They were also asked about having a personal doctor or nurse, doctors spending enough time with them, doctors listening carefully to the parent, providers showing sensitivity about family values; the parent receiving enough information from the doctor, and the doctor making the parent feel like a partner. The researcher analyzed the association of selected characteristics with successful transition and quality of health care for White, Black, and Latino children ages 12-17 with ID-DD. The study was guided by Andersen&rsquo;s (1995) <i>Behavioral Model of Health Care Use.</i> Bivariate analyses were conducted and consisted of seven chi-square analyses. For each chi-square analysis, the data split to include only children with ID-DD. <b>RESULTS:</b> The study was comprised of youth with ID-DD ranging in age from 12 to 17 years old, with an average mean age of 14.55 years old (M=14.55, SD=1.74). Results of the chi-square analysis indicated the proportions of children transitioning to adult health care for each ethnic group were not significantly different than expected (&chi;²(3) = 5.41, <i>p</i> = 0.144). Results also indicated that only four percent of children with ID-DD successfully transitioned to adult health care. Four of the six chi-square analyses related to the quality of health care were indicative of significant deviations from expected responses (doctors and other health care providers spending enough time with the child &chi;²(12) = 79.74, <i>p</i> &lt; 0.001; listening carefully (&chi;²(15) = 63.42, <i>p</i> &lt; 0.001); showing sensitivity to family values (&chi;²(15) = 34.44, <i> p</i> = 0.003); and making the family feel like a partner in care (&chi;²(12) = 33.89, <i>p</i> &lt;0 .001). A multiple linear regression was conducted to determine the relationship between the occurrence of an intellectual or developmental disability and the transition to adult health care, while controlling for predisposing (e.g., race and ethnicity, gender, parents education, and family structure), enabling factors (e.g., family income, health insurance status, and patient-centered medical home). A preliminary <i>F</i> test on the regression indicated a significant model fit (<i>F</i>(12, 10,387) = 67.76, <i>p</i> &lt; 0.001). Furthermore, a multiple linear regression was conducted to determine the relationship between the occurrence of a disability and the quality of health care, while controlling for predisposing and enabling factors. The preliminary <i>F</i> test indicated a significant model (<i>F</i>(12, 17,101) = 328.62, <i>p</i> &lt; .001). <b>CONCLUSIONS:</b> Youth with ID-DD, particularly those who are Latino and Black, face greater challenges in transitioning to adult health care and receiving a quality of care compared to other children with special health care needs in the United States. Addressing specific medical home components might reduce racial and ethnic disparities. Future research that examines the association between the HCT and family/professional partnerships in family-to-family health information centers (ACA 5507(b)) will be needed to ensure quality outcomes for youth with ID-DD.</p>

<p> <b>Background:</b> The widespread use of mammography, and its lack of specificity in younger women with denser breasts, increases the potential for a large number of biopsies and surgeries performed in women without breast cancer. Once a suspicious breast lesion is identified with mammography, the use of minimally-invasive breast biopsy (MIBB) as the initial tissue acquisition method for diagnosis is widely supported and advocated as best practice. This research focused on the utilization of MIBB techniques and surgical breast procedures to diagnose image-detected suspicious breast lesions, particularly those lesions ultimately diagnosed as benign, in an effort to better understand the quality and cost implications unnecessary surgical care. <b>Methods: </b> This retrospective cohort study evaluated the practice patterns of a variety of physicians in multiple facilities and physician offices across the country for MIBB and open surgical procedures to diagnose image-detected suspicious breast lesions among a cohort of well-insured women younger than 65 years old and eligible for TRICARE (the U.S. military's health benefit). Additionally, mean total costs were calculated to estimate the cost advantages of one initial tissue acquisition procedure versus another and how these costs were impacted by final diagnosis. <b>Results:</b> In total, 80 percent of the episodes began with the less-invasive MIBB, and 20 percent began with an open surgical procedure. Approximately 77 percent of the episodes using MIBB as the initial diagnostic technique were ultimately diagnosed as benign, as compared to a benign diagnosis in 82 percent of episodes initially utilizing open surgical biopsy and in 20 percent of episodes where other definitive surgery was the initial procedure. In total, potentially unnecessary surgery accounted for 15 percent of all cases requiring follow-up biopsy after abnormal mammography. The strongest predictors for the initial use of an open surgical procedure to diagnose a suspicious breast lesion that was ultimately diagnosed as benign were a lesion indicating benign atypia after diagnosis, patient age younger than 40 years old, a military physician performing the initial procedure, and a physician in the Midwest performing the initial procedure. On average, the excess cost associated with the use of surgical biopsy over MIBB as the initial procedure was 3 percent (ranging from 3 to 30 percent), but increased to 70 percent (ranging from 70 to 235 percent) for episodes ultimately diagnosed as benign. <b>Conclusions:</b> The use of surgical procedures to diagnose suspicious breast lesions is declining as the appropriate use of less-invasive MIBB techniques is growing. However, the variation in the utilization of these diagnostic techniques, particularly among younger women and among certain groups of physicians, results in a large number of women undergoing inappropriate surgical diagnosis of suspicious lesions that are ultimately diagnosed as benign. Policies are needed that promote the dissemination of comparative information to physicians about practice patterns, the use and monitoring of physician-level measures of compliance with care standards, payment policies that incentivize physician-level decision-making for high-value care, and balanced information sharing between physicians and patients about the harms and benefits of mammography screening.</p>

<p> The purpose of this project was to identify and create a program that would meet the needs of a target population, identify potential funding sources, and write a grant to fund a program at St. Mary's Hospital in Long Beach, California. An examination of the literature expanded knowledge about the challenges homeless individuals face. Homeless individuals commonly receive inadequate medical care and often access more costly acute care services due to limited resources, discrimination, and cost. Housing and case management services after discharge from a hospital setting can help improve health care outcomes and reduce costly services.</p><p> The program was designed to provide specialized discharge planning services to homeless individuals being discharged from St. Mary's Hospital. The California Wellness Foundation was chosen for this grant based on the program areas of the funder. The actual submission and/or funding of this proposal was not a requirement for completion of this project.</p>

<p> This secondary data analysis utilized pre-existing data from the 2007 California Health Interview Survey (CHIS) to explore associations between knowledge, awareness and attitude of Hispanic women on Human Papillomavirus (HPV) infection. The study also analyzed the relationship between demographic factors (age, poverty level, and duration of stay in the United States) and their knowledge, awareness and attitude of HPV infection. The study sample consisted of 351 Hispanic women ages 18 to 26 years old. The findings revealed that women who administered the Pap smear test are more likely to decrease their risk of contracting HPV infection and cervical cancer. In addition, findings showed that knowledge, attitude and awareness on HPV encouraged women to administer the HPV vaccine.</p>

<p> The purpose of this study was to examine the demographic differences in methamphetamine usage among youth and how methamphetamine users engaged in the use of other illegal drugs including, marijuana, cocaine, heroin, ecstasy and also engage in risk taking behaviors. The study utilized secondary data from the National Institute of Health, Youth Behavioral Risk Survey (YRBS) of20011. Sample size consisted of 294 both male and female youth who are methamphetamine users. The findings revealed that drug use amongst youth continues to be on the rise. Findings noted that male meth users had the highest rates of cocaine, ecstasy and heroin use compared to female meth users. The highest rate among female meth users was seen in cocaine use. Findings also revealed that cocaine use was the highest among Hispanic/Latino meth users and ecstasy use was the highest among Non-Hispanic/Latino meth users. In addition findings revealed that a significant association was found in youth's drug use and their involvement in risk taking behaviors. Prior research and findings from this study help society have a more proactive approach when helping youth who suffer from the disease of addiction.</p>