The purpose of this study was to investigate the behavioral impact of knowledge regarding the relationship between breast cancer, vitamin D supplementation, and sunlight exposure considering levels of self-efficacy and response-efficacy. The study was based on protection motivation theory, which attributes behavior change to cognitive processes related to perceived threats and has demonstrated efficacy in promoting breast cancer risk-reducing behaviors. The study employed a quasi-experimental research design based on a survey using SurveyMonkey. Participants were New York City-residing women ranging in age from 25 to 74 who were recruited via an invitation from SurveyMonkey. Correlation analysis and linear regression analysis were performed on the data extracted from the survey in order to better understand the relationship of the variables in this study, and to test if any of the independent variables were significant predictors of vitamin D intake through supplementation and sunlight exposure. The results of this analysis showed that knowledge regarding the reduction in risk of breast cancer from sunlight exposure and through vitamin D supplementation was not related to changes in behavior involving increases in sunlight exposure and vitamin D intake through supplementation. Further, the results showed that those participants with higher levels of self-efficacy and response-efficacy regarding sunlight exposure and vitamin D supplementation had an increased amounts of vitamin D intake through supplementation on a daily basis. The results of this study can be used to help medical professionals understand the complexity involved in how their clients may or may not take action to reduce the potential for reducing the risk of breast cancer.

The use of human immunodeficiency virus (HIV) counselling and testing (HCT) is a necessary component of implementing HIV prevention and control programs in Nigeria. Knowledge, acceptance, and use of HCT remain low in Nigeria, especially among young people ages 15 to 24 years. The purpose of this study was to ascertain how sociodemographic factors (i.e., gender, place of residence, level of education, geopolitical zone, and socioeconomic status [SES]); cognitive factors (i.e., HCT awareness, knowledge of HIV prevention, and knowledge of HIV transmission); and knowledge of sexual risk behaviors affected HCT uptake among young people in Nigeria using data from the 2013 National HIV/AIDS and Reproductive Health Survey Plus. The study was guided by the social cognitive theory. The sample was composed of 10,091 young people ages 15 to 24 years from all geopolitical zones, SES, and educational backgrounds in Nigeria. Multiple regressions and multivariate comparisons revealed a significant relationship between HCT awareness and HCT uptake (p < .001) and between knowledge of HIV prevention and HCT uptake (p < .001). Sociodemographic variables of gender, place of residence, level of education, geopolitical zone, and SES were also significantly associated with HCT uptake. The sexual risk behavior variables tested were not significantly associated with HCT uptake among young people in Nigeria. The implications for positive social change include providing public health professionals with data to plan and implement HCT awareness and knowledge programs for young people in Nigeria that could increase HCT uptake and reduce the incidence of HIV/AIDS.

Obesity, a public health issue in the United States, has been linked to numerous chronic diseases. A gap exists in the literature related to racial and cultural etiology of body satisfaction for obese women. The purpose of this qualitative phenomenological study was to describe the racial and cultural etiology of body satisfaction for obese Black women and White women residing in a rural area of the state of North Carolina. Social comparison theory provided the theoretical underpinning for this examination. The central research question was how do obese, young adult Black women and White women describe their perceptions about and experiences of the racial and cultural etiology of their body satisfaction. One-on-one interviews were used to collect data from 6 obese young adult women (3 Black women and 3 White women) between the ages of 18 and 29 years residing in a rural area of North Carolina. Braun and Clarke's 6-phase method for thematic analysis was used to analyze the data. Six themes emerged from the data analysis: (a) Black participants viewed the media through a lens of body positivity, (b) White women related media influences as confrontation with the media, (c) Black women related peer influences to include shaming and denial, (d) White women viewed peer influences as including negative comparisons and positive examples, (e) Black women related family influences to include normalizing obesity, and (f) White women related family influences as including one welcoming the outcast. The results of the study foster positive social change, as deeper understanding of racial and cultural differences regarding body satisfaction of Black women and White women could lead to positive body image and greater body satisfaction among these groups.

The lack of access to improved toilet sanitation remains a major health and environmental hazard in developing nations in the world. Despite global leadership efforts at the level of the United Nations and nongovernmental organizations around the world, diarrhea-related diseases disproportionately affect children. Evidence from the literature suggests that competent and sustained leadership is central to resolving the problem. From a historical perspective, leadership advocacy and engagement prompted the sanitary revolution in the West in the 18th and 19th century that led to the eradication of preventable infectious diseases such as cholera. Integrated leadership that made use of sanitation and water institutions at the national, state, and local levels and structured, skilled, and financial capability helped create an enabling environment for better and sustainable hygiene sanitation in the West. A qualitative approach was used to explore the role of collaborative leadership in enhancing the demand for toilet hygiene in rural Njinikom and the community's perception of the state of sanitation. One-on-one interviews were conducted with 25 adults aged 18 years and above with knowledge and exposure to poor toilet sanitation. Content analysis was used to develop themes and patterns from the data. The findings revealed barriers such as inefficient leadership and limited financial resources that impede adequate feces disposal and motivating factors for better sanitation. The results provided support for a partnership approach that is inclusive, relevant, useful, and sustainable. The implication of the study includes renewed interest in improving toilet sanitation and health and increase understanding of the importance of adequate feces disposal in preventing and eliminating associated fecal-oral diseases.

The incidence and prevalence of food safety practices among food staff working in food establishments in Manitoba is underrepresented and has not been adequately reviewed and researched. Uncertified food staff are at higher risk of not following food safety practices that can cause contamination of food and result in foodborne illness. The purpose of this quantitative study was to determine the prevalence of food safety practices among food staff in Manitoba and to determine the relationship between food safety certification and routine health inspections. Pender's health promotion model and Bandura's social cognitive theory were used to explain the relationships and associations between variables. Archived data dating from 2012 to 2014 of health inspection reports on 558 food establishments were collected and analyzed using the Manitoba Health Hedgehog database. Chi Square, Pearson Correlation Coefficients, and Fisher's Exact Tests revealed the association of food safety practices, routine health inspections, and food safety certification. Results indicated no statistical difference between food safety practices and routine health inspections. Pearson's r analysis revealed a weak relation between routine inspections, internal temperature, thermometer use, and food storage/food protection noncompliance. Logistic regression analysis revealed that food safety certification was not a predictor of food safety practice compliance. This study can provide a bridge to reevaluate current health policies pertaining to food safety practices in Manitoba. This study adheres to the need for social change in establishing and creating prevention programs for food staff. Food safety programs can safeguard the food industry and protect public health from foodborne illnesses.

Sexually transmitted diseases (STD) are preventable conditions for which treatment failure (specifically in gonorrhea) is becoming problematic. U.S. young adults (20-29 years) have high rates of STD incidence and prevention of these diseases, but reaching them to provide primary prevention educations is challenging due to low perceived susceptibility to infection and lack of knowledge about how young adults seek health information. The purpose of this quantitative survey study was to assess the association between perceived susceptibility to STDs, sexual risk behavior, and the acquisition of health information as it pertains to sexual health topics in young adults. The Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) were used in combination as the theoretical foundation of this study. Data collection was done using an adapted version of the Health Information National Trends Survey (HINTS), the Condom Use Self Efficacy Scale (CUSES), and an adapted version of the Marin County (California) Health Department's Sexual Risk Survey. There were 128 eligible participants and analysis of the data showed that the internet was the primary source of both general health information (87.5%) and STD specific health information (75.8%). A multiple regression analysis showed that there was no statistically significant correlation between perceived susceptibility and health information seeking or sexual risk (p > .05). This can aid in positive social change by prompting additional research on the subject of STD prevention in young adults through the design and dissemination of tools for education that may reduce the rate of STDs or other health ailments.

Limited knowledge exists about sexual orientation and intimate partner violence among women who have sex with women. These women are at risk for adverse physical and mental health hygiene outcomes that may result from unhealthy lifestyles secondary to intimate partner violence. The purpose of this study was to examine the association between sexual orientation and intimate partner violence among women who have sex with women. The constructs of the biopsychosocial model guided the study and examination of the relationships among biological factors (sexual orientation), social contexts (support of family and friends and use of community services), and psychological influence (mental health status) on intimate partner violence among women who have sex with women. The study was a quantitative cross-sectional analysis of archived data from the 2010 National Intimate Partner and Sexual Violence Survey. Forward stepwise logistic regression indicated a statistically significant relationship between sexual orientation and intimate partner violence victimization (p < .05) Annual household income, race, family/proximal support, and support of community were significant predictors of intimate partner violence victimization. The social change implications of the study are that findings may inform design and implementation of policies, services, and interventions that target the diverse needs of female same-sex intimate partner violence victims.

Health literacy, defined as the ability to understand and use health information to make informed decisions, is critical to maintaining health; however, not all U.S. states mandate strategies to improve adolescents' health literacy. Moreover, many middle school teachers are often unaware of how their roles could improve the health literacy of their students. Multimodal literacies help students to create meaning through viewing print-based resources and using digital technologies. The purpose of this study was to investigate teachers' perceptions of the effectiveness of multimodal literacies on adolescents' overall health literacy via the introduction of health literacy programs into the curriculum. This qualitative research data were gathered, analyzed, and categorized using unstructured narrative interviews and the research was guided by the socioecological model. A phenomenological approach was used to conduct in-depth interviews with 6 middle school teachers. These interviews yielded 4 common themes: efficacy of multimodal literacy, health literacy, blending cultures, and responsibility. The results suggested that (a) multimodal literacies with adolescent literacy components can be used in the middle school curriculum, and that (b) these literacies can help inform policy changes. Understanding teachers' perceptions about multimodal literacy could help to improve adolescent health literacy in the middle school system. Positive social change could occur if school systems understand the utility of incorporating adolescent health literacy in the present curriculum. Doing so could help reduce future health care costs and improve the future health of students.

Access to and receipt of health care is an essential human right; however, transgender people often have negative health seeking experiences that give way to the many health disparities seen in the transgender community. Using the social ecological model, this study determined, through multiple logistic regressions, that correlations existed between socioeconomic, health behaviors, and sociocultural variables and 6 measures of health seeking experiences among transgender African Americans. Secondary data from the 2010 National Transgender Discrimination Survey were used, yielding a sample size of 253 transgender African Americans. Those in the African American transgender community at most risk for negative health seeking experiences had the following characteristics: (a) earned high school diplomas and beyond, (b) were in the workforce or looking to be in the workforce, (c) earned an annual salary exceeding $10,000, (d) did not want hormone therapy, (e) abused alcohol and drugs, (f) attempted suicide, (g) were uninsured or had public insurance, (h) were out in a medical setting, (i) were homosexual, (j) had family support, (k) were homeless, (l) were older in age, (m) self-identified as transgender before 18, (n) received first transgender related medical treatment after 17 years old, (o) lived outside of the New England region, and (p) preferred other health settings than emergency rooms. Exploring this aspect of transgenderism and health care has potential for positive social impact as results from this study could improve the lives of transgender African Americans by combating transphobia among health professionals and promoting culturally competent health care.

Immunization protects millions of children. Yet, many children drop out of immunization in Jigawa State of north Nigeria. This cross-sectional quantitative correlational study based on the Health Belief Model was designed to determine whether the dropout from routine immunization (RI) was influenced by low rate of reporting of adverse events following immunization (AEFI) to health facilities by caregivers. Primary data was collected from 307 caregivers with dropout children using structured interviewer-administered questionnaire. The data were analyzed using logistic regression and descriptive statistics. The results showed that 61.3% of the children had AEFI and dropped out. Rate of reporting of AEFI to health facility was low (23.1%). This significantly influenced the dropout (95% CI; p <.001; ï?£2 = .028; OR = 2; AOR = 6). Children with AEFI were 2 times more likely to be dropouts than their counterparts with no episode of AEFI. Children with AEFI of loss of appetite or persistent crying were 4 times more likely to drop out of immunization. The place where one sought treatment for AEFI was strongly associated with the dropout (95% CI; p <.001; ï?£2 <.001). Those who sought help outside health facility were up to 5 times more likely to drop out of immunization compared to health facility treatment. Caregivers were of the view that, they would be able to improve their reporting of AEFI to health facilities for treatment and eventually complete the immunization of their children if they receive good education on immunization and the need to report AEFI to health facility. Findings of this study if appropriately disseminated could lead to positive change initiatives of preventing vaccine diseases by increasing the uptake of complete immunization through education on immunization and inclusion of caregivers' ideas in immunization interventions.