High blood pressure (hypertension) is known to be one of the leading factors that directly contributes to heart disease and stroke, which are the first and third leading causes of disabilities and death in the general U.S. population. The prevalence of high blood pressure among African American men in the United States ranks as one of the highest in the world. Research indicates the roots of this phenomenon are found in physiological, psychosocial, cultural, and socioeconomic factors differentially affecting the African American population. The purpose of this study was to examine the interaction between African American males' masculine perspective and the lifestyle and clinical dictates essential to self-management of hypertension. This qualitative study used social cognitive theory and health service utilization as its theoretical foundation. The research questions that guided the thematic analysis of the qualitative interview data centered on psychosocial/risk factors, sustaining self-management, and common themes gathered from individual interviews with ten African American men ages 40-65 years with a medical diagnosis of hypertension. Responses were transcribed, and data were analysed by using NVivo 10 to identify reoccurring themes. The dominant themes were perceptions of discrimination, lack of trust and miscommunication with providers, and self-care behaviors associated with masculine identity. The results of the study did not necessarily present new findings but support that efforts are needed by professionals to craft innovative approaches to education and support for African American males with chronic diseases. This study influences positive social change by helping health providers grasp a better understanding of how African American males' views of masculinity and race influence hypertension-related behaviors.

Childhood obesity is a major issue in the United States. The rates of obesity vary among racial and ethnic groups in the U.S. South. The purpose of this quantitative cross-sectional study was to investigate significant state health disparities differences in childhood obesity in the South region between Florida and Georgia. To steer this study, the social cognitive theory was used. The associations between neighborhood safety and support, physical activity, family health and activities on body mass index were examined in this study. Data was obtained from the National Survey of Children's Health 2011-2012 on 1,688 children aged 10-17 years residing in Florida and Georgia. Logistic regression models showed children in Georgia were 1.4 times more likely to be overweight/obese than children in Florida. Significant differences were found in Florida and Georgia for neighborhood safety and support, physical activity, and family health and activities with evidence to reject the null hypothesis for each state separately. There was no evidence to reject significant differences between Florida and Georgia on sociodemographics. Public health professionals could benefit from researchers studying the causes of racial/ethnic and socioeconomic health disparities in childhood obesity. Thus, professionals could use these results to develop programs targeted at minority populations at increased risk. Positive social change implications of these finding could provide more insight on childhood obesity in the South, where more research is vital. This could be achieved through creating state-specific policies, raising awareness, and implementing prevention programs to decrease childhood obesity.

Health care workers are at risk of contracting HIV as a result of occupational exposure while treating infected patients. HIV postexposure prophylaxis (PEP) is an effective antiretroviral treatment course used in preventing potential HIV infection following an accidental occupational exposure to HIV. The objective of this cross sectional study was to identify the factors that impact the practice of HIV PEP among health care workers at the National Hospital, Abuja, Nigeria. A cross-sectional survey using self-administered, structured questionnaires was conducted on 182 health care workers at the National Hospital comprising of medical doctors, nurses, and laboratory scientists. A chi-square test of independence was used to assess the association between knowledge of PEP and PEP use. Logistic regression was used to determine the relationship between PEP use and types of occupational exposure, existing precautionary policies, and fear of stigma. The results of this study were statistically insignificant with variables PEP knowledge (p= 0.274), types of occupational exposures (p= 0.575), awareness of precautionary policies (p= 0.219), and fear of stigma (p=0.282), which could be a result of the small sample surveyed. Nonetheless, this study can lead to positive social change whereby health care workers are well-trained on the practice of PEP after sustaining an occupational injury in order to prevent HIV infection. Factors such as inadequate knowledge on HIV PEP practice, underreporting of occupational injuries, lack of awareness of precautionary guidelines on HIV PEP, and the fear of stigma after an occupational exposure to HIV affect the practice of HIV post exposure prophylaxis. Therefore, more education on PEP for HIV among health care workers is warranted.

Despite a 90% fatality rate and high risk of complications from influenza infection, vaccination coverage remains lower among African American (AA) and Hispanic American (HA) older adults. Health care professionals, families, and older adults are concerned with improving vaccination uptake. The purpose of this study was to examine differences among older adult AA and HA compared to European Americans (EA) on how their personal beliefs and perceptions affect vaccination uptake. The health belief model guided this study. The study research design was a quantitative cross-sectional analysis of the 2009 National H1N1 Flu Survey. Weighed prevalence of vaccine uptake indicated all groups, AA (59%), HA (62%), and EA (69%) were below the Healthy People 2020 goal of 90%. Differences in adjusted odds ratios indicated that compared to EA, AA were 5 times more likely to vaccinate if they perceived a benefit (vaccine effectiveness); however, HA were 3 times less likely to vaccinate even if they perceived vaccine was effective. Both AA and HA were 3 times less likely to vaccinate even if they felt susceptible (planned to get vaccine next season) to the influenza infection. While both groups were more likely to vaccinate if they did not perceive severity (not worried about getting sick with vaccine) or were cued to action by recommendation from their health professional, vaccination uptake was 4 times more likely among HA compared to EA while AA were just slightly more likely. The positive implications for social change include effective strategies to clarify perceptions that increase vaccination rates in racial and ethnic minority groups, and to target health professionals to recommend vaccine uptake for older adults during medical appointments.

A disproportionate number of American Indians are overweight or obese and have a higher risk of other health concerns compared to the general United States population. Researchers conducting anthropometric studies have found that American Indians have higher body mass indices and worse health than most of the general United States population. There is, however, a gap in the literature regarding American Indians' perceptions, beliefs, opinions, and attitudes of obesity and its effects on their health. The purpose of this qualitative study was to determine whether American Indians view obesity as a major health concern. Focus groups and key-informant interviews were the instruments used to obtain this information. The study sample consisted of 30 participants from a local American Indian reservation. Data was coded manually using in vivo coding and focused coding, frequency counts, and cluster coding to generate themes. Results conveyed that participants did not consider obesity as a major concern on the reservation. Issues like the presence of poverty, drugs, and alcohol, combined with the absence of community leadership, community support, and parental education were more of a concern to the study participants. Participants were also concerned with culture and identity changes. This study contributed to positive social change by identifying perceptions put forth by participants regarding obesity and its accompanying risk factors. This study contributed to the missing knowledge of culture-specific perceptions regarding obesity. Study findings about risk factors for obesity among the study population may help public health practitioners create effective public health prevention programs, which may help to slow the decline in American Indian health.

Perinatal experiences of mothers in general have an impact on the well-being of the mother and child. It is however not known what the experiences of Kenyan immigrant mothers are in regards to their culture and immigration status. The purpose of this study was to explore the perinatal experiences of Kenyan immigrant mothers with respect to their cultural background and immigration to the United States. The study approach used for this study was a qualitative phenomenological approach. A total of 20 women participated in the study in a focus group session. Bronfenbrenner's ecological systems theory was used to examine how the different environmental factors around an individual affect them and influence their life as well as decisions. The results of the study showed that the various layers of the ecological system have a significant role in an individual's life, especially when that individual is exposed to a new environment. Future studies should examine the experiences of single, young, and new mothers who do not have a social support system and family around to support them. The findings from this study can promote positive social change by informing the public health community about the issues that arose as well as assisting in developing programs that are geared to this particular group as well as other similar groups that might have similar situations.

In recent years mosquito-borne diseases have reemerged, largely because of pesticide resistance. The mosquitoes develop resistance to pesticides because of broad and repeated uses of pesticides. Preventing the development of pesticide resistance requires proper understanding of the environmental factors potentially associated with the development of the resistance. The purpose of this study was to investigate the environmental factors associated with the resistance to pesticides by the Culex mosquitoes. This correlational study included the analysis of archived data samples (N = 29,794) from the Field Cage Tests results conducted between 2013 and 2017 by a large county public health department. The compartmental model was used to help understand and interpret study findings. To examine the associations between the independent variables (i.e., wind speed, temperature, humidity, time, month, and weather conditions) and the dependent variable (i.e., pesticide resistance), chi-square and multiple logistic regression analyses were performed. The results showed that the odds of mosquitoes developing resistance were 2.1 times higher during high temperatures than at low temperatures [x2(1) = 346.5, p = .000]; the resistance was 1.5 times higher during high humidity than in low humidity [x2(1) = 7.23, p = .007]; and the odds of mosquitoes developing resistance to pesticides in August were 3 times higher than when sprayed in June or July [x2 (2) = 702.606, p = .000]. Study findings may be used to help with the development of more effective methods for vector control thereby reducing the numbers of nuisance and disease-carrying mosquitoes along with a possible reduction in the incidence of mosquito-borne diseases and related human morbidity and mortality.

In the United States, college students face an increased risk of sexually transmitted diseases, sexual assault, and unwanted pregnancy due to experimental sexual behavior compared to individuals who do not attend college. Based on the theoretical framework of familism, the purpose of this study was to examine the relationship between sexual attitudes and familism among college students. Data were collected from nontraditional adult students who attend an online institution of higher education. The Familism Scale and the Brief Sexual Attitudes Scale were used to measure the variables of familism and attitudes about sex. Findings from multiple linear regression analyses indicated a statistically significant relationship between total familism and permissiveness (r = -.265, n = 118, p < .01) and between total familism and birth control attitudes (r = .20, n = 118, p < .05). There was no statistically significant relationship between total familism and communion (r = .094, n = 118, p < .353) or between total familism and instrumentality (r = -.09, n = 118, p = .402). Results may be used to inform community health centers interested in using educational approaches to educate community members and college institutions on how students make decisions about sex.

Homelessness among older women is a growing problem in many metropolitan areas of the United States. Researchers have indicated that health issues and problems accessing basic care are connected. Older homeless women face increased health issues, multiple challenges related to accessing basic care, and low incomes which put them at higher risk of becoming homeless, staying homeless, and delaying medical treatment. The homeless who lack fulfillment of social support and timely medical care are considered repetitive users of the emergency department and hospital stays. The purpose of this phenomenological study was to explore the experiences and beliefs of older homeless women with system access. The research questions were focused on what the study participants knew about healthcare system access, their personal experiences, and linked uses of access with healthcare services, as well as, negative barriers and enablers. Guided by the theory of disengagement, face-to-face in-depth interviews with 12 homeless women ages 45 and above was performed. Content analysis was used to analyze responses from interviewees. Findings included the lived experiences and beliefs regarding healthcare services linked with personal health, barriers related to healthcare services, and enablers toward healthcare access. The results of this study produced needed insights on how to shift public and persuasive support methods to meet changing health needs and desires of older homeless women. This study may lead to positive social change through gained knowledge of the personal experiences, beliefs, attitudes, and perceptions of older homeless women.

Methicillin-resistant Staphylococcus aureus (MRSA) strains have spread in Saudi Arabia, increasing morbidity, mortality, and financial burdens. Recent studies have suggested the phenotyping methods typically used to classify MRSA as either health care MRSA (HA-MRSA) or community-associated MRSA (CA-MRSA) cases are unreliable, because they lack concordance with the results of genotyping. Yet the expense associated with genotyping precludes its use in the Saudi Aramco population in Saudi Arabia. The absence of a standardized and affordable method to classify MRSA into CA-MRSA and HA-MRSA has been a challenge for infection control programs in Saudi Arabia. The objective of this quantitative, secondary data analysis was to determine the most reliable phenotyping approach to strain identification using John Hopkins Aramco hospital data. The ecological and antibiotics selection pressure theories framed this research. The results of concordance, and sensitivity and specificity tests, suggested hospital admission profiles and susceptibility pattern were the most reliable phenotypic predictors of genotype-based classifications. Multiple logistic regression for susceptibility pattern (OR = 15.47, p < .001) and hospital admission profile (OR = 2.87, p = .008) confirmed those results, whereas all other variables were not found to be statistically significant. These results can be used to clarify the epidemiological and molecular factors that affect the transition of MRSA from health care facilities to the Saudi Aramco community. Implications for positive social change include faster and more reliable classification of MRSA to aid in disease surveillance and the selection of appropriate treatments to reduce MRSA-related morbidity and mortality.