Adventists following a plant-based diet have half the prevalence and incidence of type 2 diabetes than nonvegetarian Adventists. This study used a quantitative, correlational study design to assess if there was a significant difference in type 2 diabetes prevalence rate between Adventists and non-Adventists preprogram, and if there were significant differences in biometrics between Adventists and non-Adventists with diabetes pre- and post-Complete Health Improvement Program (CHIP). This study incorporated the social ecological model for its conceptual framework and examined pre- and postprogram changes among Adventists (n=210; 20.1%) and non-Adventists (n=836; 79.9%) with type 2 diabetes. It used secondary data from participants in the volunteer-delivered CHIP intervention from 2006 to 2012 (n=7,172), a whole foods, plant-based, vegan health program. Analysis showed a significant difference in the pre-CHIP diabetic state between the two groups in step one, but not after controlling for covariates in step two (OR=0.96 and 0.91; CI=1.21 and 1.24). A repeated measures MANOVA analysis indicated that religious affiliation (Adventist or non-Adventist) was the determining factor in improved biometric outcomes pre- and post-CHIP for TC (F(1) = 5.65; p = 0.02), and LDL (F(1) = 5.76; p = 0.02) but not for HDL (F(1) = 0.00; p = 0.99), TG (F(1) = 0.19, p = 0.67), FPG (F(1) = 2.71, p = 0.10), SBP (F(1) = 2.25; p = 0.13), DBP (F(1) = 1.20; p = 0.27), and BMI (F(1) = 1.65; p = 0.20). However, both groups improved post-CHIP in all biometrics. The implications for positive social change from this study showed that CHIP is an effective lifestyle model for improving type 2 diabetes outcomes for both Adventists and non-Adventists, a model that does not involve the use of pharmaceuticals.

Breast cancer is the second leading cause of cancer death in women in the United States. Several factors have been identified that interfere with women's breast cancer screening practices, including lack of knowledge and confidence in the breast self-examination (BSE) technique, and lack of information provided by health care provider. One of the reasons nurses do not teach breast cancer detection could be the little emphasis given to breast cancer examination in nursing schools. The BSE is a measure of significant value in detecting cancer of the breast. However, less than half of the women in the United States are participating in breast cancer screening. The purpose of this quantitative study was to investigate the relationship between the freshman and senior nursing students' breast cancer knowledge (BCK) and breast self-examination technique confidence (BSE_TC). An online survey was administered to measure the students' BCK and their BSE_TC. The social cognitive theory guided this study. A sample 100 nursing students (54 senior and 46 freshman) were included for hypothesis testing. The study results indicate that senior nursing students had higher mean scores on the BCK and BSE_TC, as would be expected. However, senior nursing students' BCK_BSE_TC scores were also very low. This is a concern for the future of breast cancer detection. This study provides data showing breast cancer screening concepts are unclear to freshman students, and remain unclear with senior students. Nursing educational curricula in breast cancer screening should be revised to affect improvements in nurses' role in advising and educating patients.

Epic morbidity and mortality, and intractability make prescription opioid diversion a wicked problem. Meanwhile, college undergraduates are vulnerable to opioid misuse and its consequences. The purpose of this quantitative study was to assess U.S. undergraduate students' opioid misuse and the relationship between mediating factors. The study's theoretical framework rested on Wakeland's et al. opioid system model and Shaw and McKay's social disorganization theory. This study bridged the gap, measuring collective efficacy and testing its relationship to undergraduate decisions to regulate misuse. Thus, research questions focused on gauging the problem's scope and assessing relationships between factors that drive or potentially regulate diversion. The Campus Opioid Diversion Survey, designed for this study, was administered to a nonrandom, undergraduate survey panel (N = 434), revealing past year opioid misuse at 6.9% and heroin use at 2.9%. While a chi-square test revealed no significant relationship between motives and sources for misuse, significant relationships were found between filling a prescription for opioids and misuse, between opioid and heroin use, and between observing the negative consequences of misuse and social action. An independent samples t-test showed a significant relationship between collective efficacy and social action. Findings show campus diversion remains an emerging health and safety issue, but that collective efficacy indicates a capacity for regulation. Anticipating misuse, public safety stakeholders should complement responses to diversion schemes with continuous assessment, communications that empower student-citizens, and focused promotion of social cohesion that will fuel mitigation via social action aimed at social change.

For several decades, a national shortage of licensed clinical social workers has been growing in the United States. Licensed social workers provide counsel and advocacy for those affected by mental illness, addiction, abuse, and discrimination, among other economic difficulties, and are the largest group of providers of mental and behavioral health services. The research questions for this project addressed what challenges unlicensed social workers in central Florida identify as barriers to pursuing clinical licensure. This study also explored strategies that unlicensed social workers in central Florida reported to address these barriers and encourage the pursuit of clinical licensure. The purpose of this research was to identify both the barriers that social worker's report in seeking their licensure and effective strategies to address the barriers. The theoretical framework to inform the project was systems theory. An action research design was used including a focus group of 5 unlicensed social workers, selected through purposive sampling. Thematic analysis was used to analyze the data. Study outcomes showed that social workers in central Florida chose not to pursue licensure because of the cost and time associated with the process. Changes recommended as part of this research may bring about social change through an increase in the number of licensed social workers to assist Floridians who seek such services.

Work-related injuries and illnesses may lead to absenteeism, which affects the level of productivity. The purpose of this study was to determine the success of an employee workplace training program on work-related injury and illness rates at selected federal districts within a federal organization. Newman's model, which describes internal and external factors that may have an effect on an individual's health, was the framework that guided this project. A pre-post design was used to compare data from 2 publically available data sets, the Occupational Safety and Health Administration Illness and Injury and the Voice of the Employee Survey, for the years 2013 and 2014, before and after a wellness training program. According to a descriptive analysis of 91 illness and injury events that occurred during the 2-year period, the greatest number of employees who reported illnesses were mail handlers and mail processing clerks. Slips/trips and falls, strikes by machine/equipment or other objects, and repetitive motion were the top 3 types of injuries. After training, the total number of illness and injury days away from work and days of limited duty were decreased, indicating a positive impact of this workplace wellness program and a need for future training for these workers. This project has the potential to affect social change by supporting the benefits of workplace wellness in improving employee health and reducing workplace injuries at federal agencies.

Health inequality conflates a huge number of economic, social, and political issues. These issues, together described as social determinants, determine a population's health through influencing health status and life expectancy. The research purpose of this study was to examine how social determinants affected the life expectancy of the women of Edo State, based on secondary data from Nigeria's 2008 demographic and health survey (NDHS). The theories that guided the study were self-efficacy beliefs of the social cognitive theory and physical self-concept of the health belief model. This quantitative cross-sectional study examined the associations between socioeconomic status, nutritional status, literacy/educational attainment, access to household sanitation facilities, and life expectancy. The dependent variables were health status and life expectancy (assessed using parity and age at first delivery). The independent variables were employment, ability to read and write, listening to the radio, type of place of residence, and persons responsible for reproductive health decisions. The analysis was based on data from 950 completed face-to-face interviews in the 2008 NDHS covering 846 households in Edo State selected using a stratified 2-stage cluster sampling design. Regression analyses showed that listening to the radio, persons responsible for decisions on reproductive health issues, employment, and type of place of residence had significant positive effects on parity and age at first delivery. Employment was the best predictor of both dependent variables. Ability to read and write had a negative relationship with the age at first delivery. The social change implications include the attainment of longer lives in Edo State, Nigeria, through effective policies on employment and education.

Disparities exist in the recognition and treatment of depression among Hispanics in the United States, creating a social, ethical, economic, and public health burden. This study was designed to generate an improved understanding of the causes of and/or contributors to depression within this population. It was specifically designed to 1) assess the prevalence and severity of depression among Hispanic adults in the United States relative to adults of other race/ethnicities in the United States; 2) clarify the inconsistent results in the literature concerning the relationship between acculturation and depression among Hispanic adults in the United States; and 3) fill a gap in the literature by evaluating the potential for inflammation to mediate the relationship between acculturation and depression among Hispanic adults in the United States. The biopsychosocial model was used as a theoretical foundation for this study. Data from the 2009-2010 National Health and Nutrition Examination Survey were analyzed descriptively and via logistic regression. Findings confirmed higher prevalence of depression among Hispanic adults compared with non-Hispanic White adults, and that a lower degree of acculturation was consistently associated with a decreased likelihood of depression among Hispanics. No mediating effect of inflammation on the relationship between acculturation and depression was observed. The findings from this study are intended for use by health care providers, health educators, and public health practitioners to improve depression prevention, diagnosis, and treatment opportunities within this population and to accordingly to affect positive social change.

Childhood obesity rates have increased nationwide, but rates of childhood obesity are higher in Tennessee (TN). The Coordinated School Health (CSH) Program is a multicomponent approach designed to improve academics and health in children in Tennessee; however, researchers have not evaluated the 8 components of the plan and the impact it has on weight in children. The purpose of the study was to determine if a relationship existed between the Coordinated School Health Program and obesity in children. The conceptual framework for this study was Bandura's social cognitive theory. One hundred forty CSH coordinators in TN were surveyed and the results were analyzed using multiple regression to determine the relationship between the 8 components of the CSH program and obesity rates in children in TN. Nutrition service was the only component that was statistically significant. According to study results, many districts had been exposed to the coordinated school health program and had some components in place, but the program was not seen as a priority by school administration, which affected the successful implementation of the program. The findings from this research can be used to help school officials determine how to better integrate the components of the Coordinated School Health program into the existing curriculum, allot time and resources for implementation strategies, hire the appropriate staff, and/or determine which component needs more focus. Determining which component(s) should have more emphasis creates potential for social change by reducing obesity in children, which will likely reduce the chance of those children becoming obese adults.

Continuing education (CE) mandate laws are passed by states because it is in the public interest. The intent behind the passage of Illinois's CE law for physical therapists is to protect public health and safety through ensuring the competency of providers. However, studies into the impact of mandated CE on competency have been mixed. The problem addressed by this study was whether Illinois's CE law was effective in improving the competency of physical therapists and its impact on patient care. The purpose of this study was to understand what role mandated CE played in developing the competency of physical therapists in Illinois and whether mandated CE was the best method for the state to use to address provider competency. The main research question and sub questions focused on examining what role mandated CE played in improving the professional competency of physical therapists and its impact on patient care. Framework analysis was used to analyze the data that was then placed into themes that had been identified in the literature review. Findings from this study were examined using systems theory and human motivation theory. This study's findings indicate physical therapists believe mandated CE can improve competency and patient satisfaction. Participants indicated when patients get better faster they are more satisfied and when practitioners have advanced skills patient care is improved. The social implications of Illinois's CE law, while not perfect, is positive for both patients and providers, according to Illinois physical therapists. Overall, physical therapists believe that CE improves the competency of the provider, which in turn improves patient care.

There has been growing concern over how state and federal governments can support the increasing population of aging Americans and their need for long-term care. Current insurance funding models cover acute hospitalization and skilled care only, leaving unskilled care needs and homemaker services at the full expense of those in need. Time banking allows individuals to exchange or barter time for goods or services without monetary payment. There is insufficient evidence to determine if members believe time banks to be a viable alternative to support aging-in-place care needs. This phenomenological study explored time banking as a potential vehicle for nonskilled health care support to defray health care costs as one ages. Ostrom's co-production theory provided the theoretical foundation for the research questions, which examined the participants' lived experiences with the role time banks played in their decision to age in place. Face-to-face interviews were conducted with 10 Southern California time bank participants, age 50 years or older. Using a Moustakas-modified van Kaam method and a priori coding emergent themes were extracted. Study findings illustrated that time bank participation did support aspects of nonskilled health care needs and provided members with confident options for aging in place. Study findings also indicated a need for continued collaborations between professional and managerial staff in public agencies, including California's Health and Human Services Agency and time bank users in their communities. Reducing health care costs for taxpayers in any government-funded health insurance model benefits positive social change, and nonskilled health care provider time bank initiatives may be a sustainable alternative for those wishing to age in place.