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.

Breastfeeding is associated with numerous health and social benefits. Although support for breastfeeding is promoted globally, disparities in breastfeeding rates and support continue. African American mothers have lower breastfeeding rates than do Hispanic and Caucasian mothers. Several researchers have focused on the benefits of breastfeeding support, but no available research has explained any specific ethnic group perceptions of breastfeeding. This study explored 10 first-time African American mothers' perceptions of the breastfeeding support they received from physicians, nurses, midwives, and lactation consultants. The purposeful criterion sampling strategy was used to recruit participants, and data were collected through semistructured telephone interviews. The phenomenological research strategy, the social constructivist philosophical framework, and the breastfeeding self-efficacy theory guided the research process and helped in understanding the lived experiences of the participants. Data were analyzed thematically, revealing motivating factors for breastfeeding, experiences in getting breastfeeding support, types of breastfeeding support groups, and overall breastfeeding experiences. All participants felt it was important to breastfeed for their children's health. Their main concern was a lack of adequate professional support after they gave birth. The findings from this study can contribute to positive social change by increasing awareness related to first-time African American mothers' breastfeeding experiences and perceptions. Such awareness can assist in creating culturally sensitive programs to assist more first-time African American mothers increase their self-efficacy and promote successful breastfeeding.

Malaria is a mosquito transmitted tropical disease that accounts for more cases and deaths in Nigeria than in any other country worldwide. Globally malaria accounts for 300,000 deaths among young children and pregnant women annually. The promotion of the use of insecticide treated nets (ITNs) to reduce pregnant women's contact with mosquitoes has been the focus of malaria prevention efforts in Nigeria. However, the use of ITNs during pregnancy has been inexplicably low in Nigeria. A quantitative cross-sectional study was conducted to examine barriers to the utilization of ITNs among pregnant women in rural Nigeria. The social ecological model was utilized to analyze secondary data from a 2015 survey conducted in Nigeria in which 4,834 pregnant women between 15 to 49 years of age participated. The relationship between the use of ITNs and the knowledge of ITNs, traditional medicine, education, and family income was examined using multiple logistic regression modeling. Results showed that there was a significant relationship between the knowledge of ITN (p = 0.000), family income (p = 0.000), education of pregnant women (p = 0.000) and the use of ITN among pregnant women in rural Nigeria. However, there was no relationship between the use of traditional medicine (p = >0.5), and the use of ITN, perhaps because most of the women surveyed did not respond to the question about use of traditional medicine. Results of the study have important implications for positive social changes among pregnant women in Nigeria. These findings will inform strategies to increase the uptake of ITNs during pregnancy in Nigeria, improving birth outcomes, increasing maternal and child survival, and decreasing the economic burden due to malaria morbidity and mortality in rural Nigeria.

African Americans disproportionately develop cardiovascular disease risk factors including high blood pressure and high cholesterol levels in comparison to European Americans. The purpose of this study was to examine the associations of diet quality and physical activity with blood pressure levels and cholesterol levels among African Americans. The social ecological model was the theoretical foundation for the study. Research questions were designed to examine the extent to which diet quality and physical activity predict blood pressure levels and cholesterol levels. The research design was quantitative cross-sectional secondary analysis of 959 participants. After controlling for demographic factors, body mass index, and energy intake, there was a potential nonlinear association between the dietary approaches to stop hypertension (DASH) diet and blood pressure levels. Multivariable-adjusted logistic regression analysis showed that a fourth-quintile DASH score significantly predicted blood pressure (OR: 0.57; 95% CI [0.35, 0.93]). There was no association between the DASH diet and cholesterol levels. Physical activity was not significantly associated with blood pressure levels or cholesterol levels. Researchers can use these findings to replicate large prospective studies. In addition, findings may be used to promote positive social change by healthcare professionals including dieticians and clinicains, as well as health promotion advocates and other institutions or individuals with public health interest.

Postpartum depression (PPD) is internationally recognized as one of the most prevalent and severe but neglected maternal mental health complications of childbirth. Previous studies have indicated that there is a high burden of disease associated with PPD in both developed and developing countries. However, there remain gaps in the current literature regarding the recognition and management of PPD in remote parts of the developing world. Therefore, the purpose of this study was to understand the perceptions, attitudes, and beliefs of health professionals towards PPD and examine the factors that either facilitated or hindered its recognition and management in a remote setting in Nigeria. The pen-3 cultural model was the conceptual framework used in this study. The study focused specifically on professionals with regard to the recognition and management of PPD in a rural hospital in Nigeria. Ten semi structured qualitative interviews were conducted with doctors and nurses from a rural hospital in Nigeria. Data were analyzed via phenomenological interpretative analysis. Results from the study revealed that health professionals in a remote setting in Nigeria have a working knowledge of PPD and perceived the condition as a serious public health concern, but were faced with numerous barriers from the institutional, organizational, and community level that hindered their ability to recognize and manage PPD in a timely manner. These results make an important contribution to the existing literature and can enhance social change initiatives through the enhancement of awareness of PPD, and the need for improvement of policies on comprehensive maternal mental health in remote parts of Nigeria.

Chronic illness is an increasing concern in the United States as the CDC reports that about 50% of adults have at least 1 chronic illness. When individuals must adjust to chronic illness they may experience uncertainty regarding the illness, prognosis, and symptoms. The purpose of this qualitative, phenomenological study was to explore the lived experiences of individuals living with uncertainty in chronic illnesses. A Merle Mishel's uncertainty in illness theory was the framework used to explore the lives of individuals diagnosed and living with chronic illness. In-depth interviews were conducted with 8 individuals who have chronic disease; data were audio-recorded and transcribed. The data were analyzed using thematic coding, and stored in NVivo and categorized for commonality in results. Results revealed themes that individuals with chronic illness do experience uncertainty and that it impacts almost all aspects of their lives. The individuals expressed changes in daily activities, the need to plan ahead, altering plans based on symptoms, and retraining their minds to accept their new normal. Individuals diagnosed with chronic illness face daily challenges. Obtaining a better understanding of alternate ways to cope and manage uncertainty can greatly impact the individuals quality of life. The information produced from this study will help contribute to positive social change to enable healthcare providers to address the uncertainty at diagnoses and offer ways for individuals to cope and manage the additional stressor. Recommended areas for further research include repeating the study with a larger, more diverse sample, conducting interviews during different times of the year, and investigating the use of a multidisciplinary team approach for chronic illness treatment.

Malaria is a life-threatening parasitic disease spread to humans through bites of an infected mosquito. In rural Cameroon, malaria is one of the major causes of morbidity and mortality. Several studies have examined the use of various malaria preventive tools; however, there is insufficient literature available on use of an integrated approach to prevent and control malaria in rural Cameroon. The aim of this study was to provide information necessary for bridging the gap in understanding the proper use of insecticide treated nets (ITNs) and antimalarial drugs and the roles of education and socioeconomic status in malaria prevention and control efforts in rural Cameroon. This quantitative cross-sectional study was guided by the socioecological framework. Secondary data from the 2011 Cameroon Demographic and Health Survey (sample size of 216) was used in this study. The Chi-Square, binary logistic, and multinomial logistic regressions were used to analyze the data. The result revealed that there was a significant association (p < 0.05) between proper use of ITNs and malaria prevalence among children under 5 years old, education and proper use of antimalarial drugs, and socioeconomic status and health seeking behavior. There was also a significant association between healthcare preference and malaria treatment outcomes among children under 5 and pregnant women. These findings may contribute to social change by helping public health officials in Cameron to continue to prioritize local needs and enforce the proper use of available malaria tools in rural communities through an integrated approach to prevent and control malaria in rural Cameroon, especially for children under 5 years old and pregnant women, which would lead to improved quality of life.

The Patient Protection and Affordable Care Act (PPACA), sometimes referred to as Obamacare, or the Affordable Care Act (ACA), has been vital as far as health matters go in the United States of America. Regardless of reports that brand the legislation as unfair, it has to a great extent improved the healthcare sector in the country. It is also important to note that the act has faced numerous social, political or economic challenges (D’Elia, & Norpoth, 2014). The ACA was signed into law by president Barack Obama on March, 23, 2010, and then supported by the Supreme Court on June, 28, 2012. This act has been one of the key changes in the U.S health sector brought about by the Obama administration. It has developed a system making it mandatory for all citizen’s to acquire health insurance coverage, in which they are to pay the monthly premiums. If U.S citizens fail to comply with these guidelines a penalty will be imposed as a result of being uninsured. This paper will primarily focus on the advantages of the ACA to the American citizens. It will include an introduction, literature review, research methodology, findings, conclusion and recommendations.

Overweight and obesity and associated health risks have become epidemic in several regions around the world. Numerous studies have addressed the dietary habits of vegetarians and vegans in terms of disease prevention and nutritional deficiencies but the relationship between overweight and obesity and the demographic, psychosocial, lifestyle, and dietary intake of omnivores, vegetarians, and vegans has received less attention. Guided by the social-ecological model, this study included a cross-sectional, quantitative, anonymous web-based survey to obtain dietary information on omnivores, vegetarians, and vegans. Vegans demonstrated a significantly lower mean and median body mass index ( p=0.00) than omnivores, semi-vegetarians, and vegetarians. Multiple logistic regression analysis demonstrated no significant difference in the odds of overweight (OR=0.41; p=1.14) and obesity (OR=0.47; p=0.28) in vegans compared to omnivores. Alcohol was significantly protective against obesity for both 1-2 (OR=0.33; p=0.03) and 3-30 (OR=0.20; p=0.01) days drinking per month while binge drinking significantly increased the odds of obesity (OR=4.44; p=0.01). Multiple logistic regression analysis stratified for levels of exercise revealed an interaction between diet and exercise. A vegan diet was significantly protective against obesity for low-level exercise in terms of frequency (OR=0.31; p=0.02 ) and total minutes per week (OR=0.23; p=0.02) compared to omnivores. Coupled with prior studies these results may contribute to positive social change by facilitating a broad-based paradigm shift in the view of diet and exercise as well as providing evidence that can be implementated in broad-based obesity control programs to reduce the morbidity and mortality associated with obesity.

Fast food consumption among office workers is a common phenomenon. Frequent consumption of fast food is linked to cardiovascular risk factors. The pervasiveness of these risk factors has debilitated the office workers' health and contributed to low performance and absenteeism. However, there remains a significant gap in the current literature regarding the health impacts of frequent fast food consumption behavior of office workers. Consuming large portions of fast food has been associated with obesity. The purpose of this correlation study was to investigate the relationship between fast food consumption and obesity and hypertension among office workers. The theoretical foundations for this study are based on socio ecological model which is concerned with interactions between the individual and the different elements of the environment. Of 145 randomly selected office workers, 55 completed surveys about their food behavior and 36 of them had body mass index and blood pressure measured. Spearman rank-ordered correlations revealed significant correlations of moderate strength between fast food portion size and obesity (rs = .37) and between frequent fast food consumption and hypertension (rs = .40). These results constitute an important contribution to the existing literature and can be used by the health professionals and management to design workplace health intervention which focuses on the office workers and the social environment. Implications for positive social change include reducing the prevalence of obesity and hypertension.