The majority of data on adolescent pregnancy pertains to urban communities, therefore, the individual and social influences associated with adolescent pregnancy in rural communities have not been extensively explored. The pregnancy rate among adolescent women aged 15 to 19 in rural Vance County, North Carolina, is 113.7 per 1,000, nearly twice the state average. This sequential mixed-method study used the social ecological model to evaluate the intrapersonal and community-related factors associated with adolescent pregnancy in this rural area. A quantitative survey assessed intrapersonal factors, namely sexual health knowledge, sex-related attitudes, and self-esteem in pregnant or parenting and nonpregnant or nonparenting groups. Two sample t tests revealed significant differences between groups relative to personal sexual values and attitudes toward premarital sex. There were no significant differences between groups for sexual health knowledge scores or self-esteem scores. Qualitative focus group discussions with one group, consisting of pregnant, parenting, nonpregnant, and nonparenting participants, assessed community opportunity structure as a behavior-influencing dynamic. Open-coding analysis revealed perceptions of strained employment and education-related structures, low community expectations of pregnant adolescents, and the influence of peer-related normative beliefs in early sexual intercourse. To bring about social change, community organizations should collaborate to engage participant-driven research while prioritizing the implementation of county-wide, comprehensive sex education programs. Improved programming could repair social norms, increase sexual health knowledge, and encourage personal responsibility over sexual health decisions.

African institutions that perform health research need to continuously evaluate their practices in order to ensure compliance with international standards of good clinical practice (GCP). This mixed-methods study, undertaken at one clinical research site in Western Kenya, was an evaluation of GCP compliance at the site, research participants' satisfaction with research procedures, and research participants' comprehension of informed consent. The qualitative portion of the study involved audit of the site's compliance with GCP standards. The quantitative portion was an assessment of participant satisfaction and informed consent comprehension, undertaken through interviews with a sample of 297 participants. Thematic analysis of the qualitative data showed that the site's performance conformed with GCP standards. Descriptive statistical analysis of the quantitative data showed that the majority of study participants were content with study procedures. A majority understood those parts of the informed consent process related to study duration and purpose but not those parts of the informed consent process related to the purpose and benefits of the study. Univariate chi square analysis showed no statistically significant differences in the level of satisfaction by age, occupation, or level of education, and there were no statistically significant differences in the level of informed consent comprehension by duration in the study or staff levels of experience. Implications for positive social change include guiding future health research capacity-building efforts in Africa toward better compliance with GCP standards and development of higher quality of informed consent procedures.

The American Academy of Pediatrics and World Health Organization recommend exclusive breastfeeding for the first 4-6 months of life to reduce risk of obesity in pre-school children. Previous research has indicated a high rate of obesity among Hispanic children in the northeastern United States. There is also a gap in the literature regarding the effectiveness of exclusive breastfeeding in preventing obesity among preschool Hispanic children. Therefore, the purpose of this study was to determine if there was an association between exclusive breastfeeding and obesity among pre-school Hispanic children enrolled in the Special Supplemental Nutrition Education Program for Women, Infants and Children (WIC) in a metropolitan area of mid-Atlantic region between the years 2004 and 2009. This retrospective secondary analysis of data for 4454 Hispanic children compared the body mass index (BMI) at 36-59 months of age for those that were breastfed to those that were not breastfed using the Student's t-test. Duration of exclusive breastfeeding was examined for any correlation with BMI for the cohort of breastfeeding women using Pearson's correlation analysis. Results revealed that the BMI for 1181 breastfed children was not statistically different from the non-breastfed children (16.97 vs. 17.04). However, there was a statistically significant inverse relationship between duration of breastfeeding and BMI among children of breastfeeding mothers (r = -.75, p < .05). These results make an important contribution to the existing literature and can enhance social change initiatives by encouraging practitioners to educate Hispanic mothers on the positive effects of exclusive breastfeeding the first 4 months of life which could help minimize obesity prevalence among children.

Childhood obesity has reached epidemic proportions in the United States and has been linked to hypertension, especially among African American youth. Optimistic bias leads youth to underestimate their susceptibility to negative health outcomes. Public health officials want to reduce risk factors to result in significant long term reduction in cardiovascular disease. The purpose of this study was to explore adolescent behavior practices in a school district and prevalence of high blood pressure and obesity in that population. The health belief model guided the framework for this study. Research questions examined relationship between individual health risk practices and optimistic bias on health outcomes. Using a correlational research design, 433 African American high school students were administered a face-to-face survey and had their obesity and blood pressure measured by the school nurse. Canonical correlational analyses were used to examine relationships between health risk practices and descriptive statistics for optimistic bias and health outcomes. Among the health risk practices, engaging in moderate exercise for at least 30 minutes in the last 7 days and lower blood pressure was the only statistically significant relationship. Despite presence of clinical risk factors for hypertension and obesity, two-thirds of the students did not perceive themselves to be at risk of developing cardiovascular disease, with males at greater risk than females. Reducing health optimistic bias is viewed as an effective way of motivating young people to adopt more positive behaviors. This study has social change implications for using educational institutions to implement intervention programs that promote positive health behavior among youth not as an individual responsibility but as a way to reduce health disparities at the systemic level.

The United States has set a 90% benchmark for influenza vaccinations for healthcare personnel. Unfortunately, healthcare personnel fall far short of that mark with current rates as low as 62%. Low vaccination rates are responsible for influenza, nosocomial influenza, influenza-like illness, and mortality during influenza season. The purpose of this quantitative correlational study was to understand the relationship between leadership styles, attitudes towards evidence-based practice, and vaccination intention among New Jersey registered nurses (RNs). Diffusion of innovations theory was the theoretical foundation. The 3 instruments used were the Multifactor Leadership Questionnaire, Evidence Based Practice Attitude Scale, and Behavioral Intention Scales, which measured independent variables such as transformational leadership and attitudes toward evidence-based practice. Vaccination intent was the dependent variable. The results showed that transformational leadership was positively related to vaccination intent r(353) = .16, p < .01. There was no relationship between transactional leadership and vaccination intent r(353) = .01, p > .05 nor between attitudes toward evidence-based practice and vaccination intent r(353) = .09, p > .05. The implication of the study is that the effects of transformational leadership constitute a predictive tool to identify how an organization can increase vaccination rates among RNs. Implementing the recommendations of the study could promote social change by providing nursing leadership with tools to facilitate increased vaccination rates among health care personnel. Increasing vaccination rates for healthcare personnel will decrease vaccine-preventable illnesses and improve outcomes for hospitalized patients.

This study examined the strength of association between food workers and food to norovirus in comparison to bacteria associated with foodborne-related gastroenteritis by whether norovirus had a direct (physical evidence), indirect (statistical evidence), or suspect (neither of the two) association with food or food handlers. The Centers for Disease Control and Prevention considers norovirus to cause the largest number of foodborne-related gastroenteritis cases in the United States. The association of norovirus with foodborne outbreaks through its information data collection form focuses on the food worker as the typical source. Yet, many outbreaks are not foodborne in nature. The gap in the research is the evidence supporting the theory that norovirus transmission is the same as bacterial transmission. A secondary data anaylsis was conducted on the data from the electronic Foodborne Outbreak Reporting System between 1998 and 2006. An odds ratio analysis showed no similarity between proportion of the implicated and nonimplicated numbers of outbreaks from norovirus and those from Salmonella. The odds ratios also showed a stronger similarity between proportions of food handler implicated outbreaks from norovirus than from Salmonella. An analysis showed, though, a significant emphasis was not placed on the food handler but on other indirect routes of transmission of norovirus in outbreaks. The analysis also indicated that norovirus transmission was not mainly through food. Norovirus transmission appeared to be through person-to-person rather than food and had more similarities with pandemic influenza than gastroenteritis-associated bacteria. A change in approach to norovirus by local, state, and federal agencies could have social change implications for prevention, surveillance, and public health programs to reduce infection and outbreaks.

Upheavals in the health care landscape threaten the sustainability of contemporary hospital organizations. Yet there is limited research regarding the characteristics of leaders within successful hospitals. The problem is the leadership styles needed to effectively run hospital organizations have not been identified and/or established. The purpose of this study was to develop a model of congruent leadership styles linked to the success of hospitals in one metropolitan city. The research questions sought to uncover (a) consistent leadership styles within successful hospitals, and (b) what, if any, relationship exists between leadership styles and measures of success. Examination of the literature uncovered the value of leadership to organizations through theoretical frameworks of organizational development, organizational culture, leadership, and change strategies that supported the need for hospital organizations to foster leadership practices associated with successful outcomes. Correlational analyses were used to examine the relationship between leadership styles and successful hospital outcomes. Primary data for this research were collected from 109 hospital leaders via the Multifactor Leadership Questionnaire (MLQ) Form 5X. Results from this study indicated an increased likelihood of performance success with the application of transformational characteristics. These findings support positive social change as results may serve as a model for leadership practices within 21st century hospitals. Results should further heighten social consciousness to spawn the development of related college curricula, scholarship programs, and leadership alliances that weave transformational characteristics into the leadership fabric of contemporary hospital organizations.

Throughout the relevant literature, research addressing the impact of a specific environmental factor, such as snowfall, on injury patterns or severity among alpine skiers and snowboarders is sparse. The foundation for inquiry into this relationship was developed based on principles of physics and traumatology coupled with findings in the available literature. Secondary analysis of trauma registry data coupled with daily snowfall measurements from one of the largest ski areas in North America illustrated a negative correlation between daily snowfall amount and injury severity (r = -.08). Concordant findings demonstrated an increased odds of sustaining an injury defined as severe or critical according to Injury Severity Score (ISS) classification when there was less than two inches of fresh snowfall (OR = 3.9; 95% CI[1.06, 16.69]). Additionally, utilizing the Abbreviated Injury Scale (AIS), a regional anatomical finding illustrated that in the absence of recent snowfall, there was an increased odds of sustaining a thoracic injury defined as severe in this patient population (OR = 10.4; 95% CI[1.62, 66.9]). Secondary research considerations detailed the variances in injury severity resulting from a collision when compared to a fall and the predilection for skiers to sustain increased lower extremity injuries when compared to snowboarders. Findings from this project may lead to positive social change as the increased understanding of predictive factors contributing to injury can be directly applied to further the current understanding of trauma care in this patient population. The benefits from this work may also extend to the public health arena through enhanced educational opportunities for skiers and snowboarders as well as enhanced resort safety initiatives tailored to the ambient conditions.

Global morbidity and mortality associated with malaria is rampant, and most of the clinical malaria cases are found in sub Saharan Africa. Previous and current research show that malaria is both preventable and treatable and that socioeconomic variables have a profound influence on how persons in rural Africa respond to malaria infections and the associated preventive strategies. This study assessed two key research questions for malaria cases in the Gusii region of Kenya regarding: First, whether a community education program on malaria has an impact in changing malaria preventive behaviors; and, second, if a relationship exists between socioeconomic factors and participants' knowledge and associated behavioral change to control malaria cases. Participatory model and social cognitive theory were used in conjunction with a community intervention with pre-post-test approach. Ten trainees each interviewed 36 participants, for a total of 360 participants, using a structured questionnaire before and after providing a layperson health education program (LPHEP) related to malaria prevention. Repeated measures one-way ANOVA, Chi-square, and Cramer's V test were used for the test of significance. Results showed statistically significant differences between pre- and post-test scores on signs and symptoms of malaria. Participants were able to identify and stated > 2 signs and symptoms of malaria after exposure to the LPHEP. Implications for positive social change included evidence that a simple LPHEP can improve malaria knowledge level.

Vulnerable populations, including immigrants, are often at risk for human immunodeficiency virus (HIV) infection because of their risk-taking behaviors. This study investigated risk-taking behavior for HIV infection among Sub-Saharan African (SSA) immigrants in United States. Using social capital as a theoretical foundation, the study aimed to address the question, is there any association between social capital assets of educational opportunity, employment, and eligibility for social assistance and HIV risk-taking behavior, defined as condom use before sex (CUBS) among SSA immigrant in the U.S? Potential participants were recruited through religious and social organizations in a southwestern US state. The survey generated 167 responses. The majority of the participants were Nigerians, single females, and Christians, with monthly income of more than {dollar}500.00. Analysis using Chi square statistic and unconditional logistic regression model showed that those without education opportunity were more likely to use condom but no significant association existed between social assistance opportunity and CUBS. Employed participants were 83 times more likely than those who were unemployed to use a condom before sex. Being employed was the strongest indicator of HIV risk-taking avoidance behavior among SSA immigrants in the U.S. This study provides insight into risk-taking behaviors among SSA immigrants. This information can be used by providers of services to immigrants and other vulnerable populations in the U.S., policy makers, and social advocacy groups that target HIV prevention. Implications for social change included the recognition of employment as a deterrent to HIV risk-taking behaviors among vulnerable populations.