Obesity has increased during the past 30 years in the United States. Obese adults and children are at risk for cardiovascular disease, diabetes, hypertension, and comorbidities. Parents and child caregivers play key roles in the decisions of family health. Studies exploring sociodemographic and socioecological factors associated with obesity among U.S. Hispanic parents and child caregivers are lacking. Guided by the socioecological model, this study examined the following factors: gender; acculturation; dietary intake of fat, sugar, fruits, and vegetables; and role as food purchaser/food preparer that influenced obesity. A 3-paper-based survey, consisting of a demographic survey, the Block Fat-Sugar-Fruit-Vegetable Screener and the Bidimensional Acculturation Scale for Hispanics (BAS), was used to collect data. The volunteer sample of 165 Hispanic parents/child caregivers residing in Aurora, Illinois, was recruited using venue-based sampling. Point-biserial correlations, chi-square, and multiple logistic regression were performed to test 10 hypotheses. Acculturation, as measured by the BAS non-Hispanic domain scores, was a significant predictor of obesity. Obesity increased 1.737 times with every 1 unit increase in acculturation BAS non-Hispanic domain scores. Multiple regression results showed that developing obesity was 2.46 times lower in males compared with females in the overall sample. These findings could be used to promote positive social change by influencing the development of culturally congruent obesity prevention, management, and treatment programs produced by educators and health professionals specifically targeting obesity among Hispanic women, which could further increase the overall well-being and longevity of Hispanic families in Aurora, Illinois, and beyond.

The purpose of this phenomenological study was to investigate, from the perspective of teachers, the possible effect of school violence on teacher resiliency. School violence has been studied with respect to student behavior and academic success, as well as socioeconomic influences, but not with respect to teacher resiliency, as expressed by teachers themselves. Resiliency theory was the conceptual framework. Participants were all teachers of Grades 2-8 at an elementary/middle school in the Midwest. Twelve in-depth interviews were transcribed into text data and analyzed for common themes. Using NVivo, Version 10, I was able to more easily manage the volumes of text data. Reoccurring themes and meanings were triangulated with a resiliency questionnaire, school climate surveys, and field notes. The overarching themes that emerged were that teacher resiliency at the target school was lowered when its teachers were exposed to a school climate which allowed for excessive violence, especially fights. A second overarching theme was that there were inconsistencies in the support offered by the school administration, which negatively impacted teacher resiliency. A third overarching theme was that there was a significant lack of parental and community support, which also negatively affected teacher resiliency at the target school. Overarching themes that emerged can now be used to support the need for more effective teacher training about school violence. The outcomes may also help generate improved school violence policies at the local, state, and national levels.

Dental caries is the most prevalent childhood illness and disproportionately affects children from low socioeconomic backgrounds. Dental organizations are collaborating within communities to decrease oral health disparities among children by offering free preventive oral health events. These programs face the problem of low enrollment due to lack of informed parental consent. Also, gaps in the literature indicated the need to examine oral health perceptions and dental-care-seeking practices of culturally diverse low-income parents regarding preventive care for their children. The purpose of this qualitative case study was to explore the reasons why parents are not allowing their children to participate in the aforementioned programs. This inquiry examined how perceived barriers impede parents from seeking free preventive dental care for their children. The transtheoretical model and social cognitive theory were used in this study. Open-ended questions were used to interview 20 purposefully sampled parents regarding perceptions of free preventive dental care programs until saturation. Interviews were audio recorded, and all data were transcribed verbatim, coded, and analyzed thematically. The main themes revealed through this analysis were lack of trust and cultural dissimilarities as potential barriers. Additional themes of money, fear, lack of insurance, transportation, time, and access to care were also confirmed. This study may contribute to positive social change by increasing knowledge that may inform the development of clinical and policy solutions aimed at improving parents' awareness regarding children's oral health, ultimately enabling a reduction in childhood caries and oral health disparities.

According to the Centers for Medicare and Medicaid Services (CMS), approximately 1.3 million U.S. residents are residing in nursing homes. CMS enforced regulations in the Nursing Home Reform Act. Training in the use of restraints in nursing homes is monitored through the CMS standards. The purpose of this study was to determine whether there was a correlation between training standards of health care practitioners and their use of restraints in nursing homes based on the patterns of citations by RNs and CNAs. Data were collected from Kansas, Louisiana, and Ohio within the CMS Nursing Home Data Compendium. The key research question examined differences in standard training requirements, policies, and citations regarding restraint use in the selected states. The theoretical framework for this study was the social influence theory. The results of the analysis of variance indicated that between 2008 and 2012, there were significant differences in policy and standards requirements for the training of registered nurses and certified nursing assistants regarding restraint use; there was also a relationship between the training of staff and the number of citations of restraint use in Kansas, Louisiana, and Ohio. There were significant (p < .02) variations throughout the 3 states regarding the policies, procedures, and training expectations. The positive social change that could result from these findings is the standardization of training that may help decrease restraint use and become the foundation of more respectful and caring practices in nursing homes.

Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data were coded and analyzed for emerging themes, with the assistance of Nvivo software. The findings demonstrated that lack of time, the location of dental facilities, and the lack of sensitivity of dental providers were issues for parents in managing their children's oral health. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating the constraints faced by the underserved population in Massachusetts.

The Affordable Care Act expanded insurance coverage to the general population; however, expanding insurance coverage to immigrants might not be sufficient to improve utilization of annual physical preventive exams. This study evaluated adult Michigan immigrants' individual demographics, perceptions, and behaviors, as well as the collective cultural and system characteristics that might act as barriers to the utilization of annual physical preventive exams. Ken Wilber's integral operating system model for medicine conceptual framework was used to create a comprehensive map of factors and bring more clarity and understanding to the barriers to annual physical preventive exam. The quantitative survey was the best approach for this study because of the large numbers of explanatory independent variables identified in the literature review. Snowball sampling was used to increase the credibility of this research by involving different immigrant communities and reaching large numbers of immigrants. Descriptive results indicate immigrants' barriers revolve around difficulty accessing health care and the cultural competency of the health care provider. Logistic regression analysis found that immigrants who are stressed and worried, self-employed, and middle class are less likely to utilize annual physical preventive exams. This study could be a force for social change by promoting healthy behaviors and encouraging immigrants to use annual physical preventive exam to reduce the occurrence of chronic conditions and increase life satisfaction in the community.

Patient falls are an ongoing concern for health systems in the US and in the setting where this project took place. Inpatient falls affect consumers and health providers because falls often result in patient morbidity and mortality, legal risk, increased length of stay, and increased costs. The purpose of this project was to evaluate the existing fall prevention protocol at the site where this project took place and to make recommendations for an evidenced-based fall prevention protocol. The professional practice model was the conceptual model that guided the exploratory descriptive project. A review of the site's fall prevention policies and procedures revealed a new fall prevention protocol was in place and included bed alarms, and chair alarms to ring on nurses' phones although observation of nurses revealed that there were problems maintaining the protocol the entire day and 66% of patient falls occurred when the bed alarms were not set. The resulting recommendation was for additional education and a bundled approach with nurse education, patient and family education and a fall risk assessment that was easy to use. Nurses were then surveyed before and after education on the current protocol and the Morse Fall Risk (MFRs) to determine their willingness to use the simpler version for fall risk assessment. Before education 18 nurses confirmed they would use the protocol and MFR tool and all 20 agreed to use it after the education session. An implementation of a bundled approach to the fall prevention protocol that nurses incorporate into their daily practice will lead to a positive social change and as a result may increase patient safety by reducing patient falls.

When caregivers defer their personal routine dental care (RDC) in order to provide RDC for their children, they risk detrimental consequences in their personal health and the health of their children. The purpose of this qualitative case study was to identify the risk factors that led to the parental dental deferment decision. The oral health and personal care services conceptual models guided the development of the research questions, facilitated the selection of risk factors on the decision-making process, and provided the basis for the data analysis thematic categories. Ten caregivers who made the decision to defer their personal RDC for the sake of their children's RDC participated in the study. Interviews were transcribed verbatim and analyzed thematically. According to the results of the study, the oral health beliefs of caregivers shaped their decision to seek RDC for their children while financial barriers, dental fear, and distrust obstructed their capacity to seek RDC for themselves. Caregivers placed a higher priority on their children's wellbeing--including dental care--than on their own health, despite knowing the association between poor oral health and serious health conditions. These findings indicated, for caregivers, deferring personal RDC was not a lack of desire, education, or care but striving for constant balance between affordability and providing their children with every healthy opportunity in life. The positive social change implications of this study include increasing the proportion of adults receiving RDC yearly through development of targeted interventions that increase caregivers' access to and utilization of dental care services. Such efforts would support the strategies implemented to achieve Healthy People 2020 objectives.

Due to projected growth of the 65-and-older population and concerns of an impending care gap, reliance on informal caregivers is expected to increase. Improving support for informal caregivers is viewed as a national priority, yet research related to the unmet support needs of informal caregivers is limited. The purpose of this cross-sectional correlational study was to examine predictive relationships between contextual factors (caregiving relationship and type of illness) and environmental factors (rurality) and the unmet support needs (classes, service access, support groups, counseling, and respite) of informal caregivers of older adults. The theoretical framework was Bronfenbrenner's ecological systems theory. Archival data were drawn from the 2015 Behavioral Risk Factor Surveillance System optional caregiver module dataset provided by the Centers for Disease Control and Prevention. Findings from multiple logistic regression analysis revealed that spousal caregivers had 42.7% lower odds than adult child caregivers of reporting unmet support needs related to service access. Dementia caregivers had 2.05 times higher odds of reporting unmet support needs of counseling, 1.31 times higher odds of reporting unmet support needs related to service access, and 1.91 times higher odds of reporting unmet support needs for respite care, relative to other caregivers. Caregivers residing in a suburban county had 28.7% lower odds and caregivers not residing in a metropolitan statistical area (MSA) had 30.5% lower odds of reporting unmet support needs related to service access, relative to caregivers residing in the center city of an MSA. Health care leaders and policymakers may use the findings to distribute resources and tailor interventions to better meet the needs of informal caregivers of older adults.

Poor sexual communication among Nigerian youth can create problems for health workers, medical practitioners, and the government in determining what is and is not working in their attempts to reduce sexually-related diseases. This quantitative study used self-administered questionnaires among 107 Nigerian university students, aged 18 to 35, to determine if a statistically significant predictive relationship existed between: (a) beliefs about alcohol, (b) HIV knowledge, (c) risk behaviors, (d) age, (e) religion, (f) gender, (g) sexual activity status, (h) dating status, (i) language, (j) sexual orientation, and (k) tribes of Nigerian university students and their sexual communication with partners. Previous studies did not use the AIDS risk reduction model (ARRM) as a theoretical framework to identify frequent risk factors in this population. This study was guided by the ARRM and used the Sexual Risk Survey (SRS), the HIV-KQ-18, the Revised Alcohol Expectancy Questionnaire (AEQ-3), and the Dyadic Sexual Communication Scale (DSC) to assess the participants. Independent-sample t tests were used to analyze the correlation of study variables and the results showed statistically significant differences only in tribal affiliation (p = .022), gender (p < .001; p =.016), dating status (p = .017), age (p = .006), and sexual activity status (p = .001). Linear regression analyses results showed no statistically significant predictive relationship, R = .322, R2 = .103, F (12, 94) = 0.904, p = .546, between HIV knowledge, beliefs about alcohol and risk behaviors of Nigerian students, and their ability to communicate sexually. These findings justify the need for more culturally sensitive studies and gender/age appropriate HIV intervention strategies in Nigeria.