Sickle cell trait (SCT) is a very prevalent disorder in the United States, especially among African Americans or people of African descent. However, even with the prevalence of the disorder, there are no standardized guidelines for providing patients with information about SCT and the implications of the disorder at physicals and well-check visits. The purpose of this evidence-based project was to increase awareness for African American patients 18-44 years old in the practice setting about SCT and to provide options for testing and genetic counseling. Kotter's contemporary change theory was used as a guide to implement the new practice approach. A quasi-experimental, single-group, pretest-posttest-only design was used to explore the relationship between providing consistent SCT education and the impact on the rate of SCT screening and genetic counseling. A total of 71 patients participated in the program. The analysis showed a significant (p < 0.001) mean difference of 18.16 points from the preintervention SCT and genetics test mean, which indicated that the intervention was successful in raising SCT and genetics knowledge scores among the target population. The results demonstrated that the implementation of SCT education in the practice setting can enhance social implications related to SCT awareness and opportunities for SCT testing and genetic counseling. The implementation of SCT clinical guidelines can help to increase awareness about SCT and improve the overall population health and reduce the financial burden affiliated with care of those with sickle cell disease and SCT complications.

In 2016, prostate cancer was the second leading cause of fatality in the United States. However, the population in this study 'Black American men, ages 40 and older, in selected counties in Fulton, DeKalb, Gwinnett, Clayton and Atlanta metropolitan areas' tended to underutilize prostate cancer care. The purpose of this quantitative, nonexperimental descriptive study was to determine whether socio-economic barriers and perceptions of Black American men about prostate cancer reduce their ability to access quality care in this county in Georgia. The Health Belief Model (HBM) was used to inform the predictive validity of perceptions, attitudes, and belief on individual health behaviors. Data were collected from 303 men through online and mailed researcher-made surveys that had been piloted using the demographic/medical background instrument; data from these surveys were then analyzed using frequency distribution and analysis of variance, coupled with Tukey's honest significant difference test. According to the results, 90% of the respondents stated that early detection and treatment were a perceived benefit of undergoing prostate cancer screening, and respondents perceived early detection, early treatment, and the reduced chance of dying from prostate cancer as the main reasons for undergoing the screening. A potential social significance to this study is that it provides information to health care providers and policy makers to better understand the patterns of Black American men and their motivation to seek early prostate cancer screening. Early screening could reduce costs, both economically and socially, associated with late diagnosis of this disease.

Despite the continual prevention efforts in the United States, an estimated 1 million people are infected with the human immunodeficiency virus (HIV) and 25% of them are unaware of their infection status. There are no national surveillance data available on the incidence or prevalence of HIV/AIDS in the transgender population; this absence of data is a matter for concern. Guided by the health behavior model and social cognitive theory, this study utilized a quantitative approach to examine the associations between HIV/AIDS-related knowledge, attitudes regarding HIV/AIDS and condoms, and condom use self-efficacy as predictors of condom use in African American transgender young adults--one of the most disenfranchised and marginalized groups at increased risk for HIV infection--in the District of Columbia. Descriptive statistics, multiple regression, and chi-square analyses were used to analyze the research questions. There was no statistically significant relationship found between the dependent and independent variables at last intercourse with a steady partner. However, there was a statistically significant relationship when predicting condom use in the last 30 days and last 6 months with a steady partner. There was a statistically significant relationship for predicting condom use at last intercourse and intercourse in the last 30 days among nonsteady partners. There was no statistically significant relationship found between the dependent and independent variables at intercourse in the last 6 months with nonsteady partners. The findings could inform public health practitioners to develop and implement programs targeting African American transgender populations; the findings could also reinforce the public health policies and practices in favor of this cohort.

This purpose of this quantitative study was to examine health beliefs among Caribbean-born university students regarding acceptance or rejection of influenza vaccination among populations at institutions of higher education. In addition, acculturation was addressed as a factor affecting cultural health beliefs. A survey was completed by 98 students enrolled at Florida International University during the spring 2018 semester. Linear regression was used to analyze whether cultural health beliefs and acculturation were predictive of beliefs about influenza vaccination and beliefs about perceived barriers to influenza vaccination. The study findings showed cultural health beliefs of the students were statistically significant predictors of their beliefs about influenza vaccination and perceived barriers to influenza vaccination. Also, the levels of acculturation were a statistically significant predictor of students' cultural health beliefs and beliefs about perceived barriers to influenza vaccination. After 5+ years of acculturation in the United States, the students surveyed still held cultural beliefs and perceived barriers to influenza vaccination that contributed to their lack of acceptance of the vaccination. The information gained from this study gives credence to the need for designing health interventions and health messages on influenza vaccination that are culture specific for a college-age population if influenza vaccination acceptance is to be promoted.

Despite the trends showing a reduction in the use and abuse of drugs among American adolescents, the prevalence rates remain high. There is also comorbidity of mental illnesses among the adolescents using drugs. The aim of this study was to determine the presence and nature of the association between the use and abuse of marijuana and alcohol and mental illnesses among the American adolescent population. The noted comorbidities and the hypothesized association between the substance abuse and mental illnesses were explained using the expectancy theory. Using a quantitative research methodology, secondary data from the National Survey on Drug Use and Health for 2014 and 2015 were analyzed. Data analysis yielded a positive but weak association between use and abuse of alcohol and marijuana through proxies such as marijuana use in the past month (p = 0.01), first use of marijuana (p = 0.016), alcohol use disorder in the past year (p = 0.002), alcohol dependence in the past year (p = 0.001), and the occurrence of mental illnesses. The association was statistically significant in all proxies except alcohol use in the past month. F-test results were also statistically significant (p = 0.022, R2 = 0.242). The findings showed that adolescents who used marijuana and alcohol were more likely to develop mental illnesses. It is recommended for relevant federal and state governments and public health agencies to develop social programs to address the two issues inclusively rather than exclusively.

Type 2 diabetes is a chronic metabolic disorder and the seventh leading cause of death in the United States. Type 2 diabetes is linked to many chronic diseases, including cardiovascular disease, stroke, and chronic kidney failure. African American adults have a high prevalence of Type 2 diabetes with early onset of diabetes complications. Poor dietary behavior is the primary cause of Type 2 diabetes and its complications, changing dietary behaviors can prevent the onset of diabetes complications or impede existing ones. The purpose of this phenomenological study was to explore patients' perceptions of diet-only therapy in the prevention of diabetes complications. Face-to-face interviews were conducted with six African American adults with Type 2 diabetes between 40 to 64 years using purposeful sampling method. Health belief model formed the conceptual framework of the study. I applied inductive coding process and manually analyze data for themes. Participants expressed fear of diabetes complications, acknowledged effectiveness of dietary therapy, physician communication and strong family support in Type 2 diabetes management. Findings can produce positive social change among African American adults with type 2 diabetes. Patients can be motivated to change their dietary behaviors to prevent disability and death from diabetes complications. Adherence to diet can reduce medical costs associated with Type 2 diabetes and its complications at the individual, family, community, and government levels. Health care providers can apply the findings in their interactions with patients to provide a more patient-centered education that integrates patients' cultural and dietary preferences to facilitate adoption of dietary interventions and long-term adherence.

Malaria is one of the leading causes of death for children and women in Sierra Leone. The purpose of this qualitative study was to explore and understand the lived experiences of women from the rural areas of Sierra Leone regarding malaria. A purposive sample of Krio women from the western rural area, aged 21-55 years, spoke English, and had taken care of someone with malaria described their perceptions and lived experiences with the disease in face-to-face interviews. The research questions were based on the health belief model and focused on knowledge, beliefs, and perceptions about malaria prevention and treatment. Interpretative phenomenological analysis was used to identify themes through coding. The findings indicated that (a) lack of doctors, medicines, and medical supplies at government clinics discourages malaria victims from visiting those clinics; (b) the use of traditional herbs is prevalent because of their effectiveness, affordability, easy access, and lack of side effects; (c) women were not aware of recommended comprehensive malaria control measures, which include the continuous use of durable insecticide nets, residual spraying, case management, and artemisinin-based therapy. The results also show that (a) pregnant women should not take prescribed medications to prevent or treat malaria because they harm the fetus, and (b) traditional herbs may be taken with Western medicines to treat severe malaria. Recommendations include: that the government evaluate the efficiency and effectiveness of its current malaria programs in local clinics, and that future studies be undertaken to identify antimalarial properties in commonly accepted local herbs. Changes in policies and practices relating to the prevention and treatment of malaria will serve as building blocks for positive social change to reduce the malaria incidence rate in Sierra Leone.

In addition to cancelations and delays of needed surgical procedures, serious or fatal complications can occur when patients with low health literacy do not comply with preoperative instructions. The purpose of this quality improvement project was to provide more insight about ways to decrease on cancelled and delayed surgical procedures in low health literacy patients' due to noncompliance with preoperative fasting instructions. The project was informed by the reach, effectiveness, adoption, implementation, and maintenance model (King, D. K., Glasgow, R. E., and Leeman-Castillo, B. (2010). The project question centered on whether health literate preoperative fasting instructions could decrease cancellations and delays of surgical procedures in low health literate patients. The project setting was conducted at a doctor's office. Interventions and changes to the preoperative instruction sheet were evaluated by using the preoperative communication checklist (POCC) which was developed for this project study. A 3-month pre-post POCC intervention design was used to evaluate changes in the numbers of cancelled and delayed surgical cases among 30 low health literate patients at a local community physician's office. The Newest Vital Sign which is a health literacy skill level assessment tool developed by Pfizer (2012), was used to assess patient health literacy. 30 (13 women and 17 men) who were aged 17-75 were enrolled. Pre-intervention, the and cancellation rate was 16.67%. Post intervention, there was a zero percent cancellation rate. This project has potential to produce positive social change by empowering patients with health literacy instructions for better understanding of what is being asked of them when having surgical procedures. This knowledge may result in better patient outcomes.

Mental health professionals (MHPs) play a pivotal role in enhancing treatment outcomes for drug-using populations and minimizing their harm to the public. In response to a gap in the literature, this study sought to (a) assess MHPs' attitudes about the use and abuse of substances and their perception of their role in tackling substance abuse and related disorders in Nigeria, (b) identify predictors of perception, and (c) explore regional variations in attitude. Based on the validated drug and drug users' problems perception questionnaire and the substance abuse attitude survey, a cross-sectional survey was conducted in a randomized sample of 292 MHPs practicing in neuropsychiatric hospitals and in the mental health departments of teaching hospitals from 4 geopolitical zones of Nigeria. A response rate of 81.1% was achieved. MHPs' attitude about substance use tended towards the non-permissive, stereotypical, and moralistic spectrum, and its role perception was distinctly defined. Educational attainment (O.R = 0.50, p = 0.030), work-motivation (O.R = 0.55, p < 0.0001), and role-support (O.R = 1.48, p < 0.0001) significantly predicted MHPs' role perception. The Kruskal-Wallis test showed that there were significant regional variations in the attitudes of multidisciplinary MHPs, H (3) 18.727, p < 0.0001. Step-down follow up analysis revealed that the distribution of attitude total score vary significantly between the south-southern and southwestern region (p< 0.001), the northeastern and southeastern region of the country (p < 0.028). To foster the rehabilitation of this population and its reintegration into mainstream society, a holistic approach toward the standardization of drug treatment is needed. It should take into account the cultural, religious, and ethnic differences predominating in different regions.

Dental decay is a preventable disease, but it remains the most unmet healthcare need of American children. Untreated dental decay has adverse and long-lasting effects on a child's quality of life. Healthy oral habits among preschool children are essential for a healthy permanent dentition and are achieved primarily by 3 oral health related behaviors: proper dental hygiene, a healthy noncariogenic diet, and regular dental visits. This quantitative study, based on the theory of planned behavior, explored the relationship between these 3 oral health behaviors and 4 determinants: attitude, subjective norms, perceived behavioral control, and intention, using a 71-item questionnaire. The study utilized convenience sampling. A total of 436 parents or caregivers of children enrolled in the North East Independent School District Early Childhood Education program participated in this study; 81.5% were low-income, and 66% reported Hispanic identity. The relationship between variables was evaluated using multiple regression analysis. This study indicated that attitude alone toward a healthy diet and dental hygiene was not a significant predictor of behavior, but the attitude toward dental attendance was significant. Subjective norm, perceived behavior control, and intentions individually and combined were significant predictors of all 3 behaviors, except for subjective norm towards hygiene. Meaningful social change can be achieved by identifying and understanding the underlying motives that evoke planned and deliberate oral health behaviors among parents of preschool children. Targeted messages and cost-effective early interventions can be developed to prevent the onset of dental disease and improve the quality of life for low-income children.