Adaptive sports programs (ASPs) are important for enhancing the physical, psychological, and social aspects of life for amputee combat veterans while reducing the risk of depression and anger. Although the role of ASPs in improving quality of life (QoL) has been researched in relation to amputee combat veterans of World War II, the Korean War, and the Vietnam War, there has been limited examination of the role of ASPs in improving QoL among veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation Noble Eagle (OND). Therefore, the purpose of this study was to assess the effects of ASPs on the QoL of amputee veterans of OEF, OIF, and OND using logistic regression as well as 3 surveys assessing QoL and life satisfaction in combat veterans who suffered traumatic amputations between 2003 and 2013. The dependent and independent variables included psychosocial and behavioral factors for those amputees who participated in an ASP versus those amputees who did not. There was a statistically significant association (ï?£2(4) = 13.44, p < 0.003) between gender and perception of overall health. Likewise, there was a statistically significant association (ï?£2(2) = 15.63, p < 0.000) between enjoying life and having a meaningful life and participation in an ASP. The findings indicate that participation in ASPs may help improve QoL and overall health for amputee veterans. Public health programs and policies aimed at improving the overall health and wellbeing of amputee veterans should consider ASPs as essential therapeutic interventions for promoting health in amputee veteran populations.

Although evidence is currently available for population-based genetic screening and testing of individuals and their family members for certain hereditary chronic disease conditions (Tier 1), few states have integrated these genomic applications into chronic disease prevention programs. State and territorial chronic disease directors (CDDs) could provide the leadership needed to deliver these applications in more states. The purpose of this study was to determine whether an association exists between current chronic disease genomics funding or specific state genomic activities and the level of knowledge and interests in genomics by these directors. Rogers's diffusion of innovations (DIT) theory was used to explain the current climate of state chronic disease genomics and the need for an innovation champion to promote these evidence-based applications both in and out of the state health departments. A nonexperimental, cross-sectional, correlational survey of CDDs (N = 58) was performed using the Chronic Disease Director's Survey and results were analyzed using chi-square, independent t test, ANOVA, logistic regression, and Pearson's correlation coefficient. Results showed CDDs knowledge of genomics is unrelated to current state funding; however, CDD knowledge and interest in genomics was associated with inclusion of genetics in cancer control and cardiovascular health action plans, Tier 1 condition education, privacy and nondiscrimination laws, Behavioral Risk Factor Surveillance System (BRFSS) genomics questions, and frequent collaborations with outside entities. These results provide clear ideas to increase CDDs knowledge and interest in chronic disease genomics and potentially impact Tier 1 genomics implementation in more states.

Nigeria has high rates of sickle cell disease (SCD), which is attributed to the lack of awareness of the disease among the reproductive age in the country. The purpose of this cross-sectional study was to explore the role of religious leaders in contributing to awareness and prevention of SCD in Nigeria. Religious leaders' knowledge, attitude, and prevention and awareness practices of SCD, and how they translated to the prevention of SCD through improved counseling of premarital couples, were explored. A stratified random sampling was employed in selecting a sample of 150 religious leaders from different religious affiliations. Data were collected through a survey of sampled religious leaders in Nigeria by use of semi-structured questionnaires. Correlation analysis was used to determine the relationship among the variables under study. According to study findings, the level of knowledge towards SCD among the religious leaders was high. Additionally, there was no significant relationship between the religious leaders' knowledge of SCD and their efforts in increasing testing and genetic counseling among their congregation members. The level of awareness among the religious leaders did not contribute to the prevention of SCD in the country. The implications for positive social change from this research include religious leaders' commitment to emphasizing genotype testing during regular premarital counseling sessions and including religious leaders in health promotion activities, especially SCD prevention.

While many health benefits have been associated with increased whole grain consumption, current researchers have not considered if the consumption of whole grains in currently recommended or higher amounts actually leads to health problems, specifically to a correlated increase in gluten sensitivity. The purpose of this study was to determine if diets high in whole grains or those that met the recommended daily intake of whole grains help minimize or increase gluten sensitivity, and when whole grains are consumed as recommended if they cause more harm than good. The theoretical basis for this quantitative, cross sectional design was the precaution adoption process model, allowing for the examination of preventive behaviors as a series of cognitive steps over time. Individuals (N = 5,746) from the National Health and Nutrition Examination Survey 2007 to 2012 were assessed for daily intake of whole grains before and after the release of the 2010 Dietary Guidelines for Americans, and from 2007 to 2010 for bowel health and sensitivity to whole grains. SAS correlations and regression analysis at p < .05 were analyzed. There was an increase in whole grain intake by 7.4% and in bowel sensitivity with 50% reporting increases in gas, but more data are needed to determine exact amounts that caused these increases in symptoms. Understanding the complete picture, policy makers and others will be more informed about current recommendations and the way that Americans eat, as well as if changes are needed for the future.

Among young college-aged females, overweight and obesity, type 2 diabetes, uncontrolled hypertension, and high stress levels have increased, causing overall worse health conditions than previous generations. The use of wearable fitness technology (WFT) by young adults assists in fitness and nutrition monitoring, provides feedback in health statistics, and has shown improvements in reducing health-related issues in young college females. A wide body of literature related to physical activity, nutrition, and health issues in young college females exists; however, the experiences and intent of WFT use for behavior change by young college female millennials has not been well researched. The purpose of this phenomenological study was to examine the lived experiences of young college females' intent for behavior change with WFT. The health belief model was the theoretical framework used for this study. Ten college females, 18-25 years of age, attending colleges in northern West Virginia, who were collecting data from a WFT for a minimum of six months completed individual face-to-face interviews. Data were analyzed using phenomenological thematic analysis. Results from the study revealed young college females use WFT to increase physical activity, identify calorie intake and energy expenditure, and monitor heart rate, sleep, and stress to decrease and prevent health issues. These results can provide evidence for other researchers to address the current health inequalities in young college adults. Positive social change implications could include the value of WFT regarding the growing evidence of the importance of physical activity and nutrition by young female college students related to positive health outcomes and reducing health issues in this specific population.

This study sought to identify the level of oral health literacy held by people who live in transitional and distressed Kentucky Appalachian areas and if this effects how often they are using oral hygiene techniques. Data were also collected to describe the attitudes Kentucky Appalachian adults hold toward oral hygiene and oral health status. Current documentation shows that poor oral health remains a public health threat in this population despite efforts such as school-based sealant programs and increased dental insurance coverage. This study followed a quantitative design and 99 participants were polled using a survey specifically developed for this study's use. Composite median scores and Spearman's correlation values established the existence of a low oral health literacy level across the participant pool, an also documented that oral hygiene techniques are not used in frequencies recommended for proper oral health. A poor self-efficacy towards the ability to utilize these techniques properly was also identified. Using the Mann-Whitney U test, responses were compared based on county designation and few significant differences were found. These findings show that oral health status and related beliefs are similar across the region and not just isolated to the economically poorest areas as the currently available literature suggests. Applying the health belief model it is predicted that Kentucky Appalachians are unlikely to adopt proper oral hygiene habits until their self-efficacy is improved. A recommendation of this study is that public health officials should promote personal control when designing public health programs geared towards improving the oral health status of this population. To do so would introduce a positive social change in that people with good oral health are less likely to experience the pain, malnutrition, and negative social stigma that is associated with poor oral health.

Although efforts have been made towards improving the health of children across the globe with notable results, neonatal tetanus (NNT) remains a major contributor to the neonatal death rates in Nigeria. This problem calls for a concerted effort by the government to achieve the revised global NNT elimination deadline of 2015. The purpose of this cross-sectional quantitative study using secondary data was to establish the prevalence of NNT in Nigeria's northeast region and to ascertain if there was any significant difference in frequency of antenatal care (ANC), trained traditional birth attendants (TBAs), and umbilical cord treatments, using single sample proportions test and chi-squared tests of independence. The framework for this research was the theory of planned behavior. The participants (N = 312) were mothers of NNT babies. In spite a continual decline in the NNT cases between 2010 (26%) and 2013 (9%), the prevalence rate of NNT was unacceptably high at 28.815%. Also, significant differences existed as mothers who gave birth to NNT babies received significantly fewer or no ANC (p < 0.001), received significantly fewer or no attention from TBAs (p < 0.001), and reported significantly fewer incidences of proper umbilical cord treatments (p < 0.001). The chi-squared tests of independence resulted in significant differences in the frequencies of mothers who received ANC between Nigerian provinces (p < 0.001) and mothers who had their baby's umbilical cord treated (p = 0.005). This study will contribute to social change by guiding health care policy makers and immunization program managers on maternal and newborn health care services and indicate ways to build capacity of the TBAs for safe home delivery/hygienic handling of umbilical cord of newborns.

Breast cancer is a global public health issue, and even though the incidence and mortality rates for this disease have declined, a substantial gap in mortality rates between U.S. women of color and European American women remains. Strategies have been initiated to decrease this gap, but they have not addressed the special needs of women of color residing in the United States, who tend to be diagnosed only after they have developed late-stage breast cancer. The purpose of this phenomenological study was to understand the perceptions and behaviors of 20 first-generation Caribbean and South American-born women of color living in Atlanta, Georgia, related to breast cancer awareness, screening, treatment, and follow-up care. Qualitative data analysis was used to identify themes that included, but were not limited to, the role of genes in breast cancer, lifestyle influences and risk of breast cancer, environmental factors, positive perceptions of foods and their impact on breast health, the role of culture on health care decisions, fear of harm from radiation exposure, familial relationships, understanding why they sought screening and/or treatment, and familial health histories and increased risk of breast cancer. The participants' cues to take action were influenced by knowledge, health insurance coverage, confidence, educational attainment, age, income, family support, and self-motivation. Culture, race, or ethnicity had little to no effect on whether the women received breast cancer screening or mammography. The findings could facilitate social change by educating Caribbean and South American women of color in the United States about breast cancer and the need for screening, to reduce the incidence of breast cancer and the mortality rates among the target population and improving their quality of life.

Health care disparities are U.S. national public health concerns that disproportionately affect minority populations. The focus of published studies on the health of larger immigrant populations from Europe, Asia, South America, and the Caribbean has revealed a knowledge gap on the health of African and other minority immigrants. The purpose of this phenomenological study was to explore disparities in access to maternal and child health (MCH) care as well as the causes and effects of such disparities to care-seeking experiences of recent African immigrants. Andersen's behavioral model of health services use provided the theoretical lenses to interpret study findings. Eleven recent African immigrant mothers living in metropolitan Boston, Massachusetts, participated in semistructured questions that generated data used in this study. NVivo 11 was used to manage data, which enabled convenient use of Colaizzi's data analysis technique to identify themes and subthemes that were synthesized into final findings. Study results indicated that although participants used MCH care services, factors such as racial/ethnic discrimination, insurance differences, immigration, and socioeconomic status marred the process of seeking care, with notable access disparities that negatively affect MCH care experiences. The field of health for African immigrants is ripe for research. Other researchers could replicate this study elsewhere in the United States and other traditional immigrant-destination countries. Study findings could benefit health care providers, public health professionals, researchers, and immigrant populations. Actions for sustainable positive social change may result in the form of improved health care access and health outcomes for minority immigrants in the United States and beyond.

Nonadherence to medications for chronic illnesses is a public health problem that requires education related to its illnesses and medications in order to reduce morbidity, mortality, and health care costs, and to improve quality of life. Scholars have identified that morbidity and mortality are much higher among African Americans due to poor medication adherence when compared to Euro-Americans. This study focused on African Americans to increase their medication adherence with chronic illnesses. The purpose of this study was to analyze the effectiveness of using different educational methods to enhance medication adherence. The social cognitive theory and the theory of planned behavior were used as a foundation to develop this quantitative study. Three validated tools were used to assess the effectiveness of educational methods to see if there would be any increase in knowledge, self-efficacy, and change in health beliefs. A sample size of 144 African Americans in Chicago with chronic illnesses was randomized to an experimental group that received education on medication adherence for a period of 8 weeks through lecture, video presentation, roleplaying, and group discussion. A control group received regular education for the same 8 weeks. ANOVA, ANCOVA, and MANOVA statistical methods were used to analyze the findings that reported no statistical significance in the knowledge difference scores F(1,261) = 0.17, p = 0.678, self-efficacy difference scores F(1,259) = 0.96, p = 0.328, and health beliefs difference scores F(4,258) = 0.46, p = 0.765. This study contributes to social change by identifying a public health problem which can be improved by adding and testing other variables such as fatigue and cognitive and sensory deficits associated with chronic illnesses, which could yield a more valuable in-depth understanding.