There is a need for epilepsy-based health education programs to enlighten Nigerian communities and reduce the stigma associated with epilepsy. Epilepsy in Nigeria is viewed by some as a contagious and an infectious disease or a condition imposed from the gods, possessed by demons, as the work of witchcraft, or punishment from ancestral spirits, which are all related to a lack of knowledge about epilepsy leading to stigmatization of persons with epilepsy. Guided by the stigma theory, the purpose of this community-based, cross sectional study was to quantitatively examine the effect of an educational program on interpersonal, internalized, and institutional stigma of epilepsy in terms of knowledge, attitude, and treatment gained. Two hundred and fifty participants completed a general domain instrument which had been used in different countries, including South Eastern Nigeria, and revised for greater validity via a pilot study. Chi-square tests were used to examine any significant differences in participants' responses between pre- and post-test surveys regarding knowledge, attitude, and treatment gained of all 3 identified stigma levels. According to study results, the educational program reduced all 3 stigma levels in terms of attitude, knowledge, and treatment gained of epilepsy (p< 0.001). This study contributed to positive social change by providing information to public health workers on how to increase the knowledge and awareness of the South Eastern Nigerian community that epilepsy is not contagious or infectious and there is no need to isolate persons with epilepsy from their societies.

WISEWOMAN (WW) is a comprehensive program for medically underserved women in South Dakota (SD), aged 30 to 64, which aims to reduce morbidity and mortality from chronic diseases. Screening services include blood total cholesterol, blood pressure and blood glucose, and body mass index (BMI). Lifestyle intervention (LSI) sessions are also offered to address physical activity and nutrition. The purpose of this retrospective longitudinal study was to quantitatively examine whether the combination of LSI's and clinical screenings or clinical screenings alone lead to improvements in blood pressure, blood glucose, total cholesterol, and/or BMI at rescreening 10 to14 months from initial screening. Guided by the social ecological model, it was hypothesized that SD-WW participants attending the screening sessions as well as the intervention sessions would have greater reductions in blood pressure, total cholesterol, and blood glucose than participants who only received screenings. Participants included 653 low-income women aged 30 to 64 enrolled in the screening alone (N=423) and SD-WW program (N=230) from 2000-2005, who completed both the screening and rescreening 10 to14 months later. Secondary data analysis using forced-entry multiple regression of the traditional measures employed in the screening alone control condition yielded significant predictive models for change scores in blood pressure, BMI, blood glucose, and cholesterol among all participants. Neither dummy variable regression nor ANOVA results indicated any significant impact of the SD-WW intervention on these same health outcome changes. Findings contribute to positive social change by demonstrating that screening alone is effective in predicting health outcomes, thus allowing more disadvantaged women to be served by public agencies that may face reduced funding for their array of programs.

More than half of the incidents and mortality rates from cervical cancer occur among minority groups, including immigrant women from continental Africa living in the United States. Although researchers have examined cervical cancer screening practices among minority populations, including Black women in Africa and in the United States, there are few studies on cervical cancer screening and associated risk factors, specifically among African women living in the United States. The purpose of this study was to investigate the association between selected factors and cervical cancer screening practices among African immigrant women living in the United States. Using the behavioral model for vulnerable populations as a theoretical basis, this cross-sectional quantitative study was focused on determining the association between family income, level of education, language of interview, insurance status, age, and perceived health status and cancer screening practices. Data on 572 African immigrant women from the National Health Interview Survey in 2005, 2008, and 2010 were used for the study. Chi-square tests and logistic regression were used to analyze the data. Key findings indicate that family income, education level, and age were significantly associated with cervical cancer screening practices among African immigrant women in the United States. Findings from the study support positive social change by targeting at-risk groups for cervical cancer screening programs. The long-term goal of early cervical cancer screening is to lower cervical cancer rates among African immigrant women in the United States. The findings from the study can be used by community health professionals to provide education that can lead to utilization of cervical cancer screening services based on guidelines and recommendations.

African American men have the highest prostate cancer occurrence and deaths of any population, yet many are unaware of screening opportunities or prognoses if diagnosed with the disease. The focus of this study was to learn whether a web-based prostate health education decision aid would increase prostate cancer knowledge, declared intention to be screened, and the likelihood of scheduling a prostate-specific antigen (PSA) test. The transtheoretical model of behavior change served as the theoretical framework for the study to assess readiness to adopt new behaviors. A total of 128 African American men between the ages of 40--65 without a history of prostate cancer participated in the study and were divided into 2 nonequivalent groups. The control group had 48 participants, and the intervention group had 80. After reviewing the web-based intervention, participants completed a demographic questionnaire, The Prostate Knowledge Questionnaire, and an Intent-to-Screen Tool. Mean differences in knowledge change were compared while adjusting for covariates using least squares regression. There was no significant improvement in the Prostate Knowledge Change score between the experimental and control groups. Therefore, the alternate hypothesis cannot be accepted. The social change implications suggest that the web-based decision aid studied in this project may not be the best tool to increase knowledge about prostate cancer screening. Therefore, more research is needed regarding ways to reach and inform African American men about the pros and cons of prostate cancer screening to foster informed decision making.

In Cameroon, many disabled people (an estimated 10-20% of the population) have inadequate access to education and health care, and disabled people's organizations (DPOs) are advocating for social change. Yet, there is a scarcity of information regarding how African DPOs address HIV and AIDS. The purpose of this study was to assess how DPOs in Cameroon have responded to AIDS in the disabled population and to identify strategies to enable DPOs to manage AIDS issues. This study was guided by the complex adaptive systems theory as the theoretical framework. The research questions focused on what DPOs have done to develop their organizational capacities to address AIDS issues, and on the contextual factors that influence these organizational capacities. To answer the research questions, a qualitative, multiple case study was conducted. A purposeful sample of 25 people, primarily executive members of four community-based nongovernmental DPOs and key informants with experience in this field, participated in interviews and focus groups. Information was gathered from documents and participant observation. Data were coded using a priori and emergent codes and iteratively analyzed into themes. Evident themes were that capacities in these groups were limited by marginalization and poverty, a lack of connection between DPOs and the AIDS community, limited health education, and inadequate understandings of the complexity of AIDS. DPOs desired participation in AIDS-related efforts and continued to explore potential opportunities. These results could be used to enhance social change by improving AIDS practices and research programs, increasing organizational capacity and social inclusion of DPOs, and the development of policy at organizational and governmental levels.

Cardiovascular disease is the leading cause of death in the United States; firefighters are at a greater risk for both the disease and death. Their exposure to stress, toxic fumes and smoke, unhealthy eating habits, excessive weight, and low levels of physical activity are all contributing risk factors to this disease. The purpose of this quantitative study was to determine the effectiveness of a multi-faceted program of exercise and nutritional counseling to decrease body fat composition and increase fitness levels nine months after initial implementation among a sample of 202 firefighters. Social learning theory was the theoretical foundation for the study, as the firefighting population utilizes strong social networks which aid in the ability to observe, model, and imitate new learned healthier behaviors. Statistical analysis showed no significant difference between pre- and post-body composition. There were significant differences seen between pretest- and posttest fitness scores. The implication for positive social change lies in the fact that these study findings indicate that voluntary exercise and nutrition programs may not be adequate to address the issue of obesity among the firefighter population. Results can be used to inform better nutrition and exercise interventions for firefighters, thus helping them attain their goal of becoming a healthier workforce.

Lack of fruit and vegetable (FV) consumption is directly linked to the prevalence of obesity and chronic disease in the United States. The USDA Fresh Fruit and Vegetable Program (FFVP) offers elementary school teachers access to healthy foods as part of the public school classroom experience. The purpose of this study---which was based on self-efficacy theory and the socio-ecological model---was to examine if an association exists between selected factors: (a) daily fruit and vegetable consumption, training status in the USDA Fresh Fruit and Vegetable Program (FFVP), and an established school nutrition policy and (b) nutrition-teaching self-efficacy (NTSE) among elementary school teachers who participated in the FFVP. Using an online survey, 66 teachers out of 114 (58% response rate) completed a 26-question survey adapted from the Nutrition-Teaching Self-Efficacy Scale and the National Cancer Institute's Food Attitude and Behavior Survey. Based on the results of the chi-square test of association (p = 0.031), an association between daily FV intake and NTSE among teachers involved in the USDA FFVP was confirmed. The odds of having high NTSE are 3.45 higher in those who consume more than 3 cups of combined FV each day (p = 0.029). There were no significant associations between NTSE and FFVP training and established school nutrition policy. The social change implication of this study is that healthier, confident teachers build healthier school environments and create the impetus for increasing FV consumption in the community at large, thereby helping to reduce the risk of obesity and chronic diseases.

The purpose of this study was to examine the impact of overweight and obesity on veterans' careers. Obesity, once thought unproblematic for the military, is being recognized as a health concern that has expansive implications for the health and readiness of service men and women, as well as for veterans. There is an abundance of information on obesity within the general population, but research on the impact of obesity on military careers is limited. This quantitative, cross-sectional research study investigated how obesity is a challenge throughout a veteran's career, from enlistment to retirement, using an online survey to gather data related to demographics including rank, age, race/ethnicity, education level, marital status, and years of service. Data were analyzed using descriptive statistics, independent t tests, Levene's test, and the Mann-Whitney test. Results of the analyses showed that military veterans' overweight at separation contributes to their likelihood of adverse weight-related experiences while in the service, and that military veterans who are overweight or obese have more adverse weight-related experiences than those who were not obese when they separated from the military. Among respondents who were not overweight at separation, women had more adverse weight-related experiences than men. The findings of this study could change how military leaders and policy makers develop new programs, promoting a focus on the prevention of obesity rather than on causes of obesity. Understanding how overweight and obesity affect service members' careers could lead to increased appreciation of the importance of ensuring military readiness through interventions that address multiple levels of influence.

Research has shown that child abuse is a serious public health issue that may warrant child welfare agency intervention and removal of children from their homes. Placement with kin caregivers is considered the least restrictive placement option by social workers. It has been recognized that kin caregivers require some type of formal parental training to prepare them to care for relative children. A large city implemented the Caring for Our Own training program as prelicensing training to prepare relatives for roles as kin caregivers. Prior to this study, no research had assessed whether this training program adequately addressed caregivers' ability to adopt effective discipline practices in response to perceived child misbehavior. The purpose of the study was to examine how the Caring for Our Own prelicense training impacted kin caregivers' use of ineffective discipline practices, as measured by change in scores on the 3 subscales of the Parenting Scale. The theoretical framework for this study was based on Ajzen's theory of planned behavior. One-way repeated measures ANOVA revealed no statistically significant difference in kin caregivers' (n = 27) use of ineffective discipline practices as measured by the 3 subscales of the Parenting Scale over time. In light of this finding, the child welfare agency may create an evidence-based curriculum to assist in the development of competent kin caregivers. Social change to improve training and thus foster more effective responses from kin caregivers may occur within educational departments of child welfare agencies, through assessing and developing prelicensing kin caregiver training that allows for effective child behavior discipline management.

Women in Cameroon as well as those residing in the Maryland-Washington Metropolitan area and the Diasporas suffer a disproportionate rate of cervical cancer morbidity and mortality due to the vast disproportion in the distribution of healthcare services. The widespread human papillomavirus (HPV) vaccination holds promise for helping to attenuate the disproportion in cervical cancer screening and prevention services. Literature from other countries including Cameroon suggests that barriers to the uptake of cervical cancer screening include: culture, religion, the psychological impact of embarrassment, the influence of husbands, cost, discomfort, and vulnerability. The purpose of this study was to gain an understanding of the perceptions of the Cameroonian women regarding cervical cancer prevention, taking into consideration parental attitudes, their knowledge, and their beliefs about the acceptance and usage of the HPV vaccines and other screening services. A survey was designed from a combination of 2 separate instruments as developed, tested, and validated by Kahn et al. (2008) and Griffioen et al. (2012) for this qualitative study. The open-ended survey questions were completed by women who volunteered to participate. Data were collected between April and May, 2015. Eighty women volunteered to participate but only 30 were able to return the completed survey. Using the NVivo software version 10, data were inductively coded, analyzed, and major themes were derived. Results showed that although the women knew about HPV, the vaccines, and Pap test, there was still a need for more education. The results of this study will be provided to law makers in Cameroon to reconsider the educational needs and distribution of healthcare services for women in Cameroon.