The Centers for Disease Control and Prevention (CDC) estimates that 1.5 million women are victims of intimate partner violence (IPV) each year, and 324,000 of these women are pregnant (2013). Research on the predictability of certain factors and their relationship to current and historical IPV is limited. In order to better understand IPV as it related to a sample of 1,016 Appalachian pregnant women selected for the Tennessee Interventions for Pregnant Smokers (TIPS), it was important to evaluate various influences that may predict the prevalence of IPV in this population when compared to the State of Tennessee and the U.S. (Aim 1). An evaluation of psychological, sociocultural, and socioeconomic variables as they relate to both current and historical IPV in pregnant women presenting for prenatal care was conducted (Aim 2), and the results from this evaluation were used to model significant IPV influences to determine pregnancy predictors in the study sample when historical and current IPV is present (Aim 3). Percent prevalence of self-reported IPV was higher in the TIPS sample for Carter, Greene, Hawkins, Johnson, Sullivan, Washington, and Unicoi counties, when compared to criminal reports for State of Tennessee IPV victimization rates, and the rate per 1,000 IPV victimization rate was also higher in the TIPS sample when compared to the criminal report for the U.S. Self-esteem, social, support, stress, substance abuse, and alcohol were positive as independent effects for predicting IPV via ordinal regression; however, when evaluated via multinomial logical regression with controls for age, race, income, education, marital status, whether or not a pregnancy was planned, and parity, this effect was no longer noted. Unplanned pregnancies and lower education were significant control variables in these evaluations. The lack of support for predictive ability of those selected psychological and sociocultural variables for IPV only underscores the importance of taking into consideration the uniqueness of various populations and across various regions such as Appalachia. The influences of unplanned pregnancy and lower education may be significant predictors if IPV in pregnant women in Appalachia and warrant further research.

Traditional students enroll in post-secondary institutions during emerging adulthood. College enrollment is increasing and adult weight gain occurs most rapidly during the college-age years, with poor food decisions as a potential contributing factor. The present study examined the awareness, perception, and self-reported purchasing behaviors of college students regarding four front-of-package (FOP) nutrition labeling systems and symbols. Students were sent a 24-question web-based survey, with 908 completed surveys that met the research criteria. There were 888 (98.3%) respondents who recognized at least one of the four presented FOP nutrition labels. There were no significant differences between the groups that recognized one to four of the FOP nutrition labels in their stated likelihood to purchase foods with the specified labels. Students’ awareness of four commercial FOP nutrition labeling systems and symbols on product packaging did not have an impact on their food purchasing behaviors.

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection in the U.S., where one HPV-related cancer is diagnosed every 20 minutes. The most common HPV-related cancer is cervical cancer, with an estimated incidence of 12,000 cases annually, a third of which lead to death. Cervical cancer disparately affects women of ethnic minority groups and geographically isolated regions, such as Appalachia. Tennessee ranks third highest in cervical cancer incidence in the country. Many cases of cervical cancer could be prevented through vaccination against HPV, however, vaccination rates for females in Tennessee are among the lowest in the country. This mixed-methods study included an in-depth exploration of the factors that influence HPV vaccine acceptance in Appalachian Tennessee. Healthcare providers, mothers of adolescent girls, and college-aged women were recruited to participate in the study. From October 2016 to January 2017, interviews were conducted with healthcare providers (n=12), focus groups were conducted with mothers (n=13), and a survey was administered to college women (n=479). Interview and focus group sessions were recorded, transcribed and analyzed using a thematic framework. Survey responses were analyzed using descriptive tests, comparison of means, and regression analyses. The predominant barriers to vaccine acceptance identified in the study were: cost and novelty of the vaccine, vaccine safety, lack of school-entry requirement, and the implication of vaccine acceptance on adolescents’ sexual activity. Most negative perceptions towards the vaccine appeared to be propagated by the sociocultural influence on sex and reproductive health communication within the community. Perceived benefits for cancer prevention and receipt of strong and personal provider recommendations facilitated vaccine acceptance. Additionally, college students who reported vaccine acceptance reported discussing sexual health topics with their mothers more often than those who had not been vaccinated. The findings from this study provide foundational insights about the facilitators and barriers of HPV vaccine acceptance in Appalachian Tennessee. Identifying and understanding these factors is crucial to improving HPV vaccination rates and essential to maximizing the primary benefit of the vaccine in addressing the existing cervical cancer disparity in the region.

Active asthma and asthma-related health care utilization are higher among adult females than they are among adult males in Puerto Rico. The purpose of this study was to examine the determinants of the risk of active asthma and associated health care utilization and asthma control among women in Puerto Rico. Guided by the Andersen behavioral model, the study included data from the Asthma Call-Back Survey (ACBS) during 2011 and 2012 in Puerto Rico. The associations between active asthma and behavioral, demographic, and environmental factors were assessed using logistic regression. The relationship between asthma-related health care utilization and predisposing, enabling, and need factors was examined using multiple linear regression. The association between achieved level of asthma control and asthma-related healthcare utilization was investigated using multinomial logistic regression. Results of the logistic regression indicated that being out of work, being in a middle income category, and being obese significantly increased the odds of active asthma. Being self-employed and being in the income category of $15,000-$25,000 significantly predicted the frequency of emergency room visits (ERVs). Results of the multinomial logistic regression indicated that physician urgent visit and ERV were significantly associated with poorly controlled asthma symptoms. The positive social change implication of these findings is that the identified risk factors can be used to develop asthma management plans to prevent and control asthma attacks in at-risk populations and reduce asthma-related health care utilization cost

Falls with or without injuries among the elderly have become a public health concern, with falls among adults age 65 years and older increasing every year. Nurses play a role in ensuring patient safety by following fall prevention guidelines. The purpose of this evidence-based study was to implement the RE-AIM evaluation tool to determine the impact of the Safe Five program on staff compliance with the program; patients' awareness of the need for falls prevention; and falls among older adults, ages 65 years and older, admitted to an acute care nursing unit. The literature supports implementing a falls prevention program with multifactorial and interdisciplinary components, and an evaluation plan to help decrease falls in acute care settings. The Safe Five falls prevention program was implemented on the acute care nursing unit in an effort to decrease the inpatient falls rate on the unit. The inpatient falls data were collected retrospectively, 2 years pre implementation of the Safe Five program, and 8 to 10 months post implementation. Data were collected from the Safe Five checklists, recorded inpatient fall rates, and high fall risk chart audits provided by staff and nurse manager; they were then analyzed using the RE-AIM evaluation tool. The long-term effects of the Safe Five program include an 18% increase in patients' awareness of the importance of preventing falls, an 18% increase in staff compliance with the program, and a 14% decrease in inpatient fall rate on the unit. It is projected that the decrease in inpatient falls will result in decreased healthcare costs and improved patient satisfaction with the healthcare system, communication among the interdisciplinary team, and health outcomes for the patients.

Chronic kidney disease (CKD) is a non-communicable progressive disease that can lead to kidney failure or end-stage renal disease. In Nigeria, many people do not have access to health care due to extreme poverty, which means that those suffering from diabetes or high blood pressure, or both diseases, which have been identified as the 2 main risk factors, may not know their health status. The purpose of this phenomenological study was to explore the level of CKD awareness among Nigerians and if cultural beliefs affect individuals' health seeking behaviors because of the diverse nature of the Nigerian population. The protection motivation theory provided the framework for the study. Data were collected through semi-structured interviews with 14 participants, and data analysis included traditional coding. Findings indicated that CKD awareness in Nigeria is low. The social change implication is that the findings may be used to increase awareness of the CKD mortality and morbidity rate in Nigeria to facilitate the development and implementation of health policies that could lower the morbidity and mortality rate of CKD.

Intimate partner violence [IPV] is a preventable and costly societal issue that has reached epidemic proportions. Women are often the victims of IPV, and millions of children are exposed to it annually. The purpose of this study was to explore experiences of Puerto Rican mothers and their perceptions of how IPV exposure may have impacted their children using resilience theory. Data were collected via audiotaped individual interviews with 9 Puerto Rican mothers who endured an array of escalating IPV, often exacerbated by the perpetrators use of alcohol or drugs, and had IPV-exposed children aged 6 -11 years. Data analysis integrated content and thematic procedures. Interview data was transcribed, read, audited and coded based on compelling statements, quotes, and sentences made by the participants. The coded clusters were further evaluated, reduced to significant statements, then grouped into themes that captured the essence of the participants lived experiences and of the group. The mothers separated because they feared for their lives and the effect of IPV on the children. Once separated the mothers felt isolated, lived in shelters which were unconducive to childrearing, and had challenges navigating the system. They perceived their IPV-exposed children exhibited a multitude of behaviors including PTSD but that most were showing signs of resilience. Their IPV was perpetrated by males who were mostly the biological fathers of their children who used controlling behaviors towards the kids. The potential positive social change impact of this study is to empower Puerto Rican mothers to disclose IPV and to better inform health care providers regarding the impact of IPV on children aged 6 -11 years in an effort to increase the health, well-being, and resiliency of this vulnerable population.

The prevalence of autism in the United States is 1 in 68 children. African American children are less likely to receive advance testing to confirm the diagnosis of Asperger's Syndrome (AS) compared to other ethnic groups. The purpose of this study was to determine if demographic factors (parental education level, family annual income, marital status of custodial parent(s), parent ethnicity, number of children in home, other children with disability, family location, mother age at time of birth, gender of child, birth status of child, adoption status and age, child order, and other disability) have any predictive relationship to AS diagnosis among African American children in the Washington Metropolitan area. A quantitative correlational study of a cross-sectional nature was conducted using a survey to collect data from parents of children age 3-16 (n= 187) who may or may not have a confirmed autism diagnosis. Bronfenbrenner's ecological theory provided an understanding of how environmental factors may be related to a diagnosis of AS. Chi-square analyses were conducted and statistically significant higher frequencies of diagnosis were found in parents with no other child with a disability, later born children, and parents who have been married. Logistic regressions analysis resulted in parental marital status being found to be a statistically significant predictor of a child having an official AS diagnosis. There is a critical need to train health care professionals working in underserved communities where minority groups may reside about AS. Results from this study may provide information to develop policies, community-based services, and programs that ensure that children can receive an accurate AS diagnosis regardless of factors such as race, ethnicity, or socioeconomic status.

Young African American men who have sex with men (AAMSM) are at greater risk of being infected with the human immunodeficiency virus (HIV) and less likely to seek HIV testing than are members of other demographic groups. This behavior results in a significant public health threat because young AAMSM with an unrecognized HIV infection are less likely to practice safer sex and, therefore, more likely to pass the infection on to their partners. This study is an examination of the social and personality factors that influence HIV testing rates among young AAMSM, using Aday's model of the social determinants of health and the Big Five model of personality as the theoretical frameworks. A cross-sectional design was employed, and social networks were used to recruit study respondents. Forty-three young AAMSM completed online questionnaires, and multiple regression techniques were used to examine relationships among the variables of interest. Statistical analysis indicated that neither the social risk factors derived from Aday's model nor the Big Five model predicted HIV testing. However, it is unknown whether these nonsignificant findings are attributable to a genuine lack of influence or the unique characteristics of the sample. Given the null results of this study and the mixed findings of prior research, further studies are required to draw conclusions regarding the influence of social and personality factors on HIV testing in this high-risk group. Additional research could be helpful in developing more effective strategies for encouraging HIV testing among young AAMSM. The potential for positive social change lies in slowing the spread of HIV through this vulnerable population and in engaging young AAMSM in the medical system to improve their long-term health prospects.

Historically, 18th century anecdotal accounts of the decimation of several tribes of U.S. of the Native American population by trading of infected textile blankets alludes to the role of retail in the transmission of infectious disease. This study explores implications of the modern day retail organization practice of reselling returned clothing textiles from a public health infectious disease perspective. A qualitative multi-case study, utilized responses from 20 open-ended, unstructured interviews of retail employees assigned to the returns process. Additionally, several informal observations of select U.S.based, top-ranked clothing retail organizations, identified by the National Retail Federation were completed. Select federal, state, and local public health regulations regarding returned clothing textiles were then examined in an attempt to identify potential public health risks. Under a general systems conceptual framework, the points of interaction between the complex adaptive systems seen in retailer and the public health organizations were examined for infectious disease and infestation implications. Using MAXQDA software to perform the analyses, it was found that current retail practices and policy present unacknowledged infectious disease or infestation transmission risks. The risk applies to all, but is particularly relevant to immuno-compromised individuals. Though the risk in accepting and returning clothing to the sales cycle is an industry wide practice, it can be mitigated. Suggested mitigation takes the form of health training, and introduction of disinfection sanitizing tools such as UVC light exposures, into the returns-resale process.The findings point to an opportunity for social change for consumers, retail workers, and the community through update of public health and retail practices.