Suicide is one of the leading causes of death in the United States. The rate of suicide attempts among veterans in the United States has increased tremendously since 2001, which has left the Department of Veterans Affairs deeply concerned. The purpose of this study was to examine if there is an association between suicide attempts among African American/Black veterans and mental health support, income level, marital status, education level, and unemployment status. This quantitative study used the socio-ecological model to explain the association of the contributing factors to suicide attempts. Descriptive statistics, chi-square, and logistic regression were used to analyze the 2014 National Survey on Drug Use and Health from the United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration and Center for Behavioral Health Statistics and Quality. The publicly available dataset contains 55,271 cases with 6,698 Blacks/African American in the study. The findings of the study show 20% of African American veterans who seek support received it and 80% did not in suicide attempts among African American/ Blacks veterans and mental health support, income level, marital status, education level and unemployment status. The study showed there is a need for greater support for African American veterans through either policy or access to more mental health care. The social change implication is that need to be greater advocacy for support for African Americans who experience suicidal thought seeking support. Providing the support, they need can possibly help save lives.

The self-care management of sickle cell disease (SCD) improves mortality rate; however, compliance with SCD self-care management remains a problem. The purpose of this study was to examine the knowledge and factors that influence compliance with SCD self-care management recommendations among caregivers of children with SCD. The health belief model was used as the theoretical foundation of this study, theorizing that caregivers' perceived susceptibility, severity, and benefits of SCD self-care management will influence compliance. The study used a quantitative research design. A cross-sectional survey was administered to 100 caregivers of children with SCD attending sickle cell clinics in Lagos, Nigeria using convenience sampling. Information was obtained from participants using a structured interviewer-administered questionnaire, and data were analyzed using descriptive statistics, bivariate correlations, and binary logistic regression techniques. Findings confirmed a high adherence rate but low knowledge of SCD self-care management among the caregivers of children with SCD. There was no significant correlation between knowledge of SCD self-care management and adherence. However, the findings from the multivariate analysis identified knowledge as a predictor of adherence and religiosity and total number of barriers as barriers to adherence. Parental health beliefs did not influence adherence to SCD self-care management. These findings have social change implications by guiding the work of health educators, health care providers, and public health practitioners to incorporate group counseling on SCD self-care management at every sickle cell clinic.

The health benefits of breastfeeding exceed well beyond the first few years of an infant's life. Breast milk is often referred to as liquid gold because of its extensive protective properties that promote child growth and development. Unfortunately, African American women have the lowest breastfeeding rates compared to any other racial group. Given that African American children are disproportionately affected by the current obesity epidemic in the United States, there may be a link between a mother's preference to breastfeed her infant and her influence over her child's eating behaviors and physical activity levels. Guided by social cognitive theory, the purpose of this quantitative longitudinal study was to explore the association between exclusive breastfeeding and maternal control over childhood nutrition and physical activity among African American women and children enrolled in the Women Infants and Children Nutritional Supplementation Program (WIC). Secondary data were used from the Infant Feeding Practices II Survey and its Year 6 Follow Up. Crosstabulations were performed to assess the relationship between exclusive breastfeeding and maternal control over child health behaviors after 6 years. The null hypotheses were not rejected, as there was no relationship between exclusive breastfeeding and maternal control over physical activity or child eating behaviors. Findings revealed moderate to high levels of maternal control among WIC participants who breastfed for 3 months. This study may lead to positive social change by increasing the number of children who benefit from breast milk and improving childhood nutrition and physical activity, which will ultimately reduce child obesity disparities and promote maternal and child health altogether.

In comparison to the European healthcare system, the U.S. healthcare system has lower quality care, higher costs, and covers a smaller percentage of the population. Despite the high costs, the U.S. healthcare system remains dysfunctional. The purpose of this exploratory single case study was to identify the strategies that some healthcare managers in a hospital setting in the midwestern region of the United States use to improve efficiency while decreasing healthcare costs. Complex adaptive systems theory was used to frame this study that included face-to-face interviews with 6 highly experienced healthcare managers. Data were collected from audio recorded interviews and publicly available documents, and the audio recordings were transcribed and analyzed using deductive and open coding techniques to identify themes regarding strategies used by managers to find effective ways for improvement. Three strategies emerged as themes, including improving the accuracy of information and reports, implementing precise and accurate information, and improving quality. The findings of this study may directly benefit healthcare managers and compel positive social change by facilitating successful strategies to improve efficiency and reduce costs. The successful strategies identified in the study might provide a new direction to healthcare managers attempting to adopt new methods. The findings may also contribute to social change by providing solutions that may improve overall organizational performance in a hospital setting.

Abuse of painkiller drugs and non-medical use of drugs among young adults continues to be a public health crisis in the United States. Living arrangements and source of treatment referral were considered as the social context that could contribute to increased admissions to treatment for drug abuse. The purpose of this study was to examine the relationship between, independent living arrangement, the principal source of referral, and abuse of opioid, heroin, and cocaine. Steered by the conceptual framework of the biopsychosocial model, this study used the data from the 2015 Treatment Episode Data Set: Admissions managed by the Substance Abuse and Mental Health Services Administration. Multiple logistic regression analyses were performed to test the hypotheses regarding a predictive relationship between independent living arrangement, the principal source of treatment referral, and admissions to treatment for abuse of opioid, heroin, and cocaine. The results showed a significant association between the source of treatment referrals and independent living arrangement, and the increased odds of admissions for prescription opioids use disorder, heroin use disorder, and cocaine use disorder among adults aged 18-34 living in the United States. The implication for positive social change included a need for a targeted treatment and other intervention programs for young adults' users with associated higher-risk treatment referral categories and exposed to neighborhoods factors and health-risk behaviors in reducing the crisis of drug abuse in the United States.

African American (AA) men in the state of Alabama are affected by colorectal cancer (CRC) more than all other races. The purpose of this phenomenological study was to gain understanding of colorectal cancer screening health benefits in AA men in Mobile, Alabama. The health beliefs model (HBM) developed by Hochum, Rosemstock, and Kegels was used to to explore the barriers and facilitators to CRC screening in AA men with health insurance in Mobile, Alabama. The research questions explored knowledge, perceptions, and facilitators to CRC screening among AA men age 40 to 75. Participants were selected using purposive sampling and data were collected through face-to-face individual interviews with 13 participants living in Mobile, Al. Data were inductively coded and subjected to a thematic analysis procedure. The study findings revealed that participants had a general knowledge of cancer but a low awareness of CRC screening. Findings also revealed a perceived gap in CRC screening education from participants' doctors. Few reported understanding or remembering a conversation about the need for CRC screening during their last doctor's visit. There was no indication that age or level of education played a meaningful role in participants' knowledge or perception of CRC screening requirements. Positive social change implications stemming from this study include recommendations to Alabama public health officials and policy makers to invest in the development of intervention and education efforts to increase CRC screening among AA men, which in turn, may reduce CRC related morbidity and mortality.

Studies have shown that emergency mental health trauma (EMHT) services can significantly reduce the long-term effects of trauma after a disaster. However, rural municipalities may find they do not have the capacity to create such a service, or may not realize that their disaster planning includes no provision for emergency mental health care. Such was the case in a rural island community in the state of Washington, where, in 2014, several residents initiated a discussion that helped to identify the community's lack of EMHT services. This project, framed by action research and based on collaboration theory, sought to advance the potential for the community's 21 resident social workers to address this issue collaboratively. Accordingly, the project's research question asked how social workers on south Whidbey Island perceived the issue of a rural EMHT service in their community. Data consisted of responses from 8 participants who completed mailed questionnaires and participated in brief telephone interviews. Descriptive coding analysis of the data confirmed a nearly universal lack of knowledge about an EMHT service, a clear perception of the need for such a service, and a unanimous commitment from the respondents to participate in addressing this problem. Such collaborative activity is expected to have a positive impact on the micro, mezzo, and macro levels of social work practice in south Whidbey, as well as on the community itself, not only in spearheading a dialogue about EMHT but also in activating a group of social workers who had no prior association.

Even though initiation of breastfeeding among term and preterm infants has increased, the incidence and duration among preterm infants continues to lag because of the unique challenges of breastfeeding preterm infants. African American mothers have the lowest rates of breastfeeding initiation and duration, and their preterm infants are less likely to receive breast milk while in the neonatal intensive care unit. The objective of this cross-€sectional quantitative study was to evaluate the relationship between breastfeeding and maternal sociodemographic factors as well as medical and obstetrical conditions for infants born between 32-€37 weeks gestational age in South Carolina from 2009 to 2011. The health belief model provided the framework for this study. Secondary data from the South Carolina Pregnancy Risk Assessment Monitoring System included 1,752 preterm pregnancies. Results of binary logistic regression and multivariate logistic regression analysis indicated that mothers who were African American and those who had lower income, no Medicaid, and lower education level breastfed less frequently. Findings may be used to decrease neonatal, postnatal, and infant morbidity and mortality, and to increase breastfeeding knowledge and support to ensure successful breastfeeding of preterm infants beyond the hospital.

A lack of consistent, evidence-based practices for blood lead testing of children existed in a local public health department (LHD). No known blood lead level is safe, and toxicity can result in behavioral and cognitive impairments. The purpose of this project was to develop and analyze a clinical practice guideline to establish blood lead testing procedures in the LHD to improve testing procedures and enhance future testing within the jurisdiction. The RE-AIM framework was used to address the reach, effectiveness, adoption, implementation, and maintenance of the clinical practice guideline. Five experts evaluated the guideline using the Appraisal of Guidelines for Research and Evaluation instrument. The assessment results indicated 96.4% agreement across all domains. The experts agreed unanimously to recommend adoption of the clinical practice guideline. Implementation of the guideline might advance nursing practice and patient care in the LHD through incorporation of evidence-based practices. Implementation might also lead to early identification of lead-burdened children and may provide the opportunity for treatment to mitigate cognitive and behavioral deficits related to lead toxicity, thereby improving child health and decreasing related health care costs. Engagement of the clinical practice guideline will support positive social change through the empowerment of public health nurses to provide optimal care to a population of children at risk of deleterious and long-term side effects of lead exposure.

Older African American (AA) women are at increased risk for HIV and STDs. The purpose of this quantitative study was to examine the influence of provider-initiated condom use education on condom use among unmarried, heterosexually active AA women aged 50 and over using the constructs of self-efficacy and attitudes of the health belief theoretical model. The relationships between provider education on condom use, condom use self-efficacy, condom use attitudes, and actual condom use were tested individually, and provider education on actual condom use was tested after controlling for condom use self-efficacy and attitudes among 95 study participants recruited primarily from Raleigh-Durham, NC. A 2-tailed sample t test or analysis of covariance was used for analysis. Provider education on condom usage failed to show a benefit with regard to condom usage, condom use self-efficacy, and attitudes toward condom usage. Additionally, women who received provider education on condom use were less likely to use condoms. Possibly these women had a low perception of risk and vulnerability to HIV and STDs, which correlated with lower condom use. The counter intuitive findings could also be related to another variable that was not tested and should spur more research. Results could be used to contribute to the design of an intervention model that specifically addresses the sexual behaviors of older AA women. Results of this study, combined with previous research, can help emphasize the need for improved patient-provider communication so that provider communication produces a more positive outcome and helps limit the spread of HIV and STDs, a limitation that would benefit individuals, whole communities, and the nation.