Restaurant managers complete certification in food safety in order to ensure that food is handled and prepared in a manner that decreases risk factors associated with food-borne illness. However, the literature has been inconclusive concerning the connection between manager certification and the incidence of critical food-safety violations. The purpose of this quantitative study was to examine the relationship between the presence or absence of a certified food safety manager (CFSM) and the number of risk factors cited on food inspection reports and the food safety score. In addition, this study was designed to determine whether operation type (i.e., chain vs. independently owned) has an impact on the number of risk factors and food safety score. This study was an analysis of 2013 data from 1,547 restaurants in North, Central, and South Georgia health districts using a 2-tailed independent-sample t test. Restaurants with a CFSM had significantly more risk factors cited on food safety inspections and lower food safety scores than restaurants without a CFSM. There was also a significant difference among chain and independent restaurants. Chain restaurants had fewer risk factors cited on restaurant inspections and had higher food safety scores. In the epidemiological triangle model, breaking the chain of transmission disrupts the link among agent, host, and environment. Thus, CFSMs have the responsibility to implement food safety training programs to break the chain of transmission by identifying and correcting unsafe food practices among food workers. This study has the potential to assist managers in understanding the importance of food safety and implementing food safety training programs that decrease risk factors associated with food-borne illness. Further research is needed to explore the effectiveness of manager certification in reducing critical violations.

August 2016 Management of metabolic syndrome (MetS) may be enhanced by promoting patient engagement. Training health care providers in the conceptual and practical application of integrative patient centered care tools may promote patient lifestyle behaviors for better management of MetS. The purpose of this quantitative quasi-experimental study was to assess the impact of training providers in integrative patient centered care for patients with MetS. The biopsychosocial construct provided the conceptual framework for the study. Two groups of physicians were included; one received training in an integrative model (IM) while the second received no training and provided usual care (UC). Following training, patient disease biometrics and medication adherence were monitored for approximately four months. Due to a diminished sample size in the completer data set, an intention to treat (ITT) data set was created with baseline values brought forward. In the ITT set, BMI decreased significantly (p=0.005, d=0.18) with each group over time: (IM: 32.9 -± 7.3 Kg/m2 to 31.6 -± 6.8 Kg/m2) and (UC: 32.1 -± 6.7 to 31.5 -± 6.3 Kg/m2). However, there were no statistically significant differences between these two groups' measures. In the completer set, BMI decreased significantly (p < 0.05, d=0.18) over time with the IM group, but not the UC group: (IM: 35.14 -± 7.9 Kg/m2 to 33.65* -± 7.62 Kg/m2) and (UC: 32.4 -± 6.62 Kg/m2 and (32.4 -± 6.5 Kg/m2); indicating a possible relationship between the intervention training (IM) and improved health outcomes. Thus, providers are assisting patients with important lifestyle choices to better manage MetS, potentially leading to social change around improved patient health care behaviors and advancement in providers' patient centered practices.

Bold

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the United States in people who are 50 and older. The safety and efficacy of aflibercept for the treatment of late stage neovascular AMD (NAMD) has been demonstrated by clinical trials among several populations; however, it is unclear whether all NAMD patients respond in the same manner as was studied in the clinical trials. The purpose of this study was to examine if populations of patients treated with aflibercept for the treatment of NAMD were significantly different from one another in terms of health characteristics, treatment regimens, and treatment outcomes. The burden of treatment theory was used to guide this study. Data collected from electronic medical records were used to investigate NAMD characteristics 199 patients from 3 private, retinal practices in the United States. Data were analyzed using one-way ANOVA, 2, Spearman's correlation, and point-biserial correlation tests. The results of this study showed the specific retinal practice populations of NAMD patients treated with aflibercept were generally similar with respect to selected health characteristics, treatment regimens, and treatment outcomes. By using the information reported from this research, public health initiatives can be developed that focus on the need for early detection of AMD to capture changes that represent NAMD and move to early treatment for better outcomes. The positive social change that could result from this research is that retinal specialists may gain insight into the use and outcomes of aflibercept treatment.

According to the Centers for Disease Control and Prevention, 29.1 million people in the United States have diabetes. Among those 29.1 million people, 21 million have been diagnosed, but 8.1 million have not. Changing demographics in the United States and the prevalence of diabetes are projected to be burdens on the health care system through 2050. Guided by the social cognitive theory, the purpose of this qualitative case study was to understand the importance of culturally appropriate patient-provider communication to the self-management of Type 2 diabetes by patients who are African immigrants. Culturally based health care has unique challenges when delivering culturally appropriate diabetes care, so a focus on cultural knowledge, intercultural patient-provider communication skills, and cultural assessment were key to this case study. One pilot study was conducted to test the focus group questions with 3 diabetes providers (i.e., certified nurse diabetes educator [CDE], registered nutritionist, and dietitian) who help patients to self-manage their diabetes. The second pilot study was conducted with 5 African immigrant patients who had been diagnosed with Type 2 diabetes. The primary focus groups were conducted with 5 CDEs and 10 patients. The transcribed responses were analyzed and categorized to identify the 17 themes that emerged (9 from the CDEs and 8 from the patients). One implication for social change is that a patient-centered approach to patient-provider communication will mean better health outcomes. To ensure culturally appropriate patient-provider communication, a change in health care delivery is required to incorporate cultural constructs as part of diabetes care and education to accommodate various ethnic and racial groups.

African Americans as a group tend to have numerous health issues, and by the time they seek healthcare, the conditions often advance into more serious ailments. Researchers have shown that cultural distrust of the U.S. healthcare system coupled with some discriminatory practices has hindered African Americans seeking care and taking full advantage of the healthcare system. With the introduction of the Patient Protection and Affordable Care Act (ACA), there is some confusion about the application of the law, resulting in many intended beneficiaries misinterpreting it, and not accessing quality healthcare. This interpretive phenomenological study explored how African Americans in the Washington D.C., metropolitan area understand and interpret ACA provisions related to their healthcare needs. A sample of 10 African Americans adults participated in in-depth interviews that generated data for this study. Critical communicative methodology provided a framework for exploring the phenomenon. Study findings highlight the themes of interpreting the ACA to mean having more individual control and responsibility for healthcare decisions and having fewer perceived restrictions acting as barriers to access healthcare. Study results contribute to social change by providing knowledge to those who implement healthcare policy on optimal policy delivery to intended beneficiaries. This knowledge may also apply to other new social policy dissemination, thus ensuring policies reach their intended target populations, facilitating optimal utilization.

Sexual activity among unmarried adolescents is a major public health problem in Nigeria, because unmarried pregnant girls are more likely to have multiple sex partners and are less likely to use contraceptives, putting them at greater risk for sexually transmitted diseases (STD), unplanned pregnancy, abortion, social isolation, and poverty. Teen pregnancy and STD rates are on the rise in Nigeria, yet few data exist on the experience of the adolescents themselves. This phenomenological study was designed to explore the in-depth experiences of 10 pregnant, unmarried adolescent girls aged 16-19, including the factors contributing to their sexual activity. An ecological model served as the conceptual framework to permit individual experiences to be understood in their social and ecological context. Semistructured interviews and Hycner's method of analysis were used to collect and analyze the data. Results showed that the decision to initiate sexual activity among these girls was influenced by many factors, including: the need for financial support and a socially condoned system of "sugar daddies" who support girls in return for sex; peer pressure to have a sex partner; a romantic knowledge of sexual behavior based primarily on the mass media; and inadequate sex education. As a result of their pregnancy, the girls experienced negative reactions from their families and community, and serious psychological and financial concerns about their prospects for future marriage and their child's identity. A comprehensive community-based reproductive health program is called for, with reliable sex education, cooperation from the mass media, and support from family and community members. The social change implication of this study is to potentially lead to a decrease in unplanned pregnancy, STDs, social isolation, and poverty among adolescent girls in Nigeria.

The strategic prevention framework (SPF) is a data-driven operating system to assist designing evidence-based substance abuse prevention programs. The study performed here was to assess the effectiveness of the SPF as a prevention planning system. One purpose of this study was to determine the implementation fidelity of the programs that used the SPF process; the other purpose was to assess effectiveness of the SPF process. This study utilized a set of data collected by the national cross site evaluation team on all jurisdictions that implemented the SPF. A subset of communities collected and reported at least 2 pre-implementation and at least 2 post implementation outcomes data. The minimum sample size for the study was determined by using Cohen's d criteria. The assessments were performed using both qualitative and quantitative methods by using data collected from multiple levels with a quasi-experimental design. The qualitative data were analyzed using qualitative software with key word searches to examine implementation processes, and the quantitative data were analyzed using descriptive statistics and inferential methods such as Student t tests to examine and compare outcomes. Results show that the communities in the study implemented the SPF process with fidelity and that there were changes in desired directions. Factors related to improvements include sufficient internal resources and monitoring follow-through. This research has important implications for social change since substance abuse is a major social issue that has consequences across life span. Recent studies have shown that many behavioral problems have similar risk factors and that improvements for some behavioral problems will most likely have beneficial effects on other related problems.

African American women have the highest prevalence of overweight and obesity in the United States, thus increasing their risks for chronic diseases. Their understanding of their health status and response to it could be triggered by messages in the media, yet few researchers have examined this topic with African American women. The purpose of this phenomenological study was to explore how advertisement and editorial content in media contributed to perceptions African American women have about overweight and obesity. Following the theoretical foundation of the social cognitive theory, the research questions explored what messages study participants encountered and which messages prompted behavior changes. Ten African American females age 25 and older were recruited and interviewed about their understanding of overweight and obesity, chronic disease risks, and self-efficacy. Codes and themes about obesity, health risks, physical activity, eating, and body image were extracted line by line from interview transcripts. Six themes emerged: obesity as viewed by participants, perceptions of health risks, impact of media messages, perceptions of body image, encouragement from media, and steps to improve personal health. These results indicated that media messages are factors in the development of the views African American women have about being overweight or obese and motivated them to adopt health improving behaviors. Messages in the media can contribute to shifting the imbalance of overweight and obesity among African American women. Additionally, the results can inspire public health officials, health communication researchers and media professionals to develop and disseminate informative health related messages.

The purpose of this project was to improve support for victims of domestic violence. To that end, this project developed an evidence-based program to provide information about domestic violence including safe and confidential ways to seek assistance, rights as cohabiting intimate partners, and the resources available to community members. Several approaches were used to develop, validate, and plan for implementation and evaluation of this program, which was developed for 3 sites in Broward and Miami-Dade counties where the project is situated. The program logic model and the social ecological model, including the individual, relationship, community, and societal levels, were used to guide this project. In addition, scholarly works from 2000 to 2013 were selected from ProQuest, CINAHL, Ebscohost, Medline, and Ovid Nursing Journals to develop this program in collaboration with an interdisciplinary team of 7 community stakeholders including a physician, advanced practice nurse, law enforcement officer, pastor, and 3 recovery center directors with knowledge in these areas. Content validation involved incorporating feedback from the project team. The target population for the project includes women and men aged 18 or higher who have experienced domestic violence, homelessness, and drug addiction. Community operationalization of the initiative will be facilitated by implementation and evaluation plans developed as part of this project. The project includes community education that may help organize events and campaigns, increase domestic violence awareness among community members, and influence policy regarding issues pertaining to domestic violence.