Large portions of the US population live in poor inner-city communities. Health needs assessment data have shown that these communities have disproportionately high rates of chronic illnesses. The patient-centered medical home (PCMH) model was developed to address the gaps that exist in the primary care system, and emphasizes a redesign of primary care that is patient centered, utilizes multiple levels of healthcare professionals, information technology, and care coordination. However, little evidence exists on the value of this model which may explain why it has not gained wide acceptance by primary care providers. Therefore, this study was designed to examine the efficacy of the PCMH model through emergency department and inpatient utilization reductions, and with a specific focus on the role of social connectedness. This research used existing data on 706 participants from Columbia University and a local New York inner-city hospital. An in-depth analysis of hospital utilization data, using an unpaired two-sample t-test and linear regression, found that the PCMH framework strengthens continuity of care and care coordination, and helps reduce avoidable hospitalization utilization. Additionally, these reductions were greater for study participants with strong social support networks. This research highlights the relationships between primary care, social support networks, and good health outcomes. Over time, further enhancement of the PCMH and systemic changes to the delivery of care may contribute to the development of a stronger primary care system that place patients at the center of care, focuses on the importance of social connectedness, and contributes to a lasting impact on society through the development of overall healthier communities.

Youth violence in the Baton Rouge inner-city area continues to create heightened concerns for the communities as well as the financial and healthcare systems. Even though violence prevention programs are in place in the area, no decline has been recorded in those who are being affected by violence. Due to lack of research in this field, a need for a sound research study exists to understand how Youth Peace Olympics (YPO) community-based program may be related to changes in attitudes about aggression and violence. A correlational cross-sectional research design was used to evaluate participants' beliefs about aggression, measured using the Normative Beliefs about Aggression instrument by the organization at the beginning and end of the summer program, in addition to secondary data that was provided to me (n=50). Social cognitive theory and the social development model were used as the theoretical framework for the study. Results showed a statistically significant decrease in retaliation approval of aggression scores (pretest M = 2.24, posttest M = 1.91; t[49] = 4.07, p =.000) and marginal statistically significant decrease in general approval of aggression scores (pretest M = 1.48, posttest M = 1.31; t[49] = 1.96, p = .055). Age, gender, and ethnicity were not found to be related to pretest attitudes or pretest/posttest changes in attitudes regarding retaliation approval or general approval of aggression at statistically significant levels. The potential for positive social change is to provide researchers and community-level stakeholders with preliminary program evaluation data related to attitudes about aggression/violence approval.

Jamaican males are a high-risk population for aggressive prostate cancer (PrCa) due to genetic influences, and identifying empirical data on treatments, which provide survival benefits is a prime challenge for clinicians who manage Jamaican PrCa patients. Thus, the purpose of this investigation was to elucidate treatment effects of brachytherapy and ERBT in the survival of a Jamaican PrCa cohort. Differences in survival outcomes of brachytherapy and ERBT treated Jamaican, and White U.S.-born PrCa patients with localized PrCa were compared. The mechanism of radiation programmed cell death in PrCa carcinogenesis explained in the oxidative stress theory, was the theoretical base for interpreting the research questions. A retrospective cohort design was used, and included survival analysis of secondary data from the Surveillance Epidemiology and End Results database. The sample size was 10,752 Jamaican and White U.S.-born prostate cancer patients diagnosed between 1992 and 2011. Kaplan-Meier and Cox proportional hazard regression models confirmed that brachytherapy resulted in enhanced survival benefits to the Jamaicans, HR 0.63, 95% CI [0.55, 0.73], p < .001, but ERBT did not, HR 1.6, 95% CI [1.38, 1.84] p < .001. Hence, brachytherapy may be an appropriate treatment option for Jamaican PrCa patients. Clinicians and health care planners can utilize the results for policy decisions aimed at increasing access to brachytherapy treatments to Jamaicans. Improving access to efficient PrCa treatments could reduce the morbidity and mortality rates of PrCa among Jamaicans, decrease years of potential life lost from PrCa, and enhance the life expectancy of the Jamaican male population.

Today's academic and social environment creates uncertainties, new roles, frequent changes, and challenging situations for student affairs academic leaders. The purpose of this study was to explore how student affairs academic leaders described their recent challenging experiences in addressing student drug abuse in higher education. The conceptual framework was based on adult transformative learning theory and applied transformative leadership perspectives. An interview format with open-ended questions was used to explore the experiences of 8 student affairs leaders who had faced challenging situations in the context of student drug abuse. A qualitative interpretive analysis was used that involved open coding of significant words and statements that were further classified into themes. Results from the leaders' experiences indicated 4 themes associated with transformative learning: challenge, reflection, constructive dialogue, and action, as well as 7 themes related to transformative leadership: accurate information, collaboration, constructive dialogue, critical reflection, responsibility, support, and vision. Critical reflection and vision were also found to have aided leaders faced with challenging situations. A significant finding was that all participant leaders asserted the importance of applying evidence-based research in the hope of developing positive action for both the students' well-being and the growth of the academic institution. The results of this study have the potential to inform best practice in adult transformative learning and adult transformative leadership, benefiting academic leaders facing challenging situations in their social and academic environments.

Of the 3.5 million persons infected with chronic HCV in the United States, the African American population is the largest racial group with chronic HCV. Disparities in access to care and treatment involve a complex set of individual, interpersonal, socioeconomic, and environmental factors that influence the course of HCV infection in the African American population, resulting in poorer outcomes and survival. Drawing upon both the theory of reasoned action and the theory of planned behavior, this study was conducted to determine whether the seeking of health care by HCV-positive African Americans and the responses of health care providers to HCV-positive African Americans had improved since 2008 following the introduction of new treatment options, as compared to other HCV-positive racial/ethnic groups, using secondary data analyses with survey datasets from the National Health and Nutrition Examination Survey, 2005-2012. Using chi-square test of difference and logistic regression analyses, the study did not identify a statistically significant relationship between health care seeking behavior and responses from health care providers for HCV-positive African Americans before (2005-2008) and after (2009-2012) the introduction of new treatment options as compared to other HCV-positive racial/ethnic groups. Given the ongoing development of new and improved drugs to treat HCV infection, further research might focus on the HCV-infected population as a whole to ascertain whether differences exist as compared to earlier therapies before 2013. This study may drive social change within the health care community by raising awareness of the risks of HCV infection resulting in less provider bias and the introduction of resources into the African American and underserved communities that will improve outcomes and reduce barriers to care.

The purpose of this study was to investigate the relationships among cultural/spiritual beliefs, risk behaviors, and disclosure among Hispanic/Latino men who have sex with men and women (MSMW). Minority men who have sex with men are disproportionately affected by HIV, in particular MSM who are Hispanic/Latino or African American. Limited research is available on the link between Hispanic/Latino MSMW, their cultural/spiritual beliefs, risk behavior, and disclosure about risk behaviors to friends and family. The data were obtained from the SJS Project, which used survey methods to gather data on participants from all 50 states and Puerto Rico. Among the participants in this project, 354 indicated that Hispanic/Latino was their only race/ethnicity, 264 identified as gay (MSM), 23 identified as bisexual (MSMW) and 67 identified as some other sexuality, and thus were not included in the analysis. Chi-square analysis and multiple linear regression were used to analyze the data and test the hypotheses. Among the bisexual group, the results showed no relationship between the independent variable, cultural/spiritual beliefs, and the dependent variable, disclosure. Among the gay group, the results showed a moderate relationship on one item of the independent variable, cultural/spiritual belief, and one item of the dependent variable, self-disclosure. Thus there is a relationship between disclosing to friends, family and the neighborhood and feeling supported by family among the gay group. It is expected that these findings will inform public health practitioners who have an interest in creating and implementing HIV prevention programs geared toward the Hispanic/Latino members of the LGBT community and Hispanics/Latinos.

African American women (AAW) suffer from disproportionately high death rates due to coronary heart disease (CHD) compared to Caucasian women. Although there have been a number of studies targeting African American adults with CHD in clinical interventions, very few studies have addressed the social determinants of health and the influence of AAW's perceptions of health factors on health outcomes. The purpose of this phenomenological study was to fill the gap in the existing knowledge base by examining the lived experiences of 10 AAW diagnosed with CHD with a focus on the perceptions of environmental, socioeconomic, and cultural factors related to their disease. The framework for this study was Stokol's socioecological theory. Data were collected through individual semi structured interviews that were audio recorded, transcribed, inductively coded, and organized into themes. Results confirmed an expected connection between CHD and key external factors such as smoking, poor nutrition, and low exercise. The findings also indicated that financial considerations were a factor, including the affordability of healthy foods, although the historical cultural connections to cooking and eating were a greater impediment. The financial burden of medical treatment was less troublesome for the participants of this study, as all had access to private or public insurance plans. Other significant barriers included the inability to schedule appointments with physicians due to work and home commitments. The findings from this study contribute to social change by providing insight into the need for public policy that encourages a more culturally-competent health care system to better educate people about CHD, amend AAW's perceptions on CHD, and aid in the possible reduction of CHD.

Large numbers of individuals utilize the ER each year for mental health reasons. The health home agency in this study was designed under the Affordable Care Act with the intention of increasing patient self-management thus decreasing high-cost service utilization. The effectiveness of health homes in reducing mental health-related ER visits has remained unexplored. In this study, the relationship between participation in this program and ER utilization was examined, using the theoretical framework of the Health Belief Model. The sample of 128 health home participants with documented mental health conditions was selected using systematic random sampling. A one-way, repeated-measures t-test and a one-way, repeated-measures ANCOVA were used to analyze hospital records for ER visits with a primary or secondary mental health diagnosis. The results indicated that health home participation did not have a statistically significant impact on ER utilization when comparing overall 12-month means or at quarterly anniversary dates when controlling for age, race, and gender. These findings suggested opportunities for improvement in professional practice, identified areas that require further research, and will be used to initiate discussion into the existing and potential value that health homes offer to the mental health clientele being served. Those discussions have the potential to create social change through infrastructure changes that lead to improved service coordination, increased resources for improving access and quality of care, and overall enhancement of outcomes for individuals with mental health conditions.

While obesity is a nationwide phenomenon, African Americans - especially women - continue to be more severely affected than any other ethnic group. According to the Centers for Disease Control and Prevention, over 20% of African American women are obese compared to 15.6% of Caucasian women. The church is an important community center for many African Americans, and is often a site for health promotion programs, though little is known of the effectiveness of these programs. The purpose of this qualitative study was to study the experiences and attitudes of African American women who have gone through a church-based weight-loss program. Questions were asked about the cultural, environmental and social barriers to weight loss, and the components of effective church-based weight loss programs. Using a phenomenological approach, this study was designed to capture new data for the development of sustainable church-based weight-loss programs. The theory of social support was used as a theoretical framework. The major themes arising from the data concerned the importance of: (a) social support on all levels; (b) the involvement of the pastor, his spouse, or other church leadership; (c) the inclusion of weight-loss participants in program design; (d) a holistic program design to meet the needs of the entire family; and (e) a culturally sensitive program. The inclusion of all these elements is recommended for future programs. The social change implication is that these recommendations could be helpful in the design, development, and implementation of sustainable church-based weight-loss programs for African American women.

Obesity is a chronic disease that is caused by a number of factors such as diet, genetics, physical inactivity, and poor dietary habits. This research focused on how income affects obesity among a target population in the African American community in Durham, North Carolina (NC). It has been noted that chronic diseases that are diet-related, for example, obesity, diabetes, hypertension, and high cholesterol, affect African Americans disproportionately, especially those who earn low income. Some studies have also reported that those who make higher income have higher rates of obesity. This inconsistency and gap in the literature prompted research on this topic. Therefore, the purpose of this research was to study the relationship between family income and obesity among African Americans. The study sought to address the key factors that contribute to low family income among African Americans in Durham, NC and the ways in those key factors contribute to obesity among African Americans in Durham, NC. This study implored a qualitative approach by using an individual interview method to glean the lived experiences of participants in Durham, NC. Thirty participants were interviewed and themes from the interviews were analyzed. The health belief model was chosen as the theoretical framework for this study to understand the data and explain beliefs, attitudes, and health behaviors. Key results indicated that low family income contributes to obesity. The study contributes to social change by recommending that policy makers advocate for an increase in national minimum wage, encourage educational approaches to prevent obesity, promote good eating habits, and promote adequate physical activity among African Americans.