The study institution is a non-profit organization with a model developed from the continuous implementation of needs assessments of the families of adolescent parents in Puerto Rico, with the purpose of increasing their social inclusion potential. Addressing social exclusion and stigmatization of adolescent parents is vital because it generates a dual benefit for social interactions and growth. The social inclusion concept used and further elaborated for adolescent mothers is described by researchers as the level of access to engaging with institutions and societal relationships. This program evaluation was developed to understand the outcomes and effectiveness of the organization's social inclusion interventions. There is a gap in knowledge for comprehensive and family-centered adolescent parent's programs related to their potential for social inclusion. Guided by complex systems theory, the key research questions were designed to assess the potential gains in social inclusion characteristics for the organization's participants. The study utilized organizational, administrative data and used a pre- and post-test design with a comparison group. McNemar test findings indicated statistically significant increase for the intervention group regarding their social inclusion (p < .001); while Wilcoxon test findings indicated statistically significant gain in nurturing family environments (p = .006) and socio-economic positions (p < .001). Further research is recommended to assess the life-course protective factors' characteristics and the social inclusion pathways. The positive social change includes further understanding of social inclusion for adolescent mothers and its related ecological perspectives.

Seasonal influenza outbreaks are associated with morbidity and mortality in the United States. Though children are the most susceptible to influenza infection and are most likely to transmit the illness to others, many children are not vaccinated. The purpose of this study was to examine the relationship between seasonal influenza vaccination Advisory Committee on Immunization Practices (ACIP) recommendations, demographic characteristics, socioeconomic factors, and vaccine type among children over 3 consecutive flu seasons. This quantitative cross-sectional study was guided by the social ecology of health model. Secondary data from 3 consecutive flu seasons (2014-2015, 2015-2016, and 2016-2017) provided by the National Health Interview Survey was used for this study. Binary logistic regression and chi-square were used to analyze the data. A relationship between socioeconomic status, demographics (age, race, and family income) and vaccine type (live-attenuated influenza vaccine [LAIV]/inactivated influenza vaccine) was established among U.S. children; those who received LAIV were most likely to be White elementary school age children with a higher family income. Demographic and socioeconomic status was not considered influential in LAIV uptake for race, health insurance status, or family income. ACIP recommendations by age and year had the greatest impact on flu vaccine choice for this sample population. The results of this study can lead to social change by providing information for policy that can increase vaccine uptake, which can result in lower health cost and reduced illness and death rates associated with the flu, especially for those most at risk.

Influenza is a preventable infectious disease, against which vaccination is the primary means of protection. Health care workers (HCW) are among the most vulnerable to the illness and are likely to be sources of infection transmission while caring for patients. Circumstantial evidence suggests higher rates of vaccination coverage by HCW will coincide with a lower incidence of influenza transmission, yet a gap remains in the literature regarding governing health agencies' (i.e., licensing boards, medical and nursing associations) influence on the influenza vaccination practices of their constituents. Moreover, discrepancies exist between governing health agencies' and the National Vaccine Advisory Committee's recommendations on mandatory influenza vaccination for HCW. The main purpose of this quantitative cross-sectional study was to explore the relationship between influenza vaccination uptake by HCW and guidance from governing health agencies to vaccinate. The health belief model and social cognitive theory were used to identify the most influential determinant for HCW to vaccinate against influenza. The sample consisted of 388 HCW who provided direct patient care at the same hospital. Data were analyzed using Fisher's exact test. Study findings suggest that a workplace mandate for influenza vaccination has an influence on HCW uptake of the vaccine and that governing agencies' lack of uniformity on the matter has minimal impact on their constituents' beliefs and behavior. It is recommended that a universal policy be adopted for health agencies' implementation of an influenza vaccine mandate, which could lead to positive social change by supporting preventive self-care practices, minimizing spread of the disease to workers and patients, and maintaining workplace productivity.

Improvements in technology have allowed people with tracheostomies to live at home on mechanical ventilation (HMV). Quality of life (QOL) for HMV users has been studied quantitatively, but few qualitative studies have been published. The purpose of this phenomenological study was to explore QOL for individuals with tracheostomies on prolonged HMV focusing on activities of daily living (ADLs) and the role of decision- making. The Roper, Logan, and Tierney activities of living theory were used to categorize activities. Ten participants, 18 years and older, with a tracheostomy and on HMV for at least 6 months were enrolled using purposive sampling. Data were collected through structured, in-depth, face-to-face interviews. Themes that emerged were (a) autonomy, (b) significance of ventilator for well-being, (c) feeling tied up, (d) creating meaning, (e) tipping point, (f) reminiscence, (g) building trust and confidence, (h) adjusting to technology, (i) family support and relationships, and (g) meaning of life. The participants were relatively healthy and their QOL was improved when they were on HMV compared to the hospital. The participants felt empowered that they had control in their daily lives at home when they had competent caregivers and family members for continuity of care. Recommendations for future research would include exploring improved methods of collaboration among health care workers and families in providing holistic care and reducing role strain and isolation in young HMV users. The study may promote positive social change through education for family, health care workers, and the public about strategies to promote independence and subsequent improvement in QOL for individuals on HMV.

Heart disease has been the primary cause of death among both men and women in the United States. More African American women are developing and dying from heart disease than any other ethnic group; yet, they are less likely than European American women to know that they have the major risk factors for heart disease. The purpose of this study was to determine the overall knowledge and health beliefs about heart disease among African American women. Five health belief model constructs of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action were applied as the theoretical framework for the study. Linear multiple regression was used to analyze the association between participants' (a) knowledge of heart disease risk factors, (b) knowledge of heart attack symptoms, (c) perceptions of personal risks for heart disease, and (d) demographic background and their awareness of heart disease. Snowball sampling was used to recruit participants. E-mail, LinkedIn, and Facebook invitations with the American Heart Association Women's Health Study Google doc was sent to all family, friends, and associates who met the criteria for participation (N = 389). Results showed that the variables of African American women's knowledge of heart disease risk factors, perceptions of personal risks for heart disease, age, and family history of heart disease were statistically associated with awareness of heart disease. The positive social change implications include bringing more awareness of heart disease to African American women and encouraging them to have heart health dialogue with their friends and family.

Cardiovascular disease (CVD) is responsible for approximately 600,000 deaths in the United States each year, with African Americans (AAs) disproportionately affected. Individual-level approaches to reducing CVD remain ineffective, mobilizing a movement that advocates for population-based solutions. Workplace wellness programs (WWPs) have gained considerable traction as a viable strategy for ameliorating CVD burden among workers in general. However, no studies have looked at the efficacy of WWPs in ameliorating CVD specifically among AA employees--a knowledge gap that this investigation aimed to close. Based on the health belief model and the social cognitive theory, this retrospective cohort study used de-identified secondary data to evaluate the racial differences in the mean change in CVD biomarkers between 163 AAs and 228 Caucasians civilian workers participating in a U.S. Marine Corp self-directed WWP. The 4 CVD biomarkers evaluated were systolic blood pressure (SBP), diastolic blood pressure (DBP), and waist-to-hip ratio. Repeated measures MANCOVA analysis was used to establish the contribution of the independent variable (race) to SBP, DBP, LDL cholesterol, and waist-to-hip ratio. Results showed an overall significant main effect of time for changes in SBP and DBP even after controlling for race, sex, age, and days from baseline. However, there was no overall main effect of time for changes in LDL cholesterol or waist-to-hip ratio. Further research using randomization, a comprehensive health risk appraisal, and a larger sample size may yield additional benefits to AAs. Implications for positive social change include reduction of the extraordinarily high CVD disease burden and disparity among AAs.

Physical activity plays a key role in the health of children. Childhood obesity is increasing in the United States, and children are spending less time being physically active. Active participation by a physical education (PE) teacher in physical activities has been suggested as a means of promoting student fitness. The purpose of this quasi-experimental quantitative study was to determine whether modeling of physical activity by a PE teacher would increase student participation and physical fitness. Bandura's social learning theory provided the theoretical framework for the study. Participants included 311 4th and 5th grade elementary students enrolled in physical education classes. One group of students experienced PE teacher modeling in physical education class activities and the other group experienced no PE teacher modeling. Participation grades in physical education were used for participation scores, while the FITNESSGRAM was used to measure student physical fitness. Independent samples t tests were used to compare students' fitness and participation levels between the two groups. Results indicated no significant differences in fitness or participation between the groups based on teacher modeling. This study promoted positive social change by providing initial research findings to the local site on encouraging physical activity through teacher participation, which may be used to further examine student participation in physical activity.

Increasing obesity rates among adolescents in the State of Massachusetts are of concern to public-health professionals. High bullying rates may contribute to obesity. Guided by Maslow's safety component and Bandura's social-cognitive theory, this study investigated a relationship between hours spent television watching, bullying, and meeting physical-activity guidelines among Massachusetts adolescents. The association between the dependent variable--physical inactivity--and the independent variables--hours spent watching television andbullying--was explored using data from the 2009 Massachusetts Youth Risk Behavior Survey. Participants were 2,601 Massachusetts adolescents aged 13 to 18. Statistical analysis included chi-square, the Kruskal-Wallis Test, Mann-Whitney U, and Spearman correlation. Results revealed a significant negative correlation between television watching and physical activity, suggesting that the more hours students spent watching television, the less active they tended to be. The Kruskal-Wallis test showed a significant difference in hours of television watching by level of physical activity. To determine where the statistical differences lay, 3 pairwise Mann-Whitney U tests were conducted; 2 were shown to be statistically significant. Physical activity and bullying were significantly associated. The results of the Mann-Whitney U test were significant, indicating that levels of activity for students who were not bullied were higher than those for students who were bullied. The social-change potential of this study is a better understanding of the relationship between bullying and physical inactivity among public health professionals in an increased effort to remove barriers to physical inactivity, help limit bullying, and increase health and welfare of adolescents.

The natural practice of breastfeeding has been strongly noted as one of the most cost-effective, health promoting, disease-prevention strategies of the 21st century. Although primary health organizations recommend exclusive breastfeeding for the first 6 months of life with added complementary foods and continued breastfeeding up to 2 years of age or longer, many mothers do not breastfeed their infants for the recommendation length of time. Applied policies and health practices, such as those described under the 10 Steps to Successful Breastfeeding and The International Code of Marketing of Breast Milk Substitutes, have been noted as contributing factors that can considerably impact the manner which women choose to feed their infants. A cross-sectional methodology assessed associations between maternity health practices and breastfeeding duration among women birthing in the United States. A secondary data analysis of the Infant Feeding Practice Study II and its Year 6 Follow-Up was conducted using IBM SPSS Statistics Version 24. Procedures for data analysis included frequencies, Ï?2 tests, and ordinal logistic regressions. Outcomes revealed that feeding infants any formula during their hospital stay drastically reduces the likelihood for prolonged breastfeeding duration. Study results also concluded that offering a pacifier to infants during their hospital stay reduced the length of breastfeeding duration. This study confirms many of the primary breastfeeding practices that are at the frontline of maternity patient care in the United States. Establishing well-grounded practices that aid in the long-term duration of breastfeeding could help save lives and improve child and maternal health outcomes within the United States.

In 2014, breast cancer was the second leading cause of death among Canadian women, with women over age 50 years making up 82% of the identified cases. To address this issue, the Ontario Breast Screening Program developed a media campaign that promoted the benefits of mammogram screening, but not the associated risks (i.e., false-positive, false-negative, radiation exposure, and overdiagnosis). This study was designed to determine whether there was a statistically significant relationship between knowledge of overdiagnosis and participation in mammogram screening. This cross-sectional, correlational study used schema theory supported by the effective health communication model. Forty-one women were invited to listen to a brief presentation on the benefits and risks of screening mammograms and then completed a modified Champion Health Belief Model Scale survey. Two sample t tests and logistic regression analyses of the survey scores showed that the data did not support any correlations with education and screening, but did indicate a correlation between overdiagnosis and participation. The less a participant felt that overdiagnosis was a negative consequence, the more likely they were to participate in breast screening. Survey participants also stated that promotions of mammograms should present balanced information about the benefits and risks of screening. The positive social change and policy implications of this study include providing women aged 50-69 years more information on overdiagnosis in mammograms so they are more informed participants in the decision-making process, and educating Ontario government policymakers with information about the barriers that women aged 50-69 years face in getting balanced information on mammography programs.