Full (complete) childhood immunization against tuberculosis, poliomyelitis, diphtheria, tetanus, hepatitis B, yellow fever, measles, and the maternal retention of immunization documentation are the most cost-effective interventions against vaccine-preventable childhood diseases. The full childhood immunization rate in Nigeria has not reached the expected target level of compliance at 90%. Using the social ecological model, this study investigated the influence of maternal satisfaction with postnatal services and paternal support on full childhood immunization status; it also examined the association between maternal factors and the maternal retention of immunization documentation in Owerri, Nigeria. The hypotheses were that maternal satisfaction with postnatal services and paternal support were associated with full childhood immunization status. This study was a quantitative, cross-sectional survey design that included validated modified WHO/EPI-30 cluster immunization survey information from the cluster sample of 560 mothers of children between the ages of 12 and 23 months old. The multivariate logistic regression analysis (at the .05 level) indicated that the odds of full childhood immunization status were lower for participants who indicated no maternal satisfaction with postnatal services compared with those who indicated satisfaction with postnatal services. Public health workers and policymakers should invest more resources in maternal and child health care resources to increase maternal satisfaction with postnatal services. The study outcomes may help to evolve a system that may increase childhood immunization status and reduce vaccine-preventable diseases in Owerri, and serve as a model for other countries.

Human papillomavirus (HPV) is a preventable, sexually transmitted infection whose prevalence has been rising dramatically among men who have sex with men (MSM) in the United States since 2008. The HPV infection rate for MSM is rising even faster for MSM who are infected with the human immunodeficiency virus (HIV) and for those who have developed acquired immune deficiency syndrome (AIDS). It is not clear whether MSM in general and MSM with HIV have the knowledge necessary to prevent infection of themselves and their partners. This phenomenological study explored the knowledge, health perceptions, attitudes, and norms of the community of MSM and HIV-positive MSM relative to HPV, using private, semi-structured, detailed interviews with 37 HIV-positive MSM between 18 and 26 years of age; interviews were conducted at 3 outpatient clinics and 2 private medical practices. Interview transcripts were analyzed; these findings revealed that the study population of HIV-positive MSM had a basic understanding of HPV but knew little about the transmission of HPV or about the availability and cost of HPV vaccines. This study promotes positive social change by identifying specific opportunities to improve health education policy and programs targeting HIV-positive MSM. It also supports primary prevention efforts that have the potential to be life-saving. Through educating MSMs, the potential exists to reach more MSMs with primary prevention life-saving efforts. Study recommendations include developing inclusive education programs addressing different aspects of, and behavioral approaches to, the reduction of HPV infection risk; further exploration of a cost-benefit analysis of the HPV vaccine; and support for policy change regarding insurance coverage for male HPV vaccine in the United States.

Low immunization in Nigeria is associated with high prevalence of childhood diseases. The purpose of this qualitative phenomenological study was to describe caregivers' perceptions of routine immunization of their children ages 24 to 36 months. Caregivers' attitudes, cultural beliefs, and knowledge regarding immunization were examined. The health belief model was used to guide study. Interviews were conducted with 5 caregivers of fully immunized and 5 caregivers of partially and nonimmunized children. Digital recordings were analyzed using NVivo 10 to identify themes and subthemes. Attitudes of caregivers with fully immunized children included both perceived barriers (distance to health center, lack of information) and perceived benefits (vaccine safety and effectiveness), whereas caregivers with incomplete vaccinations reported multiple transportation-related barriers. Cultural beliefs were limited to religious beliefs and emerged as a theme among both caregiver groups, where full vaccination associated with Christian beliefs and lack of vaccination with belief in traditional healers. Caregivers' knowledge associated with full vaccination included cues to action (information from nurses and reminders by others) and self-efficacy (kept vaccination cards ready and prepared for vaccination day), and incomplete vaccination associated with lack of reminders and preparation. Perceived severity, susceptibility, and benefits were associated with full vaccination status, while lack of perceived severity, susceptibility, cues to action, and self-efficacy constituted barriers to vaccination. Social change implications include education on disease severity, susceptibility, and vaccination safety, and expanding transportation, access to vaccination centers, and religious outreach programs to increase immunization of Nigerian children.

The incidence of venous and arterial thromboembolic events (VTEs/ATEs) varies greatly by cancer type and age, with increased risk in the elderly. Very little research has been reported specific to elderly kidney cancer patients. Retrospective cohort analyses of Medicare patients, 11,463 with and 11,463 without kidney cancer, between 2003 and 2010 were conducted to compare incidence rates of VTEs/ATEs in cancer patients with matched noncancer patients and to assess independent risk factors for VTEs in cancer patients. The advanced epidemiology triangle was the theoretical framework used to interpret the association between incident events and other factors. Using Cox proportional hazard regression, the first 2 research questions examined whether the incidence rates of VTEs/ATEs were higher in kidney cancer patients than noncancer patients; the third research question assessed which factors were associated with VTEs after kidney cancer diagnosis. In the year prior to index date, cancer patients had higher incidence rates of VTEs than noncancer patients; the incidence rate of myocardial infarction was higher in cancer patients than noncancer patients for patients with a history of cardiovascular disease. Elderly kidney cancer patients with transitional cell tumors had lower rates of pulmonary embolism and ischemic stroke compared to patients with clear cell tumors. Recent history of VTE and Charlson comorbidity score were strong predictors of VTE after cancer diagnosis. These results can lead to positive social change by helping healthcare providers to determine who may benefit from closer observation or prophylaxis to prevent or minimize morbidity from these thromboembolic events, thus improving health and quality of life for elderly kidney cancer patients.

Childhood obesity is a growing challenge in the U.S. Hispanic American population. There is a need for evidence-based approaches to combat this problem. Social Cognitive Theory (SCT) is one such approach. The purpose of this study was to examine the extent to which selected constructs of SCT (expectations, self-efficacy, self-efficacy in overcoming barriers and self-control) could predict five childhood obesity prevention behaviors, namely time spent on television watching, time spent on physical activities, water consumption, consumption of fruits and vegetables, and meal portion size among Hispanic American children. A quantitative cross-sectional research design was employed for this study. Data were collected from a sample of 235 Hispanic American children between the ages of 11 and 15 years, using a cluster sampling method. A reliable survey instrument used for data collection in this study Promoting Healthy Lifestyle Survey, was developed and validated by Sharma, Wagner, and Wilkerson (2014) from three community churches in three different Georgia counties. Multiple regression analyses were used to determine the predictability of the independent variables, which were the constructs of SCT, and the dependent variables, which were the five behaviors. Significant SCT predictor of television-watching behavior was expectations (p = 0.004; adjusted R2 = 0.08). The statistically significant physical activity SCT predictor was self-efficacy (p < 0.001, adjusted R2 = 0.24). It is envisaged that the results of the study will assist public health education practitioners in developing concerted interventions among Hispanic American children and families designed to reduce childhood obesity facilitating a positive social change.

Organizations in the public sector in Qatar have a reputation for delivering inefficient services. Leaders lack an understanding of motivational factors affecting public sector employee performance. The purpose of this correlational research was to examine the relationship between leadership styles and employee motivation in public companies in Qatar. The independent variables were the transformational, transactional, and passive-avoidant leadership styles. The dependent variable was employee motivation. The moderator variables were employee age and salary. A sample of 92 employees from 4 public sector organizations in Qatar responded to the online survey. The full range leadership theory served as the theoretical foundation for describing leadership styles of managers as perceived by employees. Self-determination theory served as the theoretical foundation for describing employee motivation. A hierarchical regression model was developed, and results of the study indicated a significant positive correlation between transformational and transactional leadership styles used by managers and employee motivation levels, with a standardized beta coefficient (β) above 0.6, and a significant negative correlation between passive-avoidant leadership style and employee motivation levels, with a standardized beta coefficient (β) below -0.57. Age moderated the relationship between transformational leadership and motivation. Salary moderated the relationship between passive-avoidant leadership and motivation. Leaders of public organizations in Qatar may use the results of this study to better support employee motivation and engagement. The study may contribute to social change by helping managers improve organizational performance and increase efficiency levels.

Native-born African Americans (NBAA) bear a disproportionate burden of the effect of hypertension (HTN) in comparison to other racial groups in the United States. West African immigrants (Foreign-born African Americans) appear to carry a heavier burden than the NBAA in the United States. Using the social support theory as a guide, this study examined the association between the need to meet socioeconomic responsibility of financial and familial obligations (SERFFO) and perceived stress and the increased likelihood of HTN among West African immigrants, aged 25-54 years, in the United States. In this quantitative, cross-sectional design, self-reported data were collected from a sample of West African immigrants (N = 339) in the Dallas-Fort Worth Metroplex of Texas, using a demographic data/screening sheet, the Perceived Stress Scale and the Personal Financial Wellness Scale. Multivariate logistic regression analysis was used to determine the effect and degree of association between the dependent variable (DV), Hypertension, and the Independent Variables (IV), SERFFO, Perceived Stress, Age, Gender, Family HTN Status. Results indicated an association of SERFFO and Perceived Stress on the increased likelihood of HTN among Foreign Born African Americans in the United States of America. Family HTN Status recorded a greater likelihood of HTN. The results of this study will contribute to positive social change by leading public health agencies to target FBAA populations with HTN control programs.

The purpose of this quantitative study was to examine to what extent work demands as measured by perceived job stress affected the health-related quality of life (HRQOL) as determined by the number of unhealthy days of registered nurses in the United States. This study was also an investigation of the extent to which other variables such as body-mass index (BMI) and certain lifestyle behaviors affected the HRQOL (number of unhealthy days). The independent variables were perceived job stress, weight (BMI), and lifestyle factors such as tobacco and alcohol use, physical inactivity, and the mindful eating score, and the dependent variable was the HRQOL (measured by the summary index of unhealthy days) of the RNs. This study was guided by the enhanced DRIVE model which describes how individual differences interact with perceived job stress to affect health outcomes. A cross-sectional study design was used and relevant data to answer the research question were collected from 95 participants via a SurveyMonkey survey that was advertised in an e-newsletter from the Nurse Practitioner Association of Continuing Education as well as posted on LinkedIn groups. Logistic regression and Spearman's correlation were used to test the hypothesized associations. There were no statistically significant associations between BMI, alcohol use, smoking, inactivity, and the HRQOL. However, there was a weak correlation between perceived job stress, the mindful eating score, BMI, the total number of unhealthy days and the total number of days that the nurses' daily activities were affected by unhealthy days. The positive social change implication of this study is that, for nurses, awareness of perceived job stress is important in promoting a healthy lifestyle and reducing the risk of chronic diseases.

Obstructive sleep apnea (OSA) is a type of sleep apnea that is common, complicated, and a major contributor to cardiovascular diseases, neurocognitive impairment, and mortality. This disease has additional negative impacts on patients' lives by contributing to daytime sleepiness and low productivity at work as well as absenteeism and work-related injuries. Several studies have been conducted to assess the relationship between cardiovascular exercises and OSA; however, a definite conclusion is lacking. The purpose of this quantitative cross-sectional study was to assess the relationship between cardiovascular exercise participation and OSA by examining the relationship between total cardiovascular exercise participation per week and OSA as well as the relationship between body mass index (BMI) and OSA among adults over normal weight in the United States. Secondary data from the National Sleep Research Resource (NSRR) were used for analyses. Logistic regression was used to test the hypotheses. The Social-Ecological Model (SEM) guided the study. The findings of the study suggested that doing moderate cardiovascular exercise participation per week (0.1 and 200 minutes) had no relationship with OSA while doing higher cardiovascular exercise participation (>200 minutes) per week had relationship with OSA by increasing the odds (AOR = 2.1, CI: 1.048-4.060) of having severe OSA. BMI had no relationship with OSA. Individuals with OSA and a higher BMI could use the findings of this study to participate in an exercise program that might benefit their health and decrease the risk of exacerbated symptoms which could lead to an improved quality of life and decreased burden associated with OSA.

A lack of adherence to antiretroviral therapy (ART) increases the risk of onward human immunodeficiency virus (HIV) transmission and mortality. The purpose of this cross-sectional study based on Andersen's conceptual framework was to test the associations between age, marital status, job/occupational status, education, membership in a peer support group, community, and facility ARV drug refill and alcohol and substance use, and adherence to ART among female sex workers (FSWs) who are 15 years and older in Rivers and Cross Rivers states Nigeria. Data were abstracted from existing program data collected between January 2015 and December 2017 by Heartland Alliance International, Nigeria. Results from chi-square statistics showed that age, job/employment, and marital status were not associated with adherence to ART. Binary logistic regression analyses showed that respondents with senior secondary education were 1.385 times more likely to adhere to ART than other education levels (OR = 1.385, 95% CI = 1.203, 1.593). Respondents who had ARV refill in the facility were 1.737 times more likely to adhere to ART than respondents who had community ARV refill (OR= 1.737, 95% CI: 1.297, 2.326). Also, respondents who were a member of a support group were 6.430 times more likely to adhere to ART compared to those not in a support group (OR= 6.430, 95% CI: 4.682, 8.831). Lastly, respondents who did not abuse alcohol or substance were 1.820 times likely to adhere to ART compared to those who did (OR= 1.820, 95%: CI: 1.356, 2.444). All-inclusive key population policies could aid in lessening the barriers the FSWs face in receiving comprehensive health services as well as endorsing interventions such as alcohol and drug rehabilitation, counseling, and incentives to join peer support groups that could benefit FSWs, their clients, and families.