Limited knowledge exists about sexual orientation and intimate partner violence among women who have sex with women. These women are at risk for adverse physical and mental health hygiene outcomes that may result from unhealthy lifestyles secondary to intimate partner violence. The purpose of this study was to examine the association between sexual orientation and intimate partner violence among women who have sex with women. The constructs of the biopsychosocial model guided the study and examination of the relationships among biological factors (sexual orientation), social contexts (support of family and friends and use of community services), and psychological influence (mental health status) on intimate partner violence among women who have sex with women. The study was a quantitative cross-sectional analysis of archived data from the 2010 National Intimate Partner and Sexual Violence Survey. Forward stepwise logistic regression indicated a statistically significant relationship between sexual orientation and intimate partner violence victimization (p < .05) Annual household income, race, family/proximal support, and support of community were significant predictors of intimate partner violence victimization. The social change implications of the study are that findings may inform design and implementation of policies, services, and interventions that target the diverse needs of female same-sex intimate partner violence victims.

Health literacy, defined as the ability to understand and use health information to make informed decisions, is critical to maintaining health; however, not all U.S. states mandate strategies to improve adolescents' health literacy. Moreover, many middle school teachers are often unaware of how their roles could improve the health literacy of their students. Multimodal literacies help students to create meaning through viewing print-based resources and using digital technologies. The purpose of this study was to investigate teachers' perceptions of the effectiveness of multimodal literacies on adolescents' overall health literacy via the introduction of health literacy programs into the curriculum. This qualitative research data were gathered, analyzed, and categorized using unstructured narrative interviews and the research was guided by the socioecological model. A phenomenological approach was used to conduct in-depth interviews with 6 middle school teachers. These interviews yielded 4 common themes: efficacy of multimodal literacy, health literacy, blending cultures, and responsibility. The results suggested that (a) multimodal literacies with adolescent literacy components can be used in the middle school curriculum, and that (b) these literacies can help inform policy changes. Understanding teachers' perceptions about multimodal literacy could help to improve adolescent health literacy in the middle school system. Positive social change could occur if school systems understand the utility of incorporating adolescent health literacy in the present curriculum. Doing so could help reduce future health care costs and improve the future health of students.

Access to and receipt of health care is an essential human right; however, transgender people often have negative health seeking experiences that give way to the many health disparities seen in the transgender community. Using the social ecological model, this study determined, through multiple logistic regressions, that correlations existed between socioeconomic, health behaviors, and sociocultural variables and 6 measures of health seeking experiences among transgender African Americans. Secondary data from the 2010 National Transgender Discrimination Survey were used, yielding a sample size of 253 transgender African Americans. Those in the African American transgender community at most risk for negative health seeking experiences had the following characteristics: (a) earned high school diplomas and beyond, (b) were in the workforce or looking to be in the workforce, (c) earned an annual salary exceeding $10,000, (d) did not want hormone therapy, (e) abused alcohol and drugs, (f) attempted suicide, (g) were uninsured or had public insurance, (h) were out in a medical setting, (i) were homosexual, (j) had family support, (k) were homeless, (l) were older in age, (m) self-identified as transgender before 18, (n) received first transgender related medical treatment after 17 years old, (o) lived outside of the New England region, and (p) preferred other health settings than emergency rooms. Exploring this aspect of transgenderism and health care has potential for positive social impact as results from this study could improve the lives of transgender African Americans by combating transphobia among health professionals and promoting culturally competent health care.

Small businesses play a vital role in the U.S. economy and represent 99.7% of all U.S. businesses. Small business failure rate is 50% within the initial 5 years. Creating and executing a well-formulated marketing strategy is essential to business sustainability. Effective marketing strategy builds small business survival rates and supports long term execution advantages. The purpose of this qualitative multiple case study was to explore the marketing strategies that African immigrant small grocery store owners use to sustain their businesses for longer than 5 years. The population included 5 successful first-generation African immigrant small business owners located in the Bronx County who had developed a well-formulated marketing strategy. Kohli and Jaworski's marketing orientation theory served as the conceptual framework. The van Kaam data analysis process was used to validate findings. The data analysis included diverse mind maps, project maps, explorations with participant response and document analysis. Three marketing strategy themes emerged: customer retention and attitudes, inventory that promote value for potential buyers that result in superior performances, conventional and unconventional marketing that focuses on lowering cost of product and services to meet market needs of individuals. The findings revealed several features of how to use marketing strategies effectively to improve stability in the local economy by reducing small business failure rates, increasing profitability, and promoting buyer value. Application of the findings may result in a positive social change by increasing local community employment opportunities and enhancing residents' standards of living.

Immunization protects millions of children. Yet, many children drop out of immunization in Jigawa State of north Nigeria. This cross-sectional quantitative correlational study based on the Health Belief Model was designed to determine whether the dropout from routine immunization (RI) was influenced by low rate of reporting of adverse events following immunization (AEFI) to health facilities by caregivers. Primary data was collected from 307 caregivers with dropout children using structured interviewer-administered questionnaire. The data were analyzed using logistic regression and descriptive statistics. The results showed that 61.3% of the children had AEFI and dropped out. Rate of reporting of AEFI to health facility was low (23.1%). This significantly influenced the dropout (95% CI; p <.001; ï?£2 = .028; OR = 2; AOR = 6). Children with AEFI were 2 times more likely to be dropouts than their counterparts with no episode of AEFI. Children with AEFI of loss of appetite or persistent crying were 4 times more likely to drop out of immunization. The place where one sought treatment for AEFI was strongly associated with the dropout (95% CI; p <.001; ï?£2 <.001). Those who sought help outside health facility were up to 5 times more likely to drop out of immunization compared to health facility treatment. Caregivers were of the view that, they would be able to improve their reporting of AEFI to health facilities for treatment and eventually complete the immunization of their children if they receive good education on immunization and the need to report AEFI to health facility. Findings of this study if appropriately disseminated could lead to positive change initiatives of preventing vaccine diseases by increasing the uptake of complete immunization through education on immunization and inclusion of caregivers' ideas in immunization interventions.

High blood pressure (hypertension) is known to be one of the leading factors that directly contributes to heart disease and stroke, which are the first and third leading causes of disabilities and death in the general U.S. population. The prevalence of high blood pressure among African American men in the United States ranks as one of the highest in the world. Research indicates the roots of this phenomenon are found in physiological, psychosocial, cultural, and socioeconomic factors differentially affecting the African American population. The purpose of this study was to examine the interaction between African American males' masculine perspective and the lifestyle and clinical dictates essential to self-management of hypertension. This qualitative study used social cognitive theory and health service utilization as its theoretical foundation. The research questions that guided the thematic analysis of the qualitative interview data centered on psychosocial/risk factors, sustaining self-management, and common themes gathered from individual interviews with ten African American men ages 40-65 years with a medical diagnosis of hypertension. Responses were transcribed, and data were analysed by using NVivo 10 to identify reoccurring themes. The dominant themes were perceptions of discrimination, lack of trust and miscommunication with providers, and self-care behaviors associated with masculine identity. The results of the study did not necessarily present new findings but support that efforts are needed by professionals to craft innovative approaches to education and support for African American males with chronic diseases. This study influences positive social change by helping health providers grasp a better understanding of how African American males' views of masculinity and race influence hypertension-related behaviors.

Childhood obesity is a major issue in the United States. The rates of obesity vary among racial and ethnic groups in the U.S. South. The purpose of this quantitative cross-sectional study was to investigate significant state health disparities differences in childhood obesity in the South region between Florida and Georgia. To steer this study, the social cognitive theory was used. The associations between neighborhood safety and support, physical activity, family health and activities on body mass index were examined in this study. Data was obtained from the National Survey of Children's Health 2011-2012 on 1,688 children aged 10-17 years residing in Florida and Georgia. Logistic regression models showed children in Georgia were 1.4 times more likely to be overweight/obese than children in Florida. Significant differences were found in Florida and Georgia for neighborhood safety and support, physical activity, and family health and activities with evidence to reject the null hypothesis for each state separately. There was no evidence to reject significant differences between Florida and Georgia on sociodemographics. Public health professionals could benefit from researchers studying the causes of racial/ethnic and socioeconomic health disparities in childhood obesity. Thus, professionals could use these results to develop programs targeted at minority populations at increased risk. Positive social change implications of these finding could provide more insight on childhood obesity in the South, where more research is vital. This could be achieved through creating state-specific policies, raising awareness, and implementing prevention programs to decrease childhood obesity.

Health care workers are at risk of contracting HIV as a result of occupational exposure while treating infected patients. HIV postexposure prophylaxis (PEP) is an effective antiretroviral treatment course used in preventing potential HIV infection following an accidental occupational exposure to HIV. The objective of this cross sectional study was to identify the factors that impact the practice of HIV PEP among health care workers at the National Hospital, Abuja, Nigeria. A cross-sectional survey using self-administered, structured questionnaires was conducted on 182 health care workers at the National Hospital comprising of medical doctors, nurses, and laboratory scientists. A chi-square test of independence was used to assess the association between knowledge of PEP and PEP use. Logistic regression was used to determine the relationship between PEP use and types of occupational exposure, existing precautionary policies, and fear of stigma. The results of this study were statistically insignificant with variables PEP knowledge (p= 0.274), types of occupational exposures (p= 0.575), awareness of precautionary policies (p= 0.219), and fear of stigma (p=0.282), which could be a result of the small sample surveyed. Nonetheless, this study can lead to positive social change whereby health care workers are well-trained on the practice of PEP after sustaining an occupational injury in order to prevent HIV infection. Factors such as inadequate knowledge on HIV PEP practice, underreporting of occupational injuries, lack of awareness of precautionary guidelines on HIV PEP, and the fear of stigma after an occupational exposure to HIV affect the practice of HIV post exposure prophylaxis. Therefore, more education on PEP for HIV among health care workers is warranted.

Despite a 90% fatality rate and high risk of complications from influenza infection, vaccination coverage remains lower among African American (AA) and Hispanic American (HA) older adults. Health care professionals, families, and older adults are concerned with improving vaccination uptake. The purpose of this study was to examine differences among older adult AA and HA compared to European Americans (EA) on how their personal beliefs and perceptions affect vaccination uptake. The health belief model guided this study. The study research design was a quantitative cross-sectional analysis of the 2009 National H1N1 Flu Survey. Weighed prevalence of vaccine uptake indicated all groups, AA (59%), HA (62%), and EA (69%) were below the Healthy People 2020 goal of 90%. Differences in adjusted odds ratios indicated that compared to EA, AA were 5 times more likely to vaccinate if they perceived a benefit (vaccine effectiveness); however, HA were 3 times less likely to vaccinate even if they perceived vaccine was effective. Both AA and HA were 3 times less likely to vaccinate even if they felt susceptible (planned to get vaccine next season) to the influenza infection. While both groups were more likely to vaccinate if they did not perceive severity (not worried about getting sick with vaccine) or were cued to action by recommendation from their health professional, vaccination uptake was 4 times more likely among HA compared to EA while AA were just slightly more likely. The positive implications for social change include effective strategies to clarify perceptions that increase vaccination rates in racial and ethnic minority groups, and to target health professionals to recommend vaccine uptake for older adults during medical appointments.

A disproportionate number of American Indians are overweight or obese and have a higher risk of other health concerns compared to the general United States population. Researchers conducting anthropometric studies have found that American Indians have higher body mass indices and worse health than most of the general United States population. There is, however, a gap in the literature regarding American Indians' perceptions, beliefs, opinions, and attitudes of obesity and its effects on their health. The purpose of this qualitative study was to determine whether American Indians view obesity as a major health concern. Focus groups and key-informant interviews were the instruments used to obtain this information. The study sample consisted of 30 participants from a local American Indian reservation. Data was coded manually using in vivo coding and focused coding, frequency counts, and cluster coding to generate themes. Results conveyed that participants did not consider obesity as a major concern on the reservation. Issues like the presence of poverty, drugs, and alcohol, combined with the absence of community leadership, community support, and parental education were more of a concern to the study participants. Participants were also concerned with culture and identity changes. This study contributed to positive social change by identifying perceptions put forth by participants regarding obesity and its accompanying risk factors. This study contributed to the missing knowledge of culture-specific perceptions regarding obesity. Study findings about risk factors for obesity among the study population may help public health practitioners create effective public health prevention programs, which may help to slow the decline in American Indian health.