<p> A personal belief exemption (PBE) has allowed parents to exempt their children from immunization when they are opposed to it based on their personal beliefs. As the number of PBE increased over the past few years, there was an increase in incidence of vaccine preventable diseases such as measles and pertussis among kindergartens. The current study examined the association between the percentages of PBEs filed by parents of kindergarten and three socio-demographic variables of schools including ethnicity, income level, and religious affiliation. The statistical findings showed that the percentages of PBE were lower among Asian Americans and Hispanics than Caucasians, higher among the religiously affiliated schools than religiously affiliated schools, and higher among south Orange County (OC) schools than north OC schools. The findings can help public health field detect which risk factors correlate the percentage of PBE and develop interventions more effectively and can help limit future outbreaks.</p>

<p> Girls in early adolescence today face numerous challenges to their positive and successful growth into happy, productive, and powerful women. These challenges may include peer pressure, racism, family issues, school navigation, and poor self-image. The purpose of this action research study was to examine the potential of a weekly wellness program for girls in the 5th through 8th grades. Research was conducted with 13 early adolescent girls utilizing interviews, observations, and participant journal reflections and incorporating interactive lessons and physical activity. In particular, the research examined how lessons with a focus on the effects of healthy behavior positively affected the participants. Participants were encouraged to reflect on experiences and individual challenges, and were taught strategies that allowed them to connect the mitigation of those challenges to the physical activities they participated in. Results indicated 3 areas of importance among all participants: having connections with individuals in their life, understanding a sense of wellness and maintaining that wellness through the challenges presented to them, and creating and reaching new goals in life. Classroom educators, social workers, recreation managers, and planners are encouraged to foster and implement wellness programs that include physical, nutritional, social, and emotional education for early adolescent girls in all communities.</p>

<p> High-stakes testing in undergraduate nursing education are those assessments used to make critical decisions for student progression and graduation. The purpose of this study was to explore the different ways students experience multiple high-stakes tests for progression in one undergraduate BSN program. Research participants were prelicensure senior baccalaureate nursing students enrolled in their final semester of the nursing program. A descriptive qualitative design, using the framework of phenomenography, captured the various ways a group of prelicensure BSN students described their experiences with multiple high-stakes to progress throughout the nursing program towards graduation. Phenomenography is designed to examine the various ways in which a group individuals experience or perceive the same phenomenon. Analysis revealed five major categories of descriptions, including values, stress, inconsistency, high demand/expectations, and transfer of learning. Each category included various sub-categories. The findings provided a rich understanding of the student's point of view of high-stakes tests that is lacking in the nursing education literature. In addition, the results were used to develop a structure of learning model as a useful tool to guide nursing faculty in developing program-specific strategies that promote student success with high-stakes testing throughout nursing curricula. </p>

<p>Older adults&rsquo; knowledge and perceptions about Ebola have not been previously explored in the literature. A survey, administered during the Ebola outbreak in 2014, was performed to capture East Harlem senior residents&rsquo; knowledge about Ebola and identify their major sources of information, their self-reported levels of trust in city officials, and whether or not they would follow officials&rsquo; directions. Results using frequency testing showed that senior respondents were not knowledgeable about disease transmission. The major trusted sources of information identified were television and newspapers. Overall, respondents trusted city officials and were very likely to follow city instructions. This study is important because it elucidates the need for better information to be more efficiently disseminated through media during a health emergency. </p>

<p> When children are engaged in school gardens, they aren&rsquo;t just digging in the dirt. School gardens have been shown to help improve student health by impacting food preferences and physical activity; to enhance learning in many subject areas; to encourage critical thinking skills by utilizing inquiry-based learning; and to engender a positive association with nature. Children from disadvantaged environments disproportionately may miss out on each of these important experiences. School gardens can serve as venues to enhance social justice by helping marginalized students access these advantageous experiences they otherwise might not have. Given the evidence that school gardens improve the educational experiences of students, this study explored how they can expand across varied schools and classes so that more students can enjoy their benefits. The research question posed was: What are the opportunities for and barriers to the expansion of the school garden and cooking program of Grow Pittsburgh, called Edible Schoolyard Pittsburgh (ESY)? As an evaluator, I worked collaboratively with a wide range of stakeholders, convening focus groups and discussions with staff, parents and guardians, classroom teachers, and principals. Incorporating feedback from stakeholders, and using a mixed methods design, I developed four instruments to investigate the research question: a survey of parents and guardians, student interviews, principal interviews, and a principal survey. In addition, an extant student survey concerning willingness to taste and try a new vegetable was used. An analysis of seven Likert scale and two yes-no questions found no significant differences between the parent and guardian responses of two schools surveyed, suggesting the program was implemented equally reliably in both schools. The Parent/Guardian Survey enjoyed a strong return rate of 65.5%. Comprised of two open-ended questions, it generated 768 individual comments, which were transcribed and grouped thematically. The general findings suggest areas of positive impacts in students&rsquo; willingness to try fruits and vegetables, students&rsquo; comfort in nature, and parents&rsquo; and guardians&rsquo; connection to their child&rsquo;s school. These observations merit further study. Barriers as identified by principals, teachers, and parents and guardians included limited instructional time, limited number of grades served, and limited curricula connection to subjects other than science. Opportunities which emerged from the data included overall robust stakeholder commitment, capacity, and confidence (3Cs), including principals choosing to pay for the program from their own budgets, parents and guardians showing strong confidence, and, in some schools, parent-teacher groups raising half the cost of the program. Recommendations of the study for successful scaling include implementing an intentional Improvement Inquiry and measuring and tracking of stakeholder 3Cs. Researchers and practitioners should continue to evaluate impacts of school gardens on students in academics, ecoliteracy, and health.</p>

<p> Maternal mortality, an example of poor maternal health outcomes, is widely accepted as an indicator of the overall health of a population. One of the Millennium Development Goals was reduction in maternal mortality by 3 quarters by 2015. These goals were not met in Nigeria and it is important to look at some of the reasons why. Education has been shown to have positive impact on pregnancy outcomes; however, the characteristics of pregnant women, their health literacy level, their usage of antenatal care services and how these impact pregnancy outcomes are yet to be analyzed in Lagos, Nigeria. Guided by the social cognitive theory and health belief model, the purpose of this cross-sectional quantitative study was to determine if there is a relationship between maternal health literacy, antenatal care visits, development of medical conditions during pregnancy, and pregnancy outcomes (measured by healthy or unhealthy baby) in Lagos, Nigeria. The research question for this study tested if there was a relationship between these variables. Lisa Chew&rsquo;s health literacy assessment tool was used in a sample of 130 women in Shomolu local government in Nigeria who met the inclusion criteria. Using binary logistic correlations, only problems developed during pregnancy is statistically significant with pregnancy outcomes (<i>p</i> &lt; .05). The results suggested an increase in problems developed during pregnancy most likely will increase the chance of having negative pregnancy outcomes. Results from this study could promote positive social change by helping health professionals identify the characteristics of at-risk women during antenatal education sessions. The results could also help health professionals in the development of targeted antenatal care interventions.</p>

<p> Nurses at a suburban northeastern U.S. community hospital reported that they felt unprepared to effectively respond to a pediatric emergency. Empirical data were not available to identify if this local problem was due to a lack of the nurses&rsquo; self-confidence or if other factors were involved. The purpose of this study was to determine if there were relationships between nurses&rsquo; self-efficacy in pediatric emergencies and their knowledge of pediatric emergency care, as well as their years of clinical experience, nursing education, pediatric life support certification, specialty certification, and caring for pediatric patients. In addition, the research questions guided the investigation to determine if any of the variables could predict nurses&rsquo; self-efficacy in pediatric emergencies. The theoretical framework was based on Bandura&rsquo;s social learning theory, which incorporates the concept of self-efficacy, as well as Zimmerman&rsquo;s self-regulated learning theory. A quantitative correlational design was used with a convenience sample of 37 nurses. Self-efficacy was measured with the General Self-Efficacy Scale and knowledge was quantified using a 32-item researcher-developed instrument. The data were analyzed using multiple regression analysis and correlations. Results showed that none of the variables predicted self-efficacy; however, years of nursing education, pediatric life support certification, and clinical experience were all significantly related to knowledge. Based on the results, a 3-day educational program was developed to address pediatric emergency practice. The results of this study can direct positive social change by informing future nursing education and training efforts in order to improve the medical outcomes of pediatric patients.</p>

<p> The purpose of the study was to compare risk factors for hypertension among African Americans, Whites and Mexican Americans. The following risk factors were investigated: demographic, socio-demographic, dietary intakes (total calories, fiber, sodium, potassium, magnesium, calcium, total protein, fat (saturated, cholesterol, monounsaturated and polyunsaturated), blood pressure, smoking, alcoholic, body mass index (BMI), waist circumference (WC), health insurance, physical activity (PA), and sedentary behaviors.</p><p> The National Health and Nutrition Examination Survey (NHANES) 2009-2010 data were utilized for this study. The sample included 1,745 individuals, aged 40-60 years. SUDAAN software was used for data analysis. Statistical procedures included chi-square and t-tests. Multiple logistic regression was used to determine variables predictive of hypertension in each of the ethnic groups.</p><p> Except for systolic blood pressure (SBP) in Mexican Americans, SBP and diastolic blood pressure (DBP) levels were higher in African-American, White and Mexican-American males compared to females. WC and BMI (except in African Americans), smoking in African Americans, Mexican Americans and Whites were significantly higher in hypertensives. Moderate and vigorous activities in Whites, vigorous weekly activity in Mexican Americans, and walking/bicycling for transportation in African Americans were lower in hypertensives.</p><p> African Americans were more hypertensive and higher DBP than Whites and MA, and highest SBP followed by Mexican Americans, then Whites. Higher dietary intakes of cholesterol and protein were found in hypertensive African Americans. </p><p> SBP was higher in African Americans with annual household incomes of $20,000-$34,999 and $55,000-74,999, Whites with annual household incomes of $35,000-$74,999. DBP was higher in African Americans with annual household incomes of $55,000-74,999, but lower in Whites with annual household incomes of $75,000-$99,999.</p><p> White males were more hypertensive than White females. In all ethnic groups subjects aged 50-60 years were more hypertensive than those aged 40-49 years. DBP was lower in African Americans with high school or GED diplomas. SBP was lower in Whites with College degrees or higher levels of education. DBP was higher in Whites and Mexican Americans with high school or GED diplomas. Whites with health insurance had lower SBP and DBP levels, and African Americans with health insurance had lower DBP levels.</p><p> Future studies on hypertension in the three ethnic groups should include dietary intakes determined using 3day food records, as well as dietary protein and cholesterol intakes in African Americans.</p>

<p> This business plan proposes a health promotion center to help educate low-income families in Compton suffering from obesity on how to begin and maintain weight loss. Obesity is one of the leading causes of preventable deaths in adults and children. By creating a family and community-based center that provides individualized and group nutrition and fitness services, the rate of obesity can be significantly reduced. </p><p> The center which will be located in east Compton will operate as a non-profit organization. It will offer nutrition and fitness services through certified nutritionist and fitness specialist with emphasis placed on gradual weight loss. Meal planning, label reading and training, and grocery store tours are some of the nutrition services that will be offered, while aerobic training and weight training will be part of the fitness service. There will be a life coach and an on-site daycare at the center. The life coach will help potential families establish their weight loss needs, while the on-site day care will provide care for children while families exercise. Services will be offered at reduced prices, and payment will only be made out-of pocket.</p>

<p> The war on obesity is a compelling topic in the United States&mdash;especially when as of 2012 17 percent, approximately 12.7 million, of children between the ages of 2-19 years are obese. This topic matters to anthropologists for two reasons&mdash;first, childhood socialization has been a focal point in the study of anthropology, and secondly, food is culture. This project report reflects my collaboration with a school in Southern California to implement a different approach to teaching children healthy eating habits. It focuses on ways that introducing new foods in a positive and fun environment will create a better relationship with food while increasing the students&rsquo; cultural awareness. This approach combined the fields of geography, history, culture, and cuisine to teach students how each field influences one another and affects the nutrition of the people and in turn ourselves. Using standard ethnographic techniques of participant observation this research reports on the reaction the students have to learning about food in a cultural context. </p>