Numerous studies have shown a rising HIV/AIDS epidemic among U.S. Hispanics/Latinos. Risky sexual behavior, alcohol, drug abuse, and sociodemographics contribute to Hispanics/Latinos' elevated risk for contracting HIV and other STDs. There is a need for additional research to understand the combination of factors associated with HIV and other STD infection among Hispanic/Latino youth. Based on social cognitive theory, this study examined the influences of peer pressure and relationship knowledge on risky sexual behavior among Hispanic/Latino young adults as measured by the Peer Pressure Inventory (PPI), the Teenage Research Unlimited Survey (TRU), and the Youth Risk Behavior Survey (YRBS). A group of 18-to-24 year olds (n = 173) from the 6 wards of Harris County, Houston, Texas completed the PPI, TRU and YRBS via paper questionnaires. Logistic regression determined a marginally significant association between relationship knowledge and number of lifetime sex partners. The remaining logistic regressions indicated no significant relationships between the variables of peer pressure, relationship knowledge, and risky sexual behavior. Descriptive statistics revealed that a large proportion of participants were engaging in several risky behaviors, including sex without condoms, sex while using alcohol or drugs, and sex with multiple partners. The results of this study also confirmed that Hispanics/Latinos aged 18-24 years are at risk for HIV and other STDs. Implications for positive social change include evidence to inform peer- and community-driven prevention programs targeting Hispanic/Latino young adults living and working in Harris County, Houston, Texas as a means to reduce transmission of STDs and HIV/AIDS in the Hispanic population.

There is a gap in infertility research regarding resource availability within rural communities, yet existing research declares infertility a public health concern. This qualitative study was grounded in the Heggerian phenomenological framework by way of assessing participants' perceptions of and experiences with infertility resources in a rural community. The purpose was to analyze the meaning of those experiences within their world. To accomplish this, Antonovsky's salutogenic theory was applied to investigate the strengths and weaknesses of infertility resources including the availability of resources, participant understanding of, and participants' experiences. Purposive sampling was used and in-depth interviews were conducted with 12 women, ages 24 to 39, who reside within rural communities. Interviews consisted of 60 questions that were designed to examine 13 research questions. Data were analyzed following Ritchie and Spencer's framework, requiring documentation and data classification, through 3 phases: open coding, focused coding, and axial coding. Emerging themes included a need for more resources on infertility, assistance with locating infertility resources, and an association between insurance coverage and use of infertility treatments. Findings from this study indicated a need for additional resources and knowledge regarding infertility in rural areas, also confirming a need for additional research on the topic. Social change implications for this research include developing resources for consumers and health care providers as well as improved provider knowledge. With increased knowledge and resources, these individuals may be able to achieve their goals and cope with the challenges of understanding and dealing with infertility.

Twenty million people in the United States have some form of thyroid disease. In 2014, there were 62,980 new cases of thyroid cancer and 1,890 deaths. Water source is a known risk factor for thyroid disease. Pollutants that are known to alter thyroid function can find their way into water sources. The effect of various water sources on thyroid- related mortality has not been determined in the state of Georgia. The purpose of this correlational study was to investigate whether invasive thyroid disease mortality differs between urban participants who drank municipal water and rural participants who drank untreated water in Southwest Georgia. Using the ecologic systems theory, secondary data from the Georgia Department of Public Health and the Department of Environmental Services were analyzed for 179 cases of invasive thyroid disease mortality and corresponding water source. According to the Wilcoxon-Rank sum test, there was no statistically significant difference in invasive thyroid disease mortality between individuals who consumed municipal water and individuals who consumed untreated well water. However, a disproportionate number of cases came from Dougherty County, particularly within rural areas and among women. The positive social change implication of this study was to discover an area of disparity for thyroid disease mortality in the state of Georgia. Larger studies need to be conducted to determine if there is a correlation between water consumption and thyroid disease and to explore the geographical, environmental, and demographic factors associated with cases in Dougherty County.

The prevalence of autism spectrum disorder (ASD) is estimated to be one in every 150 births. While both genetic and postpartum environmental exposure have been linked to ASD, prenatal maternal weight has not been investigated. The objective of the study is to assess whether overweight or obesity at pregnancy is an important risk factor for the diagnosis of ASD in offspring. A case-control study was designed to answer this question using the public health ecosocial theory. The study population consisted of 70 mothers, who were recruited via the Internet using the viral expansion loop. Multiple logistic regression analysis was used to test the hypotheses. No significant difference in risk of ASD by level of body mass index (BMI) was found after adjusting for covariates. The odds ratio for obese women in comparison to normal or underweight women was 1.19, 95% CI [0.53, 2.66] after adjusting for covariates. Gaining the appropriate amount of weight during gestation, as determined by the Institute of Medicine, was not associated with ASD either, with the odds ratio at 0.67, 95% CI [0.31, 1.48]. The results indicate that BMI category at pregnancy and gestational weight gain were not risk factors for autism in children. The implications for positive social change include a better understanding of maternal prenatal BMI as a risk factor for autism spectrum disorder. Appropriate health information provided to mothers prenatally could result in improved birth outcomes.

The purpose of this investigation was to generate a context- specific model of the lived experience of HIV positive Tanzanian orphans. With the advent of anti-retroviral drugs, Sub-Saharan African populations with high burdens of human immunodeficiency virus (HIV) face annually accumulating increases in the number of HIV positive children, and ultimately adults. Perinatally infected, these children often become orphans while still young. Extended interviews were performed with a purposive sample of 12 HIV infected orphaned children between 9 and 12 years of age. Half of the research participants lived in an orphanage and half were children living with guardians in villages near Arusha, Tanzania. A phenomenological approach to data analysis was employed with the guidance of literature-based constructs of intrinsic traits and developed tools used by children to meet challenging life circumstances. Data demonstrated that disclosure of HIV and orphan status engendered widespread social consequence. The phenomenon also negatively affected the children's physical, material, and emotional quality of life. Even in the face of these challenges, participants demonstrated resilient and self-reliant coping mechanisms. Responses ranging from caretaker education to stigma reduction in the schools will help to meet the needs of these children. In addition, the information generated by this research will be a basis for beginning to examine the social change responses that will be necessary for Tanzanians in the healthcare, social service, and policymaking arenas to successfully integrate this new population group into all levels of society.

The 2001 destruction of the World Trade Center and the subsequent anthrax attacks highlighted the inability of an antiquated public health system in the United States to respond effectively to emergencies. Little documentation exists to define how public health agencies can improve performance. The overarching research question was the extent to which drills and exercises improve performance in public health emergencies. Adult learning theory and deliberate practice theory were explored in this context. The research data were from 50 state public health departments, which were required to report performance information to the U.S. Centers for Disease Control and Prevention. The data were examined using Poisson analysis and logistic regression. Results indicated that drills and exercises had no statistically significant impact on public health performance for the 3 performance measures examined; of all predictors, what explained the most variance in reaching performance targets was the number of real emergencies to which a health department had responded in the past. Performing drills and exercises did not predict the likelihood of reaching performance targets. These findings have implications for positive social change for Congressional leaders and other government representatives. Such public servants could use this information to guide their efforts to redirect public health emergency preparedness funds away from drills and exercises and toward other fundamental public health activities. These more focused efforts could facilitate the improvement of public health laboratory capacity, the training of field epidemiologists, and the advancements in technology for enhanced reporting and surveillance.

Racial disparity is present in deaths attributed to sudden infant death syndrome (SIDS) and unintentional suffocation. The Back to Sleep Campaign that began in 1994 caused an overall decrease in SIDS rates, but the racial disparity has continued to increase. Researchers have analyzed and described various socio-demographic characteristics of SIDS and infant deaths by unintentional suffocation in urban areas yet have not simultaneously controlled for multiple risk factors that may contribute to racial disparity such as race, poverty, maternal education, and number of children born to each mother (parity). The purpose of this study was to determine if there is a relationship between poverty, race, maternal education, parity, and infant sleep-related deaths in the African American population in an urban setting. This quantitative case-control study used secondary data collected from birth certificates and matched birth/death certificates by a Midwestern state health department between 2005 and 2009. The health belief model was used as a conceptual framework. To answer the research questions that asked if there was a relationship between infant sleep-related deaths (dependent variable) and race, poverty, maternal education, and parity (independent variables), chi-square analysis and logistic regression analysis were performed. These analyses suggested that race and poverty have significant relationships with infant sleep-related deaths. The analyses did not suggest a relationship between maternal education or parity and sleep related infant deaths. The social significance of these findings may be that the results could be useful for population-specific modifications of prevention messages that will reduce infant sleep-related deaths.

Although the incidence of breast cancer in women under 40 years of age is somewhat rare, young women tend to present with cancer that is more advanced and with poorer prognostic characteristics. This research will be important to providers, women and their families and those seeking to clarify screening guidelines. The purpose of this quantitative, retrospective, cohort study was to evaluate differences in prognostic characteristics by socioeconomic position (SIP). The cohort was comprised of females aged 18 to 39 with a primary diagnosis of breast cancer. Data were obtained from the Surveillance, Epidemiology and End Results registry for all primary breast cancers reported between 2001 and 2006 (n = 14,696). Hierarchical regression analysis was performed to assess to what extent SEP had an independent effect on tumor size and cancer summary stage upon diagnosis, and overall survival. SEP was found to be a significant predictor of tumor size and summary stage at the time of diagnosis. As cancer summary stage increases by 1 unit, women were .14 times as likely to have a tumor size of less than 2 cm versus a tumor size of greater than 5 cm. As SEP increases by 1 unit, the likelihood of having a tumor size of less than 2 cm versus greater than 5 cm increases by a factor of 1.14. SEP was not a significant predictor of survival time. The results of this study have the potential to promote positive social change by advancing the understanding of breast cancer in young women, as well as raise awareness of socioeconomic, racial and clinical inequalities. In addition, it may assist researchers and policy makers clearly defined formal screening guidelines for young women in higher-risk subgroups based on socioeconomic position.

Children with special health care needs (CSHCN) generally have physical, mental, or emotional conditions that require a broader range and greater quantity of health and related services compared to typical children. Care coordination (CC) and family-centered care (FCC) are necessary in the quality of health care for CSHCN. A gap exists in the literature regarding the impact of CC and FCC on children's functional ability (FA). Previous researchers have focused on met and unmet health care needs, but not on health outcomes or functionality. The purpose of this study was to determine if there was an association between CC, FCC, and FA in CSHCN. The design of this study was a secondary analysis of data from the 2005--2006 National Survey of CSHCN. The study was guided by an adapted socioecological multilevel conceptual framework. Statistical methods included univariate, bivariate, and multiple logistic regression analysis. Results indicated that CC was associated with FA in CSHCN. CSHCN that did not receive CC had a 53% increased risk (OR =1.53, 95%CI 1.21--1.94, p < 0.001) for a limitation in FA compared to CSHCN that received CC, controlling for age, gender, number of conditions, household poverty level, parental educational level, and health insurance. FCC was not associated with a limitation in FA in CSHCN ( p = 0.61). Findings from this study were consistent with the socioecological multilevel framework and the literature on care coordination. This study contributed to positive social change by providing information that can be used by public health officials, health care providers and policy makers in developing policies to assure that care coordination is provided to CSHCN and their families in order to improve their health outcomes and functionality.

Gatekeeper Suicide Prevention Trainings such as Question Persuade and Refer (QPR) are used to increase suicide awareness and teach participants basic suicide intervention skills. Previous researchers showed that QPR training increases knowledge of suicide risk factors and increases participants' willingness to intervene with individuals at risk of suicide. It was hypothesized that completion of QPR would also increase positive attitudes toward the utilization of mental health services and that this outcome would be more pronounced among male participants. The examination of attitudes was rooted in the theoretical framework of Ajzen's theory of planned behavior. The Inventory of Attitudes toward Seeking Mental Health Services (IASMHS) was the instrument used for the study. The study occurred in a rural community college in southern Oregon. Student attitudes were assessed prior to completion of a 1-hour QPR presentation followed by a 3-week post assessment. Analysis of Variance revealed significant effects of QPR training. IASMHS scores were significantly higher at post QPR training. A significant interaction between gender and QPR training showed that women scored significantly higher than men only at pre QPR training. There was no statistical gender difference in attitudes measured by the IASMHS at post QPR training. QPR increased help seeking attitudes in both men and women with the increase being more pronounced in men. Increasing positive attitudes toward help seeking can contribute to positive social change. Practitioners in the field of men's health should consider using gatekeeper suicide prevention training such as QPR as a means of increasing male help seeking.