Obstructive sleep apnea (OSA), a disorder in which the airway intermittently collapses and obstructs during sleep, is associated with increased cardiovascular and cerebrovascular morbidity and mortality, increased risk of motor vehicle accidents, metabolic syndrome, hypertension, and depression. Treatment of OSA attenuates or reverses many of these associated risks. However, most cases of OSA are unrecognized and untreated. The two most recent studies using 1990s data found that only 6.5 - 15.4% of OSA cases, depending on severity, are clinically recognized in mixed gender populations. Based on a conceptual framework of improved physician awareness of OSA, and reduced diagnostic access bias with the increased availability of sleep laboratory services, increased OSA recognition since the 1990s was predicted. Study participants with clinically recognized OSA were identified using the resources of the Rochester Epidemiology Project, while the Berlin Questionnaire OSA high risk classification was used as a surrogate for prevalent OSA in this population. Analysis in a mixed gender population determined that OSA clinical recognition among those with prevalent OSA was 22.7 % (95% CI 19.6 - 25.8%) for mild or greater OSA severity leaving more than 75% of prevalent OSA clinically unrecognized and untreated in this population. Obesity and male gender were associated with increased likelihood of clinical recognition in bivariate and multivariate analyses, though even among obese men only 36.5% of OSA was clinically recognized. In order to support positive social change and address these inequities of OSA clinical recognition, strategies that enhance OSA recognition overall, and more specifically target recognition of OSA among women and the nonobese, should be developed and implemented. Further research regarding such strategies should consider whether they reduce OSA associated morbidity and mortality.

Childhood obesity is a worldwide problem that can lead to adverse health conditions. In several rural Pennsylvania communities, over one third of elementary students are characterized as overweight, having a body mass index above the 85th percentile. The purpose of the study was to investigate educational stakeholders' perspectives about school-based obesity-prevention programs. The conceptual framework focused on cognitive theory, the theory of planned behavior, and the trans-theoretical model of health behavior change, which postulates that an individual's readiness to change is the most important factor of intervention programs. Qualitative interview data were gathered from 18 educational stakeholders. Inductive code-based analysis led to categories and themes. Key findings revealed a variety of barriers that limited and prevented effective student-wellness initiatives: students' physical activity; family dynamics, schedules, and socioeconomic factors; lack of transportation limiting children's participation in physical activities; parental engagement and input on obesity-prevention initiatives; and cafeteria environment and meal offerings. Findings informed the development of a policy recommendation for a research-based nutrition education program for schools and a strategy to communicate students' cafeteria habits to parents. Recommendations include a heightened awareness on factors contributing to obesity, as well as better educator-led planning to make improvements to school-based programs. Implications for positive social change may be the potential to increase awareness of healthy behaviors and improved student health through obesity-prevention methods, exercise patterns, and dietary habits of youth. These healthy habits may reduce adverse health effects in adulthood, which could hold the potential to improve the health of the next generation.

Effective recognition and proper treatment of cardiovascular diseases (CVDs) in Hispanic woman is a public health problem that needs further investigation. Guided by the stress and coping social support theory, the purpose of this cross-sectional survey study was to examine the relationship between attitudes, emotional support, and the perception of success in managing cardiovascular diseases (CVDs) in 335 Hispanic women living in Atlanta, Georgia. Correlations, independent-sample t tests, simple linear regression, and multiple linear regressions showed ethnicity as a moderating variable between the perception of success in handling CVD and emotional support, while emotional support was shown to be a significant predictor of perceived success for all participants. The relationship between the 2 variables was positive for Hispanic women and negative for non-Hispanics women. Diet and exercise also emerged as a significant direct predictor of perceived success in handling CVD when the variable of emotional support was controlled. Key findings also showed that, while Hispanic women had higher scores for perceived success in handling CVD, non-Hispanic women had higher emotional support scores. This study supports positive social change by highlighting the unique needs of Hispanic women to healthcare providers, relative to effective recognition and positive treatment regimens, if cardiovascular disease is suspected. Positive social change will be demonstrated with the recognition of better health outcomes for Hispanic women.

Recent research clearly demonstrates that a decrease of physical activity has occurred among young people. Hence, the purpose of this study was to examine the impact of external motivation on physical activity. Drawn from self-determination theory, the specific research question examined if academic incentives effectively motivated 7th grade students to participate in a 3-week fitness program. A quasi-experimental pre-post design examined treatment and control groups drawn from a sample of 24 students from three physical education classes. The treatment group received academic incentives whereas the control group received no external incentives but were asked to complete the same fitness Program. Independent-sample t-test of the physical activity section of the 2005 Youth Risk Behavior System Survey (YRBS) revealed no group differences on the posttest. Dependent-sample tests indicated little pretest-posttest change in YRBS scores, leading to the conclusion the academic incentive had no major effect on students' motivation to be physically active outside the school environment. This research contributes to positive social change by provided additional insight into what motivates or does not motivate 7th graders to be physically active.

The lack of mentored relationships among nursing educators has the potential to negatively influence perceptions of leadership practices and could decrease the numbers of nursing faculty staying in academia. The purpose of this study was to investigate the perceptions of mentorships and leadership practices of nursing faculty teaching in academia. Watson's caring theory was the theoretical foundation to explain the congruence between mentored relationships, leadership practices, and the association with faculty retention. The first research question focused on differences between mentoring experience, assistance, and characteristics by mentor training type. Question two assessed the relationship between leadership practices by mentor training type. In this cross sectional, research design, a nonrandomized convenience sampling method was used to select 65 masters or doctoral level nursing faculty from one Midwestern state in the United States. The z test statistic measured the perceptions of mentoring experience, assistance, and characteristics by mentor training type; results indicated no significant differences in the perceptions of mentoring experience, assistance, and characteristics by training type. The ANOVA measured the perceptions of leadership practices by mentor training type. Results showed that nursing faculty who reported no mentor scored significantly lower on the perception of leadership practices when compared with nursing faculty who had formal mentor training. Recommendations for action include an exploration of barriers to mentorships and the perceptions of leadership practices within the workplace setting. This study contributes to positive social change by encouraging administrative personal and nursing leaders to focus on developing and maintaining healthy working relationships to potentially offset the nursing faculty shortage.

Researchers have identified inadequate sleep duration as one of the factors contributing to global obesity. The purpose of this study was to test a hypothesis deduced from a new sleep-duration-based evolutionary theory claiming that sleep extension in response to lengthening night duration in early fall evolved into a behavioral marker of an approaching winter; this adaptive trait was theorized to produce adiposity gain in White men in response to sleep extension. The hypothesis was that White Americans would show a greater increase in the age-adjusted fat mass index per unit of sleep duration compared to that of Black Americans. Data were part of the National Health and Nutrition Examination Survey (NHANES) study between 2005 and 2010. The multiple regression analysis did not support the study hypothesis. The results indicated that habitual sleep duration had no effect on the annual rate of adiposity gain in White men, while in Black men, longer sleep was associated with significantly higher annual rates of adiposity gain. Implications for social change include the case for population-specific antiobesity interventions in Black men, including closer monitoring of sleep duration in order to prevent adverse habitual sleep extension and to improve time budgeting for physical exercise.

Mexican Americans, one of the fastest growing segments of the population, have been identified as having above-average rates of obesity. Yet, among this group, obesity rates seem to differ by immigrant status: recent immigrants, immigrants who have lived in the United States more than 15 years, and U.S.-born Mexican Americans. Guided by the acculturation phenomenon and the social ecological model, the current study assessed all 1,732 Mexican American children 12-19 years old who participated in the National Health and Nutrition Examination Survey between 2003 and 2008 to determine the association between body mass index (BMI) and language, years living in the United States, citizenship, birth country, household income and size, and school attendance. Analysis of variance and linear regression were used for statistical analysis. All of these variables were significantly associated with BMI in both the bivariate and linear regression analysis, although the R-squared value was small at .138, indicating that additional factors not included in this study also influence BMI. Measuring obesity and the correlated acculturation variables with currently available data sets will provide insight in the planning and administering effective interventions for Mexican American children 12-19 years of age and promote the global social change goal of healthy weights for all children.

Every year, more than 400,000 Americans die prematurely because of tobacco use, and most users began smoking during their teen years. Adolescent tobacco use remains the nation's most preventable threat to life and health. A better understanding of the relationships between susceptibility to smoking and intention to smoke on smoking behavior by ethnicity, age, and gender is useful for program planners and health educators in designing ethnic, age, and gender specific strategies for tobacco control and prevention initiatives. The purpose of this study was to test the relationships between susceptibility to smoking and intention to smoke on smoking behavior among adolescents by ethnicity, age, and gender. The theory of reasoned action by Ajzen and Fishbein formed the basis of this study and supports the findings and conclusions. To get good representation of the study populations, the study utilized secondary data from the 2007 National Survey on Drug Use and Health. The study population includes person ages 12-17 years old, smokers and nonsmokers, who represent White, African American, Hispanic, Asian, Multi-Racial, American Indian, and Native Hawaiian race/ethnicities. Data were analyzed with Kruskal-Wallis test, analysis of variance (ANOVA), multiple regression analysis, and bivariate Spearman correlation. A statistically significant positive relationship was found between participants' susceptibility to smoking and their intentions to smoke (r = .57, p < .01). More specifically, a significant difference was found among ethnic groups on smoking intentions and among age groups on susceptibility to smoking. Positive social change can occur through improved efforts geared toward primary, secondary, and tertiary interventions. This can result in empowerment programs and enhanced decision making, useful for adolescents of different ethnic groups to resist social and environmental pressures.

While research has indicated that impaired mental health partially mediates the relationship between adverse childhood experiences (ACEs) and alcohol and illicit drug use, little research has examined potential mediators in the relationship between ACEs and smoking, the number one cause of preventable mortality in the United States. Accordingly, this study examined the potential mediating effect of psychological distress on the relationship between ACES and smoking using data from Wave II of the ACE Study, a cross-sectional study completed between June and October of 1997 on a sample of adult health maintenance organization members (N = 7,211). The theoretical underpinnings for this study were grounded in the developmental psychopathological perspective which examines both environmental and biological influences as they interact to promote or impede social, emotional, and behavioral development. Mediation modeling employing both linear and logistic regression techniques indicated that, after adjusting by select covariates, psychological distress (as assessed using the SF-36 Mental Component Summary score) partially mediated the relationship between several of the ACEs examined and smoking in women. These same relationships were not found in men. This research contains several key findings with social change implications. First, additional research should be conducted to examine the causes, developmental paths, and critical points that link ACEs and psychological distress to smoking among women. Second, given the gender differences in the association between ACEs and smoking, gender-specific intervention programs that build resiliency, increase positive social support, and provide tools for developing alternative coping strategies may be important adjuncts to smoking cessation programs, particularly for women with a history of ACEs.

The bacterium Staphylococcus aureus has been an important human ailment for centuries, and with the overuse of antibiotics, methicillin resistant Staphylococcus aureus (MRSA) has emerged as a deadly, costly pathogen worldwide. Healthy carriers can become sick or can spread MRSA without symptoms. The amount of asymptomatic colonization among healthy college students and risk factors for colonization by MRSA are not well understood. According to the epidemiologic triangle model, the host (students who take antibiotics or have a history of skin infections), the infectious agent (MRSA) and the environment (direct contact with people, animals, or objects that may harbor MRSA) all play an important role in this disease. This study explored MRSA colonization rates among healthy students at a community college and explored the possibility that students exposed to sources of MRSA might have a higher colonization rate. Using a cross-sectional quantitative design with stratified sampling, risk factors to include student's discipline, gender, race, work, and leisure exposure were surveyed. In tandem, Mannitol Salt Agar and MRSA Select Agar were inoculated from nasal swabs to identify students colonized by MRSA. The data were analyzed using contingency tables and Chi Squares. Significant risk factors identified included students who had a major that involved touching shared equipment and/or those who were in majors such as nursing, students who had close contact with animals, and students who had a skin infection. The implication for positive social change include improved awareness of MRSA colonization and risk factors which can lead to better prevention strategies and increased awareness among the student population.