Research has revealed that underutilization of breast cancer screening by ethnic minorities often is related to language difficulties and cultural values and beliefs about cancer. The problem addressed in this secondary data analysis was the late diagnosis of breast cancer in the Chinese immigrant community. The purpose of the quasi-experimental study was to test the efficacy of a theatrical preschool performance, guided by the diffusion of innovation theory, in educating Chinese American women about breast cancer detection. The research questions sought to determine whether the performance increased the participants' knowledge of breast cancer screening guidelines and whether country of origin, length of stay in the United States, and self-reported attentiveness were associated with knowledge gain of breast cancer screening guidelines. The preschool performance was performed by Chinese children ages 3 to 5 who displayed breast health guidelines from the Susan G. Komen for the Cure. One hundred and seventy-seven pre- and postperformance surveys were collected from a sample of Chinese women (84% foreign born). The secondary data were analyzed using standard linear regression analyses and bivariate logistic regressions. The findings demonstrated that promoting breast health screening guidelines among Chinese American women through a preschool theatrical performance significantly increased the participants' knowledge of the guidelines. However, no major impact was detected between knowledge score and attentiveness to the theatrical performance and any of the demographic variables. Health care professionals can foster social change by adapting a preschool theatrical performance to educate ethnic communities on cancer control guidelines for early detection.

Currently, little is known about patients' perceptions and beliefs in discussing complementary and alternative medicine (CAM) with their conventional medical (CM) doctor. The purpose of this descriptive research was to show whether CAM-using patients have an interest in discussing CAM treatments with their CM doctor for comprehensive care as described by the health belief model (HBM) constructs of perceived susceptibility, perceived seriousness, and perceived benefits of taking action. A sample of 165 participants age 18 or older from 2 chiropractic clinics in the midwestern United States completed a Likert-scaled survey. The data were analyzed using descriptive statistics and multiple regression to determine if there is a relationship between the variables of the need for a CAM discussion with a CM as the outcome using HBM constructs as the independent variables. The primary findings from this study were that (a) the participants were interested in discussing CAM with their physicians, with the majority of the participants stating that they discussed CAM either often (33.5%) or always (29.3%); and (b) perceived susceptibility, perceived seriousness, and perceived benefits of taking action were not predictive of a CAM discussion. Future studies should be conducted to (a) examine samples with varying demographic characteristics to assess the generalizability of the current findings; and (b) to include additional predictors of CAM discussions from the HBM such as barriers, cues to action, and self-efficacy. The results of this study add to the limited literature on CAM usage and may prompt future research. Implications for positive social change include understanding patient interest in discussing CAM which can help improve the overall quality of patient service.

Sexual activity among unmarried adolescents is a major public health problem in Nigeria, because unmarried pregnant girls are more likely to have multiple sex partners and are less likely to use contraceptives, putting them at greater risk for sexually transmitted diseases (STD), unplanned pregnancy, abortion, social isolation, and poverty. Teen pregnancy and STD rates are on the rise in Nigeria, yet few data exist on the experience of the adolescents themselves. This phenomenological study was designed to explore the in-depth experiences of 10 pregnant, unmarried adolescent girls aged 16-19, including the factors contributing to their sexual activity. An ecological model served as the conceptual framework to permit individual experiences to be understood in their social and ecological context. Semistructured interviews and Hycner's method of analysis were used to collect and analyze the data. Results showed that the decision to initiate sexual activity among these girls was influenced by many factors, including: the need for financial support and a socially condoned system of "sugar daddies" who support girls in return for sex; peer pressure to have a sex partner; a romantic knowledge of sexual behavior based primarily on the mass media; and inadequate sex education. As a result of their pregnancy, the girls experienced negative reactions from their families and community, and serious psychological and financial concerns about their prospects for future marriage and their child's identity. A comprehensive community-based reproductive health program is called for, with reliable sex education, cooperation from the mass media, and support from family and community members. The social change implication of this study is to potentially lead to a decrease in unplanned pregnancy, STDs, social isolation, and poverty among adolescent girls in Nigeria.

Despite increased access to prenatal care, birth outcomes continue to be a major source of disparity among women in the United States. The focus on lifestyle choices and negative behaviors prior to a pregnancy to reduce adverse birth outcomes has become a well-documented strategy. The purpose of this study was to determine if preparing for a pregnancy in advance improves birth outcomes for African American women of childbearing age between the ages of 12 and 45 years in the State of Rhode Island (RI). The theoretical foundation for this study was based on Prochaska's model of change, which is also known as the readiness to change model. This study was conducted using secondary data from the Rhode Island Department of Health PRAMS data set. The research questions determined if African American women received preconception care education at the same rate as White women, if African American women had a higher rate of infant mortality than other races, and if African American women had a higher rate of unintended pregnancies than White women in the state of Rhode Island. Independent t tests and chi square tests were used to answer the research questions. The results indicated a difference between the infant mortality rates for African American women compared to other races as well as a difference between African American women compared to White women with regard to unintentional pregnancies in Rhode Island. However, there was no difference in African American women compared to White women receiving preconception education in the state of Rhode Island. The implications for positive social change include micro- and macro-level changes in support of how planning for a pregnancy in advance can reduce poor birth outcomes.

No description available.

Congressional appropriations for federal public health agencies are subjected to external factors throughout the congressional appropriations process, resulting in fluctuations in funding. Recent literature has focused on externals factors, such as political attention and public attitudes, that could influence government funding levels; however, the impact of these factors on federal public health funding was not addressed. The purpose of this study was to determine whether a relationship exists between these external factors and federal public health appropriations. A quantitative study was used to examine congressional attention, policy mood, and the influence on the change in the level of federal public health appropriation during fiscal years 1947-2015. The theoretical framework for this study was based on the punctuated equilibrium theory. The population of this study included 68 years of time series data and analyzed using bivariate linear regression to determine the relationship between the independent variables of congressional hearing days and the policy mood scores and the dependent variable of federal public health appropriations. The results of the regression models indicated that congressional hearings days and policy mood scores did not have a statically significant effect on the change in the level of public health appropriations. Policy implications include informing public health officials and advocacy groups targeting public health messages to Congress that focus on increasing resources to targeted programs. Social change implications include informing health officials in planning congressional outreach and appropriations strategies, which can be used to improve the implementation of public health programs benefiting the community and promoting positive social change.

American Indian and Alaska Native adults are 2.6 times more likely to have adult onset diabetes resulting from higher weight at birth. Pregnant women, providers, and Indian Health Service administrators may benefit from timely information during pregnancy to intervene and prevent Type 2 diabetes. The purpose of this study was to examine the role of birth weight in the development of Type 2 diabetes among Southeast Alaska (SEA) Natives. Guided by the socioecological model, this study examined the extent to which birth weight and gestational age predict the incidence of Type 2 diabetes. The study used a quantitative research design with retrospective analysis of 540 Native children born in SEA whose data were abstracted from birth journals and electronic medical records at ages 43-53. A t test indicated a significant positive correlation between gestational birth weight and incidence of Type 2 diabetes (t(285) = 13.91, p < .001). Birth weight for gestational age was associated with frequency of Type 2 diabetes, where small for gestational age (SGA) had the lowest risk (1.42%), average for gestational age (AGA) at medium risk (8.76%), and large for gestational age (LGA) had the highest risk at 32.25% (x^2(12) = 63.29, p < .0005). Findings indicate that adult Type 2 diabetes among the SEA Native population is due to excess intrauterine fetal weight gain. The positive social change implications include preventing Type 2 diabetes in SEA Natives by controlling weight gain during pregnancy; the findings also suggest using diagnostic risk profiles for those who are LGA at birth for the management of diabetes and prevention of obesity and chronic disease.

Youth violence is a pervasive and ongoing public health concern. Based on the paradigm of resilience, the purpose of this quantitative study was to test the relationship between prolonged (3 or more hours) of non-school related media use and youth violence. Secondary data from the Centers for Disease Control and Prevention (CDC) were utilized for this study. Logistic and multiple regression models were used to test whether exposure to prolonged non-school related media (video games and TV) use was associated with violent behavior, and whether there was a relationship between prolonged exposure to non-school related media use and electronic bullying among urban youth (N = 1228). Prolonged exposure to both types of non-school related media use was associated with violent behavior (carrying a weapon, physical fighting, perpetrating physical bullying), and playing video and computer games 3 or more hours per day was positively associated with electronic bullying. However, 3 or more hours of TV viewing per day was not associated with electronic bullying. Policy makers, constituents, and parents may benefit from a greater understanding of media exposure and urban youth violence. The knowledge gained from this study may promote positive social change within family systems by increasing parental awareness of what youth do in their unstructured free time and how this impacts subsequent behaviors. Public health professionals, community organizations, and social service agencies in urban communities could incorporate the results to create a culture that supports youth leadership programs that focus on limited use of non-school related media and on violence prevention.

Voluntary HIV/AIDS testing and counselling (VHTC) is one of the preventive measures used in many countries to decrease the spread of HIV/AIDS. Archived data from National HIV/AIDS Response Program's (NHARP) raw 2016 dataset were used to identify relationships and to assess significant differences between sociodemographic factors and selected sexual risk behaviours versus VHTC practices among adults 18 years and older who resided in Dominica. The health belief model was used as the framework for this cross-sectional study. The sample comprised 982 participants (40% [394] men and 60% [588] women). Logistic regression analysis was used to assess associations between sociodemographic and sexual risk exposure factors versus VHTC. Findings revealed that, as compared to age group > 65 years, participants in age groups 25-44 years were 5 times more likely--and 45-64 years were 2 times more likely--to have engaged in VHTC (OR = 5.11, 95% CI = 2.03, 12.8 and OR = 2.63, 95% CI = 1.07, 6.49, respectively). The odds not to engage in VHTC were 48% higher for participants from Grand Bay district (rural area) compared to Roseau health district (capital) (OR = .52, 95% CI = .29, .94). The odds of nonengagement in VHTC were 51% higher for participants not having vaginal sex, compared to those who reported having vaginal sex (OR = .49, 95% CI = .26, .92). The implications for positive social change include providing public health practitioners with data to plan and implement educational programs specific to the demographic characteristics in Dominica. This will enhance current efforts to raise awareness regarding HIV/AIDS and may increase VHTC practice among the population that may reduce the incidence of HIV/AIDS.

Clostridium difficile is a frequent cause of healthcare-associated infections (HAI) and is associated with increased risk of morbidity and mortality. Studies suggest environmental and host characteristics increase patient's susceptibility to C. difficile infection (CDI). However, few studies have examined the risk of CDI among those with diabetes or patients in the acute rehabilitation (AR) setting. A case-control study, using secondary data (n = 473), evaluated the relationship between CDI and diabetes and identified modifiable environmental exposures. An ecosocial framework was used to examine the relationship between these two complex diseases among hospitalized patients in an AR setting. Results of the multiple logistic regression showed that patients with diabetes experienced 2.5 times the risk for CDI (p = 0.03) compared to non-diabetic patients. Multiple logistic regression was also used to assess for modifiable exposures among AR patients with diabetes only. Findings from this sub-analysis found the significant exposures in this population were antibiotics (OR = 3.9; p = 0.01) and insulin use (OR = 2.6; p = 0.015), suggesting an effect on the intestinal microbiome. Understanding the relationship between CDI and diabetes among the AR population promotes positive social change through the reduction of CDI associated morbidity and mortality among diabetic patients. Findings from this study support antibiotic stewardship efforts across the spectrum of healthcare delivery and the development of new strategies to decrease the economic burden associated with CDI for individuals, healthcare facilities, and at the national level.