Community coalitions have had successful reductions in adolescent substance abuse, and the legalization of marijuana presents an opportunity for these coalitions to re-evaluate their current methods and messages for preventing adolescent marijuana usage. Using the theory of planned behavior, the purpose of this qualitative study was to determine how legalization of marijuana for recreational purposes affects the methods and messages of coalitions and how the coalition members perceive their efforts to reduce adolescent marijuana usage post-legalization in Colorado. Participants were obtained by recommendations from the executive director in each of four coalitions. A purposive sample of 12 coalition members was interviewed via telephone and recorded. Data from the transcripts were analyzed, coded, and repeated as necessary until themes arose. The major themes suggested that programs alone were inadequate to change adolescents' perception of marijuana, despite the current success of the methods and messages expressed by coalition members. Recommendations included continuing current programs despite legalization, partnering with marijuana retail shops, engaging youth through multiple tactics, developing relationships with youth, and improving parent education to help prevent adolescent marijuana usage. These themes could shape the development of programs that guide adolescents into making better choices, which could ultimately lead to positive social change.

Unsafe abortions pose serious threats to women's health. Medical abortion provides safer abortion access to many. The lengthy interval between misoprostol and mifepristone creates multiple barriers for women and providers. A paucity of research exists about medical abortion protocols that allow single day procedures. The efficacy and the safety of 3 medical abortion protocols of varying lengths were explored in this study. A secondary data set of over 55,000 patients from the United Kingdom was retrospectively analyzed using binomial logistic regression. Efficacy results showed no significant difference between the conventional and the simultaneous protocols; when compared to those, the 6- to 8- hour protocol showed a 79% higher risk (OR = 0.210, 95% CI = 0.178 - 0.246) of failure. Safety of the simultaneous protocol was 48% lesser (OR = 0.524, 95% CI = 0.447 - 0.613) and the safety of the 6- to 8- hour protocol 61% lesser (OR = 0.386, 95% CI = 0.304- 0.489) compared to the conventional protocol. The absolute risk of complications or severe adverse events of all protocols (0.98%, 1.97%, and 2.67%) was very low. The results suggest the simultaneous protocol is a viable alternative to the conventional protocol up to 10 weeks' gestation. The results could promote the adoption of the simultaneous protocol by health systems, give millions more women access to safe and effective single day medical abortions, reduce the need for skilled clinicians, and reduce cost burdens for both women and for healthcare systems overall. Implementation of these social changes could make abortion safer globally.

Traditionally, in Nigeria women play a subservient role in relation to men. While a man can practice polygamy by marrying many wives, women cannot marry more than one husband at a time. Although researchers have documented the effects of polygamy on the spread of HIV/AIDS, little is known about the experiences of polygamy by Nigerian women who stopped practicing polygamy by immigrating to the United States without their husbands. It is important to know the experiences of these women as they pertain specifically to the spread of HIV/AIDS so as to develop a preventive intervention for HIV/AIDS among Nigerian women in polygamy. The purpose of this phenomenological study was to explore the perspectives on HIV/AIDS held by 10 Nigerian women who practiced polygamy in Nigeria before immigrating to the United States. Recruitment was done through purposive sampling at a faith-based organization. Guided by the health belief model, interview transcripts from the 10 women were analyzed to reveal recurrent themes that expressed the women's lived experiences in polygamy with their perspectives on HIV/AIDS. Findings revealed that these women had a basic knowledge of the risk of contracting HIV/AIDS by engaging in polygamy but needed to comply with the terms of sexual encounters as dictated by their husbands; therefore, they were at risk for HIV/AIDS. The results of this study can be used to increase awareness among Nigerian women in polygamy and Nigerian health policy makers regarding the transmission of HIV/AIDS and the preventive measures available for HIV/AIDS. Understanding the experiences of women in polygamy may lead to greater understanding of the impact of polygamy on HIV/AIDS and may help to decrease the prevalence of this disease.

In recent years, many dramatic changes have occurred in the nation's health care delivery system, particularly in health education. The National Consumer Health Information and Promotion Act was enacted in 1976. In response to this legislation, the nation's health education efforts were greatly expanded through the creation of a Bureau of Health Education within the Center for Disease Control and establishment of the Office of Health Information and Promotion in the Office of the Assistant Secretary for Health, Department of Health, Education and Welfare. A National Center for Health Education was also established. Health education was prominently included among the ten national health priorities outlined in the National Health Planning and Resources Development Act of 1974. Concurrent to these developments have been intensified demands among health organizations and the public for an expanded health education component of the health care delivery system. Health education of the hospital patient (or hospital patient education) is a significant aspect of the broader area of health education. This thesis examines the relationship between some of the national health education developments and the patient education responsibilities of small hospitals. Issues inherent in these responsibilities are identified and analyzed in an attempt to develop a philosophy (or concept) of the extent to which small hospitals should provide patient education. For purposes of this study, small hospitals are defined as general, acute-care hospitals of the 100-bed and less category. To facilitate understanding of how patient education hospitals has reached its present position, a brief history of hospital patient education is presented. This history leads to an overview of current hospital patient education activities and the identification of issues and trends in this area relative to the small hospital. This thesis examines some of the current questions raised on the appropriate role of the small hospital in meeting the health education needs of its patients. Specific aspects of hospital patient education are also discussed; for example: philosophies, planning, coordination, methodologies, financing, materials, cost effectiveness, and evaluation. After discussing the above-mentioned issues, this thesis concludes with the presentation of a concept of patient education in the small hospital and some recommendations relating to the small hospitals' patient education activities. The concept presented was based on the conclusion that the philosophical and humanitarian tenets upon which small hospitals provide service demand the provision of maximal patient education which is integrated into routine patient care regimens.

Objective: This study sought to examining the gender-based expectations of an ideal body, for self and opposite gender, among college students. Methods: The study used a qualitative approach using thematic analysis. Common words and phrases were first identified and later grouped into category, through open and axial coding respectively. Next, central theme was identified using selective coding. Results: This study examined a total of 145 student participants responses of which 94 were self-identified women and 51 were self-identified men. The results reveal that men’s ideal body perception for a woman is different than women’s expectations for women. For example, women’s perceptions of ideal body for women were focused on features such as lips, nose, eyebrows; whereas the men’s perception of ideal body for women was considered to be a small body type. Similarly, there was also variation of ideal body expectations for men. Although both men and women considered fit body types to be the most ideal body for men, women also reported personal hygiene as being an important factor. Furthermore, the men’s perception focused more on body types rather than other factors such as hygiene. Conclusion: Our results show unique differences in body image perception based on self-identified gender. These results can aid public health professionals in creating targeted body positivity initiatives.

Every year, about 1 million children are abused in the United States and an average of 4.5 of those children die daily at the hands of caretakers, parents, relatives, or friends. Using the ecological model as a guide, the purpose of this study was to investigate the relationship between family structure and specific types of child maltreatment utilizing cases from an agency in Montgomery, Alabama, in 2012-2013. Approximately 727 cases of child maltreatment were reviewed. Logistic regression results indicate married and common law families' children are 1.83 times more likely to experience sexual abuse than the reference category (single) (OR= 1.834, 95% CI:1.19, 2.81). As it relates to relationship to the offender, children are 2.1 times more likely to experience sexual abuse from an acquaintance; someone who is known by the child but is a non-family member, compared to the reference level (stranger) (OR= 2.1, 95% CI:1.20, 3.65). This research can promote positive social change by providing awareness to the local community about child maltreatment; the findings provide policymakers, public health departments, healthcare officials, health advocates, and communities needed information on the child maltreatment and the specific family structures that are associated.

Hispanic and African American women are infected with sexually transmitted diseases more often than are Caucasian women. This racial disparity is also seen in the incidence of human papillomavirus (HPV) and cervical cancer. The medical connection between HPV and cervical cancer is often unknown or misunderstood among women. This study addressed the beliefs and subsequent health decisions of minority parents regarding whether to get their daughters vaccinated against HPV. The theoretical framework for this study was Rosenstock's health belief model (HBM). The specific study design used was Husserl and Heidegher's theory on Phenomenology. This qualitative study utilized focus groups containing mothers of young girls ages 9 to 12 years, who were recruited from local churches in San Antonio, TX. Twenty-seven mothers, African American (9), Hispanic (7), and Caucasian (11), participated in one of two focus groups for each racial group. Each focus group session was audiotaped and NVivo for Mac was used to perform a content analysis and to identify the themes present. Minority parents held stronger cultural and spiritual beliefs against vaccinating their daughters for a sexually transmitted disease more so than believing that their daughters were at risk for being exposed to STDs such as HPV. These beliefs presented as barriers to initiating the desired HPV prevention and screening practices. Gaps in the current knowledge of all parents exist and must be thoroughly addressed for all racial/ ethnic groups. Future educational programs need to not only address the gaps in knowledge but also shape and package public health messages with sensitivity to cultural and spiritual concerns.

Health disparities have mostly affected African Americans who are poor, uninsured, under insured and unemployed. This population of African Americans seek spiritual solace and social counseling from their pastors, and church-based health promotion (CBHP) offers the opportunity to reach millions of the U. S. Black population. The lack of studies on female African American pastors implementing congregational health promotion activities influenced this study. This qualitative study helped in understanding the experiences, perspectives, and influences of 13 female African American Christian pastors on health-related issues within their congregation. Feminist theory and CBHP model guided this qualitative case study. Open-ended interview questions, field notes, and audio recordings were used to collect data. Data analysis was done using constant comparison method. Open coding and categorizing were done to develop the final themes and subthemes for the study. This research study has the potential for other researchers to replicate this study elsewhere in the United States. Potential positive social change may lead to increase in young female pastors in the churches. Possible social change benefits also include the increase of African American female pastors implementing CBHP activities in their own churches, change in congregation's health behaviors and habits, and improved health status.

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.

Only three states have enacted informed consent laws aimed at providing more information concerning any alternative treatments for women who undergo hysterectomy. This study attempted to fill the research gap regarding consent laws and perceptions of women who underwent hysterectomy in a state with no informed consent laws. Supported by the health belief model (HBM), the research questions focused on the perceptions of women and their lived experiences. The purpose of this qualitative study was to examine the beliefs and attitudes of women in a state with no informed consent laws. Interviews were the main data collection technique. The participants were 10 women who underwent a hysterectomy and were between 20 and 40 years of age at the time of the research. The interview data were analyzed using thematic analysis. The findings demonstrated that the women who underwent hysterectomies in the absence of comprehensive informed consent law could be subjected to the procedure without sufficient information. Participants negatively described their physiological, psychological, and emotional consequences of undergoing hysterectomies without sufficient information; many of them reported feeling deceived by their doctors. Overall, the women expressed the belief that care providers should be required to offer all the pertinent information about hysterectomies and alternative treatments prior to the procedure. The results of this research can be used to advocate for the introduction of comprehensive informed consent laws, promoting the positive social change that would benefit the women of the U.S.