Many men who have sex with men (MSM) engage in alcohol and drug use. Drug use, particularly methamphetamines, amyl nitrates (poppers), and drugs used to treat erectile dysfunction among MSM may also contribute to risks such as unprotected sex, which leads to the possibility of contracting syphilis, Human immunodeficiency virus (HIV), and other Sexually Transmitted Infections (STIs). In the Metro Atlanta Area (Fulton and Dekalb Counties), primary and secondary syphilis rates among MSM are still rising and rank highest among the other counties in the area. Guided by the risk and protective factor theory, the purpose of this study was to determine if club drug use was a contributing factor in high-risk sexual behavior among MSM with syphilis. Data were collected from the State Electronic Notifiable Disease Surveillance System with permission from the State of Georgia's Division of Public Health's STD division and was tested by using hierarchical regression analyses. The findings were inconsistent with the reported literature; there was no association between drug use and risky sexual behavior in this sample of MSM infected with syphilis. However, there was an association between prior incarceration being predictive of engaging in sex with anonymous partners and having sex while high. Implications for positive social change include evidence for the need for public health interventions that target incarcerated MSM because they exhibit the highest-risk sexual behavior due to their time served in the correctional system. Further exploration of this topic could be used to develop health information and policies to meet the needs of those affected by high-risk sexual behavior while incarcerated and upon release, ultimately reducing the spread of HIV.

Among young adults at risk for unintended pregnancies, preconception health and prenatal care programs aimed at positive birth outcomes remain unaddressed. The purpose of this phenomenological study was to explore the lived experiences of young adults in terms of their willingness to use preconception health and prenatal care as a means for increasing both positive birth outcomes and overall health. All study participants met the following criteria: (a) young adult man or woman, (b) age 18 to 25, (c) at risk for unintended pregnancies, (d) sexually active, (e) single or in cohabiting partnerships, and (f) living in the greater Los Angeles, Calif., area. The researcher conducted individual, semi structured interviews with study participants, and analyzed the resulting transcripts using a modified van Kaam analysis. Data analysis yielded 3 major themes to address the study's 3 research questions. First, participants believed that parenthood is largely learned through witnessing the practices of their parents, family members, and friends. Second, participants believed in the necessity of healthy lifestyle choices for healthy preconception and optimal prenatal care. Third, the key obstacle to perinatal care was the lack of awareness of pregnancy and available health care resources. These findings may provide a guideline for improving preconception health and prenatal care programs for young adults who are at risk of unintended pregnancies.

Amish communities have persistently low childhood immunization rates. Prior to this study, reasons for low rates had not been clearly identified. Researchers have speculated that access to health care, religious factors, and fear might be reasons that Amish parents refuse childhood immunizations, but more empirical evidence was warranted.The purpose of this study was to gather that empirical evidence regarding the knowledge, attitudes, opinions, and beliefs of Amish parents residing in Ashtabula County Ohio, an additional purpose was to examine how these factors influence timely immunizations of Amish children. The theoretical framework was the PEN-3-Cultural Model, focusing on cultural influences, beliefs, and experiences in health behavior of individuals in a community. The development of a 20 question survey was guided by 4 research questions designed to evaluate any differences in Amish parents' decision to defer recommended childhood immunizations. Multivariate analysis of variance was used to evaluate the 4 research questions based on the 84 individual surveys received. Results revealed a significant link between knowledge, beliefs, and opinions toward immunization and immunization adherence. Results also revealed that age and gender had no effect on the relationship between knowledge, beliefs, attitudes, and opinions toward immunization adherence. This study contributes to positive social change by educating parents of Amish children as to why it is important to receive timely childhood immunizations; thereby, keeping their children safe from vaccine-preventable diseases.

Caregivers' compliance with polio vaccine regimens and timely receipt of the recommended 4 doses of polio vaccine are pivotal to eliminating polio. This cross sectional study, conducted in Lagos State, Nigeria, examined polio vaccine compliance and demographic attributes of caregivers' for statistically significant associations. Using an adapted health belief model theoretical framework, 1,200 participants were recruited from well-baby clinics in 8 local government areas in Lagos State. Participants completed a brief demographic survey providing data on caregivers' age, gender, residence (rural or urban), and their level of education as well as records from their children's immunization cards. Data obtained were tested for associations between caregiver's demographic information and their children's receipt of polio doses within specified timelines using chi-square and logistic regression analysis. Fisher's exact analysis were conducted for variables with frequencies less than 5. The only significant association recorded was between the receipt of Polio Dose A and location of caregivers' residence: Rural dwelling caregivers were less likely to receive the first dose of polio. Results showed Polio Dose D to be the dose most likely received in an untimely manner as well as most likely missed of the 4 doses. Logistic regression analysis did not show any variable to be of greater odds in predicting completion of the 4 doses or compliance with timelines of their receipt. Study's results may inspire polio program planners to develop interventions that broaden the immunization coverage for rural dwellers to include nontraditional maternity locations. Positive social change will ensue by the improvement caregivers' compliance with full polio dose receipts with timelines, maximizing immunity.

HIV screening is recommended to destigmatize the condition, prevent partner transmission, and postpone AIDS progression. However, determinants associated with implementation of opt-out HIV screening are not well understood. The purpose of the study was to examine determinants that predicted odds of HIV screening for persons impacted by Hurricane Sandy, and how these factors differed according to demographic characteristics, geographical attributes, health-related quality of life score, access-to-care, and health insurance status. The social ecologic model provided the framework for this multilevel cross-sectional study that included New Jersey data from the Behavior Risk Factor Surveillance System. Bivariate chi-square, simple logistic regression, and adjusted multivariate and weighted logistic regression analyses were performed to estimate HIV screening odds. Findings indicated a significant odds ratio with access to care post- Hurricane Sandy and HIV screening (odds ratio = 1.74, 95% CI = 1.38-2.21). The positive social change implications may include assisting people to develop realistic plans for HIV screening, improving understanding of HIV screening determinants, and raising awareness of the risk factors related with access to medical care post-Hurricane Sandy.

Increased poverty and unemployment rates, minimal investment in social amenities, a shortage of healthcare professionals, poor infrastructure, inadequate social services, and poor institutional and political leadership have weakened the healthcare status of Cameroon's women who have reached the age of childbearing. The World Health Organization expressed increased urgency for healthcare providers and patients to develop new healthcare policies to eliminate health-related disparities. The aim of this phenomenological study was to examine the perceptions of women of childbearing age living in Mamfe rural community in regard to Cameroon's healthcare system and its impact on their lives. The theoretical foundation of the study was the healthcare utilization model. Interviews were conducted with 10 women participants, ages between 18 and 45. The data collected through semistructured interviews were analyzed using NVivo 11 and the Colaizzi 7-step processes to identify themes and subthemes. Study findings revealed systemic challenges that affected healthcare access which need to be adequately addressed to reduce maternal and child mortality among women of child-bearing age. The study findings could foster social change by improving the development of healthcare standards, as well as illustrating methods of increasing the level of access to healthcare services among women of childbearing age.

Dementia is a serious public health concern in the United States, with a prevalence of 5.2 million. There is currently no effective way to prevent or cure dementia, and the precise etiology is unknown, but it appears there are multiple risk factors. Prediabetes (PD) has been identified as a risk factor although the scientific evidence is conflicting. This study is important to those at high risk for dementia and to healthcare professionals who lack substantiated dementia prevention strategies. The purpose of this case control study was to determine whether PD is associated with dementia in adults aged 65-95 years and whether the association varies according to demographic (age, gender, race, and socioeconomic status [SES]) and health (atherosclerosis, body weight, cerebrovascular disease, dyslipidemia, hypertension, and stroke) risk factors. The ecosocial theory was selected to bridge the study findings to life-course exposures and risk factors. Cases (n = 574) and controls (n = 2,157) were sampled from a large ambulatory care dataset, and multivariable logistic regression was used to test the research hypotheses. No unadjusted association between PD and dementia was found (OR 1.08, 95% CI = .854, 1.241, p = .604). The regression analysis revealed no association between PD and dementia; however, atherosclerosis, hypertension, low body weight, and low/average SES were found to be significantly and independently associated with dementia. A stratified analysis revealed that race and SES did not alter the effect of PD on dementia. The implications for positive social change include the potential reduction of incident dementia through initiatives targeted toward demographic and health risk factors including atherosclerosis, hypertension, low body weight, and low/average SES.

Posttraumatic stress disorder (PTSD) is a serious issue for post-deployment United States Marine Corps (USMC) veterans, especially because PTSD can increase the risk of suicide. Marines are screened post-deployment, yet little is known about Marine veterans' perceptions of the PTSD screening process. The purpose of this phenomenological study was to explore USMC male veterans' perceptions of the Post- Deployment Health Reassessment (PDHRA). The social cognitive theory constructs of a triadic relationship among person, environment, and behavior were the framework for understanding this population's perceptions of the PDHRA and potential stigma. Two research questions focused on how people, culture, and behavior affect Marines perception of the PDHRA and PTSD attached stigma. Interviews were conducted with 10 Marine veterans' participants and transcribed interview responses were input into NVivo 11 software to retain a reliable database and Colaizzi's strategy to identify emerging themes. Key findings revealed potential positive social change to military chaplains and veterans' health service providers. This knowledge might inform about the perceptions of Marines through informed understanding and may help develop an updated evaluation tool. Future researchers might focus on the forthcoming answers and treatment of PTSD and the attached stigma among Marines by alleviating repercussions for Marines' answers on the PDHRA. An understanding of the study's findings may elicit strategies for health care administrators to expound on the PDHRA and provide educational programs to assist in future screening environments and processes through Marines perspectives.

Research indicated that depression is now the leading cause of disability globally. Depression and help-seeking experiences among African American men have not been adequately studied. The purpose of this phenomenological study was to explore the help-seeking experiences of African American men with depression. The theoretical framework was Andersen's Behavioral Model of Health Services. Purposive sampling was used to recruit participants. Inclusion criteria were (a) African American men, (b) aged 18 through 65, (c) having a medical diagnosis of depression or symptoms of depression, (d) not currently in treatment, and English speaking. Six African American men with depression or depressive symptoms were interviewed. Coding analysis of data generated two major themes: African American men's perceptions of factors that inhibit help-seeking and African American men's perceptions of factors that promote help-seeking. The 6 sub-themes identified were (a) African American men with depression tend to feel misunderstood and stigmatized; (b) some African American men admit to a degree of self-stigma; (c) some African American men deny their depression or any need for help; (d) African American men who had therapy found it helpful until the therapist was changed, causing feelings of mistrust and inadequate mental health care; (e) African American men fear guilt, fear being a burden to others, and feel they should be able to handle their problems; and (f) it is difficult being depressed and Black in America, which leads to stress, frustration, and perceived racism. Findings may be used by mental health professionals seeking to improve cultural competency, mental health and support services, and treatment regiments for African American men with depression.

Obesity has been identified as a significant risk factor for chronic diseases, contributing to health disparities in minority and vulnerable populations. Though research has identified an increased risk for obesity in the Hispanic immigrant population, there is little or no research on the heterogeneity of obesity predictors in specific immigrant populations in the United States. This study examined the predictors of obesity in the Nigerian immigrant population in the United States. Guided by the social ecological model and the segmented assimilation theory, this cross-sectional study collected primary data from 205 Nigerian immigrants in the United States using the CDC's Behavioral Risk Factor Surveillance System self-administered web-based survey. Spearman's correlation and logistic regressions were used to analyze data through SPSS. The results showed no significant relationship between obesity and the factors education, socioeconomic status, length of stay, and level of physical activity. This study, however, identified a significant association between weekly consumption of alcohol and all obesity (OR 1.78, p = .021), and moderate/morbid obesity (OR 2.46, p = .013). There was also a significant association between gender and moderate/morbid obesity (OR 3.30, p = .031). These findings provide strong evidence to inform the development of targeted culturally-relevant community-based interventions for Nigerian immigrant population in the United States, including health education and targeted screenings for alcohol consumption, and other unrecognized behaviors that increase their risk for obesity. The lack of association between other well-known predictors of obesity and obesity outcomes calls for further investigation into other causes of obesity in this immigrant population.