Introduction In 2015, compared to the national rates, Tennessee had the 9th highest teen birth rate, 15th highest rate of reported cases of chlamydia, and 14th highest rate of reported cases of gonorrhea. Sex education that includes instruction on contraception along with abstinence has been found to delay sexual initiation, decrease number of sexual partners, and increase condom or contraceptive use. These behavioral choices by young people can help reduce teen pregnancies and Sexually Transmitted Infections (STIs). Introduction of contraception topics in earlier grades can equip young people with necessary tools to prevent unwanted pregnancies and STIs before they become sexually active. We explored the grades in which sex education providers taught topics such as birth control, condoms, and abstinence and the lowest grade at which they prefer to teach these topics. We then compared providers’ responses with responses from ETSU college students who had their sex education in TN. Methods To obtain information from sex education providers in TN public schools, we sent a recruitment email or letter with a weblink to a web-based survey from April to June 2017, to 3,249 potential providers. Of all potential providers, 509 completed the survey, yielding a response rate of 15.7%. Of those who completed the survey, final analysis included 137 providers who taught sex education in the 2015-2016 school year to any of grades 5 through 12 students. To get information from recipients of sex education in TN schools, a convenience sample of ETSU college students were asked to complete a survey using the ETSU SONA system in Fall 2017 semester. Of 385 students who completed the survey, final analysis included 216 (56.1%) students who were between ages 18-24 and attended the grade in which they had most of their sex education in TN. Provider and student surveys had similar items on grades in which sex education topics were taught and the lowest grade in which they would want these topics to be covered. Survey responses were analyzed using descriptive tests. Results Most providers (83.9%) taught abstinence by grade 12, and 37.2% had taught it by middle school (i.e. at or before 8th grade). Similarly, many students mentioned that abstinence was taught by 12th grade (92.1%) and by 8th grade (62.5%). Whereas, fewer providers taught topics, such as, birth control (65.0%), how to use condoms (22.6%), how to use and where to get birth control (31.4%), and much fewer providers taught these topics by middle school (17.5%, 8.0%, 8.8%, respectively). Most students expressed that these topics be taught by 12th grade (97.7%, 97.2%, 96.3%, respectively), and over two-thirds preferred that these topics be taught by middle school (71.8%, 67.6%, 63.9%, respectively). Also, about half of providers expressed that these topics be taught by middle school (68.6%, 46.7%, 51.8%, respectively). Conclusion This study finds that students want contraception topics to be taught in earlier grades, and that providers also prefer to teach these topics earlier. Future research should focus on factors that can enable providers to teach these topics in earlier grades.

A healthy diet has been established as a key component contributing to an individual’s quality of life. Statistics show that the diet of Americans needs improvement (Guenther et al., 2007) indicating possible lack knowledge of what healthy eating behaviors are. There is an abundance of nutrition misinformation available to the consumer (American Dietetic Association, 2002a). Dietary interventions that provide credible education based on readiness to change behaviors and goal setting have been successful in increasing awareness of what healthy eating behaviors are and changing existing behaviors over time (Ammerman et al., 2002; Evans & Sawyer-Morse, 2002; Gambera et al., 1995; Hebert et al., 1999; Oenema & Brug, 2003; Proper, et al., 2003). In an effort to provide a college community with credible nutrition education based on dietary analysis and stage of change, a nutrition assessment and consultation program was developed and implemented at a college campus during the fall 2003 quarter. It was integrated into the existing fitness testing and prescription program, polyFIT. Seven students, referred to as fitness consultants, majoring in Nutrition or Kinesiology were recruited and trained to distribute appropriate education based on individual clients’ dietary analysis, a stage of change assessment and personal goals. Intervention materials were constructed using a variety of resources focusing on areas of nutrition. Thirty clients participated during the fall 2003 quarter; all were freshman and sophomores enrolled in a Healthy Living course. Separate survey questionnaires were designed for the consultants and the clients to gather their perceptions of the program components. PolyFIT continued to offer the program, modifying it over time, for at least 4 years after the initial implementation.

Ectopic pregnancy (EP) is a rare condition that occurs in 1% of all pregnancies. However, women of lower socioeconomic status (SES) and ethnic minority groups are at greater risk of adverse outcomes associated with EP than White women. The purpose of this study was to examine data from the 2014 National Inpatient Sample to identify predictors of complications from EP in 2,626 females ages 15-44 in the United States. The theoretical framework used to guide this study was the theory of fundamental causes to explain why the association between SES and mortality has persisted despite progressive advances in the diseases and risk factors that are believed to explain it. Independent t-tests were conducted to determine whether significant differences in patient outcomes existed between EP participants who required one medical intervention during hospitalization and those with two or more medical interventions. Multiple linear regression analyses were used to examine the association between race, primary expected payer, income, number of procedure codes on record, number of diagnoses on record, and length of stay. The key findings were that for every increase in number of procedures (β = 0.13, p <.001) the length of stay also increased by 0.13 units; for every increase in number of diagnoses (β = 0.37, p <.001) length of stay increased by .37 units, and within the Black racial/ethnicity (β = 0.05, p < .05) length of stay increased by 0.05 units. Finally, for females within a higher income quartile of $45,000 or more (β = .08, p < .001), length of stay decreased by -0.08 units. Positive social change implications may include assistance to public health professionals in identifying individual factors that place women at increased risk for EP and the ability to increase EP prevention activity in populations that may be more susceptible to the condition and complications.

Breastfeeding has been shown to protect both the mother and infant, and health care professionals consider it to be the best choice for feeding an infant. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food, referrals to other social service programs, and nutrition and breastfeeding education for enrolled families. However, community support for the breastfeeding woman once she leaves the hospital is limited, especially in Philadelphia, PA. The purpose of this mixed-methods study was to explore the impact of prenatal breastfeeding education and understand the role that members of the community play in the infant feeding decision-making process. A purposive, convenience sample of 36 postpartum breastfeeding women enrolled for WIC benefits completed a survey and an in-depth interview about infant feeding choices and their support system at their return WIC appointment. The quantitative survey data were analyzed using Spearman's rank correlation coefficient and multiple regressions while the qualitative data were analyzed using Moustakas' modification of two methods, referred to as MVKMAP. The analysis of data showed that the postpartum breastfeeding education given at the WIC office had the most influence on participants' decision to breastfeed followed by prenatal education. Some participants reported receiving overwhelming breastfeeding support from the WIC peer counselor, which indicates that members of the WIC community play a role in the infant feeding decision making process. The study findings help to contribute to social change by identifying the need for breastfeeding support by medical providers, hospitals, and WIC offices at the prenatal period not only at the postpartum appointment.

The human immunodeficiency virus (HIV) is an epidemic that disproportionally affects the Haitian immigrant women in Palm Beach County, Florida. I have learned about this association from others' published research that the Haitian immigrant women within this locality are more likely to be hospitalized for HIV-related complications and to delay seeking care than are other racial and ethnic groups. The knowledge on the perceptions of lives for Haitian immigrant women as it relates to the HIV transmission could help fight this virus. Guided by the health belief model, the purpose of this phenomenological study was to understand the lived experiences and perceptions of Haitian immigrant women about vertical HIV transmission. Data were collected via 25 interviews with HIV-positive Haitian immigrant women of 18 to 65 years old. Three-step approach of Creswell was used under which data were reduced into themes, coded, and condensed. The respondents reported that the inadequate healthcare system, lack of HIV testing, lack of HIV education, HIV stigma, and the Haitian culture impacted their lives and vertical HIV transmission. Twelve out of twenty-five participants suggested that cultural factors have a significant role to play in the high rates of vertical HIV transmission in Palm Beach County. Participants emphasized the role of polygamy as the main cultural issue that promotes vertical HIV transmission in Palm Beach County. This study addresses the gap in the literature by adding to the knowledge of the perceptions of Haitian immigrant women as it relates to vertical HIV transmission, the intended audience of this study are Haitian immigrant women and the healthcare providers.

Recent multicenter, randomized, double blind clinical trials have shown no association between HIV preexposure prophylaxis (PrEP) and increased sexual risk behavior among high-risk men who have sex with men (MSM). However, little research has been conducted under natural conditions devoid of clinical trial controlled environment to confirm the lack of association between PrEP and increased sexual risk behavior. Also, research has shown conflicting associations between sociodemographic characteristics and sexual risk behavior among MSM. In this cross-sectional, web-based, primary data analysis, MSM who reside in United States of America (USA) and who make use of PrEP for HIV prevention were examined to determine and explain the relationship between PrEP and sexual risk behavior using the theory of health belief model. Also, the relationship between social demographic factors and sexual risk behavior among MSM was examined. The data were analyzed using logistic regression and the findings showed that the adoption of PrEP for HIV prevention did not significantly increase sexual risk behavior among PrEP users. Also, the findings demonstrated that all the social groups of MSM examined such as race, age, education, income, employment status, health access and alcohol/drugs were not associated with risky sexual behavior. However, MSM who had full-time employment and those who were unable to work for health reasons were more likely to adopt PrEP for HIV prevention. The results from this study may help in the design of effective HIV prevention program for MSM and subsequently lead to healthy social interaction, respect and friendship between MSM and the larger society.

Patients in hospital intensive care units are at increased risk to develop delirium, a condition which is characterized by a disturbance of consciousness and a change in cognition. Critical care nurses must have the knowledge to assess, recognize, and manage delirium. The purpose of this project was to develop an evidence-based policy for the assessment of delirium and a comprehensive nursing education plan which included an analysis and synthesis of the literature, a curriculum plan, and a pretest/posttest. The Johns Hopkins Evidence-Based Practice Model framed the project, which used a multidisciplinary team approach. Two nursing leaders, each with a doctor of philosophy degree, served as content experts for the educational curriculum plan and the pretest/posttest. The curriculum plan was evaluated using a dichotomous scale of 1 = not met and 2 = met. An average score of 2 was achieved showing the content met the objectives. The pretest/posttest items were validated using a Likert-type scale ranging from 1 = not relevant to 4 = very relevant. A content validation index score of 1.0 was computed, revealing that the items met the objectives and content of the curriculum. The pretest/posttest was administered before and after the educational program to determine the knowledge gained. A paired samples t test was conducted and found to have a statistically significant difference in the scores for the pretest (M = 81.25, SD = 11.29) and post-test (M = 94.06, SD = 7.12); t (31) = -5.92, p = 0.01, revealing that the critical care nurses gained significant knowledge with the delirium educational program. This project can promote positive social change because early recognition and management of the patient with delirium can facilitate positive outcomes for patients, families, and systems.

After HIV/AIDS, tuberculosis (TB) is the deadliest single infectious agent worldwide; globally in 2013, 1.5 million people died of the disease. Although TB infection rates in the United States are low compared to that of other countries, TB still remains a threat to public health in the U.S., especially among immigrant populations. The main purpose of this study was to investigate the correlations between the independent variables of immigration status, years of residence, and race/ethnicity and the dependent variable of TB infection within South Carolina between 2006 and 2012. To examine these possible relationships, this quantitative study employed the ecological perspective theory and used secondary data from the Center for Disease Control's Online Tuberculosis Information System. The data were analyzed via linear regression and the findings indicated that the most statistically significant predictors of TB infection rates among the study population were immigration status and race/ethnicity. By analyzing the relationships between the study variables and population through relevant data analysis, this study provides public health professionals with additional resources to assist in designing effective TB interventions that have the highest likelihood of stemming the spread of TB. These factors also have the potential to illicit positive social change, not only within South Carolina but also on the national level by decreasing the incidence and prevalence of TB and allowing for the best use of resources to targeted populations most at risk for the disease.

Advances in surgical technique and medical management have led to fundamental changes in surgical care allowing for a paradigm shift from inpatient to outpatient surgery. Enhanced recovery pathways have moved surgical recovery from inpatient to outpatient settings requiring informal caregiver support. The purpose of this study was to determine the prevalence of caregiver burden in this patient population and to explore whether caregiver burden contributes to preventable use of emergency room services. The conceptual framework supporting this retrospective cross-sectional study was Andersen's behavioral model of health services utilization. Data collected from 28 urologic patient/caregiver pairs were analyzed using descriptive statistics and linear and logistic regression. Findings indicated measurable caregiver burden in 2 of the 5 Caregiver Reaction Assessment (CRA) subscales: impact on schedule and impact on health. Findings also indicated a measurable protective effect of high socioeconomic status of caregivers and the CRA subscale of impact on finances, and a possible protective effect of caregiver self-esteem as measured by the CRA subscale and emergency room utilization within the first 30 days after enhanced recovery surgery. Social change implications include improving the surgical experience of patients and caregivers and enhancing the use of health care resources.

The role of hospitals as partners in community health improvement is changing, especially for nonprofit hospitals receiving tax exemptions in exchange for providing benefits to the community. There are examples of reported health improvement activities funded through hospitals' charitable donations, but there's a gap in the literature on the effect of policy and legislation on hospitals' investments in community building activities that address the social determinants of health. Grounded in eco-social theory, this quantitative, correlational study compared secondary data from CA's nonprofit hospitals' annual 2009 and 2012 reports to determine what, if any, changes have occurred in the hospitals' investments in community building since the 2010 implementation of the IRS' new community benefit standard. Matched-pair t test and chi-square goodness of fit tests were used to determine if there is a relationship between IRS regulations and how hospitals distribute their charitable dollars. Independent sample t test and ANOVA were run to determine if the characteristics of the hospitals studied were predictive of the changes found. Aside from a shift in the distribution of community building investments by types of activities, this study found no significant change in the use of nonprofit hospitals' community benefit funds to address the social determinants of health. Analysis did not indicate that current public policy supports hospitals' shift from sick-care institutions to institutions that promote population health. Rather, it revealed that CA's hospitals currently make only small financial contributions to activities that address the social determinants of health missing opportunities to leverage their resources to more effectively impact multi-sector efforts to improve population health and reduce health inequities.