The National Health Planning and Resources Development Act. Public Law 93-641, the last major step in the regulation of the health care system, created a network of health system agencies and state level health planning agencies. Subsequent legislation, the Health Planning and Resources Development Amendment 1929, Public Law 96-79, amended 1974 Law and changed the role and function of health systems agencies to include more regulatory activities. By 1981, the activities of Health System Agencies were being curtained by the action of the Reagan administration. The Health promotion/wellness movement which seeks to improve health has been developing as a compliment to medical medicine for several years. Previous research has determined that health systems agencies were active in health promotion and identified several planning and implementation activities related to this involvement. This is a survey of health systems agencies to determine their efforts in healthy promotions. Resources allocated to these activities, and opinions of the director relevant to agency involvement in health promotion. All active healthy system agencies listed in the 1980. Directory of Health System Agencies (DHSH) were surveyed by a mailed questionnaire. Reponses were receive from 112 agencies (57%) and the respondents were found to be representative of the population. The results revealed health systems agencies to be involved in health promotion. More than 90 percent of the responders listed some type of health promotion activity in their Healthy System Plans for the 1979-1980 planning year. Approximately half of the responders reported some community activity in health promotion. The majority of executive directors saw health systems agencies as being only moderately effective in controlling health care costs: considered healthy promotion as a viable means of controlling health care cost: and believed that modifications of individual life-styles had the greatest potential for improving health status. The survey revealed that Healthy System Agencies did not restrict the wellness/health promotion activities to traditional health facilities, but were defining health broadly and working with a variety of agencies to develop services.

The prevalence of obesity has doubled over the past 25 years in the United States, particularly in North Carolina. Obesity is influenced by biological, social, and environmental factors; its prevalence has been found to be higher among African American women and other racial ethnic minorities. Guided by the social ecological model, the purpose of this cross sectional study was to examine the relationship of the psycho-social, psycho-behavioral factors, and body mass index levels (BMI) in African American women living in North Carolina versus their Hispanic American and European American counterparts. A logistic regression model using secondary data from the Behavioral Risk Factor Surveillance System revealed a significant association in income levels, house hold size, dietary intake, physical activity, and increased BMI levels in African American women. African American women were significantly more likely to be obese (r = 0.93 p > 0.05) compared to European American and Hispanic American women. The association of each variable to BMI assessed for African American women was as follows: income (r = 0.46, p = 0.001), dietary intake (r = 0.-17, p = 0.04), household size (r = 0.57, p = 0.001), physical activity (r = -0.16, p = 0.05), depression (r = 0.37, p = 0.001), and alcohol consumption (r = 0.39, p = 0.001). A culturally sensitive weight loss model addressing the psycho-behavioral and psychosocial risk factors that negatively influence BMI and subsequently obesity is warranted for African American women living in North Carolina to promote social change and decrease the incidence of obesity in this ethnic group.

Background Recent studies have demonstrated a significant relationship between vitamin D and cholesterol levels. Cholesterol is important in the synthesis and metabolism of vitamin D. Additionally, foods rich in vitamin D also contain high cholesterol supplements. Given that sources of vitamin D and cholesterol are different, we hypothesized that there is a potential mean bias in true relationship between an individual’s vitamin D and cholesterol levels. The study therefore aimed to examine the relationship of serum cholesterol and vitamin D levels. Methods We utilized NHANES 2001-2006 data (n=30,954). The outcome was vitamin D deficiency defined as individuals with serum 25-hydroxyvitamin D level12 ng/ml were classified as normal. Significant differences in cholesterol levels between the two groups were determined using Chi-Square contingency test. Generalized linear models were conducted to assess the association of vitamin D deficiency with cholesterol levels adjusting for age, sex, physical activity (proxy measure for sunlight exposure) and other serum lipid levels. Results Vitamin D deficiency was significantly lower in males(5.2%) than females(7.8%)(P Conclusion Vitamin D deficiency was associated with high LDL and triglyceride levels. Study findings help establish the importance of distinguishing vitamin D and cholesterol levels as separate entities while making inferences about their relationship with chronic diseases.

Adolescents and Young Adults (AYAs) ages 15-39 years with cancer have received little attention in the health field, resulting in a lack of progress. The purposes of this study were to use the Tennessee Cancer Registry for all new cancer cases from 2004-2008 to determine the main types of cancer that affect AYAs in Tennessee and understand if there were any cancer types that warranted additional investigation. A total of 8,097 cancer cases were diagnosed in AYAs in Tennessee from 2004-2008. The main types were breast, melanomas, thyroid, lymphomas, and testicular, accounting for over 50% (N=4,269) of cancers in the sample. The incidence of melanoma and thyroid cancer was higher in Tennessee compared to the United States, deserving further examination. In Tennessee, females were significantly more likely to be diagnosed with melanomas (AIR 14.01, 95% CI 12.96-15.06) and thyroid cancers (AIR 13.39, CI 12.37-14.42) compared to males (AIR 8.08, CI 7.28-8.88 and AIR 3.50, CI 2.98-4.03. Regression models were used to further analyze melanoma and thyroid cancers, specifically looking at predictors of late stage diagnosis and treatment types, respectively. Individuals with government insurance were eight times (OR 8.41, CI 3.04-23.27) more likely to be diagnosed with late stage melanoma when compared with private or other types of insurance. Individuals diagnosed with regional or distant stage thyroid cancer compared to localized stage were three times (OR 3.01, CI 1.84-4.94) more likely to have a total thyroidectomy. These data suggest the need for additional cancer prevention and control efforts geared towards AYAs.

Background: The incidence of cardiovascular disease (CVD) is high in obese people. The potential effects of inadequate calcium intake on CVD are receiving increased attention. We assessed the association between several risk factors for CVD and calcium intake among obese adults. Methods: We investigated 14,856 obese subjects age 20 years or older from the National Health and Nutrition Examination Survey, 1999-2010. ANOVA and Pearson correlation analyses were used to examine if any relationships existed. Simple and multiple linear and logistic regression analyses were conducted to determine the association between risk factors for CVD and calcium intake. Results: After adjusting for energy intake and other potential confounders, systolic blood pressure, diastolic blood pressure, C-reactive protein, glycosylated hemoglobin, and albuminuria were negatively associated with calcium intake at =0.05 level in both linear and logistic regression analyses. Adjusted regression coefficients and ORs did not show a significant relationship between high-density lipoprotein (HDL) and calcium intake. Total cholesterol was negatively associated with calcium intake in continuous form, but no relationshipwas seen between total cholesterol and the calcium intake quartiles form. When comparing low quartile to high quartile, total cholesterol had a weak negative association with calcium intake at =0.1 level. Conclusion: Our study provides evidence that adequate calcium intake could decrease the risks of CVD, such as high blood pressure and high glycosylated hemoglobin, among obese adults. However, calcium intake was not associated with HDL levels. More research is needed to assess the effect of total cholesterol by calcium intake.

Childhood obesity remains prevalent among African American (AA) adolescents in low income neighborhoods with limited access to a variety of foods from stores. Guided by the ecological framework, the purpose of this study was to examine the impact of neighborhood stores on food choices, and physical activity among AA adolescents in a low income neighborhood. A quantitative research design with cross sectional primary and secondary surveys was used. Participants included 176 high school students and 42 store merchants. Data sources were the 2011 New Jersey Student Health Survey with core questions from the Youth Risk Behavior Survey and the Hmong Food Store Survey. Descriptive statistics were used to describe the sample characteristics and food store food variety and cost. Inferential statistics were used in analyzing the association between the dependent variable (grade level, age, or gender) and the independent variables, food choices and physical activity level, and to test for hypotheses. The findings revealed there were no significant associations between grade level, age, or gender and food choices, or physical activity level. Food variety reported as MyPlate food items were low for adolescents who shopped at small grocery and convenience stores as compared to those who shopped at supermarket and large grocery stores. Average cost differed by, MyPlate food groups and store type. Convenience stores had the lowest costs for fruits, grains, and protein, and highest for diary, reflecting the lack of variety in the mix of foods used to calculate costs. This study demonstrated the need for policy change at the community that will benefit disadvantaged AA adolescents in low income neighborhoods and improve access to a variety of food choices for purchase that are nutritious and affordable.

Multiple research studies have demonstrated racial, socioeconomic status (SES), and neighborhood disparities in first-line treatment of colorectal cancer patients, including those with metastatic colorectal cancer. However, disparities in adjunct monoclonal antibody treatment disparities have not been explored. The purpose of this study was to assess racial, SES, and neighborhood disparities in adjunct monoclonal antibody treatment of elderly metastatic colorectal cancer patients. The research was rooted in 3 theories: the fundamental cause theory, the diffusion of innovations theory, and theory of health disparities and medical technology. Data from the SEER-Medicare database and logistic regression were used to assess the relationship between the variables of interest and adjunct monoclonal antibody therapy. In this study, race (p = 0.070), SES (p = 0.881), and neighborhood characteristics (p = 0.309) did not significantly predict who would receive monoclonal antibody therapy. The results demonstrated a potential improvement in historically documented colorectal cancer treatment disparities. Specifically, historical treatment disparities may not be relevant to newer therapies prescribed to patients with severe disease. The difference could be related to improved access to care or a change in treatment paradigm due to the severity of metastatic colorectal cancer. Future studies aimed at understanding the causes of this social change (i.e., reduced treatment disparities) are warranted. Understanding the root cause of the reduced treatment disparities observed in this study could be used to reduce treatment disparities in other cancer populations.

Despite significant research and inroads with the human immunodeficiency virus (HIV), disparities in HIV infection continue to widen for African American (AA) men who have sex with men (MSM). In recent times, cultural competence has been receiving increased attention as a possible factor to enhance the quality of health messaging and lessening HIV disparities. However, there is a dearth of research specifically dedicated to AA MSM and culturally competent HIV health messages. To address this gap, this qualitative research was designed to investigate the self-perceived cultural competency among HIV counselors. The theoretical framework for the project was the PEN-3 cultural model. The interview participants for the study were 10 HIV interventionists employed with health institutions that partially or entirely specialize in HIV prevention in the Richmond, Virginia, area. The analysis of the data was aided by a phenomenology analytical approach. The results revealed that cultural competence training can be one effective means to enhance the quality of health messages targeting AA MSM. This investigation has social change implications, especially in the context of developing sustainable HIV prevention interventions focused on integrating culture, thereby reducing HIV disparities in the Richmond metropolitan area. The findings may also lend insight into the various ways that health establishments can engage in culturally relevant prevention and position themselves to be leaders in informing the development of culturally competent HIV prevention messages that will aid in the acceleration of changing longstanding, ineffective prevention approaches targeting AA MSM.

Gate control theory posits the idea that the brain and spinal cord have the ability to control the perception of pain sensation throughout the body. Biofeedback provides a proven way to teach a person how they may control their heart rate, breathing, and skin temperature. Through this process, individuals learn to lessen their migraine frequency and intensity. There are no studies to date that have measured the effectiveness of biofeedback in conjunction with medication for migraines in children despite established evidence of success in adults. In this study, an online format via SurveyMonkey was used to document the perceptions of parents with regard to the observation of their children's migraines. Pre€ and posttreatment measures were recorded to document migraine activity with implementation of biofeedback or medication using the Individualized Numeric Rating Scale. A total number of 48 participants reported about their children's migraine frequency and intensity. One group of 24 parents were asked to give information on medication only treatment, and an additional 24 parents provided information on biofeedback and medication. The data were processed using 2 mixed model (i.e., 1 within and 1 between) ANCOVAs. Although frequency and intensity of migraines decreased across both groups posttreatment, there was no statistically significant interaction between the within subject factors of time and type. In this particular data set, medication plus biofeedback was not more effective than medication alone. The implications for positive social change using the results of this study are the potential for happier, healthier, migraine free children who are more able to be productive and contribute positively to society.

Lack of accessibility to healthy foods is a factor associated with the increase in obesity, diabetes, and other negative health consequences. While programs such as WIC (Women, Infants, and Children) provide supplemental nutritional access to healthy foods, few organic food items are included in the WIC authorized food list. Government programs and policy makers that provide to the most vulnerable populations are concerned about equal availability of healthy foods. The purpose of this study was to compare variability and cost of organic food items in 24 large chain grocery stores located in high- and low-income areas. The theoretical concepts of social production of disease and political economy of health guided the study. The study used a quantitative research design to investigate the relationship between neighborhood income level and the consumer nutrition environment. Organic food scores were compared by neighborhood income level using t test and ANOVA. There were significant differences in availability and variability scores of healthy organic foods between high- and low-income neighborhood stores. Organic food items, specifically 15% fat content ground beef, peanut butter, apple juice, and eggs were priced significantly higher than conventional items (p < 0.05). Pricing of organic foods varied and no significant pricing trends were noted between neighborhood income levels. This study may contribute to social change by enhancing the conversation on organic food availability and affordability. Social change may be promoted through identification of the need to expand WIC authorization of organic food items and increasing produce voucher amount to allow WIC participants to purchase higher amounts of organic produce.