Rising worldwide rates of noncommunicable diseases (NCDs) in the Middle East, principally Saudi Arabia, have put an increasing load on the health system and employers. Middle Eastern organizations have been slow to develop targeted health programs, which include an emphasis on employee productivity. The purpose of this study was to determine the relationship, if any, between employee lifestyle and workplace productivity. Productivity is the amount of work produced based on the time and cost required to do so. The underlying theoretical foundations of this research were the socioecological health model and the human capital model. The quantitative, ex post facto design relied on secondary data from Saudi Aramco. Lifestyle data were collected from a health risk assessment including the Stanford Presenteeism Scale. Data analysis consisted of both a correlational and multiple regression analysis. Correlational results indicated that exercise, tobacco use, body mass index (BMI), and nutrition were significantly related to workplace productivity. Exercise and nutrition had a significant positive correlation with workplace productivity, while tobacco use and increasing BMI were negatively correlated with workplace productivity. Multiple regression analysis results explained 21% of the variance in the dependent variable, a sizable percentage with such a large sample. Overall, these results suggest a strong influence of health choices on productivity. Since this research was the first to explore the unique cultural context and draw attention to the increasing NCD burden, the results are notable. Implications of this research should resonate with organizational leaders in the Middle East, and provide a clear opportunity to improve organization and human performance.

There has been a shift toward e-cigarette use and away from tobacco smoking among American youth. Despite effects of ongoing public health campaigns that bring attention to the harmful effects of tobacco and nicotine use generally, youths might not perceive e-cigarette use to be unhealthful in terms of psychological functioning. This study was an investigation of the impact of the method of tobacco use (cigarette or e-cigarette), past cessation attempts, cravings or needs to use tobacco, and serious cognitive difficulties, upon youths' intentions concerning future tobacco usage. The conceptual framework was based upon the self-medication hypothesis, biopsychosocial model, and social cognitive theory. The research questions focused on whether factors surrounding youth tobacco use would significantly predict the youths' intent. Data were drawn from 2015, 2016, and 2017 National Youth Tobacco Survey (NYTS) responses. Cross-sectional data from 56,258 cases allowed for a total of 387 cases to be identified for inclusion in the analysis, based upon completeness of the data and inclusion criterion of a singular form of recent and regular tobacco use. Data were analyzed by using a chi-square test of independence and multinomial logistic regression. The research findings suggest that past cessation attempts and methods of tobacco use are variables that could significantly predict intent concerning future tobacco use; however, the findings did not suggest that craving or need for tobacco or serious cognitive difficulties significantly predicted these intentions. The study is replicable and amendable for purposes of more specific analyses. This research also contributes to the understanding of the e-cigarette epidemic, and the findings of the study can ultimately benefit young e-cigarette users who receive psychological treatment.

In spite of the National Asthma Education and Prevention Program guidelines outlining how to diagnose, treat, and educate asthmatics, asthma morbidity and mortality rates are still mounting. Furthermore, the minority population has disproportionately higher rates of unfavorable outcomes from asthma, thereby diminishing their quality of life. The study's theoretical framework was based on the health belief model and explored associations of asthma control with self-efficacy and asthma education. Few studies focus on asthma inequity. The purpose of this quantitative study was to assess relationships between asthma control, race, asthma education, and healthcare utilization amongst asthmatic children residing in the Midwest. Secondary data from the Centers for Disease Control's Behavioral Risk Factor Surveillance System's Asthma Call-back Survey were used (n=477,221). Participant characteristics were examined using descriptive statistics. A sequence of bivariate and logistic regression analysis was used to test each hypothesis. The findings revealed significant associations amongst asthma control, race, asthma education, and healthcare utilization. In addition, children with uncontrolled asthma have greater visits to the emergency department and to their pediatrician's office due to their asthma symptoms. Moreover, the study results indicated that African American children experienced uncontrolled asthma at a higher rate when compared to other children, consequently decreasing their quality of life. The study showed the need for policy change to expand funding and programs aimed at decreasing uncontrolled asthma by improving asthma education, especially in African American communities, in hope of empowering asthmatics to play a vital role in their health and increasing their quality of life.

Despite decades of the implementation of the directly observed therapy short-course (DOTS), Sierra Leone is ranked among the 30 highest TB-burdened countries. Several factors account for unfavorable treatment outcomes, among which are patient characteristics. Previous studies have only focused on treatment compliance without any consideration for the factors that lead to noncompliance to treatment. The purpose of this study was to investigate patient characteristics that are associated with treatment noncompliance (treatment not completed) among TB patients undergoing the DOTS program in Sierra Leone. A retrospective longitudinal quantitative design was used to analyze secondary data from the completed records of 1,633 TB patients, using the Andersen's behavioral model of health services utilization as a theoretical framework work. Descriptive statistics and bivariate and multivariate logistic regressions were used to analyze the data. The results show that there was no significant association between treatment completion and age, gender, and TB-case category. On the other hand, being HIV-positive decreases the odds of treatment completion. Also, the educational level, geographic location, and year of treatment were significantly associated with treatment completion. Overall, program performance improved as the number of dropouts decreased significantly between 2013 and 2015. The social change implication of this study was that it identified HIV-positive patients and rural communities as areas needing specific attention such as the assignment of case managers to ensure compliance thereby improve DOTS program performance, thereby reducing the incidence and transmission of TB

More than 10 million people in the United States are known to have latent tuberculosis infection (LTBI), and more than 300,000 begin treatment for LTBI annually. However, many fail to adhere to therapy for numerous reasons. The purpose of this project was to evaluate the impact of a new guideline, Targeted Tuberculin Testing and the Treatment of Latent Tuberculosis, at inner-city tuberculosis (TB) control clinic in the United States. The practice-focused question for the project asked if the implementation of the clinical guideline using a shorter regimen improved LTBI treatment adherence. The health beliefs model was the framework used to guide the project. I analyzed data from deidentified LTBI treatment adherence records of 12 patients before the change to the shorter treatment regimens and 12 patient records 1 year after the change. Results after implementation of the new treatment guideline showed no improvement in adherence. Before the guideline implementation, 75% (n=9) of individuals had adhered to traditional therapy whereas, after the shortened course was implemented, only 66.7% (n=8) of the random sample adhered to treatment. It is important to evaluate new methods of treatment and determine success early to promote health and reduce complications of ineffective treatment of TB. These results can support positive social change by raising awareness of the need to evaluate new treatment effectiveness early. Such knowledge can help providers and clinicians examine the barriers to adherence to the medications used for treating TB and implement appropriate measures to overcome the obstacles.

Adult physical activity is important for prevention of chronic diseases and to minimize health issues; therefore, the motivational influences of sociodemographic variables on participation in organized physical activity events warrant an investigation. The purpose of this quantitative study was to investigate differences in motivational influences between various sociodemographic variables as related to physical activity events in organized settings. The theoretical framework that guided this research study consisted of the theory of reasoned action (TRA), and the health belief model (HBM). The TRA was applied to study the intention of health behavior, while the HBM was used to investigate individuals' motivation to engage in organized physical activity events. A cross-sectional study design in which an online survey consisting of the 40 item Physical Activity and Leisure Motivation Scale was used to collect data from adults who participated in an organized 5K or 10K running or walking event. The inferential statistical tests of the independent t test, one-way ANOVA, and ordinal logistic regression were used to determine the statistical relationships. The main research finding suggested that 6 motivational influences showed statistically significant relationship with organized physical activity events, which consisted of others' expectations (p = .025), competition/ego (p = .001), appearance (p = .001), affiliation (p = .034), mastery (p = .001), and psychological condition (p = .002) as it relates to their age group and gender. The research findings may be used to influence engagement in future organized physical activity events by understanding the sociodemographic variables relating to participation rates that may result in increased physical activity behavior within the community.

There is a growing body of evidence on the positive association between diabetes and tuberculosis (TB), especially in populations with low socioeconomic status. According to the CDC and the WHO, diabetes is increasingly seen as a global epidemic, one that poses a threat to global TB control. The goal of this DNP project was to develop a program to educate clinical staff on the importance of early identification of diabetic and TB patients. The logic model was chosen as the framework for this project because it allows the planner to rationally observe each stage of a project's development. The program design consisted of several steps: (a) assembling the planners and stakeholders, (b) conducting relevant literature review, (c) gathering educational materials, (d) creating education modules, (e) developing an evaluation method, (f) presenting the results to the organization, and (g) standardizing the modules to be implemented in each of the organization's clinics. Ten participants including nurses, physicians, educators, and administrators reviewed the program in a formative (n = 5) and summative (n = 5) round to evaluate the ease of use and content. During the summative review, participants demonstrated 92.3% agreement using the AGREE II instrument. This tool supported the stakeholders' understanding and support for the developed modules. Overall, the program serves as an important tool to educate clinical staff to better manage and decrease the spread of tuberculosis among diabetic patients, and also as a comprehensive guide for developing similar projects in community clinical settings. The resulting educational program, which could be implemented by health care providers and clinical administrators, could serve as a catalyst for improved community health outcomes.

A public health workforce must be trained to react quickly, especially in the case of terrorist attack. Political leaders and emergency management experts have often cited inadequate emergency training as a contributing factor in the public health system's failed preparations for a bioterrorist event. As a result of these failures, billions of dollars have been allocated towards correcting infrastructure deficiencies including training for public health nurses (PHNs), who are critical to a communitywide medical response. This quantitative study used Pearson's correlation and a multivariate regression analysis to evaluate the most effective modality of bioterrorism training (BTT) for PHNs working in rural communities in North Carolina. Using a conceptual framework created by Handler, Issel, and Turnock, this study compared 3 modalities of instruction (MOI) to seek the best predictor of success in retaining learned bioterrorism skills. The research question focused on whether MOI for BTT/all-hazards training courses significantly predicted the degree of retention of emergency knowledge/skills for PHNs working in public health agencies in North Carolina. A multiple choice survey was used to test 103 PHNs' level of knowledge retention on a bioterrorism quiz. The results of this study were ultimately inconclusive in that no MOI was found to be a statistically significant predictor of retention. Factors such as age were found to be successful predictors of knowledge retention. The readiness issues identified in this study have a potential for positive social change if community decision makers use this information to prioritize future funding for public health professionals or enhance communitywide emergency preparedness education programs.

In the United States, over two-thirds of adults are overweight or obese, and the number of children and adolescents who are overweight is increasing. Obesity is a significant issue as obesity-related chronic diseases can result in diminished quality or life, high morbidity and mortality, and substantial healthcare costs. The purpose of this study was to examine neighborhood social capital and how it relates to adolescent obesity. The socio-ecological model was used as the theoretical framework of this study to examine how the environment and social contexts influence health behaviors. Utilizing a quantitative cross-sectional research design, bivariate and multivariate analyses were conducted on 43864 10 to 17 year-olds using secondary data from the 2011-2012 National Survey of Children's Health. Controlling for age, gender, race, and overall health status, logistic regression analysis indicated that supportive environments predict the odds of adolescent overweight and obesity, while safer communities did not significantly predict the odds of adolescent overweight or obesity. The results of this study showed that there was a significant association between living in a supportive neighborhood and a decreased likelihood of an adolescent being overweight or obese (OR = 0.797). Associations were also found in demographic variables such as race, gender, and age. Positive social change implications from this study may include use of the findings by public health practitioners to better understand the factors that influence adolescent obesity in general, and the role of the social neighborhood environment in particular. In turn, public health workers can use this improved understanding to improve the quality of interventions, programs, and policies, resulting in positive social change among adolescents.

African American women living in rural Ohio have a history of low mammogram screening rates and a high incidence of breast cancer identification in the late stage of the disease, leading to mortality rates exceeding those of Caucasian women. The purpose of this doctoral project was to establish a breast health educational program for health providers in a local mammography center that did not provide such a program specifically targeted for African American women. Three theoretical frameworks, the health belief model, Knowles's learning theory, and the PEN-3 model, guided the development of a staff education program based on cultural appropriateness. The practice-focused question was whether or not the educational program would enable health care providers and staff to use an evidence-based approach to promote the message of breast cancer prevention in a population at high risk for breast cancer. A radiology specialist, nurse navigator and radiology supervisor reviewed the educational plan and the Komen Toolkit materials and graded the program as strongly supporting a cultural competency program. The education and experience of the three panel experts in mammography enabled them to serve as evaluators for this research project. The strategy to use faith-based leaders' as representatives of the African American patient population collaborating with providers supported cultural competency in health care. Mammography centers and faith-based organizations benefit from this project because of its focus on culture at the center of its development. Cultural competency supports positive social change in health care for an at-risk population.