Over the past 13 years, the United States Army has been engaged in armed conflict within Afghanistan. Unfortunately, the United States Army has been forced to evacuate soldiers from the battlefield because of malaria, a parasitic disease that is endemic in Afghanistan. Even though the U.S. Army has adopted an effective chemoprophylaxis protocol, soldiers' adherence to their prescribed medication has been historically low. This research addressed a gap in literature regarding the adherence rates of U.S. Army enlisted soldiers to their prescribed oral malaria chemoprophylaxis. In addition, this research investigated self-reported reasons for soldiers' nonadherence to this medication. The study employed an experimental, correlational research design to aid in understanding the relationship between adherence to malaria chemoprophylaxis and age, gender, military rank, education level, and previous deployment experience. Ninety-four active-duty U.S. Army personnel deployed to Afghanistan participated in the study. The frequency distribution of responses to the 8-questions Morisky Medication Adherence Scale were presented and indicated that for almost all of the questions, the percentage of participants who answered yes was larger than the percentage who answered no, indicating low levels of adherence among the study participants. The findings indicated that age, gender, and perception of risk all significantly contributed to the models predicting medication adherence. With the scientific and medical advances of the 20th and 21st centuries, few if any military personnel should contract malaria. These findings contribute to a greater awareness of medication adherence, which directly supports positive social change within the Armed Forces of the United States.

The prevalence of diabetes and other pathophysiological conditions has been correlated with the incidence of obesity. A large portion of an adult community in the northwestern United States suffers from excessive weight that has been linked to premature mortality rates and certain forms of diabetes. Excess calories from carbohydrate have been shown to increase weight. Therefore, diets that are modified in carbohydrate and calories may help mitigate weight and obesity comorbidities. This qualitative, single case study's purpose was to explore the methods health care professionals use for teaching adults about controlling weight. Altheide and Johnson's analytic realism theory, in which they describe how the experiences of educators and learners affect the way information is perceived, formed the conceptual framework for this study. An illustrative case study paradigm was used to identify the perceptions of licensed health care practitioners regarding the current adult teaching methods for modifying dietary carbohydrate and excess weight. Using a purposeful sample, data were collected in 2 phases with 5 licensed health care practitioners: Phase 1 entailed an open-ended electronic questionnaire and semistructured telephone interviews with open-ended questions during phase 2. Data were analyzed through coding and aggregation by NVivo and Tosmana software, respectively. The findings indicated that the American Diabetes Association (ADA) plate method was the most effective teaching model for controlling weight and carbohydrate intake. Consequently, the ADA plate method was used to create a professional development program to teach health care educators about nutrition instruction methods for adults. The study contributes to positive social change by enhancing preventive health measures for the local adult population through diet therapy education.

The roles of immigration status in preventive health care services among Nigerian immigrants in the United States were investigated in this quantitative, cross-sectional survey study. About 260,724 Nigerian immigrants reside in the Unites States, but many do not complete lifesaving preventive health services such as immunization and screening, a major factor contributing to the rise in the cost of healthcare resultant from their use of emergency room services. This study investigated the extent to which immigration status independently explains the relationship between health disparities and risks in non-completion of preventive health care among Nigerian immigrants in the United States by comparing data from Nigerian immigrant adults residing in the United States to data from the African American adults in the United States. Socio-cognitive theory and the social behavioral model served as the conceptual framework for this study. There were 291 adult Nigerian immigrants in the cross-sectional survey using a purposive sampling technique. The data were analyzed using the Levene's test for homogeneity of variances, the Pearson's Chi- Square test and the Kruskal-Wallis non-parametric test. The Kruskal-Wallis results showed that there was a significant difference in screening for preventive care services among the 4 immigrant status categories (p = .000) based on length of residency in the United States. Understanding the health disparities of this population according to their country of origin and immigration status will assist health providers with awareness of population-specific health needs, and may be beneficial in designing public health programs for this population group.

The purpose of this quantitative study was to examine possible risk factors that predict asthma among adult, foreign-born African Americans in California. A total of 794 foreign-born African Americans (87 asthma cases) were included from the 2017-2018 California Health Interview Survey database. Data analysis included both descriptive and inferential statistical methods including chi-square analysis and multiple logistic regression techniques. The socioeclogical model was used to help understand and interpret the findings. The dependent variable was asthma status and the independent variables were the risk factors (tobacco smoking, alcohol use, health insurance, income level, and education level). Confounders included in the analysis were age, gender, and marital status. Findings yielded no statistically significant relationship between asthma status and tobacco smoking (p = 0.19, x2 = 1.74, OR = 0.59, 95% CI = 0.27-1.30), alcohol use (p = 0.92, x2 = 0.01, OR = 0.98, 95% CI = 0.61-1.58), health insurance (p = 0.63, x2 = 0.23, OR = 0.85, 95% CI = 0.44-1.65), income level (p = 0.99, x2 = 0.00, OR = 0.99, 95% CI = 0.44-2.24), or education level (p = 0.47, x2 = 0.52, OR = 1.51, 95% CI = 0.49-4.59). Although this study did not find significant associations between asthma and study variables, study limitations, mainly the small sample size, may have prevented the detection of small associations. Future research should involve a larger sample size to investigate whether the findings reported remain true. This study is a step in the exploration of the problem and has the potential to promote positive social change by increasing asthma awareness among foreign-born African Americans in California and among public health policy makers.

As a validation study, this study addressed an under-researched area of bronchopulmonary cancer mortality and incidence. The association between altitude and bronchopulmonary cancer mortality and incidence was investigated using data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. The theoretical framework for my study was Bronfenbrenner's ecological model. This model emphasizes the relevance of social and physical environments that influence patterns of disease and injury and shape responses to these patterns of disease and injury. The age-adjusted bronchopulmonary cancer mortality and incidence rates per 100,000 people in the highest elevation and lowest elevation states were investigated. The data used in this study spans from 2006 to 2014. In this study, bivariate statistics were used to analyze the data. The relevant technique of performing an unpaired t-test was used. After performing age, gender, and race-stratified analysis, no significant difference in cancer mortality and incidence was found within the following three groups: Black or African American, Asian or Pacific Islander, and American Indian or Alaska Native. This was a new finding, as previous studies did not stratify for race. Cancer mortality and incidence were found to be lower in both the male and female groups for the highest elevation states. Cancer mortality and incidence were also found to be lower in all age categories for the highest elevation states. A positive social change impact of this study is that this research provides the groundwork for future studies to probe what in the environment is lowering the bronchopulmonary cancer mortality and incidence for the White population.

Abstract The purpose of this qualitative study was to examine domestic violence victims' perceptions of advocacy and counseling programs that provide women with safe refuge, prevention education, mental health treatment, and other services. Many women in the United States are victims of intimate partner violence. Review of existing literature found that little is known about the extent to which the needs of these victims are met from available advocacy and counseling services. The health belief model was used to theorize victims' perceptions of services and risk factors for re-abuse. A phenomenological design was used to answer research questions, and in-depth interviews were conducted with 8 women who stayed at a domestic violence shelter and used shelter services, such as advocacy, emergency shelter, and individual and family counseling. Data from the transcripts were inductively analyzed using NVivo 10.0 and hand coding techniques for emergent themes. The findings revealed that women were pleased with the services received, and most had no awareness of advocacy or counseling services until they sought shelter. Also, most agreed that counseling and advocacy services could help prevent re-abuse. Recommendations include establishing a google page for domestic violence shelters, which can provide information on available advocacy and counseling services and how they can assist victims of domestic violence. Study findings can promote positive social change by increasing awareness of advocacy and counseling programs and their importance to prevent re-abuse. This may also provide useful information for implementing new programs to help victims of domestic violence.

Type 2 diabetes mellitus (T2DM) is a disease that affects the body's ability to metabolize glucose effectively. The disease is predicted to be prevalent in over 300 million people by the year 2030. African Americans (AA) have the highest prevalence rates in the United States. Lifestyle modification and awareness of risk factors, including family history, are important aspects for prevention of developing T2DM. The purpose of this study was to understand if a family history of T2DM played an influential role in individuals making positive health behavior changes for T2DM prevention. The phenomenological study was grounded in the health belief model. Participants selected for this study were at least 18 years of age, self-identified as AA, self-reported a family history of T2DM, and were not diagnosed with the disease themselves. Transcriptions of 20 face-to-face interviews were stored and organized via a qualitative research software NVivo Version 12 for Mac and later analyzed for data outcome. Participants demonstrated a strong awareness of T2DM with an accurate definition of T2DM and explanation of signs, symptoms, and prevention. Participants recognized family history as a risk factor in only 55% of the responses. However, family history played a major role in prevention in the lives of the participants. The participants reflected on personal barriers to health behavior changes and were encouraged to incorporate better life choices in their own lives. This research offers communities, healthcare providers, and stakeholders a better understanding of the importance of family history as a risk factor to T2DM as programs are developed to mitigate health disparities in the AA community.

This study examined the prevalence rate of obstructive sleep apnea (OSA) as an independent variable in association with hypertension as an outcome. Studies conducted outside of the United States suggest that differences in craniofacial features among middle-aged Asians increase the prevalence of OSA in comparison to Caucasians with similar age and lower BMI. No similar study had been conducted in the United States. The sufficient component cause theory guided this study and was able to describe the association between OSA and hypertension among middle-aged Asians. The objective of this cross sectional retrospective study was to determine the prevalence rate of OSA and the association between OSA and hypertension among a sample of 462 middle-aged Asian patients. Also, the study evaluated the association of 8 clinical parameters: age, gender, smoking, body mass index, Mallampati score, Epworth Sleepiness Scale and Apnea-Hypopnea-Index, and hypertension. The logistic regression analysis showed that OSA is associated with hypertension. The model containing the 8 variables was statistically significant, x2 (8, N = 462) = 139.59, p < .000). Age was the strongest predictor among the 8 variables. This study showed that OSA is common among middle-age Asians. This research may necessitate the need to evaluate to change current medical awareness, diagnosis, and treatment of OSA and hypertension among Asians, which could reduce the cardiovascular disease (CVD) morbidity and mortality.

Unsafe food handling practices are implicated in many restaurant-associated foodborne disease outbreaks. Factors that contribute to unsafe food handling in restaurants include inadequate food safety knowledge, employees who perceive that safe food handling is not under their control, and restaurant cultures that do not prioritize food safety. The purpose of this study was to determine whether temporary restaurant closures were associated with reduced food handling violations after closure in restaurants from the Vancouver Coastal Health Authority and the Fraser Health Authority, in British Columbia, Canada. The theoretical foundations used were the health action process approach and the theory of planned behavior. Mixed-effects Poisson regression analyses showed that the typical restaurant had an estimated 16% increase in the average number of overall food handling violations per inspection after temporary closure, compared with before closure. Restaurant- and employee-related factors responsible for unsafe food handling practices likely result in the continuation of unsafe food handling practices, despite temporary restaurant closures. This study may contribute to positive social change by challenging the assumption that temporary restaurant closures motivate food handlers to improve their food handling practices. To protect the public's health, additional interventions must follow temporary restaurant closures for reasons such as insanitary conditions and improper food handling. Suggested interventions include the provision of targeted learning resources to restaurant managers, the issuing of directives requiring food handlers to attend recognized food safety training courses, and environmental health managers requiring a reduction in problematic menu items.

Approximately 35.1% of live births for the state of Georgia were delivered by the cesarean delivery procedure with significant variation among hospitals. The purpose of this research was to develop a population-based hospital profiling methodology for study of the cesarean delivery procedure. This was a retrospective, observational design, using a 2012 linked dataset that included maternity deliveries from all nonfederal hospitals. The research was guided by Robson 10 Group Classification System, propensity score methodologies, and ethical precepts, for the development of hospital profiles and the study of variations in the cesarean delivery procedure. Key research questions aimed to determine whether hospital profiling methodologies differed according to risk adjustment methods and statistical techniques. Propensity score matching with stratification methods aimed to determine whether there were differences in patient treatment effects on the cesarean delivery outcome. Findings suggested there was a significant difference in hospital ranks and model effects according to the statistical technique and the risk adjustment methods applied. Propensity score matching with stratification demonstrated an increased risk of the cesarean delivery procedure across strata, with the majority of high risk patients situated in the 90th percentile ranges and questionable utilization practice among other strata. Applying profiling methodologies at the facility and population level could advance statewide quality improvement programs for the timely reduction in the variation of inappropriate utilization of the cesarean delivery procedure.