This meta-analysis investigated the association of gender and socioeconomic position with cardiorespiratory fitness in adolescents. Public health professionals know the importance of physical activity level as a modifiable behavior; however, the literature has revealed that more research is needed on the association of sociodemographic variables like gender and socioeconomic position with cardiorespiratory fitness in adolescents. Using the physical fitness and health outcomes conceptual model as a guide, the overall effect sizes across studies were assessed as well as the moderators of study design, sample size, age, and country. A systematic review of literature identified a total of 18 peer-reviewed studies meeting inclusion criteria, which yielded a total of 41 unique effect sizes. Meta-analysis utilizing a random effects model indicated that gender and socioeconomic position are associated with cardiorespiratory fitness and that age and country moderated these effects. The positive social change implication of this meta-analysis may provide evidence-based knowledge to public health officials, physical educators, and health educators who are considering changes in school health promotion policies and health promotion interventions geared toward different gender and socioeconomic groups. Long term results include increased physical activity, decreased clustered cardiovascular risk factors, and lowered all-cause and cardiovascular disease mortality as adolescents track into adulthood.

A lack of available data exists regarding environmental factors related to prescription drug abuse (PDA), which could explain the ineffectiveness of efforts to reduce PDA in Florida. Prescription drug abuse among adults older than age 18 varies with the level of education achieved, and these metrics potentially reflect socioeconomic differences. The purpose of this quantitative study was to examine the connections between contextual aspects of prescription opioid abuse among Florida's middle and high school students to understand youth PDA in relation to their environments. This study consisted of a secondary analysis of existing PDA data (dependent variable) in relation to a number of independent variables, including the incidence of female-headed households, the nature of residential environment, adherence to religious precepts, and students' ability to achieve educational goals. Incidence of female-headed households, the nature of residential environment, and adherence to religious precepts were not found to predict youth PDA. The only finding of significance was that PDA predicted lowered students' ability to achieve educational goals (p = .015). Data collected from this study might be used by school counselors and administrators when developing drug abuse prevention, intervention, and educational programs, thereby leading to positive social change in helping to reduce PDA among youth.

The rate of obesity is increasing in the United States. In Florida, almost 60% of the population will be obese by 2030. This increase is expected to contribute to millions of cases of preventable chronic diseases costing the state an estimated $34 billion dollars. Employer-sponsored health programs can positively influence employees' lifestyle choices and support weight loss programs to reduce health-related costs to the employee and the employer. Guided by the transtheoretical model, the purpose of the project was to conduct an employee assessment to determine the need for, interest in, and readiness for a lifestyle intervention weight loss program. One-hundred sixteen employees from a participant pool of 1,500 employees of a community hospital completed an online survey by providing information on age, weight, gender, body mass index, and exercise patterns. They also answered the 36-item University of Rhode Island Change Assessment Scale to determine readiness for participating in the workplace-based Group Lifestyle Balance program. Data were summarized using descriptive statistics; 52% of respondents were between 26 and 55 years of age and 44% of respondents were obese. Scores on the Change Assessment Scale revealed that 46.4% (n = 54) of the respondents were thinking about making a lifestyle change within the next 6 months. The findings indicated that many hospital employees were in the contemplation stage of readiness for change and they were receptive to additional information about the weight loss program. The needs assessment was the first step toward establishing community-level social change, starting with hospital employees, to decrease obesity and improve population health.

Cardiovascular disease (CVD) is a major contributor to chronic diseases. High blood pressure and other modifiable cardiovascular risk factors are on the increase in Nigeria. The purposes of this study were to (a) explore associations among high blood pressure, social economic status, and health status awareness and (b) measure the incidence and prevalence of cardiovascular diseases in 3 states of Nigeria: Lagos, Ekiti, and Ondo. Participants (N = 368) were selected through stratification and randomization. Data were collected in person with the aid of validated questionnaire, which measured socioeconomic status as well as other variables in Lagos, Ado Ekiti, Ijesa-Isu, and Akure. Logistic regression and correlation analyses showed no significant difference in the regional incidence and prevalence of cardiovascular disease (F (4, 362) = 1.23, p = 0.30); and there was no significant relationship between the health status variable and the standard of living variable. Due to the fact that only 3 out of 36 states were sampled, this study is not generalizable and some other cardiovascular diseases modifiable risks factors that were not measured could have reacted differently in analysis. This study's results set precedence by promoting cardiovascular health. When disseminated, the results of this study will help advocate for a change process that curtails cost and decreases the general burden of CVDs in other, similar areas. Recommendations include measuring this incidence and prevalence of CVDs in all 36 states of Nigeria and exploring the interactions between culture, religion, health, and beliefs.

Social support represents a network that provides for family, relatives, and friends and is an important predictor of future health and well-being. A knowledge gap exists in the literature regarding a need for social support for Black mothers of preterm babies. This qualitative study explored the perception of social support for Black mothers of preterm babies in Southwest Ohio. The phenomenological method of inquiry was used to gain an in-depth understanding of social support Black mothers receive after preterm birth. The social ecological theory provided a framework for understanding how individual, interpersonal, community, organizations, and policy affect a Black mother's perception of social support after preterm birth. NVivo was used to organize each data category for thematic analysis. The themes included (a) father of the baby, (b) help in times of need, (c) financial assistance, (d) government assistance, (e) lack of support, (f) mom and baby, (g) transition challenges, (h) depression, (i) acknowledging hospital support, (j) uncomfortable support, (k) unrelated support, and (l) increase in assistance. The findings indicate the lack of understanding of preterm birth and its long-term implications for a child, the need for additional interventions prior to discharge, and additional culturally appropriate training of healthcare staff. The study contributed to social change by increasing the understanding of researchers and health care professional regarding social support and improving transitions after preterm birth from hospital to home for Black mothers.

In the United States, African-American residents are an underserved population with evidence of higher health disparities than those associated with any other race, contributing to escalating health care costs. Despite the absence of health promotion and wellness training, pastors in predominately Black churches accept the responsibility for addressing more than the spiritual needs of their church members. The purpose of this qualitative grounded theory research study was to explore the perspectives of African-American Christian pastors on giving health guidance and their lived experiences as health promotion advocates. A total of 10 African-American Christian pastors were voluntarily recruited from 3 southern U.S. states using both purposeful and theoretical sampling strategies. Interviewing was the main data collection method. Social cognitive theory along with grounded theory were used to examine the interactions based on participants' points of view, and inductive analysis was also used. The results indicated that pastors have knowledge of their congregational members' health challenges and goals and have achieved positive health outcomes. The pastors also agreed that seminary should incorporate more information on health and wellness into the curriculum. These findings suggest that pastors, who are faith-based resources outside of health care systems, need to be educated, equipped, guided, and groomed as health leaders to assist efforts to reduce or eliminate health care disparities. Members of the clergy, their church members, and surrounding community residents would all benefit from the knowledge, understanding, and development of skills to change their unhealthy lifestyle habits and effective self- management of chronic diseases to achieve positive health outcomes.

Type 2 diabetes mellitus affects patients' health across the globe and is costly to manage. The chronic high blood sugar of diabetes is linked to cardiovascular and kidney damage, impaired functional status, and multiple organ failure. To lessen the complications associated with diabetes and promote self-care in those with the disease, health care professionals must be vigilant in offering diabetes education to patients with each clinic or primary care visit. Lack of diabetic educators in the clinic that provided the setting for this study indicated a need to increase clinical staff competency in teaching self-care and diabetes management to patients. The resulting project, guided by Bandura's theory of social learning, involved the creation of an educational curriculum, which was evaluated by 5 content experts with 5 or more years of experience caring for adult patients with Type 2 diabetes mellitus who provided narrative feedback. The content experts indicated satisfaction with the program and offered the following recommendations: (a) implementation of staff coaching on motivational interviewing, (b) additional help in securing medications and blood glucose testing supplies for noninsured patients, (c) translation of patient tools into Spanish at a Grade 3 or 4 reading level for better patient understanding, and (d) proceeding with full implementation after the recommendations are carried out. Improved self-care among diabetes patients could promote positive social change through the prevention of acute, long-term complications and disability.

There are more than 3.4 million South Asians in the United States. Among this subgroup, Bangladeshis in New York have a high prevalence of Type 2 diabetes ranging from 15 to 24% compared to the general population. This study examined the effect of acculturation through length of stay in the United States and understanding of the English language, and the role of gender on self-efficacy (SE) and diabetes self-management among 336 New York Bangladeshi immigrants between the ages of 21 and 75 who had been diagnosed with type 2 diabetes with A1C -‰¥ 6.5%, as verified by their medical record for inclusion criteria in the original DREAM study. Health belief model was used as a theoretical framework. The key findings showed a significant relationship between gender and SE levels (p ¤ .0001). Bangladeshi women were 79% less likely to have high SE levels compared to their male counterparts (OR= .212; 95%CI: .099 -.453). Additionally, those who had low education attainment were 68% less likely to develop high SE levels (OR = .323, 95%; CI: .105 -.998). The findings demonstrate the need to understand the influence of social and contextual factors on SE and underscore the importance of integrating a systems approach and ontological lens in the implementation of gender-specific innovative strategies. Such an understanding might help destigmatize diabetes, improve medication adherence, and enhance SE and coping skills for Bangladeshi women across the life span. The findings of this study might provide knowledge to public health practitioners that would help create gender-specific diabetes education and lifestyle management for equity-centered capacity building to alleviate the disproportionate burden of diabetes in Bangladeshi minority women in the United States, ultimately improving health outcomes and reducing healthcare expenditures.

Osteoarthritis (OA) is a debilitating chronic illness that can prevent older adults from accomplishing their activities of daily living or ambulate without pain. The project's purpose was to develop and disseminate multidisciplinary educational practice guidelines to nurses for use in older homebound male Veteran's Administration OA patients to improve home-based pain management and self-care preventative strategies. Orem's theory of self-care management constituted the theoretical framework. The design was a quality improvement project and involved formation of 6 panels of interdisciplinary teams who reviewed the American Society of Anesthesiologist (ASA) and Osteoarthritis Research Society International (OARSI) guidelines. The ASA and OARSI guideline components were evaluated via a scoring sheet for pain control and self-management effectiveness for the OA patient. The panels assessed these treatment plans in terms of suitability, tolerance, and patient adherence for inclusion into the educational program. The panel members independently reviewed both sets of guidelines and then convened as a group to share their scores and reach a consensus on these guidelines, in the patient population served. Agreement of 85% among the panel members was needed for inclusion into the practice guideline. Based on the scoring results the panel concluded that the ASA and OARSI guidelines would likely improve pain control, functional ability, and psychological well-being essential to lifestyle modifications and OA symptoms management education program. The social impact of developing nursing practice guidelines for the self-management of OA pain in home-based settings will be manifested in better patient lifestyle and behavior modification leading to better symptom management.

Heart failure is ranked as one of the leading causes of hospitalizations and mortality among adults of all racial/ethnic groups in the United States. Telemonitoring, as a homecare intervention for heart failure management, has been used across all groups although the benefit for Hispanics not established. The purpose of this retrospective, quantitative study was to determine the differences in hospital readmission between Hispanic, non-Hispanic Black, and non-Hispanic White patients with heart failure disease who either received or did not receive home telemonitoring services from a homecare agency in Connecticut. The research questions for this study examined the effect of home telemonitoring, race, age, gender, and insurance on heart failure hospitalization across the 3 groups. The chronic care model was used as the theoretical framework for this study because it offers a method for reforming healthcare to ensure optimization in chronic disease management. A purposive sample of 138 records of patients admitted between January 1, 2012 and June 30, 2017 with a diagnosis of heart failure provided the data for the study. Data were analyzed by conducting a simple and multiple logistic regression analysis. The key findings of the simple logistic analysis showed that only Hispanics who used telemonitoring were almost 4 times less likely to be readmitted to the hospital compared to Hispanics who did not use telemonitoring (p = 0.04). The multiple logistic analysis revealed race, age, gender, and insurance were not significant predictors of readmissions (p > 0.05). The findings from this study may promote positive social change by providing healthcare providers with a better understanding of the effects of home telemonitoring for treating adult Hispanic patients with heart failure disease.