Regardless of the advances that have been made in stroke research and treatment and the overall decrease in stroke mortality, the stroke mortality rate for African Americans is still high at 45.2/100,000 and is still the leading cause of adult disability. Knowledge of the risk factors of stroke is paramount to reducing the morbidity and mortality of stroke, but knowledge of stroke risk factors has been found to be suboptimal in the African American population. The purpose of this study was to examine if there is a relationship between the knowledge, perception, and sources of stroke information of risk factors for stroke. The theoretical framework for this study was knowledge, attitude, and practice model and the health belief model. A cross-sectional quantitative approach was used for this study, and data was obtained through in-person administration of a questionnaire to willing participants in two South District Cook County, Illinois, health centers, two churches, a barber shop, and a beauty shop. A total of 273 respondents that consisted of 42% men (n = 113) and 58% women (n = 160) provided valid responses. Chi-Square test of association showed a statistical significance between source of stroke information and previous stroke/transient ischemic attack at Ï?2 (1) = 29.133, p = 0.001. Multiple regression analysis model showed a statistically significant result of perception and stroke, F (14, 259) = 22.692, p < 0.0005. This study found that stroke education should go beyond traditional medical risk factors to also explore people's perception of preventive practices. This study will contribute to social change by providing support for targeted stroke education not only on knowledge but also perception of preventive practices in the African American population.

One out of every 8 couples experiences infertility. Few publications exist examining the association between the addition of adjunctive therapies when applied to the in vitro fertilization (IVF) procedure and pregnancy outcome. The purpose of this study was to compare the effectiveness of 2 types of adjunct acupuncture exposures on IVF outcomes by applying the concept of the epidemiology triad. The association between the type of adjunct acupuncture exposure received (the independent variable) and pregnancy (the outcome) was determined via binary logistic regression using SPSS software. Medical records of women having received the IVF procedure along with adjunct acupuncture were eligible for analysis. A total of 444 qualifying patient records were collected from participating acupuncture clinics. Analysis of the data showed there was no significant difference in pregnancy outcomes between the two types of adjunct acupuncture reviewed. However, an increase in pregnancy outcomes was noted in the adjunct acupuncture groups when compared with pregnancy outcomes in IVF protocols without the addition of adjunct acupuncture. Additionally, there was no significant difference between pregnancy outcomes when accounting for various race or age groups. This study has implications for positive social change in the form of both providing data to women undergoing the IVF procedure to allow for more informed decision making and ultimately with hopes of improving the odds of success to the nearly 165,000 IVF procedures undergone in America each year.

Youth assault-injury is 1 of the 5 leading causes of adolescents' death in the United States. Despite public health efforts, the prevalence rates of youth assault-injury and almost all its risk factors have remained consistent in the past 10 years. The purpose in conducting this cross-sectional quantitative study using archival data of the Add Health Wave II in-home survey was to examine the underlying-multidimensional structure of youth assault-injury. Problem behavior theory (PBT) lens and a multidimensional model were used and a structural equation model was conducted to examine the relationships between 22 risk and protection variables, 3 unobserved latent factors, and assault-injury, while controlling for demographics. Three questions were answered that addressed whether the multidimensional model: (a) explained the underlying structure of youth assault-injury among the indicator variables and latent factors; (b) explained the relationships between assault-injury and indicator variables and latent factors; and (c) revealed whether the interaction among latent factors influenced assault-injury likelihood. The study results were affirmative for the 3 questions and explained the relationships between youth assault-injury and various risk and protection behaviors that researchers failed to examine in the past decade. The results also illustrated disagreements with many of the PBT's assumptions. Further research is necessary to affirm or dispute the study's results. The findings highlighted key intervention areas for adolescents' assault-injury prevention and control. Should public health practitioners use these study results, positive social change will occur from saving youths lives and altering their efforts toward positive contribution in their surroundings.

Registered nurses (RNs) have a significant role in communicating health information to patients. The problem addressed in this study was RNs roles with health literacy and communicating health information using words that the patient understands. This study found that ambulatory RN perspectives on their roles in health literacy and patient communication may improve health outcomes and optimal wellness. The purpose of this qualitative study was to examine and describe ambulatory RN perspectives on their roles in health literacy and patient communication, as these are necessary components linked to better health outcomes. The conceptual framework for this study was the nurse role effectiveness model. Fifteen RNs participated in face-to-face, structured, interviews using open-ended questions to contribute perspectives on health literacy roles and nurse-patient communication. Data analysis consisted of Miles and Huberman's methodology to code, extract, sort, review, generalize, and examine for themes. Emergent themes and key findings of this study may improve the gap in knowledge regarding ambulatory RN perspectives on health literacy roles and patient communication, as well as more awareness of the term health literacy, increased formal training on the concepts of health literacy, and techniques to formally assess patients' understanding of health information. An opportunity exists to bridge the gap between RN knowledge of health literacy roles and patient communication. Positive social change implications for health services include promoting RN health literacy roles and strategies for effective communication to promote patient behavior changes for optimal wellness.

United States high school student obesity rates have doubled in the past 30 years to 13%, threatening the health of millions of adolescents. To mitigate the epidemic, Congress passed the Healthy, Hunger-Free Kids Act (HHFKA) in 2010, which mandated significant changes to school nutrition and physical education. From a public policy perspective, the HHFKA changed school nutrition and exercise policy to affect obesity rates by changing intake and energy expenditure at school, though no study using national-level data examined this relationship. As such, the purpose of the study was to examine whether HHFKA policy compliance had a statistically significant effect on high school obesity rates. The theoretical framework for this study was the energy imbalance theory (EIT), as developed by James Hill, Holly Wyatt, and John Peters. The research questions focused on the relationship of HHFKA nutrition changes and childhood obesity rates. The study used Pearson's Product-moment correlation to test for a simple correlation between Compliance Scores and High School obesity rates. Findings revealed no statistically significant correlation between state high school student obesity rates and HHFKA compliance scores. Future research is needed to validate the findings after more time has passed with the HHFKA mandates in effect. The implications for social change include informing the debate over the efficacy of implementing the HHFKA as currently written to mitigate childhood obesity.

Highly active antiretroviral therapy (HAART) contributes to metabolic disorders and the growing prevalence of metabolic syndrome (MetS) in human immunodeficiency virus (HIV)-infected patients. Hypertension, obesity, and hyperglycemia (components of MetS) are risk factors for cardiovascular disease. Studies have shown that HIV patients on HAART have a 2-fold risk of dying from MetS. There are no such studies in Umuahia; hence the need for this study to fill this gap. Using a sample size of 192 medical records of HIV-infected patients in Federal Medical Centre, Umuahia, and applying metabolic syndrome theory, this study examined the relationships among types of HAART regimen, duration of HAART and hypertension, obesity, and hyperglycemia among HIV-infected adult patients. The records were stratified into 4 by duration of HAART. Chi-square test was used to determine associations between the nonparametric variables, whereas multiple logistic regressions were used to estimate the odds ratios. Odds of hypertension were more than 18-fold (OR = 18.52, 95% confidence interval [CI] = 5.464, 42.50) at >12 months on HAART, whereas odds of obesity was more than 5-fold (OR = 5.43, 95% CI = 2.227, 13.158) at >12 months. Odds of hyperglycemia were more than 14-fold at >12 months compared with <12 months on HAART. Statistical significance was achieved with duration of HAART for hypertension and hyperglycemia (p < .05) but none with types of HAART (p < .05). Being male, older age, and duration of HAART were associated with odds of metabolic syndrome components. This knowledge provides a base for population-based intervention programs for the HIV-positive population undergoing antiretroviral therapy in the Umuahia metropolis.

The use of pharmaceutical products has steadily increased in the United States from 2 billion prescriptions in 1999 to 3.9 billion in 2009. Half of patients do not comply with the recommended prescription regimen and dispose of unused drugs in the environment. The U.S. Environmental Protection Agency and many researchers have highlighted the human-health risks associated with improperly disposing of pharmaceutical products. This quantitative cross-sectional study examined the potential correlations between people's actual disposal practices and their knowledge of the impact of disposal practices on the environment and human health, and availability of disposal options. The conceptual framework selected for this study comprised 2 models: the health belief model and the theory of planned behavior. Respondents to an online survey were 485 residents of the northeast United States, polled from the general population. Descriptive statistics and logistic regression were used to model responses from the dependent variable actual disposal practice (ADP) across the independent variables, and analysis of variance explored whether ADP differed across demographic variables. Statistically significant associations emerged among individuals' knowledge of environment and human-health impact, recommended disposal practices, disposal options, and that person's likelihood to practice recommended disposal. Demographic variables did not impact disposal behavior. To promote positive social change, it is recommended that policymakers plan and implement the expansion of convenient drug disposal options, as well as information campaigns on proper disposal practices. In parallel, health care professionals should stress to their patients the importance of complying with prescribed regimens, thus minimizing the amount of unused or expired medications.

In the United States, about 8.5 million women live with osteoporosis. Osteoporosis is a debilitating systemic skeletal disorder characterized by low bone mass and reduced bone mineral density that occurs with the loss of estrogen. The mortality rate for this group is about 3 to 4 times higher than other women and as many as 1 in 3 experience a fracture. Guided by the Health Belief Model, this project evaluated how a bone health fact sheet impacts knowledge about osteoporosis and self-efficacy for preventative behavioral change in premenopausal women (age 40-58 years). The project also evaluated if an electronic medical record (EMR) alert system with an additional bone health education in the patient instruction menu can improve participation by 11 health care providers (HCPs). Prior to the participants receiving the fact sheet, the knowledge, health beliefs, and perceived risks for developing osteoporosis were measured using the Revised Osteoporosis Knowledge Test (ROKT) and the Osteoporosis Health Belief Scale (OHBS). Although 87% of participants identified menopause as a major osteoporosis risk factor, fewer women (33%) knew that surgical removal of the ovaries was also a risk factor and half agreed or strongly agreed that calcium and exercise can prevent osteoporosis. After receiving the fact sheet, the participants had an average confidence score of 62% on the Osteoporosis Self-Efficacy Scale (OSES) for engaging in exercise and an average confidence score of 65% for adhering to calcium intake guidelines. Furthermore, the EMR alert system facilitated 100% documentation by HCPs. These results indicated the fact sheet can motivate premenopausal women to engage in osteoporosis preventive behaviors. Importantly, the EMR reminder with education fact sheet can facilitate the active involvement of HCPs in patient education.

HIV-positive children in sub-Saharan Africa have numerous challenges to overcome. These challenges increase psychosocial stress as well as symptom burden including fatigue, weight loss, pain, and mental changes. The symptoms may persist even after initiation of antiretroviral therapy, so such children need additional care. Palliative care lays emphasis on holistic patient-centered care, including physical, psychological, social, and spiritual symptoms, alongside antiretroviral therapy. There is limited data on the impact of integrating palliative care with standard HIV care and treatment in children. The purpose of this study was to fill the gap in the literature by investigating the impact of palliative care on health status in HIV-positive children on antiretroviral therapy. The theoretical framework was based on the humanistic nursing theory. Using the Mann Whitney U and logistic regression tests, the health-related quality of life of 97 children who received palliative care in addition to standard HIV care was compared to 180 HIV-positive children who received standard HIV care only through chart reviews. According to study results, children receiving palliative care alongside antiretroviral therapy have better physical and psychosocial health compared to children receiving only antiretroviral therapy. Increasing age was a contributing factor to better psychosocial and physical health in patients receiving palliative care. Emotional, social, and school functioning are important factors that determine treatment outcomes in children on antiretroviral therapy, and addressing those factors through palliative care will create a positive social change by improving treatment outcomes, quality of life, and longevity.

According to the CDC, young people, aged 15-24 years, share the greatest risk of new sexually transmitted diseases (STD) and the negative impact of alcohol and drug use. The purpose of this quantitative study, based on the theory of social-psychological problem-behavior, was to analyze the 2013 YRBSS secondary data and document if a relationship existed between race/ethnicity and youth sexual behavior, alcohol consumption, and drug use for the 13,583 survey participants. A Kolmogorov-Smirnov test and Chi-Square were conducted to answer the research questions. Results indicated that American Indian/Alaskan Natives were most likely to report first sexual activity before 11 years old (7.5%), while Asians were most likely to report never having sex (76.6%). Race/ethnicity also impacted all other variables, such as drugs, with a mixture of results. Hispanic/Latinos were most likely to report higher alcohol consumption (15.12%) compared to Multiple Hispanic (5.12%), while, Multiple Non-Hispanic were more likely to report use of drugs before sexual activity (9.7%) compared to Hispanic Latinos (7.99%). Social change implication of the study called for developed and effective sustainable interventions to help youth with behavior, and it required full integration of race/ethnicity as prerequisites in alleviation strategy. Dissemination plans involved use of public health campaigns, school workshops, and churches to fight the negative impact on youth.