According to the CDC, each year approximately 0.06 % of the world's population dies in infancy. The March of Dimes indicated that the leading causes of infant mortality include birth defects, preterm birth, low birth weight, sudden infant death syndrome, maternal complications of pregnancy, and respiratory distress syndrome, most of which are considered preventable with access to adequate prenatal care by mothers. The goal of this study was to examine the association between maternal health literacy levels and preterm birth. This research was based on the theoretical framework of the Interaction Model of Client Health Behavior. The hypothesis for this study was that reproductive-age women with low levels of maternal health literacy would be more likely to experience a preterm birth. In this case control study, cases were defined as women delivering before 37 weeks gestation. The REALM health literacy assessment tool was used in a sample of 169 women meeting the criteria; 56 fit the case criteria and 113 fit the control criteria. The data were analyzed in SPSS using logistic regression, with preterm birth as the dependent variable, and health literacy levels as the independent variable. When comparing mothers who delivered preterm to mothers that delivered term, there was no significance difference (p = 0.112) with respect to maternal health literacy. There was no association between low maternal health literacy levels, as assessed by the REALM instrument, and preterm birth for English-speaking women between the ages of 18 and 35 within the metropolitan Atlanta area. This study reinforces the need to reengage health practitioners to achieve a modest understanding of the principals of health literacy and the health literacy levels of their patients to assist in maternal health improvements. A focus on the development and implementation of educational competencies for clinicians on maternal health literacy would attribute to a positive social change.

Black River Memorial Hospital identified obesity as a priority health concern in its rural service area; this concern was in line with the county's needs assessment. It was identified that women of childbearing age affect the lifestyle and health choices of their families and that they are at higher risk for the additional health risks associated with obesity affecting pregnancy and birth. Despite the identification of these risk factors, the factors that affect healthy weight management have not been well understood. Using the life course theory, a qualitative inquiry in the form of a structured interview was developed with local community experts and stakeholders. Sixteen women, aged 18-44, were recruited from the area Women Infant Children (WIC) program, the local food pantry, and area businesses. Audio-taped interviews were conducted. Data were analyzed using open and axial coding. The findings suggest that the health literacy among this sample of women was low with regards to healthy weight (BMI) and the risks posed by obesity. The most cited barriers to healthy nutrition were the cost of healthy food, food preferences, and the time to prepare healthy food. The most cited barriers to healthy activity were lack of motivation, lack of child care and lack of fun, affordable activities, and severe weather. The most common motivators for pursuing a healthy lifestyle were identified as the respondents' children, the encouragement of significant others and friends, and the participation of the family in healthy lifestyle choices. Based on the literature review, knowledge of community resources, and these findings, broad recommendations to enhance the culture of healthy weight management were provided to local community stakeholders to facilitate community planning for a healthier population.

Nosocomial infections are a cause of concern for hospital patients and the incidence rates of these infections are greater in intensive care units (ICUs) due to the invasive nature of treatments, additional risk factors and comorbidities, and therapies used. Invasive devices, such as vascular central lines, Foley catheters, and mechanical ventilators pose a risk for critically ill patients in the ICUs to develop device-related, healthcare-associated infections (HAI). The purpose of this study was to describe the epidemiological characteristics of patients who developed device-related HAIs within 3 ICU units (medical-surgical, cardiovascular, and neurosurgical) of an academic medical facility. The ecosocial theory of disease distribution provided the theoretical framework for the study to describe how ecological and social determinants interact and affect health variances. Secondary data were analyzed using analysis of variance (ANOVA), Pearson correlations, and chi-square statistical tests. A total of 4,213 patients admitted to the 3 ICUs from 2010-2014 were identified. According to the chi-square analysis, there was significant association between race/ethnicity and type of device-associated infection; between gender and types of infection; and between risk factors (diabetes, obesity, smoking habits) and kinds of infection, all of which the statistical significance had varied for each individual ICU. Bacterial differences were noted between device-associated infections. The potential positive social change from this study could be insight on possible new processes and interventions to reduce nosocomial infections and improve adult ICU patient outcomes such as decreased HAIs, decreased length of stay, comorbidities, and cost for both the patient and the hospital.

A decline in Human Immunodeficiency Virus (HIV) prevalence rates have been observed among females ages 15 to 19 years and 20 to 24 years in Zimbabwe between 2005 and 2010. However, for males 15 to 19 years, rising trends were observed, whereas for males ages 20 to 24 years, rates fluctuated between 2005 and 2011. The purpose of this cross-sectional study was to examine relationships between sexual behaviors and practices and HIV prevalence among young males and females ages 15 to 24 years in Zimbabwe. Guided by constructs of proximate determinants framework, extracted data from two National Demographic Health surveys of 2005/06 and 2010/11 were analyzed using chi square and binary logistic regression. This study revealed that sexual practices, relationship status, and education status increase the odds of being HIV positive differently among 15 to 19-year-olds and 20 to 24-year-olds based on gender and changes through time. Significant relationship existed between HIV positive serostatus and total number of life time partners among females 15 to 19 years and 20 to 24 years; lack of condom use among males 20 to 24 years in 2005/06; early sexual debut and lower education status among females 20 to 24 years; and being widowed, separated, or divorced among males and females 20 to 24 years in 2010/11. The Odds of being HIV positive for males ages 15 to 19 years was not predicted by sexual practice, creating a need for future study. This study can contribute to positive social change by providing information about the associations between HIV serostatus and the assessed risk factors, which may help promote awareness about HIV infection risk, thereby helping develop and implement targeted public health interventions to reduce the burden of HIV.

Hispanic Americans experience a disparate burden of human papillomavirus vaccination (HPV)-related cancers. Despite vaccine availability, HPV vaccine uptake amid Hispanic American adolescent males in the United States is under the national goal. Furthermore, childhood vaccination compliance is driven by the parents; yet, there is little research on parents' perceptions of HPV vaccination of male children. The purpose of this phenomenological study was to explore the attitudes, beliefs, concerns, and decision- making factors of Hispanic American parents of male children aged 11- to 13- years-old surrounding HPV vaccination. The health belief model provided the framework for the study. Face-to-face interviews were conducted with 12 participants in a rural county in Colorado in which Hispanic Americans had a higher rate of reportable sexually transmitted infections than non-Hispanics. Data analysis included descriptive coding to summarize and synthesize the interview results. The results showed Hispanic parents had a positive attitude toward HPV vaccination, and parents believed that the vaccination would protect their child. Most of the parents were aware of the HPV vaccine. The parents believed in healthcare providers and would accept the vaccine if it was recommended by them. Despite several parents having concerns about HPV vaccinations, they still claimed they would vaccinate their child. The findings from the study can be used to inform educational offerings regarding HPV vaccination for Hispanic American boys.

Cardiovascular disease (CVD) is the leading cause of death among United States women. Regular aerobic exercise can significantly reduce CVD risk. This dissertation reflects one of the first studies of the efficacy of Community Health Programs (CHP) in promoting exercise among American women aged 25 to 65. Primary data used from a study involved a sample of 42 women aged 25 to 65 who attended a CVD and exercise-related CHP, while a 42-member control group merely received the CHP information in a printed form. A pretest was administered at the outset of the study, and a posttest was administered at 3 months from the date of the CHP. Differences in gain scores between the groups were analyzed to determine the effects of the CHP on the following: exercise behaviors, self-efficacy, exercise-related self-efficacy, knowledge of CVD and recommended exercise guidelines, knowledge of community-based opportunities for exercise, tendency to involve other community members in exercise and/or discussion of exercise and CVD, blood pressure, blood glucose, body weight, and LDL Cholesterol. As expected, participants in the community health program reported, a stronger awareness of how exercise can affect cardiovascular health, better understanding of exercise guidelines, improved knowledge of exercise possibilities in the community, and improved self-efficacy scores. As hypothesized, participants in the health program were more likely to discuss exercise with friends and relatives, take part in exercise programs, and have reduced blood pressure, blood glucose, body weight and blood cholesterol measurements. This research demonstrates societal and individual benefits and creates a catalyst for positive social change.

Oral health impacts general health and well-being throughout the lifespan. Recent trends in the United States towards cessation of community water fluoridation (CWF) may increase disparities in oral health. The purpose of this quantitative retrospective cohort study was to analyze Medicaid dental claims records for caries related procedures among 0 to18-year-old patients during an optimal CWF year 2003 (n = 854) and compare them to claims records from 2012 (n = 1,053), 5 years after CWF was ceased. The theoretical framework of this study was the diffusion of innovations theory. Statistically significant results included higher mean number of caries related procedures among 0 to18 year and < 7-year aged patients in the suboptimal CWF group (2.57 vs. 2.43, p < 0.001; 2.68 vs. 2.01, p = 0.004, respectively). Mean caries related treatment costs per patient was also higher in the 0 to18 year and < 7-year suboptimal CWF groups compared to the optimal CWF group (583.70 vs 344.34 $, p < 0.0001; 692.87 vs. 350.13 $, p < 0.0001, respectively). Binary logistic regression analysis results indicated a protective effect from optimal CWF for the 0 to18 and < 7 year age groups ([OR] 0.75, 95% CI [0.62, 0.90], p = 0.002); OR = 0.70, 95% CI [0.52, 0.95], p = 0.02, respectively). The results confirm optimal CWF exposure prevents dental decay, expand the evidence base of caries epidemiology under CWF cessation, and indicate patients without early childhood CWF exposure experience more dental caries procedures and treatment costs. These findings may create opportunities for social change by supplying evidence that can be used to improve equity oriented oral health public policies that protect population health.

Attention-deficit hyperactivity disorder (ADHD), the most commonly diagnosed childhood neurobehavioral disorder, is increasing annually at about 5% per year. ADHD has been diagnosed in approximately 6.4 billion children in the U.S., and it is estimated that 66% of those afflicted have 1 or more comorbid conditions. Children with ADHD are often from socioeconomically challenged households. What is unclear from the literature is the relationship between socioeconomic status (SES), defined as education, employment, and income and the reporting of comorbidities with ADHD. The problem is that children with ADHD from low SES households may be reporting a higher prevalence of comorbid conditions, which can lead to misdiagnosis, improper treatment, and greater financial burden for families and the public health system. The purpose of this quantitative, descriptive, nonexperimental study was to examine the relationship between household SES and the reporting of a comorbidity (anxiety, depression, behavioral issues) in children with ADHD by analyzing secondary data from the National Survey of Children's Health (N = 99,677). Ecological systems theory guided this study which is based on the premise that individuals encounter many environments in their lives and these environments can impact health and well-being. Multiple logistic regression analysis revealed that parental education level, employment, and household income were significantly associated with the reporting of comorbidities for children with ADHD. This research may lead to positive social change by allowing resources to be allocated to low SES households of children with ADHD to decrease the number of children developing comorbid conditions.

Abstract African Americans are disproportionately affected by heart failure, with prevention and treatment of heart failure being a public health concern in the United States. The purpose of this retrospective quantitative study was to examine the primary variable race, specifically African Americans, and how this variable relates to 30-day readmission post discharge when controlled with geographic location (urban vs. rural), gender, and insurance status. The expanded chronic care model was used as a framework to shape health promotion, prevention efforts, and social determinants of health and to enhance community involvement related to chronic disease issues. The research questions were focused on determining a relationship among African Americans being at a higher risk for 30-day readmission than others using selected control variables. Secondary data were collected for 565 patients diagnosed with congestive heart failure from the 2015 Hospital Inpatient Discharges data set and analyzed using simple and multivariate logistic regression methods to answer research questions and test hypotheses. Key results of the simple logistic regression revealed that African Americans were 1.7 times more likely to be readmitted than other races and 1.3 times more likely to be readmitted than Caucasians. The multiple logistic regression revealed race, gender and geographic location (urban) as significant predictors of readmission among African Americans. Insurance status revealed no significance for readmission among African Americans. Implications for social change from this study may include policy implementation at the family, organizational, and societal levels, such as policy related to education on establishing a surveillance system that identifies those in the population who are at risk and more vulnerable to social and health care disparities.

Suicidal behaviors have continued to increase in the United States (U.S.) Army population since the beginning of the wars in Iraq and Afghanistan. Suicide rates are higher in men compared to women; yet, the rate of suicidal ideation is higher in women than men. The purpose of this study was to determine if there is a correlation between suicidal ideation and protective factors, if social support and resiliency are different for men and women within the U.S. Army population, and if gender acts as a moderating variable between suicidal ideation and protective factors. The interpersonal-psychological theory of suicidal behavior was used as the foundation for this study. Secondary data were collected from the U.S. Army Public Health Center. After removing missing responses, the total sample size for this study was N = 3,446. Chi-square, independent samples t test, and multiple logistic regressions were used to determine the relationship between gender, suicidal ideation, resiliency, and social support in the U.S. Army active duty population. The percentage who reported suicidal ideation was 3.6% versus 4.9% for males and females, respectively. Social support was statistically significantly correlated with suicidal ideation (p = 0.002) while resiliency was not statistically significantly correlated with suicidal ideation (p = 0.68). Neither scale was effective in detecting differences among gender groups. Refined instruments are needed for evaluation of small changes in regard to protective factors. To promote social change, this study can be used to enhance knowledge about protective factors and gender in the context of the suicidal process, thus furthering the knowledge about how to prevent suicide in the U.S. Army population.