Undernutrition is a global public health challenge. In Somalia, undernutrition is chronic with the situation often graded for emergency response. The purpose of this study was to provide contextual evidence regarding trends of prevalence and predictors of undernutrition in South Central Somalia. Following the UNICEF conceptual framework of determinants of undernutrition, the study examined which individual, household, and society factors were associated with undernutrition. Using secondary data from cross-sectional nutritional surveys implemented by the Somalia Food Security and Nutrition Analysis Unit from 2007 to 2012, a sample of 75,756 and 60,856 children aged 6-59 months was used in analyzing trends in prevalence and predictors of undernutrition respectively. Linear regression was used to examine trends, while Generalized Estimation Equations were used to determine predictors of undernutrition. Results of this study showed that from 2007 to 2012, there was a declining trend in the prevalence of stunting (R2 = 0.73; p < 0.05) while there was no significant trend in terms of underweight and wasting. When individual, household, and society factors were considered simultaneously, diarrhea, child gender, diet diversity, and minimum meal frequency were significant predictors of underweight; child gender and meal frequency significantly predicted stunting while wasting was significantly predicted by diarrhea, malaria, and diet diversity. Geographical region and livelihood system were significant predictors of undernutrition. The study findings provide evidence to inform nutrition policy and programs that could result in eliminating disparities in child nutrition and reducing undernutrition, ultimately improving survival and development of children in Somalia.

African American men in their late teens to early 20s account for nearly half the victims of violent crimes. This mixed methods social epidemiological study was designed to identify the social determinants of violence as described by a purposive sample of young adult African American men (n=353) who have experience as a victim or witness to any type of violence to determine the impact post traumatic stress disorder (PTSD) symptoms have on recurrent violent injury. The pathways to recurrence model shaped the theoretical framework of this study. Quantitative data were collected using the Past Feelings and Acts of Violence (PFAV) instrument and the PTSD checklist civilian version (PCL-C). Logistic regression and Pearson correlation analysis techniques were used to examine correlations between the variables. The results showed that with higher levels of past violent behaviors there is an increase in PTSD symptoms. Qualitative data regarding exposure to and experiences with violence were collected from a subgroup of participants using open-ended, semistructured interviews (n=5) that were later analyzed using a phenomenological approach. Weapon-carrying, living in urban settings, and gang presence were themes identified by those interviewed as being related to recurrent injury. These findings will encourage social change by stimulating new strategies aimed at long-range systems changes by those who shape policies and influence community investment and engagement in resource -poor communities where violence is prevalent. More research is needed to determine if early identification and treatment for PTSD among African American men who have been exposed to violence may reduce the incidence of future violence and injury.

Multiple Myeloma (MM) is a hematologic malignancy that accounts for approximately 1% of all adult cancers. This study investigated the impact of patient distance traveled to MM care sites, which was not considered in previous research on any disease-specific staging or prognostic schema despite evidence suggesting that distance impacts patient outcome. This study investigated the impact of patient distance from the site of care on survival outcomes using a group of 480 clinical trial participants. Andersen's behavioral model of health services use functioned as the theoretical model for this study. The independent variable was patient travel distance, controlling for established measures of risk, including ISS Stage and Gene Expression Profiling based risk stratification. A Cox proportional hazard model was used to analyze time to progression and/or death outcome. Analysis revealed that patients who lived-?¥ 121 miles. When controlling for ISS Stage and GEP risk, participants who lived-?¥ 121 miles. Participants aged -?¥ 65 years who lived-?¥ 121 miles. Statistically significant results (p =

Obesity increases asthma severity and is costing the health care industry a significant amount of money. Decreasing adolescents' obesity will decrease the risk for chronic health problems, which can have a significant impact in adulthood. Implementing a school-based health education program can decrease the prevalence of obesity amongst adolescents. This program will be implemented by school nurses in the after-school program at Public School 59 (P.S) in New York City. The purpose of this project is to develop adolescents' school-based obesity prevention policies and documentation which will focus on increasing their nutrition education, increasing physical activities, and providing skills to maintain behavior changes. The goal of this program is to decrease the incidence of obesity among adolescents and reduce the economic cost associated with obesity. The program was planned to use the trans-theoretical model to assess adolescents' readiness for behavior changes. The logic model tool will be used to evaluate relationship between resources and the activities for health education program. Adolescents' height and body weight will be measured and BMI will be assessed using Centers for Disease Prevention Control Pediatric Growth Chart. A posttest will be given after the 14 weeks to assess adolescents' knowledge about nutrition and increase physical activity. Adolescents will also be asked to discuss the skills they developed to maintain these behavior changes. School nurses will review formative evaluations and will provide information for stakeholders. Implementation of the structured nutrition education and increase physical education program is hypothesized to decrease obesity amongst adolescents.

The risk of developing Type 2 diabetes is increasing at epidemic proportions, and is 12-17% higher in Marion County Florida than it is across the state, based on Florida Department of Health statistics. The purpose of this DNP project was to determine if awareness of individual risk of developing Type 2 diabetes through a questionnaire would result in high-risk participants agreeing to attend a diabetes prevention program (DPP) at a local medical clinic. The health belief model and Rosswurm and Larrabee's model for change were used as frameworks. The review of the literature showed that prevention programs were highly effective in reducing the risk of developing diabetes. A validated diabetes risk questionnaire was placed at reception desks at 3 clinic sites. Forty-four anonymous participants completed the questionnaire. The convenience sample obtained from the questionnaire provided a score that categorized individuals into a high-risk and a low-risk group. Quantitative data from the participants were analyzed using descriptive statistics. Twenty-one of the participants indicated they were at high risk of developing diabetes. Ninety-five percent of those who received a high-score on the diabetes risk questionnaire responded that they would be interested in participating in a DPP at a local medical clinic. As a result of the DNP project completion, a DPP with the goal of reducing the risk of developing Type 2 diabetes will be implemented in the Marion County medical clinic. Future collaboration with health care and community organizations will assist to expand DPP's, bring awareness of diabetes risk, and promote social change.

Lack of safe drinking water and lack of water hygiene literacy contribute to a large disease burden in rural areas of Africa, and children suffer disproportionately more than adults from diarrheal diseases caused by nonpotable water. Research is needed to help merge education and water sanitation to provide more effective methods of preventing diarrheal diseases. The ecological model and hygiene improvement framework were used to guide the study. The purpose of this phenomenological study was to describe the shared experiences of people participating in the water hygiene education program provided by Lifewater International. Lifewater is a nonprofit organization focused on improving access to clean water and increasing water hygiene literacy in rural parts of developing countries. Individual interviews were conducted with six Lifewater program participants, using the Delphi sampling technique. After I transcribed and thematically analyzed data for codes, three main themes were identified that motivated Lifewater partners and members of their community to change behavior: improving their children's health, saving time and money, and being a better Christian. The most meaningful part of participating in the program is that they use the information to improve the lives of those in their communities. In addition to making curricula for the Lifewater organization and its partners more streamlined, if the lessons are more culturally relevant, people are more likely to accept the behavior changes being taught, which can also influence the behavior change. Culturally relevant curriculum could help increase the access to and knowledge of clean water in developing areas, which contributes to the United Nation;s Millennium Development Goals, and thus promotes social change.

Alzheimer's disease (AD) is a significant public health concern for all elders in the United States. It is a particular concern for the American Indian (AI) population, which is one of the fastest-aging populations in the United States and the smallest, most underrecognized, and most culturally-diverse group in the country. A formal caregiver understanding of AD in the AI population is scarce. This phenomenological study was designed to discern what is known about AD in the AI population by exploring the cultural beliefs and experiences of formal caregivers who provide care for AI dementia patients. Specifically, this study sought to document formal caregiver and AI dementia beliefs about AD. Data came from 4 in-depth interviews that included 3 Western and one AI formal caregiver. These interviews explored the variability of cultural beliefs regarding AD and dementia among a sample of formal caregivers who minister to AI patients; in the interviews, these participants also provided examples of challenges they faced, providing a better cultural understanding of AI dementia. Results suggested that challenges include adopting a bicultural approach to AD, illuminating interactions between patient and provider, and fostering awareness of cultural competency. Research on this topic is critical in advancing cultural, public health, and evidence-based health practices regarding AI dementia patients. The potential implications for social change include enhancing cross cultural provider-patient interactions and advancing public health policy and practice for this underserved population. Many of the issues and challenges explored may have implications for other ethnocultural minority groups.

DeKalb and Fulton Counties, which share the metropolitan Atlanta area, have seen an increase in West Nile infected vector mosquitoes; the increase is associated with close proximity to combined sewer overflow facilities. Despite completion of the remediation system in 2008, the mosquito population testing positive for West Nile virus has increased each year from 2010 through 2012. Guided by the Geographical Information System framework and using spatial analysis and regression analyses, this study described and quantified the relationship between sewer system overflows and amplification of vector mosquitoes; an additional goal was to investigate their proximity to human cases of West Nile VIrus (WNV) infections. Comparing the prominence of all WNV vectors revealed how different mosquito species occupy the area. The Culex species was not detected in adult surveillance in 2012; however, the infection rate of mosquito pools increased by 15% and the human infection more than doubled. The influence of sewer system overflows became pronounced when this study analysis also identified that a proportion of West Nile-virus positive mosquito pools was significantly higher in approximately 58% of trap sites within 1 km of sewer overflow events and 30% over 1 km distance from sewer overflow events. Thus, the research contributes to shared information both in support of previous findings and considering novel sources that contribute to the proliferation of WNV. This research can help reduce the rate of WNV infection and decrease the resources needed to protect the public.

Mental health and obesity were ranked among the health priorities of the 2014 and 2017 Community Health Needs Assessments in Kent County, Michigan. Exposure to nature is correlated to improved health outcomes across a variety of morbidities including poor mental health and obesity. This cross-sectional study set within the frameworks of attention restoration theory, environmental health, and pathways to health benefits from nature assessed county survey data including self-reported nature exposures/interactions separated into 3 domain areas: access to nature, attitudes about nature, and physical activity in nature or in nature-based activities. Binary logistic regression analyses of the 653 respondents found that those who self-reported higher frequency of physical activity in nature or in nature-based activities possessed lower odds of also reporting poor mental health (p < .001, OR .652, 95% CI .535, .795) and obesity (p < .001, OR .666, 95% CI .548, .808) with each ascending level of agreement with the physical activity statement question. Ascending levels of agreement with the ease of access to nature statement question was found to be associated with lower odds of poor mental health (p < .001, OR .585, 95% CI .470, .797); however, no correlation was found between this variable and obesity status. The attitudes about nature domain statement questions were not consistently found to be associated with either mental health or obesity status. The significantly associated independent nature variables demonstrated weak effects (Nagelkerke R� < .300) on their respectively linked health outcomes. These findings may equip public health officials with information to develop more effective interventions for addressing mental health and obesity in their respective communities.

Emotional intelligence (EI) is essential for providing quality and competent care in the nursing profession. Because nurses need to be competent in EI, it is important to determine if inherent factors and academic performance contribute to the development of EI. The purpose of this study, guided by the 4-branch ability model of EI by Mayer and Salovey, was to examine the relationship of EI levels and academic performance, gender, and ethnic background in associate degree nursing (ADN) students who attended a community college. Using convenience sampling, 110 ADN students completed the Schutte Self-Report Emotional Intelligence Test and sociodemographic data. Data were analyzed using an independent t-test, and analysis of variances which indicated no statistical significance between EI levels and academic performance, gender, and ethnic background. Although the findings did not show statistical significance, drawing attention to EI among nursing students and nurse educators may increase nurse educators' awareness of the importance of cultivating EI in nurses and the need to incorporate concepts of EI into the nursing curricula. Doing so can effect positive social change because nurses with higher EI may be better able to understand and manage the emotions of others and themselves in stressful situations. The concept of EI is important to incorporate into nursing curricula to provide the nursing student opportunities to practice and apply the concepts learned in an educational setting. Doing so may improve students' preparation to use EI in their nursing careers. Future research could be done to determine if EI levels change throughout a nursing program and to determine if EI skills are taught in nursing programs.