Health promotion and disease prevention are a focus of population health management. Without ongoing and rigorous evaluation, these programs may be in jeopardy of continuing. The purpose of this project was to conduct a descriptive population health- focused evaluation of a large-scale health system's employee health and wellbeing program. Guided by the Center for Disease Control and Prevention (CDC) framework for program evaluation in public health and National Center for Organization Development guidelines, a nurse-led evaluation was conducted using 5 specific data sets emphasizing organizational structure, employee health offerings, employee surveys, Pathway to Excellence survey, and program contributions. A descriptive analysis was applied towards interpreting the organizational structure, and identifying all contributions to employee wellness. Inferential analysis was applied to identify correlations between survey results. The findings of the evaluation were mixed. The organizational structure of the program complied with CDC wellness program guidelines; of the 97 service departments surveyed, results revealed an 83.51% improvement in engagement, disengagement, satisfaction, best places to work, and customer satisfaction. The Pathway to Excellence survey results revealed a supportive organizational structure for a culture of wellness. The program contribution analysis showed that the health system provided accessible wellness and health promotion opportunities. Positive social change may result from this evaluation as the program is reinforced and the focus on employee wellness, health promotion, and disease prevention services are continued. As a result, the lives of employees, their families, and communities might be improved.

Human papillomavirus (HPV) is a preventable infection responsible for anogenital and oropharyngeal cancers, as well as genital warts. Two safe and effective vaccines are recommended for adolescents and young adults to protect against HPV infection. Both are severely underutilized. Sexual and ethnic minorities are disproportionately affected by HPV infection and its sequelae. The goals of this study were to (1) assess baseline differences in HPV-related awareness, knowledge, and attitudes between men and women, and (2) evaluate the differential efficacy of a brief, educational HPV intervention among ethnically and sexually diverse college students. Students attending undergraduate courses from 2015 to 2017 participated in a brief, tailored, classroom intervention designed to improve HPV-related awareness, knowledge, and attitudes. These outcomes were assessed immediately before and following an evidence-based educational presentation about HPV risks, outcomes, treatments, and prevention. At baseline, 84% of participants (N=386) had heard of HPV; 28% of men and 55% of women reported receiving ≥1 dose of HPV vaccine. Vaccinated women were seven times more likely to report favorable attitudes than unvaccinated women (RR=7.1, CI[3.3-15.5]). Hispanic participants had more positive attitudes toward HPV vaccination (62% vs. 44%; P=0.009) and were more willing to become vaccinated (66% vs. 46%; p=0.02) than non-Hispanic participants at baseline. Gay and bisexual men (92%) were more likely than heterosexual men (68%) to have heard of HPV, to receive any doses of HPV vaccine (37% vs 19%), to view HPV vaccination positively (58% vs 39%), and more willing to be vaccinated (86% vs 39%; P

Children's physical inactivity and poor eating patterns have received a great deal of attention in our country and worldwide. Studies have been conducted to identify determinates related to children's physical activity and eating patterns and to identify strategies for promoting positive behaviors. Parental support is a well-accepted determinate of children's physical activity and eating patterns. However, little qualitative research has been done to determine parental attitudes and perceptions related to this critical role. First, the study sought to gain a greater understanding of parental perspectives on their children's physical activity and eating patterns. Second, the study examined parental attitudes and perceptions of their own personal roles related to their children's physical activity and eating patterns and the possible role of others. Focus groups were conducted with parents who had a child or children in kndergarten through sixth grade in the Madison School District in Rexburg, Idaho. Grounded theory was used to analyze findings. The results of the study indicated common elements of parental perceptions of physical activity and positive eating patterns in children. These elements were the same for supportive networks, supportive environments, and individual factors. Of these elements, most participants felt that their role as a parent was the most critical. Although knowing how critical their involvement was, participants continually brought up concerns and barriers associated with their role. The most common concerns addressed by parents were the significant impact of not having enough time and busyness of family schedules. Findings indicated that these elements should be considered and researched when conducting a needs assessment and planning interventions designed to increase physical activity and improve eating patterns in children. Findings also indicated that parents should play an extremely important role when collecting needs assessment data related to the physical activity and eating patterns of children. Interventions aimed at improving the health of children should be family focused and include strategies for incorporating positive changes into households and must address the demands of families' schedules. Effective health education strategies may also include facilitating parental involvement in community and school advocacy related to their perceived need for changes.

Depression has been shown to increase an individual's risk for heart disease. Despite this finding, physicians are not identifying depression in their hospitalized cardiac patients. This study looked at hospitalized cardiac patients and determined whether their physicians were identifying depression in those that scored > 5 on the PHQ-9 depression inventory. Methods included assessing patient depression during their stay at an intensive care unit using the PHQ-9. Those patients scoring > 5 were determined as depressed. Chart audits were performed after the patient discharged from the hospital to discover whether physicians were identifying these patients as depressed. The results showed that out of 111 surveys, 83 had a score of > 5, meaning that 74.7% of hospitalized cardiac patients have some type of depression while in the hospital, ranging from mild, moderate, or severe. Of those 83 patients, only 9 or 10% were identified as depressed by their physician during their stay at the hospital. Conclusions suggest that although depression appears to be prevalent in the hospitalized cardiac patient, physician detection of such is very low.

Despite great effort to improve physical activity, little success has come to pass. Due to this, some researchers have shifted from individual approaches to promoting physical activity to multilevel environmental approaches. One of these multifaceted environmental approaches is through community trails. A small body of research has suggested that community trails may be a successful ecological approach to promoting physical activity. However, the research is minimal and inconsistent in supporting effectiveness of community trails for promoting physical activity. This study sought to examine ecological factors to learn if and how they might influence trail use among women. The ecological factors measured in this study were intrapersonal (age, time, race/ethnicity), sociocultural (income, education, social support), and physical environmental (cost, convenience, safety). A survey was conducted among 67 women using a community trail in St. George, Utah during the spring of 2008. Multiple linear regression models and Pearson correlations performed measured the predictive value of the ecological influences of physical activity, studied the relationship between community trail use and physical activity, and gained a clearer understanding of the characteristics of women trail users. Eighty-four percent of the sample reported using trails for physical activity and 74% reported since they began using trails, they participated in more physical activity. Physical activity and trail use were significantly and positively correlated. Convenience, outdoors and aesthetics were reported as motivators to use trails. Sixty-nine percent of the sample perceived the trail to be very convenient and convenience significantly predicted trail use. Convenience was also significantly and negatively correlated with the distance one traveled to the trail. The remaining ecological factors failed to predict trail use. Promoting community trail use among women who live within close proximity to trails may be an effective approach to reaching out to more people in an effort to promote physical activity. This conclusion is supported by the findings that women trail users were significantly likely to use trails regularly, participate in physical activity, and live within close proximity to trails. It is inconclusive what and how other ecological factors might influence community trail use among women.

This pilot study used photovoice methodology to explore the current health needs of youth who were trafficked for sex and are now living in an alternative family care setting. The goals of this study were to add to the current literature regarding the health needs of victims of domestic minor sex trafficking and to add a qualitative aspect to the evaluation of the Citrus Helping Adolescents Negatively Impacted by Commercial Exploitation (CHANCE) program. Disposable cameras were distributed to a group of adolescent girls enrolled in the program who were then tasked with taking pictures of things that made them feel safe and healthy and things that made them feel unsafe and unhealthy. Five youth then participated in a focus group to discuss these photographs. Qualitative analysis of the focus group transcript revealed that youth were able to identify several emotional health coping mechanisms and that participants craved stability in their relationships with others. Youth felt that the police made them feel unsafe and they also struggled with learning how to drive. This pilot study revealed a need for emotional support systems for youth who are trafficked for sex. The study also emphasized that fact that many youth who are trafficked for sex are still dealing with everyday teenage issues, including learning to drive and navigating social media websites

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.

Most people have had an episode of foodborne illness at one time or another; however, the majority of those stricken with foodborne illness fails to associate ill health with something consumed within the past 72 hours. The World Health Organization (WHO) estimates that foodborne diseases affect 30% of the population in developed countries, and that in developing countries, about 2 million people die yearly due to foodborne illness. Previous researchers have indicated that food handlers with poor personal hygiene are potential sources of infection. Although public health agencies in many countries already regularly inspect food facilities to control potential foodborne illnesses to some extent, the question of the most appropriate and effective means of achieving the goal of food safety remains unanswered. Therefore, the purpose of this study was to determine whether a color-coded placard grading system is an effective tool for achieving this goal while simultaneously educating the public about food safety. This study involved 1,410 randomly selected food service establishments, consisting of traditional restaurants, take-out restaurants, grocery stores, public school cafeterias, and institutional food facilities located in Alameda County, California. Inspection data were analyzed for the first 12 months of placard grading and compared to the following 12 months during the placard grading period. Statistical analysis results did not show significant differences in the CDC major violations and in confirmed foodborne illnesses between the 2 years. However, it is expected that the new program will provide improved food handling practices in the future. Improvement in food handling practices will contribute to social change by reducing the number of foodborne illnesses, promoting better health for the community, and educating the public about food safety.

HIV has remained a public health problem in Nigeria. The purpose of this cross-sectional study was to examine the effect of social support and HIV-related stigma on depression in people living with HIV/AIDS (PLWHA) and to examine the moderating effect of sociodemographic factors, Quality of Life (QOL), and time since HIV diagnosis on this relationship. This study was based on the social cognitive theory. Data were collected from 98 PLWHA attending the antiretroviral clinic of Federal Medical Center, Umuahia, Nigeria. Regression analyses were used to examine the relationships between the variables. Some 24.5% of the study participants were depressed. Significant relationships identified included negative relationships between depression and social support, positive relationships between depression and negative self-image, and a combination of poor social support and HIV-related stigma having synergic effects in predicting depression. Sociodemographic variables, quality of life, and time since HIV diagnosis did not have a moderating effect on the relationship between social support, HIV-related stigma, and depression in PLWHA. There is a need to improve social support and reduce HIV-related stigma in PLWHA in order to improve their mental health. These findings can help in bringing about positive social change by informing the development of public health initiatives aimed at improving the mental health of PLWHA.

This study was conducted to gain a better understanding of HIV/AIDS-related stigma within religious communities in rural Gujarat, India. This study used the hidden distress model of HIV stigma and the HIV peer education model as conceptual frameworks to examine a rural population sample of 100 participants. Regression analysis was conducted to test if school education had a moderating effect on the relationship between illness as punishment for sin (IPS) and HIV stigma. Religiosity was tested for mediating effects on the relationship between early religious involvement (ERI) and HIV stigma. The results of this study indicated that single unemployed men under the age of 28 were more likely to relate religiosity, IPS, and ERI to HIV stigma. Furthermore, education did not significantly moderate the relationship between IPS and HIV Stigma, and religiosity also did not mediate the relationship between ERI and HIV stigma. However, an additional mediation analysis showed that IPS did mediate the relationship between religiosity and HIV stigma in this study. The results of this study suggested that HIV/AIDS awareness programs may need to focus on young unemployed men because they may be the most susceptible to stigmatic thinking. It can be concluded that IPS was a major contributor in the proliferation of HIV stigma for participants in this study. Further research is needed to understand how belief in an authoritarian God could increase IPS, and how education initiatives may aid in decreasing IPS among inhabitants. This study strived to add to the existing body of knowledge and help improve the lives of those infected with HIV in rural parts of India.