The study of obesity has evolved into one of the most important public health issues in the United States (U.S.), particularly in Hispanic populations. Mexican Americans, the largest Hispanic ethnic subgroup in the U.S., have been significantly impacted by obesity and related cardiovascular diseases. Mexican Americans living in the Lower Rio Grande Valley (the Valley) in the Texas-Mexico border are one of the most disadvantaged and hard-to-reach minority groups. Demographic factors, socioeconomic status, acculturation, and physical activity behavior have been found to be important predictors of health, although research findings are mixed when establishing predictors of obesity in this population. Furthermore, while obesity has long been linked to cardiovascular disease (CVD) risk factors such as hypertension, type 2 diabetes, and dyslipidemia; information on the relationships between obesity and these CVD risk factors have been mostly from non-minority population groups. Overall, research has been mixed in establishing the association between obesity and related CVD risk factors in this population calling attention to the need for further research. Nevertheless, identifying predictors of success for weight loss in this population will be important if health disparities are to be addressed. The overall objective of the findings presented in this dissertation was to attain a more informed profile of obesity and CVD risk factors in this population. In particular, we examined predictors of obesity, measures of obesity and association with cardiovascular disease risk factors in a sample of 975 Mexican Americans participating in a health promotion program in the Valley region. Findings suggest acculturation factors to be one of the most important predictors of obesity in this population. Results also point to the need of identifying other possible risk factors for predicting CVD risk. Finally, initial body mass index is an important predictor of weight loss in this population group. Thus, indicating that this population is not only amenable to change, but that improvements in weight loss are feasible. This finding strengthens the relevance of prevention programs such as Beyond Sabor for Mexican populations at risk, in particular, food bank recipients.

The average age-adjusted incidence and mortality rates of lung and bronchus cancer is 55% and 56% higher in Kentucky than the national averages in the United States, respectively. Populations with low income and educational attainment, and those who live close to the mining regions across Kentucky are more affected by the high prevalence and resulting mortality rates of lung and bronchus cancer. This study was conducted because of the high incidence of lung and bronchus cancer and resulting mortality rates in the state of Kentucky that may not be caused solely by social and demographic factors. The theoretical foundation for this study was the social-ecological model (SEM). This quantitative cross-sectional study assessed whether the association between geographic factors and incidence, and mortality rate of lung and bronchus cancer is significant in Kentucky, controlling for social and demographic factors respectively. The sample size was n = 960. Bivariate analysis and ordinal regression were used to address the research questions. The outcome of the study revealed that populations that reside in rural zones are significantly (p < .05) more likely to be exposed to trace elements with less access to effective care, and higher mortality as compared to populations living in metropolitan and micropolitan zones. Healthy individuals promote healthy families, which in turn promote healthy communities. This could improve the local work force, investments, and development which could enhance self-esteem and social change in each county across Kentucky.

The level of knowledge and awareness among patients about the concepts and implications of medical radiation is unknown. The purpose of this qualitative, case study was to explore patients' awareness and knowledge of information regarding this topic from their perspectives. The health belief model provided the framework for the study. A total of 20 individuals were recruited using purposive sampling. All participants were above the age of 18 in central North Carolina and had undergone or are currently undergoing medical radiation exams. Data were collected using semistructured interviews and analyzed using Yin's 5-phased cycle, which involved compiling, disassembling, reassembling, interpreting, and concluding. According to study findings, patients were generally aware of the harmful effects and seriousness of medical radiation if uncontrolled. Patients also cited the importance of having the proper information and resources to educate oneself, being more careful with their bodies to avoid examinations with radiation, and hearing reports about individuals getting ill from medical radiation exposure as cues to action that may benefit patients who are about to undergo medical radiation exams. The findings of this study may contribute to positive social change by illustrating ways to improve information dissemination and involvement of patients in understanding medical radiation and its perceived risks. The results of this study may help health practitioners in developing strategies to encourage patients to discuss their medical radiation exposure concerns proactively.

Registered Nurse (RN) turnover is costly for hospitals and healthcare facilities. The problem that healthcare administrators face today is their inability to retain nurses for long periods of time and the detrimental effects that come from the lack of retention. The purpose of this quantitative secondary data analysis is to explore the relationship between the retention of RNs and the geographic regions in which they work. The theoretical framework for this study was Barney's concept of viewing people as resources. Deidentified secondary data of RNs was utilized from the Healthforce Center at the University of California San Francisco to probe differences in retention rates between full-time and part-time RNs and the differences in retention rates between new graduate and specialty RNs in California geographic regions. The data was analyzed through descriptive and inferential statistical techniques to perform a t test of independent means. As a result, it was determined that there was no significance in geographic regions in California influencing the retention rates of full and part-time RNs neither was there a significant finding that geographic regions in California influence the retention rates of new graduate RNs or specialty nurses. It was concluded that the retention of RNs is determined by how well they are maintained and managed. A recommendation would be to investigate retention strategies that create longevity among RNs. This study can contribute to positive social change by having a cohesiveness that builds trust and creates a better work environment and positive outcomes for healthcare facilities which will reduce overall cost.

Unintended pregnancies, defined as either being unwanted or mistimed, represent a major public health challenge. Roughly half of all pregnancies in the United States are unintended, and have been associated with poor health and economic outcomes for infants, children, women, and families. Modern contraceptives have been proven to be both safe and effective in reducing unintended pregnancy. This is particularly true for long-acting reversible contraceptive (LARC) methods, which are associated with both higher user satisfaction and overall efficacy as compared to short-acting methods. We therefore investigated types of contraceptive services offered among rural and non-rural clinics in South Carolina. A survey was developed; all clinics in South Carolina who offer contraceptive services were invited to participate. Completion of the survey was voluntary and an incentive was provided. The survey was multi-faceted, covering several aspects of contraceptive care including scope of services provided, availability of resources, and training received. Of primary interest to this research, is the extent to which highly effective contraception methods, such as LARCs, are available in both urban and rural clinics. Findings suggest that access to highly effective LARCs is not equitable among rural and urban clinics. Approximately 62% of urban clinics offered LARC methods, compared to 36% among rural clinics (p=0.0015). These data indicate that women who reside in a rural locale have significantly lower access to these more effective contraceptive methods. As nearly 25% of women within the United States reside in a rural locale, the need to address barriers to access to contraceptive care is essential. This work will be a useful tool in understanding barriers to contraceptive care utilization and can lead to the development of novel programs to reduce the rate of unintended pregnancy, births and abortions, and corresponding savings in health care costs.

Purpose: Moderate-intensity aerobic exercise (MAE) has been shown to elicit improvements in cognition and subsequent academic performance among preadolescents. Aerobic exercise has also shown to increase cortisol release in response to increasing exercise intensity. However, it is unknown if increased cortisol levels following exercise are related to acute improvements in executive function following a bout of MAE in preadolescents. The purpose of this study was to examine the potential effects of increased cortisol release after acute MAE on attention and working memory among preadolescents. Methods: Eleven preadolescents [6 males, 5 females] volunteered to participate in this study (age=9.45±1.03). Participants were randomized in a counterbalanced fashion to 30 minutes of rest or 30 minutes of treadmill MAE (60-70% HR max). Immediately pre-post each condition, participants completed a cognitive battery consisting of tests of attention (Flanker Test) and working memory (List Sorting Working Memory Test), as well as salivary samples for the analysis of cortisol. Linear Regression models were used to assess significance of covariates. Generalized linear models were used to assess significance of changes in each dependent variable against time, condition, time*condition and change in cortisol. Tukey’s HSD post-hoc tests for multiple comparisons were used to assess the effect of condition on working memory, attention, and salivary cortisol. Results: There was a significant effect of condition on working memory (F=3.16, p =0.04), with no change from pre-post rest (p=0.93) and improving from pre-post exercise (p=0.04). There was no effect of condition on attention or salivary cortisol, most likely due to a small sample size. Multiple linear regression models showed a significant effect of age (p=0.03) and change in cortisol (p=0.007) on working memory. Conclusion: Exercise had a positive effect on working memory, however, we were unable to relate this improvement to changes in salivary cortisol due to a lack of statistical power. This study could provide insight into the physiological effects of increased cortisol release on cognition, specifically in regard to working memory. However, more data are needed to achieve sufficient statistical power to detect these relationships.

The material in current emergency medical services (EMS) curricula is insufficient to prepare prehospital emergency medical care personnel recognize the signs and symptoms of post-traumatic stress disorder (PTSD) within their workforce. Prehospital emergency textbooks focus on treating patients affected with PTSD, but there is very little included about how EMS professionals may also be affected. Moreover, supervisors and managers of EMS agencies receive very little education on workforce PTSD in their personnel. The purpose of this study was to understand the educational preparation of EMS supervisors in order to develop a PTSD-awareness course. The research question investigated the educational preparation that EMS supervisors receive. The conceptual framework of the study was Conti-O’Hare’s wounded healer theory. EMS professionals are wounded healers from frequent critical incident exposure. A qualitative approach featuring a case study design was used. The study included 9 participants. A focus group was used that consisted of three paramedics and three emergency medical technicians (EMTs). Separate interviews were conducted with three EMS supervisors. Data gained from the focus group and individual interviews were analyzed through coding with the goal of investigating the education received by EMS supervisors on PTSD. The themes that emerged were EMS supervisors do not receive enough education on workforce PTSD and a course specifically targeted on this subject is needed. Positive social change may be achieved through this study by enabling EMS managers to help paramedics and EMTs cope with a critical incident (CI) improving prehospital healthcare.

The increase in use of e-cigarettes in adolescents is a major public health concern that must be addressed. Research studies showed some e-cigarettes contained varying amounts of nicotine and sever cancer-causing chemicals. The purpose of this quantitative, cross-sectional study was to assess the perception of harm (dependent variable) from using e-cigarettes and being exposed to state and school-based antitobacco programs (independent variable) and to determine if the association was modified by socioeconomic status or area of residence. Attitude-social influence-self-efficacy theory was the chosen theory for research and suggests that attitude, social influence, and self-efficacy variables can be persuaded via specific health promotion activities. Texas students enrolled in 6th to 12th grade of an eligible school who voluntarily consented to participate and received written authorization from a parent were included. Nearly half of participants out of N=9,239 adolescents considered e-cigarettes very dangerous, yet more than half reported using the device. Ordinal logistic regression was used to determine the relationship between the independent and dependent variables. The results concluded that though majority of adolescents perceived e-cigarettes as harmful, exposure to state and school antitobacco programs are not completely effective at discouraging use. The findings of the study may provide potential impact for positive social change for adolescents and tobacco cessation by increasing understanding of what factors are associated with increased/decreased perception of harm. Results of the study may encourage public health professionals to create and disseminate tailored antitobacco educational information including school and state activities and resources.

Men who have sex with men (MSM) are at high risk of HIV in Nigeria. However, African countries like Nigeria, Botswana, Mali, and Mozambique have laws that prohibit homosexuality, making it a punishable crime in these countries. For example, the Nigerian government signed the anti-gay law in 2014. Laws like these affect the health status and outcomes among Nigerian MSM. The purpose of this qualitative study was to examine the influence criminalization of homosexuality has on the willingness to test for HIV among MSM in Abuja, Nigeria. Guided by the socio-political theory (SP) as the theoretical framework, a qualitative approach was designed to understand HIV testing perception among MSM since after the criminalization of homosexuality in Nigeria. Interviews were conducted among 15 MSM to understand how the law created factors that influence their decision to test for HIV and their quality of life. Data gathered from the face to face interview was coded based on the research questions. Further analysis was done using thematic to develop themes that addressed the research questions. Findings revealed that anti-gay law influenced MSM to avoid HIV testing and disclosure. Additional themes revealed respondents’ perceptions on homosexual criminalization’s impact on healthcare access, fear of imprisonment, relationships, and psychological and physical fears. The research findings will help address the discrimination, social injustice, violence and human right violation MSM face in Nigeria. Through dissemination of these findings, positive social change will be achieved through increased HIV testing among MSM and improve HIV prevention programs aimed at MSM.

Nigerians have been opting for a more processed Western diet. These changes in dietary choices have aligned with obesity and undernutrition, attributable to micronutrient deficiencies or malnutrition. Many scholars have presented varying intervention strategies ranging from consumption of a variety of foods containing the necessary micronutrients to food fortification. The purpose of this grounded theory study was to explore the perceptions of women in an urban city in Nigeria on indigenous foods and Western dietary influences to determine social interactions, the consequence of the interactions, and the women’s current perceptions of food choices. The social-ecological model was used to explore the interaction between a woman and her environment. Women between the ages of 20 to 30 from the urban city of Jos, Nigeria, constituted the population of interest, and 12 women were chosen for the sample. From the in-depth interviews, a thematic analysis was employed to provide sociocontextual reasoning for changes in diet that have led to the loss of interest in traditional foods and cultures. This study found that Jos has a variety of foods, yet women choose the same staple foods to feed their families. Additionally, despite a marginal understanding of the health impact of diet, most women choose the convenience and palatability of Western options, citing cost as the rationale for choosing to cook staple Western-inspired meals at home. Understanding media, convenience, and cost can impact social change by enlightening communities on the interconnectedness of human health, cultures, and industrialization. Health care providers can monitor the outcomes of those who consume a variety of indigenous foods to see how such a practice could influence the overall health status of Nigerian families.