Around the world, women are subject to an earlier incidence of cataracts, have a higher risk for cataracts, and also have a higher risk for other vision-related problems than men. Previous research has indicated an association between endogenous lead stored in long bones and cataracts in men over 60 years of age; however, a similar study in women did not reveal an association. This case control study was conducted to investigate whether perimenopausal mobilization of endogenous lead serves as a possible causative factor for women's generalized vision issues and cataract incidence in particular. Secondary data were gathered from 1,416 women aged 40 to 55 years of age from the 2005-2006 and 2007-2008 National Health and Nutrition Examination Surveys. Variables of interest included vision-related issues, cataract surgeries, bone density data, blood lead levels, and markers of lead mobilization. The results of the logistic regression analysis in the absence of confounders (OR = 1.50, 95% CI [1.08, 2.09]) indicated that endogenous lead is a possible causative factor for the low-level vision problems women experience during their perimenopausal years. Chi-square analysis of mobilized lead was also associated with cataract surgeries, p < .05. This appears to be the first report of a possible association between lead and cataracts in women and highlights the need for women to be studied in the context of their biology when their clinical results differ from those of men. These results should engender positive social change initiatives to minimize women's perimenopausal exposure to endogenous lead. Recommendations for further research include a case control study, which includes plasma lead levels, and a longitudinal study.

Health care provider perceptions of typical practices play a significant role in evaluating the efficacy of screening and diagnosis of teen high blood pressure in African Americans. African American adults are more likely to develop high blood pressure than are any other ethnic group; however, there is a gap in the literature concerning high blood pressure in teens. Approximately 1 to 5 of every 100 children has high blood pressure. This purpose of this phenomenological study was to explore the perspectives of health care providers on high blood pressure screening and diagnosis of African American asymptomatic teens. The health belief model (HBM) was the conceptual framework used to describe how beliefs and attitudes influence provider high blood pressure screening. Purposive sampling resulted in 9 health care providers (8 pediatricians and 1family medicine physician), who completed a hypertension survey and individual interview. Data were coded and analyzed using thematic analysis. Atlas.ti was used for data management. Theoretical saturation was reached after 9 interviews. Emergent themes included observations from the participants that the absence of initial standardized high blood pressure screening for teens is a significant problem and that age-appropriate high blood pressure resources are not used consistently. Study results contribute to social change by providing an opportunity for heightened awareness and education among health care providers in teen high blood pressure screening and diagnosis processing. Ongoing education and research may engender proactive steps to develop universal guidelines, tools and practices to consistently and accurately detect high blood pressure in teens.

Native Americans have high rates of teen births and intimate partner violence, though little is known about how historical trauma impacts these experiences. The research that has been conducted on teen pregnancy and violence has been among reservation-based Native Americans; little research has been conducted on the experiences of urban Native Americans. The research question for this study examined the potential impact of historical trauma on the lives of parenting urban Native Americans. This phenomenological study gathered the narrative lived experiences of participants via semistructured interviews. Purposeful random sampling was used to recruit 7 parenting urban Native American teens aged 18 to 25 residing in Albuquerque, New Mexico. Interview responses were transcribed and entered into NVivo11-© to support the analysis. Nine themes were identified: chaos; trauma; violence; family, with the subcategory of negative family experiences; responsibility; altered life plans; historical trauma as defined by past events; traditions; and sense of belonging. It was not explicit how historical trauma as defined in the literature had impacted the lives of urban Native Americans and how they raised their children. However, the participants experienced violence and trauma, which impacted outcomes in their lives. The social implications of this study are that it supports the development of culturally sensitive interventions targeted towards urban Native Americans. The findings of this study identified gaps in services for urban Native Americans that community groups and other agencies can use to develop or expand targeted support services focused on urban Native American needs.

Approximately half of all female adolescents and young adults suffer from body dissatisfaction and, in turn, body image-related health concerns. Poor body image can contribute to various negative health behaviors including low self-esteem, depression, anxiety, eating disorders, and suicide. Research indicates a positive relationship between physical activity and self-esteem, and between self-esteem and body image. However, a paucity of research examines the effect of physical activity frequency on the body image of young women with two-like body compositions, as measured by body mass index (BMI). Based on self-discrepancy theory, self-schema theory, and the health belief model, this quantitative study explored the difference in body image in 18- to 20-year-old females within similar BMI categories who differ in physical activity frequency. A survey design was employed to measure BMI and physical activity frequency, the independent variables. Body image was the dependent variable. Participants were 161 females between the ages of 18 and 20 years who were grouped into a BMI category of overweight, normal weight, or underweight based on self-reported height and weight. Participants completed a survey on physical activity frequency and body image from 2 previously developed instruments: rapid assessment of physical activity and body image states scale. An analysis of variance indicated that physical activity frequency significantly affects body image among women in the overweight category, and indicated a positive relationship between physical activity frequency and body image. Findings could promote physical education programs and other organized physical activity programs in communities, and in turn, improve body image within young adult females.

This quantitative research is on the efficacy of Minnesota Statute 144.574 enacted in 2005 in response to the growing awareness of behavior leading to inflicted Traumatic Brain Injuries (iTBI) in infants and children. The model for this research is grounded in the Theory of Reasoned Action wherein the education of new parents which graphically explains the physiologic changes to the structural architecture of the brain post-trauma, paired with their signature on a social contract (SC), demonstrated a reduction in incidence. Because the enacted statute does not include the signing of a SC, nor does it require face-to-face education as in the model, Statute 144.574 cannot claim to be completely grounded in medical science. The result is that neither legislators nor the medical and public health community know whether the statute is effective in lowering incidence. This research was designed to explore the difference in the incidence pre-and post-enactment, in rural vs. urban communities, the proportion of incidence and ethnicity, and an ordinal shift in the distribution of severity. All births in Minnesota from 1998 through 2017 were included. Cases defined using International Classification of Disease were extracted from secondary data from the brain and spinal cord injury, hospital discharge, and vital statistics databases. A Z-test was employed to compare the incidence in a control cohort of infants and children born prior to enactment to the incidence of same in an interventional cohort born post-enactment. Results suggest the statute has not resulted in lowering incidence, have uncovered an unanticipated statistically significant increase in rural vs. urban incidence, yet point to a trend in favor of less severe iTBI. These results represent a positive social change which is grounded in the society's imperative and social justice of protecting children by informing public health officials, caregivers, and legislators of the need for meaningful reform and strengthening of programs leading to lowering the incidence of iTBI in children in Minnesota.

Obesity among over-the-road truckers (OTRs) is an epidemic creating significant public health issues among this population. The consequences of obesity (hypertension, diabetes, heart disease) put both truckers' health and their medical clearance at significant risk. The purpose of this study was to examine the impact of gender, physical activity, diet, and sleep on obesity among OTRs. Through a socioecological lens, this study examined whether obesity is significantly impacted by gender, physical activity, nutrition, and sleep. This study also examined the impact of the trucking environment on obesity. The study used a quantitative research design and data were collected through a national online survey. Descriptive statistics were used to characterize the sample. The final sample size analyzed consisted of 105 adult men and women. The findings of the research questions were that the source of food for truckers impacted obesity. Truckers who got their food from truck stops and restaurants had a higher incidence of obesity than those who got their food from grocery stores. In addition, those truckers who consumed most or all of their meals/food on the road had higher levels of obesity than those who consumed most or all of their meals in a home environment. In this study, gender was a compelling variable, as women had twice the rate of obesity as men; however, there were more women than men who participated in the study. Limitations included small sample size, unequal gender distribution, and limited ability to advertise the study. Helping the trucking industry understand what contributes to obesity could be the key to creating positive social change through health policy development and implementation. This in turn has the potential to create a healthier workforce in the trucking industry.

Type 1 diabetes mellitus (T1DM) is one of the most frequently diagnosed endocrine and metabolic conditions that occur during childhood. This research study utilized a phenomenological study design to examine how the lived experiences of 20 African American (AA) parents of children with T1DM recruited using social media affects their management and control of the disease among AA youth age 5-17 years old. The interview questions were outlined in categories that tested key constructs of the health belief model (HBM) to determine the perceived barriers, seriousness, and susceptibility to maintaining good glycemic control for their children. Data from each interview was classified and coded to identify and categorize, and then used as codes. Themes were then developed in order to determine intent and importance of the responses. Three themes emerged: the disease's impact on the life of the parents, its impact on the life of the child, and its social impact. The impact on the parents' lives included financial burden and time management. The impact on the lives of the child included, the parent's beliefs and fears about their child's future with diabetes and their child's ability to successfully manage their diabetes. The impact on the socialization for both the parent and the child, included family socialization, how others perceived diabetes and diabetes management, teaching diabetes management to others, and the parent's trust in other's ability to manage their child's diabetes. The findings of this research study provides insight into population based needs for successful diabetes management, such as how to make healthier cultural and ethnic meals and the need for culturally-centered whole family diabetes education, to enhance family relationships and diabetes management.

African Americans diagnosed with diabetes are less likely to self-manage diabetes-specific modifiable risk factors. As a result, utilization of healthcare services occurs at a greater rate than other racial groups, and thereby incurs higher than expected healthcare costs. This ethnographic study explored the elements of diabetes educational material African Americans in a large city in the southern part of the United States found most useful to facilitate self-management of their disease. Bandura's self-efficacy theory provided the theoretical framework. Research questions addressed the preferred educational content, layout of material, and methods for educational delivery and caregiver support. A purposive sample of 30 African Americans with diabetes who had engaged in diabetes education classes participated in this study. Data were collected through in-depth personal interviews, which were inductively coded and then categorized around emergent themes. A key finding of this study is that participants preferred group learning formats, but perceived educational material to be confusing and difficult to understand. They also expressed some preferences for the use of color, pictures, and presentation of graphical information that may provide the basis for a revision of educational materials. Interestingly, participants indicated a tendency to seek out church members rather than family for support. The positive social change implications of this study include recommendations to healthcare professionals to adopt educational curricula that reflect cultural nuances and needs of target populations in order to support better health outcomes for at-risk populations and cost efficiency improvements.

Catheter-associated urinary tract infections (CAUTIs) occur frequently in Intensive Care Unit (ICU) patients, who are hospitals' most vulnerable population. This quality improvement project is the evaluation of 2 interventions used in one acute care facility's ICU to decrease CAUTI rates over a 3-year timeline. The 2 interventions used for the project were 1) an evidence-based guideline developed from the Comprehensive Unit-based Safety Program and 2) simulation-based education for teaching the guideline. Using the Iowa model and Havelock's theory of planned change as a framework, the 2 interventions were evaluated over a 3-year timeline: 2014 pre- intervention, 2015 intervention, and 2016 post-intervention. The results were compared quarterly for the 3 years using the standardized infection rate (SIR) and standard utilization ratio (SUR), which show the effectiveness of preventative activities. Data were obtained from the National Healthcare Safety Network and the results from the project showed an 82.46% decrease in SIR from 2014 through 2016 in Baseline 1, and a 71.33% decrease in SIR from 2015 through 2016 in Baseline 2. This is statistically significant for CAUTI reduction over a 3-year period (p < 0.001). For the SUR there was a 14.29% decrease from 2014 to 2016 in Baseline 1 and no statistically significant difference from 2015-16 in Baseline 2. It can be concluded that an evidence-based guideline taught through simulation significantly reduces SIR and has a positive effect on catheter use. This study contributes to positive social change because it promotes decreased patient length of stay and cost of care and decreases morbidity and mortality for patients. It also has a positive effect on health behavior-related outcomes for the ICU nurses for CAUTI prevention.

When the Minority Health Improvement and Health Disparity Elimination Act of 2007 went into effect, there was a corresponding increase in research focused on cardiovascular disease (CVD) in underrepresented groups, except for 1: culturally Deaf Americans. Guided by the health belief model, the purpose of this study was to determine if there were significant differences in the level of knowledge, perceived barriers, and preventive behaviors associated with CVD among Deaf and hearing employees at Gallaudet University, Washington D.C. This cross-sectional quantitative research study used a survey with questions derived from 2 existing national surveys. One hundred eighty-six subjects were recruited on the campus of Gallaudet University. Chi-square analysis was conducted to seek any association between respondents and cardiovascular knowledge. A t test assessed for association between respondent characteristics and knowledge of CVD. A multivariate linear regression model was used to discover if differences in CVD knowledge score were predicted by socioeconomic factors. Deaf (28%) and hearing (43%) participants differed significantly in identifying all 6 correct signs/symptoms of heart attack (p = 0.04). Hearing females (80%) managed their blood pressure at healthy levels which is twice more than their Deaf female counterparts (61%, p = 0.01). Hearing Blacks (78%) had a discussion of their high blood pressure with their doctor more than Deaf Black counterparts (28%, p = 0.05). Gaining a better understanding of the Deaf health trends on CVD could inspire positive social change that ultimately could improve health for Deaf individuals in the United States.