In the United States, many private wells are used as the only source of potable water. These wells, under current federal and state regulations, are neither monitored nor checked for water purity. The purpose of qualitative case study was to gain an understanding about how the documented nitrate contamination problem in the Lower Yakima Valley River Valley is perceived by members of the community and to measure their willingness to engage in collective action for social change. Purposive samples of 6 participants were interviewed using 10 questions derived from the drinking water disparities framework by Balazs and Ray. Additional historical information and data were reviewed. While analyzing interview responses, observations, and documents to understand how the documented nitrate contamination problem, themes and patters emerged and were identified. According to the study results, the community was not actively engaged in any communication regarding the nitrate contamination. Private well owners hold beliefs about the safety of their individual water supply but had no knowledge of the water quality being used by their friends, neighbors, and families This community, if engaged in a collective action to deal with the nitrate contamination problem, could be successful in influencing larger organizations, such as state and federal governmental entities, to work toward nitrate contamination source identification and remediation.

Type 2 diabetes is epidemic in the American Indian population. One problem health care providers face when working with the American Indian population is communicating about secondary complications, such as periodontal disease. From a public health standpoint, periodontal disease prevention is important not only to prevent unnecessary oral pain and tooth loss, but also to prevent other more serious systemic problems from occurring such as cardiovascular disease, strokes, and bacterial pneumonia. The purpose of this qualitative study was to examine the communication efforts of health care providers and understand if and how they discuss periodontal disease with their American Indian patients with type 2 diabetes. Structured interviews were conducted with health care providers at an American Indian community clinic using questions based on the model of communication competence. Data analysis consisted of an analysis of the interview transcripts looking for concepts, themes, and events to see if discussion of periodontal disease is occurring at diabetic visits. Results of the study showed that although all the providers knew about the link between diabetes and periodontal disease risk, not all the providers were discussing the risk with their patients, and time, perceived health literacy, and other priorities all played a role in the lack of communication. This finding has the potential to influence positive social change by being an impetus for change in current diabetic patient care policies in the areas of communication and education regarding American Indian patients with diabetes about periodontal disease risk.

The disparity between survival rates for Black and White women with breast cancer is well documented and has been examined in terms socioeconomics, environment, tumor type, and genetics. However, there is little examination of the role of health care facilities in cancer disparities. Health care facilities are representative of societal norms and beliefs that include location, quality of care, finance, policies, and staffing; therefore, they are a proxy for social justice and social change. The purpose of this study was to examine correlations between health care facility type; social determinants of cancer such as poverty, culture, and social justice; and breast cancer survival rates. Using the social determinants of cancer theoretical framework, the breast cancer survival rate of 4,087 Black and White women in Georgia between the ages of 45 and 69 was studied. The relationship between breast cancer survival and predictors including race, income, health care facility type, grade, and tumor type (4 sub-variables) were examined using the Kaplan-Meier Method, log-rank test, and Cox proportional hazard model. The log-rank test suggested no statistically significant difference in the survival functions among patients in different health care facilities (Ï?2(2) = 0.0150, p = 0.9926). The Cox proportional hazard model suggested no statistically significant relationship between breast cancer survival and health care facility type, after controlling for other predictors (Ï?2(2) = 0.3647, p = 0.8333). This result indicates that healthcare facilities do not influence breast cancer survival rates, however, given the persistent health outcome disparities further research in the area is warranted.

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.

Vaccination is regarded by many as the most effective means of reducing influenza infection and disease; however, many people in the United States are hospitalized from flu-related illness each year. Adults 65 years and older account for more than half of these hospitalizations and almost all flu-related deaths. This project aimed to identify barriers to receiving the influenza vaccine among the adult population (> 65 years of age) in a community setting. The goal was to develop a teaching tool that would assist practitioners towards improving influenza vaccination rates among this population. The Health Belief Model was the theoretical framework utilized. The project was conducted at a primary care practice located in a community outside of New York City. Fifty participants (> 65 years) with no prior influenza vaccination were invited to take part in a short survey involving immunization status and reason for lack of influenza vaccination. Participants completed a researcher designed survey in a private location within the practice setting. Descriptive analysis was completed. Results revealed that 45 (32 females and 13 males) participants refused the influenza vaccine based on fear of becoming infected with the flu from the vaccine itself. The remaining 5 (males) participants based their refusal on never having the flu and therefore deemed the vaccine unnecessary. An educational handout was developed to aid in patient education related to influenza vaccination. Future implications involve the utilization of this tool by all healthcare worker and providers, as well as educating the target population in all community settings where influenza vaccines are administered, ultimately reducing the incidences of influenza and its associated complications by overcoming barriers to vaccination.

Alzheimer's disease (AD) is the 6th leading cause of death in older Americans. Currently there is no cure for AD, and even though the specific cause is unknown, diabetes mellitus type 2 (DM2) is regarded as a risk factor. Hispanics have a higher incidence of DM2 and possibly AD. I chose a life course theoretical model for this quantitative cross-sectional study to illuminate the variables most pertinent to a pathway from good health to poor health. The variables chosen were hypertension (HTN), obesity, smoking, stroke, dyslipidemia, and lower educational attainment. The research questions were used to examine biologic, metabolic, sociologic, and genetic risk factors in the development of DM2 and subsequently, AD. Using data from the National Alzheimer Coordinating Center, the association between DM2 and AD in Hispanics over 65 years of age was examined using Ï?2 and logistic regression to determine whether DM2 in this population contributes to AD development. No association was found between DM2 and AD (OR .791, 95% CI = .441-1.509, p = .476). Risk factors independently associated with AD were HTN, a history of stroke, and lower education in Hispanics. Obesity measured by BMI, dyslipidemia, smoking, and the APOE gene was not significant in their association to AD. This study offers information that medical providers can use to help determine which risk factors affect this population and may thereby alter the course of AD in their patients. Medical providers can make a significant impact on an individual's life by diagnosing dementia early. Early diagnosis could prevent or delay cognitive dysfunction and improve quality of life by using culturally and linguistically appropriate tools.

There is a high HIV prevalence rate for Black women in Virginia; however, few scholars have examined how sexual assertiveness and self-esteem against HIV vary within this group. Black women who have low levels of self-esteem may increase their risk for HIV. The purpose of this quantitative cross-sectional study was to determine if four aspects of sexual assertiveness (sexual initiation, sexual refusal, HIV/AIDS/STD communication, and contraception/STD prevention) differed across demographic categories and were associated with self-esteem in a diversified group of Black women living in Virginia. A cross-sectional survey was conducted with a community-based sample of 117 adult Black women. The social cognitive theory was the framework that guided this study. ANOVAs were used to determine differences in means of the four sexual assertiveness subscales across the demographic categories (age, sexual orientation, income, education, and relationship status. HIV, AIDS, and sexual transmitted disease communication assertiveness mean scores were significantly higher among higher income Black women (padj=.016) and Black women with a college versus a high school degree (padj=.047). Moreover, Pearson bivariate correlation results showed self-esteem was significantly positively associated with all but one measure (sexual initiation) of sexual assertiveness. Health educators can use the findings of this study to create education initiatives that focus on building self-esteem and sexual assertiveness behaviors among Black women as an HIV/AIDS prevention method.

Adolescent pregnancy and the sexual behaviors of adolescents continue to be robust public health and social problems in Caribbean countries such as Jamaica. Numerous researchers have conducted studies on the impact of sex education on sexual behaviors and pregnancy patterns among adolescents with mixed results (i.e., a lack of knowledge) especially in rural communities. The purpose of this study was to ascertain the impact of school- or home-based sex education on sexual behavior and pregnancy patterns of adolescents aged 15 —19 years in the rural community of St. Thomas, Jamaica. The parental expansion of the theory of planned behavior and cognitive behavior theory constituted the theoretical foundation for this quantitative descriptive cross-sectional study. Secondary data from the 2008 Jamaica Reproductive Health Survey (N = 8,200) were analyzed. Descriptive statistics, chi-square, and Cramer's V were computed to determine the relationship and strength between the independent variables (school- and home-based sex education) and the dependent variables (pregnancy and sexual behaviors of adolescents). The results indicate a weak negative inverse relationship that was not statistically significant between sex education in school and sex education at home on adolescent pregnancy. There is a weak positive relationship between sex education in school on condom use and a positive measure of association between sex education at home on condom use. This study may be significant to local community health departments seeking inventive techniques for improving and enhancing existing programs. The results of this study also contribute new data on the impact of sex education on adolescent pregnancy and the sexual behavior of adolescents.

Although occupant protection laws exist, limited research has been conducted on how current child passenger safety (CPS) issues and CPS marketing strategies relate to child passenger safety seat (CPSS) usage. The purpose of this cross-sectional study was to analyze the relationship between parents' perception and knowledge of CPS issues and CPSS usage rates. The diffusion of innovation and the social marketing theories provided the frameworks for this study. The overall research question for the study examined the correlation between parents' knowledge of CPS issues and CPSS usage. Data (participants' surveys, car seat check-up information, and observational statistics) were collected from events that occurred in 3 locations across the county. The population consisted of a convenience sample of adults (parents of children 8-years-old and younger) from each of the locations. The study survey was distributed to 93 participants and only 71 surveys (76.34%) were received for analysis. Data analysis methods included deductive coding, Cronbach's alpha, descriptive statistics, hypotheses testing, linear regression, and Pearson Correlation. The overall test results showed that there were no significant relationships between the independent variable predictors (parents' knowledge of proper CPSS installation techniques, CPS laws and regulations, and marketing strategies) and the dependent variable (CPSS usage rates). The overall study was not statistically significant. The study should be replicated, however modified (on a larger scale for a longer period). Thus, having a stronger possibility to impact the community (producing noteworthy results and promoting social change).

Nigeria is a patriarchal society, which puts women in subordinate positions that may prompt gender-based discrimination. While evidence of this phenomenon has been investigated in Nigeria and other African countries, no such investigation has been conducted with immigrant and first-generation Nigerian women in the United States. The purpose of this study was to examine the role of a Nigerian woman's perceived empowerment and status on her willingness to access reproductive health services. The research questions examined views of Nigerian traditional beliefs' influence on status and how attitudes around traditional beliefs relate to access to reproductive health services and/or knowledge. Data were gathered through semi structured interviews with 9 Nigerian women in the Washington DC-Maryland-Virginia area. The women were recruited using purposive and snowball sampling. Data were analyzed using the ecological systems theory as a framework, which theorizes that a woman's status is related to her ability to access services or information; empowerment increases that access of services/information, and that traditional Nigerian beliefs have mostly positive effects on their status. However, the findings revealed that, among these 9 women, traditional beliefs did not have an overwhelming direct effect to access to services or information. Empowering women is vital for social growth, no matter what the place of origin. This study contributes to positive social change by providing a resource that demonstrates the importance of these women's contributions to society, thus helping to move society forward.