Environmental tobacco smoke (ETS) is a serious public health threat. Residual ETS in vehicles unknowingly exposes future occupants to environmental tobacco smoke. Reducing or removing exposure to ETS has been proven to reduce long-term health complications. This quasi-experimental study investigated 5 cleaning methods and their effect on air particulate matter2.5 (PM2.5) along with the correlation between air nicotine levels and PM2.5 levels. Study variables included cleaning methods as the independent variable, and changes in air nicotine and PM2.5 levels as the dependent variables. This study is framed within primary prevention and risk reduction based on the harm reduction theory. The harm reduction theory professes that when a hazard cannot be completely removed, methods to reduce the social and personal costs associated with the hazard should be developed. Fifty vehicles were placed in 5 groups: car wash vacuumed, shop vac vacuumed, air change, hand held vacuumed, and Hepa filtration air cleaned. Nicotine and PM2.5 levels were measured before and after cleaning. A Wilcoxon ranked test analysis of the data showed all methods of cleaning studied had a statistically significant decrease in both air nicotine (Z = -6.154, p < .001) and PM2.5 levels (Z = -5.934, p < .001). Kruskall-Wallis analysis showed no statistical significance between cleaning methods. Correlation analysis determined no correlation between nicotine and PM2.5 (r value = <.3). Results of this study provides public health program professionals with information linking cleaning methods to reduction of exposure to ETS. Positive social change comes when programs are developed to training and education people to reduce their exposure, resulting in an increase in health and a decrease in medical costs.

Posttraumatic stress disorder (PTSD) is a psychiatric condition that presents with 3 main symptoms're-experiencing, avoidance/numbing, and hyper arousal'after an individual experiences a traumatic event. Recent evidence suggests a potential genetic basis for PTSD and a sub symptom of hyper arousal, sleep, as a potential pathway for PTSD development, but no study has identified candidate genes associated with specific symptoms such as sleep difficulty. Based on a conceptual framework in which specific genes are associated with the onset of PTSD, this study used a genome-wide association study (GWAS) method with a case control study design to compare the genomes of individuals with and without PTSD. A secondary GWAS dataset from a study on alcohol dependence in European and African Americans was obtained from the National Center for Biotechnology Information. PTSD cases and controls were analyzed using PLINK software. Signals from 2 single nucleotide polymorphisms (SNPs), which have not been previously associated with PTSD, exceeded the established genome-wide threshold: SNP rs13160949 on chromosome 5 (p = 7.33x10-9, OR: 1.565) and SNP rs2283877 on chromosome 22 (p = 2.55x10-8, OR: 1.748). Neither SNP, though, maintained genomewide significance following corrected tests for multiple testing, population stratification, and false discovery, so the planned analysis for possible associations with PTSD by symptom category then by the sub symptom of sleep could not be completed. The results of this study suggest that PTSD may be the result of polygenic SNPs with weak effects, which supports a recent study indicating the disease may be highly polygenic. Positive social change implications include bringing attention to the clinical and research community that PTSD may involve complex polygenic factors in need of further study.

Obesity is a national health problem with serious medical, psychological, and economic outcomes. Nurses and nurse practitioners (NPs) are frequently the first point of patient contact and play an essential role in the management of obesity. The current literature noted that practitioners working in primary care settings demonstrate inadequate knowledge related to evidence based practice (EBP) strategies to treat obesity, including diet modification and physical activity. The purpose of this DNP project was to develop and validate an EBP provider educational module related to diet modification and physical activity education for adult patients diagnosed with obesity in a primary care setting. The theoretic frameworks used in this DNP project included the theory of planned behavior, the health belief model, and the plan-to-do-study-act model. Five clinical experts on adult obesity were asked to review the newly developed education module and complete a 4-point Likert scale survey evaluating the module content. Experts were encouraged to provide additional recommendations at the end of the survey. Descriptive analysis was used to analyze the survey data and 100% of the experts strongly agreed that the module contained comprehensive content related to adult obesity pathology, patient behavior modification, and the benefits of evidence-based adult diet and physical activity guidelines. Experts also strongly agreed that this project will strengthen provider skills related to history intake, assessment, and physical examination of obese patients. The project promotes positive social change in the primary care setting by improving provider awareness, knowledge, and EBP management guidelines of adult obesity patients.

The Supplemental Nutrition Assistance Program (SNAP) is the United States' largest government assistance program that aims to alleviate food insecurity. The SNAP program allows low-income individuals and families the ability to purchase nutritious foods through a monthly benefit. However, the current body of literature presents evidence of the program's counterproductive effect. The purpose of this study was to determine whether incentivizing SNAP recipients to purchase additional fruits and vegetables was beneficial in increasing such purchases. Social cognitive theory was used as a theoretical framework to address research questions associated with shopping patterns and attitudes and beliefs. This quantitative study used a randomized controlled trial to study differences between incentivized and control groups. The Healthy Incentives Pilot Program (HIP) used a stratified sampling of 55,095 SNAP households receiving benefits between July, 2011, and December, 2012. Statistical analyses (t test, Pearson correlation, and multiple regression analysis) were conducted to identify changes in food shopping patterns and eating behaviors associated with the HIP intervention. Results indicated that (a) incentivizing SNAP recipients leads to an increase in fruit and vegetable purchase, and (b) a correlation exists between fruit and vegetable purchase and attitudes and beliefs. No correlation was found between the intervention and changes in food shopping patterns. Positive social change implications include the improvement of health outcomes in over 43 million people currently enrolled in the SNAP program on a national level.

African-born residents of the United States have a higher incidence of HIV than African Americans. Factors such as lifestyle, habits, behavior practices, and activities may predispose African-born residents to behave sexually in ways that place them at risk of becoming infected with HIV. This study used a qualitative narrative approach to understand the lived experiences first generation Sub-Saharan African-born men who are U.S. residents to analyze the behaviors that expose them to HIV. To analyze data, the study used the health-belief model as the conceptual framework and NVivo for data analysis to assist in identifying, categorizing, and analyzing common themes and grouping unstructured data. The study used a purposive convenience sampling of 14 first generation Sub-Saharan African-born men who are U.S. residents residing in the states of Delaware, New Jersey, and Pennsylvania and discovered that they engage in sexual risk taking behaviors which include: having multiple sexual partners, preferring heterosexual relationships without a condom, have limited knowledge of HIV prevalence in the United States, and preferring to have sex with both African born females and American born women who are thought to be healthy. Their tendency to visit strip clubs, visit sex houses, and to abuse alcohol was also apparent in the study. Social change implications include adding new relevant knowledge in the understanding of how HIV spreads among Sub-Saharan African-born male U.S. residents by discovering the risk behaviors in which Sub-Saharan African men engage to expose themselves to contracting HIV disease. This knowledge can influence future health education efforts and target culture specific behaviors.

Vitamin D is essential to optimizing health; vitamin D deficiency (VDD) can increase risk of hypertension, cardiovascular disease, and insulin resistance. VDD occurs when individuals do not receive sufficient oral intake or obtain adequate sun exposure. Previous researchers indicated there is a relationship between VDD and depression, while others have indicated there is no relationship. The purpose of this study was to examine the relationship between vitamin D levels and depression, and how this relationship might be moderated by an individual's demographic characteristics (gender, age, smoking status, or marital status). This study was a quantitative data analysis of archival data from the 2005-2006 National Health and Nutrition Examination Survey. The Health Belief Model was the theoretical framework. An ex-post facto exploratory analysis was used to test 2,623 adults located throughout the United States. Employing moderated multiple regression, a significant relationship was found between vitamin D levels and depression (p. < .001); however, the relationship was not moderated by demographic characteristics (gender, age, smoking status, or marital status). This study supports prior researchers who affirmed a correlation between vitamin D levels and depression. Given the definitive findings, practitioners should continue to recommend intake of vitamin D to individuals not meeting recommended daily dosages, but recommendations should not be based on gender, age, smoking status, or marital status. Understanding the connection between VDD and depression provides a basis on which to foster positive social change at the individual, family, organizational, and societal level.

Although Lyme disease is the most frequently reported vector-borne illness in the United States, recent evidence from the CDC suggests that Lyme disease incidence in the United States may be much higher than reported. Lyme disease symptoms can be mistaken for a wide variety of diseases, which can complicate the diagnosis. To date, no diagnostic criteria analysis has been conducted examining the association between sociodemographic variables (sex and age) and seasonality of infection with the severity and symptomology found in Lyme disease cases. Using the CDC's outbreak investigation model, a primary case/control study was conducted using the ROSS Scale to collect data. Comparisons were made between a Lyme disease-diagnosed group (n = 203) and a convenience sample of non-Lyme disease patients (n = 388). Novel symptom patterns were found to significantly predict a diagnosis of Lyme disease. Odds ratio results revealed a positive association between musculoskeletal (OR = 11; 95% CI), neurological (OR = 12; 95% CI), cognitive (OR = 10; 95% CI), and cutaneous (OR = 144; 95% CI) symptoms frequency and severity and the diagnosis of Lyme disease. In addition, overall symptom frequency and severity scores displayed significant differences between cases and controls, between males and females, and among certain age groups. No correlation was found between symptom frequency and severity with the seasonality of infection. Current diagnostic tools search for antibodies to the Borrelia bacteria, but antibody production takes a few weeks. The results of this study help identify at-risk patients based on the presentation and severity of Lyme disease symptoms when antibodies are not present in measureable quantities in the blood stream, allowing for earlier diagnosis.

Over the past few decades, there has been an increase in prevalence of diabetes in the United States. Prevention of diabetes and improving patients' knowledge and awareness of diabetes are crucial for healthcare providers. Using the Health Belief Model (HBM) as a theoretical foundation, the student used the National Diabetes Prevention Program (NDPP) from the Centers for Disease Control and Prevention (CDC), to improve awareness and knowledge of diabetes among obese individuals with prediabetes. The key research question of this project was to determine whether the patients' diabetes knowledge and awareness improved after the NDPP program. A convenience sample of 30 participants was recruited from patients seeking care at a family practice clinic. Data collection was conducted using the Michigan Diabetes Research and Training Center's Diabetes Knowledge Test (DKT). Pretest and posttests were used to evaluate improvement in the participants' knowledge and awareness after administration of education sessions. The t-tests indicated a significant improvement in the patients' knowledge (p < 0.000) and awareness (p < 0.000) of diabetes after the NDPP program. Thus, the NDPP program was effective in improving the patients' diabetes knowledge and awareness. The nationwide adoption of the NDPP program was recommended to reduce the rate of diabetes among high risk individuals. The implication of this Doctor of Nursing Practice (DNP) project to social change was that improving knowledge and awareness of diabetes among obese patients with prediabetes would increase their participation in lifestyle and behavioral modification programs, thus, improving the control of blood sugar levels.

As childhood obesity continues to increase, so do the comorbidities and related health issues, putting youth at a greater risk of developing adult-related diseases such as hypertension, Type 2 diabetes, and cardiovascular diseases. Current literature indicates that healthcare organizations have a significant role in the fight against this epidemic, yet most children's hospitals have no policy to accomplish this task. The purpose of this project was to develop a program proposal for a hospital-based, sustainable obesity program that will aid in improving patient and family awareness of the importance of maintaining an ideal body weight to decrease the incidences of obesity-related comorbidities in pediatric patients ages 2-19 with a Body Mass Index (BMI) greater than or equal to 30. Lewin's theory of planned change and the logic model were used as the theoretical framework to guide the change process for this project through its development. To that end, the proposal was accepted at the site by the executive leadership in consideration for full implementation and evaluation. Key stakeholders and content experts were brought together to create the proposal for the program which includes an algorithm to guide care. The results of this project, once adopted will promote positive change in the quality of life, decrease BMI to a healthy limit, improve overall population health, and reduce healthcare expenditure. Additionally, dissemination of results of the project may stimulate changes in other children's hospitals to adopt the measures of care in the fight against childhood obesity, and contribute to social change. .

Type 2 diabetes disproportionately affects low-income African American women, age 50 years and older: 30% to 40% of this population has this chronic disease. Two significant factors affecting poor diabetes practice adherence are food insecurity and depression; another is obesity. The purpose of this quantitative correlational study was to determine if either food insecurity or depression significantly affect Type 2 diabetes self-management practices; and/or if food insecurity significantly influences practice adherence indirectly, through the mediator of depression, while controlling for obesity. The research questions were aligned with the theoretical pathways posited in Matthews's reserve capacity model (RCM) and used the most current national data from the 2015 BRFSS dataset. The results of the linear regression models indicated that as hypothesized, depression was significantly associated with poor practice adherence; contrary to hypotheses, food insecurity and obesity were not. The lack of significance between food insecurity and depression eliminated the need to test for mediation. While correlational analyses revealed a significant association between obesity and depression, this relationship was no longer detected in linear regression analyses. An unanticipated finding was the significant relationship between education and Type 2 depression self-management practices, a relationship that maintained significance even with the entry of depression. These findings have implications for positive social change in the form of preventative interventions aimed at weight-loss and/or reducing depression among African American women at risk for developing Type 2 diabetes.