Minority women groups in the United States have the highest incidence and mortality rates of cervical cancer. Hispanic women have the highest incidence rate and the second highest mortality rate of the disease. Researchers have examined the lower rates of cervical cancer screening among Hispanic women, as compared to other groups of U.S. women, but researchers have not examined the extent to which socioeconomic status, acculturation, and sexual activity impact Hispanic women's compliance with screening. The purpose of this study was to examine the association between compliance with cervical cancer screening and acculturation, socioeconomic status, and sexual activity among U.S. Hispanic women. The framework for investigating the extent of association between these identified barriers and willingness to comply with screening was the behavioral model for vulnerable populations. Chi-square tests and logistic regression were used to analyze data from the National Health Interview Survey for 2011, 2012, and 2013, focusing on U.S. Hispanic women ages 21 - 65 (N = 739). The findings from this study revealed that educational level was significantly associated with U.S. Hispanic women's cervical cancer screening; however, no statistically significant associations were found for socioeconomic status, acculturation, and sexual activity and screening rates for this group. Findings from this study can better inform researchers and others of the lower rate of screening for cervical cancer among U.S. Hispanic women. The findings will also promote positive social change by targeting U.S. Hispanic women and other minority women groups for programs that promote cervical cancer screening.

HIV incidence among Black men who have sex with men (BMSM) is extremely high in contrast to their estimated population size and compared to other racial groups. Researchers have established that a significant proportion of these new cases annually originate from HIV transmission by BMSM who are unaware of their HIV status. The purpose of the study was to assess the relationship between age, sexual behavior, social support, substance use, internalized homophobia, depression, and HIV test history in BMSM. Guided by the social ecological model (SEM) as the conceptual framework, a quantitative cross-sectional study was designed to analyze secondary data from the HIV Prevention Trials Network Study 061. Bivariate and multivariate logistic regression was used to estimate the association. The research goal was to identify strategies to engage BMSM with infrequent/nonexistent HIV testing history into testing services. While there was very little difference between the bivariate and multivariate models, the results indicated that BMSM who were younger in age, had lower levels of internalized homophobia, and were recruited at a particular study site were more likely to have tested for HIV in the past 12 months. The other variables did not show a significant relationship to HIV testing history. Implications for positive social change included informing HIV prevention and testing messages and strategies that will result in an increase in HIV testing among BMSM with infrequent/nonexistent HIV testing histories. This increase in HIV testing among BMSM with infrequent/nonexistent HIV testing histories will reduce the number of BMSM who are unaware of their HIV status and who may subsequently transmit HIV to their sexual partners unknowingly.

The need for increasing efficiencies for medical resource delivery during a mass casualty incident/event is a paramount logistical planning factor that could mean life or death to the citizens affected by a disaster. As such, Washington State has prioritized emergency management and preparedness. Using the just-in-time system by way of Baghbanian' s complex adaptive decision-making theory as the foundation, gave purpose to this qualitative study. This was accomplished by analysis of emergency management professional responses, and to what degree, improvements can be made to the medical resource delivery system during a mass casualty incident/event. Data were collected through semi structured interviews with a random sample of 12 experienced emergency professionals from the State of Washington. This study was guided by primary research questions that focused on emergency managers and their understanding and adaptability toward preparedness. Interview data were deductively coded and analyzed through a thematic analysis procedure. The key theme of this study is that participants perceived slight differences in logistical and operational approaches that vector into transportation and operational understanding as the main factors influencing medical resource delivery. The positive social change association of this study is that it provides emergency managers, first responders, and medical staff with recommendations for analysis and planning development for medical resource delivery, thereby mitigating the life and death implications for citizens in future disasters.

Abstract The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) continue to be a major public health threat, not only within the United States but also on a global scale. Within the U.S. heterosexual population, African Americans (AAs) continue to bear the greatest burden of new HIV infections. Additionally, HIV/AIDS interventions have focused on low-income AA women, virtually ignoring their middle-class counterparts who may be subject to the same sexual risks. The purpose of this quantitative, cross-sectional study was to determine whether if there was an association between the 5 constructs of the Health Belief Model (HBM) and self-efficacy in condom use among middle-income AA women. One hundred and fifty two middleincome AA women were recruited through personal social media accounts and Survey Monkey to participate in this study. Multiple linear regression analyses indicated that 4 of the 5 constructs (i.e. perceived benefits, perceived barriers, cues to action, relationship self-efficacy) were predictors of self-efficacy in condom use, after controlling for age, income, education attainment, and marital status. There was no association between perceived threat and self-efficacy in consistent condom use. The results can inform HIV prevention counseling at the primary care level to reduce the spread of HIV among all AA women. Implications for positive social change include evidence for the need to expand the paradigm for HIV prevention interventions to include middle-income AA women and restructure HIV prevention strategies to address all women of color in the United States.

Despite antenatal care presenting opportunities to identify and monitor women at risk, use of recommended antenatal care services remains. Barriers preventing use of antenatal services vary between countries, and limited knowledge exists about the link between geographical settings and antenatal service use. The objective of this cross-sectional quantitative study was to explore geographical variations and investigate how social demographic characteristics affect use of antenatal care for women in Sierra Leone using the Andersen behavioral model. The data used were from the 2016 maternal death surveillance report of the whole counrty (N =706). Logistic regression analysis was used to determine the individual predictor effects on antenatal care, including geographical location, the age of women, marital status, parity, and institution of birth impact. Southern, Northern, and Eastern women had significantly lower odds of attending the recommended antenatal services compared to women in the Western region (OR = .517, p = .019; OR = .497, p = .021; OR = 0.014, p = .041, respectively). The odds of married women attending the recommended antenatal services was 7.3 times more than that of the single women (OR = 7.397). Also, significantly associated with less uptake of recommended antenatal visits was lower education level among women (OR = .517). This study will contribute to positive social change by highlighting inequities in antenatal care use among women, thus allowing for accurate targeting of health promotion programs and ultimately saving lives of mothers and children of Sierra Leone through more inclusive policies.

Synthetic xenoestrogens have differential estrogenic properties. Research has shown that exposures to xenoestrogens could promote breast cancer by disrupting normal function of the human epidermal growth factor receptor 2 (Her2) gene. Although animal models demonstrated a connection between xenoestrogen exposure and Her2 activity, no study using human cells has systematically examined their carcinogenic potential influencing the Her2 gene expression. Furthermore, breast cancer cells are phenotypically disparate (ER+, Her2+), with some phenotypes (Her2+), leading to more aggressive disease. This study aimed to dosimetrically assess the carcinogenic potential of commonly used xenoestrogens influencing Her2 gene expression, and delineate cellular phenotypes at greater risk of more aggressive disease. The study assessed whether the composition, concentrations, and exposure duration of BPA, EE, NPH, and DDT significantly altered Her2 copy numbers in estrogen and Her2 receptor positive or negative breast cancer lines. Each line was randomly assigned to cases (exposed) and control (unexposed) groups using a randomized block design. Fluorescent in-situ hybridization measured Her2 gene copies. Mann Whitney, Kruskal Wallis, and Incidence Rate Ratios revealed Her2 copy gains in all 4 xenoestrogens and receptor types with persistent exposures. A 44% increase in Her2 was observed in the normal ER and Her2 line, marking a shift in its Her2 status, and a 30-times greater risk was noted in the Her2+ lines. These findings promote positive social change by revealing all 4 xenoestrogens as risk factors for breast cancer. This information can be used by breast cancer advocacy groups, health educators, and steering committees to educate women and formulating policies.

Childhood overweight and obesity are public health concerns that have negative health consequences and affect many children. Efforts are needed to identify children who are at a higher risk of developing overweight and obesity so that early detection and treatment may be offered. The intent of this study was to investigate the differences in the effects of postpartum depression on infant feeding practices and infant weight gain between Hispanic and African American women. Data were obtained from Infant Feeding Practices Study 11, a longitudinal study involving mothers in their third trimester through infants first year of life. The overall test of model coefficient of complete cases (N = 192, missing = 443) was not statistically significant (x-² = 4.842, df =2, p = 0.089). The result of the overall test after multiple imputation (n = 289) remained insignificant (on average x-² = 4.031, df = 2, p = 0.133). However, results indicated a significant association between excessive infant weight gain and feeding practices (breast feeding vs. formula feeding; r = 0.207, p = 0.01), supporting previous research on the protective effect of breast feeding on excess infant weight gain. Positive social change implications include an understanding of how maternal and infant characteristics may identify early symptoms of maternal depression, through increased awareness and reduced incidents of childhood obesity and maternal postpartum depression.

Tularemia is a vector-borne disease of global concern with diverse regional foci. Arkansas is an endemic state with differences in case distribution and land suitability supporting host and vector sustainment. The aim of this study was to conduct a geospatial and spatiotemporal assessment of factors associated with case distribution and timeliness and completeness of public reporting. Guided with direction from spatial epidemiology and nidality, referring to the association of ecology, climate, and proximity of disease, analysis included secondary data collected from the Arkansas Department of Health between 1995 and 2018. Using Poisson-based software, 2 clusters were found: a high-risk cluster encompassing 23% of the total population within 24 counties spanning an 8-year period (RR = 4.98, p < 0.05), and a low risk cluster that included 25% of the population within 28 counties during a 12-year period (RR 0.14, p < 0.05). Analysis of ecological data revealed associations between annual precipitation within the high-risk cluster and total number of cases (AUC = 0.716 and AUC = 0.726, respectively) with trends toward higher incidence rates in suitable land cover and moderate to high elevation using maximum entropy software. Analysis of timeliness and completeness revealed gaps for clinical form and transmission mode determination (p < 0.05), while increases in probable cases followed decreases in confirmed cases revealing gaps in laboratory diagnostics. Positive social change necessitates multidisciplinary collaboration between climatologists, clinicians, and epidemiologists to reach high-risk populations and promote educational awareness. The potential for social change includes predictive modeling optimizing funding while representing underserved populations.

Back pain is a chronic disease epidemic and the most common chronic painful condition in Americans. It is associated with human suffering and enormous financial and social burdens. Smoking is a prevalent and harmful health behavior and is the greatest modifiable risk factor for many chronic diseases. Cigarette smoking is associated with back pain, but there is little research on this relationship among adults in the United States. Using biopsychosocial theory, this study examined (a) the prevalence of back pain (dependent variable) among smokers, former smokers, and never smokers (independent variable), and (b) the influence of age, sex, race, body mass index, level of physical activity, level of education, depression, and anxiety on predicting the likelihood of back pain. This cross-sectional secondary analysis of the 2012 National Health Interview Survey included over 34,000 respondents and utilized chi-square distribution, t test, one-way analysis of variance, and multiple logistic regression analysis. People who self-reported being anxious or worried, had been diagnosed with depression by a health care provider, were current or former smokers, obese, or failed to meet recommended levels of physical activity were more likely to have back pain. This study has implications for social change in the United States because it shows that anxiousness, depression, smoking, obesity, and low physical activity are risk factors for back pain in Americans. Further, it indexes the need for primary studies of the relationship between smoking and back pain to determine whether smoking is causal for back pain. These studies could lead to public health interventions that develop strategies to prevent back pain and thereby alleviate some of the social burden associated with this common and costly ailment.

Although the human papillomavirus (HPV) vaccine has been approved by the Federal Drug Administration (FDA) and is available for males and females, completion of the 3-shot series in Georgia remains relatively low. The purpose of this study was to examine the predictors of HPV vaccination initiation and completion for male and female adolescents, ages 13 to 17 years old, in Georgia between 2013 and 2015. The theoretical foundation of the study was the structural model of health behavior which is an ecological model. Logistic regression was performed to determine if there was any relationship between the independent variables of parental knowledge, providers' recommendation, and physical access to vaccination sites, and the dependent variables of vaccination initiation and completion while controlling for and separately testing the impact of age, race, and gender. The data sets from the Centers for Disease Control and Prevention, National Immunization Survey-Teen from 2013-2015 were used. There was no significant difference in HPV vaccination initiation or completion for any of the 3 years that were analyzed related to parental knowledge, as indicated by a p-value.