Following completion of a 4-year nursing program, some graduates have difficulty applying theories learned in the classroom to the clinical environment. This difficulty results in healthcare employers providing additional in-house training to ensure graduates' ability to safely care for their patients. The purpose of this research was to explore how traditional lecture methods have prepared students for the clinical environment. Based on a constructivist theoretical framework, a case study design was used to examine students' learning of theories delivered by traditional lecture methods. The research questions focused on student activities in the classroom and clinical setting, teaching strategies, critical thinking skills, and transfer of theory. Interview and observational data were collected from 10 randomly chosen students, their instructor, and 2 preceptors. Data were analyzed through a manual coding process, one that sought to identify emergent themes. Observational data revealed that nursing students were disengaged during the 3-hour lectures. Interview data revealed that students preferred that nursing skills be demonstrated prior to implementation. Both sources of data revealed that the 3-hour lectures should be divided into segments, that simulation and hands-on demonstration be incorporated in the curriculum, and that repetition should be allowed during instruction to accommodate different learning styles and increase students’ confidence. These findings have implications for positive social change by improving the transfer of theory from the classroom to the clinical setting through use of a newly developed 9-week participative curriculum project for nursing students in the childbearing class. Improved preparation of graduates will increase safe care of patients in the community.

Diabetes has quickly become an epidemic in the United States and affects all genders and races. Some ethnic groups are at greater risk for being diagnosed and face devastating health consequences due to poor diabetes self-management. Diabetes self-management education (DSME) is considered to be a positive step toward patient self-efficacy and diabetes management. The benefits of diabetes self-management education can only be realized if patients diagnosed with diabetes not only enroll, but complete the program. The purpose of this research study was to investigate the association between race and gender and dropout rates among participants enrolled in a DSME program. Archival data from a DSME were collected for 352 participants enrolled in the program. A multiple logistic regression was used to analyze whether independent variables of race and gender were predictors of dropout rates. Chi-square was used to explore if there was an association between race and gender and drop-out rates. Results revealed that there was no statistically significant association between race and gender and dropout rates from participants in a DSME program. Positive implications for social change include exploring the reasons participants choose to drop-out of a DSME program and potentially identify those at risk for droppoing out due to challenges and barriers.

Over 17 million food-insecure households are associated with increasing obesity rates across the United States. Although food insecurity and obesity are distinct social concerns, the two are linked and may be influenced by poverty and geographic location. Public health authorities and state leaders responsible for the health and nutrition of rural populations in particular would benefit from this information. The purpose of this quantitative cross-sectional study was to examine whether poverty mediated the relationship between food insecurity and obesity among urban and rural adults. The study was guided by the poverty, food insecurity, and obesity conceptual framework. The study addressed the association between poverty and food insecurity, poverty and obesity, and food insecurity and obesity. Records from 9068 participants in the 2012 Behavioral Risk Factor Surveillance System (BRFSS) were weighted to represent the population of Louisiana. Logistic regression models indicated that individuals living in poverty were 6 times more likely to experience food insecurity and that living in poverty and being food insecure doubled the odds of being obese. Poverty mediates the relationship between food insecurity and obesity in a dynamic and complex manner. Findings also indicated gender and age differences in rates of obesity, poverty, and food insecurity, as well as higher rates of obesity in rural populations. Social change implications include providing additional evidence of how poverty affects food insecurity and obesity, which may encourage states with high poverty rates to initiate food insecurity surveillance using BRFSS to reduce obesity.

Despite enormous research on the experience of living with HIV, many questions remain regarding self-disclosure of HIV status to sexual partners by people living with HIV (PLWHIV), which is essential to reducing further infection. In this study, a phenomenological approach captured the experience of self-disclosure among South Africans living with HIV in Louwsburg, South Africa. The health belief model served as a theoretical framework, and in-depth interviews were conducted with 12 PLWHIV (8 women, 4 men) who self-disclosed their HIV status to their sexual partners. Their experiences were explored, discovering their illness, motives for self-disclosure, feelings regarding disclosing, responses of their sexual partners, their emotional reaction, and about their medical care. The themes rose from interviews showed that (a) many PLWHIV are reluctant to self-disclose until they actively experienced health issues; (b) motives for disclosure include the wish to ensure fairness; support and to empower other PLWHIV to prevent further infection; (c) feelings of disclosure are primarily relief and liberation, even though risks remain, especially for families separated by labor migration laws; (d) the response of sexual partners to disclosure varies widely; some are motivated to get tested and use condoms, decline and respond only with anger, blame, even abandonment; and (e) after accessing medical care, most PLWHIV reported support and appearing less sick, which reduces social stigma. The women were more open, forthcoming, and transparent about disclosing than men participants. Findings will assist with the creation of future health education programs aimed at creating safe environments to disclose HIV status, which may reduce community risk of contracting the virus.

The impacts of chronic fatigue syndrome (CFS) are far reaching, resulting in many burdens in the individual lives of CFS patients. One notable challenge lies in the inability to participate in the workforce due to associated physical, mental, and emotional symptoms. Previous research indicates that alternative employment options may help to overcome work related barriers presented with various types of chronic illness. Entrepreneurship is one path to working that offers many benefits, including autonomy, flexibility of work schedule, choice of work environment, and control. Questions though remain as to whether entrepreneurship enhances QOL or exacerbates symptoms among individuals with CFS. This interpretive descriptive study investigated the lived experiences of individuals diagnosed with CFS who have pursued a path of entrepreneurship. A semistructured interview was used to gather the 12 participants' descriptions of their history of living with CFS while working as entrepreneurs. The interviews were coded and analyzed to extract overarching themes. Results included the ways in which participants were transformed as a result of having CFS, their experiences of living with CFS and being self-employed, and the interpersonal factors that arose in connection with these experiences. This study served to shed light on the challenges involved in being self-employed while living with CFS, how being self-employed affected participants' quality of life both positively and negatively, and how participants interpret these changes. The findings of this study have the potential to set the stage for future qualitative and quantitative research that would provide more support in terms of tangible action when it comes to employment options for individuals living with CFS.

American youth are facing a mental health crisis. Rates of depression and suicide continue to rise among all children ages 12-17. While there is considerable research on the mental health of underserved children, much less is known about the mental health status of youth from affluent communities. The purpose of this study was to evaluate the effectiveness of community health assessment (CHA)-driven mental health interventions on the youth of affluent communities. Using a pre and post evaluation model, this study compared the frequencies of self-reported depression and suicide ideation for students in Grades 8, 10, and 12, and geographic location of the youth of affluent communities before and after implementing CHA-driven interventions. The diffusion of innovation theory guided this study and a quantitative quasiexperimental research design was used. The Utah Student Health and Risk Prevention survey provided 2,973 responses from students attending public high school during the 2011, 2013, 2015, and 2017 school years. Acting as the control, survey responses for depression and suicide ideation from 2011, prior to CHA-driven interventions, were compared to postCHA intervention efforts in 2013, 2015, and 2017. Statistical analyses indicated that the change in self-reported frequencies of depression and suicide ideation were not statistically significant for grade level or geographic location before and after CHA-driven mental health interventions. The results of this study might help local public health agencies working in affluent communities understand how the mental health status, especially among the youth demographic, might shape the future of public health and the role of public health practitioners in promoting social change.

Eating disorders are associated with high mortality rates. Most eating disorder prevention research is conducted within the fields of psychology and psychiatry, not in public health. This gap in public health research can lead to insufficient attention to the root causes of eating disorders and minimal upstream prevention efforts. The purpose of this phenomenological study was to identify public health leaders' perceptions of and attitudes concerning eating disorders as a public health issue. Objectification theory was used to describe how societal expectations have created an environment in which people's self-worth is based on their outward physical appearance. Ecological theory was used to identify environmental factors that influence the development of eating disorders. Public health leaders at local public health departments throughout California were invited to participate in the study, as they hold significant public health positions in the state. Data were collected using open-ended questions. Results were coded and analyzed via thematic analysis. NVivo 11 software was used for data management. Theoretical saturation was reached after 6 interviews when the information was redundant and no new themes were revealed. Emerged themes included observations from the participants that eating disorders are not considered a public health issue. The participants did not view eating disorders as a significant problem and they noted that they do not monitor the rates of these illnesses. They expressed interest in exploring the public health role in eating disorder prevention. Public health educators, researchers, and leaders can use these results to assess the burden of eating disorders and recognize ways to address this health threat at the macro level. In doing so, they will affect positive social change.

Excessive alcohol consumption (EAC) is an important public health problem. Several researchers have examined work-related influences on EAC, but few have investigated the predictors of EAC related to business travel. This study measured the association between EAC and frequency of business travel, duration of business travel, and job industry among U.S. business travelers. Research was conducted within the social-ecological theoretical framework. Snowball sampling was used to gather data from 187 business travelers. Data were evaluated using bivariate analysis to assess the association between measures of EAC and each independent variable. Multiple logistic regression was used to adjust for covariates. Respondents aged 45-54 and 55 and older had significantly lower odds of binge drinking than those aged 18-34, OR = 0.33, 95% CI [.11, .98], p < .05; and OR = .13, 95% CI [.03, .55], p < .01, respectively. Females aged 55 and older and all females who traveled frequently in the previous month had lower odds of binge drinking compared to females 18-34 and infrequent female travelers (OR = .03, 95% CI [.00, .37], p < .01; OR = .34, 95% CI [.12, .99], p < .05, respectively). Both males (compared to females) and Protestants (compared to Catholics) had lower odds of heavy drinking (OR = .34, CI [.14,.84], P < .05; OR = .301, CI [.09,.99], P < .05, respectively). Results highlight the prevalence of EAC among business travelers, particularly among females. Multilevel interventions are proposed, which may reduce health-related disparities associated with EAC among this population of business travelers.

The close proximity of the United States to the Mexican border poses a concern for communicable diseases because of the high flow of population movement. The purpose of this retrospective, quantitative study was to identify risks associated with respiratory diseases using an analysis of archived data from the Severe Acute Respiratory Illness (SARI) surveillance program. Based on the epidemiologic triangle theory, demographic and etiologic factors were analyzed to examine any associations with SARI in this population. Between 2010 and 2012, 798 subjects enrolled in this program, with 336 (42.1%) testing positive for respiratory pathogens. Chi square analysis determined that age (X2 (4, N = 786) = 255.361, p < 0.001), clinic location (X2 (3, N = 780) = 290.841, p < 0.001), and race/ethnicity (X2 (4, N = 762) = 1456.701, p < 0.001) showed significant associations with SARI in the population. The logistic regression model showed that the youngest age group (0-4) had the highest risk of developing SARI compared to other age groups (5-24 OR = 0.521, 95% CI [0.311-0.871]; 25-49 OR = 0.377, 95% CI [0.224-0.636]; 50-64 OR = 0.211, 95% CI [0.118-0.376]; >65 OR = 0.225, 95% CI [0.143-0.356]. African Americans were also at higher risk of developing SARI compared to Hispanic Americans (OR = 3.997, 95% CI [1.272-12.558]. This study promotes positive social change by informing efforts to increase vaccination and health literacy, improve the accessibility and availability of preventive health care in low socioeconomic communities, and promote healthy lifestyles among at-risk groups. These steps will improve the overall health of the communities along the U.S.-Mexico border region.

Childhood obesity is a prevalent chronic condition affecting millions of children and adolescents in the United States and is rising in record-breaking numbers among African Americans in low-income communities. Guided by the social cognitive theory, the purpose of this evidence-based project was to understand the impact of an educational intervention on parents' perceptions of childhood obesity risk factors, weight status, and prevention strategies in a rural South Carolina community. A convenience sample of parents who attended a church-based community health promotion service in a low-income area (n = 10), aged 28 to 54, completed The Childhood Obesity Perceptions survey before and after the completion of the educational program. The pretest and posttest responses were analyzed with paired sample t tests and frequency tables. There were several responses with a statistically significance change (p < .05), including the impact of obesity on the development of diabetes, stroke, cancer, and bone or joint problems. Survey participants strongly agreed (90%) that they could help their children live a healthier lifestyle by initiating preventive strategies which include providing healthy snacks and increasing exercise. Findings suggest that African American parents in low-income communities would benefit from regularly occurring education on the prevention of childhood obesity, including information on healthy diet choices, exercise, and the risk factors for childhood obesity. By educating parents, healthcare providers and community leaders can begin forming community health and childhood obesity prevention programs that support positive social change and help low-income families to achieve healthy lifestyles.