Sexual minorities (lesbians, gays, and bisexuals) have a greater risk for substance abuse and mental illness than sexual majorities (heterosexuals). Associations between substance abuse and mental illness among sexual minority adults have not been widely studied. The purpose of this quantitative cross-sectional study was to use the 2015 National Survey on Drug Use and Health data from the Substance Abuse and Mental Health Administration to study the association of substance abuse (alcohol; hard drugs such as heroin, cocaine, methamphetamine; and hallucinogens), prescribed drugs (pain relievers, tranquilizers, sedatives, stimulants, psychotherapeutic, and inhalants, as well as marijuana) and mental illness (no past year, mild, moderate, and severe in the past year) among sexual minority adults ages 18 and older in the United States. Confounding factors that may influence these associations were controlled. The theoretical framework for this study was Meyer's minority stress model. The sample was 43,561 adults. Chi-square and logistic regression analyses were performed to estimate odds for mental illness by drug type. Findings showed that higher odds of mental illness were significantly associated with prescribed drugs and marijuana abuse (OR: 3.48, 95% CI:1.66, 7.29) among gays/lesbians, and with alcohol abuse among bisexuals (OR: 2.31, 95% CI: 1.62, 3.29). Positive social change resulting from this study may include increased knowledge of associations between substance abuse and mental illness among sexual minority adults and guidance for public health interventions to improve sexual minorities' access to early substance abuse and mental health prevention and treatment.

Transitions of care is a model designed to ensure that patients have resources needed to assist them to care for themselves at home after hospital discharge, which helps to decrease preventable adverse events. For people with heart failure (HF) to transition home from the hospital successfully, specific education is needed that is individualized to the disease process, but most patients' educational needs after discharge are unmet. The purpose of this qualitative study, guided by the Meleis middle range theory of transition, was to explore the perspectives of people with HF about their educational needs in order to gather data that could inform better care practices for them once they are discharged from the hospital. Twelve participants with HF were interviewed post hospital discharge about their education experience at discharge and what they felt was needed for them to be successful in caring for themselves after discharge. Data were analyzed, and three themes emerged: discharge preparation, lifestyle changes, and transitions of care. Participants indicated that they had a positive experience with the education provided, that they had to make changes to their daily routines, and that the transition of care program was beneficial in helping them successfully care for themselves after discharge. Further studies should interview people of different ethnicities with HF, should include multiple sites in the study, and should extend the research to people with other illnesses to gain their perception of discharge education. Results contribute to positive social change because individuals with HF who know how to care for themselves at home will be able to improve their quality of life as they can effectively transition to home from the hospital setting.

Falls among the elderly is a health concern affecting multiple patients annually. Hospice patients and those with multiple comorbidities are at the greatest risk of falling and sustaining injuries from falls. Aromatherapy has been used for reducing multiple symptoms as well as for decreasing falls. The practice-focused question explored whether an education program on using aromatherapy for fall prevention would increase knowledge of this intervention for an interdisciplinary group of hospice staff. The design was developed using Knowles's theory of andragogy and Bloom's taxonomy. Thirteen staff members from the same facility participated in the education program. The program was targeted to educate staff who worked with hospice patients about implementing the intervention in their practice. The program was also offered facility-wide to allow all staff the opportunity to increase their knowledge in using the intervention in their fall- reduction programs. Assessment tools including pretest, posttest, and evaluations were completed by all program participants. Using a Likert scale to calculate participant responses, results revealed an increase in knowledge gained from 15% to 60%. The participants rated the program favorably with a mean score of 4.4 to 4.6 out of 5. This program would be beneficial to hospice caregivers and a broader range of staff members including nonhospice nurses, therapists, and providers who are interested in decreasing falls in their patient population. The program would also be of interest to accrediting bodies, hospice, palliative care, oncologic, and geriatric organizations for alternative fall-reduction interventions. Reducing falls will result in a positive social change by decreasing fall-related injuries costs and improving quality at end-of-life.

A community initiative to develop and sustain a farmer's market can address insufficient access to fresh and affordable fruits and vegetables for individuals working and residing in a United States Department of Agriculture (USDA) designated food desert. This project addressed a particular USDA food desert in South Wood County, Wisconsin. The purpose of this project was to develop and plan for implementation and evaluation of a community-supported farmers market in South Wood County, with the goal to increase access to fruits and vegetables. Project objectives included development of a sustainable community infrastructure to support the market, development of policies and guidelines for creation and sustainment of the market, and development of implementation and evaluation plans for the overall market initiative. In collaboration with an interdisciplinary project team of community stakeholders, the above objectives were met and necessary products and plans were developed to direct the initiative over a 5-year period, with long-term evaluation planning extending to 10 years. The plan has been validated by external scholars with content expertise in the area, approved by the project team, and formally endorsed and approved by the Wood County Health Department. The market initiative has been approved for establishment in the community for the 2015 market season. Rooted in the socioecological model, a community supported farmers market can be a key catalyst for positive social change by improving the health of underserved populations who lack access to fresh, affordable fruits and vegetables. By using existing evidence relevant to the population's needs, the market will address disparities surrounding food access and affordability in a rural community affected by food desert conditions.

Many women aged 20-30 are postponing their first pregnancies until their mid 30s and beyond, which has resulted in compressed childbearing years and/or infertility. Little is known about the knowledge and understanding that Canadian women of advanced age (age 35-45) possess of their reproductive capacity. This phenomenological study sought to explore these women's knowledge and perception of their reproductive capacity in relation to the timing of first pregnancy. Research questions using the constructs of Ajzen's theory of planned behavior were developed to explore how the behavioral, normative, and control beliefs of women's childbearing behaviors were based on their perceptions of their reproductive capacity. A purposeful sample of 10 participants provided data in semistructured interviews about their lived experiences of being pregnant for the first time at an advanced age. Thematic analysis was used to analyze interview transcripts. Emergent themes derived from the data included being naïve about natural conception, use of fertility specialist, discussions of childbearing plans by family doctors, lacking energy to care for young children, and feeling judged by others. Results indicated inaccuracies in the women's factual knowledge in terms of the narrow window for fertility, chances of natural conception, the impact of long-term use of contraception, and the use of artificial reproductive technologies to compensate for age-related fertility decline. This study may promote positive social change by offering healthcare providers information that assists them in tailoring reproductive messages for patients that dispel misconceptions regarding women's reproductive potential, which may reduce the number of women experiencing involuntary childlessness and infertility

The lack of knowledge regarding congenital heart disease (CHD) among the Lagos populace is leading to late presentation, late diagnosis and poor outcomes. The purpose of the research was to document the level of knowledge of parents and caregivers regarding CHD using the Leuven questionnaire for assessing knowledge of parents on CHD (LKQCHD). A quantitative correlational cross-sectional study, with purposeful convenience sampling strategy, was used. Health belief model was the theoretical framework used. Primary data of demographic information such as gender, age, the level of education, and the number of years of accessing care were obtained using a survey. The data were analyzed using Chi-Square, Fisher's exact test, and Pearson's correlation coefficient. There was poor knowledge of CHD among the subjects as the level of knowledge of parents of children with CHD on CHD was lower than 80% of correct answers using the LKQCHD. There were negative correlations between the level of knowledge of the subjects and their age, level of education and number of years of accessing care at the study centre. A critical area of need for education and training in the field of public health in Lagos is health education of parents and caregivers of children with CHD in Lagos on CHD, which will help improve awareness of the populace in Lagos on CHD, thereby encouraging early presentation of the children with CHD in Lagos, improve the compliance of parents and caregivers of children with CHD to treatment, medications and clinic follow up. All the above effect of health education will have a positive effect in the quality of life and life expectancy of patients with CHD in Lagos.

Firefighter Emergency Medical Service (EMS) responder personnel are at a high risk for occupational exposures to bloodborne and airborne infectious pathogens due to their unpredictable work duties in the pre-hospital environment. Not much is known about the compliance with Universal Precautions (UP) among firefighter EMS responders' personnel with regards to occupational exposures to infectious diseases. The purpose of this cross-sectional research study was to determine the relationship between compliance with UP, knowledge of UP, attitudes towards UP, occupational practices, and occupational exposures to bloodborne and airborne pathogens to prevent transmission of infectious disease among firefighter EMS responder personnel in the pre-hospital environment. A convenience sample (n = 246, 99% response) was gathered from the 6 career fire service departments in Miami-Dade County Florida. The participants completed a 40-question, self-administered survey questionnaire. Research questions and related hypotheses were evaluated with Pearson's product moment correlation, t test, analysis of variance, and linear regression models. In this study, the correlation between knowledge and compliance with UP was statistically significant (p = 0.005). This suggest that the compliance with UP among firefighter EMS responder participants increased with increase in knowledge. However, firefighter EMS personnel are not consistently complying with UP to prevent exposures to infectious diseases in the pre-hospital work environment. This research contributed to positive social change by increasing innovative knowledge that will allow the firefighter EMS responders to improve occupational practices and compliance with universal precautions.

Intimate partner violence (IPV) is a public health issue that transcends cultures and nationalities. Women and men have been impacted by sexual violence through rape and other types of IPV. Each year, women experience IPV before and during pregnancies and are impacted by physical and psychological outcomes as a result. The purpose of the study was to examine the impact of IPV on the health outcomes of diabetes (Types 1, 2, and gestational), high blood pressure before pregnancy, and depression/anxiety among adult women before and during pregnancy. The social ecological model provided the framework for this quantitative cross-sectional study that included national data from the Pregnancy Risk Assessment Monitoring System between 2012 and 2015. A series of binary logistic regressions was conducted. Findings indicated significant predictive relationships between IPV and diabetes before pregnancy (OR = 1.20, 95% CI = 1.01-1.43), high blood pressure before pregnancy (OR = 1.65, 95% CI =1.47-1.85), and depression/anxiety before and during pregnancy, respectively (OR = 3.14, 95% CI 2.91-3.35 and OR = 9.03, 95% CI 7.37-11.05) after controlling for age, income, and race. A social change implication of this study is that results from this project may assist in increasing societal knowledge of what IPV is and its physical and psychological impacts on women before and during pregnancy.

The incidence of food insecurity coupled with poor management of illnesses poses a public health challenge. Poor adherence to medication regimens is a contributor to poor health outcomes, especially among the socioeconomically disadvantaged. Food insecurity is a global health and nutrition problem that affects approximately 50 million people in the United States. The number of food-insecure households in the United States has increased by 12% since 1995, and so has the burden of management of illnesses. The cost of healthcare has risen from 5% of the Gross Domestic Product (GDP) in 1960 to 20% of the GDP currently. This quantitative study used responses from questionnaires from a sample size of 130 to assess the impact that food insecurity has on the management of illnesses in families in Wayne County, Ohio. The social-ecological model was used as a theoretical framework to understand the various levels of influence of food insecurity on the management of illnesses. Results showed that people who were food insecure were 4 times more likely to skip medication (OR = 4.174; p = 0.0096), and people who used food assistance programs were more likely to skip medication (OR = 4.305; p = .0088; OR = .351; p = .0288). These results suggest that food insecurity is associated with the management of illness. To promote social change, solutions at the individual, healthcare, community, and policy levels are necessary to improve management of illness and prevent health complications. Providing communities with sustainable methods to empower them to supplement food and support consumption of balanced meals.

The aging population and burden of chronic conditions have led researchers and practitioners to develop, implement, and evaluate evidence-based programs (EBPs) for older adults. The Healthy Aging Regional Collaborative (HARC) was established to make EBPs including Diabetes Self-Management Program, Chronic Disease Self-Management Program, Matter of Balance, and EnhanceFitness (EF) accessible in south Florida. According to the REAIM model, reach, effectiveness, adoption, implementation, and maintenance determine the impact of EBPs. Evaluation of HARC demonstrated widespread adoption of EBPs by community organizations that reached diverse participants and effectiveness among participants attending the recommended number of sessions, but only 19% of EBP participants were male, and only 25% of EF participants met attendance criteria for adherence. This mixed-methods dissertation explored program instructor and coordinator perspectives on barriers and strategies related to male participation in EBPs, examined predictors of short-term and long-term adherence to EF, and applied a theoretical framework to explore participant and instructor perspectives on factors influencing adherence to EF. Fourteen program coordinators participated in a focus group to identify barriers and strategies to improve male participation, and 49 instructors participated in a survey to triangulate findings. Themes among barriers to male participation included women outnumbering men in programs, incompatibility of programs with male gender roles, and preference for other activities. Themes among strategies included endorsement by male community leaders, advertisements featuring males, and content adaptation. Among 5,619 EF participants, logistic regression confirmed age, race/ethnicity, gender, and health status as significant predictors of adherence. The likelihood of short-term and long-term adherence increased with age and health. Black participants were less likely than whites to adhere short-term (OR=0.82, p=.05) but more likely to adhere long-term (OR=1.77, p=.000). Hispanics were more likely than whites to adhere short-term (OR=1.25, p=.008) and long-term (OR=1.30, p=.001). Men were more likely to meet the criteria for short-term (OR=1.47, p=.001) and long-term adherence (OR=1.19, p=.04). Interviews with 12 adherent EF participants and 10 instructors revealed cues to action, goals, beliefs, intentions, program factors, social factors, and benefits that supported adherence. Findings inform efforts to improve participation and adherence in EBPs and maximize their impact on health among older adults.