The group most affected by HIV/AIDS, according to the Centers for Disease Control and Prevention (CDC), is African Americans. The purpose of this study was to explore the knowledge of HIV/AIDS held by African American children as a first step towards developing prevention strategies for these youths. In order to bridge the knowledge-behavior gap, this study sought to investigate the attitude towards HIV/AIDS of African American 8th grade students. The study involved secondary data from the 2012 District of Columbia (DC) Middle School Youth Risk Behavior Survey, obtained from the District of Columbia Office of Superintendent of Education (OSSE). Guided by the theory of reasoned action and social cognitive theory, descriptive survey data were analyzed using descriptive statistics, frequencies, Chi-square, and independent sample t test. Results of the study indicated that the students, especially the male students, were still engaging in behaviors that may expose them to HIV despite exposure to HIV/AIDS preventive programs in school. A Chi-square test indicated that the proportion of students who have had sexual intercourse were similar for students exposed to HIV education and those not exposed to such education, suggesting no association between attending an education program on HIV/AIDS and sexual intercourse. This study supports social change by guiding education administrators and policy makers in the formulation of science-based, age-appropriate, and culturally-relevant HIV prevention policies for DC public schools.

This study was an investigation of the access problem to fresh and affordable fruits and vegetables and how limited access influenced the beliefs and opinions of residents of a food desert as designated by United States Department of Agriculture. Many researchers have documented that price, availability, and transportation are barriers to fruit and vegetable consumption, particularly among low-income individuals. Researchers in other studies have concluded that these barriers are further exacerbated by an individual's distance from a supermarket or grocery store. However, much less information is available regarding the beliefs and opinions about life in a food desert and how these factors affect food-shopping. Accordingly, this study used the socioecological model framework to explore the beliefs and opinions of the low-income residents who lived in a food desert. Qualitative data were collected from semistructured interviews with 14 low-income participants to learn their beliefs and opinions about access to fresh produce. The qualitative data were transcribed and analyzed, using ATLAS.ti software, to generate themes. Results showed that the participants felt fresh fruits and vegetables were available, but they were not always able to purchase them because of cost. Respondents had an awareness of how their budgets influenced food choices and shopping behaviors as well as how the mode of transportation and mileage from a grocery store impacted food shopping behaviors. The implications for positive social change include creating additional options for food access, such as farmers' markets, community gardens, mobile food trucks, and lowered prices (or subsidies).

In the United States, rural hospital closures increased 34% since 2015 due to financial reasons, affecting access to healthcare services in rural communities. For rural hospital leaders, improving the hospital's financial performance is a valuable strategic goal. This multiple case study was designed to explore strategies that rural hospital leaders implement to improve their hospital's financial performance in Arizona, Georgia, Illinois, Oklahoma, Pennsylvania, and the United States Virgin Islands. The strategic decision-making framework supported the study because top leaders make decisions that affect the organization's health and survival. Fifteen rural hospital leaders who maintain their hospital's financial stability provided hospital documentation and pertinent strategic information from their respective semistructured interviews. Sections of text signifying concepts from collected documentation and transcribed interviews were organized and coded according to research question and interview questions to explore strategies rural hospital leaders implemented to improve their hospital's financial performance. The methods triangulation process encompassed comparing findings from the interview themes and hospital strategic documentation analysis. The key themes that emerged from coded data were rural hospital leaders' decision-making when addressing rural hospital financial performance, developing synergies with external providers and hospitals, creating effective short-term and long-term strategies, and translating success to the entire organization. Implications for social change include the potential to prevent rural hospital closure and ensure access to healthcare services for the communities rural hospitals serve.

Measles remains a major global public health problem. Attainment of high population immunity to measles through vaccination is necessary to control this disease. Children infected with HIV infection often experience secondary measles vaccine failure by 2 years of age, making them susceptible to measles. It is not clear whether HIV-infected children on Highly Active Antiretroviral Treatment (HAART), older than 2 years, have a higher risk of measles than HIV-uninfected children. This retrospective cohort study, guided by the proximate determinants framework, was conducted to compare the risk of measles between HIV-infected children on HAART (exposed) and HIV-uninfected peers (unexposed). The age group with the highest measles susceptibility in the exposed children, which could inform timing for revaccination, was investigated. The role of age at initiation of HAART, low CD4+ count, and undernutrition as predictors of the risk of measles in the exposed children was examined. Univariate, bivariate, and binomial logistic regression analytical procedures were used in data analysis. Results showed no significant difference in the risk of measles between exposed and unexposed children. The age groups 5 to 9 years and 2 to 4 years were the first and second most affected by measles among the exposed children. Undernutrition (stunting) was a significant predictor of measles in exposed children (odds ratio of 4.14, p = 0.02), while age at initiation of HAART and CD4+ count prior to measles exposure were not. The study findings provide evidence to inform vaccination policy and nutrition care for HIV-infected children on HAART in Uganda, so as to reduce their risk of measles illness and mortality, thus contributing to positive social change for the children and the country.

In low-income, suburban Black communities, the prevalence of diet-related chronic illnesses is alarming. Various influences often increase diet-related illnesses among this population. One influence is the use of SNAP benefits to purchase food. In this study, the influences of SNAP as well as other influences affecting food purchase decisions among the study population was examined. A qualitative multicase study approach was used and, face-to-face interviews were conducted, to understand the experiences of 20 low-income, current recipients of SNAP who were Black and lived in suburban, New York. The data indicated the most significant influence, communicated by the participants, was that children in the household had a great deal of influence over food purchases. This was followed by health issues and concerns of those in the household and, the SNAP benefit amount. The study results shed light on multiple issues faced not just with buying food, but with trying to buy healthy food on a SNAP budget. The findings are consistent with previous studies which suggest food choices are often influenced by personal and cultural ideals, and controlled by present income, family structure, and the health of family members. The study findings also support Bandura's conceptual framework which believes before changes in behavior can take place, factors that can possibly influence behavior must be considered. In conclusion, providing guidance for both public health and social service providers on the influences that effect behavior among specific populations may impact social change and lead to greater success in the prevention of diet-related chronic illnesses.

Researchers have reported on the relationship between academic achievement and physical fitness levels. At one rural middle school, 25% of the students enrolled were either overweight or obese and failing at least one course. Educators at the local site were seeking methods to improve the academic achievement of their students. The purpose of this quantitative study was to examine the relationship between academic achievement and physical fitness of middle school students at the study site. Framed by the theoretical connection between improved physical fitness levels and academic achievement, the research questions examined the relationship between physical fitness levels of 6th grade students (N = 216) as measured by their Presidential Youth Fitness Test (PYFT) and the state-mandated Criterion Referenced Competency Test (CRCT) scores in the areas of mathematics and reading. Findings from correlational analyses indicated small, significant positive relationships between students' CRCT in mathematics and reading and their PYFT levels. The link between personal fitness and academic achievement should be further explored; researchers should also consider potential moderating variables related to demographics, motivation levels, and educational and community support. Based on the findings of the study, physical educators at the local site should advocate for physical fitness and promote the connection between physical fitness and academic achievement. The implications for positive social change include providing local research findings to the school leadership that may have a positive effect on academic achievement.

Immigration may be an effective survival strategy for individuals from countries involved in war or political unrest.However, the immigration process may exacerbate a number of physical and psychological health symptoms. There are limited data on the health status of new Canadian immigrants, and some social support networks are not formally connected to settlement programs.The purpose of this cross-sectional quantitative study was to assess the level of stress and self-esteem of 400 recent and older immigrants in Canada, and to investigate the impact of social support networks on the mental well-being of recent immigrants.Cultural care and general adaptation theory provided the theoretical frameworks for the study. Results from logistic regression analyses indicated that there were no significant differences in stress and self-esteem levels between recent and non recent immigrants. Results also indicated marginal significance for new immigrants with Hispanic ethnicity, who had lower stress scores than African immigrants (OR:0.196, 95%CI: 0.034-1.150, p<0.071). Afro-Caribbean recent immigrants had4.36 odds of having low self-esteem compared to African recent immigrants (OR:4.36, 95%CI: 1.113-17.078, p<0.05). Implications for social change include providing information to immigration and public health authorities on factors affecting stress and self-esteem of immigrants to promote the best possible integration outcomes.

Insufficient physical activity detracts from healthy living and has a disparate impact on African American women and their female children. The extensive body of prior research addressing preventable chronic disease and other consequences of insufficient physical activity includes limited information specific to African American single mothers. The purpose of this descriptive phenomenological study was to gain an understanding of African American single mothers' perceptions of physical activity. Specifically investigated were African American women's familial influences and potential effects of these influences on their children's health behaviors. The health belief model served as the theoretical framework for this study and provided a contextual lens to explore research questions to elicit African American single mothers' perceptions of physical activity. Six African American single mothers participated in semistructured interviews that produced data for this study. Use of Colaizzi's data analysis method revealed thematic single mother reports of healthy lifestyle, social support, resources/education, body/self-image, stress management, fear and embarrassment, motivation/inspiration, and injury/illness as factors affecting their engagement in physical activity. Future research opportunities include exploring multilevel interventions specific to African American single mothers and using common weight-related terminology. Study findings could benefit health educators, administrators, and providers. Positive social implications include improved physical activity and health outcomes for African American single mothers with ultimate decreased health care costs for the U.S. society.

According to the literature, identifying and treating tuberculosis (TB) in correctional facilities have been problematic for the inmates and also for the communities into which inmates are released. The importance of training those who can identify this disease early into incarceration is vital to halt the transmission. Although some training has been done by public health authorities for corrections, there is little to no evaluation of such training. The aim of this mixed methods retrospective study was to evaluate the effectiveness of a training to control TB in correctional facilities. The Southeastern National Tuberculosis Center (SNTC) conducted 12 trainings between 2010 and 2014 with custody, medical, and public health staff working in correctional facilities, as well as with TB program staff from health departments. A total of 442 participants quantitatively and qualitatively evaluated the trainings. Gagne-Briggs and tripod models comprised the theoretical framework of the study. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed thematically. Analysis showed that the usefulness of the training was considered very good to excellent in each of the trainings. Also, many participants stated that they were going to educate others as well, in order to improve the management of TB in their facilities. The results of this study revealed that using systematic training can contribute to promote a more coordinated release of TB-infected inmates into the community, and therefore improve the quality of life of this population group, resulting in the promotion of social change.

The World Health Organization classified carbaryl, glyphosate, and paraquat as hazardous to human health. In the Agriculture Health Study in the United States, health problems were associated with the use of these 3 agrochemicals 12 or more times per year. These 3 agrochemicals were commonly used in Grenada. The purpose of this quantitative cross-sectional study was to investigate the relationship between the social and economic characteristics of the farmers who participated in the 2012 agriculture survey and the use of agrochemicals at frequencies that could pose health risks. Five constructs of the social cognitive theory were used as the premise to hypothesize relationships between the variables. Binomial regression analysis was conducted to test the hypotheses of relationships between the characteristics of 8,868 farmers and use of agrochemicals or herbicides -?¥12 timers per year. Statistically significant relationships were found between 16 characteristics of the farmers and use of agrochemicals. Significant relationships were also found between 8 characteristics of the farmers and use of herbicides -?¥12 timers per year. The findings of this study show that several characteristics of the farmers in Grenada were associated with the use of agrochemicals at frequencies that were hazardous to health. By demonstrating the need to implement preventive measures and adopt the precautionary principle in the use of agrochemicals, positive changes can be made in monitoring agriculture practices, health surveillance, and clinical practice.