The Human Papillomavirus (HPV) is a common sexually transmitted infection (STI) and etiological agent of cervical cancer. It has been suggested that religiosity may promote a generalized disassociation between all STIs/STDs, including HPV, and personal relevance thus contributing to lower levels of HPV awareness and knowledge among certain groups. This study sought to identify the role of religiosity as a predictor of HPV awareness and knowledge among women in a Christian university. Religiosity was defined and measured using the Duke University Religion Index (DUREL). The schemata and social identity theories provided the theoretical framework for this study. A total of 173 women completed the modified survey instrument to assess level of HPV awareness and knowledge, attitudes toward premarital sex, and level of religiosity. Multiple linear regression analysis was used to test the hypotheses. Religiosity, as defined by the intrinsic religiosity subscale of the DUREL significantly contributed to HPV awareness (p = .002) and HPV knowledge (p = .036). The positive social change implications of this study include a better understanding of the role of religiosity in HPV awareness and knowledge; consideration of religiosity in dissemination of health information by informing public health policies and programs to ensure adequate and culturally relevant education and awareness about HPV transmission, HPV-related cancers, and HPV vaccination.

Undocumented end stage renal disease (ESRD) patients in the United States only have access to emergency dialysis. To compensate for the lack of regular dialysis these patients must follow strict renal dietary restrictions. However, nutrition counseling by a dietitian is not part of the renal management of patients on emergency dialysis. The purpose of this quantitative quasi-experimental treatment-control study was to assess how the application of nutritional counseling that is both culturally and linguistically competent affects dialysis frequency and biochemical lab values such as serum potassium, phosphorus, and vitamin D of patients in emergency dialysis. The study was grounded on the social cognitive theory and consisted of a secondary data analysis of information collected from electronic medical records. The sample size consisted of 96 emergency dialysis patients, 51 from the intervention group, and 45 from the control group. Results from Quade's test revealed there is statistically significant difference in serum levels of phosphorus [F(1,94) = 9.616, p = 0.003] and levels of Vitamin D [F(1,94) = 51.411, p = .000] between the intervention and control groups, controlling for age, gender, and time on dialysis. These findings suggest the implementation of nutrition counseling that is both culturally and linguistically competent can improve phosphorous and vitamin D levels among emergency dialysis patients. The potential social change implication of this study is that its findings may serve to assist health care professionals to design and implement interventions to improve the health status of emergency dialysis patients and reduce their impact on the public health system.

Abstract In 2016, a dramatic shift occurred in demographics in the United States because the oldest people in the baby boomer generation, which consists of people born between 1946 and 1964, reached age 65. The larger aging population and longer lifespans have produced an increased need for care and services. There are an estimated 5.4 million Americans of varying ages living with a diagnosis of dementia or Alzheimer's disease. Diagnoses of Alzheimer's disease are more prevalent among African Americans than other ethnicities. With little research found on culturally appropriate interventions for specific ethnic groups, a more detailed review of the experiences of African American women was necessary to explore the relationship between caring for loved ones with dementia and managing lifestyles. The purpose of this study was to explore the lived experiences of African American women who care for their loved ones with dementia and Alzheimer's disease. Guided by the conceptual framework of attachment theory, a phenomenological study design was used with semistructured interviews of 10 caregivers to examine their experiences and how they cope with caring for loved ones with dementia and Alzheimer's disease. The results of the thematic analyses of the collected data uncovered 6 main themes: sense of responsibility, grounded in faith, guidance for future caregivers, difficult journey, caregiver challenges, and coping strategies. The study may positively impact social change by informing health care professionals who may use the findings to help African American families caing for loved ones to apply interventions, use services, and manage resources more efficiently.

Seasonal influenza is associated with signiï¬?cant morbidity and mortality among older adults, aged 65 and older. Since vaccination is the single most effective preventive measure against seasonal influenza, clinicians and senior citizen center administrators need a better understanding of the perceptions of older adults concerning the reason for poor influenza vaccine uptake. The purpose of this study was to identify perceived factors that may be associated with poor influenza vaccination uptake among older adults. The health belief model (HBM) guided the study. The research questions examined perceptions predicting the odds of influenza vaccination uptake among older adults. This quantitative cross-sectional study consisted of administration of a newly developed 33-item questionnaire to a convenience sample of 147 older adult participants. A 2-week reliability test-retest on 50 participants indicated the instrument had moderate internal consistency (α -?¥ 0.7). Paired-sample t tests were not significant (p > .05), indicating that participants provided reliable responses across time. Ordinal regression analysis indicated that all HBM constructs were significantly associated (susceptibility, barriers, benefits, cues to action, and self-efficacy p = .000; severity p = .002) with frequency of influenza disease and recency of influenza vaccine uptake within 1 year. The social change implications from this study may help to improve vaccination uptake among older adults by providing senior public health decision makers and direct care clinicians with informed knowledge on perceptions and barriers that may play a role in influenza vaccination decision-making among older adults.

The number of women diagnosed as infertile continues to grow every year. The psychological impact of the infertility experience has been said to create distress equivalent to that associated with life-threatening illnesses and has been linked with posttraumatic stress disorder (PTSD). Using shattered assumption and stress-buffering theory, this quantitative causal comparative study explored the potential functional relationship between infertility and PTSD. The majority of the (all-female) participants were 24- to 34-year-old college graduates. A 2 X 3 factorial between-subjects ANOVA examined and compared the cause and effect of the independent variables, fertility treatment and psychological intervention, on the dependent variable, PTSD. A multiple linear regression was conducted to understand PTSD symptomology scores. The results revealed that the type of infertility treatment does not impact PTSD symptomatology in medically diagnosed women. However, the main effect of psychological treatment was significant, as was infertility treatment by psychological treatment interaction. Additionally, the impact of fertility problems on the participant's physical health was the highest ranking predictor, which suggests that stress levels in women receiving infertility treatment are equivalent to those in women with cancer, AIDS, and heart disease, as suggested by other researchers. This study has implications for positive social change, in that it may promote better understanding of the psychological impact of infertility and decreased PTSD symptomatology for medically diagnosed infertile women. It opens the door for future research about the effectiveness of psychological intervention, and provides awareness of possible PTSD susceptibility.

Over 2 million adult men in the United States have been diagnosed with prostate cancer, with nearly 200,000 new diagnoses each year. This type of cancer is the leading cause of mortality in U.S. men. One possible risk factor for prostate cancer is a high level of iron in the body, but the association has yet to be confirmed. This study was an investigation of the relationship between serum iron concentration and prostate cancer using data obtained from the 2009-2012 National Health and Nutrition Examination Surveys. This quantitative study involved 1,850 men in the U.S. aged 51 to 70 years. The framework for this research was based on the exposure-disease model. Participants' data were analyzed using chi-squared independence tests and hierarchical logistic regression, while controlling for demographic variables (body mass index, age, ethnicity, poverty-to-income ratio, educational attainment, and hours worked in the last week) to account for potential confounding effects. Serum iron concentration was not found to be significantly associated with prostate cancer diagnosis in this sample. Additional results indicated a significant association between age and prostate cancer, and between ethnicity and prostate cancer, confirming previous research findings. This study contributes to positive social change by confirming the importance of screening for prostate cancer among high-risk populations and by suggesting that it is premature to use serum iron concentration as a screening tool to detect prostate cancer.

The Ryan White HIV/AIDS Program (RWHAP) provides HIV-related medical and support services for uninsured and underinsured people living with HIV (PLWH) in the United States. In addition to HIV-related medical care, the program provides medical nutrition therapy and food assistance. The role of nutrition in the health of PLWH is well-documented, especially in resource poor areas; however, the role of medical nutrition therapy and food assistance provided through the RWHAP in resource rich areas is not well documented. This study addressed the association between the nutrition services of food assistance and medical nutrition therapy and the HIV-related health outcomes of viral suppression, retention in care, and CD4 counts. The behavioral model for vulnerable populations was used as the theoretical foundation for this quantitative cross-sectional study. A sample of 428 RWHAP clients was used from the Ryan White Services Report data. Pearson's chi-square was used to examine the association between medical nutrition therapy (MNT) and viral suppression. Findings indicated statistically significant associations between MNT and viral suppression, retention in care and any nutrition service (food assistance, MNT, or both), and MNT and retention in care. Implications for social change include emphasizing the role of nutrition services in HIV-related health outcomes for PLWH in resource rich areas.

Shaken baby syndrome (SBS) is one of the most violent forms of physical child abuse. In 2007, the State of Ohio enacted a health education mandate known as Claire's law. Claire's law requires all birthing hospitals to provide SBS education to mothers prior to their discharge. This law is the result of public demand and advocacy initiatives; however, it was not clear how the mandate was developed or whether or not the mandate and subsequent educational programs have had an impact on efforts to prevent SBS. The purpose of this qualitative case study was to explore the state of Ohio's processes involved in creating legislation to mandate SBS education. Data were collected through document reviews and interviews with SBS workgroup members (n = 5). The precede-proceed program planning model provided the conceptual framework to examine the participatory process involved in the development of the mandate from its beginning. The findings of the study showed that SBS workgroup members believed mandated education would affect SBS incidence and would ensure that mothers receive SBS education in Ohio hospitals during their birth experience. The findings also demonstrated a lack of a formal program planning methodology and no public inclusion in the development of the mandate or its required health education component. The state of Ohio has an additional means to ensure widespread education on SBS through the creation of this mandate. Statutory requirements provide opportunities for health professionals to educate the public on the effects of shaking a baby, resulting in a key implication for social change. Legislation focused on health education should be multifaceted and include varying layers of intervention.

Sexually transmitted infection (STI) prevalence rates are increasing in the United States and globally. Education has been found to be an important strategy for increasing STI testing and treatment rates among sexually active young adults. The goal of this project was to develop an interactive educational game suitable for young adults to decrease the social and economic burden of STIs. The health belief model informed the project. A moderated usability evaluation was conducted using the concurrent think-aloud technique. The participants (N = 5) were a purposive sample of professionals who played the interactive game and then completed Schnall, Cho, and Lie’s Health-Information Technology Usability Evaluation Scale instrument. The findings revealed the necessity of (a) an introduction screen, (b) a reward system for correct answers, and (c) avatars, while also highlighting that (d) the effect on indicator value bars is difficult to understand and (e) the timer led to a feeling of being rushed. The Cronbach’s alpha for the participant group was 0.798, the subscale “Perceived Ease of Use” achieved an alpha level of 0.815, and the subscale “Perceived Usefulness,” 0.762. Refinements to the game based on these data might help to ensure that use of the interactive game contributes to social change by increasing knowledge of STIs in the young adult population.

Tornadoes are occurring with increased frequency in Oklahoma. Emergency preparedness planning is essential to decreasing individuals' risks of injury or death from a tornado. Research on immigrant Hispanics' knowledge and perceptions of emergency preparedness is limited. The purpose of this study was to explore the perceptions and lived experiences of immigrant Hispanics who had experienced a tornado or other crisis weather conditions in Oklahoma during spring of 2013. The research questions explored their perceived risk for injury and knowledge of tornado preparedness planning. The health belief model provided the theoretical underpinnings for this qualitative phenomenological study. Semi structured interviews were conducted with a purposeful sample of 10 immigrant individuals living in and around Oklahoma City, Oklahoma. Data were subjected to triangulation and analyzed to identify themes and patterns. Findings indicated that immigrant participants had experienced multiple tornadoes, routinely sought shelter during a tornado, and 50% had created a family emergency plan and supply kit because of their experience with tornadoes and perceived risk for injury. Identified barriers to preparedness planning were language barriers and lack of information on natural disaster preparedness. Recommendations included conducting public health outreach and establishing multidisciplinary partnerships within communities to provide cultural and linguistically appropriate disaster preparedness information to immigrant individuals. Findings provide public health practitioners with the ability to improve access and dissemination of preparedness planning information that may promote positive social change by decreasing immigrants' risk of injury and death.