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This study explored the association between socioecological factors and outdoor physical activity (PA) and play in children with disabilities during the COVID-19 pandemic. Parents (N = 133) completed a survey to report changes in their child's outdoor PA and play during the pandemic (from prepandemic levels), and child, household, and neighborhood environment factors. Children with a PA-supporting parent and from multichild and White households had lower odds of reporting decreased outdoor PA. Children from multichild, higher income, married couple households and a PA-supporting parent had lower odds of decreased outdoor play. Living in neighborhoods with higher urbanization (i.e., high dwelling density, street intersections, and land-use mix) was associated with greater odds of decreased outdoor PA and play. Future research that uses larger and more representative samples of children with disabilities is needed to test for the multivariate effects of socioecological variables on outdoor PA and play. [ABSTRACT FROM AUTHOR]

Commercial sexual exploitation of children (CSEC) has emerged as a critical child protection and public health concern in recent years. While the phenomenon is prevalent globally, its impact is compounded in sub-Saharan Africa owing to the cultural and socioeconomic challenges that leave many households in the region vulnerable. The present study synthesized existing evidence using the socioecological model as a guiding framework to assess the risk and protective factors associated with CSEC in sub-Saharan Africa. A protocol for the study was published in PROSPERO (CRD42022331832) with pre-specified inclusion and exclusion criteria. Studies were screened and extracted from eight databases: PsycINFO, Scopus, Web of Science, PROQUEST (Social Science Premium), PubMed, CINAHL, EMBASE, and MEDLINE via Ovid. After an initial screening of 4,377 papers, seven studies were found eligible for the final review. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide for reporting systematic reviews. Included studies were appraised and rated using the Cambridge Quality Checklist and GRADE. Findings revealed risk factors, including adverse childhood experience and victimization, females aged 16 years and older, school dropouts, technology influence, child and parental alcohol use, and separation from caregivers. On the other hand, protective factors such as the number of female adolescents in a household, frequent health screening in schools, children being in school, and high parental monitoring were found to be associated with a lower risk of CSEC. Based on these findings, we recommend that interventions in sub-Saharan Africa adopt a holistic approach that addresses identified risk factors while harnessing protective factors to combat CSEC effectively. [ABSTRACT FROM AUTHOR]

Background: There is a limited understanding of the dynamic influences that shape infant and young child feeding (IYCF) decisions over time. We conducted an innovative qualitative study to reconstruct IYCF trajectories across early life course phases, in the context of the socioecological model (SEM) and the commercial determinants of IYCF. Methods: Women of different socioeconomic status were interviewed in two large metropolitan areas in Mexico. Our specific goal was to allow us to better understand if and how the commercial milk formula (CMF) marketing influenced breastfeeding decisions in a complex dynamic way involving the individual, relational, community and societal levels. Results: Hospitals, health professionals, and interactions with social media were key category entry points throughout the prenatal, perinatal, early infancy period and beyond. The CMF industry interfered by engaging a wide array of actors across the different layers of the SEM, most prominently the health care system and the workplace. Through its marketing strategies the CMF operates subconsciously and its messages are most effective when health institutions, health care providers, workplace spaces and social norms are weak in their support for breastfeeding. Conclusions: The cases in our study highlight how, together with a weak breastfeeding counseling system, and health professionals who lack training in breastfeeding and normal infant behavior, lead to the opportunity for CMF marketing to shape infant feeding, and ultimately to the decision to feed formulas that some mothers were not planning to use and cannot afford. [ABSTRACT FROM AUTHOR]

Objective To explore the attitude of medical students to premarital sex and its association with social ecological risk factors, so as to provide scientific basis for sex education in schools and relevant departments. Methods From September to November 2021, an anonymous survey was conducted among 1 280 students from a medical college in Shanxi Province, including general demographic characteristics, socio-ecological risk factors, and attitudes toward premarital sexual behavior. Results There was 39.75 percent of the students who had a positive attitude toward premarital sex. After adjusting for general demographic characteristics, binary logistic regression analysis showed that in the household dimension, the approving rate about premarital sex of high-risk group (OR = 1.61, 95%CI: 1.01-2.54) was 1.61 times higher than in the low-risk group. In the time dimension, the approving rate about premarital sex of medium-risk group (OR = 1.57, 95%CI: 1.14-2.17) was 1.57 times more than the low-risk group, and compared with the low-risk group of the cultural dimension, the medium-risk group (OR = 1.96, 95%CI: 1.43-2.69) and the high-risk group (OR = 4.75, 95%CI: 3.24-6.97) were positively correlated with premarital sexual attitudes, that is, the higher the approval of premarital sex is, as the risk increased. The results of WQS model analysis showed that cultural dimension had the most influence on medical students' attitudes towards premarital sexual behavior, accounting for 45.40%, meantime, time dimension and family dimension accounted for 15.60% and 14.40%, respectively. Conclusion The positive attitude of medical students towards premarital sexual behavior is the result of the comprehensive effect of social and ecological risk factors. Besides the high-risk family factors and the medium-risk time factors, the medium and high-risk cultural factors increase the approval of premarital sexual behavior of medical students. Then, the cultural factors have the most influences on the outcome. [ABSTRACT FROM AUTHOR]

Introduction: Mental health professionals, teachers, families, and public administrators are concerned about suicide rates among young people, particularly in the university context. For every ten college students worldwide, three attempt suicide in their lifetime, and two experience suicidal ideation. Reducing these rates requires interventions that recognize the problem in terms of risk factors and protective factors. Objective: The general aim of the study was to map the protective factors for suicide among college students, as perceived by them, mental health professionals, and coordinators of undergraduate courses in a public university in the North of Brazil. Methods: The study followed an exploratory, mixed-method design. Data were collected through interviews and the application of a questionnaire with 54 participants, including college students (n = 20), mental health professionals (n = 22), and course coordinators (n = 12). Data were analyzed using Content Analysis and simple descriptive statistics. Results: The findings show that the protective factors for suicide most cited among the three groups were social support, strengthening of internal resources, institutional support, and finding meaning about the change to enter the university. Although the three audiences did not converge, the protective factors also frequently reported were psychological treatment, leisure activities, religious engagement, medical treatment, civic engagement, employability, opportunities for social ascension offered by the university, and quality family relationships. Conclusion: It is suggested that these protective factors are considered when formulating policies to promote mental health and suicide prevention in the university environment. [ABSTRACT FROM AUTHOR]

Background: Mothers play a crucial role in influencing their daughters' HPV vaccination decisions. Addressing barriers to receiving HPV vaccination among mothers of girls may achieve two goals in one strike: increasing vaccination coverage among both mothers and their daughters. This study aims to examine the HPV vaccination uptake and its determinants among mothers of girls in China at both the individual and interpersonal levels. Methods: From July to October 2023, a cross-sectional online study was conducted to investigate HPV vaccine refusal for daughters aged 9–17 years among 11,678 mothers in Shenzhen, China. A randomized selection method was employed, targeting 11 primary schools and 13 secondary schools in Shenzhen. The research team invited mothers of girls to participate in an anonymous online survey. Multilevel logistic regression models (level 1: schools; level 2: individual participants) were employed to analyze the data. Results: Among 11,678 mothers, 41.1% self-reported receiving at least one dose of HPV vaccination. Through multilevel logistic regression analysis, eight items measuring illness representations of HPV, which refers to how people think about HPV, were associated with higher HPV vaccination uptake (AOR: 1.02–1.14). These items included identity (identifying symptoms of HPV), timeline (whether HPV is acute/chronic), negative consequences, personal and treatment control (whether HPV is under volitional control), concern, negative emotions, and coherence (overall understanding of HPV). In addition, participants refusing HPV vaccines for the index daughters (AOR: 0.82, 95%CI: 0.76, 0.89) had lower vaccine uptake. Perceived more difficulties in accessing the 9-valent vaccines (AOR: 1.06, 95%CI: 1.04, 1.08) and more satisfaction with vaccine-related promotional materials (AOR: 1.50, 95%CI: 1.46, 1.54) at the individual level were associated with higher vaccine uptake. At the interpersonal factors, higher frequency of exposure to testimonials given by others about HPV vaccination on social media (AOR: 1.19, 95%CI: 1.14, 1.25) and thoughtful consideration of the veracity of the information (AOR: 1.11, 95%CI: 1.07, 1.16) were correlated with higher HPV vaccination uptake. Conclusions: These findings offer essential implications for modifying HPV disease perceptions, addressing difficulties in accessing the 9-valent HPV vaccines, and enhancing health communication needs to improve HPV vaccine uptake among mothers of girls. [ABSTRACT FROM AUTHOR]

Background: Advance care planning (ACP) can contribute to individuals making decisions about their healthcare preferences in advance of serious illness. Up to now, the acceptance level and associated factors of ACP among the public in China remain unclear. This study aims to investigate the acceptance level of ACP in China and identify factors associated with it based on the socioecological model. Methods: A total of 19,738 participants were included in this survey. We employed a random forest regression analysis to select factors derived from the socioecological model. Multivariate generalized linear model analysis was then conducted to explore the factors that were associated with the acceptance level of ACP. Results: On a scale ranging from 0 to 100, the median score for acceptance level of ACP was 64.00 (IQR: 48.00–83.00) points. The results of the multivariate generalized linear model analysis revealed that participants who scored higher on measures of openness and neuroticism personality traits, as well as those who had greater perceptions of social support, higher levels of health literacy, better neighborly relationships, family health, and family social status, were more likely to accept ACP. Conversely, participants who reported higher levels of subjective well-being and greater family communication levels demonstrated a lower likelihood of accepting ACP. Conclusions: This study identified multiple factors associated with the acceptance level of ACP. The findings offer valuable insights that can inform the design and implementation of targeted interventions aimed at facilitating a good death and may have significant implications for the formulation of end-of-life care policies and practices in other countries facing similar challenges. [ABSTRACT FROM AUTHOR]

This research seeks to understand the challenges faced by settlement service providers (SSPs) in assisting humanitarian migrants to secure appropriate employment. In‐depth interviews with 26 SSPs identified that current impediments to facilitating humanitarian migrants' employment related to employment support programmes; settlement service partnerships; cultural appropriateness of services; employment readiness, experience, skills and knowledge; social support and networks; and limitations of funding and service agreements. While employment is recognised as key to effective settlement, the findings of this study show that employment services are not currently a focus of settlement services, that is, most employment services delivered by settlement services were coordinated as part of job preparedness or readiness programmes. The paper argues for government to ensure financial and human resources to enable SSPs to deliver services that can formally recognise and overcome barriers to humanitarian migrants' employment. [ABSTRACT FROM AUTHOR]

People living with HIV (PLWH) experience a disproportionate burden of mental health problems compared to people living without HIV. This systematic review aims to depict the spectrum of resilience resources that may promote the mental health of PLWH at the individual, interpersonal, organisational, community and policy levels. A systematic literature search was conducted in PsycINFO, Scopus, Medline and advanced Google Scholar. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Of the 591 studies identified, fourteen were included representing a total of 5,142 PLWH from China, Ghana, Nepal, Spain, Tanzania and the USA. Resilience resources were identified at the individual level (self-efficacy, self-esteem, acceptance, hope, optimism, religiosity/spirituality, belief in fate, mindfulness, strength and self-responsibility); interpersonal level (social support and parental monitoring); and community level (attending HIV clinic support groups and access to healthcare). All quantitative studies were cross-sectional, limiting inferences about causation or directionality. Future research should focus on resilience resources at the organisational and policy levels and incorporate longitudinal designs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to draw consensus among an expert panel regarding essential elements of an accessible fitness center guide for people with intellectual disabilities that will enable them to engage in physical activity fully and effectively. The study was situated in the socioecological model of disability. Researchers drew expert consensus regarding the essential features of accessible guides in fitness environments. A three-round Delphi procedure was used, involving repeated circulation of the questionnaire to an expert panel (N = 33). The panel was asked to rate the importance and adequacy of 66 items regarding the accessible fitness guide. A consensus was reached regarding 43 items after three rounds. The items include 7 body-weight exercises, 2 machine exercises, 12 environment-related items, 15 exercise preparations, 4 social etiquettes, and 3 emergencies. [ABSTRACT FROM AUTHOR]

Children's independent mobility (CIM) is the freedom of children to move around their neighbourhood or community without adult supervision. The aim of this study was to explore experiences with CIM from the perspectives of children and their parents living in rural and remote areas of British Columbia, Canada. Semi-structured interviews were conducted with 21 parent–child dyads or triads (45 participants). Child participants aged 7–12 were invited to create and describe drawings, maps, or take images of their independent mobility. Artwork and interview transcripts were analysed following an inductive thematic approach and mapped to the social-ecological model. We developed four themes to describe rural and remote family perspectives on CIM: (1) natural places, spaces, and forces; (2) embracing informal and unstructured play destinations; (3) decision-making and knowing when they are ready; (4) neighbourhood and community environments. Children identified several environmental characteristics impacting their independent mobility including wildlife, seasonal weather patterns, and lack of destinations. Parents reported the environment of rural communities, including neighbourhood cohesiveness and people looking out for each other, as being supportive of CIM. To promote CIM in rural and remote areas, efforts should focus on providing education on wildlife encounters, creating safe and interesting destinations for play, and consider children's safety and connectivity in road design. [ABSTRACT FROM AUTHOR]

Objectives: Adolescents and young adults are the main target population for human papillomavirus (HPV). The study aimed to investigate school students' HPV vaccination intentions and explore the contributing factors from a socio‐ecological perspective. Design: A questionnaire survey was conducted in three secondary schools and three colleges in China. Sample: A total of 1756 students aged 14–22 years participated in this study. Among the 1756 participants, 182 students have received the HPV vaccine. For the remaining 1574 students, we analyzed their HPV vaccination intentions and the influencing factors. Measurements: Survey items for sociodemographics, knowledge and awareness of HPV, sexual intercourse and sexual knowledge, subjective socioeconomic status, self‐efficacy, eHealth literacy, perceived social support from family, and the availability of HPV vaccine information were measured. Results: Only 182 (10.4%) had received the HPV vaccine among the 1756 participants. Among the remaining 1574 students, the majority of the students (1403, 89.1%) were willing to receive the HPV vaccine. Binary logistic regression analysis showed that students who were female, had lower self‐efficacy, scored higher on sexual knowledge, believed vaccination preventing related diseases, worried about side effects after vaccination, thought oneself at risk of contracting HPV, had higher family support, knew the availability of the HPV vaccine in Mainland China from healthcare institutions, and with family residence in rural areas were more willing to receive the HPV vaccine. Conclusions: Students had high HPV vaccination intentions while had low vaccination rate. Intrapersonal, interpersonal and institutional or community factors predicted HPV vaccination intention. Public health nurses in communities and schools could target the modifiable factors to promote students' HPV vaccine uptake. [ABSTRACT FROM AUTHOR]

Often, perpetrators of sexual violence first aggress in their teens. Presently, very little is known about environmental factors that may influence adolescents' engagement in sexual aggression. Drawing upon data collected at 27 high schools in the Northeast United States, this study is the first to test the association between community-level factors and male adolescents' sexual aggression. A series of backward linear regressions determined that 10 of 19 community variables were associated with males' sexual aggression, which were then used to generate a ratio of positive to negative correlates of sexual aggression for each high school. In multilevel analyzes, as hypothesized, the ratio of positive to negative correlates was positively associated with schools' sexual aggression perpetration rates. We discuss the study's implications for future sexual assault research and prevention interventions. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsAbstinence has long been considered the defining feature of recovery from substance use disorder, with a focus on individual level factors associated with abstinence rather than identifying individual and socioecological factors that support recovery. This paper proposes greater consideration of dynamic behavioral ecological influences on recovery and offers an expanded contextualized approach to understanding and promoting recovery and predicting dynamic recovery pathways.Conceptual and empirical bases are summarized that support moving beyond research, treatment, and policy agendas that focus narrowly on the individual as the fundamental change agent in recovery and that emphasize changes in substance use as the primary outcome metric. A model is presented that expands the scope of recovery-relevant variables to include dynamically-varying ecological contexts that variously support or hinder recovery along with an expanded scope of functional and contextual outcome variables.Examining behavior patterns through time in changing environmental contexts that include community and neighborhood-level variables and social determinants of health is critical for understanding recovery and developing multi-level interventions to promote change. Molar behavioral and ecological perspectives are needed to understand how recovery is influenced by broader contextual features in addition to individual determinants. This paper provides concrete recommendations for the pursuit of this broadened research agenda.Individual pathology-based approaches to understanding and promoting substance use disorder recovery are too narrowly focused. This review calls for greater consideration of the dynamic behavioral ecological and temporally extended contexts that contribute to harmful substance use and systemic changes necessary to promote and sustain recovery. [ABSTRACT FROM AUTHOR]

Background: Healthy lifestyles are crucial for preventing chronic diseases. Nonetheless, approximately 90% of Chinese community residents regularly engage in at least one unhealthy lifestyle. Mobile smart devices-based health interventions (mHealth) that incorporate theoretical frameworks regarding behavioral change in interaction with the environment may provide an appealing and cost-effective approach for promoting sustainable adaptations of healthier lifestyles. We designed a randomized controlled trial (RCT) to evaluate the effectiveness of a socioecological model-guided, smart device-based, and self-management-oriented lifestyles (3SLIFE) intervention, to promote healthy lifestyles among Chinese community residents. Methods: This two-arm, parallel, cluster-RCT with a 6-month intervention and 6-month follow-up period foresees to randomize a total of 20 communities/villages from 4 townships in a 1:1 ratio to either intervention or control. Within these communities, a total of at least 256 community residents will be enrolled. The experimental group will receive a multi-level intervention based on the socioecological model supplemented with a multi-dimensional empowerment approach. The control group will receive information only. The primary outcome is the reduction of modifiable unhealthy lifestyles at six months, including smoking, excess alcohol consumption, physical inactivity, unbalanced diet, and overweight/obesity. A reduction by one unhealthy behavior measured with the Healthy Lifestyle Index Score (HLIS) will be considered favorable. Secondary outcomes include reduction of specific unhealthy lifestyles at 3 months, 9 months, and 12 months, and mental health outcomes such as depression measured with PHQ-9, social outcomes such as social support measured with the modified Multidimensional Scale of Perceived Social Support, clinical outcomes such as obesity, and biomedical outcomes such as the development of gut microbiota. Data will be analyzed with mixed effects generalized linear models with family and link function determined by outcome distribution and accounting for clustering of participants in communities. Discussion: This study will provide evidence concerning the effect of a mHealth intervention that incorporates a behavioral change theoretical framework on cultivating and maintaining healthy lifestyles in community residents. The study will provide insights into research on and application of similar mHealth intervention strategies to promote healthy lifestyles in community populations and settings. Trial registration number: ChiCTR2300070575. Date of registration: April 17, 2023. https://www.chictr.org.cn/index.aspx. [ABSTRACT FROM AUTHOR]

Background and Objectives Food insecurity is considered an increasing public health problem worldwide with adverse effects, especially among older adults. Although the literature related to food insecurity among older adults in low- and middle-income countries (LMIC) are expanding, little is known about existing patterns and knowledge gaps in these settings. This scoping review aims to provide a comprehensive overview of the current research related to food insecurity among older adults in LMIC. Research Design and Methods A systematic search was conducted in November 2021 and revised in July 2022 on six databases using terms related to food insecurity and older adults. Data were extracted, and the emerging themes from the main findings were summarized using a social-ecological model (SEM). Results Forty-one studies met the inclusion criteria. Almost half (48.8%) were published in the last 2 years and utilized a quantitative approach (n  = 38). Only one study was conducted in a low-income country. Using the SEM, most studies included in this review focused on addressing the relationship between food insecurity with intrapersonal factors. Discussion and Implications Several gaps in the current literature were identified. There is a lack of longitudinal and qualitative studies available on this topic. Also, only 15 LMIC were represented in the literature. A critical point in this review is that only a few studies addressed the relationship between food insecurity and the policy/social structure, institutional, community, and interpersonal levels. These identified gaps can serve as a guide for future research on this topic. [ABSTRACT FROM AUTHOR]

Cyber-dating violence (cyber-DV) is a prevalent issue among adolescent girls that can have negative consequences including post-traumatic stress symptoms and suicidal ideations and attempts. In the aim to reduce its prevalence and impacts, researchers are increasingly relying on the identification of risk and protective factors associated with cyber-DV across multiple ecological contexts. The current study aimed to examine the influence of individual (e.g., dissociation), interpersonal (e.g., offline forms of dating violence) and community level (e.g., community support) factors associated with the cyber-DV victimization of adolescent girls. A sample of 456 adolescent girls (M = 16.17 years old, SD = 1.28) was recruited online to complete a survey. At the individual level, emotion dysregulation, dissociative symptoms, post-traumatic stress symptoms and resilience were measured. Offline forms of DV and a history of child sexual abuse were assessed at the interpersonal level. Finally, at the community level, community support, community resilience, neighborhood material and social disadvantage were evaluated. Results from a hierarchical logistic regression indicated that exposure to offline DV namely verbal-emotional DV, sexual DV, threats, as well as living in neighborhoods with lower levels of social disadvantage were significantly associated with an increased risk of cyber-DV victimization. Cyber-DV preventative intervention efforts should focus on incorporating cyber-DV specific modules and activities into offline DV prevention and intervention programs as to reduce the likelihood of adolescents suffering both forms of DV and their associated repercussions. [ABSTRACT FROM AUTHOR]

Exposure to intimate partner violence (IPV) incurs significant public health consequences. Understanding risk markers can accelerate prevention and response efforts, important in settings like Sub-Saharan Africa (SSA) where resources are scarce. In this study, four databases were searched to identify studies that examined risk markers for male-to-female physical IPV. With application of the socioecological model, we analyzed 11 risk markers for male physical IPV perpetration (with 71 effect sizes) and 16 risk markers for female physical IPV victimization (with 131 effect sizes) in SSA from 51 studies. For male IPV perpetration, we found medium-to-large effect sizes for six risk markers: perpetrating emotional abuse and sexual IPV, witnessing parental IPV, being abused as a child, cohabitating (not married), and exhibiting controlling behaviors. We found small effect sizes for substance use. Employment, age, marital status, and education were not significant risk markers. For female IPV victimization, a medium effect size was found for post-traumatic stress symptoms. Small effect sizes were found for reporting depressive symptoms, being abused as a child, witnessing parental IPV, and reporting drug and alcohol use. Rural residence, approval of violence, length of relationship, income, education, employment, age, marital status, and religiosity were not significant risk markers. Findings highlight opportunities for screening and intervention at the couple level, show the need to test and incorporate interventions for IPV in mental health treatment, and emphasize the importance of further research on sociodemographic risk markers and the interventions that target them. [ABSTRACT FROM AUTHOR]

Background: Mounting evidence is revealing disparities in cognitive function and heightened dementia risk among refugees, yet research in this area remains scant. Despite bearing most of the world's refugee burden, limited-resource countries like Jordan are facing challenges when dealing with refugee health. There is a lack of research on the attitudes toward dementia and the cognitive healthcare gaps among refugees in Jordan. Methods: 32 older (≥ 55 years) Syrian refugees resettled in Jordan were recruited through a local community-based organization and interviewed in four focus groups (2 female and 2 male groups). Interviews were transcribed and translated, then coded using inductive thematic analysis. Results: Mean age of the sample was 60.1 years and 53.1% were female. Only 34.4% rated their memory as good or excellent. Themes were organized using the socioecological model: 1) At the individual level, participants believed high levels of stress, including low socioeconomic status, poor health, and traumatic history from their refugee experience increased their dementia risk. 2) Interpersonally, there is a fear of dementia due to the possible impact and burden on loved ones, particularly with the stigma surrounding dementia. 3) At the community level, participants noted that resettlement in Jordan – with a shared language, religion, and culture – offered protective effects due to facilitated access to social connection, information, and mental health self-care. 4) At the institution and policy level, participants believed older refugees faced restrictive policies for economic aid, healthcare, and employment, presenting a significant barrier to healthy aging. Conclusions: Findings from this study are the first to examine the attitudes of Syrian refugees in Jordan toward dementia and cognitive aging. These results could provide essential data inclusive of refugees as Jordan develops its National Dementia Plan. Investing in dementia awareness interventions and age-friendly neighborhoods may benefit aging refugees in limited-resources settings. [ABSTRACT FROM AUTHOR]

Sport participation can play a key role in older adults' successful aging as it provides an enjoyable opportunity for leisure-time physical activity. Research focusing on the benefits of sport participation in later life and facilitators for involvement has been increasing in the past several years. Drawing on the socioecological model, this study investigated select socioecological factors that predict older adults' sport participation from a holistic perspective. An online survey provided quantitative data from 1203 adults aged 50 and older across the United States. Results from logistic regression analyses showed that personal characteristics, individual behavior, environment/policy, and life course effects were significant predictors of sport participation in later life. The findings in this study enhance our understanding of factors related to older adults' sport participation and are also of value to practitioners seeking to promote sport participation among older adults. [ABSTRACT FROM AUTHOR]

Every counselor–client interaction is an opportunity for mutual learning through inquiry, listening, exploring, and understanding about a client's experiences with development and well‐being. Given the convergence of multiple sociopolitical events and systems that impact mental health and well‐being, we issue a call to increase promotion and uptake of preventative mental health strategies by assessing the social determinants of mental health (SDMH) in counseling practice. We contend that counselors are uniquely prepared to assess the SDMH at the intrapersonal, interpersonal, and environmental levels. Therefore, we review the parallels between counseling frameworks and the SDMH with the aim of explaining why and how counselors should assess the SDMH. Specifically, we describe ways that counselors can use their foundational skills and expertise in assessment procedures to identify client needs, as well as potential individual and community interventions. We outline a four‐phased approach for assessing the SDMH in counseling practice and provide implications for improving counseling outcomes. [ABSTRACT FROM AUTHOR]

Background: The eating behaviors of older adults are associated with multiple factors. To promote older adults’ healthy diets, it is imperative to comprehensively study the factors associated with the eating behaviors of the aging population group. This study aimed to probe the associated factors of older adults’ eating behaviors from a socioecological model (SEM) perspective. Methods: In 2021, a cross-sectional survey was performed to recruit participants in China. The survey data were analyzed using a multivariate generalized linear model to identify the factors associated with eating behaviors in older adults. Standardized regression coefficients (β) and 95% confidence intervals (CIs) were estimated using a multivariate generalized linear model. Results: The survey contained 1147 valid older adult participants. Multivariate generalized linear model results showed that older adults with older age [aged 71–80 (β = -0.61), ≥ 81 (β = -1.12)], conscientiousness personality trait (β = -0.27), and higher family health levels (β = -0.23) were inclined to have better eating behaviors. The older adults with higher education levels [junior high school and high school (β = 1.03), junior college and above (β = 1.71)], higher general self-efficacy (β = 0.09), more severe depression symptoms (β = 0.24), and employment (β = 0.82) tended to have poorer eating behaviors. Conclusions: This study identified factors that are specifically associated with older adults’ eating behaviors from an SEM perspective. The comprehensive multiple-angle perspective consideration may be a valuable idea for studying healthy eating behaviors in older adults. [ABSTRACT FROM AUTHOR]

This study examined the adoption and implementation process in early efforts to implement ecological ("outer layer") sexual violence (SV) prevention strategies. Interviews with 28 preventionists from 26 local sites within a large, midwestern state, were conducted to examine individual preventionists' problem definitions of SV and ecological factors surrounding implementation. Findings suggest that SV prevention in the state is primarily implemented at the individual‐level; when preventionists described engaging in or anticipating outer layer interventions, they were often tertiary (i.e., responding after perpetration; e.g., Sexual Assault Response Teams). A majority expressed problem definitions rooted within the individual (e.g., perpetration due to a lack of consent education), and a majority of implemented efforts matched this individual‐level conceptualization. Yet, contradictions between problem definitions (e.g., SV stemming from oppression) and implemented activities (e.g., single‐session educational interventions) emerged. Such contradictions may be best understood in light of contextual implementation influences: diverse preventionist job responsibilities, less training/support for outer layer prevention, preventionist autonomy, leadership messaging, time requirements, partner reticence, and extensive work with schools. Inner layer influences, including identification with job roles, preference for, and a sense of urgency toward inner layer work, appeared to interact with contextual factors. Implications across community psychology domains are discussed. Highlights: Sexual violence (SV) prevention can be at approached inner (e.g., increasing personal knowledge) and outer layers (e.g., addressing inequities).A focus on outer layer prevention efforts requires a shift for some SV preventionists.Preventionists often paired inner layer SV understandings with implemented inner layer prevention.Contradictions emerged when outer layer understandings were paired with inner layer prevention implementation.Moving to ecologically informed prevention requires attention to the ecology of prevention work itself. [ABSTRACT FROM AUTHOR]

Sport official's experience of abuse in their role is well documented, but the additional gendered barriers that women officials face are not. This study used Concept Mapping to explore the most important and frequent barriers that women referees and officials in Australian basketball face. Results were analyzed according to the Socio-Ecological Framework with a feminist lens, which demonstrated the complexity and interconnectedness of barriers between different levels. While participants were not specifically asked about gendered experiences, the results indicated that barriers were overwhelmingly gendered at every level, including discriminatory resourcing, lack of senior women, and concerningly, incidents of sexual harassment. This research sheds new light on the experience of women officials and the organizational and societal barriers that limit their careers and make their workplace unsafe. Finally, it discusses where the locus of responsibility lies in addressing these issues for women sport officials, placing emphasis on the role of organizations. [ABSTRACT FROM AUTHOR]

Despite the success of health programs conducted within African American (AA) churches, research has been limited in understanding facilitators and barriers that exist when conducting adult health programs within AA churches. Thus, the objective of this study was to systematically review the literature to identify these facilitators and barriers. A comprehensive literature search was conducted and studies that met the eligibility criteria were divided based on their focus: disease topic or behavior, health promotion activities, or church readiness. Facilitators and barriers were also stratified using the socioecological model. Out of 288 articles initially identified, only 29 were included. Facilitators and barriers were predominantly found at the intrapersonal and organizational level for disease topic or behavior studies, and at the organizational level for studies focused on health promotion activities and church readiness. None of the articles identified facilitators and barriers at the policy level. [ABSTRACT FROM AUTHOR]

Young girls who participate in sport may receive holistic health benefits from participation. Yet, socioecological factors limit their participation on structural, cultural and individual levels. Moreover, scholars are focusing more on theories that explore how race and gender work simultaneously to permeate the meanings and motivations influencing Black girls' sport participation. Given the multilevel effects of race and gender, the voices of Black girls are vital to creating more authentic and robust theories about the socioecological factors shaping their sport participation. The purpose of this study was to provide a critical socioecological understanding of Black girls' sport participation. To this end, Black girls' voices were employed to understand sport as an institutional space through the lens of three dimensions of Black Feminist Thought: ethics of caring, a situation of struggle and internal empowerment. In this study, 27 middle school girls were interviewed using a semi-structured interview method. Questions asked were open-ended and based on literature from youth development, sport-for-development and Black studies. Probing questions were also asked to allow girls to speak to themes that may not be prominent in the literature. Interviews were conducted over three days; feedback from teachers and administrators was also collected to triangulate the data. Results of the study suggest four salient aspects of Black girls' sport participation: family social support, gender dynamics, structural support and internal motivation. Informants discussed positive experiences from playing sport with adult family members having the largest influence on their sport participation. Moreover, Black girls desire to participate in sport yet are hindered by the intersection of racial, gendered and class-based socioecological barriers. Study implications include providing social support from adult relatives, a dedicated and equipped physical activity space and competent physical educators with support from school administrators for Black girls to engage in sport and receive benefits from doing so. [ABSTRACT FROM AUTHOR]

Findings on children's mental health promotion at the policy level are scarce, and the perceptions of the municipal administration on factors affecting children's mental health have not been reported. This study describes the perspectives of policymakers and leading officeholders on promotive and risk factors for children's mental health in a socioecological context. The perspectives of Finnish policymakers (n = 15) and officeholders (n = 10) in municipalities were examined using semi-structured interviews. The data were analyzed using inductive content analysis and were categorized according to the five levels of a socioecological model of health promotion: public policy, community, organizational, interpersonal and individual levels. The public policy level emerged strongly in the findings, specifically strategic planning and implementation challenges related to the promotion of children's mental health in the municipality and state administration. At the community level, environmental factors promoting children's mental health as well as risk factors were described. The organizational level consisted of support, requirements and development needs in children's services. The importance of family and close networks at the interpersonal level, as well as the individual basis of mental health, were also evident. The integration and better collaboration of child and family services, the use of child rights impact assessment in political decision-making, and financial support from the state could contribute to improving strategic planning to support children's mental health at the municipal level. [ABSTRACT FROM AUTHOR]

To explore gym staff perspectives on the inclusion of people with disability in the gym setting. Semi-structured interviews were conducted with 16 staff at four urban gym facilities, exploring perspectives on disability inclusion. An interpretive descriptive approach was adopted with reflexive thematic analysis of interview data and subsequent mapping of themes to the socioecological model. Consistent with the socioecological model, the themes identified were "people with disability benefit from participation in gym settings" (personal); "positive interactions with people with disability" (interpersonal); "managing expectations of other gym users" (interpersonal); "inclusion is supported by a positive ethos, staff training and accessible facilities" (organisational); "people with disability lack awareness of inclusive exercise opportunities" (community); "desire to increase collaboration with healthcare professionals" (community); "access to transport can facilitate gym attendance" (community) and "local gym policy" (policy). Although an overall ethos of inclusion was apparent, areas identified for enhancement were: awareness of gym services in the community; inter-sectoral collaboration with healthcare and disability organisations; comprehensive disability inclusion training; transport systems and accessibility; engaging people with disability in gym service planning. Gym staff value collaboration with healthcare and rehab professionals to support inclusion of people with disability in exercise. Standardised disability inclusion training for gym staff is recommended. Individuals with disability should be empowered to contribute to the development of inclusive gym facilities and services. Rehab professionals have a role to play in raising awareness and advocating for inclusive exercise opportunities. [ABSTRACT FROM AUTHOR]

Substance use disorders are increasingly prevalent among veterans in the United States. Veterans in recovery face unique challenges, such as high rates of psychiatric comorbidities, difficulties adjusting to civilian life, and inadequate housing and mental health services. While prior research has explored veterans' experiences in recovery, studies have not implemented a multilevel perspective in their analyses. The current qualitative study examined how individual veteran experiences intersect with interpersonal and systemic factors. Semistructured focus groups were conducted with veterans who were former or current residents of recovery homes (N = 20). Thematic analysis was utilized to explore veterans' personal experiences through the CHIME‐D framework (connectedness, hope & optimism, identity, meaning in life, empowerment, and difficulties). The data were further analyzed within a socioecological model (intrapersonal, interpersonal, and community). Each component of the CHIME‐D framework was salient across all focus groups, with connectedness, empowerment, and difficulties being the most prominent themes that occurred across all socioecological levels. Results suggest that recovery initiatives can effectively assist veterans by promoting empowerment, facilitating social connections, and addressing cooccurring difficulties across multiple socioecological contexts. Additionally, treatment programs should encourage veterans to take on meaningful roles in their communities. Future research should continue to explore veterans' recovery experiences using a socioecological model. Highlights: Veterans have specific characteristics that hinder or benefit their substance use recovery.Applying a socioecological model to the connectedness, hope & optimism, identity, meaning in life, empowerment, and difficulties framework captures veterans' recovery experiences.Individual, interpersonal, and community‐level support are all paramount to recovery.Veterans who are empowered and connected within their communities help peers in recovery. [ABSTRACT FROM AUTHOR]

In Uganda, almost half of children under 5 years old suffer from undernutrition. Undernutrition, a common form of malnutrition in children, encompasses stunting, wasting and underweight. The causes of child undernutrition are complex, suggesting that interventions to tackle malnutrition must be multifaceted. Furthermore, limited access to healthcare for vulnerable populations restricts the potential of hospital‐based strategies. Community‐based management of acute malnutrition (CMAM), which includes nutritional counselling, ready‐to‐use therapeutic foods and the outpatient management of malnutrition by caregivers, is recognised as an effective approach for children's recovery. However, evaluations of CMAM programs are largely based on biomedical and behavioural health models, failing to incorporate structural factors that influence malnutrition management. The objective of this evaluation was to understand the factors influencing malnutrition management in a CMAM program in rural Uganda, using the socioecological model to assess the multilevel determinants of outpatient malnutrition management. This evaluation used qualitative methods to identify factors related to caregivers, healthcare providers and societal structures that influence children's outpatient care. Data were collected at a community health clinic in 2019 through observations and interviews with caregivers of malnourished children. We observed 14 caregiver‐provider encounters and interviewed 15 caregivers to examine factors hindering outpatient malnutrition management. Data were thematically analysed informed by the socioecological model. Findings showed that caregivers had a limited understanding of malnutrition. Counselling offered to caregivers was inconsistent and insufficient. Poverty and gender inequality limited caregivers' access to healthcare and their ability to care for their children. Factors at the caregiver and healthcare levels interacted with societal factors to shape malnutrition management. Results suggest that CMAM programs would benefit from providing holistic interventions to tackle the structural barriers to children's care. Using a socioecological approach to program evaluation could help move beyond individual determinants to address the social dynamics shaping malnutrition management in low‐ and middle‐income countries. [ABSTRACT FROM AUTHOR]

Background and Objectives In the last decade, sport has been considered a tool in active aging to maintain physical fitness, improve mental well-being, and form social relationships among older people. However, a thorough psychosocial understanding of the phenomenon of older athletes competing in sports events is lacking. Most research has focused on competitive sports participation in the young population. This study analyzes the general state of knowledge of competitive sports participation among athletes aged 50 years and older from a psychosocial perspective. Research Design and Methods We followed the 5-step process outlined by Arksey and O'Malley. After the search in 4 electronic databases, 69 peer-reviewed articles met the inclusion criteria. Results The findings indicate that psychosocial research into older people's participation in competitive sports has grown moderately in the last decade. While intrapersonal and interpersonal aspects have dominated the academic psychosocial discourse on older athletes' competitive sports participation, aspects related to the environment/community and policy have largely been overlooked. Discussion and Implications We identified several critical gaps in the literature, classified into conceptual (e.g. lesser attention to personality, emotional, and cognitive aspects), methodological (e.g. longitudinal studies almost absent), and diverse aspects (e.g. focus on a wide indiscriminate age range; few comparisons between types of sports; underrepresentation of some nation or world regions as well as few cross-national comparative studies). These research gaps hint at opportunities that future research on older people's participation in competitive sports should address. [ABSTRACT FROM AUTHOR]

Background: Precursors driving leisure-time sedentary behaviors remain poorly investigated, despite their detrimental consequences. This study aimed to investigate the predictive validity of controlled and automatic motivational precursors toward reducing sedentary behaviors and being physically active on leisure-time sedentary behaviors. The influence of demographic, physical, socio-professional, interpersonal, and environmental variables was also examined and compared with the associations of motivational precursors. Methods: 125 adults completed questionnaires measuring controlled motivational precursors (i.e., intentions, perceived competence), demographical (i.e., sex and age), physical (i.e., body mass index), and interpersonal (i.e., number of children) variables. Regarding automatic motivational precursors, habit strength and approach-avoidance tendencies were captured using the Self-Report Behavioral Automaticity Index and a manikin task. Time at work was computed as a socio-professional variable, days of the week and weather conditions were recorded as environmental precursors. Participants wore an accelerometer for 7 days and leisure time was identified using notebooks. Associations between the different precursors and the leisure-time sedentary behaviors were examined in linear mixed effect models. Results: Intention to be physically active and habit strength toward physical activity were negatively associated with leisure-time sedentary behaviors. Sex, body mass index, time at work, number of children, day of the week, and weather conditions were more strongly associated with leisure-time sedentary behaviors. Conclusion: Our findings show that, in comparison with other variables, the influence of motivational precursors on leisure-time sedentary behaviors is limited. This study supports the adoption of a broad-spectrum of precursors when predicting sedentary behaviors. [ABSTRACT FROM AUTHOR]

Many factors affect an individual’s resilience. Low resilience has been attributed to increased stress, anxiety, depression, and suicidality within the LGBTQIA + population, which is heightened compared to different populations. This study identifies predictors of resilience in the LGBTQIA + population and aims to identify predicting factors at all levels of the socioecological model. This was a cross-sectional study of data from a web-based survey that was conducted from January to February 2022. A national sample of 1033 LGBTQIA + adults was utilized for hierarchical regression analysis. Hierarchical regression analyses were performed for total resilience, which had an average score of 143.66 (SD = 33.88) and accounted for 53.4% of resiliency variance. Factors that were found to decrease an individuals resiliency score were depression, stress, suicidality, and isolation discrimination distress. Factors found to increase an individuals resiliency scores are college graduate 4 years+, married, outness, personal comfortability with being SGM, gender expression discrimination distress, and vicarious discrimination distress. Understanding the factors that influence resilience is vital to improving the resilience of the LGBTQIA + communities. Interventions that focus on decreasing depression, stress, and suicidality may be particularly impactful for all types of resilience. [ABSTRACT FROM AUTHOR]

Puerto Rico is a territory of the United States, making Puerto Ricans vulnerable to damaging colonial policy. The purpose of this article is to utilize the socioecological model (SEM) to evaluate how the Jones Act impacted Puerto Rico after Hurricane María, examining colonialist policy as a social determinant of health (SDOH) in Puerto Rico.Levels of the SEM used in this examination included: individual, institutional, community, policy, and context.Evaluation of the Jones Act using the model demonstrated relationships between all socioecological levels. The Jones Act caused delays and increased prices for goods needed to rebuild community utility infrastructure, which led to extended closures of institutions like workplaces, schools, and hospitals, and ultimately contributed to increased acute and chronic physical and mental illness among Puerto Ricans.This evaluation establishes that colonialist policy negatively impacts the health of Puerto Ricans, positioning colonialism as an SDOH. [ABSTRACT FROM AUTHOR]

To identify factors that influence the sugar-sweetened beverage (SSB) intake of caregivers of middle school-aged adolescents. Cross-sectional. Southwestern Virginia, US, part of Central Appalachia. Caregivers (n = 362) of adolescents enrolled in the Kids SIPsmartER trial. Participants were mostly female (91%) and non-Hispanic White (96%), and 21% received Supplemental Nutrition Assistance Program (SNAP) benefits. Caregiver daily SSB intake and demographics, personal-level, interpersonal-level, and environmental-level determinants. Descriptive statistics, 1-way ANOVA, and stepwise regression. On average, caregivers consumed 25.7 (SD, 33.2) fluid ounces of SSB per day. In the final model, which included all variables, age (β = −0.41; P < 0.05), receiving SNAP benefits (β = 14.19; P ≤ 0.01), behavioral intentions (β = −5.48; P ≤ 0.001), affective attitudes (β = −2.15, P < 0.05), perceptions of whether their adolescent frequently consumes high amounts of SSB (β = 1.92; P ≤ 0.001), and home availability (β = 7.43; P ≤ 0.01) were significantly associated with SSB intake. Caregivers of Appalachian middle school students are high SSB consumers. Findings highlight the importance of implementing behavioral interventions for caregivers of adolescents that target multiple levels of influence, including demographic, personal-level, interpersonal-level, and environmental-level factors. Interventions may be particularly important for communities and groups with higher SSB intakes, such as those in Appalachia and who receive SNAP benefits. [ABSTRACT FROM AUTHOR]

The study aims were to 1) examine profiles of perception of motor competence (PMC) in relation to actual motor competence (AMC), i.e. under-estimators (UEs), realistic estimators (REs) and over-estimators (OEs) and 2) investigate associations between the profiles and selected socioecological factors at the individual, family and environmental levels. PMC (Pictorial Scale of Perceived Movement Skill Competence) and AMC (Test of Gross Motor Development-Third Edition) were administered to a representative sample of children from 37 childcare centres in Finland (n=441;6.2±0.6yrs;52% boys). Socioecological factors were investigated using a parental questionnaire. The three profiles were formed based on age- and gender-adjusted PMC and AMC z-scores. Multinomial logistic regression showed that OEs (n=81; p=0.04) tended to be younger than REs (n=306; p=0.04) and UEs (n=54; p=0.03). Parents of OEs reported more child health and developmental issues than parents of REs (p=0.03). Parents of UEs self-reported providing more support for physical activity than parents' of REs (p=0.04). REs tended to live in denser population areas than UEs (n=54; p=0.03). Whilst PMC profiles revealed some socioecological differences, future research needs to focus on a broader range of potential correlates and untangle methodological analyses challenges to deepen the knowledge about PMC development in children. [ABSTRACT FROM AUTHOR]

Suicide is the second leading cause of death among youth in the United States. Data from the 2015 Youth Risk Behavior Survey of 9th–12th grade students in New Hampshire (N = 14,837) were utilized. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression models to evaluate associations between suicidal ideation, adverse childhood experiences (ACEs), and other risk factors including using opioids/drugs without a prescription and food insecurity. We also examined whether potentially protective behaviors may attenuate the relationship between ACEs and suicidal ideation. The prevalence of suicidal ideation was 15.4% (girls 20.15; boys 10.67). In unadjusted models, the crude odds ratio reflecting the relationship between suicidal ideation and higher ACE scores was 1.85 (95% CI 1.76–1.94). In adjusted models, suicidal ideation remained positively associated with higher ACE scores (aOR 1.61, 95% CI 1.52–1.70). Risk and protective behavioral factors identified in relation to suicidal ideation and ACEs are discussed within the context of community–academic partnerships and policy. [ABSTRACT FROM AUTHOR]

There is emerging evidence of a rise in new human immunodeficiency virus (HIV) infections in Ethiopia. This may partly be explained by an increase in risky sexual behaviors among high school adolescents. The current study was conducted to explore the association between a set of predictor variables (comprehensive HIV knowledge and condom use self-efficacy score) and an outcome variable of risky sexual behavior among high school adolescents in the Angacha District of Southern Ethiopia. The study employed a quantitative crosssectional design to answer the research question. Primary data were collected using a self-administered questionnaire from 374 participants using a stratified random sampling technique. Descriptive statistics and bivariate and multivariate logistic regressions were computed using SPSS Version 25. The prevalence of risky sexual behavior among school adolescents was 30.04/per 1000. The Cronbach's Alpha for condom use selfefficacy score (CUSES) was 0.79. The association between HIV comprehensive knowledge and risky sexual behavior was not statistically significant. A statistically significant association was found between CUSES and the risky sexual behavior of the student, P = 0.048, OR =2.23, 95% CI [1.007, 4.925] when the covariates were held constant. The mean CUSES for males (M = 3.44) was significantly higher than females (M = 3.22), U = 14523.5, P = 0.025, X2 = 0.016). Policy decisions to revitalize school-based adolescent sexual health promotion to empower adolescents with life skills are needed to sustain the gains of HIV/AIDS control and enhance social change in the country. [ABSTRACT FROM AUTHOR]

Background: Handwashing with soap is a cost-effective, efficient health behavior to prevent various diseases. Despite its immense health benefits, the lowest prevalence of handwashing is found in low-income countries. Here, its practice is not only determined by individual behavior, but also heavily shaped by deprivations in the social and structural ecology. Moreover, handwashing barriers are not equally experienced as overlapping social identities (e.g., age and gender) intersect and create inequities between members of different social groups. To embrace the complexities of handwashing beyond individual-level behavior and singular social identities, a combined socioecological and intersectional perspective is employed. This multi-level approach with regards to intersecting privileges and disadvantages serves as a basis to promote this highly important health behavior. Methods: This study used a qualitative, theory-based approach and combined data from two samples: experts in health promotion (n = 22) and local citizens stratified by gender and rural/urban location (n = 56). Data was collected in face-to-face interviews in Sierra Leone between November 2018 and January 2019 and analyzed using thematic analysis and typology of the qualitative data. Results: The conceptualization of multi-level determinants of handwashing within a socioecological model showed the high relevance of inhibiting social and structural factors for handwashing practice. By establishing seven distinguishing social identity dimensions, data demonstrates that individuals within the same social setting yet with distinct social identities experience strikingly differing degrees of power and privileges to enact handwashing. While a local leader is influential and may also change structural-level determinants, a young, rural wife experiences multiple social and structural constraints to perform handwashing with soap, even if she has high handwashing intentions. Conclusion: This study provides a holistic analytical framework for the identification of determinants on multiple levels and accumulating intersections of socially produced inequalities for handwashing and is applicable to other health topics. As the exploration of handwashing was approached from a solution-focused instead of a problem-focused perspective, the analysis can guide multi-level intervention approaches (e.g., using low-cost, participatory activities at the community level to make use of the available social capital). [ABSTRACT FROM AUTHOR]

Aim: To describe promotive and risk factors for children's mental health at the individual, interpersonal, organizational, community and public policy levels of the socioecological environment. Design: A descriptive qualitative interview study. Methods: Data were collected in Finland during autumn 2019 via semi‐structured interviews. Participants (n = 23) comprised public health nurses who worked in child health clinics and school healthcare. Data were analyzed using inductive content analysis. Results: Several promotive and risk factors were identified to have affected children's mental health. Intra‐family factors were the most important in the opinion of public health nurses, and they were most concerned about family related risk factors. In addition, the descriptions of nurses revealed that children are in a socially unequal position in terms of their place of residence. It was also uncovered that there were fewer social and healthcare and leisure services in small municipalities, the distances to services were longer, which was perceived to complicate the use of services, and the fear of stigma was greater. Conclusion: According to public health nurses, factors at the individual, interpersonal, organizational, community and public policy levels of the socioecological environment affect children's mental health and overall well‐being. Consequently, the promotion of children's mental health should be emphasized at every level of the society, considering the whole family. Impact: This study indicated the importance of considering factors that affect children's mental health at all levels of the socioecological environment. The results can be reflected in the relation of the socioecological model of health promotion and used in planning the work of nurses in primary healthcare and other relevant nursing settings to emphasize promotive and preventive work. [ABSTRACT FROM AUTHOR]

Background: Handwashing with soap is a cost-effective, efficient health behavior to prevent various diseases. Despite its immense health benefits, the lowest prevalence of handwashing is found in low-income countries. Here, its practice is not only determined by individual behavior, but also heavily shaped by deprivations in the social and structural ecology. Moreover, handwashing barriers are not equally experienced as overlapping social identities (e.g., age and gender) intersect and create inequities between members of different social groups. To embrace the complexities of handwashing beyond individual-level behavior and singular social identities, a combined socioecological and intersectional perspective is employed. This multi-level approach with regards to intersecting privileges and disadvantages serves as a basis to promote this highly important health behavior.Methods: This study used a qualitative, theory-based approach and combined data from two samples: experts in health promotion (n = 22) and local citizens stratified by gender and rural/urban location (n = 56). Data was collected in face-to-face interviews in Sierra Leone between November 2018 and January 2019 and analyzed using thematic analysis and typology of the qualitative data.Results: The conceptualization of multi-level determinants of handwashing within a socioecological model showed the high relevance of inhibiting social and structural factors for handwashing practice. By establishing seven distinguishing social identity dimensions, data demonstrates that individuals within the same social setting yet with distinct social identities experience strikingly differing degrees of power and privileges to enact handwashing. While a local leader is influential and may also change structural-level determinants, a young, rural wife experiences multiple social and structural constraints to perform handwashing with soap, even if she has high handwashing intentions.Conclusion: This study provides a holistic analytical framework for the identification of determinants on multiple levels and accumulating intersections of socially produced inequalities for handwashing and is applicable to other health topics. As the exploration of handwashing was approached from a solution-focused instead of a problem-focused perspective, the analysis can guide multi-level intervention approaches (e.g., using low-cost, participatory activities at the community level to make use of the available social capital). [ABSTRACT FROM AUTHOR]

The health and social benefits of volunteering behaviours by older adults are well acknowledged. However, few review articles have been concerned with the correlates/dimensions of older adults' volunteerism. Some focused only on the North American context or reviewed studies only up to 2008. This study reviewed the recent global literature in the past decade about the correlates of older adults' volunteerism. We carried out a literature search in PsycINFO, Social Services Abstracts, Sociological Abstracts and Google Scholar to identify empirical journal publications about the correlates of older adults' (age 60+) volunteerism from 2008 to 2019. Among 112 initially eligible papers, 41 were selected. Findings were synthesised using the framework of the Socioecological Model. Existing studies mainly have used quantitative methodologies and were conducted within the context of a single Western country. Motivations included higher education, morale and mentality, previous experiences, social network, community cohesion and organisational management. Major barriers were health and financial constraints. Few studies focused on macro-level correlates. Irrelevant and confounding correlates were also discussed. We suggest practitioners recruit and retain older volunteers by identifying their needs and optimising management within the organisation. Policy makers should create a supportive environment and increase resource accessibility. Future research could conduct cross-cultural comparisons, use diverse methodologies and embrace more correlates, especially at the macro-level. [ABSTRACT FROM AUTHOR]

Background: Nigeria is one of the ten countries globally that account for 62% of under- and unvaccinated children worldwide. Despite several governmental and non-governmental agencies' interventions, Nigeria has yet to achieve significant gains in childhood immunization coverage. This study identifies intrapersonal, interpersonal, organizational, community, and policy-level factors that influence childhood immunization uptake from various stakeholders' perspectives using the Socioecological Model (SEM).Methods: Using the Socioecological Model as a guiding framework, we conducted ten focus group sessions with mothers/caregivers and community leaders residing in Lagos state and nine semi-structured interviews with healthcare workers who provide routine immunization services in Lagos state primary healthcare facilities. We performed a qualitative analysis of focus groups and semi-structured interviews using deductive coding methods.Results: The study sample included 44 mothers/caregivers and 24 community leaders residing in Lagos State, Nigeria, and 19 healthcare workers (routine immunization focal persons) working in the primary healthcare setting in Lagos state. Study participants discussed factors at each level of the SEM that influence childhood immunization uptake, including intrapersonal (caregivers' immunization knowledge, caregivers' welfare and love of child/ren), interpersonal (role of individual relationships and social networks), organizational (geographical and financial access to health facilities, health facilities attributes, staff coverage, and healthcare worker attributes), community (community outreaches and community resources), and policy-level (free immunization services and provision of child immunization cards). Several factors were intertwined, such as healthcare workers' education of caregivers on immunization and caregivers' knowledge of vaccination.Conclusions: The reciprocity of the findings across the Socioecological Model levels emphasizes the importance of developing multi-pronged interventions that operate at multiple levels of the SEM. Our results can inform the design of culturally appropriate and effective interventions to address Nigeria's suboptimal immunization coverage. [ABSTRACT FROM AUTHOR]

Background: In the U.S., strong ethnic/racial, socioeconomic, demographic, and geographic breastfeeding (BF) inequities persist, and African American and Hispanic women are less likely to meet their breastfeeding goals compared to White women. This systematic review (SR) was designed to answer the question: What is the impact of breastfeeding interventions targeting ethnic/racial minority women in the U.S. on improving BF initiation, duration and exclusivity rates? Methods: The SR was conducted following the Institute of Medicine Guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study protocol was developed and registered a priori in PROSPERO (ID#CRD42020177764). The electronical databases searched was MEDLINE All (Ovid). Search strategies were led by the team's expert public health librarian using both controlled vocabulary and free text queries and were tested against a validated set of relevant papers included in existing reviews. The GRADE methodology was used to assess the quality of the studies. Results: We included 60 studies that had randomized (n = 25), observational (n = 24), quasi-experimental (n = 9), or cross-sectional (n = 2) designs. The studies focused on populations that were multi-ethnic/racial (n = 22), only Hispanic (n = 24), only Black (n = 13), and only American Indian (n = 1). The study interventions were classified following the socioecological model: macrosystem/policy level (n = 6); community level (n=51), which included healthcare organizations (n = 34), The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n = 9), and community organizations/public health institutions (n = 8); and interpersonal level (n = 3). Conclusions: Policy and community level interventions delivered through WIC, healthcare facilities, and community agencies) are likely to improve BF outcomes among women of color. The combination of interventions at different levels of the socioecological model has not been studied among minority women in the U.S. Implementation science research is needed to learn how best to scale up and sustain effective BF interventions, taking into account the needs and wants of minority women. Thus, it is strongly recommended to conduct large scale implementation research studies addressesing how to strengthen the different health and social environments surrounding women of color in the U.S. to improving their BF outcomes. [ABSTRACT FROM AUTHOR]

Language focused on individual dietary behaviors, or alternatively, lifestyle choices or decisions, suggests that what people eat and drink is primarily a choice that comes down to free will. Referring to and intervening upon food consumption as though it were a freely chosen behavior has an inherently logical appeal due to its simplicity and easily defined targets of intervention. However, despite decades of behavioral interventions, population-level patterns of food consumption remain suboptimal. This debate paper interrogates the manner in which language frames how problems related to poor diet quality are understood and addressed within society. We argue that referring to food consumption as a behavior conveys the idea that it is primarily a freely chosen act that can be ameliorated through imploring and educating individuals to make better selections. Leveraging practice theory, we subsequently propose that using the alternative language of eating practices and patterns better conveys the socially situated nature of food consumption. This language may therefore point to novel avenues for intervention beyond educating and motivating individuals to eat more healthfully, to instead focus on creating supportive contexts that enable sustained positive dietary change. Clearly, shifting discourse will not on its own transform the science and practice of nutrition. Nevertheless, the seeds of change may lie in aligning our terminology, and thus, our framing, with desired solutions. [ABSTRACT FROM AUTHOR]

The transition from solitary life to sociality is considered one of the major transitions in evolution. In primates, this transition is currently not well understood. Traditional verbal models appear insufficient to unravel the complex interplay of environmental and demographic factors involved in the evolution of primate sociality, and recent phylogenetic reconstructions have produced conflicting results. We therefore analyze a theoretical model for the evolution of female social philopatry that sheds new light on the question why most primates live in groups. In individual‐based simulations, we study the evolution of dispersal strategies of both resident females and their offspring. The model reveals that social philopatry can evolve through kin selection, even if retention of offspring is costly in terms of within‐group resource competition and provides no direct benefits. Our model supports the role of predator avoidance as a selective pressure for group‐living in primates, but it also suggests that a second benefit of group‐living, communal resource defense, might be required to trigger the evolution of sizable groups. Lastly, our model reveals that seemingly small differences in demographic parameters can have profound effects on primate social evolution. [ABSTRACT FROM AUTHOR]

This study tests a socioecological model of relapse and recovery using latent class growth mixture modeling to identify neighborhood, social network and individual-level predictors of alcohol dependence trajectories among a large, longitudinal sample of problem drinkers recruited from substance use treatment settings. We identified four distinct alcohol dependence trajectories: Stable Recovery/Low (Class 1); Relapsing/Rising (Class 2); Late Recovery/Declining (Class 3); and Chronic/High (Class 4). Neighborhood context (poverty and density of bars), social network characteristics (less involvement with Alcoholics Anonymous [AA], continued affiliation with heavy drinkers), and individual predisposing (psychiatric severity) and need (returning to treatment) characteristics each distinguished individuals in the Relapsing/Rising class from individuals in the Stable Recovery/Low class. Social network characteristics (AA involvement and continued affiliation with heavy drinkers) were the primary distinguishing factors for individuals in the Chronic/High class compared to the Late Recovery/Declining class. Study findings can be used to promote recovery and help prevent relapse by: guiding development of community-level interventions to improve social and physical environments; identifying potentially modifiable factors (social network support for sobriety, participation in self-help) to reduce negative consequences among problem drinkers who remain in high-risk neighborhoods; and contributing to ongoing discussions about new and continued licensing of alcohol outlets and regulation of alcohol sales to prevent alcohol problems in high-risk areas and among high-risk people. [ABSTRACT FROM AUTHOR]

Objective: To determine associations between African American female obesity and SEM variables. Design: Data from the National Survey of American Life Self-Administered Questionnaire (NSAL-SAQ), a 2001-2003 nationally representative cross-sectional survey was used to extract data for African American women. Participants: African American females at a BMI of 18.5 kg/m² or greater were included in the final sample (n = 2,100) for analysis. Main Outcome Measure(s): BMI. Analysis: Measures for socioecological model (SEM) were analyzed using a regression model in SPSS. Results: Intrapersonal and community/institutional levels were found to be significantly associated with BMI. Two multiple regression analyses models were developed to determine predictive capabilities. Model 1 was found to be more predictive than model 2, but both had a low level of predictive capability for BMI. Conclusion and Implications: Findings in this study indicate that intrapersonal and community influences have the greatest impacts on obesity rates among African American women. Providing African American women with the resources needed to improve their financial circumstances, through higher educational attainment women can impact a number of community/institutional variables, impacting weight. [ABSTRACT FROM AUTHOR]

Multiple factors may influence the risk of exposure to childhood violence and repeated victimization, although most research has focused on individual rather than contextual factors. Moreover, it is unclear whether family background factors associated with exposure to childhood violence also are associated with revictimization in young adulthood. This article investigates individual and contextual factors associated with childhood abuse and revictimization. Data from a community telephone survey, collected at two different time points (N = 1,011, 16-33 years of age), were used. Logistic regression analysis was applied to analyze family background factors in childhood violence–exposed cases and non-exposed controls. Similar analyses were conducted for the relationship of individual and contextual variables in the revictimized and the non-revictimized groups. The adjusted analyses showed that social problems (≥2 or more social problems: odds ratio [OR] = 2.89, 95% confidence interval [CI] = [1.41, 5.94]) and frequent binge drinking (OR = 1.21, 95% CI = [1.05, 1.40]) were significantly associated with repeated victimization whereas social support decreased the odds (OR = 0.74, 95% CI = [0.55, 0.99]). Family problems and low family cohesion growing up (although measured at Wave 2) were significantly associated with childhood exposure to violence, but not with revictimization. Our findings emphasizes that it is useful to separate factors associated with childhood abuse from factors related to revictimization to identify current ecological aspects that can be addressed to prevent further abuse. [ABSTRACT FROM AUTHOR]