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Rural women and their babies experience poorer perinatal outcomes than their urban counterparts and this inequity has existed for decades. This study explored the barriers and enablers that exist for rural women in Australia in accessing perinatal care. A qualitative descriptive design, using reflexive thematic analysis, was employed. Semi-structured interviews were conducted in 2023 with women who had recently given birth in rural Victoria, Australia (n=19). A purposive sampling strategy was used, recruiting women via social media platforms from rural communities across the state. The Socioecological Model (SEM) was used as a framework to organise the findings. Study participants reported multilevel barriers and enablers to accessing perinatal care in their own communities. Intrapersonal factors included financial resources, transportation, self-advocacy, health literacy, rural stoicism, personal agency, and cost of care. Interpersonal factors included factors such as ineffective relationships, poor communication, and care provider accessibility. Organisational factors included inequitable distribution of services, under-resourcing of perinatal services in rural areas, technology-enabled care models and access to continuity of care. Community factors included effective or ineffective interprofessional or interorganisational collaboration. Policy factors included centralisation of perinatal care, lack of funded homebirth and midwifery care pathways and access to free perinatal care. Participants in this study articulated several key barriers influencing access to perinatal care in rural areas. These factors impede help-seeking behaviour and engagement with care providers, compounding the impact of rurality and isolation on perinatal outcomes and experience of care. Key enablers to accessing perinatal care in rural communities were also identified and included personal agency, health literacy, social capital, effective collaboration and communication between clinicians and services, technology enabled care and free perinatal care. [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 United States benefits economically and socially from the diverse skill-set and innovative contributions of immigrants. By applying a socioecological framework with an equity lens, we aim to provide an overview of the health of children in immigrant families (CIF) in the United States, identify gaps in related research, and suggest future areas of focus to advance health equity. The literature review consisted of identifying academic and gray literature using a MeSH Database, Clinical Queries, and relevant keywords in 3 electronic databases (PubMed, Web of Science, and BrowZine). Search terms were selected with goals of: 1) conceptualizing a model of key drivers of health for CIF; 2) describing and classifying key drivers of health for CIF; and 3) identifying knowledge gaps. The initial search produced 1120 results which were screened for relevance using a meta-narrative approach. Of these, 224 papers were selected, categorized by topic, and reviewed in collaboration with the authors. Key topic areas included patient and family outcomes, institutional and community environments, the impact of public policy, and opportunities for research. Key inequities were identified in health outcomes; access to quality health care, housing, education, employment opportunities; immigration policies; and inclusion in and funding for research. Important resiliency factors for CIF included strong family connections and social networks. Broad structural inequities contribute to poor health outcomes among immigrant families. While resiliency factors exist, research on the impact of certain important drivers of health, such as structural and cultural racism, is missing regarding this population. More work is needed to inform the development and optimization of programs and policies aimed at improving outcomes for CIF. However, research should incorporate expertise from within immigrant communities. Finally, interventions to improve outcomes for CIF should be considered in the context of the socioecological model which informs the upstream and downstream drivers of health outcomes. [ABSTRACT FROM AUTHOR]

The socio-ecological model (SEM) is a widely used framework that can be applied to heat-related illness (HRI) in the context of multiple influencing factors that exist in society. Leaders and policymakers must intervene to mitigate the deleterious effects of climate change on those at risk. The purpose is to introduce the SEM as a framework to address the complex factors contributing to the impact of excess heat. Conceived through the SEM, the compounding and cumulative impact of excess heat resulting in HRI is operationalized. The SEM provides a structure for understanding the complex nature of climate change and HRI and proposed interventions. The prevention of HRI is dependent on actions, related to practice, education, research, and advocacy across multiple levels of the SEM. The SEM has the potential to target HRI at all levels of society to reduce the harm of excess heat. • The socio-ecological model can be applied to climate change and heat-related illnesses. • The socio-ecological model highlights the cumulative impacts of excess heat. • Heat-related illnesses can be mitigated by intervening at various levels in society. • Clinicians can decrease the harm of excess heat by intervening at all levels. • Addressing impacts at the policy level requires compliance from organizations. [ABSTRACT FROM AUTHOR]

Identifying risk factors of incomplete immunization among children is crucial to developing relevant policies to improve immunization coverage. In this study, we investigated factors associated with incomplete immunization among children in Indonesia and elucidated differences in risk factors between urban and rural areas. The data came from a national-wide survey, the 2017 Indonesia Demographic Health Surveys. In total, 3264 children aged 12–23 months were included in the study. An incomplete immunization status was defined as a child who did not complete the ten doses of basic vaccinations, consisting of one dose of bacille Calmette-Guérin, one dose of hepatitis B, three doses of pentavalent vaccine (diphtheria, pertussis, tetanus, hemophilus influenza type B, and hepatitis B vaccine), four doses of polio vaccine, and one dose of measles vaccine. Generalized linear mixed models were constructed to examine the effects of different levels of risk factors on the incomplete immunization status. We further conducted stratified analyses by urban and rural areas. About 40% of the 3264 children were incompletely immunized, among whom 45.3% were in urban areas and 54.7% were in rural areas. Eight of the 34 provinces had incomplete immunization rates exceeding 50%, and the Papua and Maluku regions had the highest rates of incomplete child immunization. The multivariate analyses showed that when women attended fewer than four antenatal care sessions and resided outside the Nusa Tenggara region, their children were more likely to have incomplete immunization in both urban and rural areas. On the other hand, having no health insurance was positively associated with incomplete immunization in urban areas, whereas having received a tetanus vaccination during pregnancy was negatively associated with incomplete immunization in rural areas. Results of this study suggest that tailored interventions should be developed to address significant risk factors in rural and urban areas. [ABSTRACT FROM AUTHOR]

Most people in developed countries are not physically active enough to reap optimal health benefits so effective promotion strategies are warranted. Theories of behaviour change are essential to understand physical activity and provide an organizing framework for effective intervention. The purpose of this paper was to provide a narrative historical overview of four key theoretical frameworks (social cognitive, humanistic, dual process, socioecological) that have been applied to understand and change physical activity over the last three decades. Our synthesis of research included the brief history, basic efficacy, strengths, and potential weaknesses of these approaches when applied to physical activity. The dominant framework for understanding physical activity has been in the social cognitive tradition, and it has provided valuable information on key constructs linked to physical activity. The humanistic framework for understanding physical activity has seen a surge in research in the last decade and has demonstrated initial effectiveness in both explaining and intervening on behaviour. The most recent and understudied framework for understanding physical activity is dual process models, which may have promise to provide a broader perspective of motivation by considering non-conscious and hedonic determinants of physical activity. Finally, the individual-level focus of all three of these approaches is contrasted by the socioecological framework, which has seen considerable research attention in the last 15 years and has been instrumental in understanding the role of the built environment in physical activity behaviour and critical to shaping public health policy in government. Despite the strengths of all four frameworks, we noted several weaknesses of each approach at present and highlight several newer applications of integrated models and dynamic models that may serve to improve our understanding and promotion of physical activity over the next decade. • Provides a narrative historical overview of four key theoretical frameworks applied to understand physical activity over the last three decades. • Brief history, basic efficacy, strengths, and potential weaknesses of these approaches are addressed. • Highlights applications of integrated and dynamic models that may serve to improve our promotion of physical activity over the next decade. [ABSTRACT FROM AUTHOR]

Abstract Objective The current study aimed to examine the interplay between self-efficacy and perceived availabilities of fruits and vegetables (F&V) and energy-dense, low-nutrient foods and sugary drinks (EDLNF&SD) at home and in the school neighborhoods on adolescents' eating behaviors. Design The Family Life, Activity, Sun, Health, and Eating study, a cross-sectional, Internet-based survey was analyzed. Participants Adolescent–parent dyads (n = 1,657). Interventions Self-efficacy for F&V intake and limiting EDLNF&SD consumption, perceived F&V and EDLNF&SD availabilities at home and in the school neighborhood, and F&V intake and EDLNF&SD consumption. Analysis Multiple regression analyses. Results Adolescents' self-efficacy and perceived home and school neighborhood availability of F&V and EDLNF&SD had significant main effects on their F&V intake and EDLNF&SD consumption, respectively (all P <.01). The positive effect of self-efficacy on F&V intake was greater when home F&V availability was high (+1 SD; b =.29; P <.001) than when it was low (–1 SD; b =.07; P =.040). The effect of home F&V availability on F&V intake was significant when F&V were not available in the school neighborhood (b =.09; P =.006). Conclusions and Implications Given the central role of home availability, it may be considered a fundamental unit of nutrition intervention for adolescents. Multiple contexts (eg, individual, home, school neighborhood) need to be considered to promote adolescents' eating behaviors. [ABSTRACT FROM AUTHOR]

Objectives: Identify perceived barriers to leisure-time physical activity during pregnancy to inform future interventions aimed at improving physical activity levels in pregnancy.Design: PubMed/Medline and Web of Science databases were systematically searched using a reference period between 1986 and January/2016.Methods: A comprehensive search strategy was developed combining the following keywords: (barriers OR constraints OR perceptions OR attitudes) AND (physical activity OR exercise OR motor activity) AND (pregnancy OR pregnant women OR antenatal OR prenatal). Thematic synthesis was conducted to analyze the data. A socioecological model was used to categorize the reported barriers.Results: Twelve quantitative studies and 14 qualitative studies were included. Barriers belonging to the intrapersonal level of the socioecological model were the most reported in the studies and were categorized in five themes as follows: (1) Pregnancy-related symptoms and limitations; (2) Time constraints; (3) Perceptions of already being active, (4) Lack of motivation and (5) Mother-child safety concerns. At the interpersonal level, barriers were coded into two descriptive themes: (1) Lack of advice and information and (2) Lack of social support. Two other themes were used to summarize Environmental, Organizational and Policy barriers: (1) Adverse weather and (2) Lack of resources.Conclusions: A range of relevant barriers to leisure-time physical-activity engagement during pregnancy were identified in this literature review. Pregnancy-related symptoms and limitations barriers were the most reported in studies, regardless of study design. Mother-child safety concerns, lack of advice/information and lack of social support were also important emphasized pregnancy-related barriers to be targeted in future interventions. [ABSTRACT FROM AUTHOR]

In this study we explore the relationship between the benefits of greenspace and fear of crime in New Zealand neighbourhoods. To ensure that the full benefits of investment in greenspace are realised, it is important to understand the complex interactions that occur within natural environments and the effect of these interactions on individual wellbeing within different populations (in this case New Zealand). Employing an ordered logit model, this study uses data on self-reported life satisfaction, fear of crime and access to greenspace from the New Zealand General Social Survey. In line with existing evidence, results suggest that greater access to greenspace is associated with higher levels of life satisfaction. The strength of this association, however, is strongly dependent on fear of crime. That is, when residents report that they feel ‘unsafe’ or ‘very unsafe’ in their neighbourhood, the psychological benefits of access to greenspace disappear almost entirely. This relationship is conditioned further by age and gender, with residents between 50 and 59 years of age and males being less likely to report being very satisfied with their lives. Given the considerable level of public investment in providing and maintaining greenspace, there is a clear need to address fear of crime in the neighbourhood in order to ensure that the full benefits of policies directed at promoting the use of neighbourhood greenspace for health and well-being can be realised. [ABSTRACT FROM AUTHOR]

Objective: To develop and apply a framework exploring the extent of involvement in promoting environmental changes to prevent obesity by a group of nutrition educators (NE). Design: Cross-sectional, mixed methods: qualitative interviews informed framework development; survey applied framework to describe NE’s involvement in environmental changes. Setting: Cooperative Extension in New York State. Participants: Interviewees (n = 7) selected to vary in environmental change activities and rural/urban location. Survey response rate was 100% (n = 58). Phenomenon o f Interest/Variables Measured: Dimensions and degree of NE’s involvement in promoting environmental change. Analysis: Thematic analysis of qualitative data, triangulated with descriptive analyses of NE’s performance of tasks in various settings. Results: NE’s promotion of environmental changes was characterized using framework based on settings and tasks, dimensions that emerged from qualitative analysis. NE’s actions varied across these dimensions and ranged from low to high intensity of collaboration and leadership for environmental change. Most NE surveyed reported actions limited to providing information and recommendations on healthy eating and physical activity. Few reported intensive engagement in developing, implementing, and evaluating plans to change environments for obesity prevention. Conclusions and Implications: Framework identifies the levels of engagement in promoting environmental changes and supports future research and practice of community nutrition professionals by providing a roadmap for assessing their involvement on multiple levels to prevent obesity. [ABSTRACT FROM AUTHOR]

Abstract: Objective: A suboptimal level of seasonal influenza vaccination among pregnant minority women is an intractable public health problem, requiring effective message resonance with this population. We evaluated the effects of randomized exposure to messages which emphasize positive outcomes of vaccination (“gain-frame”), or messages which emphasize negative outcomes of forgoing vaccination (“loss-frame”). We also assessed multilevel social and community factors that influence maternal immunization among racially and ethnically diverse populations. Study design: Minority pregnant women in metropolitan Atlanta were enrolled in the longitudinal study and randomized to receive intervention or control messages. A postpartum questionnaire administered 30 days postpartum evaluated immunization outcomes following baseline message exposure among the study population. We evaluated key outcomes using bivariate and multivariate analyses. Results: Neither gain- [OR=0.5176, (95% CI: 0.203,1.322)] nor loss-framed [OR=0.5000, 95% CI: (0.192,1.304)] messages were significantly associated with increased likelihood of immunization during pregnancy. Significant correlates of seasonal influenza immunization during pregnancy included healthcare provider recommendation [OR=3.934, 95% CI: (1.331,11.627)], use of hospital-based practices as primary source of prenatal care [OR=2.584, 95% CI: (1.091,6.122)], and perceived interpersonal support for influenza immunization [OR=3.405, 95% CI: (1.412,8.212)]. Conclusion: Dissemination of vaccine education messages via healthcare providers, and cultivating support from social networks, will improve seasonal influenza immunization among pregnant minority women. [Copyright &y& Elsevier]

Abstract: Objective: This study investigated socioecological factors influencing HIV vaccine research participation among communities living in geographic areas with high HIV prevalence and high poverty rates. Methods: We surveyed a sample of 453 adults ≤18 years from areas of high poverty and high HIV prevalence in metro Atlanta and differentiated the effects of individual-, social/organizational-, and community-level characteristics on participation in HIV vaccine research via multilevel modeling techniques that incorporated questionnaire, program, and census data. Results: Models that adjusted for both individual-level covariates (such as race, gender, attitudes, and beliefs concerning HIV research), social/organizational- and community-level factors such as local HIV prevalence rates, revealed that the extent of HIV prevention-related programs and services in census tracts contributed to individuals’ likelihood of participation in an HIV vaccine study. Additionally, neighborhood-based organizations offering HIV medical and treatment programs, support groups, and services (e.g., food, shelter, and clothing) encourage greater HIV vaccine research participation. Conclusions: The findings support the hypothesis that community-level factors facilitate participation in HIV vaccine research independent of both individual- and social/organizational-level factors. [Copyright &y& Elsevier]

Abstract: Increasing the use of urban green space has appeared on the political agenda, primarily because increased use is expected to improve the health and well-being of the urban population. Green space is contributing to restoring mental fatigue, serving as a resource for physical activity, reducing mortality and reducing the level of stress. However, knowledge and experience on how to implement this agenda are scarce. In this paper, we use a socio-ecological model as framework when studying influences on the use of respondents’ nearest urban green space in the Danish city of Odense. Data were obtained from a survey sent to 2500 randomly selected adult residents within the central part of the city. We tested the relative importance of different factors on the frequency of use of the nearest urban green space by using a multivariate logistic regression model. The results show that almost half of the respondents did not use their nearest green space the most. Whether or not respondent used their nearest green space most depends primarily on area size, distance to the area and factors that are likely to express a reduced mobility; old age, young children and poor health. If the nearest urban green space also is the most used green space, having a dog is the only factor that significantly increases the frequency of use. Further research is needed to determine what it is that makes people use an area more, if the basic conditions of a reasonable size (>5ha) within a reasonable distance (<600m) are fulfilled. [Copyright &y& Elsevier]

Background Dietary habits formed during the first 5 y of life portend lifelong eating patterns. Objective The Synergistic Theory Research Obesity and Nutrition Group (STRONG) Kids 2 birth cohort study aimed to examine multilevel predictors of weight trajectories and dietary habits including individual biology, child socioemotional and behavioral characteristics, family environment, and child care environment over the first 5 y of life. This report describes recruitment strategies, an overview of survey measures, and basic descriptive statistics of the cohort. Methods The cohort includes 468 mothers and their offspring. A brief survey was completed at a 1-wk home visit including child's birth weight, intent to breastfeed, collection of an infant stool sample, and additional contact information should the family move. Mothers completed surveys including diet, child temperament, family environment, and child care when their child was 6 wk, 3, 12, 18, 24, 36, 48, and 60 mo of age. Height and weight of the mother and child were collected at each visit. Stool samples of the child were collected at each visit as well as saliva at 1 visit. Results Close to half of the mothers were either overweight (24.2%) or obese (25.2%) prepregnancy. At 6 wk of age, 32.9% of the children were overweight and 31.4% were obese based on direct measurement. Conclusions The STRONG Kids 2 research team has adopted a socioecological model that accounts for multiple influences on children's health including biological, child social and behavioral, family household organization, and community factors. The study is limited by a relatively educated and nondiverse sample. However, variations in maternal and child weight may inform future prevention programs and policy aimed at improving the diet and health of children under the age of 5 y. This trial was registered at clinicaltrials.gov as NCT03341858. [ABSTRACT FROM AUTHOR]