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Background: Based on findings from a recent systematic review of the methodological aspects related to data collection for the walk-along interview (WAI) method applied to healthy older adults, complementary questions emerged, among them, what are the main outcomes of studies that have used the WAI? Objective: The aim of this systematic review is to identify the outcomes of published studies that have used the WAI method to identify correlates of the perceived neighborhood environment on walking activity in healthy older adults. Methods: In accordance with the PRISMA guidelines, a date-unrestricted search spanning four databases was performed. Of the 164 articles identified in the initial search, 31 articles published between 2012 and 2022 met the inclusion criteria. Results: The extracted outcomes were classified into two categories: (1) the relationship between the physical characteristics of the environment and walking among healthy older adults (e.g., pedestrian infrastructure, safety, access to facilities, aesthetics and environmental conditions) and (2) the facilitators and barriers to walking, based on the dimensions of the socioecological model. Conclusions: This review provides a valuable resource for researchers, students and professionals who wish to work with the WAI method, working on aging and age-friendly cities policies. [ABSTRACT FROM AUTHOR]

Despite the many benefits of club-organized sports participation for children, studies have shown that sports participation is lower among children from low-income families than among children from middle- or high-income families. Adopting a socioecological perspective, the main aim of our study was to identify and describe experiences of person–environment (PE) misfits in relation to parental facilitation of children's sports participation. We conducted 24 interviews with parents from low-income families. PE misfits were found in multiple behaviors related to the facilitation of children's sports participation: financing sports participation; planning and investing time; transporting children; acquiring, processing, and providing information; and arranging support. Across these PE misfits, influential attributes were found on the individual level (e.g., skills) as well as within the social, policy, physical, and information environment. In response to PE misfits experienced, parents deployed multiple strategies to reduce these PE misfits, aimed at enhancing either themselves (e.g., increasing financial capacities) or their environments (e.g., arranging social support). These results provide an insight into experienced PE misfits that took the form of multiple specific behaviors which parents found difficult while facilitating their children's sports participation. Furthermore, the results provide insight into the environmental and individual attributes that were involved in these PE misfits, and into how parents modified themselves or their environments in order to make their environments more supportive. The study contributes to future research on individual and environmental influences on parental facilitation of their children's sports participation, as well as on the development of multilevel interventions aimed at increasing sports participation among children from low-income families. [ABSTRACT FROM AUTHOR]

The aim of our study was to explore the barriers and facilitators that teachers, principals, and parents face when adapting to COVID-19 pandemic scenario in terms of promoting toddlers' physical activity (PA). Thirty-four (20 teachers and principals, and 14 parents) semi-structured qualitative interviews were conducted from October 2020 to March 2021. The socioecological model has enabled the identification of barriers and facilitators, some of which are related to the pandemic and others which are not. The main results suggest that upon reopening the ECEC institutions, regarding environmental barriers, educators mentioned the impact on the use of space, and parents, the modification of daily activities generated by COVID-19. However, educators also considered that the presence of suitable spaces in the school for practicing PA was a facilitator. At the intra- and interpersonal level, facilitators of PA that were unrelated to the pandemic included, for parents, the predisposition of children to be physically active and their own function as role models, and for educators, the curricular practices themselves. At an environmental level, the risk of danger in the traditional classroom plus bad weather were considered barriers by educators, while parents mentioned difficulties accessing outdoor space and the poor suitability of indoor spaces. Our results suggest the simultaneous analysis of the perceptions of different actors in the educational environments offers a broad vision of the ecological alternatives for offering children opportunities for PA in these difficult times. [ABSTRACT FROM AUTHOR]

Families living in under-resourced communities are at risk of obesity and obesity-related chronic diseases. To develop effective interventions, it is important to identify parent and child perspectives of factors that influence food-related choices and decisions. This paper reports qualitative findings from a larger mixed method study investigating this topic. Hybrid thematic analysis was used to code and analyze the interviews. Family-generated photographs of factors influencing food choices were discussed during the interviews. Qualitative findings were organized by the socio-ecological model. Verbatim quotes and photographs were used to support themes. Thirty-six interviews were conducted (18 parents, 18 children). Findings from parents revealed personal (e.g., culture, beliefs, time), family (e.g., mother, child, father, health, finances, cohesiveness), environmental (e.g., availability, convenience, cost), and other (e.g., school food) factors influenced food choices. Similarly, child-reported influences were personal (e.g., preferences, beliefs, taste), family (e.g., mother, family encouragement, father, family time), social (e.g., school, friends), environmental (e.g., availability), and other (e.g., media, sports). The socio-ecological model provided a useful framework for identifying factors that influence food choices and decisions of families living in under-resourced communities. A deeper understanding of these factors could enhance both responsiveness and effectiveness of interventions to enhance diet and reduce obesity risk in families living in underresourced communities. [ABSTRACT FROM AUTHOR]

Meta-analysis of physical activity interventions in school settings have revealed low efficacy and that there is a need to explore implementation fidelity. The aim of this rapid realist review was to determine, what physical activity interventions in school settings for children aged 7- to 11-yearsold works, for whom, and in what circumstances. The realist synthesis was conducted following RAMESES guidelines. Relevant studies were identified following a systematic search process and data from 28 studies was extracted for evidence to form context-mechanism-outcome configurations that were clustered and refined. Using the five-level socioecological model, the program theories were classified into the levels of intrapersonal (child), interpersonal (teachers), institutional (program content, school administration, and school environment), community (home and neighborhood), and policy. The school level led to most context-mechanism-outcome configurations related to school leadership and policy, workforce structure, program characteristics, and school environment. At each level, we identified features of interventions, alongside implementation considerations that might work to promote efficacy and sustainability. The need to recognize the school environment as part of a complex system with multi-level interaction and influences was a key finding. In line with realist philosophy, the researchers encouraged primary research to confirm, refute, and refine the program theories presented. [ABSTRACT FROM AUTHOR]

Background. Adolescent girls are less active than boys, with approximately 10% of girls in Ireland and the United Kingdom meeting the minimum recommended daily physical activity (PA) guidelines. This study investigated factors perceived to influence PA among adolescent girls from low socioeconomic areas in order to inform the design of a future intervention (The HERizon Project). Methods. A total of 48 adolescent girls (13-18 years) from low socioeconomic areas of the United Kingdom and Ireland participated in focus groups (n = 8), to explore perspectives of physical activity and the influence of gender within this. Focus groups were thematically analyzed and interpreted within a socioecological framework. Results. Most girls enjoyed PA and were aware of its benefits. They identified both barriers and facilitators to PA at intrapersonal (fear of judgement and changing priorities WITH age), interpersonal (changing social pressures and support from others) and organizational (delivery of PE) levels. Gender inequality was a multilevel factor, crossing all socioecological levels. Conclusion. Although many adolescent girls enjoy PA, their experiences appear to be limited by a fear of judgement and an overarching sense of gender inequality. Future interventions, such as the HERizon Project, should address influences at intrapersonal, interpersonal and organizational levels to promote positive PA experiences for adolescent girls. [ABSTRACT FROM AUTHOR]

(1) The harm-reduction benefits of opioid agonist treatment (OAT) are well-established; however, the UK government's emphasis on "recovery" may be contributing to a high proportion of people leaving treatment and low retention rates. We wanted to develop a rich and nuanced understanding of the factors that might influence the treatment journeys of people who use OAT. (2) We explored factors at each level of the socioecological system and considered the ways these interact to influence treatment journeys in OAT. We carried out semi-structured interviews with people who use OAT (n = 12) and service providers (n = 13) and analysed data using reflexive thematic analysis. (3) We developed three themes representing participant perceptions of treatment journeys in OAT. These were: (1) The System is Broken; (2) Power Struggles; and (3) Filling the Void. (4) Conclusions: The data suggest that prioritisation of treatment retention is important to preserve the harm-reduction benefits of OAT. Stigma is a systemic issue which presents multiple barriers to people who use OAT living fulfilling lives. There is an urgent need to develop targeted interventions to address stigma towards people who use OAT.

With a stratified multi-stage sampling approach, 1361 male factory workers in the Longhua district of the Shenzhen Municipality of China were selected to investigate the multifaceted determinants of sexual intercourse with non-regular female sex partners (NRP) and female sex workers (FSW) among them. The results showed that 24.5% and 21.2% of participants had sexual intercourse with NRP and FSW in the past 6 months, respectively. More specifically, at the individual level, perceived higher job stress and maladaptive coping styles were linked with a higher likelihood of having sexual intercourse with NRP and FSW (adjusted odds ratios [AOR] ranged from 1.06 to 1.17). At the interpersonal level, those who had higher exposure to information related to sexual intercourse with NRP or FSW were more likely to have sex with these female sex partners (AOR: 1.08 & 1.11). At the social structural level, perceived social norms supporting multiple sex partnerships were linked with a higher likelihood of having sexual intercourse with NRP and FSW (AOR: 1.10 & 1.11). No interaction effects were found between the variables at different levels. Providing pre-employment training to clarify roles and job duties, introducing adaptive coping strategies, and addressing misconceptions of social norms are useful strategies to reduce sexual intercourse with NRP or FSW.

In the last few years, the World Health Organization has highlighted that physical inactivity is a global issue affecting women to a greater extent than men. Faced with this, different nation states have developed public policies to reduce physical inactivity at school; however, the biomedical and individualistic models used have generated widespread criticism, as figures remain the same. In the context of failed interventions on increasing levels of physical activity, this study utilizes a socioecological model to analyze and understand how physical inactivity is reproduced in girls in the Chilean education system. A qualitative study was implemented, as it allows a focus on the entailed meanings, context, and processes. Active semi-structured interviews were conducted with 40 groups comprising headmasters, teachers, non-teachers, students, and families. The results show that physical inactivity is linked to factors that go beyond the individualistic model; that is, consideration must include intrapersonal, interpersonal, organizational, community, and public policy dimensions. Furthermore, gender stereotypes gain relevance in physical education classes, in addition to friendships and family, teaching, and administrative work, access to safe play areas, use of spaces, and widespread cultural factors associated with men and women. This study concludes that the assessed gender differences should be approached from a pedagogical perspective beyond common sense, further reporting that the individualized explanation for physical inactivity is irrelevant to answer why women are more inactive than men.

Fathers of refugee background with young children can experience significant mental health difficulties, with the potential for intergenerational impacts. This study aimed to explore how fathers of refugee background experience risk and protective factors for their own health and wellbeing during the early years of parenting. Semi-structured interviews and one semi-structured focus group were conducted with fathers of refugee background, with young children (0-5 years), who had settled in Australia. Transcribed interviews were analysed using thematic analysis, informed by the socioecological model of health. A total of 21 fathers participated in the study. Risk factors experienced included: prior experiences of trauma, reduced access to family support in Australia, adjustments in parenting roles, and the challenges of learning a new language and securing employment. Fathers drew on a number of sources of strength, including a sense of joy from fatherhood and support from partners, families, and communities. While most fathers regularly accompanied their partners and children to healthcare appointments, they were rarely asked by healthcare professionals about their own needs. Our findings support the idea that there is a need for greater assistance for fathers, particularly for navigating issues arising from the settlement process. Healthcare services working with families of refugee background must adopt a father-inclusive, trauma-informed approach that is responsive to fathers' needs.

Energy balance-related behaviors (EBRBs), i.e., diet, sedentary behavior, physical activity, and sleep, combine into lifestyle patterns, which we aim to identify in French preschoolers and analyze their family correlates within the framework of a comprehensive socioecological model. Parental questionnaires provided information about family characteristics and children's EBRBs for 978 5-year-olds of the EDEN cohort. We used principal component analysis to derive lifestyle patterns from EBRBs and hierarchical multivariable linear regressions to assess their associations with family socio-demographics, parent health/behaviors, and parent-child interactions. Analyses were stratified by sex. Of the three lifestyle patterns identified (unhealthy, healthy, and mixed), the mixed pattern differed the most between sexes. Lower parental education, suboptimal maternal diet, TV during meals, and later bedtime were associated with higher adherence to unhealthy patterns. Children cognitively stimulated at home and boys of mothers not employed adhered more to the healthy pattern. Older siblings (for girls) and higher engagement of parents in leisure-time physical activity (for boys) were related to greater adherence to mixed patterns. The identification of various correlates from multiple socioecological levels suggests that tackling the potentially synergistic effect of lifestyle patterns on health requires addressing processes relevant to the parent-child dimension and structural barriers parents may encounter. [ABSTRACT FROM AUTHOR]

One strategy to promote physical activity (PA) is for health care providers to give exercise prescriptions (ExRx) that refer to community-based facilities. However, facilitators and barriers specific to urban programs in the US for under-resourced women are unknown. Thus the purpose of this formative research was to explore ExRx barriers and facilitators specific to US under-resourced women to inform future intervention targets and strategies. This mixed-methods community-engaged research was conducted in partnership with an urban women's only wellness center that exchanged ExRx for free access (1-3 months). Qualitative semi-structured interviews and validated quantitative questionnaires (SF-12, International Physical Activity Questionnaire, Physical Activity Self-Efficacy, Physical Activity Stage of Change, and Barriers to Physical Activity, Social Support for Exercise, and Confusion, Hubbub, and Order Scale) were administered by phone and guided by the socio-ecological model. ExRx utilization was defined as number visits/week divided by membership duration. Means and percentages were compared between ≥1 visit/week vs. <1 visit/week with t -tests and chi-square, respectively. Women ( n = 30) were 74% Black, 21-78 years of age, 50% had ≤ high school diploma, and 69% had household incomes ≤45,000/year. Women with ≥1 visit/week ( n = 10; 33%) reported more education and higher daily activity, motivation, number of family CVD risk factors and family history of dyslipidemia compared with <1 visit/week. Facilitators among women with ≥1 visit/week were "readiness" and "right timing" for ExRx utilization. Barriers among women with <1 visit/week ( n = 20; 67%) were "mismatched expectations" and "competing priorities". Common themes among all women were "sense of community" and "ease of location". ExRx utilization at an US urban wellness center may be dependent on a combination of multi-level factors including motivation, confidence, peer support, location and ease of access in under-sourced women. Additional resources may be needed to address mental and/or physical health status in additional to physical activity specific programming.

Obesity is an increasing public health concern in the U.S. and a contributor to chronic illness, with trends revealing a rise in adult obesity and chronic disease rates among the most vulnerable and disadvantaged populations, including those in rural communities. A mixed-methods approach was used to examine perspectives on perceived physical activity barriers, resources, and level of community support. Researchers utilized the socioecological model to examine the multiple domains that support physical activity in rural Appalachia. The present study focuses on baseline data, including a cohort survey to assess physical activity, health status, and barriers to physical activity, and five focus groups with elected community leaders, community residents, members, and key stakeholders to assess perspectives on physical activity barriers and resources within the county. The cohort survey sample ( N = 152) reported a median of 6 barriers (range 0-13) to participating in at least 30 min of physical activity daily. The qualitative analysis yielded three overarching themes related to physical activity participation: lack of motivation, physical environment, and cultural barriers. This mixed-methods study revealed the challenges and perceptions among rural residents across the socioecological model when assessing physical inactivity. Findings can be used to tailor future interventions focused on expanding social support, designing infrastructure, and creating policies that promote physical activity.

Most public health issues in Kuwait are related to unhealthy behaviours. Research shows that behaviours are the result not only exclusively of personal choices but also of myriads of other social and environmental factors. Kuwait is one of the leading countries in obesity and tobacco use in the world. Cardiovascular diseases stemming from complications related to these and other risk factors are important health issues based on their morbidity and mortality implications. These risks are spread across society and affect the old as well as young boys. The serious gaps between Kuwait's health-related needs and the existing policies to reduce public health risks in Kuwait create a significant obstacle to healthy behaviour change. Kuwait requires adequate laws, policies, regulations, activities, and programs to promote people's health. The Socio-Ecological Model (SEM) has been used successfully in health promotion in various behavioural settings, including obesity, physical inactivity, and smoking. We propose the use of SEM as a planning framework in building sustainable health promotion programs in Kuwait while paying attention to other concepts such as systems thinking, authentic community participation, community capacity, policy development, public health infrastructure enhancement, health coaching, and equity. [ABSTRACT FROM AUTHOR]

The study objective was to determine prevalence of food insecurity and its associations with socioecological model (SEM) characteristics for undergraduate and graduate students. An online questionnaire was distributed to a convenience sample of students aged 18-34 at a Midwestern university. Of the 938 responses, 675 were complete for analysis. Outcome measures included demographics, food security level, housing, food access barriers, coping strategies, and food assistance program usage. Results found that predictors associated with undergraduate food insecurity included non-White race, receipt of financial aid, lower self-reported health status, living off-campus, employment, and food cost ( p < 0.001). Graduate student food insecurity was associated with Asian self-identification, employment, food cost, no time to prepare foods, and lack of foods for dietary needs ( p < 0.001). Students with food insecurity were more likely to buy cheap food ( p < 0.001). Almost 50% of food-insecure undergraduates asked friends or family to help buy food. Food-insecure students were more likely to want information on meal preparation and budgeting. More graduate students were likely to know of and use food pantries. Overall, food insecurity was higher among undergraduate than graduate students. Universities should consider institutional and policy changes tailored to the separate populations to mitigate the prevalence of campus food insecurity.

Migrant health has been identified as one of the most pressing issues of the 21st century. Migration experiences are influenced by gender and gender norms and have important implications for the sexual health of migrant women. This systematic review explored socioecological factors influencing sexual health experiences and health outcomes of migrant Asian women living in "Western" high-income countries. PRISMA guidelines were followed and this study was registered with PROSPERO. Five academic databases were searched for peer-reviewed articles published between 2000 and 2019. Of 2415 studies retrieved, 17 met the selection criteria: 12 qualitative, 4 quantitative, and 1 mixed-methods study. The four levels of Bronfenbrenner's socioecological model were applied to examine the individual, interpersonal, institutional, and societal factors of influence. Most studies ( n = 13) reported individual level factors, focusing on knowledge and use of contraceptives. At a societal level, host country sociocultural factors, including gender and cultural norms, influenced knowledge, ability to access and utilise contraceptives, and access to health services. Findings suggest that the public health policy, practice, and research to improve the sexual health of migrant women requires greater consideration of the intersecting factors of gender, culture, and the migration process.

Physical activity and motor competence (MC) have been considered to be closely related and prevent childhood obesity. The aim of the study was two-fold: to examine MC measured with two different tools in relation to individual, family, and environmental correlates and to investigate gender differences in MC. The Test of Gross Motor Development-Third Edition (TGMD-3) was administered to three- to seven-year-old children ( n = 945), while the Körperkoordinationstest für Kinder (KTK) was also used for five- to seven-year-old children ( n = 444). The parent questionnaire ( n = 936) included questions about individual (e.g., participation in organized sports), family (e.g., parents' education level), and environmental (e.g., access to sports facilities) correlates. The children's temperament was assessed using the Colorado Childhood Temperament Inventory (CCTI) questionnaire. Data were analyzed using one-way analysis of variance and linear mixed-effects regression models. The regression models explained 57% and 38% of the variance in TGMD-3 and KTK, respectively. Individual correlates, including older age, more frequent participation in sports, and specific temperament traits of activity and attention span-persistence, were the strongest predictors for better MC. Small gender differences were found in both assessment tools, albeit in a different manner. In conclusion, socioecological correlates of MC in young children are multidimensional, and individual correlates appear to be the most important predictors of MC. Importantly, the correlates can differ according to the MC assessment tools.

Cardiac patients who engage in ≥150 min of moderate- to vigorous-intensity physical activity (MVPA)/week have lower mortality, yet MVPA declines even following cardiac rehabilitation (CR), and is lower in women. A randomized trial of nine socioecological theory-based exercise facilitation contacts over 50 weeks versus usual care (1:1 parallel arms) was undertaken (NCT01658683). The tertiary objective, as presented in this paper, was to test whether the intervention impacted socioecological elements, and in turn their association with MVPA. The 449 participants wore an accelerometer and completed questionnaires post-CR, and 26, 52 and 78 weeks later. At 52 weeks, exercise task self-efficacy was significantly greater in the intervention arm (p = 0.01), but no other differences were observed except more encouragement from other cardiac patients at 26 weeks (favoring controls). Among women adherent to the intervention, the group in whom the intervention was proven effective, physical activity (PA) intentions at 26 weeks were significantly greater in the intervention arm (p = 0.04), with no other differences. There were some differences in socioecological elements associated with MVPA by arm. There were also some differences by sex, with MVPA more often associated with exercise benefits/barriers in men, versus with working and the physical environment in women. [ABSTRACT FROM AUTHOR]

Background: School physical activity (PA) policy, physical education curriculum, teacher training, knowledge of physical fitness, and parental support are among the key issues underlying the declining trend of physical fitness in children and adolescents. The Chinese CHAMPS was a multi-faceted intervention program to maximize the opportunities for moderate and vigorous physical activity (MVPA), and increase physical fitness in middle school students. The purpose of the study was to test whether the levels of modification in school physical education policy and curriculum incrementally influenced the changes in cardiorespiratory fitness and other physical fitness outcomes., Methods: This 8-month study was a clustered randomized controlled trial using a 2 × 2 factorial design. The participants were 680 7th grade students (mean age = 12.66 years) enrolled in 12 middle schools that were randomly assigned to one of four treatment conditions: school physical education intervention (SPE), afterschool program intervention (ASP), SPE+ASP, and control. Targeted behaviors of the Chinese CHAMPS were the student's sedentary behavior and MVPA. The study outcomes were assessed by a test battery of physical fitness at the baseline and posttest. Sedentary behavior and MVPA were measured in randomly selected students using observations and accelerometry., Results: The terms contrasting the pooled effect of SPE, ASP, and SPE+ASP vs. Control, the pooled effect of SPE and SPE+ASP vs. ASP only, and the effect of SPE+ASP vs. ASP on CRF and other physical fitness outcomes were all significant after adjusting for covariates, supporting the study hypothesis. Process evaluation demonstrated high fidelity of the intervention in the targeted students' behaviors., Conclusions: Chinese CHAMPS demonstrated the impact of varying the amount of MVPA and vigorous physical activity (VPA) on the physical fitness in middle school students in support of the need to increase the opportunity for PA in schools and to introduce high-intensity exercises in school-based PA programs. Modification of school policy, quality of physical education curriculum, and teacher training were important moderators of the improvement in physical fitness. (Trial registration: ChiCTR-IOR-14005388, the Childhood Health; Activity and Motor Performance Study.)., Competing Interests: The authors declare that they have no competing interests.

Aims: The present study aimed to examine and compare the socioecological correlates of park-based physical activity (PA) among Hong Kong and Leipzig older adults in terms of types of activity areas, perceived park environment, psychosocial factors, and the interactions between the perceived park environmental and psychosocial factors., Methods: Based on the SOPARC, systematic observations were conducted in six randomly selected urban parks in each city. A total of 317 Hong Kong ( M age = 69.96; SD = 6.81) and 311 Leipzig ( M age = 72.06; SD = 6.78) older adults from these six parks completed an interviewer-delivered survey measuring their perceived park environment, psychosocial variables, and park-based PA., Results: In both cities, the types of activity areas were positively associated with the number of older adults observed being active in parks. Psychosocial factors, especially self-efficacy and perceived barriers, had larger associations with park-based PA compared with the perceived park environment. The interaction between perceived park features and self-efficacy in the association with park-based PA was found in Leipzig, but not in Hong Kong., Conclusion: Findings of the current study contribute to the cross-cultural understanding of the socioecological correlates of park-based PA among older adults.

Preschool children's high levels of sedentary time (ST) is a public health concern. As preschool reaches a large population of children from different socioeconomic status (SES) backgrounds, more knowledge on how the preschool setting is associated with children's ST is relevant. Our aims were to examine (1) the associations of preschool setting (covering social, physical, and organizational level) with children's ST, and (2) the moderating role of the setting on the association between parental SES and children's ST. In the cross-sectional DAGIS (increased health and wellbeing in preschools) study, the participating children ( n = 864, aged 3⁻6 years) were asked to wear an accelerometer for one week. In total, 779 children had valid ST accelerometer data during preschool hours. Preschool setting and parental SES was assessed by questionnaires and observation. Multilevel linear regression models with cross-level interactions were applied to examine the associations. Early educators' practice of breaking children's ST often, more frequent physical activity (PA) theme weeks, and higher number of physical education (PE) lessons were associated with lower children's ST. Higher parental SES was associated with higher children's ST in preschools (1) with organized sedentary behavior theme weeks, (2) with a lower number of PA theme weeks, and (3) with a lower number of PE lessons. The factors identified in this study could be targeted in future interventions.