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Purpose: This qualitative study explores the barriers and facilitators to health care from the perspective of providers who care for patients without documentation status in the San Francisco Bay Area. Methods: Twenty-four direct providers were interviewed using semi-structured in-depth interviews. Participants included health care providers and community-based organization leaders. Interviews were independently coded using grounded theory analysis. The socioecological framework was used to develop the interview guide, analyze findings, and guide the discussion. Results: Participants identified fear as a barrier that transcended multiple levels of influence. At the public policy level, national policies, such as public charge and anti-immigration rhetoric, limited access to services. Local expansion of health care coverage, such as Healthy San Francisco, facilitated access to care. At the organizational level, law enforcement presence generated fear. This was countered by a welcoming environment, described as culturally concordant clinical sites, representation of the community in the provider pool, and resources to address social needs. Individual-level fear, rooted in trauma and economic insecurity, was eased by trauma-informed care and health navigators. Community engagement and sustained partnerships built trust and credibility to transcend the fear that hindered access to care. Conclusion: In a region with expansive policies for improved health care access, barriers are rooted in fear and span individual, organizational, and public policy levels of access to care. Richer community engagement may lessen the national and systemic barriers that this vulnerable population continues to face. Developing an understanding of this topic improves health care providers' ability to meet the needs of this growing and vulnerable population., Competing Interests: No competing financial interests exist., (© Riham M. Alwan et al., 2021; Published by Mary Ann Liebert, Inc.)

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.

Background: Understanding young women and men's perceived barriers and facilitators to participation in biomedical HIV prevention research is important for designing youth friendly services (YFS) and acceptable technologies, which are necessary for preventing high sustained HIV incidence in South Africa. This study explores the multileveled barriers and facilitators to young men and women's willingness to participate in hypothetical biomedical HIV prevention research. Methods: Eight age- (16-18 and 19-24 years) and gender-stratified focus group discussions (FGDs) were conducted using semi-structured interview guides to explore young South African women and men's willingness, perceived barriers, and facilitators to participating in biomedical HIV prevention research. FGD transcripts were uploaded to NVivo and coded collaboratively with youth study team members. Thematic analysis using Bronfenbrenner's ecological model (individual, inter-personal, community, and societal) was used to guide a deductive coding procedure, which was documented and compared by gender. Results: Thirty-one participants from Durban and 34 from Soweto participated in FGDs. Individual facilitators for participation were discussed more by young men and included financial incentives and altruism. Concerns about side-effects of biomedical products were a common barrier. Interpersonal relationships with peers, intimate partners and caregivers influenced young people's willingness to participate in HIV prevention research, more so among young women. For young women, gendered power dynamics and distrust of intimate partners and parents influenced both communication regarding participation and willingness to participate in research that is often stigmatized, due to societal norms around women's sexuality. On a societal level, participants expressed distrust in medical and research institutions, however a sense of community that was developed with the study staff of this project, was a motivator to participate in future studies. Discussion: At each level of the ecological model, we found participants expressed gendered barriers and facilitators for participation. Gender norms as well as distrust of partners, parents, and health care professionals were key barriers that cut across all levels. At each level participants discussed facilitators that were youth-engaged, underscoring the need to implement YFS, establish trust and address gender inequities within future biomedical HIV prevention studies wishing to engage and retain South African youth., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Closson, Lee, Dietrich, Beksinska, Hornschuh, Smith, Smit, Ndung'u, Brockman, Gray and Kaida.)

Sedentary behavior is associated with poor physical and mental health. Targeting sedentary behavior is a simple strategy that may help counter physical and mental health concerns associated with COVID-19-related social restrictions. Of course, traditional strategies such as achieving optimal exercise and physical activity levels are also important and should be recommended. However, even under normal circumstances, the difficulty in promoting lasting exercise habits at multiple levels (e.g. individual, environment, policy) are well documented, and chances of maintaining or improving these factors is now even lower. Thus, relative to other lifestyle behaviors - sedentary behavior may be more amenable to change. Moreover, reducing sedentary behavior may be less susceptible to influence from factors associated with health disparities such as age, race, and socio-economic status compared to exercise or physical activity. Sedentary behavior is a feasible health strategy that should be targeted during COVID-19., (© Society of Behavioral Medicine 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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.

Introduction: Wet markets are predisposed to Aedes breeding due to nature of daily activities that involve frequent water storage and usage of water collecting containers. Large numbers of visitors patronising wet markets could cause rapid spread of dengue infection. This study aimed to determine the level of dengue prevention practices among wet market traders in Hilir Perak District and their associated socioecological factors. Methods: A cross sectional study using stratified sampling method was conducted where 246 wet market traders were interviewed to collect data on dengue prevention practices (prevention of Aedes mosquitoes breeding and prevention of mosquito bites), and socioecological factors. Chi square test and logistic regression modelling were performed to identify socioecological factors associated with dengue prevention practices. Results: Response rate for this study was 88.9%. Majority of the respondents were male, above 40 years old, had secondary education and above, had monthly income of above MYR2000, were owner of the shop lots, was or had ever married and sold fish, vegetable or groceries products. Most of the respondents had high level of dengue prevention practices (78%). Those who were owner of shop lots, had high perceived susceptibility, high family support, and high perceived dengue prevention and control laws and regulations were predicted to have high level of dengue prevention practices. Conclusion: Level of dengue prevention practices is determined not only by individual factors, but also other factors from relationship to societal level which must also be considered in planning or evaluating current dengue control programmes. [ABSTRACT FROM AUTHOR]

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]

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]

Objective : To investigate whether the relationship of neighborhood environmental factors with physical activity (PA) is moderated by cognitive functioning in Belgian older adults. Methods : Seventy-one older adults completed validated questionnaires on PA and environmental perceptions, wore an accelerometer, and completed a computerized assessment of cognitive functioning. Moderated linear regression analyses were conducted in SPSS 24.0. Results : Overall cognitive functioning significantly moderated the associations of traffic safety and street connectivity with PA. Detailed analyses showed that these factors were only positively associated with PA in older adults with lower cognitive functioning. In addition, particularly, performance on tests assessing visuospatial and episodic memory moderated these associations. Discussion : Living in traffic-safe neighborhoods with short and many alternative routes might motivate older adults with lower cognitive functioning to be active. As such, the increase in PA might improve their cognitive abilities. This knowledge is crucial for health practitioners to develop effective PA promotion initiatives.

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.

Despite the health benefits of sport, the proportion of people participating in sport decreases with age. This qualitative study explored the benefits and barriers regarding older adult community sport participation, from the perspective of national sporting organizations, in addition to older adult sport club and nonsport club members, across eight focus group interviews (n = 49). Seven benefits were discussed, primarily social and physical health and intergenerational opportunities. Ten barriers were also discussed, including physical health, time constraints, and lack of appropriate playing opportunities. Ensuring access to activities that can benefit social health is of great importance to older adults. As sport can provide participation opportunities across generations, it can be an ideal physical activity option for this age group. However, a major barrier is that sport policy often prioritizes the participation for younger age groups. Policymakers should include a focus on older adults, to derive social health benefits.

Behavioral mechanisms of intergroup feeding competition remain unclear, despite its importance as a benefit of group living. Japanese macaques in the coastal and highland forests of Yakushima, Japan, are ideal study subjects because the intensity of intergroup feeding competition differs without phylogenetic effects. We aimed to test whether macaques modify home range use and food patch use in response to the location-specific risk of intergroup encounters. Using behavioral data from 3 groups, we examined the border avoidance and the effects of food patch location on food patch use. All 3 groups used the border less frequently than expected from its area. In the coastal forest characterized by frequent intergroup aggression, the smaller subordinate group, not the larger dominant group, increased the number of co-feeding individuals along the border. This response might reduce the potential costs of intergroup aggression. Feeding duration in one patch, visual scanning, and co-feeding with adult males did not depend on food patch location for the 2 groups. In contrast, the highland group did not modify food patch use along the border owing to the low risk of intergroup encounters. Our results highlight the importance of intergroup hostility as a social factor affecting animal behavior., (© 2018 S. Karger AG, Basel.)

Introduction: New strategies are needed to lower health care costs and address the health care needs of communities, especially for marginalized persons and subpopulations. Improved education in health systems, which encompasses population, community, preventive, and public health, is one way to better train the future physician workforce to meet national and local health care needs. This resource was created as part of an 18-month science of health systems and navigation curriculum., Methods: The purpose of this resource is to use the socioecological model lens to analyze health disparities for marginalized persons and subpopulations. A medically and socially complex patient with HIV is presented as the initial case study that leads to identification of barriers and needs on individual, community, and public policy levels. This is an active-learning resource that includes both small- and large-group discussion driven by self-directed learners using the provided resources., Results: This resource was successfully implemented as a required session for 150 medical students beginning the second year of medical school. A cohort of 21 students randomly selected to complete a standard online course evaluation for the session, rated their agreement (1 = strong disagreement , 5 = strong agreement ) to the statement "Rate the extent to which the lecture supported your mastery of the learning objectives," as 4.4, on average., Discussion: This curriculum has been implemented and evaluated for medical students, but it is broadly applicable to residents and interprofessional students in health-related fields. It is designed to give learners a practical medical context for the application of principles that may be taught within a health systems or population health course., Competing Interests: None to report.

Introduction: Species of the order Primates are highly gregarious with most species living in permanent heterosexual social groups. According to theory in socioecology maximum social group size is limited by rates of intra-group feeding competition and associated increases in travel costs. Unlike other hylobatids, which are predominantly pair living, cao vit gibbons (Nomascus nasutus), and two other species of crested gibbon (Nomascus spp.) living in northern seasonal forest, regularly exhibit larger bi-female groups. To better understand the ability of northern gibbons to live in stable bi-female groups, we examined food distribution, feeding competition and reproductive success over a period of six years in a small cao vit gibbon population at Bangliang, Guangxi, China., Results: In general, we found weak evidences for within-group contest or scramble competition in our two study groups, which we attribute to high spatial and temporal heterogeneity in the distribution of their important food species. Nevertheless, the larger of the two groups studied increased feeding time and group spread during lean periods, factors that may limit cao vit gibbon group size to a maximum of two breeding females. Relative to tropical pair-living gibbons, there is no evidence that cao vit gibbons travel farther or spend more time feeding, but they did consume more leaves and buds and less fruit and figs. Despite their highly folivorous diet, the average inter-birth interval is comparable to tropical gibbon populations, and the survival rate of infants and juveniles in our study groups is high., Conclusion: Cao vit gibbons do not suffer obvious costs in terms of feeding competition and reproductive success by living in bi-female groups, but within-group feeding competition may determine the upper the limit of cao vit gibbon group size to a maximum of two breeding females. These findings contribute to a growing body of evidence that bi-female grouping can be a stable grouping pattern of gibbons in certain habitats and further emphasize the flexibility of gibbon social organization.

This case study describes Kentucky's partnership with the Centers for Disease Control and Prevention (CDC) EMPOWER (Enhancing and Making Programs Work to End Rape) program to enhance the mission and services of existing rape crisis centers to include comprehensive primary prevention programming to reduce rates of sexual violence perpetration. The planning process and the successful implementation of a statewide, 5-year, randomized control trial study of a bystander prevention program (Green Dot), and its evaluation are described. Lessons learned in generating new questions, seeking funding, building relationships and capacity, and disseminating knowledge are presented., (© The Author(s) 2014.)