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Background: Despite the increased development and use of mobile health (mHealth) devices during the COVID-19 pandemic, there is little knowledge of willingness of the Chinese people to use mHealth devices and the key factors associated with their use in the post-COVID-19 era. Therefore, a more comprehensive and multiangle investigation is required., Objective: We aimed to probe Chinese attitudes regarding the use of mHealth and analyze possible associations between the attitude of willingness to use mHealth devices and some factors based on the socioecological model., Methods: A survey was conducted using quota sampling to recruit participants from 148 cities in China between June 20 and August 31, 2022. Data from the survey were analyzed using multiple stepwise regression to examine the factors associated with willingness to use mHealth devices. Standardized regression coefficients (β) and 95% CIs were calculated using multiple stepwise regression., Results: The survey contained a collection of 21,916 questionnaires and 21,897 were valid questionnaires, with a 99.91% effective response rate. The median score of willingness to use mHealth in the post-COVID-19 era was 70 points on a scale from 0 to 100. Multiple stepwise regression results showed that the female gender (β=.03, 95% CI 1.04-2.35), openness personality trait (β=.05, 95% CI 0.53-0.96), higher household per capita monthly income (β=.03, 95% CI 0.77-2.24), and commercial and multiple insurance (β=.04, 95% CI 1.77-3.47) were factors associated with the willingness to use mHealth devices. In addition, people with high scores of health literacy (β=.13, 95% CI 0.53-0.68), self-reported health rating (β=.22, 95% CI 0.24-0.27), social support (β=.08, 95% CI 0.40-0.61), family health (β=.03, 95% CI 0.03-0.16), neighbor relations (β=.12, 95% CI 2.09-2.63), and family social status (β=.07, 95% CI 1.19-1.69) were more likely to use mHealth devices., Conclusions: On the basis of the theoretical framework of socioecological model, this study identified factors specifically associated with willingness of the Chinese people to use mHealth devices in the post-COVID-19 era. These findings provide reference information for the research, development, promotion, and application of future mHealth devices., (©Xue Wang, Yibo Wu, Zhiyu Meng, Jiayuan Li, Li Xu, Xinying Sun, Shuang Zang. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.02.2023.)

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.

Purpose: To explore gym staff perspectives on the inclusion of people with disability in the gym setting., Materials and Methods: 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., Results: 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)., Conclusion: 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. Implications for rehabilitationGym 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.

(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.

Background: Determinants of waterpipe use in adolescents are believed to differ from those for other tobacco products, but there is a lack of studies of possible social, cultural, or psychological aspects of waterpipe use in this population. This study applied a socioecological model to explore waterpipe use, and its relationship to other tobacco use in Swedish adolescents. Methods: A total of 106 adolescents who attended an urban high-school in northern Sweden responded to an anonymous questionnaire. Prevalence rates for waterpipe use were examined in relation to socio-demographics, peer pressure, sensation seeking behavior, harm perception, environmental factors, and depression. Results: Thirty-three percent reported ever having smoked waterpipe (ever use), with 30 % having done so during the last 30 days (current use). Among waterpipe ever users, 60 % had ever smoked cigarettes in comparison to 32 % of non-waterpipe smokers (95 % confidence interval 1.4-7.9). The odds of having ever smoked waterpipe were three times higher among male high school seniors as well as students with lower grades. Waterpipe ever users had three times higher odds of having higher levels of sensation-seeking (95 % confidence interval 1.2-9.5) and scored high on the depression scales (95 % confidence interval 1.6-6.8) than non-users. The odds of waterpipe ever use were four times higher for those who perceived waterpipe products to have pleasant smell compared to cigarettes (95 % confidence interval 1.7-9.8). Waterpipe ever users were twice as likely to have seen waterpipe use on television compared to non-users (95 % confidence interval 1.1-5.7). The odds of having friends who smoked regularly was eight times higher for waterpipe ever users than non-users (95 % confidence interval 2.1-31.2). Conclusion: The current study reports a high use of waterpipe in a select group of students in northern Sweden. The study adds the importance of looking at socioecological determinants of use, including peer pressure and exposure to media marketing, as well as mental health among users. [ABSTRACT FROM AUTHOR]

Background: Effective interventions that target socioeconomic status (SES) differences to avoid the potential widening of inequalities in health are needed. Children at preschool age is a valuable intervention target since sedentary behaviors, physical activity (PA), dietary behaviors, and sleep habits, jointly called the energy balance-related behaviors (EBRBs), are established in early childhood and tend to persist later in life. The interventions are most effective, when they focus on evidence-based factors. One potential factor associated with EBRBs and SES is children's stress regulation, which receives special attention in this study. Based on the socioecological approach, the combinations of multiple levels (e.g. individual, environmental, societal) of analysis and diverse methodologies (e.g. surveys, observations, biological measurements) are used to assess the healthfulness of environments (e.g. social, physical, learning, policy) in preschool and family settings. The intervention aimed to diminish SES differences in EBRBs is then conducted in the preschool setting. Methods/design: The DAGIS study is divided into two phases. The first phase comprises focus group interviews and a cross-sectional survey. Parents and preschool personnel in low SES neighborhoods participated in interviews about children's sedentary behaviors, dietary behaviors, and PA in 2014. In the cross-sectional survey beginning in autumn 2015, preschools will be recruited from a random sample of preschools in 3-5 municipalities in Southern Finland. A total of 800 children will wear an accelerometer for seven days. Children's hair and saliva samples will be taken. Parents and preschool personnel will complete questionnaires on EBRBs, social and physical environments and SES factors. The quality of preschool environment is also observed. In the second phase, an intervention targeting to narrowing SES differences in EBRBs is conducted. The effects of the intervention will be evaluated in randomised controlled trial. The implementation of the intervention will also be evaluated. Conclusion: If effective, this unique preschool-based study will be able to narrow the SES differences in preschool children's EBRBs. This study is anticipated to identify the most important modifiable factors in preschool and family environmental settings associated with children's EBRBs, especially in children from low SES backgrounds. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Parent and child perceived neighborhood safety predicts child health outcomes such as sleep quality, asthma, physical activity, and psychological distress. Although previous studies identify environmental predictors of parent perceived safety, little is known about predictors of child perceived safety. This study aims to identify the social and physical environmental neighborhood features that predict child and parent perceived neighborhood safety and, simultaneously, to assess the association between child and parent perceptions. Data were from the QUebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort, an ongoing study of Caucasian children (aged 8-10 years) with a parental history of obesity, and their biological parents from Québec, Canada. Measures of social and physical neighborhood features were collected using a spatial data infrastructure and in-person audits. Structural equation modeling was used to test direct and indirect associations between neighborhood features, child and parent perceived safety. Results suggest that among children ( N = 494), trees and lighting were positively associated with perceived neighborhood safety, whereas a high proportion of visible minorities was associated with poorer perceived safety. Parents' perceptions of safety were more strongly tied to indicators of disorder and a lack of community involvement, and to traffic. Child perceived safety was partly explained by parent perceived safety, suggesting moderate concordance between perceptions. Although associated with each other, parent and child perceived safety seemed to be determined by distinct environmental features. Though this study focused on determinants of child and parent perceived safety, future research investigating the impact of neighborhood safety on child health should consider both child and parent perspectives. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify the empirical contribution made by the social work profession in the prevention and treatment of overweight and obesity. The constructs of the socioecological model of health, which suggest that there are multiple levels of influence on individual behaviors, were used as a conceptual framework to synthesize studies authored by social work researchers investigating overweight and obesity risk factors. A review of obesity-related research written by social workers published over an unrestricted time was conducted. The author found 51 articles in published peer-review journals written by social workers from 1993 to 2013. The reviewed studies included participants living in the United States, China, Israel, and Australia. Findings indicate that the majority of research conducted by social workers address overweight and obesity treatment and consequences at the individual level, and there is little on how social workers plan to address this issue from community-level or policy-related perspectives. This review is the first comprehensive study of social workers’ empirical coverage of varying levels of influences affecting obesity. Practice and policy implications are discussed for social work professionals employed in community settings. [ABSTRACT FROM PUBLISHER]

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]

Socioecological models provide a framework for predicting how animals respond competitively to the abundance and distribution of food resources. Testing predictions of socioecological models requires analysis of relationships among food resource characteristics, competitive behaviors, and measures of rank-related skew in energy balance or reproductive success. A positive relationship between dominance rank and energy balance has been observed among female mountain gorillas in Bwindi Impenetrable National Park, Uganda. This study examines the proximate mechanisms underlying feeding competition among those females. To assess the contestability of food resources, we measured the time a female spent feeding at a food site (food site residence time). We also examined the relationship between dominance rank and the access to resources, as well as the rate, context, and direction of aggression, and the number of neighbors in close proximity. As predicted, females had longer food site residence times and higher aggression rates with fruit and decaying wood than with herbaceous vegetation, suggesting that those resources may be contestable. Aggression was predominantly directed down the dominance hierarchy, although against expectation, rank was not significantly correlated with aggression rates or the time spent feeding on contestable foods. Higher-ranking females had significantly fewer neighbors, suggesting that lower-ranking females avoid higher-ranking ones. This study provides additional support for the claim that there is variability in how primates respond to the quality and distribution of food resources and that avoidance as a strategy to cope with feeding competition may result in similar skew in energy balance as rank-related aggression. [ABSTRACT FROM AUTHOR]

Background: There is a seeming lack within the public health fields of both research and practice of information sharing across so-called "silos of work". Many professionals in the public health fields dealing with infectious diseases (IDs) are unaware of the programs and approaches taken by their colleagues in the non-communicable diseases (NCDs) arena, and vice versa. A particular instance of this is in the understanding and application of health promotion approaches. This is a problem that needs to be addressed with the goal of producing the most efficient and effective health promotion approaches to the prevention and control of diseases in general. Objectives: This project examined health promotion approaches to the prevention of NCDs that could be used in the prevention of IDs. Methods: A knowledge synthesis and translation perspective was undertaken. We screened and analyzed a wide range of sources that were considered relevant, with particular emphasis on systematic reviews, published articles and the grey literature. Results: The analysis revealed a diverse health promotion knowledge base for application to IDs. Comprehensive health promotion models were found to be useful. Findings suggest that there are profound similarities for health promotion approaches in both NCDs and IDs. Conclusions: This study revealed gaps in knowledge synthesis to translation. The need for development of intervention and implementation research is considered. [ABSTRACT FROM AUTHOR]

Although cervical cancer is one of the most commonly diagnosed cancers among Vietnamese American women (VAW) and Korean American women (KAW), both groups consistently report much lower rates of cervical cancer screening compared with other Asian ethnic subgroups and non-Hispanic Whites. This study aimed to explore multilevel factors that may underlie low screening rates among VAW and KAW living in a city where their ethnic communities are relatively small. The socioecological model was used as a conceptual framework. Thirty participants were conveniently recruited from ethnic beauty salons run by VA and KA cosmetologists in Albuquerque, New Mexico. The participants' average age was 44.6 years (SD = .50; range = 21-60). Most participants were married (80 %) and employed (73.3 %), and had health insurance (83.3 %). A qualitative interview was conducted in Vietnamese or Korean and transcribed verbatim. A thematic content analysis was used to identify major codes, categories, and patterns across the transcripts. The study identified several factors at the individual (e.g., pregnancy, poverty, personality), interpersonal (e.g., family responsibility, mother as influential referent), and community (e.g., lack of availability, community size) levels. The study sheds light on four major areas that must be taken into consideration in the development of culturally appropriate, community-based interventions aimed to reduce disparities in cervical cancer screening among ethnic minority women in the United States: (1) ethnic community size and geographic location; (2) cross-cultural similarities and dissimilarities; (3) targeting of not only unmarried young women, but also close referents; and (4) utilization of trusted resources within social networks. [ABSTRACT FROM AUTHOR]

As more interest is paid by researchers and community groups to food insecure communities and the associated health impacts for residents, interventions have been conducted to improve healthy food accessibility. Not much literature can be found, however, evaluating the healthy corner store programs implemented to improve the food environment and change consumer behavior. This case study attempts to fill that gap with an examination and discussion of the strategies developed by a community collaborative to evaluate a healthy corner store project for a coupled individual and environmentally based intervention. We address limitations of the evaluation approach and recommendations for improving community-based assessment. [ABSTRACT FROM PUBLISHER]

The aims of the this prospective study were to analyse physical activity (PA) engagement during the first and second trimesters, considering the different guidelines published on PA, to document the individual characteristics associated with the accomplishment of these guidelines and to examine pregnant women’s perceived barriers to leisure PA, using a socioecological framework. A sample of 133 pregnant women in two stages – at 10–12 weeks’ gestation (T1) and 20–22 weeks’ gestation (T2) – were evaluated. PA was assessed by accelerometry during the T1 and T2 evaluation stages. Socio-demographic characteristics, lifestyle factors and barriers to leisure PA were assessed via questionnaire. A large proportion of women (ranging from 32% to 96%) did not reach the levels of PA recommended by the guidelines. There were no significant differences between T1 and T2 with regard to compliance with PA recommendations. A decrease in PA levels from T1 to T2 was noted for all recommendations. No associations were found between participants’ characteristics and adherence to the recommendations in T1 and T2. No significant differences were found in barriers to leisure PA between T1 and T2. The most commonly reported barriers to leisure PA were intrapersonal, not health related. Our results indicate that there were no differences between trimesters regarding compliance of PA recommendations, and perceived barriers were similar in both trimesters. [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]

Objective Rural Australians have a higher likelihood of chronic disease and lower levels of physical activity than urban Australians. Little is known of the factors associated with physical activity among rural-dwelling Australians. This study sought to determine the correlates of physical activity among men and women of the South Australian Riverland region. Design Cross-sectional survey. Setting Regional area. Participants There are 299 randomly selected 18-65 year olds. Main outcome measures Determinations of insufficient and sufficient physical activity levels based on public health recommendations. Results Using logistic regression: in men, sufficient physical activity was associated with reporting perceived sufficient physical activity for health (odds ratio 3.194 [1.703-5.989]), and having friends who encouraged physical activity (3.641 [1.450-9.141]). Men who reported insufficient time (0.350 [0.151-0.812]) and getting enough physical activity at their job (0.374 [0.199-0.702]) were less likely to be sufficiently active. In women, sufficient physical activity was associated with not being employed (2.929 [1.063-8.066]), higher self-efficacy (2.939 [1.118-7.726]) and having a regular physical activity routine (3.404 [1.829-6.337]). Older age (0.960 [0.929-0.995]), poorer self-rated health (0.233 [0.060-0.900]) and weekend sitting time (0.823 [0.692-0.980]) were negatively associated with sufficient physical activity for women. Conclusions Factors associated with physical activity in this rural adult population differed by sex. Sex-specific approaches to promote physical activity might have utility for this population. Strategies to enhance social connectedness among men and encourage physical activity outside of work can be warranted. Women can require programs to help them develop a regular physical activity routine and improve self-efficacy. [ABSTRACT FROM AUTHOR]

Although a distant fourth to alcohol, tobacco, and marijuana use, nonmedical prescription drug use (NMPDU) far exceeds all other illicit drug use on college and university campuses. Campus officials might be unaware of the impact of NMPDU on student health, including drug-related emergency room visits, sexual assault, violent behavior, and academic misconduct. The authors collaborated as scholar-practitioners, representing the nonprofit sector, the public sector, and university life, to understand the needs of campus practitioners in preventing and responding to NMPDU. As a result of a collaborative needs assessment, the authors recommend a number of key elements necessary for strategic campus–community partnerships to reduce the prevalence and harm associated with NMPDU. The role of social workers in this framework is discussed. [ABSTRACT FROM PUBLISHER]

Introduction: Violence against children (VAC) is a critical public health issue that affects billions of children worldwide. The combination of its prevalence and severity of effects on children creates an urgent need for effective interventions. Multiple studies associate VAC with lifelong implications that affect children through adulthood. In Qatar, multiple approaches such as legislation are being used to protect children from all forms of violence. Despite the gravity of the issue, there is still low readiness for the prevention of VAC in Qatar. This review aimed to map approaches to addressing VAC in Qatar from the panelists' perspectives on current approaches to addressing VAC., Methods: The review obtained data from a recorded video entitled "A Public Health Approach to Addressing Violence Against Children." The panel discussion in this video clip was organized as a side event of the WISH virtual summit by UNICEF and WISH on World Children's Day, held in Qatar in November 2020. The video was transcribed and analyzed using thematic analysis., Findings: It shows the importance of both global and national level interventions in addressing VAC. The review uses the socioecological model to show relationships among different levels of interventions addressing VAC in Qatar. The findings highlight the national approaches to addressing VAC using public health, and legislative and policy approaches., Discussion: The interventions addressing VAC at different levels in Qatar are interconnected. Delineating each level is key to the formation of holistic interventions that leverage global, regional, national, communal, familial, and individual factors that support interventions to address VAC., 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 © 2022 Al-Mohannadi, Al-Harahsheh, Atari, Jilani, Al-Hail and Sigodo.)

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., (© 2022 Society for Community Research and Action.)

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.

Considering interactions between barriers to physical activity, sociodemographic factors, and rurality can support an equity-focused approach to physical activity promotion. In this cross-sectional analysis of the Canadian Community Health Survey Barriers to Physical Activity Rapid Response module, we compared self-reported individual and social-environmental correlates of physical activity between rural and urban residents and explored interactions with sociodemographic factors. Lack of social support was associated with lower odds of meeting physical activity guidelines for rural residents (OR = 0.71 [0.57,0.89], p = 0.003), but not for urban residents (OR = 0.99 [0.84,1.17], p =.931). Limited access to low-cost facilities was associated with lower odds of meeting physical activity guidelines (OR = 0.85 [0.73,0.98], p = 0.030) regardless of location, but was reported more commonly as a barrier by rural males (27.3 % vs 8.6 % urban) and females (30.0 % vs 9.1 % urban). Inadequate social support was associated with lower odds of meeting physical activity guidelines in females (OR = 0.79 [0.66,0.94], p =.009), but not males (OR = 0.99 [0.84,1.17], p =.931). Individual-level barriers such as time, costs, enjoyment, and confidence were associated with meeting physical activity guidelines for both rural and urban residents. Social-environmental factors appear to be the main contributors to physical activity inequities between rural and urban residents. Interventions designed to bolster social connectedness may support physical activity engagement for people living in rural communities., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

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., Competing Interests: The authors declare that they have no conflict of interest. The sponsors had no role in the design, execution, interpretation, or writing of the study.

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., (© 2022 John Wiley & Sons Ltd.)

Purpose: Sexual minority (SM) identity as well as sociodemographic and socioeconomic factors are associated with asthma prevalence. A syndemics framework analyzes disease conditions in a population and the social, economic, and environmental contexts in which they are found. We used a syndemic model of individual-level socioecological factors to identify profiles of asthma prevalence among SM adults. Methods: Latent class analysis (LCA) was conducted on a subpopulation of SM adults aged 18-59 years from the 2001 to 2016 National Health and Nutrition Examination Survey. Indicators in the LCA model included current asthma, gender, sexual identity, poverty-income ratio, education, and serum cotinine level. Multinomial logistic regression analyzed the effects of covariates (race/ethnicity, nativity, age, marital status, body mass index, lifetime smoking, and mental health care seeking) on identified profiles. Results: Four classes were identified among our sample of n  = 1097 SM adults. Classes 1 and 2 had 19% and 18% conditional probabilities of current asthma, respectively, and were primarily female and bisexual. Classes 3 and 4 had 5% and 2% conditional probabilities of asthma, respectively, and were primarily male and gay. Classes 1 and 3 also had conditional probabilities of high income and educational attainment. Black individuals had higher odds than White individuals of being in Class 1 (odds ratio [OR] = 4.46, 95% confidence interval [CI] = 1.43-13.93), Class 2 (OR = 21.66, 95% CI = 7.50-62.60), and Class 4 (OR = 7.41, 95% CI = 2.05-26.71), relative to Class 3. Conclusion: Findings extend past literature that suggests within-group asthma disparities among SM adults. Informational campaigns on asthma management should target this community to avoid severe disease exacerbations.

The widely used socioecological rainbow model from Dahlgren and Whitehead specifies determinants of health inequity on multiple hierarchical levels and suggests that these determinants may interact both within and between levels. At the time of its inception, digital determinants only played a minor role in tackling inequities in public health and were therefore not specifically considered. This has dramatically changed: From today's perspective, health inequities increasingly depend on digital determinants. In this article, we suggest adapting the Dahlgren-Whitehead model to reflect these developments. We propose a model that allows formulating testable hypotheses, interpreting research findings, and developing policy implications against the background of the global spread of digital technologies. This may facilitate the development of a new line of research and logic models for public health interventions in the digital age. Using the COVID-19 pandemic as a case study, we illustrate how the digitization of all aspects of life affects the different levels of determinants of health inequities in the Dahlgren-Whitehead model. In doing so, we deliberately argue for not introducing a separate digital sphere in its own right, but for understanding digitization as a phenomenon that permeates all levels of determinants of health inequities. As a result, we present a digital rainbow model that integrates Dahlgren and Whitehead's 1991 model with digital environments to identify current health promotion and research issues without changing the rainbow model's initial structure., Competing Interests: Declaration of Conflicting Interests: The authors declared that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© The Author(s) 2022.)