A quarantine paradox: understanding Gender-Based Violence (GBV) in post-COVID-19 era: insights from Golden Valley mining community, Zimbabwe.

The COVID-19 pandemic has brought unprecedented challenges globally, with a notable surge in gender-based violence (GBV) incidents. This descriptive, exploratory study conducted in the Golden Valley mining community in Kadoma, Mashonaland West Province, Zimbabwe, delves into the challenges faced by GBV survivors during and after the pandemic, alongside community perceptions of GBV in the post-COVID-19 era. Guided by Bronfenbrenner's Social-Ecological Model which offers insights into the various levels of influence on GBV behavior and experiences,aiding in the development of contextually relevant prevention strategies. The study used qualitative methods such as interviews and focus group discussions, there were 24 study participant classified by random and convenient sampling techniques including traditional and community leaders, gbv surviours medical personnel and male and female, community members. The research followed the COREQ guidelines to transparently document the research process and findings. The research sheds light on the multifaceted nature of GBV exacerbated by societal norms and economic instability in a low-income, masculine-dominated work culture experience in the COVID-19 period. Findings underscore the urgent need for comprehensive prevention programs, effective legislation, and community engagement to address GBV in post-pandemic communities. The research provides valuable lessons for enhancing GBV prevention efforts globally, emphasizing the significance of survivor voices and addressing root causes of GBV.

Challenges and strategies for navigating Australian healthcare access: experience from Chinese international students.

BACKGROUND: Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia. METHODS: Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19-30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels. RESULTS: Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information. CONCLUSIONS: Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks.

Baby-Friendly Hospitals, Social Determinants of Health, and Disparities in Breastfeeding Initiation in a Low-Income Population, 2017-2020.

BACKGROUND: Organizational-level interventions (i.e., Baby-Friendly Hospital Initiative) that support breastfeeding and target breastfeeding initiation are critical to reducing breastfeeding disparities and promoting breastfeeding equity. RESEARCH AIM: To determine the association between delivery in a Baby-Friendly accredited hospital and breastfeeding initiation among United States recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Washington DC, the majority of whom report their race as Black. METHOD: We conducted a secondary analysis of de-identified program data collected as part of routine WIC visits from the Washington DC WIC program, 2017-2020. Women who delivered a firstborn, singleton infant were included (N = 8,225). Multivariable logistic regression models accounted for social determinants of health and other factors. One set of models included a binary exposure variable (Baby-Friendly accredited vs. non-accredited hospitals), and another set included a categorical exposure variable for hospitals (1) Baby-Friendly accredited, (2) Baby-Friendly activities but not accredited, and (3) neither Baby-Friendly activities nor accredited. RESULTS: Breastfeeding initiation was 57.4% (n = 1988) for women delivering in accredited hospitals versus 55.4% (n = 2540) in non-accredited hospitals and multivariable model results were non-significant (OR = 0.95, 95% CI [0.86, 1.05]). However, more women initiated breastfeeding who delivered in either accredited hospitals (57.4%, n = 1988) or hospitals with Baby-Friendly activities but not accredited (55.9%, n = 2430) compared to those delivering in hospitals with neither (45.3%, n = 110), and multivariable models results concurred (Baby-Friendly accredited hospitals OR = 1.44, 95% CI [1.07, 1.94]; Baby-Friendly activities but not accredited, (OR = 1.55, 95% CI [1.16, 2.09]). CONCLUSION: Organizational-level interventions that create hospital environments supportive of breastfeeding initiation are important to promote equity in breastfeeding, but underlying social determinants of breastfeeding outcomes must be addressed.

Multilevel factors associated with HIV-related stigma among women living with HIV in Guangdong Province, China: a social-ecological model-informed study.

BACKGROUND: HIV-related stigma continues to hinder optimal HIV care, and its determinants should be understood at multiple levels. Based on the social-ecological model, this study aimed to explore factors associated with HIV-related stigma among women living with HIV in Guangdong Province, China. METHODS: A cross-sectional study was conducted from July to August 2022 to recruit newly reported women living with HIV with a history of pregnancy or current pregnancy in 2021 in 21 cities in Guangdong Province. HIV-related stigma was assessed using an abbreviated Chinese version of Berger's HIV Stigma Scale. Univariate and multivariable hierarchical regression analyses based on the social-ecological model were conducted to explore factors associated with HIV-related stigma and its four dimensions (personalized stigma, disclosure concerns, negative self-image and concerns about public attitudes) at the community/hospital, interpersonal, and individual levels. RESULTS: A moderate level of HIV-related stigma was found among the 360 participants included, with a mean score of 45.26. Multivariable hierarchical regression analysis showed that at the community/hospital-level, individuals were more likely to experience high levels of HIV-related stigma if they had experienced the discriminatory behaviors from health care workers (aOR = 2.34, 95%CI: 1.48-3.70) and if they rated serostatus disclosure services as less helpful (aOR = 0.69, 95%CI: 0.48-0.98). At the interpersonal-level, individuals with an HIV-positive partner (aOR = 1.71, 95%CI: 1.01-2.90) were more likely to experience high levels of HIV-related stigma than those with an HIV-negative or unknown partner. Individuals with high resilience (aOR = 0.22, 95%CI: 0.13-0.35) had lower levels of HIV-related stigma at the individual-level. In addition, ever experiencing discriminatory behaviors from health care workers, thinking serostatus disclosure services helpful, having ever seen publicity about personal interest protection services and complaint channels for people living with HIV(PLHIV), knowing about care and support services for PLHIV from social organizations at the community/hospital-level, partner notification and support at the interpersonal-level, and violations of personal interests, resilience at the individual-level were also associated with different dimensions of HIV-related stigma. CONCLUSIONS: HIV-related stigma was moderate among women living with HIV. The social-ecological model can facilitate a better understanding of factors associated with HIV-related stigma. Multilevel intervention strategies need to be tailored to reduce HIV-related stigma.

Bolstering Access to HIV-Related Health care in Zimbabwe Among Young Mothers Living With HIV: Lessons Learned on HIV Health Promotion From Zvandiri's Young Mentor Mother Program.

HIV disproportionately affects adolescent girls and young women living in Southern Africa. Rates of perinatal HIV transmission are high in this population, emphasizing the need for targeted health promotion and public health programming to improve the health of young mothers living with HIV. Zvandiri, a non-profit organization in Zimbabwe, created the Young Mentor Mother (YMM) program in response to this issue. This health promotion program uses peer-led service delivery conducted by trained young mothers living with HIV, called YMMs. We conducted semi-structured virtual interviews (N = 29) among Zvandiri staff and YMMs to identify benefits and challenges, and to inform future program scaling. We applied thematic analyses to the transcriptions. Participant narratives revealed several themes, including three key benefits from the YMM program: (1) peer support, (2) holistic care, and (3) women's empowerment. Participants also shared barriers to the success of the program, reflecting two overarching dimensions: (1) barriers related to scaling up the YMM program and (2) challenges related to addressing socio-structural factors. Barriers to scale-up included limited funds and resources, and food insecurity. Socio-structural challenges included HIV-related stigma, cultural and geographic differences, and intimate partner violence (IPV). These challenges align with the social-ecological model, whereby structural factors (lack of funding, food insecurity), community factors (HIV-related stigma, socio-cultural differences in accepting HIV care), and interpersonal factors (IPV) affect the implementation and scale-up of the program. We recommend future adopters of the YMM program to tailor the model for their community, prioritize peer supporter's well-being, foster women's empowerment, and adopt a holistic care approach.

Barriers to physical activity in the Iranian population: findings from the STEPwise surveillance 2021.

BACKGROUND: Physical inactivity is a critical predictor of all-cause mortality and many non-communicable diseases (NCD) including coronary heart disease, diabetes, hypertension, dementia, and several cancers. The main objective of this study was to determine the main barriers to physical activity based on the STEPwise Surveillance in Iran in 2021, to guide policymakers in developing the most effective physical activity increasing strategies. METHODS: This cross-sectional study was conducted on 27,515 female and male individuals aged over 18 years from the STEPwise Surveillance 2021. The barriers to physical activity according to the modified version of barriers questionnaire and intrapersonal, interpersonal, economic, cultural, and environmental domains based on social-ecological models were determined. Association between barriers domain and physical activity level was assessed. RESULTS: Lack of time due to job commitments (31.4%) and family (19.3%) and inappropriate physical conditions including illness, pain, injury, disability, and fatigue (30.4%) were the most frequent barriers to physical activity. Interest in sedentary leisure time activities including virtual space, computer games and watching TV were the next frequent barriers to physical activity (10.01%). Intrapersonal domain had the highest frequency (62.9%) and cultural domain had the lowest frequency (2.3%). Intrapersonal and interpersonal barriers reduced the odds of engaging in physical activity (OR: 0.62, P value < 0.001, OR: 0.76, P value < 0.001). CONCLUSION: Intra- and inter-personal domain barriers might reduce the odds of being active. Developing action plans addressing these factors is suggested to increase physical activity levels.

Tobacco in hotels: A study of smoke exposure and resident risk.

Objectives: Extended-stay hotels (ESH) are a reliable and accessible housing option for low-income, minoritized renters, who are disproportionately exposed to secondhand and thirdhand cigarette smoke (SHS and THS). This study explores ESH residents' perceptions of their SHS and THS exposure, harms related to this exposure, their willingness to mitigate these harms, and the contextual factors associated with smoking in hotels. Methods: Eighty ESH renters from the metropolitan Atlanta region were recruited to complete a survey about the perceived harm and persistence of tobacco smoke, exposure experiences, knowledge, attitudes, self-efficacy, and intentions to protect oneself. Eleven of these participants completed semi-structured interviews, during which they discussed their daily SHS and THS exposure at their ESHs in greater detail. Results: Of the survey respondents, 62% reported being bothered by their level of smoke exposure, and 77% said they believed smoke particulates remained in their rooms even after housekeeping cleaned them. Approximately half of survey respondents had attempted to stop smoking in the 3 months prior to the study, and 29 of these individuals were still on their smoking cessation journeys. Most interview participants agreed that SHS and THS exposure exacerbated their existing chronic illnesses and could possibly result in death in the long term. Participants agreed with the benefits of smoke-free policies, but also acknowledged other priorities for ESH living-affordability, safety, and proximity to the workplace-that overshadowed their desires for such policies. Conclusion: Overall, study findings suggest that ESH renters understand the dangers of smoking and SHS/THS and want to decrease their exposure, but the persistence of cultural and contextual factors prevents them from fully engaging with 100% smoke-free policies.

Teachers' perception on physical activity promotion in kindergarten children in China: a qualitative study connecting social-ecological model.

BACKGROUND: Globally, the majority of kindergarten-aged children face obesity issues and insufficient physical activity (PA) engagement. Regular PA participation can provide various health benefits, including obesity reduction, for kindergarten-aged children. However, limited studies have investigated the factors influencing kindergarten-aged children's PA engagement from the perspective of their teachers. This qualitative study aimed to identify factors that could help promote PA among kindergarten-aged children from teachers' perspectives, including facilitators, barriers, and teachers' recommendations. METHODS: Fifteen kindergarten teachers (age range: 28-50 years; mean age: 38.53 years) with teaching experience ranging from 2 to 31 years (mean: 16.27 years) were recruited from Shanghai municipality, Henan, and Jiangsu provinces in China. One-on-one semi-structured interviews were conducted via face-to-face (n = 7) or telephone (n = 8) to gather insights into factors influencing PA promotion among kindergarten-aged children. The interviews were audio-recorded, transcribed, and analyzed using a constant comparison approach based on grounded theory, which involved open, axial, and selective coding processes. RESULTS: The study revealed mutual theoretical support between themes and the social-ecological model (SEM), as factors identified in the study are distributed at various levels of the SEM. Twelve factors were identified at four levels of the SEM: (1) intrapersonal level (children's personality and skills), (2) interpersonal level (family, peers, and teachers influence), (3) organizational level (school environment and resources, opportunities for kindergarten teachers' training and children's PA, design and organization of PA, and PA that children need), (4) community level (family-school partnerships). CONCLUSION: Various factors at different levels can influence kindergarten-aged children's PA. The study's findings revealed that these factors are distributed across the first four levels of SEM, with the majority being at the organizational level. These multilevel findings are expected to assist in developing and implementing more effective PA interventions for kindergarten-aged children. Future research is warranted to identify strategies for promoting PA among kindergarten-aged children at the policy level of the SEM.

"They made me feel like I mattered": a qualitative study of how mobile crisis teams can support people experiencing homelessness.

BACKGROUND: Mobile crisis teams (MCTs) can be important alternatives to emergency medical services or law enforcement for low-acuity 911 calls. MCTs address crises by de-escalating non-violent situations related to mental health or substance use disorders and concurrent social needs, which are common among people experiencing homelessness (PEH). We sought to explore how an MCT in one city served the needs and supported the long- and short-term goals of PEH who had recently received MCT services. METHODS: We conducted 20 semi-structured interviews with service recipients of the Street Crisis Response Team, a new 911-dispatched MCT implemented in San Francisco in November 2020. In the weeks after their encounter, we interviewed respondents about their overall MCT experience and comparisons to similar services, including perceived facilitators and barriers to the respondent's self-defined life goals. We analyzed interview transcripts with thematic analysis to capture salient themes emerging from the text and organized within a social-ecological model. RESULTS: Nearly all respondents preferred the MCT model over traditional first responders, highlighting the team's person-centered approach. Respondents described the MCT model as effectively addressing their most immediate needs (e.g., food), short-term relief from the demands of homelessness, acute mental health or substance use symptoms, and immediate emotional support. However, systemwide resource constraints limited the ability of the team to effectively address longer-term factors that drive crises, such as solutions to inadequate quality and capacity of current housing and healthcare systems and social services navigation. CONCLUSIONS: In this study, respondents perceived this MCT model as a desirable alternative to law enforcement and other first responders while satisfying immediate survival needs. To improve MCT's effectiveness for PEH, these teams could collaborate with follow-up providers capable of linking clients to resources and services that can meet their long-term needs. However, these teams may not be able to meaningfully impact the longstanding and complex issues that precipitate crises among PEH in the absence of structural changes to upstream drivers of homelessness and fragmentation of care systems.

The factors related to depressive symptoms in urban older adults in South Korea: a study based on the Seoul Aging Survey.

PURPOSE: This study aims to comprehensively examine the determinants of depression among urban older adults in Seoul, utilizing the social-ecological model to address multifaceted influences. METHODS: A comprehensive analysis was conducted using data from the 2022 Seoul Aging Survey, which surveyed 2,914 individuals aged 65 and above. A multiple logistic regression analysis was performed to identify factors contributing to depressive symptoms, including socio-demographic characteristics, health behaviors and status, research accessibility, social support, and environmental influences. RESULTS: This study revealed that poor subjective health (OR = 1.47) and the presence of multiple chronic diseases (OR = 1.59) significantly increased the risk of depressive symptoms among urban older adults. From a social support standpoint, living alone was associated with a higher risk of depression (OR = 1.66), low food security (OR = 2.56), and low digital competency (OR = 2.70) were all significant predictors of depressive symptoms. Additionally, a lack of engagement with cultural facilities (OR = 2.15) was identified as a critical environmental factor contributing to depression. CONCLUSIONS: The findings underscore the need for comprehensive policy and practical interventions aimed at preventing chronic disease, enhancing social support networks, improving digital literacy, ensuring food security, and expanding access to healthcare and cultural facilities. Such measures are crucial in mitigating depression among urban older adults, thereby enhancing their overall well-being and quality of life.

Developing and Validating a Nomogram for Non-Adherence to Inhaler Therapy Among Elderly Chronic Obstructive Pulmonary Disease Patients Based on the Social Ecological Model.

Purpose: This study aimed to identify the risk predictors of non-adherence to inhaler therapy and construct a nomogram prediction model for use in Chinese elderly patients with chronic obstructive pulmonary disease (COPD). Patients and Methods: A cross-sectional study was conducted with 305 participants recruited from a tertiary care hospital in Anhui, China. Adherence was analyzed using the Test of Adherence to Inhalers. Potential predictive factors were incorporated based on the social ecological model, and data were collected through a questionnaire method. R version 4.3.3 was utilized to perform the least absolute shrinkage and selection operator regression model and multivariable logistic regression analysis to identify risk factors and establish a nomogram prediction model. Results: The results of the multivariable analysis revealed that medication beliefs, illness perception, the COPD Assessment Test score, smoking status, and education level were significant risk factors for non-adherence to inhaler therapy in elderly COPD patients (all P < 0.05). The nomogram prediction model for non-adherence to inhaler therapy in elderly COPD patients demonstrated a good discriminative ability, with an area under the receiver operating characteristic curve of 0.912. The C-index was 0.922 (95% CI: 0.879 to 0.965), and the Brier value was 0.070, indicating good consistency and calibration. Decision curve analysis indicated that the use of the nomogram would be more beneficial in clinical practice when the threshold probability of non-adherence exceeds 17%. Conclusion: This study identified predictive factors regarding non-adherence among elderly patients with COPD and constructed a predictive nomogram. By utilizing the nomogram model healthcare professionals could swiftly calculate and comprehend the non-compliance level of COPD patients, thus guiding the development of personalized interventions in clinical practice.

Marginalized voices: a qualitative exploration of multilevel environmental barriers to assistive technology use among hispanics.

PURPOSE: Assistive technology (AT) can increase or maintain the quality of life and overall well-being of people with disabilities. Nevertheless, access to AT is limited among Hispanics with disabilities in the United States (U.S.). AT research representing the experiences of Hispanics is limited, potentially leading to disparities in AT use. Moreover, poor inclusion of Hispanics neglects the needs of this population, resulting in discrepancies in research, practice, and policy related to AT. To address these limitations, this study aimed to identify and explore multilevel environmental barriers to AT use among a sample of Hispanics in the U.S. METHODS: This was a descriptive qualitative research design study guided by the Social Ecological Model framework using in-depth interviews to collect data. Nine Hispanic individuals with disabilities and their caregivers who received AT services at the University of Illinois at Chicago Assistive Technology Unit outpatient clinic were interviewed. Data was analyzed using a qualitative thematic analysis approach. RESULTS: Barriers to AT use were found to exist in all levels of the Social Ecological Model. The most common barriers to AT use were identified in the community domain, which was related to the lack of AT information, and in the societal domain, which was related to sociocultural norms and the availability of AT funding, policies, and regulations. CONCLUSIONS: The participants' lived experiences and perspectives underscored that environmental barriers to AT use are not isolated occurrences; rather, systemic attitudes permeate across all levels of the Social Ecological Model.

Limited availability of assistive technology information and services in Spanish is a challenge that can impact assistive technology usage.Bridging language and cultural gaps is crucial to ensuring equitable access to assistive technology and rehabilitation services.Multilevel environmental barriers impact assistive technology use, adversely impacting the quality of life and overall well-being of Hispanics with disabilities.

Healthcare delivery to patients from culturally and linguistically diverse backgrounds in emergency care: a scoping review protocol.

BACKGROUND: Worldwide, the culturally and linguistically diverse (CALD) population is increasing, and is predicted to reach 405 million by 2050. The delivery of emergency care for the CALD population can be complex due to cultural, social, and language factors. The extent to which cultural, social, and contextual factors influence care delivery to patients from CALD backgrounds throughout their emergency care journey is unclear. Using a systematic approach, this review aims to map the existing evidence regarding emergency healthcare delivery for patients from CALD backgrounds and uses a social ecological framework to provide a broader perspective on cultural, social, and contextual influence on emergency care delivery. METHODS: The Joanna Briggs Institute (JBI) scoping review methodology will be used to guide this review. The population is patients from CALD backgrounds who received care and emergency care clinicians who provided direct care. The concept is healthcare delivery to patients from CALD backgrounds. The context is emergency care. This review will include quantitative, qualitative, and mixed-methods studies published in English from January 1, 2012, onwards. Searches will be conducted in the databases of CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), SocINDEX (EBSCO), Scopus (Elsevier), and a web search of Google Scholar. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram will be used to present the search decision process. All included articles will be appraised using the Mixed Methods Appraisal Tool (MMAT). Data will be presented in tabular form and accompanied by a narrative synthesis of the literature. DISCUSSION: Despite the increased use of emergency care service by patients from CALD backgrounds, there has been no comprehensive review of healthcare delivery to patients from CALD backgrounds in the emergency care context (ED and prehospital settings) that includes consideration of cultural, social, and contextual influences. The results of this scoping review may be used to inform future research and strategies that aim to enhance care delivery and experiences for people from CALD backgrounds who require emergency care. SYSTEMATIC REVIEW REGISTRATION: This scoping review has been registered in the Open Science Framework https://doi.org/10.17605/OSF.IO/HTMKQ.

Identifying the Determinants of Hookah Smoking Among the Youth; A Mixed-Methods Study.

Hookahs have been rising in popularity in the United States (U.S.) especially among the youth yet not much research has been carried out to understand the various predictors of hookah use among youth. We have thus conducted a cross-sectional study with a mixed-methods triangulation design to identify the hookah use determinants at different levels of the Social Ecological Model among youth. Participants between the ages of 18-24 years were sampled purposively, between April to November 2023, following a snowballing technique from various communities in Virginia and California, United States. Data were collected via a survey, one-on-one interviews, and focus groups. The study had a total sample size of 20. We found that participants smoked for a median of 5 times in the past 30 days. The main determinants of hookah smoking included the limited knowledge of health effects and addiction, positive attitude, family and peer influence, use as a means to socially connect with others, culture, social acceptability, lack of education at school and work place, access to hookah bars and smoke shops, and lack of strict enforcement of laws to ban smoking of youth. Educational interventions should be implemented by public health authorities to target the youth, their social and communities to provide education on hookah harm and addictiveness and to restrict access to- and the production, distribution, marketing and sales of hookahs.

Daily activities of older adults before and during the COVID pandemic.

OBJECTIVES: This study examines how older adults' (65 years old plus) daily activities shifted in the years around the coronavirus disease (COVID) pandemic. METHODS: Using data from American Time Use Survey, this study compares activities across the pre-pandemic (2019 to March 2020), early-pandemic (May to December 2020), and pandemic-normal (2021) periods. RESULTS: In the first year of the pandemic, there was less time spent on average on leisure outside the home, traveling, and with nonhousehold members, and more time alone and at home, compared with before the pandemic. Moving beyond averages, sequence and cluster analyses find 5 similar typologies of days across the three periods, characterized by days predominated by (a) housework, (b) leisure at home, (c) TV, (d) a combination of leisure at home and outside with TV, and (e) paid work. Duration of time across various daily activities differed, however, even for the same clusters. For example, in days predominated by indoor leisure, adults spent 405 min in this activity before the pandemic, 432 min during the early-pandemic period, and 549 min during the pandemic-normal period. We also observed changes in the proportion of older adults in each cluster. Across the pre-pandemic and early-pandemic periods, the proportion of days predominated by leisure at home increased (9.9%-17.9%) whereas the proportion belonging to days predominated by housework decreased (45.7%-17.6%). DISCUSSION: COVID-19 shifted the daily life of older adults, and our findings are consistent with selection, optimization, and compensation theory, documenting that older adult adapted across the first 2 years of the pandemic.

Medical-Legal Partnerships: a promising approach for addressing health-harming legal needs among people with HIV.

Introduction: People with HIV (PWH), particularly those at the intersection of sexual and gender identities, face enduring obstacles to accessing HIV care, including structural stigma, structural racism and discrimination, housing instability, and limited access to health insurance. To address these challenges, Medical-Legal Partnerships (MLPs) in HIV care offer an innovative approach that integrates medical and legal services. By targeting health-harming legal needs (HHLN), MLPs aim to enhance the HIV care continuum outcomes for PWH. Methods: This study examines the benefits and challenges of MLPs within organizations serving PWH through the social-ecological model. MLP providers (n=111) identified organizational-level challenges such as funding limitations, resource integration issues, and staffing constraints. Results: MLPs demonstrated numerous benefits, including patient impact and benefits, comprehensive service provision, enhanced staff support and capacity, and potential for policy influence. Discussion: These results underscore the feasibility of MLPs while offering valuable insights into their efficacy and challenges, guiding the implementation of MLPs to address health-harming legal needs, including discrimination, and thereby improving HIV care outcomes.

Culinary Comfort: Understanding the Connection between Food and Well-Being.

This study investigated the complex interaction between individuals' culinary tastes, at-home dining habits, and their broader impact on general well-being and relationships dynamics. An all-encompassing tool for assessing the impact of dietary choices on emotions related to coziness, social interaction, and general wellness, the multidimensional Culinary Comfort and Connection Index (CCCI) focuses on traditional home-cooked meals, in particular. We used an online-based survey to validate the CCCI. With a Cronbach alpha of 0.844, this scale is reliable and valid. It covers a wide range of aspects including self-care advocacy, traditional values, and a preference for handmade food. We performed descriptive and stratified analyses and tested correlations. The CCCI shows complicated patterns when analyzed with respect to gender, education level, and family income that demonstrate a myriad of factors impacting people's views on food and its relationship to health. While some patterns emerged, the results imply that dietary choices do not necessarily correlate with overall health. The research highlights the complex interaction between cultural, societal, and personal elements in determining perspectives on nutrition and health by drawing on theoretical models like Bronfenbrenner's ecological systems theory and the Theory of Planned Behavior. Future research should incorporate broader age ranges, longitudinal designs, different populations, objective measurements, and intervention trials to better understand the dynamic link between dietary preferences and health outcomes.

A systems approach to multilingual language attitudes: A case study of Montréal, Québec, Canada.

Purpose: People are shaped holistically by dynamic and interrelated individual and social-ecological systems. This perspective has been discussed in the context of varied aspects of bilingual experiences, namely language acquisition and development. Here, we applied a Systems Framework of Bilingualism to language attitudes, which may be especially responsive to social-ecological influences. Methodology: One hundred twenty-three French-English bilingual adults (M age = 21.20, SD = 3.21) completed self-report questionnaires on demographic information and their attitudes toward languages. A subset of these bilinguals (n = 73) completed a social network survey. Data and analysis: We used language-tagged social network analysis and geospatial demographic analysis to examine the role of individual characteristics (i.e., first language), interpersonal language dynamics (i.e., person-to-person interactions), and ecological language dynamics (i.e., neighborhood language exposure). Findings and Conclusions: At an individual level, we found that bilinguals' language background (i.e., first language) predicted attitudes of solidarity toward a language (i.e., whether a language is associated with personal identity and belongingness). When considering sociolinguistic layers of influence, we found that bilinguals' social network and neighborhood-level language exposure jointly predicted their attitudes of solidarity toward a language, as well as their attitudes toward the protection of minority languages. Originality: While most studies have examined language experience in a unidimensional nature, the present study investigated multilingual language attitudes by considering multiple systems within a social-ecological framework. Implications: Taken together, the results suggest that several interrelated interpersonal and ecological systems are associated with language attitudes, which could have important implications for planning future language policies in multilingual societies such as Montréal.

Parental Travel Behaviors and Children's Independent Mobility: A MultiSite Study.

PURPOSE: Children who are allowed greater independent mobility (IM) are more physically active. This study investigated associations between parents' current travel mode to work, their own IM and school travel mode as a child, and their child's IM. METHODS: Children in grades 4 to 6 (n = 1699) were recruited from urban, suburban, and rural schools in Vancouver, Ottawa, and Trois-Rivières. Parents reported their current travel mode to work, IM, and school travel mode as a child. Children self-reported their IM using Hillman's 6 mobility licenses. Multiple imputation was performed to replace missing data. Gender-stratified generalized linear mixed models were adjusted for child age, parent gender, urbanization, and socioeconomic status. RESULTS: The older a parent was allowed to travel alone as a child, the less IM their child had (boys: ß = -0.09, 95% confidence interval [CI], -0.13 to -0.04; girls: ß = -0.09, 95% CI, -0.13 to -0.06). Girls whose parents biked to work (ß = 0.45, 95% CI, 0.06-0.83) or lived in Trois-Rivières versus other sites (ß = 0.82, 95% CI, -0.43 to 1.21) had higher IM. IM increased with each year of age (boys: ß = 0.46, CI, 0.34-0.58; girls: ß = 0.38, 95% CI, 0.28-0.48). CONCLUSION: Parents who experienced IM later may be more restrictive of their child's IM. This may help explain the intergenerational decline in children's IM.

Increases in loneliness among Older Americans Act participants during COVID-19.

Loneliness is increasingly understood as a public health crisis, and older adults are experiencing particularly severe impacts. Social distancing efforts during the COVID-19 pandemic may have increased loneliness among older adults. Guided by the Social Ecological Model, this study uses two cross-sectional waves of the National Survey of Older Americans Act Participants (NSOAAP) from 2019 and 2021 to expand understanding and identify possible points of intervention to increase social support for vulnerable older adults. Results reveal that while home-delivered meal participants have higher levels of loneliness than congregate meal participants, levels of loneliness did not increase during the COVID-19 pandemic and their loneliness levels did not differ significantly by age, geographic location, or living arrangement. Congregate meal participants' loneliness increased during the first year of the pandemic, particularly for participants aged 65-74, those living in suburban or rural areas, and those living alone. These findings suggest opportunities for policymakers and aging services providers who seek to increase social engagement among older adults who participate in Older Americans Act (OAA) nutrition programs. The evidence suggests a need for increased social engagement initiatives through OAA programs that prioritize social support for groups who are disproportionately burdened by loneliness.