Factors Associated with Suicidal Behavior in Adolescents: An Umbrella Review Using the Socio-Ecological Model.

Adolescent suicide is a critical social issue with profound and lasting individual and collective consequences. This umbrella review examines factors associated with adolescent suicidal behavior through the socioecological framework of prevention and seeks to identify gaps in the existing literature. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included a comprehensive search of the of the Web of Science, Scopus, and Cochrane databases in both English and Spanish, covering the period from 2018 to 2024, using terms related to adolescence and suicidal behavior. Out of 6,138 articles identified, 37 met the quality criteria and were selected for analysis. The studies highlighted individual risk factors such as age, gender, belonging to ethnic or gender minorities, emotional disorders, self-destructive behavior, emotional regulation, and experience of physical or emotional pain. Interpersonal factors such as parental relationships, sexual abuse, social isolation, peer pressure, and loneliness were also found. However, the review revealed a worrying lack of studies on societal and community factors and a paucity of research focusing on protective factors. The study highlights the need to include factors related to the physical and social environments that influence health and behavior in future research, as well as to enhance the resources and strengths of adolescents.

The role of emotion regulation in decreasing alcohol harm for veterans.

Using the socio-ecological model, this study aims to understand factors associated with alcohol misuse in veterans of the New Zealand Defence Forces, and identify approaches for reducing harm. Using interviews, veterans were asked to recount their relationship to alcohol, and provide a narrative of its use before, during and after military service. Seven themes were identified including bars and drinking as 1) social hubs; and 2) social lubrication; providing others with 3) duty of care; the military 4) consequences of harmful drinking; and use of alcohol as 5) emotion regulation strategies; with the impact of that on 6) Civvy street, and 7) family impacts. Duty of care in military drinking environments is a new theme to the literature. Introducing emotion regulation training throughout the personnels' career, from transition to becoming civilians and beyond, was identified as key to effective health marketing interventions.

Transgender Women in India: Neocolonialism, Stigmatization and Discrimination.

Stigmatization is a widespread social process that is sustained via the use of social, cultural, economic, and political power, and it has negative outcomes such as discrimination and exclusion. In India, transgender people have historically been called Hijra, Aravanis, and Kothis, and they have struggled since British colonialism against cisgender and heteronormative conventions that label them as outsiders despite their deep pre-colonial cultural origins. This research uses Bronfenbrenner's socio-ecological model t explore the independence and vulnerability of 45 transgender women living in Sambalpur City, Western Odisha, India. Semi-structured interviews were used to gather information from the group through the snowball sampling method. The research findings show that transgender women in India confront multiple forms of prejudice and stigma that diminish their agency and leave them more susceptible to harm. By underscoring the significance of historical, social, and cultural aspects, the socio-ecological model provides a holistic lens through which to comprehend these difficulties. Despite progress in legal recognition, transgender women continue to face significant barriers, necessitating ongoing socio-cultural, legal, and political efforts to reduce stigma and discrimination and enhance the agency, social inclusion, and wellbeing of transgender women.

Perceived patient navigator services and characteristics to address barriers to linkage to hepatitis C care among people released from provincial prison in Quebec, Canada.

BACKGROUND: Patient navigation increases linkage to hepatitis C virus (HCV) care following release from prison; however, little is known about the services patient navigators should provide to maximize linkage to care. We aimed to identify perceived barriers and facilitators to linkage to HCV care post-release, and to determine patient navigator services and characteristics best suited to address barriers to linkage to care among people released from prison. METHODS: Ten semi-structured interviews were conducted with adult (age ≥18 years) men living with chronic HCV, released from the largest Quebec provincial prison, and linked to HCV care by a patient navigator. Interviews were guided by the Socio-Ecological Model (SEM) and aimed to explore the multi-level barriers and facilitators to linkage to HCV care post-release. Interviews were audio-recorded, transcribed, and analyzed using a deductive, thematic approach. RESULTS: The median age of participants was 54 years. Barriers to linkage to HCV care included competing priorities post-release (e.g., substance use, mental health issues, unstable housing), stigma (related to HCV, injection drug use, and incarceration), and lack of transportation. Facilitators included social support, established relationships with existing healthcare providers, prior cure with direct-acting antivirals, and HCV-related health literacy and knowledge. Perceived essential patient navigator services to enhance linkage included pre-release discharge appointments, housing assistance, and facilitated transportation to HCV appointments. Ensuring a consistent, non-judgemental, and empathetic patient navigator were considered important characteristics; lived experiences of incarceration and/or HCV were not felt to be essential for a patient navigator. CONCLUSIONS: Interventions that seek to improve linkage to HCV care for people following release from prison should address many levels (individual, interpersonal, and policy) of the SEM. While people experience several competing priorities post-release, having an empathetic and consistent patient navigator, regardless of their lived experiences of HCV and/or incarceration, may improve linkage to HCV care post-release.

Mental health awareness, stigma, and help-seeking attitudes among Albanian university students in the Western Balkans: a qualitative study.

Introduction: The significance of mental health and its impact on overall well-being is increasingly acknowledged across various sectors, including higher education. However, despite this growing recognition, the stigma associated with mental health issues and related help-seeking, particularly within certain cultural groups and socio-economic contexts, continues to pose a formidable barrier to effective care, especially among university students. Addressing these challenges, this study explores the intricate interplay of factors affecting mental health awareness and stigma, including help-seeking behaviors among Albanian university students in three Western Balkan countries: Kosovo, North Macedonia, and Albania. By dissecting these multi-layered influences, this study aims to develop targeted interventions to enhance mental well-being and dismantle barriers to care in these regions. Methods: This qualitative study involved 60 Albanian university students from Kosovo, North Macedonia, and Albania, using focus groups to gather data. The discussions were structured around the socio-ecological model, facilitating a comprehensive exploration of the individual, interpersonal, organizational, and societal factors influencing mental health awareness, stigma, and help-seeking behaviors. Results: Findings from the study indicate a moderate awareness of mental health issues among students. Familial and cultural stigma among Albanians in the Balkans hinder open discussions and access to professional help. There is a notable lack of support from higher education institutions, with only 20% of students reporting that their mental health needs are met. These needs include affordable and confidential counseling, empathetic faculty interactions, and a supportive campus environment. Additionally, there is a lack of continuous and professional help within the community. Societal attitudes deeply rooted in Albanian cultural norms and traditional beliefs perpetuate stigma, limiting effective health care and help-seeking behavior. Discussion: The results emphasize the need for a culturally sensitive and holistic approach to mental health interventions that integrates strategies across multiple levels of the socio-ecological model. Enhancing mental health literacy, reducing stigma, and advocating for supportive legislation and policies in the Western Balkan region are critical. Moreover, the study highlights the urgent necessity for universities in particular to improve their mental health services, which will significantly enhance both the academic success and personal development of students.

Revisiting the conceptualization of social sustainability from a health promotion perspective: a scoping review.

AIMS: Both social sustainability and health promotion emphasize the development of local communities that satisfy human needs and enhance health and well-being. This scoping review aimed to identify frameworks, components, and operationalizations of social sustainability described in peer-reviewed articles and systematize the results from a health promotion perspective. METHODS: Six databases were searched for relevant articles following the JBI methodology and PRISMA guidelines. Articles were included if they provided a unique framework for social sustainability, that is, a conceptual model outlining the essential components of this concept. Information concerning the components of social sustainability and their operationalizations was analyzed through a six-step narrative synthesis. The final step involved categorizing the operationalizations of social sustainability into distinct levels by employing a socio-ecological model as an analytical tool. RESULTS: This review identified 22 articles presenting a social sustainability framework. The frameworks covered 11 components, of which social equity, safety, and neighborhood quality were the most frequent, while only five included health and well-being. The frameworks commonly provided practical interpretations of the concept with limited theoretical considerations. Furthermore, the identified operationalizations revealed a diverse understanding of social sustainability, encompassing all levels of the socio-ecological model applied. CONCLUSIONS: Health promotion research can offer theoretical and empirical insights that enhance the understanding of social sustainability, especially how societal, physical, and social determinants of health and well-being interact to create socially sustainable places. Likewise, the social sustainability literature may provide valuable knowledge underscoring the importance of contextual factors of health and well-being within the field of health promotion.

What explains adolescents' physical activity and sports participation during the COVID-19 pandemic? - an interpretable machine learning approach.

Adolescents' physical activity (PA) and sports participation declined due to the COVID-19 pandemic. This study aimed to determine the critical socio-ecological factors for PA and sports participation using a machine learning approach. We did a cross-sectional secondary data analysis utilising the 2021 National Survey of Children's Health (NSCH) dataset (N=16,166; 49.0% female). We applied an interpretable machine learning approach (e.g. decision tree-based models) that examined the critical factors associated with PA and sports participation. The factors related to the intrapersonal, interpersonal, organisational, and community levels of the socio-ecological model. Out of the 25 factors examined, our findings unveiled the 11 critical factors associated with PA and the 10 critical factors associated with sports participation. Factors at the intrapersonal levels (e.g. age, screen time, and race) held greater importance to PA than those at the other three levels. While interpersonal factors (e.g. parent participation in children's events/activities, family's highest educational level, and family income level) were most important for sports participation. This study identified that the common critical factors of physical activity and sports participation during the COVID-19 pandemic mainly relied on intrapersonal and interpersonal levels. Unique factors were discussed.

In this study, we identified 11 critical factors for PA, with the top five being age, neighbourhood amenities, screen time, missed school days, and family income level. Additionally, we identified 10 critical factors for sports participation, with the top five factors being parent participation in a child's events/activities, family's highest educational level, family income level, screen time, and school engagement. These findings emphasise the shared significance of intrapersonal and interpersonal factors as common determinants of both PA and sports participation. Notably, PA appears to be primarily influenced by intrapersonal factors (e.g. age, screen time, and race), reflecting its more internally driven nature. In contrast, sports participation appears to be more externally driven, primarily shaped by interpersonal factors (e.g. parent participation in the child's events/activities, family's highest educational level, and family income level). This distinction underscores the need for educators and policymakers to carefully consider these common and unique factors when devising promotion strategies during the COVID-19 pandemic. By recognising these distinctions, interventions can be better tailored to encourage both PA and sports participation among adolescents.

Latine perspectives on the impact of family, perceptions of medication, health systems, incarceration, and housing on accessing opioid agonist therapy: A thematic analysis.

INTRODUCTION: Opioid-related overdose deaths rates among Latine individuals are increasing rapidly and, in Massachusetts, have exceeded rates among non-Hispanic White individuals. Yet Latine individuals are less likely to receive opioid agonist therapies (OAT) methadone and buprenorphine, which have been demonstrated to prevent opioid deaths. Amid climbing Latine overdose rates, we lack qualitative data from Spanish-speaking people who use opioids about their views on and access to OAT. In this paper, we sought to assess variables affecting Latine individuals' initiation of OAT. METHODS: We conducted 21 semi-structured interviews - half in Spanish - with Latine-identifying individuals recruited from four locations-three residential treatment sites and one city shelter-in Boston offering services to people who use drugs. We utilized thematic analysis to identify barriers and facilitators to starting and continuing OAT. RESULTS: The following themes - which cut across individual-, interpersonal-, and systems-level variables - emerged as core considerations shaping Latine participants' OAT engagement: (1) family, (2) medication desirability and accessibility, (3) health care resources, (4) housing stability, and (5) incarceration. First, family members were prominent interpersonal influences on participants' treatment decisions. For some participants, family introduced participants to opioids at young ages and later supported them in recovery. Second, engagement with OAT was shaped by individual-level opinions on the medications as well as by systems-level experiences with trying to access the medications. Participants identified benefits and drawbacks of methadone versus buprenorphine, with greater access difficulties for methadone. Third, the health care setting in Boston provided notable systems-level facilitators to OAT access, including outreach workers, Medicaid, and Spanish-speaking providers. Fourth, housing instability impeded some from accessing OAT while motivating others to initiate the medications. Finally, incarceration created systems-level barriers to OAT engagement. Most participants had been incarcerated in jail or prison but did not have access to OAT during incarceration or during their transition back to the community. CONCLUSIONS: Approaches to increase OAT engagement among Latine individuals should consider integrating family into recovery pathways, tailoring information in Spanish, developing bilingual/bicultural staffing, ensuring supportive insurance coverage systems, addressing housing needs, and making OAT available for individuals involved in the legal system.

Barriers and facilitators for strengthening physiotherapy services in Nepal: perspectives from physiotherapists and health providers.

BACKGROUND: Physiotherapy provides non-invasive and non-pharmaceutical intervention for curative, rehabilitation and preventative purposes. Physiotherapy is also a central provider of health promotion. As the global burden of non-communicable diseases and chronic health conditions is rising, the importance of physiotherapy services increases. Unfortunately, physiotherapy services in low- and middle-income countries (LMICs) are generally unsatisfactory. In Nepal, the earthquake in 2015 and the COVID pandemic have clearly illuminated the importance of physiotherapy. OBJECTIVE: This qualitative study aimed to identify barriers and facilitators at different system levels for strengthening physiotherapy services in Nepal. METHODS: Forty semi-structured individual interviews were performed with different health providers. Transcribed interviews were assessed with thematic analysis. A five-level socioecological framework conceptualised multilevel determinants of barriers and facilitators. RESULTS: The study revealed various factors that were potential barriers and facilitators across five different levels, namely individual (taking the lead, need for advocacy), interpersonal (lack of recognition and autonomy, networking for referrals and coordination), community (lack of knowledge and awareness, social and family support), organisational (accessibility, workplace and clinical practice, educational opportunities, role of organisations and rehabilitation centres), and public policy level (planning and implementation of policies and programs, medical hegemony, priorities). Government officials, local leaders, and clinicians, half of whom were physiotherapists, agreed on many of the same issues, where a lack of awareness of what physiotherapy is and knowledge about what physiotherapists do was central. CONCLUSIONS: The results provide information for the development of physiotherapy by pointing out key elements that need attention. Our broad and structured investigation strategy is applicable to others for a comprehensive analysis of barriers and facilitators for physiotherapy services.

A qualitative exploration of the reasons and influencing factors for pregnancy termination among young women in Soweto, South Africa: a Socio-ecological perspective.

BACKGROUND: Pregnancy termination is an essential component of reproductive healthcare. In Southern Africa, an estimated 23% of all pregnancies end in termination of pregnancy, against a backdrop of high rates of unintended pregnancies and unsafe pregnancy terminations, which contributes to maternal morbidity and mortality. Understanding the reasons for pregnancy termination may remain incomplete if seen in isolation of interpersonal (including family, peer, and partner), community, institutional, and public policy factors. This study therefore aimed to use a socio-ecological framework to qualitatively explore, in Soweto, South Africa, i) reasons for pregnancy termination amongst women aged 18-28 years, and ii) factors characterising the decision to terminate. METHODS: In-depth interviews were conducted between February to March 2022 with ten participants of varying parity, who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured, in-depth interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach. RESULTS: An application of the socio-ecological framework indicated that the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners for the participant and their pregnancy. In addition to these reasons, Factors that characterised the participants' decision experience were identified across all socio-ecological domains and included the availability of social support and (lack of) accessibility to termination services. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants' decisions through detrimental changes in interpersonal support and financial situation. CONCLUSIONS: Amongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women's needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support.

In South Africa, where the number of unintended pregnancies is high, we need an improved understanding of the main reasons why women terminate their pregnancies and what factors characterise this decision. Aside from individual factors, this should also be seen within the context of their environment, including relationships, community, and institutions. We therefore aimed to explore women's reasons for choosing to terminate their pregnancy through semi-structured in-depth interviews with participants. We included ten participants from Soweto, South Africa, who had undergone a pregnancy termination. The main reasons for terminating a pregnancy had to do with personal factors and reasons related to their social relationships and support. These included financial insecurity, not feeling ready to have a child (again), and lack of support from family or partners. We also found factors that characterised how the participant experienced the decision, such as barriers to getting a safe (legal) pregnancy termination. We found that amongst South African women, the decision to terminate is made in the context of their complex (social) environment. Insight into the reasons why women choose to terminate helps to better align legal termination services with women's needs, for example by reducing judgement within healthcare settings and improving access to social and mental health support.

Preliminary Insights on Barriers to and Facilitators of Healthy Eating for Rural Residents Emerging from Extreme Poverty: A Qualitative Study in Dafang, China.

The purpose of this study was to examine the dietary views and practices and to identify associated barriers to and facilitators of healthy eating of rural residents emerging from poverty in the context of rapid socio-economic development. A qualitative design with semi-structured interviews was utilized to collect detailed insights into the dietary behaviors of 22 rural residents from 10 villages in Fengshan town, Dafang county, Guizhou province, China. Thematic analysis was applied to interpret the interview data, guided by the socio-ecological model. Four themes were identified: traditional eating patterns, factors influencing food choice, limited knowledge of healthy diet, and lack of nutritional guidance. Barriers to healthy eating included traditional but unhealthy foods, limited nutritional knowledge, inadequate understanding of nutritional requirements, overwhelming nutritional information, and limited professional guidance. Facilitators encompassed healthy traditional eating patterns, household composition, home gardening, preference for traditional bean and soy products, improved food supply and availability owing to poverty alleviation efforts, and being open to receiving professional dietary guidance. As a preliminary investigation into the dietary views and practices of this population, the study highlights a significant gap in the nutritional knowledge and guidance available to rural residents in China, emphasizing the need for comprehensive strategies that address the complex socio-ecological factors influencing dietary behaviors.

Care Needs, Challenges, and Experiences of Sexual and Gender Minority Cancer Survivors in Taiwan: Findings from a Qualitative Study.

OBJECTIVES: This study aimed to explore the care needs, challenges, and experiences of cancer care among sexual and gender minority (SGM) cancer survivors in Taiwan. METHODS: Semi-structured interviews were conducted face-to-face or telephonically with 30 SGM cancer survivors in Taiwan. Data were analyzed using the socio-ecological model and the constant comparative technique. The study used the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. RESULTS: The needs, challenges, and experiences of cancer care among SGM cancer survivors were categorized and presented according to the level of the social-ecological model: (1) intrapersonal level: physical and psychological impacts and changes in outlook on life after cancer diagnosis and treatment; (2) interpersonal level: informal social support resources and challenges for developing intimate relationships; (3) community level: formal social support resources and lack of SGM support groups; and (4) societal and policy level: positive and negative experiences with oncology healthcare providers (HCPs), sexual orientation disclosure, and lack of an SGM-friendly environment. CONCLUSIONS: Multilevel care needs and challenges in cancer care among SGM cancer survivors were identified. Oncology HCPs should be aware of and assess SGM cancer survivors' psychosexual issues and psychological status and provide suitable care resources to individuals. Moreover, training courses on culturally competent cancer care and information on SGM-related health policies (including same-sex marriage) should be provided to oncology HCPs to improve their sensitivity, knowledge, and skills to provide suitable care for SGM cancer survivors. IMPLICATIONS FOR NURSING PRACTICE: The study findings can be used to design and develop training courses for culturally competent cancer care for oncology HCPs to improve the quality of care and reduce cancer care disparities among SGM cancer patients.

Barriers to help-seeking for postpartum depression mapped onto the socio-ecological model and recommendations to address barriers.

Postpartum depression affects nearly a quarter of women up to a year after childbirth. Although it is treatable, significant barriers to help-seeking prevent women from being treated. This paper assesses key literature on the barriers for help-seeking among women with postpartum depression. The barriers identified have been mapped onto the socio-ecological model in addition to potential recommendations that professionals can use to address barriers on individual, interpersonal, organizational, community and societal levels. The recommendations provided are meant to serve as leverage points for professionals in efforts to create appropriate support and interventions. As such, this paper serves as a mapping tool for healthcare and public health professionals to assess obstacles to women's help-seeking and to guide multi-pronged interventions on various levels of the socio-ecological model that may increase help-seeking among women with postpartum depression. Holistically and comprehensively providing support to women will require significant effort throughout all sectors of society as opposed to isolated, siloed interventions.

Sedentary behaviour among elderly patients after total knee arthroplasty and its influencing factors.

To understand the status of sedentary behaviour in elderly patients after total knee arthroplasty and analyse its influencing factors so as to provide a reference for developing targeted interventions. Conveniently selected elderly patients undergoing total knee arthroplasty (> 6 months) in a tertiary hospital in Jiangsu Province were investigated using a general information questionnaire, the Charlson Comorbidity Index, patients' self-reported sedentary behaviour information, the WOMAC Score, The Groningen Orthopaedic Social Support Scale, and Lee's Fatigue. The median daily sedentary time was 5.5 h (4.5 h, 6.625 h) in 166 elderly patients after total knee arthroplasty, of whom 82 (49.40%) showed sedentary behaviour (≥ 6 h per day). Logistic regression analysis showed that being retired/unemployed (OR = 8.550, 95% CI 1.732-42.207, P = 0.0084), having a CCI score ≥ 3 (OR = 9.018, 95% CI 1.288-63.119, P < 0.0001), having high WOMAC scores (OR = 1.783, 95% CI 1.419-2.238, P < 0.0001), having a high social support score (OR = 1.155, 95% CI 1.031-1.294, P = 0.0130), and having a fatigue score ≥ 5 (OR = 4.848, 95% CI 1.084-21.682, P = 0.0389) made patients more likely to be sedentary. The sedentary time of elderly patients after total knee arthroplasty is long, and sedentary behaviour is common among them. Healthcare professionals should develop targeted sedentary behaviour interventions based on the influencing factors of sedentary behaviour in order to reduce the occurrence of sedentary behaviour in elderly patients after total knee arthroplasty.

Practitioner perspectives on the nature, causes and the impact of poor mental health and emotional wellbeing on children and young people in contact with children's social care: A qualitative study.

BACKGROUND: Children and young people (CYP) who are in contact with social care are at higher risk of developing mental health difficulties compared to the general population. This has been attributed to their experience of significant childhood adversity. With an increased likelihood of experiencing poorer health outcomes which can persist into adulthood, it is crucial that key factors for their positive mental health development are identified. OBJECTIVE: To identify factors associated with the poor mental health of CYP in contact with social care from the perspective of practitioners working in children's social care and mental health. PARTICIPANTS AND SETTING: Social care and mental health practitioners; three Local Authorities across the North-East of England. METHODS: Four focus groups were conducted with 23 practitioners between April and May 2022. A semi-structured topic guide exploring the nature and associated factors of mental health was used to focus discussion. Data were thematically analysed and informed by the four levels of the socio-ecological model. RESULTS: Individual level risk factors were associated with the CYP's emotional health and included what practitioners described as the 'sense of shame'. Interpersonal level risk factors were most recurrent and included parental factors within the home environment. Community level risk factors consisted of characteristics of settings and institutions that increased the risk of the CYP developing mental health and wellbeing difficulties. Societal level risk factors included broader societal factors such as poverty. Practitioners maintained that certain protective factors possessed or developed by CYP including secure attachments, prevent the development of mental health difficulties. CONCLUSIONS: Our current study provides strong evidence for the interlinkage between multiple levels of risk and their interacting impact on the CYP's mental health and emotional wellbeing. It is imperative that this, and the need to strengthen protective factors, whilst reducing risks are carefully considered for the development of effective support interventions for CYP in contact with social care.

Preventing Type 2 Diabetes after Gestational Diabetes: A Systematic Review Mapping Physical Activity Components using the Socio-Ecological Model.

OBJECTIVES: Gestational diabetes commonly occurs during pregnancy and increases lifetime risk of type 2 diabetes following pregnancy. Engaging in physical activity postnatally can reduce this subsequent risk. Interventions aiming to increase physical activity after gestational diabetes may not address the wide range of post-pregnancy barriers. A socio-ecological approach highlights the need to include multi-level factors such as social, community and organisational factors. The aim of the review was to map intervention components to prevent type 2 diabetes after gestational diabetes using the socio-ecological model as a framework and investigate how physical activity changes align with different intervention components utilised. METHODS: Eligible studies included any study type within 5 years of a gestational diabetes diagnosis and targeted physical activity. A systematic search of MEDLINE, Cochrane Library, Web of Science, CINAHL Complete, and Scopus was conducted in October 2022. Results were categorised based on whether findings demonstrated no increases, non-statistically significant increases or statistically significant increases in physical activity. RESULTS: Forty-eight studies were included (37 different interventions). Thirty-eight studies were assessed as "adequate" quality, only two studies were "good" quality, and the remaining were limited quality. Mixed physical activity outcomes were observed across components used at the intrapersonal level, with components across other levels of the socio-ecological model showing more increases in physical activity. Intervention components within the social and organisational levels, for example childcare provision, providing group-based sessions and offering remote delivery, were more often present in interventions with physical activity increases. CONCLUSIONS FOR PRACTICE: Future interventions targeting physical activity after gestational diabetes should aim to include social and organisational-level components in their intervention design. This systematic review was registered in PROSPERO (ID: CRD42021272044).

Using the Socio-Ecological Model to Understand Increased Risk of Gun Violence in the African American Community.

Gun violence is a major public health issue of growing concern in the United States (U.S.) with 48,830 lives lost to gun related violence in 2021, documenting the highest number of gun related homicides and suicides ever recorded. The African American community is disproportionately impacted by gun violence and members of this community are almost 14x more likely to die by gun homicide than their white counterparts. The Centers for Disease Control and Prevention (CDC) has identified a socio-ecological framework as a lens through which to better understand violence and inform potential prevention strategies to address it. This model identifies four levels (individual, relationship, community, societal) which help to enhance our understanding of the complex interplay between individuals and their environments. Here, we use this model to understand why the African American community experiences elevated risk of gun violence in the U.S. and propose strategies for prevention. Understanding the issue of gun violence beyond individual level risk, this analysis highlights the interplay between multiple levels including the ways in which societal level factors influence violence. While this paper provides a lens through which to understand the multi-leveled factors that contribute to gun violence in the African American community, it also serves as a call to action for policymakers, scholars, and agencies to develop culturally informed policy and programming efforts specific to those who are most impacted.

Socio-ecological model as a framework to understand the low participation of Earth Hour among Chinese college students: conflict between belief and practice.

Earth Hour, a global mass effort coordinated to show concern for green urban construction and sustainable development, was first organized by the World Wildlife Fund in Australia in 2007 with a growing trend of participation worldwide. However, analysis of participation in Earth Hour based on a large population are sparse, with only a few studies reporting details in positive results without a clear pattern that explains the potential low participation. This study focuses on the non-participants and analyzed the reasons for low participation in Earth Hour using a questionnaire with 401 college students based on the socio-ecological model. Two aspects are explored: (1) social-demographic features; (2) psychosocial traits (environmental awareness, acceptance for law, social support from family and friends and knowledge about the event). Barriers toward participation are included as mediators to explain how these basic features change students' decision on joining large-scale environmental campaign. A participation analysis method using binary logistic regression and one-way MANOVA is applied in data analysis. This study highlights that the irrelevance between students' belief and practice on environmental protection should not be overlooked, and that college students are inclined to join in groups in relevant activities-conversely, herd effect could greatly reduce their willingness to participation. The findings of this study have wider implications for school educators, practitioners and organizations involved in pro-environmental career. This paper highlights that, from an international perspective, the essence of collective action with a similar nature to Earth Hour and contributes to a global dialogue on fostering sustainable behaviors.

Trends in socio-demographic characteristics and substance use among high school learners in a selected district in Limpopo Province, South Africa.

BACKGROUND: Substance use is an escalating public health problem in South Africa resulting in risky behaviours and poor educational attainment among adolescents. There is a huge battle to overcome substance use among learners as more drugs become easily available with the mean age of drug experimentation reported to be at 12 years of age. It is important to continuously understand the trends in substance use in order to assess if there are positive changes and provide evidence for the development of context-specific effective interventions. This paper outlines the prevalence of substance use among selected high schools in a district in Limpopo province. METHODS: To determine the prevalence of substance use among selected high school learners in a district in Limpopo Province, a cross-sectional school survey of 768 learners was conducted. Data was analysed using SPSS v 26. Descriptive analysis was used to describe the independent and dependent variables and Chi-Square test was used to investigate associations between demographic characteristics and substance use among high school learners. RESULTS: The most abused substances by learners were alcohol (49%), cigarettes (20.8%) and marijuana (dagga/cannabis) (16.8%). In a lifetime, there was a significant difference (P < 0.05) in cigarette smoking with gender, school, and grade; with more use in males (14.2%) than females (7.6%); in urban schools (14.6) than peri-urban (6.7%) and more in Grade 12 (6.4%). There was a significant difference (P < 0.05) in alcohol use with more use in Grade 10 (12.6%) and varied use among male and female learners but cumulatively more alcohol use in females (27.7%). Drug use varied, with an overall high drug use in urban schools (20.7%). CONCLUSIONS: Substance use is rife among high school learners in the district and health promotion initiatives need to be tailored within the context of socio-demographic characteristics of learners including the multiple levels of influence such as peer pressure, poverty, unemployment and child headed families. Additional research is required to investigate the factors leading to a notable gradual increase in use among female learners and into the environmental and family settings of learners in influencing substance use.

Determinants of physical activity habit formation: a theory-based qualitative study among young adults.

PURPOSE: Engagement in physical activity significantly contributes to reducing the onset and severity of chronic diseases. Nonetheless, establishing habits around this behaviour remains a persistent challenge. This research endeavours to discern the determinants influencing the formation of physical activity habit among young adults in Israel, drawing upon a socio-ecological model. METHODS: A qualitative approach with phenomenological-hermeneutical method was used. In-depth interviews were carried to cover four levels of the socio-ecological model. RESULTS: Interviewees were categorized into three subgroups according to their physical activity habit strength: Habitually physically active (n = 8), Variably physically active (n = 11), and physically inactive (n = 6). The content analysis yielded four overarching themes associated with physical activity habit formation. Intrapersonal determinants encompassed personal traits, perceptions and attitudes, perceived benefits, and emotional responses related to physical activity. Interpersonal determinants encompassed social support, modelling support, and peer pressure. Community determinants pertained to social norms, resource availability, and accessibility. Finally, public policy considerations encompassed educational policies as well as workplace policies and cultural influences. CONCLUSIONS: This study highlights the unique determinants contributing to the formation of physical activity habit. As intrapersonal and interpersonal factors are significant determinants, interventions should focus on these elements in order to promote this behaviour among young adults.