Individual Behavior Change Research Articles

Analysis of Social Media Strategy on Behavioral Changes: A Case Study of Dilans Indonesia Organization

Digital media access is crucial for the disabled and elderly, but access gaps limit their participation. Dilans Indonesia seeks to empower and fight for their rights through social media. This research aims to analyze the strategies implemented through Dilans Indonesia's social media aimed at achieving changes in public behavior. The initiative of the establishment of Dilans Indonesia is to empower individuals with disabilities and the elderly to become empowered and independent communities while advocating the voices of the disabled and elderly community to the government. This research uses a qualitative research method with a case study approach, which is analyzed through data processing using NVivo software. The research findings show that social media activities carried out by Dilans Indonesia in promoting a culture of inclusive living have created changes in individual perspectives and behaviors towards disability issues as well as increased visibility and involvement of the disabled and elderly community. The continuity in the delivery of the message campaign is in line with the social marketing strategy applied, with the aim of raising awareness, expanding understanding, and changing people's perspectives, attitudes and behaviors towards people with disabilities and the elderly.

Estimating the accumulation and re-accumulation of commercial tobacco, electronic cigarette, and cannabis waste based on a stratified random sample of census blocks.

We investigated the amount and distribution of waste generated by commercial tobacco, electronic cigarette, and cannabis (TEC) use to inform policy options aimed at mitigating the environmental harm caused by these products. Using disproportionate stratified random sampling, we selected 60 census blocks from the eight largest cities in San Diego County, California. We twice surveyed publicly accessible areas in these blocks to quantify TEC waste accumulation and its re-accumulation. All collected items were photographed, classified, geocoded, counted, and properly discarded. We identified demographic, land use, and behavioral data from public sources and direct observations. We modeled total cigarette butt quantities for all census blocks across the eight cities and found similar results for Round 1 (8.63 million) and Round 2 (8.66 million) collections. Single-use plastic cigarette filters were the primary contributor to TEC waste (94%). Total TEC waste counts and cigarette butt counts showed strong linear associations (r = +0.86 and r = +0.91). The area surveyed, land use category, resident demographics, smoking prevalence, and walkability explained 78% of the variance in cigarette butt count. The interval between Round 1 and 2 counts did not affect re-accumulation counts, suggesting that baseline TEC waste levels were re-established within 1-2 months after cleanup. Annually, we estimate up to 200 million cellulose acetate plastic filters may be discarded in public areas of the eight cities. Given the continuous deposition, vast quantity, heterogeneous distribution, and rapid re-accumulation of TEC waste after cleanup, increasing removal efforts alone are financially untenable and impractical downstream solutions for TEC waste. Community-wide policies (e.g., filter bans, outdoor smoking restrictions) and individual behavior changes (e.g., reduced smoking rates, proper disposal of cigarette butts) are necessary to effectively mitigate the environmental impact of TEC waste in urban settings.

MY PRODUCT, YOUR GREEN CHOICE: EXPLORING THE INTERPLAY BETWEEN INFLUENCER’S SUSTAINABILITY COMMUNICATION AND GREEN MARKETING STRATEGIES ON TIKTOK

This paper examines the ways in which companies collaborate with green influencers on TikTok in order to combine sustainable communication with product sponsorship. TikTok, with its highly visual and meme-based communication style, offers companies a channel to align their marketing strategies with green messaging. Green influencers play a central role in this dynamic, blending activism and promotional content to raise awareness about sustainability while endorsing products. However, the actual willingness of these narratives to challenge the capitalist neoliberal logic has been questioned in the literature. A content and thematic analysis of 45 TikTok videos was conducted to see how companies express their environmental commitment through the affordances offered by the platform, including visual and viral aspects. Indeed, the aim of the paper is to explore the main actors, central themes and recurring narratives in these collaborations. The findings reveal that companies from diverse sectors integrate product sponsorship into educational narratives that inform users about environmental issues while positioning the sponsored product as a solution. This approach aligns with the storytelling styles of green influencers, potentially enhancing the credibility of their content. However, there is a predominant focus on individual behavioural changes with limited emphasis on collective action or broader societal responses to sustainability challenges. This reflects a tension that simultaneously critiques unsustainable practices while remaining rooted in neoliberal consumer logics. As a result, these collaborations may promote sustainable consumption but fail to address the social dimensions of sustainability, restricting the potential for fostering a more comprehensive approach to environmental advocacy.

Modelling the compensatory and carry-over effects between physical activity and fruit-vegetable consumption in young adults

Physical activity (PA) and fruit and vegetable consumption (FVC) are crucial factors jointly affecting young adults’ physical and mental health. However, the psychosocial interactive mechanisms of these behaviors remain understudied. Using a two-wave prospective design over two months, this study investigated the psychological mechanisms underlying multiple health behavior change (MHBC) through a novel two-layer social-cognitive framework, the Compensatory Carry-Over Action Model (CCAM), among 322 Chinese college students (19.47 ± 0.99 years; 55.6% female). Structural equation modeling with path analysis was conducted using Mplus 8.8 for data analysis. Results indicated an acceptable model fit for the hypothesized model, with χ2 = 120.845, df = 41, χ2/df = 2.947, CFI = 0.940, TLI = 0.901, RMSEA = 0.078 [90% CI = 0.062 to 0.094], and SRMR = 0.079. The model explained 54.9% and 50.0% of the variance in PA and FVC, respectively. In the first layer, focusing on the individual behavior change process, both volitional self-efficacy and planning were identified as significant mediators in the intention-behavior relationship for PA and FVC (indirect effects = 0.03 to 0.14, all p < .01). In the second layer, targeting the interaction between the two behaviors, the mediating role of compensatory cognition (e.g., PA/FVC can compensate for FVC/PA) in the relationship between intention and behavior was not supported (all p > .05). However, volitional self-efficacy and planning played a significant mediating role in the interaction between PA/FVC intention and FVC/PA behavior (indirect effects = 0.01 to 0.04, all p < .05). Future interventions aiming at promoting MHBC should address compensatory cognition and the carry-over effects between diverse behaviors.

Psychological and psychiatric standardized procedures for metabolic bariatric surgery: a clinical practice model for mental health providers.

Obesity is a multifactorial and chronic disease, constantly growing in prevalence. Metabolic and Bariatric Surgery (MBS) is among the most effective therapies for obesity, determining consistent long-term weight loss and maintenance. Increasing evidence suggests a relevant mental health contribution to obesity pathogenesis. European and International Guidelines for MBS emphasize the importance of a pre-surgical psychological/psychiatric assessment and a post-surgical follow-up to improve MBS outcomes. Yet, no standard psychological/psychiatric procedures currently exist. This paper overviews the psychological/psychiatric procedures which Italian mental health providers currently perform on MBS candidates to provide psychological support through every step of the MBS, from the assessment to the postsurgical follow-up, to evaluate eligibility, prevent mental health flare-ups and weight regain, as endorsed by the Board of the Italian Society of Surgery for Obesity and Metabolic Diseases (SICOB). The psychological/psychiatric procedures should encompass two phases: pre-surgical assessment and post-surgical follow-up. Pre-surgical assessment should investigate every condition that might reduce the MBS effectiveness or contraindicate the surgical process. It must include a mental state evaluation, weight history, eating behavior, body image, psychosocial conditions, and motivation. The post-surgical follow-up should offer psychological support to patients in achieving weight loss and maintenance. It should also prevent the onset or recurrence of psychiatric disorders that may affect clinical outcomes. This paper is the first to introduce a standardized protocol for psychological/psychiatric procedures for each phase of the surgical process, to allow MBS candidates to receive similar care despite geographical differences. It also serves as a potential clinical model for assessing mental eligibility or contraindications prior to MBS, and subsequently support the individual behavioral and lifestyle changes to achieve and maintain weight loss.

Addressing the commercial determinants of mental health: an umbrella review of population-level interventions.

There is increasing evidence that commercial determinants impact mental health. Addressing the commercial determinants may therefore be a way of improving population-level mental health. This umbrella review aimed to provide an overview of evidence in this field and identify knowledge gaps. Five databases (MEDLINE, Embase, PsycINFO, Scopus and Cochrane Library) were searched on the 18/19 of July 2022. Eligible papers were systematic reviews published after 31 December 2011. No geographical limits were applied. Eligible interventions were those that targeted the behaviours or products of commercial actors. Ineligible interventions included individual behaviour change interventions, such as those seeking to educate consumers. Included mental health outcomes were anxiety, depression, self-harm and suicide, whilst surrogate outcomes included product consumption. Industry involvement and the quality of included reviews (critical components of A MeaSurementTool toAssess systematicReviews -AMSTAR 2) were assessed. A narrative synthesis was used to compare the findings by industry, and a typology of interventions was developed. Eight reviews with mental health outcomes were included, each with multiple methodological weaknesses. There is some evidence that reducing the availability of alcohol or pesticides may lower suicide rates. Despite the known links, no evidence on the mental health impacts of population-level interventions tackling the social media, tobacco, gambling and ultra-processed foods industries were located. All gambling reviews were identified as having links to industry. Future high-quality evaluations of commercial determinants interventions developed specifically with the aim of achieving positive mental health outcomes and/or that evaluate mental health outcomes and are free from industry links are needed. PROSPERO ref. number CRD42022346002.

Sexual and reproductive health: Right not privilege.

Despite the prominence of international discourses on sexual and reproductive health and rights, much remains to be done to meet both needs and wants of individuals, couples and families. Socioeconomic disparities and geographic differentials, compounded by inappropriate policies besides resource constraints, hbave hampered the achievements of these rights to the extent that, in many jurisdictions, access to quality sexual and reproductive health services continues to be a privilege for some as opposed to a right for all. A rights-based approach, accompanied by appropriate policy formulation and sustained advocacy for resource mobilisation, can promote equity through community acceptance and individual behaviour change.

Experiences of the changing illicit drug supply among racial and ethnic minoritized people in three US states: a qualitative study

BackgroundAmidst a national surge in overdose deaths among racial and ethnic minoritized people and people who use stimulants (cocaine or methamphetamines), our objective was to understand how these groups are adapting to a rapidly changing illicit drug supply.MethodsWe conducted semi-structured interviews with 64 people who use drugs and who self-identified as Black, Hispanic, Multiracial, or other Non-White race in three states (Michigan, New Jersey, and Wisconsin). Transcribed interviews were coded thematically.ResultsMost respondents used stimulants alone or in combination with opioids. Respondents perceived that the drug supply had become more unpredictable and dangerous but differed in their personal perception of risk and their adaptations. For example, respondents had very mixed perceptions of their own risk of being harmed by fentanyl, and differing opinions about whether fentanyl test strips would be useful. Xylazine, a novel adulterant in the opioid drug supply that has received public health and media attention, was not well known within the sample.ConclusionOur study highlights the challenges experienced by minoritized people who use drugs in responding to a changing drug supply, underscoring the limits of public health approaches focused solely on individual behavioral change.

Community perspectives of heat and weather warnings for pregnant and postpartum women in Kilifi, Kenya.

Extreme weather is a recognised risk factor for stillbirth and preterm birth, disrupts women's access to healthcare during pregnancy and childbirth, and negatively affects the care of newborns. Reliable and accessible heat and weather warning systems are key in alerting individuals to undertake protective measures. There is a notable gap in understanding how women and caregivers in rural East Africa perceive and utilize weather information. We investigated community members' heat and weather warning information-seeking behaviour, identified available sources, assessed their reliability and utility, and examined their influence on behaviour. Our research was conducted in rural Kilifi County in Kenya's coastal region. The area experiences temperatures exceeding 23°C throughout the year, with extended periods of extreme temperatures [> 40°C] and long and severe droughts. We conducted in-depth interviews [IDI] with pregnant and postpartum women [n = 21] and held six focus group discussions [FGDs] involving mothers-in-law and community health volunteers [CHVs]. The data were analysed in NVivo 12 using both inductive and deductive approaches. We found significant gaps concerning pregnant and post-partum women, and their caregivers, having timely access to weather forecasts and heat information from health or meteorological authorities. Information on heat and weather warnings is disseminated through various channels, including television, radio, mobile phones, and word of mouth, which are facilitated by community influencers such as CHVs and local chiefs. Indigenous methods of weather forecasting, such as cloud observation, consulting local "rainmakers", and studying the behavioural patterns of amphibians, are employed in conjunction with warnings from the Kenyan Meteorological Department (KMD). Barriers to accessing weather information include the cost of television and smartphones and a lack of segmented information in local languages. National and county meteorological services need to enhance public participation, communication, and the delivery of heat and weather information to guide community-level response measures and individual behaviour change. They should also collaborate with health professionals to address heat risks for vulnerable groups. Further research is needed to empower indigenous weather predictors with modern weather information and revise national policies to deliver tailored messages to vulnerable populations like pregnant and postpartum women.

Optimization of Appraisal Case Teaching in Law from the Perspective of Social Cognitive Theory

In response to the challenge of implementing the method of appraisal case analysis in legal education, this study explores the optimization of legal case teaching using social cognitive theory. Social cognitive theory, as a crucial framework for individual learning and behavioral change, provides systematic theoretical support for legal education. The application of observational learning, the cultivation of self-efficacy, and the impact of triadic reciprocal determinism offer concrete guidance and insights for the implementation of the appraisal method. Applying these theories can effectively promote the implementation of the appraisal method and ultimately improve the quality of legal education.

Abstract 4126463: The Relationship Between Hope and Hopelessness in Adults with an Acute Cardiac Event

Introduction: Hope has been positively associated with behavior change in individuals screened for cardiovascular risk, and negatively associated with fatal ischemic heart disease (IHD). Hopelessness is associated with increased risk of mortality or nonfatal myocardial infarction in patients with IHD, and negatively associated with physical activity outcomes. Hope and hopelessness are sometimes considered to be ends of a continuum, yet the relationship between hope and hopelessness is not commonly examined in IHD patients. Aim: To determine the relationship between the State-Trait Hopelessness Scale (STHS) and Snyder Adult State and Adult Trait Hope Scales in a sample of patients with IHD. Hypotheses: 1) There would be an inverse relationship between hopelessness and hope as measured by the scales and 2) discriminant validity of the instruments would be confirmed. Methods: A total of 156 participants were enrolled as part of a 3-group randomized controlled trial testing an intervention to promote physical activity and reduce hopelessness. Data were collected two weeks after hospital discharge. Correlations and partial correlations were computed for all combinations of scales. Principal component analysis (PCA) was conducted on hope and hopelessness scales. Results: A total of 106 participants (68%) had moderate or high trait hope, and 92 (59%) had moderate or high state. Moderate or severe hopelessness was reported by 93 participants (59.6%) for state hopelessness and 108 participants (69.2%) for trait. There were moderately strong negative correlations (r=-0.54 to -0.66, p=&lt;0.001) between the total STHS and the Snyder Hope scales for both full and short versions of the STHS. Correlations were virtually unchanged when adjusted for age, sex, cardiac diagnosis, and marital status (r=-0.5 to -0.63, p&lt;0.001) indicating that as hopelessness increases, hope decreases. PCA revealed 4 factors that explained 64.7% of the variance in scores while demonstrating conceptual distinctions between the STHS and Snyder Hope scales. Conclusions: As hypothesized, as hopelessness increased, hope decreased; however, we found a proportion of patients with hopelessness who still expressed hope for the future. Discriminant validity was supported by inverse correlations and factor analyses indicating conceptual distinctions between the two instruments. Interventions to reduce hopelessness for patients with IHD may be successful since hope and hopelessness are not mutually exclusive.

Dilemmas of care: Healthcare seeking behaviours and antibiotic use among women in rural communities in Nam Dinh Province, Vietnam

Antimicrobial resistance is a silent pandemic to cause an estimated ten million deaths by 2050. Self-medication with antibiotics in low- and middle-income countries has been identified as a driver of antibiotic resistance. Interventions targeting solely individual behaviour change around antibiotic practices are often unsuccessful as they fail to address socio-cultural and structural causes of the problem. Understanding the context of antibiotic use in communities will better inform interventions addressing the misuse and overuse of antibiotics. Vietnam faces a growing threat of antimicrobial resistance due to inappropriate use of antibiotics in the healthcare system, farming and food production, and in the community. To understand the roots of this problem, we conducted qualitative research in 2020, with one component focusing on the community. This included fifteen in-depth interviews with women and four months of participant observation in three districts in Nam Dinh Province to explore the healthcare seeking practices and perceptions of medicine and antibiotic use. We argue that even when participants understood antibiotic resistance and were willing to adjust their care practices with antibiotics, there were cultural and structural challenges demotivating changes. The participants faced what we term “dilemmas of care”. For example, while public health messaging promoted appropriate antibiotic practices, the healthcare system did not provide a suitable environment to support appropriate use. Besides, the introduction of biomedicines into the long-standing traditional medical system caused confusions in community health practices, leading to issues such as poor adherence to treatment. At an individual level, participants faced challenges in accessing healthcare knowledge, adhering to social expectations surrounding care, and financial issues. We argue that the misuse of medicines and antibiotics in communities are responses to a deficient healthcare system and unequal access to quality healthcare.

Towards posthuman climate change education

ABSTRACT Climate change is one of the most critical challenges of our time, requiring significant responses from all aspects of society, including education. The prevailing responses to climate change tend towards treating the crisis as a predominantly scientific and managerial issue that requires technological solutions or behaviour changes. Correspondingly, climate change education (CCE) often focuses on teaching climate science and (predominantly individual) behaviour change. We argue that CCE, as part of a broader environmental and sustainability education (ESE), needs, in addition to a short-term damage limitation response, a simultaneous, longer-term, transformational approach that goes beyond critical humanism and engages with posthumanism. We explore ideas about human continuity with the more-than-human world, and the relationality and materiality of humans. Drawing on recent developments within posthuman pedagogies research, we consider how posthumanism might influence ESE/CCE, focussing on how two sustainability competency frameworks, UNESCO’s key competencies and the EU’s GreenComp, might be posthumanised.

Feasibility of a custom-tailored, evidence-based, theory-informed, intervention to prevent burnout and reduce stress for healthcare professionals: protocol for a single-arm trial

BackgroundHealthcare professionals face high levels of occupational stress, time pressure, workload, and poor organizational support. This makes them particularly vulnerable to burnout. The COVID-19 pandemic has further exacerbated this situation. This single-arm, multicenter, mixed-methods feasibility study pilots the LAGOM program: A tailored, evidence-based intervention to prevent burnout and reduce stress among healthcare professionals.MethodsParticipants will include healthcare professionals (N = 30) working at Charité–Universitätsmedizin Berlin and Immanuel Hospital, Berlin. LAGOM focuses on support for individual behavior change and personal resources and also addresses the organizational level. The intervention´s feasibility will be evaluated through a non-randomized feasibility trial with a mixed methods process evaluation. The exploratory primary study aims are to assess the acceptability and feasibility of the (1) evaluation procedures and of the (2) intervention content and structure using study records, standardized questionnaires, protocol checklists, and diaries. Exploratory effectiveness analysis will take place as well. Further, semi-structured interviews (n = 3 to 6) and electrophysiological measurements (n = 20) will be conducted.DiscussionCustom-tailored, well-implemented multi-level interventions are needed to prevent burnout and reduce stress among healthcare professionals. Long-term strategies are warranted to sustainably implement effective programs. This feasibility study helps to refine trial procedures and content of the LAGOM program for a randomized controlled trial to evaluate the intervention’s effectiveness.Trial registrationGerman Clinical Trials Register: DRKS00032014, registered 17th October 2023.

Early behavioral indicators of aberrant feces in newly-weaned piglets.

Post-weaning diarrhea (PWD) is a frequently occurring health and welfare issue in weaned piglets. Behavioral changes indicating impaired health may be detectable before the onset of signs and could be useful to detect the development of PWD early, enabling targeted and timely interventions. Current algorithms enable automated behavioral classification on the group level, while PWD may not affect all piglets in one pen and individual level analysis may be required. Therefore, this study aimed to assess whether changes in pen activity or individual piglet behavior can be early indicators of the occurrence of PWD. During 3 replicated rounds, 72 piglets (Sus scrofa domestica, Landrace x Large White) weaned at 27days of age, were housed in 4 pens with 6 piglets each. Individual fecal color and consistency were scored (0-5; ≥ 3 considered as aberrant feces) six times during the first two weeks post-weaning using rectal swabs. Additionally, using a similar scoring scale, feces on the pen floor were assessed daily. Two methods were applied for behavioral scoring. Individual behaviors (eating, drinking, standing, walking; n = 48) were scored manually and instantaneously with a five-minute interval from videos of the first two rounds, while pen activity (eating, drinking, moving; n = 12) was analyzed automatically and continuously using a commercially available algorithm from videos of all three rounds. Piglets showing a relatively higher proportion of standing behavior one day before fecal scoring had increased odds of an aberrant fecal color score (odds ratio (OR): 4.8; 95% confidence interval (CI): 1.5-15.3). Furthermore, odds of aberrant colored feces increased in pens where piglets showed more moving activity two days before (OR: 6.14; 1.26 < 95%CI < 29.84), which was also found for fecal consistency (OR: 4.77; 95%CI: 1.1-21.6). Our results indicate that increased standing in individual piglets and an increased moving activity on the pen level may be important behavioral indicators of PWD before the onset of diarrhea. Further development of current algorithms that can identify behavioral abnormalities in groups, from the pen to the individual level, may therefore be a promising avenue for improved and targeted health and welfare monitoring.

Do attitudes toward air pollution influence climate change perception? Evidence from online customers in China

Abstract The perception of climate change as an abstract and distant concept hinders climate action. Previous studies suggest that individuals may conflate climate change and local air pollution due to misconceptions, as these environmental issues share similar emission sources and mitigation strategies. However, it remains uncertain whether leveraging the public’s high perception of air pollution can lead to increased climate change awareness and supportive behaviors. In this study, we surveyed 1236 Chinese online customers to explore the influence of air pollution perception on climate change perception and willingness to pay (WTP) for supporting climate actions. Structural equation modeling results revealed that higher air pollution perception, which is connected to an individual’s living environment and health status, is significantly associated with higher climate change perception. Despite this link, higher climate change perception does not necessarily translate to higher WTP for climate actions. However, air pollution perception can indirectly increase WTP for climate actions by fostering avoidance behavior intentions. For practical implications, our findings suggest that an emphasis on the co-benefits of climate change mitigation efforts for improving air quality may help lead to greater policy support and understanding. Additionally, promoting individual behavioral changes requires connecting these issues to personal experiences and highlighting tangible benefits such as improved health and well-being.

Forces at play: A qualitative study of risk aversion, policy and decision making for children's physically active play in schools

This study investigated (i) the social and political factors driving risk averse decision making for children's physically active play in schools, and (ii) the policies shaping these decisions in Victoria, Australia. A theory-informed multi-method case study design combined policy document mapping, semi-structured interviews, and photo elicitation with 30 education policy actors. Data were analysed using reflexive thematic analysis. Findings showed the policy landscape was heavily skewed towards managing risk and safety (84%; n = 42), with fewer, mostly optional, policies for promoting physical activity, and a lack of policy to promote or protect play. Thematic findings indicated an intersecting range of factors in this setting (including occupational health and safety, knowledge and skill gaps, parent factors, children's physical capabilities, an undervaluing of play) can deter schools from providing an environment that enables children's freely chosen, physically active play. Multi-faceted, systems-based approaches that go beyond interventions aimed at individual behaviour change are needed.

Can we adapt fairly? Systematic review of health equity implications of climate change in coastal communities in the UK

Abstract As climate change becomes more apparent, it is important to evaluate the equity implications of adaptation interventions and policy measures. Many coastal populations experience high levels of social deprivation, which can be compounded by environmental factors. Coastal hazards, such as erosion and flooding can cause short and long term impacts on physical and mental health. To systematically review the published evidence on the differential impacts of coastal change on health inequalities and review the implications of adaptation responses for health inequality. We systemically reviewed the evidence for the UK only on a) inequalities in coastal flood impact or risk, and b) effectiveness and equity implications of current measures to manage the climate risks to an acceptable level of impact. Interventions included: plans and guidance, insurance, and infrastructure, including natural flood management. We found 8 papers quantifying differentials in current and future impacts of coastal flood risk and 6 papers assessing equity implications of adaptation measures. Coastal flood risk is unevenly distributed. Those owning their own home were more likely to experience flood impacts including increased stress and displacement. There is good evidence that policies for household insurance and property level protection measures have the potential to increase inequalities; other measures (community engagement; planning; defences) may reduce health inequalities, depending on implementation and local context. Adaptation to coastal change requires a range of approaches in the short and longer term, which potentially exacerbate current inequalities. Adaptation responses that rely on individual behaviour change, such as relocation, purchasing insurance, or retrofitting dwellings, may exacerbate inequalities within coastal communities. Climate change challenges organisations to deliver national and local policy responses ensuring that adaptation is effective and equitable.

The ecology of ageing in wild societies: linking age structure and social behaviour.

The age of individuals has consequences not only for their fitness and behaviour but also for the functioning of the groups they form. Because social behaviour often changes with age, population age structure is expected to shape the social organization, the social environments individuals experience and the operation of social processes within populations. Although research has explored changes in individual social behaviour with age, particularly in controlled settings, there is limited understanding of how age structure governs sociality in wild populations. Here, we synthesize previous research into age-related effects on social processes in natural populations, and discuss the links between age structure, sociality and ecology, specifically focusing on how population age structure might influence social structure and functioning. We highlight the potential for using empirical data from natural populations in combination with social network approaches to uncover pathways linking individual social ageing, population age structure and societal functioning. We discuss the broader implications of these insights for understanding the social impacts of anthropogenic effects on animal population demography and for building a deeper understanding of societal ageing in general.This article is part of the discussion meeting issue 'Understanding age and society using natural populations'.

A Systematic Review of Dental Antibiotic Stewardship Interventions.

Antimicrobial resistance is a significant threat to global health. Antimicrobial stewardship is reducing inappropriate antimicrobial prescribing to counter it. Dentists prescribe ~10% of all antibiotics worldwide, yet up to 90% of antibiotic prescriptions by dentists are inappropriate. The aim of this systematic review was to update a 2017 review evaluating the effects of antibiotic stewardship interventions in dental settings, using the international consensus on core outcomes for dental antibiotic stewardship. Systematic database searches were undertaken in April 2023, of the: Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE via OVID, EMBASE via OVID, Dentistry and Oral Sciences Source, the US National Institutes of Health Trials Register, the World Health Organisation International Clinical Trials Registry Platform and the ISRCTN registry databases. Randomised controlled trials (or non-randomised studies with clearly reported mechanism of group formation and inclusion criteria) of interventions to optimise and/or reduce dental antibiotic prescribing were eligible for inclusion. Two authors independently screened for eligible studies. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, certainty of evidence assessed using GRADE. Meta-analysis was planned whether the results of studies reported similar outcomes, otherwise narrative synthesis was undertaken. Three eligible studies randomising 2148 participants were included. The interventions were combinations of education, audit and feedback and written behaviour change messages, guideline summary, practice visits and patient leaflets. None of the control groups received an intervention. All three included studies measured the quantity of antibiotics prescribed and two measured the appropriateness of prescribing. None measured patient-reported or adverse outcomes. Two included studies were assessed as 'high risk' and one with 'low risk' of bias. There was high-certainty evidence that audit and personalised feedback with individualised behaviour change messages can be effective. Evidence for in-person education was low-certainty. Guideline dissemination alone was ineffective at improving antibiotic prescribing. Due to different outcomes reported, meta-analysis was inappropriate. Although various dental antibiotic stewardship interventions have been reported in the literature, none provided high-certainty evidence of effectiveness and only three have been evaluated using a randomised design. To strengthen the body of evidence, well-powered, robust, randomised controlled trials are required, with adequate follow-up, reporting the internationally-agreed core outcomes and including a parallel process evaluation is recommended. PROSPERO (CRD42023411476).