Integrated Health Promotion Program Research Articles

Prevalence and Factors Related to Nomophobia: Arising Issues among Young Adults.

Nomophobia is characterized as apprehension of being apart from smartphone, which causes the user to seek proximity with the device. The purpose of this study was to explore the prevalence and factors associated to nomophobia among young adults in Athens, the capital city of Greece. A cross-sectional study was performed on a sample of 1408 young adults aged 18-25 years. The questionnaire was anonymous, including the socio-demographic characteristics of the participants, the smartphone uses, and the nomophobia questions. Statistical analyses were done by simple univariable techniques or modeling the data through generalized linear models. Almost all participants (99.9%) exhibited any level of nomophobia, with the moderate level prevailing (57.0%). Women and non-working participants were more likely to exhibit severe nomophobia (adj PR = 1.57) and any level of nomophobia was 30% higher among the participants whose father had no academic degree (p = 0.029). In addition, 59% of those with severe nomophobia had very frequent phone checking (p < 0.001) while 45.8% with any level of nomophobia reported a negative influence on their academic performance. Attention should be paid to early prevention through the development of integrated health promotion programs.

Community Empowerment to Prevent Stunting Through Integrated Health Promotion in Cilayung Village, Jatinangor Sub-District

ABSTRACT Stunting is a growth disorder or a short (dwarf) child's height compared to his age standard. Of the problems that occurred in Cilayung Village, out of 517 toddlers, 12 experienced stunting and delays in thinking processes. This report provides an overview of community empowerment to increase community knowledge and skills in stunting prevention through integrated health promotion programs. This community empowerment program is carried out using a hybrid method. Preparatory activities are carried out offline and online, while extension and training implementation activities are carried out directly or offline. The results of the community empowerment program show that it can increase community knowledge and participation in efforts to prevent stunting in Cilayung Village, Jatinangor District. Much of the increase in public understanding and awareness is related to the importance of exclusive breastfeeding for infants, food processing for toddlers aged 2-5 years, maternal reproductive health and nutritious diets for children, and early stimulation for children in preventing stunting. The integrated stunting prevention health promotion program is expected to become one of the additional programs that aim to prevent stunting in Indonesia by developing capabilities and independence through community empowerment. Keywords: Community Empowerment, Health Promotion, Integrated Programs, Prevention, Stunting

A health promotion program for older adults (KABAN!): effects on health literacy, quality of life, and emotions

ABSTRACT The importance of an integrated health promotion program has been proposed in recent years. However, the traditional program with lectures might decrease the effectiveness of learning. A game-based learning program provides a supportive social environment and further increases the quality of life and positive emotions. The present study evaluates the effectiveness of the proposed game-based health promotion program, KABAN!, to enhance health literacy, positive emotions, and quality of life for older adults. The proposed intervention included physical exercises, nutritional knowledge, social interaction, cognitive training, and oral health care skills. All activities were designed based on the gamification principles and experiential learning theory. Both qualitative and quantitative data were collected from participants and instructors. A total of 221 older adults were randomly recruited (age: mean = 71.1, SD = 7.1) as participants. To gather feedback on program implementation, 22 experienced instructors were selected based on the criteria of leading five or more sessions. Health literacy, quality of life, and emotional states before and after participation were collected. The instructors were invited to provide constructive feedback through open-ended survey questions. Analyses revealed that health literacy levels, positive emotions, and quality of life significantly increased after participation, while negative emotions remained identical. Further investigation of qualitative data via the constant comparison method showed positive feedback on instructors’ perceived changes in participants. This study showed that participation in health promotion programs like KABAN! significantly enhanced older adults’ health literacy, quality of life, and positive emotions.

Effects of the School-Based Integrated Health Promotion Program With Hydroponic Planting on Green Space Use and Satisfaction, Dietary Habits, and Mental Health in Early Adolescent Students: A Feasibility Quasi-Experiment.

Background: School-based green space activities have been found to be beneficial to the physical activity level and lifestyle habits of adolescent students. However, their effects on green space use and satisfaction, mental health, and dietary behaviors required further investigation. This study aimed to investigate the effects of school-based hydroponic planting integrated with health promotion activities in improving green space use, competence and satisfaction, healthy lifestyle, mental health, and health-related quality of life (QoL) among early adolescent students in secondary schools.Methods: This study adopted a three-group comparison design (one control and two intervention groups). Secondary school students (N = 553) of grades 7–9 participated in either (1) hydroponic planting (two times per week for 8 months) integrated with health promotion activities; (2) only health promotion activities (one time per week for 6 weeks); or (3) control group. Outcomes assessed by questionnaire included green space use and satisfaction, life happiness, lifestyle, depressive symptoms, and health-related QoL.Results: After adjusting for sex and school grade, the scores in “green space distance and use” and “green space activity and competence” were significantly better in the intervention groups than in the control group. Hydroponic planting integrated with health promotion activities was also associated with better scores in dietary habits and resistance to substance use. Intervention groups had a higher score in “Green space sense and satisfaction” and life happiness when compared with the control group.Conclusions: Our study shows that the school-based hydroponic planting integrated with health promotion activities were feasible and, to a certain extent, useful to improve green space use and competence, dietary habits, and resistance to substance use among early adolescent students in secondary schools in urban areas. Future studies should address the limitations identified, for example, designing a randomized controlled trial that could fit school schedules to generate new evidence for physical and mental health in adolescent communities.

Barriers to and facilitators of South Asian immigrant adolescents’ access to sexual and reproductive health services in Canada: A qualitative study

Data on immigrant access to sexual and reproductive health (SRH) services in Canada typically focus on adult populations generally but not adolescents specifically. To fill this gap, this study explored South Asian immigrant adolescents’ perceptions of barriers and facilitators for SRH care and services in Edmonton, Alberta, Canada. In this qualitative descriptive study, researchers conducted six focus group semi-structured interviews with South Asian immigrant adolescents who live in Edmonton, Canada. Barriers included fear of stigma and judgment, lack of information about the healthcare system, lack of privacy and youth-friendly SRH services, lack of comprehensive sexuality education, lack of trust of online SRH information, and language barriers. Facilitators included SRH information classes at school, parental support, and provision of free services. South Asian immigrant adolescents expressed their need for more inclusive and relevant sexual health education, more support from parents and teachers with adequate and evidence-based SRH information and effective communication strategies to enhance communication with adolescents, and more youth-driven integrated health promotion programs to allow them to make informed choices. Their voices and perspectives are useful in informing inclusive and youth-centered sexual health education at home, in school, and in the community.

The Effectiveness of the Integrated Health Promotion Program for the Elderly

The Effectiveness of the Integrated Health Promotion Program for the Elderly

Development and Effect of the Integrated Health Promotion Program for Cancer Survivors Living at Home

Purpose: This study aimed to develop an integrated health promotion program for cancer survivors residing in the community based on the shared care model, and evaluate its effectiveness. Methods: A quasi-experimental trial was conducted. The participants consisted of 35 cancer survivors with completed intensive cancer therapy at the cancer hospital. The intervention group (n=20) and the control group (n=15) were recruited from among a district home cancer patient registrations. The intervention group participated in an integrated health promotion program based on the MAPP (Mobilizing for Action through Planning and Partnership) development process. The program consisted of physical, psycho-social and body image units. The participants were assessed before the program, and immediately after the program. Data were collected between July 1 and September 2, 2018 using FACT-G quality of life (QOL), distress thermometer (DT), and resilience. The data were analyzed by performing a χ2 test, Fisher’s exact test, Mann-Whitney test, and ranked ANCOVA using SPSS. Results: The intervention group reported a higher QOL overall and significantly higher social/family well-being than the control group. Distress was significantly lower in intervention group than in the control group. Resilience had no significant difference between the two groups. Conclusion: These findings indicate that the integrated health promotion program base on the shared care model and MAPP development process could be effective intervention for improving social/family well-being and the QOL, and reducing distress of cancer survivors at home. Community health center nurses need to provide intervention to support self-care competency for cancer survivors’ comprehensive care with physical, psycho-social, and body image to help them adjust their life to a moderate risk group in the community.

Evaluation of an Integrated Health Promotion Program for a low-income urban population: Findings and lessons learned.

ObjectivesTo evaluate a multicomponent pilot program for low‐income individuals with, or at risk for, hypertension, diabetes, and/or overweight.DesignPre‐post evaluation including baseline and follow‐up assessments, satisfaction surveys, program utilization data, and focus groups.SampleThe evaluation included 138 participants. The majority were Latinx (88%), female (82%), born outside the United States (80%), and had not graduated from high school (52%). The most common health conditions were hypertension (59%), overweight or obesity (55%), high cholesterol (53%), and diabetes (34%).MeasurementsEngagement in program activities, health indicators (e.g., blood pressure), and behavior change. Qualitative data focused on perceptions of the program and its impacts.InterventionThe program offered a number of health promotion services, including consultation with a nurse and a community health worker (CHW), health and nutrition talks, subsidized farm shares, cooking classes, exercise classes, and home visits.ResultsThere were improvements in general health, blood pressure, and knowledge and behavior related to disease management and healthy eating.ConclusionsProgram success was attributed to the wide range of complementary program components. The staffing model was also a strength: the CHW/nurse collaboration combined clinical expertise with cultural, language, and community knowledge to create a program that was accessible and empowering.

Youth perspectives on sexual health education: Voices from the YEP study in Toronto

The Youth Engagement Project (YEP) is a community-based pilot study in Toronto, Canada that we developed to better understand perspectives about and experiences of sexual health education among socioeconomically marginalized, racialized, and LGBTQ youth. We investigated: 1) what sex-related messages these young people received as they grew up, 2) how those messages affected their perspectives and sexual behaviour, and 3) their recommendations for sexual health education that meets their needs. Engaging youth whose voices are often overlooked due to their low socioeconomic status and their racial, sexual, and religious identities, and using a place-based method, we recruited a total of 47 young people, aged 16–24, and divided them into six groups based on gender and residential neighbourhood. The data was collected through a demographic and sexual practice survey, followed by a series of two focus groups. We conducted thematic analysis, guided by a socio-ecological approach and paying particular attention to participants’ intrapersonal, interpersonal and environmental factors. Our results indicate that participants received inadequate and contradictory sexuality related information from multiple sources. These mixed messages contributed to confusion, misconceptions, distress, and sexual vulnerabilities. Youth expressed their need for more inclusive and relevant sexual health education starting from an early age, more support for parents and teachers to help them talk with children and youth about sexuality, and more youth-driven integrated health promotion programs to allow them to make informed choices. Their voices and perspectives are useful in informing inclusive and youth-centred sexual health education at home, in school and in the community.

Elucidating knowledge and beliefs about obesity and eating disorders among key stakeholders: paving the way for an integrated approach to health promotion

BackgroundUnderstanding the knowledge and beliefs of key stakeholders is crucial in developing effective public health interventions. Knowledge and beliefs about obesity and eating disorders (EDs) have rarely been considered, despite increasing awareness of the need for integrated health promotion programs. We investigated key aspects of knowledge and beliefs about obesity and EDs among key stakeholders in Australia.MethodsUsing a semi-structured question guide, eight focus groups and seven individual interviews were conducted with 62 participants including health professionals, personal trainers, teachers and consumer group representatives. An inductive thematic approach was used for data analysis.ResultsThe findings suggest that, relative to obesity, EDs are poorly understood among teachers, personal trainers, and certain health professionals. Areas of commonality and distinction between the two conditions were identified. Integrated health promotion efforts that focus on shared risk (e.g., low self-esteem, body dissatisfaction) and protective (e.g., healthy eating, regular exercise) factors were supported. Suggested target groups for such efforts included young children, adolescents and parents.ConclusionsThe findings indicate areas where the EDs and obesity fields have common ground and can work together in developing integrated health promotion programs.

Participation in the Gyeongsangbuk-do Health Saemaeul Program and Health Behavior Improvement Effect

Objectives The purpose of this study was to determine association between participation degree and any changes in health behaviors in the Gyeongsangbuk-do Health Saemaeul Program, a community-based health promotion project. Methods The study used surveys of the Gyeongsangbuk-do Health Saemaeul Program, in 2016, 2018 and data from KOSIS. Results The multi-level linear regression analysis was completed with a total health behavior improvement score based on the six types of health behavior changes. People with temporal participation showed a higher total health behavior improvement score than the non-participants. Females showed a higher total health behavior improvement score than males and people with any chronic diseases showed a higher total health behavior improvement score than those without. None of the community-related variables showed any statistical significances. The results of the stratified analysis according to individual and community-related variables revealed that a group with the following community-related characteristics were more likely to have a higher total health behavior improvement score according to the participation degree; (1) a higher proportion of vulnerable subjects, (2) a higher financial self-reliance, and (3) a higher participation degree with willingness. No statistical significance was revealed with the individual characteristics. Conclusions In order to enhance health status of its residents in a community-level, designing an integrated health promotion program in considering the community characteristics would be more effective. In order to improve the quality of the Gyeongsangbuk-do Saemaeul Health Program and to expand its effects, an establishment of strategic plans is required at the level of selecting the target community. Key words: Participation of resident, Health behaviors, Health village, Health Saemaeul Program

Testing of a dental student-administered multidisciplinary health promotion program.

Background:A multidisciplinary approach involving healthcare students for health promotion has been recommended. With this view, the primary phase of the integrated health promotion program (IHPP) was designed and pilot tested.Methods:A pre-post-intervention study was conducted among 55 housewives of two self-help groups in India. The intervention consisted of a motivational interview, interactive session with a nutritionist, group discussion, personal hygiene training, and an illustrative reinforcement leaflet. Interventions were provided by trained dental students. The evaluation was based on outcomes from six tools specifically tailored for the program. These were the health self-regulation self-efficacy scale (HSSS), visual analogue scale (VAS) for self-health perception, oral health knowledge and attitude questionnaire, motivational interview, group discussion, and personal hygiene demonstration test.Results:Statistically significant change in mean pre- and postprogram scores in HSSS (P < 0.001), its two components, metacognitive component, action component, as well as VAS (P = 0.001) indicated a change in health-related perceptions in the participants. Mean oral health knowledge score (6.1), as well as attitude score (3.8), was fair. Most of the participants were able to demonstrate personal hygiene and tooth brushing correctly; take collective decisions about their health, plan changes in their diet, and resolve upon bringing about healthy changes in their lifestyle.Conclusion:The program evaluation indicated successful intervention and may be replicated in a larger population. Healthcare student population may be used in developing countries to bring about an attitude change in the underprivileged population through an IHPP.

Determinants of an integrated public health approach: the implementation process of Greenland\u2019s second public health program

BackgroundGreenland struggles with a high prevalence of smoking, alcohol and drug abuse. In response to the increasing need for preventive initiatives, the first public health program Inuuneritta was introduced in 2007. Internationally, frameworks focus primarily on the implementation of a single, well-described intervention or program. However, with the increasing need and emergence of more holistic, integrated approaches, a need for research investigating the process of policy implementation from launch to action arises. This paper aims to augment the empirical evidence on the implementation of integrated health promotion programs within a governmental setting using the case of Inuuneritta II. In this study, the constraining and enabling determinants of the implementation processes within and across levels and sectors were examined.MethodsQualitative methods with a transdisciplinary approach were applied. Data collection consisted of six phases with different qualitative methods applied to gain a comprehensive overview and understanding of Inuuneritta II’s implementation process. These methods included: observations and focus group discussions at the community health worker (CHW) conference, telephone interviews, document analysis, and a workshop on results dissemination.ResultsEnabling determinants influencing the implementation process of Inuuneritta II positively were high motivation among adopters, local prevention committees supporting community health workers, and the initiation of the central prevention committee. In contrast, constraining determinants were ambiguous program aims, high turnovers, siloed budgets and work environments, and an inconsistent and neglected central prevention committee.ConclusionInuuneritta II provided a substantial framework for an integrated health policy approach. However, having a holistic and comprehensive program enabling an integrated approach is not sufficient. Inuuneritta II’s integrated approach does not harmonise with the government’s inflexible organisational structure resulting in insufficient implementation.

The Impact of Health Promotion Program on Quality of Life to Overcome Elderly and Middle-aged Woman’s Crisis

이 연구는 보건소의 통합건강증진 프로그램이 노인과 중장년 여성의 삶의 질에 어떠한 영향을 미치는지를 살펴보고자 함이었다. 기존의 선행연구들과 달리, 이 연구에서는 보다 세분화 된 즉, 건강증진사업의 운영을 시설적 측면, 행정(운영)적 측면, 인력 측면, 프로그램 측면으로 구분하여 각 요인들이 건강증진사업 효과(신체적, 정신적, 대인관계적, 일상생활적)에 어떠한 영향을 미치는지를 구체적으로 살펴보고자 하였으며, 또한 건강증진사업의 효과가 삶의 질(신체적 활동 향상, 자기효능감상승, 자아존중감 상승, 전반적 삶의 질 향상)에 어떠한 영향을 미치는 지를 살펴보고자 하였다. 아울러, 통합건강증진사업을 실시함에 따라서 운영의 주체가 보건소와 민간기관으로 이원화되어 있기 때문에 공공기관과 민간기관에서 운영하는 건강증진프로그램이 삶의 질에 어떠한 차이가 있는지를 이 연구에서는 밝혀내고자 하였다. 이를 통하여 궁극적으로 농촌지역 건강증진 프로그램의 발전에 학문적 및 정책적 기초자료를 제공하고자 하였다. 결과적으로, 민간기관 이용자보다 보건소 프로그램 이용자들이 자아존중감, 신체적 활력, 삶의 질 만족을 더 높게 인식하고 있었다.The purpose of this study was to examine how integrated health promotion programs at public health centers affected the quality of life of elderly and middle-aged women in Jeungpyeong-gun in Korea. Unlike the existing studies, this study classified the operational aspects of health promotion programs into the four factors (facility, administration/operation, manpower and program), and analyzed how each of these factors influenced the outcomes of health promotion programs. In addition, this study explored the effects of health promotion programs on the quality of life and compared them between the public and private institutions. The eventual goal of this study was to provide the basic information which would be needed for the theoretical and practical development of health promotion programs in rural areas.

경로당 여성노인의 신체활동에 대한 영향요인

Purpose: The purpose of this study was to investigate physical activity of elderly women at senior citizen centers and to identify factors influencing physical activity. Methods: The study was conducted from February 22 to April 20, 2013 for 200 elderly women at senior citizen centers in J City. Levels of physical activity, cognitive function, and nutritional status were measured. Results: The total physical activity amount was <TEX>$2118.94{\pm}2.36$</TEX> MET-min. The average cognitive function score was <TEX>$21.17{\pm}4.63$</TEX>, and the average nutritional status score was <TEX>$24.04{\pm}3.37$</TEX>. There were significant relationships among physical activity, cognitive function, and nutritional status. In addition, there were significant differences of groups of physical activity by levels of cognitive function and nutritional status. Cognitive function, nutritional status, and age were significantly associated with level of physical activity in elderly women. Conclusion: The results showed many older women were doing moderate physical activity. Physical activity was associated with cognitive function and nutritive conditions. Integrated health promotion program needs to be implemented to increase physical activity level, the cognitive function, and nutritive conditions in elderly women.

대학생의 문제음주행동 및 고위험음주행동과 관련된 건강 특성

Objectives: Recently, there have been increases in the rates for binge and problem drinking among youth. This study analyzed the health characteristics associated with problem and high-risk drinking among Korean university students. Methods: A health interview survey was conducted in November 2011 with 700 Korean university and college students located in seven metropolitan cities in the largest province (Gyeonggi-do). To examine the factors related to drinking behavior, the survey assessed health problems in the last year, health risk factors, and the intention to participate in drinking prevention programs. Multiple logistic regression analysis of the survey data identified differences in drinking behavior. Results: The majority (58.1%) of university students were identified as problem drinkers and 16.6% were classified as high-risk drinkers. A gender difference in drinking behavior was found. Multiple logistic regression models indicated significant differences by sex, academic year, experience of drinking problems in the last year, current smoking, secondary smoking exposure, skipping breakfast, and intention to participate in drinking prevention programs (p < 0.01, p < 0.05). Conclusion: Future efforts should focus on the association between problem drinking and health risk factors among university students. To achieve this, the provision of an integrated health promotion program for reducing drinking problems in university campus is necessary.

우리나라 대학생의 흡연행동과 환경요인, 건강생활실천 간의 관련성

Objectives: This study performed to analyze general characteristics, environmental factors, and health promoting lifestyle by smoking behavior among university students. Methods: In 2011, interview survey was conducted with 700 Korean students of university and college in located 7 metropolitan cities and the biggest province (Gyeonggido). To examine the factors related to smoking behavior, it collected environmental factors, health promoting lifestyle, and mental health. Multiple logistic regression analysis for survey data identified the difference of smoking behavior. Results: The 20.4% of university students was current smoker. Smoking rate of male was higher than that of female. The university students residing in Seoul and surrounding areas were less likely to have smoking behavior than them residing in local areas. In multiple regression models, difference by gender, academic year, college level, college type, region, secondary smoking exposure time, health status, monthly drinking, alcohol use disorder, and eating breakfast remained significantly (p<0.01, p<0.05). Conclusion: Future efforts should be focused on association between health risk factors and environment factors in physical, mental, and social aspects. To achieve this, we will need to provide the integrated health promotion program to decrease smoking problems of university students.

Community Oral Health Promotion

JKAOH is available at http://www.jkaoh.org pISSN 1225-388X / eISSN 2093-7784 According to the 2012 National Oral Health Status Survey, the decayed-missing-filled-teeth (DMFT) index was 1.84, which confirms the constant decreasing trend in dental caries over the past 10 years. This improvement in the national oral health status may be attributed to the socioeconomic development of our country, technological advances in dentistry, various effective oral health promotion programs, and increase in awareness of and interest in oral health care among people. Of these factors, oral health programs, which play a key role for community oral health promotion, have been expanding their services through various activities such as community oral health status surveys, problem identification, and project goal setting, implementation, and evaluation. For continuous progress of these oral health programs, it is important to focus on community oral health promotion, accurately identify problems by analyzing the community-wide oral health status, and evaluate the effects of the programs already carried out by systematically analyzing their outcomes. In this regard, a paradigm shift has recently occurred from the sector-dependent separate community health programs to the inter-sector joint operation of integrated health promotion programs. As a result, an increasingly large number of beneficiaries of oral health projects are profiting simultaneously from nutritional health projects or exercise interventions, thereby increasing the number of factors influencing community oral health promotion. However, there is a lack of research examining such integrated community oral health programs or evaluating the impact of the associated changes. For community oral health promotion, it is necessary to continuously support integrated oral health programs by analyzing their results, evaluating their effects, conducting opinions polls among the local program participants and professional staff, and incorporating the results of these polls in future programs. Such continuous support and research efforts toward various community-based oral health programs will contribute to the continuous improvement of oral health index.

공공부문 보건의료조직의 만성질환 예방사업에서 요구하는 필요능력과 보건교육사의 직무 강화 방안

Objectives: This study performed to enhance the competency of health education specialist on population-based program to prevent chronic disease in public health organizations. In addition, it will provide the basic data to enhance specialized competency for health education specialist. Method: The current operating strategy and demanded competency related to chronic disease programs were analyzed by reviewing the Korean Health Plan 2020, the guideline of integrated health promotion programs, and the job description of health education specialist. Results: Preventive programs for chronic disease provide with healthy lifestyle programs in integrated health promotion service. First, health education specialist should learn to professional knowledge on health risk factor and chronic disease. Second, they should cultivate the integrated competency to manage operations on obesity, hypertension, diabetes, cardiovascular disease, and cancer prevention programs. Third, they get strengthened the-job training to implement health education, public relations, campaigns, media advocacy, and utilization of multi-media. Conclusion: It should implement the preventive programs for chronic disease in various health promotion services through coordination with multiple sectors. To identify of the job in preventive program for that, it would be required empowerment of health education specialists on disease prevention science and practical life skill.

우리나라 성인의 건강행태군집 유형과 관련요인

Abstract This study sought to identify types of health behavior clusters among Korean adults and their related factors. A secondary analysis of 1,441 subjects, aged 19 to 64, in the 2009 Korean National Health and Nutrition Examination Survey (KNHANES IV-3) was conducted. A cluster analysis was used to identify types of clusters related to physical activity, smoking, and alcohol drinking. A complex samples chi square test and multivariate logistic regression were performed to analyze the associations between types of health behavior clusters and sample’s characteristics using SPSS WIN 21. Five clusters were identified: health promotion, smoking, alcohol drinking, passive attitude, and risky behavior. The passive attitude cluster had the most subjects, with 47.7% of subjects as members. Socio-demographic factors, hypertension, and depressive symptoms were associated with membership in the alcohol drinking, smoking, passive attitude, or risky behavior cluster rather than the health promotion cluster. The findings of this study suggest that integrated health promotion programs incorporating multiple strategies need to be investigated. In addition, further studies should explore psychosocial factors that affect health behavior clusters, such as stress, self-efficacy, social support, and social networks.