Macro-level Factors Research Articles

Health inequalities among people experiencing food insecurity. An intersectional approach.

The study examines the socioeconomic determinants of physical health among populations experiencing food insecurity and receiving free meals in soup kitchens in the Prefecture of Attica, Greece. Data were collected from the same six soup kitchens in 2012, 2017 and 2021, resulting in a dataset of 1533 observations. The study revealed that periods characterised by an economic recession are associated with deteriorated physical health of food-insecure people. Moreover, the study found that physical health deteriorations among food-insecure people are associated with older age, female gender, immigration status, disability and/or long-term health conditions, LGBT status, unemployment, economic inactivity, homelessness, living below the poverty threshold, long-term food dependency, illicit drug consumption and residing in lower- and middle-class areas. The study proposes the Intersectional Model of Health Inequalities, which integrates multiple factors involved in shaping the health inequalities of people experiencing food insecurity, from macro-level factors such as a country's economic performance to individual-level factors like education, employment status and demographic characteristics. The model emphasises that low-income populations should not be treated as a homogeneous entity. Its goal is to inform policymakers about the diverse health inequalities experienced by people with low incomes.

ACCESS AND USAGE OF CARE AMONG OLDER MIGRANTS: CHALLENGES AND OPPORTUNITIES

Abstract Equitable access to care is critical to support healthy aging in underserved groups. Recent global demographic trends such as the rapid aging of the population in developing and developed countries, the growing proportion of migrants from the Global South to the Global North over the past 50 years, and increasing health inequalities between and within countries reflect a continued need to address the underlying pathways and causal mechanisms that determine access to and usage of care among migrants. This paper reviews the current state of knowledge on the micro-, meso-, and macro-level determinants that intersect and shape access to and usage of care services and programs among older migrants. It makes the case that foreign-born older adults are more likely to experience challenges accessing services and programs due to cultural and language barriers and factors related to their socio-economic status, race/ethnicity, gender, and time since immigration. Next, the paper provides a deeper exploration of the interface of structure and agency and an interrogation of how access and usage of care among older migrants may be conditioned, not simply by individual socio-economic circumstances and life course events, but also by macro-level factors like the distribution of power relationships and neoliberal public policies. The paper concludes with a call for sustained efforts to acquire a more profound understanding of individual-level, socio-economic and socio-political forces that influence access and usage of care. Finally, it provides directions for future research with the ultimate goal of supporting healthy aging among older migrants.

DISPARITIES IN LONELINESS AMONG OLDER ADULTS IN THE UK: AN EVIDENCE OVERVIEW AND CRITICAL EVALUATION

Abstract We propose that there are three elements to healthy ageing: physical, mental and social. As a concept social health is less well researched although there is a significant literature on specific aspects of this concept such as loneliness or isolation. Researchers in the USA and Europe focussing on inequality in later life health outcomes have predominantly emphasised inequalities in physical and/or mental health. It is only comparatively recently that attention has been given to addressing disparities in aspects of social health because of the wide-spread stereotype that ‘all older adults’ are lonely and isolated. UK studies consistently demonstrate that specific individual characteristics such as gender, marital status, household composition, physical/mental health, ethnicity and socio-economic status are associated with higher risk of loneliness. Interventions for loneliness are rarely effective. We critique this evidence base on three grounds. First analysis of loneliness disparities focuses on individual characteristics rather than considering an intersectional approach that addresses the complexity and multiplicity of characteristics and identities that each of us embody and how these are associated with loneliness and other social health outcomes. Second research evidence is predominantly cross-sectional with some longitudinal studies. We argue that to fully understand loneliness and other late life social health disparities we need to adopt a lifecourse approach. Thirdly analysis of disparities in loneliness emphasises individual characteristics rather than adopting an ecological perspective which incorporates these, the effects of time as well as macro-level factors such as cultural norms and meso neighbourhood type, urban design and community cohesion.

“WE DON’T AGE ALONE; WE AGE AS A COMMUNITY”: BARRIERS AND ENABLERS OF AGING WELL IN BLACK/AFRICAN AMERICAN OLDER ADULTS

Abstract Eurocentric understandings of successful aging privilege optimal physical and cognitive health, absence of disease and disability, and active social engagement in later life. This marginalizes the experiences of diverse older adults who may live with chronic conditions but maintain a good quality of life, supported by factors such as spirituality, resilience, and close familial ties. Further, this approach is myopic because it fails to capture social determinants of health (SDOH) that influence the aging process over time. The Perceptions of Aging Well in Diverse Older Adults study is a 5-year series that seeks to identify: 1) micro-, meso- and macro-level factors that shape aging well in racial/ethnic minority older adults, and 2) strategies to support aging well in racial/ethnic minority older adults. This presentation highlights preliminary findings from a sub-study with Black/African American participants. In-depth, semi-structured interviews were conducted with 23 community-dwelling Black/African American adults age 50+ (14 females, 9 males; mean age = 71.2 years). Thematic analysis of the interview data showed that neighborhood safety, food insecurity, pharmacy deserts, adverse childhood experiences, structural racism, and everyday micro-aggressions shaped perceptions of aging well in powerful ways. Strong kinship bonds and a desire to leave a legacy of resilience and empowerment for younger generations motivated participants to engage in prosocial activities such as volunteering in local church communities. These findings suggest that along with addressing key SDOH, fostering generativity through teaching and mentoring, creative arts, and taking on community leadership roles may enhance subjective well-being in Black/African American older adults.

The Rubik's cube of doing and being: Factors influencing professional identity transition to the medical registrar.

Professional identity transitions, such as the transition to medical registrar, are challenging. How minoritised identities influence transitions during medical training requires further study. This study aimed to explore the factors influencing the transition to the medical registrar in Scotland to guide support during training. Interviews exploring this transition with internal medicine trainees were audio recorded, transcribed verbatim and double-coded using template analysis. We applied an initial coding template informed by multiple and multidimensional transition theory of individual, interpersonal, systemic and macro-level factors. Using a critical theory lens, a further template analysis specifically sought to understand how trainees' social identities interacted with the various levels. Nineteen IM trainees were interviewed between January 2021 and February 2022. Influential factors reflected a parallel process of competence (doing) and identity (being) development. The interaction of social identities, such as gender (being a woman) and country of origin (being an international medical graduate), occurred across levels. This can be conceptualised as a Rubik's cube with the interplay between doing and being from an individual to a macro level with trainees' social identities interacting at all levels. The transition to the medical registrar is multifaceted; with a challenging balance between support and independence in providing opportunities to perform (doing) whilst identity develops (being). Identity transitions involve multiple Rubik's-cube-like rotations between the facets of 'doing' and 'being,' until these align. Taking heed of influential factors and the interaction of minoritised social identities could guide a trainee-centred and smoother transition.

Features of the value-motivational component of creative industry employees' psychological readiness for career making

Introduction. The effectiveness and productivity of modern organizations in the field of creative industries, depends on their employees, in particular, employees' psychological readiness to overcome the challenges faced by organizations, as well as to develop professionally and build a career. This involves studying the level of development of the main components of employees' psychological readiness for career making, among which the value-motivational component occupies a prominent place. Aim. To find out empirically the features of the value-motivational component of the employees' psychological readiness for career making of workers in the sphere of creative industries. Methods. The data were collected and processed using various diagnostic tools and a questionnaire-passport in the form of Google Forms. Results. The authors describe the essence of the value-motivational component of the psychological readiness for career making in creative industries, analyze the levels of development of its components (career values and career motivation) and the relationship between the value-motivational component and its general indicator and its micro-level (characteristics of employees), meso-level (characteristics of the organization) and macro-level (characteristics of society) factors. Conclusions. The findings reflect the peculiarities of the development of the value-motivational component of employees' psychological readiness for career making in creative industries, in particular, in war conditions, which will be useful in career management, both for the employees themselves and for management staff.

Do countries’ freedom status and gender equality level inform gender differences in bribery? Evidence from a multi-country level analysis

Given the continuing debate on whether women are less corrupt than men, this study investigates the socio-political context in which men and women give bribes based on the seventh round of the Afrobarometer multi-country data set. We also seek to understand how a country’s freedom status and gender equality level inform the extent to which women and men are likely to be involved in corruption. In doing so, the study focuses on the influence of gender status, the number of female legislators, gender equality, and political freedom on bribe-giving among men and women. Research results indicate that (1) women in Africa are less likely to pay bribes than men, controlling both macro-level and micro-level factors, (2) women are less likely than men to give bribes in countries with high gender equality, and (3) the tendency for women to give bribes is the lowest in politically free countries. However, the inclination of women’s bribery reached the highest level among countries with partial political freedom. This study extends the theoretical and empirical understanding of the context within which women are more or less likely to give bribes, especially in the global South.

A Critical Review of Social Exclusion and Inclusion among Immigrant and Refugee Women

International and global migration has risen over the last 50 years, and this trend is not expected to change. Immigrants and refugees make sociocultural and economic contributions to settlement states; however, this does not always mean that they feel included or welcomed. Social exclusion as a determinant of health reflects the social inequalities of some groups in a population over others. Immigrants and refugees are excluded from participating in social, economic, civic, and political domains within Western settlement countries; women experience greater social exclusion because of intersecting social identities and the interplay between sociostructural systems that create inequalities within host societies. To explore this phenomenon more fully, we conducted a critical review of how social exclusion and inclusion are experienced by women settling in Western contexts and the factors that impact daily life and health. Intersectionality was the lens with which we situated, examined, and analyzed the findings of the critical review to inform the development of a conceptual model. A five-stage process was used to comprehensively review the literature using six databases. Sixty papers were included in the review. The conceptual model highlighted two overarching themes that were further distinguished by micro-, meso-, and macro-level factors of exclusion and inclusion. The first theme considers the causes and outcomes of social exclusion represented as social determinants in the context of settlement and includes social environment, social supports, language ability, discrimination and racism, settlement and identity, income and employment, education and professional credentials, institutions, and government services. The second theme of social inclusionary processes consisted of social capital, social and civic participation, empowerment, and policies and settlement programs. The conceptual model advances knowledge of potential improvements required in formal settlement programs and the importance of informal programs that collectively may enhance inclusion for immigrant/refugee women and their families in Western contexts.

Life Satisfaction of Immigrants and Length of Stay in the New Country

A large amount of research is dedicated to the measurement of immigration trends and integration processes, but comparative studies of the components of immigrants’ well-being are rare. This paper investigates the link between the length of stay and the subjective well-being (SWB) of immigrants. A step-by-step regression method is used to understand interactions between different individual- and macro-level factors in the life satisfaction of immigrants. The results of the European Social Survey (ESS) show that the effect of length of stay on SWB is mitigated by numerous individual- and country-level variables. After all background variables are considered, newly arrived immigrants and those who have been in the new country for more than 20 years had a similar life satisfaction to that of the local-born population. Immigrants with 10 to 20 years’ experience in the country seem to have lower life satisfaction than the local-born population. The SWB of different immigrant groups is shaped by cultural background, economic coping, number of social contacts, perception of discrimination, and democracy. These factors influence the life satisfaction of migrants with different lengths of stay differently. The most vulnerable immigrant groups in Europe are those from Africa region.

The impacts of economic policy uncertainty on firm cash holding in China.

Cash holding is an important strategic decision of enterprises. As a macro-level factor, economic policy uncertainty causes risks, affecting enterprises' cash holdings. Taking the quarterly financial data of China's A-share non-financial listed firms for 2010-2020 as a sample, this study adopts the OLS and fixed effect models to investigate how corporate cash holdings are affected by economic policy uncertainty. The findings indicate that economic policy uncertainty is directly proportional to the level of cash that listed corporations hold. The higher the uncertainty, the more cash the company holds. Among them, state-owned enterprises and the manufacturing industry are more significantly affected by economic policy uncertainty. Finally, considering the regional marketization level and the differences in financing constraints enterprises face, it is concluded through grouping empirical studies that enterprises located in regions with lower marketization levels are more susceptible to policy uncertainty, while financially constrained enterprises are more susceptible to economic policy uncertainty. The study of economic policy uncertainty is helpful to guide enterprises to realize the importance of coping strategies in advance under the background of intensifying economic policy uncertainty. Therefore, this paper proposes to introduce policies on the premise of fully considering the smoothness of the economy and the differences in the conditions of firms of different natures, as well as some proposals to alleviate financing constraints, reduce the adverse effects of uncertainty on firms, and bolster the marketization process.

Shaping citizenship: Dynamic relations between the reified and the consensual universes in defining the “good foreign resident”

A social and political psychology of citizenship can be furthered by the analysis of the values and representations through which citizenship is constructed in the text of laws and reconstructed during implementation and how these (re)constructions best serve some groups. This article views laws as facts from the reified/institutional universe whose texts operate a simplification process by prioritizing certain values from the plurality existent in the consensual universe and sees institutions in charge of law implementation as mediating systems operating re-complexification processes. Using this perspective, it (1) explores how the values and social representations prioritized in Portuguese foreign residency laws exclude/include certain groups and define rights and duties of “the good foreign resident/citizen”; (2) illustrates with interviews with experts from a mediating system (n = 6) the re-complexification of the laws in implementation. It highlights how the “worthiness” of foreign residents in Portugal depends upon three central values (work, study, and investment) keeping, however, some ambiguity of these values in the legal texts. Interviews illustrate how mediating systems re-signify the laws, amplifying the ambiguities by resorting to other values and representations. We discuss how the analysis of the dynamic relation between the reified and the consensual universes contributes to a better understanding of how macro-level factors interact with everyday citizenship.

Economic disadvantage and depressive symptoms among Arab and Jewish women in Israel: the role of social support and formal services

ABSTRACT Objectives Depression is a major public health concern due to its high prevalence and association with functioning. Ethnic minorities in Western countries are more likely to experience economic disadvantage and exposure to stressors that may put them at higher risk of developing depression. One major protective factor associated with reduced depressive symptoms is an existing support network. This study examined the associations between economic disadvantage, formal and informal social support, and depressive symptoms among two ethnicity groups in Israel: Arab and Jewish mothers of young children, as well as the potential mediating role of formal and informal social support in the associations between economic disadvantage and depressive symptoms. Design We recruited a representative sample of 837 Jewish and Arab mothers of children aged 2–6 years. We collected data via structured face-to-face interviews following approval of the university ethic committee. We used the Center for Epidemiologic Studies Depression Scale (CES-D), the Medical Outcomes Study (MOS) scale to measure maternal perceived social support, and a measure designed for this study to quantify formal social support. Results Compared to the Jewish mothers, Arab mothers reported more depressive symptoms, greater economic disadvantage, and fewer informal and formal support networks. Economic disadvantage was negatively associated with informal support but positively associated with formal support among both Jewish and Arab mothers. Results further revealed that informal and formal social support mediated the associations between economic disadvantage and symptoms of depression. Conclusions More attention should be paid to the associations between social determinants and mothers’ mental health, with a possible shift of focus to macro-level factors, such as economic inequality and minority status.

Moderating effect of country-level health determinants on the association between hobby engagement and mental health: cross-cohort multi-level models, meta-analyses, and meta-regressions

BackgroundTheories from anthropology, evolutionary psychology, and sociology have focused on the potential adaptive benefits of hobby engagement for mental health in older adults. However, previous studies have used data from single countries, potentially biased by specific measurement and methodological approaches, cohort effects, or cultural specificities. Whether there are genuine benefits for mental health in older adults cross-culturally remains unknown. This study explored the consistency of this association across 16 different nations. MethodsFor this epidemiological study, we used data from adults aged 65 years or older across 16 countries in the USA, Europe, and Asia, represented in five longitudinal studies (ELSA, JAGES, HRS, SHARE and CHARLS; N=93 263, 45–62% female, mean age 72–76 years, data collected 2008–20). We harmonised measures of self-reported engagement in hobbies and past-times, depressive symptoms (validated scales), and Likert scale responses for self-reported health, happiness, and life satisfaction. We conducted fixed-effects models and longitudinal regression models of hobbies and mental health for each country and then pooled in multinational meta-analyses. We accounted for all time-constant factors including those unobserved (eg, genetics, past leisure behaviour, medical history, psychological traits) and identified time-varying factors (eg, sociodemographic background, clinical conditions, daily functioning). We tested the potential moderating effects of country-level determinants of health in meta-regressions and multilevel models. FindingsMeta-analytic fixed-effects findings showed that having a hobby was associated with fewer depressive symptoms (pooled coefficient –0·10, 95% CI –0·13 to –0·07, I2=69·5%, H2=3·28), and higher levels of self-reported health (0·06, 0·03 to 0·08, I2=48·1%, H2=1·93), happiness (0·09, 0·06 to 0·13, I2=67·0%, H2=3·03), and life satisfaction (0·10, 0·08 to 0·12, I2=33·6%, H2=1·51). Results were consistent in meta-analyses of longitudinal regression models testing directionality of findings. Macro-level factors such as life expectancy, world happiness index, country wealth, and income inequality predicted prevalence of hobby engagement, but they showed only marginal moderating effects on the association between hobbies and mental health. InterpretationDespite some heterogeneity in measurement between the cohorts, the apparent universality of the health benefits of hobbies internationally suggests that facilitating greater opportunities for engagement across demographic groups and between countries could be an important part of multidisciplinary care. Findings have implications for social prescribing schemes (currently in trial in many countries) and multidisciplinary work on origins and human behavioural patterns of hobby engagement. FundingNational Endowment for the Arts, Wellcome Trust, Belgian Nnational Scientific Fund (FNRS).

International students in China: regional distribution and macro-influencing factors

ABSTRACT As a key player in intellectual migration, international students are affected by various micro-, meso- and macro-level factors when making their study destination choice. Existing literature on this topic mostly adopts a qualitative approach and limits to investigations of country choice. By applying exploratory spatial data analysis and spatial econometric modelling on a set of panel data, this study instead focuses on macro-level analyses of international students’ regional destination choice in China. First, we found that the spatial distribution of international students in China have changed over the course of our 1999–2018 study period. International students primarily concentrate in and/or around economic hubs or intellectual gateways although increase in semi-intellectual gateways are also observed. Second, international students in China has spatial effects and their study area choice is significantly affected by the number of international students studying there in the past, the quality of higher education, the availability of public infrastructure, touristic attractiveness, and the presence of policy incentives. These factors exercise greater influence on degree-seeking than non-degree-seeking students. Together, they represent persistence effect, learning and living environment effect, and spatial diffusion effect.

Psychosocial functioning in individuals with advanced oesophago-gastric cancer: a mixed methods systematic review

BackgroundOesophago-gastric cancer is an aggressive disease with a high rate of recurrence and mortality across the disease trajectory. Reduced psychosocial functioning has been evidenced amongst those with advanced disease, however little is known about the contributing factors. Determining these factors is an important clinical consideration to inform assessment and intervention. This review aimed to synthesise the available evidence on the psychosocial functioning of individuals with advanced oesophago-gastric cancer and their carers.MethodsA JBI mixed-methods systematic review. Four bibliographic databases, MEDLINE, Embase, PsycINFO, and CINAHL, were searched. Quantitative and qualitative studies were screened for inclusion and critically appraised for methodological quality. Both types of data were extracted using JBI tools for mixed-methods systematic reviews. A convergent segregated approach to synthesis and integration was used. The findings of the synthesis have been configured according to JBI methodology.ResultsA total of 12 studies were included in this review, including 6 quantitative studies and 6 qualitative studies. The quantitative results provide preliminary indication of several physical, biological, psychological and macro-level contextual factors associated with psychosocial functioning in this clinical population. The qualitative findings shed light on a range of physical, psychosocial, and existential challenges faced by advanced oesophago-gastric cancer patients. These multiple and often persistent challenges appear to cause considerable distress; however, patients describe the importance of maintaining a sense of normality and control over their illness and its effects. Patients value continuity and structure, however many report shortcomings when accessing care. No findings reporting the experiences from the perspective of carers were found, therefore all findings represent the perspective of the patient.ConclusionsFurther high-quality research is needed to understand how best to support and manage the palliative care needs of individuals living with advanced oesophago-gastric cancer. Implications for practice are discussed, suggesting that psychosocial interventions, complex symptom management and continuity of care could improve the psychosocial functioning of individuals in this setting.Pre-registrationThe systematic review was pre-registered at the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020181273) and the protocol can be viewed on the OSF (http://osf.io/exuzf).

Constraints on the Labour Market Trajectory of Youth and Growth of NEET in India

This paper explores the trends, composition, and determinants of the rising ‘Not in Employment, Education and Training (NEET)’ population in India. Based on the national level employment-unemployment surveys and macro level panel data, and using instrumental variable (IV) Probit and system generalized method of moments (GMM) regression models, it is explored that a set of supply and demand side factors determining the growth of NEET population in India. At the micro level, the individual’s level of general education, technical and vocational training, gender, occupation and gender of head of the family, religion, standard of living of the family, earnings of the spouse, and a set of complex socio-cultural factors determine the NEET status of educated and trained youth. On the other hand, the macro level factors, including the growth of mechanization in agriculture, stagnant real wages, sluggish non-farm sector output growth, infrastructural backwardness, and the existing social-cultural setup in which educated youth live together create a negative macro level environment that compels them to remain out of the workforce for a longer period even after completion of their education/training. Based on these results, it is argued that policies aiming at the development of infrastructure along with the promotion of industry and modern service sectors should be given the top priority for checking the upsurge in the NEET population in India.

Factors influencing engagement in advance care planning in the community: A mixed-research synthesis

Abstract Background The development of innovative Advance Care Planning (ACP) health behaviour change interventions for adults (≥50 years old) in the community should be informed by a findings synthesis. The objectives of this review were to (a) identify stakeholders' perspectives on facilitators and barriers to ACP behaviours and (b) map these factors across the Capability, Opportunity, and Motivation dimensions of behaviour (COM-B model). Methods This hybrid mixed-research synthesis followed a published protocol. Content analysis was applied to the results sections of the included studies. Data transformation and triangulation processes underpinned findings integration (4,5). Results The review included 117 records and studies recruited patients (62%), service providers (29%), and trusted others (9%). ACP behaviours were ACP as a general concept, (41%), communication (28.7%), documentation (22%), decision-making (5.3%), or surrogate appointment (3%). Ten categories of influencing factors were identified, ranked according to frequency of reporting. They included Connectedness, Psychological Factors, Metapreferences, Service Provision, Temporality, Sociodemographic Characteristics, Literacy, Resources, Experience, and Macro-Level Factors. Their sub-categories (52 in total) were mapped across the COM-B model. The most frequently reported Motivation sub-categories were Comfort and Readiness (n = 78), Actors and Roles Requirements (n = 56), and Perceptions and Beliefs (n = 45). The Opportunity dimension included Communication and Understanding (n = 43), Effect of the Other (n = 42), and Involvement and Collaboration (n = 41). The top Capability sub-category was ACP literacy (n = 43). Discussion The triangulation of stakeholders' perspectives facilitated identification a complex array of factors influencing ACP behaviours. Their mapping across the COM-B model informed future research, policy, and ACP intervention development. Key messages • Stakeholders’ engagement in ACP behaviours is influenced by a complex array of factors, with the majority of them falling into the categories of motivation and opportunity. • Future ACP interventions design need to build on this learning and develop strategies and policies that support meaningful stakeholders’ engagement in ACP activities, including their collaboration.

Factors that influence the uptake and delivery of HPV vaccines in migrants: a systematic review

Abstract Background Migrants are known to be an under-immunised group for many routine vaccinations. We did a global systematic review to explore and assess factors that influence uptake of vaccines for human papillomavirus (HPV) infection, using the WHO-endorsed Behavioural and Social Driver of Vaccination Framework (BeSD). Methods Using PRISMA guidelines, 3,075 records were found from 7 databases (2006-2023), with no exclusions based on country or language. After title/abstract screening and full-text review, data were extracted for thematic analysis using BeSD (4 domains for vaccine behavioural change) and qualitative synthesis. Results We included 104 studies from 16 countries: two thirds from the US, 25% from Europe, and only 2% from LMICs. The majority focused on vaccine eligibility and/or parents; 10% looked at providers’ views; 2% involved wider stakeholders, and most research focused on females. Migrant sub-groups reported diverse views and experiences about HPV vaccines. Many examined vaccine initiation and identified low awareness/knowledge of HPV/HPV vaccine. “What people think/feel” domain: barriers such as concerns on vaccine safety, cultural belief, lack of information, vaccine unnecessary; mixed view on vaccine benefit. “Social process”: doctor recommendation and information via providers/peers was influential but depended on framing and migrant characteristics. “Motivation” domain was understudied. “Practical issues” that impact uptake included cost, mobility, accessibility, and language. Conclusions Culturally sensitive education to address misconception and enhance importance of HPV vaccines were considered important, alaongside practical efforts to address mobility (mHealth), proactive vaccine behaviour and strong provider recommendation. A comprehensive strategy along the BeSD pathway, using a multipronged approach, would be valuable, and may be further enhanced by exploring wider macro-level factors. Key messages • Special efforts will be needed to engage mobile groups in HPV vaccination, with further research needed in LMICs. • Culturally sensitive education to address misconception and enhance importance of HPV vaccines were considered important.

Reproductive Interconception Care Among Women Recently Pregnant and Homeless: A Qualitative Analysis.

Reproductive interconception care provided at maternal postpartum visits may help reduce unintended pregnancies and elongate birth intervals for women experiencing homelessness. To improve interconception care uptake, this qualitative study aimed to identify barriers and facilitators to reproductive interconception care from the perspectives of women who were recently pregnant and homeless. A semi-structured interview guide and demographic survey were developed based on epidemiological findings, Information-Motivation-Behavioral Skill framework components, and a review by community health workers for content validity. After conducting 12 interviews with women recently pregnant and homeless in a local continuum of care in 2022, audio-recorded interviews were transcribed, iteratively coded using a priori and emerging codes, and thematically analyzed. Key themes were identified to determine implications and next steps to improving reproductive interconception care uptake. Interrelated themes focused on information (e.g., knowledge and misconceptions about pregnancy, birth intervals, contraception), motivation (e.g., attitudes about interconception care experiences, perinatal social influences), behavioral skills (e.g., objective ability to obtain interconception care and perceived self-efficacy related to attending maternal postpartum visits and increasing birth intervals), and macro-level factors (e.g., obtaining housing, contextualizing socioeconomic factors, navigating COVID-19). The findings suggest the need for flexible, streamlined, and personalized interconception care delivery that acknowledges pressing housing and relationship considerations and supports women's autonomy. Improvements to reproductive interconception care may reduce future unintended pregnancies, increase birth intervals, and improve birth outcomes among women experiencing homelessness.

Fertility transition of Han and ethnic minorities in China: A tale of convergence and variation

China's large and diverse population exhibits interethnic variations in fertility, socioeconomic status, and culture. This study comprehensively analyzes data from multiple population censuses and qualitative interviews to identify fertility transition dynamics among ethnic groups in China. Taken together, the quantitative and qualitative results reveal a rapid decline in total fertility rates among both Han and ethnic minorities and a trend of convergence across different ethnic groups over the past few decades; in addition, the findings also show significant heterogeneity within ethnic minority populations. Our analysis sheds further light on the crucial role of social context and macro-level factors in shaping individuals’ reproductive behaviors. The results offer insights into how policies may address low fertility rates in China.