Socio-ecological Model Research Articles

Using the socioecological model to explore factors associated with obesity among reproductive age women

IntroductionWomen of reproductive age (18–44 years) are at an increased risk of developing obesity due to pregnancy, life-transitions, and marginalization. Obesity in women negatively affects women’s health and pregnancy outcomes and can increase risk their children will develop obesity. Less is known about obesity risk at the interpersonal and environmental levels for women of reproductive age. This study uses the socioecological model to explore women’s obesity risk across ecological levels.Materials and methodsA secondary cross-sectional analysis was conducted using baseline data (March 2019–June 2022) from the cluster-randomized Healthy Eating and Active Living Taught at Home (HEALTH) Dissemination and Implementation study. Descriptive statistics and multivariate logistic regression models were used to determine associations between individual, interpersonal, and environmental level factors with weight status (overweight vs. obesity).ResultsAmong 221 participants (43% Hispanic/Latino, 51% High school or less), 37% were overweight and 63% had obesity. Interpersonal and environmental factors were not statistically significantly associated with obesity relative to overweight in bivariate analyses. In multivariate models, individual level factors of high/moderate physical activity (OR = 0.47, 95% CI: 0.26,0.84, p = 0.01) and food insecurity (OR = 2.51, 95% CI: 1.33,4.71, p = 0.00) were statistically significantly related to risk of having obesity compared to being overweight.DiscussionPhysical activity and food insecurity were associated with obesity in this study. Associations with interpersonal and environmental level factors were not statistically significant, which may be due to limited sample size or measures available to assess these levels. Future studies should investigate structural determinants (e.g., economic, neighborhood and physical environment), which may drive physical activity and food insecurity.

A socio-ecological model of the management of leprosy reactions in Indonesia and India using the experiences of affected individuals, family members and healthcare providers

BackgroundLeprosy reactions (LR) are immune-mediated complications of leprosy that may be associated with severe and irreversible nerve damage. Non-medical aspects, such as financing, service provision, and healthcare resources in the management of LR are generally overlooked as studies tend to concentrate on clinical features and treatment. Barriers to accessing care and services are a major cause of suboptimal care for people with leprosy. This study aims to explore the barriers to and facilitators of high-quality care and management of LR in two leprosy-endemic countries with different health care models – Indonesia and India – and identify areas for improvement.MethodsA socio-ecological model was adopted. Data were obtained from 66 interviews with individuals who experienced LR and were seeking care at the two study sites. In addition, immediate family members of individuals with LR and healthcare workers attending to people with leprosy participated in seven focus group discussions (FGDs).ResultsThis study highlights the significant impact of public health insurance regulations and uptake at the macrosystem level on the provision of healthcare services, clinical decision-making, care expenditure, and the psychological well-being of individuals with LR in Indonesia and India. Lack of specialized health professionals and communication challenges were identified in both study populations. Indonesian participants encounter additional challenges due to a fragmented information system and drug shortages. This study identifies key facilitators in providing high-quality care for LR-affected individuals, including financial assistance, availability of corticosteroid alternatives, timely provision of care, and counselling. It found that the high coverage of public health insurance cards in the Indonesian model has increased access to care among individuals affected by LR, despite the challenges. Conversely, the Indian model of care offers treatment subsidies. The advantage of the Indonesian model is its ability to provide wider access to high-quality care, whereas the Indian model focuses on those in most need. This study emphasizes the importance of addressing these challenges through improved communication strategies, education aimed at the affected individuals, and accessible medical care. Furthermore, variations in care-seeking behaviour and self-care practices were observed in both sites, underscoring the need for culturally sensitive and comprehensive approaches to the management of LR.ConclusionThe study findings demonstrate that the factors identified at the four systemic levels are interrelated and have an impact on the access, acceptability, and management of LR services. Despite its accessibility and wider coverage of public health insurance, the integrated service model in Indonesia faces challenges associated with complex regulations and the availability of medication. India’s care model offers intensive, specialised care but has difficulties in ensuring sufficient health personnel, resources, and public health insurance coverage. These findings highlight the need to address these challenges to ensure timely, effective, and comprehensive care for individuals with LR.

Socio-ecological Determinants of Detectable Viremia among Pregnant People Living with HIV in South Brazil: The Role of Stimulant Use Disorder and Homelessness.

Pregnant patients living with HIV are a priority group for the recruitment into the HIV healthcare cascade to prevent adverse maternal and neonatal health outcomes. Understanding the structural, interpersonal, and individual factors that are associated with detectable HIV viremia is of importance to guide outreach and intervention priorities. This was a retrospective cohort study of pregnant patients living with HIV who delivered from January 1, 2017, to December 31, 2023, at a tertiary-level hospital and referral institution for HIV care in Porto Alegre, Brazil. The socio-ecological model was used to guide hypothesis testing regarding associations with detectable viremia. In total, 549 patients were included, of whom 110 (20%) were found to have detectable viremia. Significant differences between detectable and undetectable viremia included prenatal care, homelessness, having a sero-different partner, and stimulant use. Multivariable associations included prenatal care (adjusted Risk Ratio [aRR] = 0.20, 95% Confidence Interval [95% CI] = 0.15-0.26), homelessness (aRR = 4.02, 95% CI = 2.74-0.26), stimulant use disorder (aRR = 3.30, 95% CI = 2.23-4.87), crack use (aRR = 2.82, 95% CI = 1.85-4.29), and cocaine use (aRR = 1.89, 95% CI = 1.17-3.06). Intervention research should focus on housing and mental health services, and how to mitigate their impact on HIV healthcare. Intervention research is greatly needed as current tools may not be sufficient to tackle the issue of stimulant use disorder and its effects on ART adherence.

COEPA ready: Innovative pedagogy for integrating social determinants of health in PharmD curricula.

The American Association of Colleges of Pharmacy Curriculum Outcomes and Entrustable Professional Activities (COEPA) recognize the need for social determinants of health (SDH) education for pharmacy learners. However, there is a dearth of published strategies for incorporating comprehensive SDH education in Doctor of Pharmacy curricula. The objectives of this study were to: 1) highlight unpublished exemplars of SDH teaching models and 2) propose strategies for teaching SDH. A survey was distributed to relevant AACP Special Interest Groups and Sections soliciting previously unpublished exemplars of SDH teaching models. The survey collected descriptions of the teaching model, relevant SDH domains as outlined in Healthy People 2030, and the level of influence on health outcomes according to the socioecological model. Deidentified survey submissions were analyzed and categorized by type (didactic, IPPE/APPE, or both), course type (elective or required), year taught, interprofessional education components (if applicable), innovation, assessment domains and tools, course structure, SDH domains, and the socioecological model. Eight programs submitted diverse exemplars of which six (75%) were part of required didactic courses for P1-P3 learners. Teaching models included individual lectures and activities, didactic and experiential courses, and implementation of longitudinal curricular experiences. Seven (87.5%) of the exemplars covered all five SDH domains, and seven (87.5%) covered all levels of influence within the socioecological model. Exemplars featured simulations (50%) and case-based learning activities (62.5%). Three (37.5%) featured interprofessional education and research components. These exemplars provide faculty with varied models for implementing SDH-related teaching opportunities within their institutions.

Exploring drivers and prevention strategies for sexual violence among adolescent girls and young women in Kicukiro, Rwanda

IntroductionSexual violence against adolescent girls and young women (AGYW) is a pervasive issue globally, with particularly high prevalence in sub-Saharan Africa. This study explores the drivers and prevention strategies for sexual violence among AGYW in Kicukiro, Rwanda.MethodsA descriptive exploratory design guided by the socioecological model and feminist standpoint theory was employed. In-depth interviews were conducted with 13 AGYW participating in a mentorship program and 5 male community members. Data was analyzed using thematic analysis to identify key drivers and potential prevention strategies.ResultsFour themes emerged: (1) empowering mentorship programs, (2) tiered drivers of sexual violence, (3) optimizing violence-mitigating resources, and (4) interference with judicial processes. Key drivers of sexual violence included substance use, transactional sexual relationships, inadequate family protection, entrenched gender stereotypes, and limited legal literacy.ConclusionFindings underscore the need for multifaceted interventions that address systemic and cultural barriers, strengthen legal frameworks, and expand community-based programs. Addressing sexual violence requires a holistic approach, integrating empowerment initiatives, robust community engagement, and legal reforms to create safer environments for AGYW. The mentorship program's success suggests scalability across other settings.

P-578. Just “Short of a Cure”: Unique Considerations in Uptake and Use of Long-Acting Injectable Cabotegravir/Rilpivirine Among Long-Term Survivors with HIV

Abstract Background Understanding perspectives of subgroups of people with HIV (PWH) who have accessed long-acting cabotegravir/rilpivirine (CAB/RPV-LA) is crucial for optimizing implementation; especially among long-term survivors (LTS) who have lived through the trauma of the early epidemic to the innovation of today. Methods We analyzed semi-structured interviews collected from 08/2022-05/2023 via a parent study at four Ryan White clinics in Atlanta, Chicago, and San Francisco among early adopters of CAB/RPV-LA (received ≥3 injections or discontinued). Our analysis explored factors impacting CAB/RPV-LA uptake and use in LTS (living with HIV since 2000 or earlier) using a socioecological model of HIV care engagement. Results Among 20 LTS, median age was 56 (Q1-Q3 54-60) years and median time living with HIV was 27 (Q1-Q3 25-34) years. Thirteen (65%) identified as racial/ethnic minorities and seven (35%) as cis or trans women. We identified three primary themes: 1) The majority of LTS eagerly awaited CAB/RPV-LA and seemed unconflicted in their choice to switch from oral antiretroviral therapy (ART). Their confidence stemmed from experience using new iterations of oral ART over decades, with some citing CAB/RPV-LA as being a step closer to a cure. 2) Choosing to start CAB/RPV-LA was sometimes facilitated by input from longstanding, trusted relationships with healthcare providers or other PWH. 3) Reflections on the emotional gravity of witnessing loved ones die from AIDS-related illnesses early in the epidemic, and the mental imprisonment of around-the-clock pill taking required for their own survival, influenced use of CAB/RPV-LA. In fact, many reported transforming HIV-related psychological trauma and tragedy into education, support, and advocacy efforts: using CAB/RPV-LA was a unique mechanism to further benefit their community—indeed, it was an obligation to both PWH who have passed as well as PWH to come, who could learn from their experience. Conclusion The perspectives of LTS who initiated CAB/RPV-LA during early implementation revealed uptake and use was shaped by the emotional, psychosocial, and physical impact of living with HIV for decades. These data serve as a framework to tailor service delivery of current and future long-acting ART options in this population. Disclosures Moira McNulty, MD, Gilead Sciences, Inc.: Advisor/Consultant Katerina Christopoulos, MD, MPH, Janssen: Honoraria

How Do People Living With Cancer Navigate Health Systems?: A Multi-Grounded Theory.

Cancer and its physiological and psychological effects are well defined, but how these factors impact health system navigation for people living with cancer (PLWC) is lacking. To develop a theory explaining how PLWC navigate health systems to meet their health and well-being needs. This study used multi-grounded theory to explain how PLWC navigate health systems to meet their needs. Individuals more than 6 months postdiagnosis participated in semistructured interviews. The theory was grounded with the Health Beliefs Model and Socioecological Model to generate a candidate theory. Eighteen participants were interviewed (n = 12 female); the most prominent cancer type was breast (50%). The theory comprised 5 components describing how PLWC navigate health services: (1) "being on the journey" referenced a core care team and differing utilization over time; (2) "adjusting to a new identity" addressed feeling lost and isolated and a desire to be around people who have experienced cancer; (3) "assimilating knowledge" included knowledge about cancer, timing, and source of information; (4) "navigating the health system" found health-seeking attitudes and behaviors dictated whether services were accessed; and (5) "policy environment" acknowledged how policy set the context within which all theory components exist. The candidate theory depicts core factors influencing how PWLC navigate health and well-being services over their cancer journey and into survivorship. The theory identifies factors that influence access to healthcare, including trust and knowledge, which can form the basis of navigational initiatives and programs.

Facilitators and barriers to parental involvement in neonatal pain management in the NICU: a scoping review

ObjectivesNeonatal pain prevention is not only a humanistic but also an ethical imperative. Fitting with the principles of family-centred care, parental involvement in neonatal pain management plays an active role...

Exploring influencing factors of healthy lifestyles in rural area among older adults with diabetes based on socioecological model

Previous research on lifestyle has primarily focused on individual lifestyle factors, often overlooking the broader influence of social determinants. This study aimed to examine factors associated with healthy lifestyle scores (HLS) among older adults with diabetes, emphasizing modifiable behaviors within the framework of the socioecological model (SEM). A cross-sectional survey was conducted from July 1 to August 31, 2023, in Jia County, Henan Province, utilizing a whole-cluster sampling method. Influencing factors were categorized into five levels based on the socioecological model (SEM). We used Generalized linear models to examine the associations between these factors and HLS, while adjusting for potential confounders. The study included 5,451 eligible participants. The proportion of participants with healthy sleep habits was notably low (14.71%). Higher HLS were positively associated with being female, better cognitive competence, greater social engagement, and unemployment. In contrast, lower HLS were significantly associated with the presence of complications, depression, higher income, and residing farther from major roads. This study identified the key modifiable factors influencing HLS among older adults with diabetes. Disrupted sleep patterns emerged as a significant concern warranting targeted intervention. Medical insurance directly affects the accessibility and economic burden of medical resources. The government should further optimize medical insurance policies to facilitate patients in adopting healthier lifestyles choices.

Factors associated with girl child marriage in Iran: a qualitative socio-ecological approach.

Girl child marriage is an example of a human rights violation, the unfortunate consequences of which have raised growing concerns in the health system and have become a development challenge. Therefore, this research was conducted to identify the factors driving girl child marriage based on the Socio-Ecological Model. The present qualitative study employed guided content analysis and a deductive approach to identify the driving factors behind girl child marriage in Bam City. Sampling was targeted among Women aged 15-30 got married under the age of 15, family members, informants, and policymakers. Data were collected through semi-structured interviews and analyzed using Hsieh and Shannon approach and MAXQDA software. The data was classified into five categories: individual, interpersonal, organizational, community, and society. Individual factors were classified into biological, psychological, and demographic factors. Interpersonal factors were categorized into two categories: family structure, Ineffective interactions and social support. Organizational factors included Weakness in the education and care system. Community factors included the economic situation governing the society. The society factors were divided into two categories: Cultural and social factors governing the society, and Weakness in policy making and legislation. The findings showed that the socio-ecological model is a suitable framework for explaining the driving factors of child marriage. Girl child marriage is not merely a personal or familial decision; rather, it is influenced by the interactions of different systems that can either exacerbate or mitigate the issue. Consequently, the management, control, and prevention of Girl child marriage necessitate comprehensive efforts at regional, national, and international levels. In addition to creating platforms for the empowerment of girls at both national and regional levels, international policies can also foster a supportive environment.

Strategies for strengthening cervical cancer screening programmes in Gwanda district, Zimbabwe: a qualitative study

BackgroundNumerous studies have been conducted on barriers to cervical cancer screening in low resourced settings. Few have however explored the factors that motivate women to make the decision for screening. This study therefore aimed at identifying strategies that could strengthen the utilisation of screening services, with the goal of informing the development of context for enhancing cervical cancer programmes in Gwanda district, Zimbabwe. The socio-ecological model that implies individual, inter-personal, community, and health system factors as influencers of screening behaviours guided the study.MethodsA cross sectional qualitative design using five focus group discussions with 36 screening-eligible women aged 25–50 years, and 25 in-depth interviews of health providers with varied responsibilities in the screening programme were conducted. Data were analysed thematically with the aid of the Web Atlas.ti software.ResultsKey findings suggest that women’s willingness to be screened, on-going awareness campaigns and an increasing number of screening sites and nurses trained in screening procedures promote the uptake of screening. Concomitantly, awareness and knowledge about cervical cancer screening, male support, and community involvement in planning and implementation of programmes were seen as facilitators to screening, with accessibility of cervical cancer screening services being recognised as the most important.ConclusionsTo exploit on women’s willingness to be screened, delivery of screening services need to be re-engineered through development of strategies for increased and sustained educational programmes and increase of screening facilities. This could effectively address the prevalent barriers and enhance the facilitators for screening uptake.

Relationships between socioecological characteristics and families’ playground use in different seasons in Finland

ABSTRACT This study used a socioecological model (SEM) to investigate families’ use of public playgrounds in different seasons in Finland. Altogether, 561 parents of young children responded to the questionnaire. Multiple linear regression analyses were used to assess the relationships between the child-, parent-, and family-related characteristics and the use of playgrounds in different seasons among families with preschool-aged children. Families visited playgrounds (on average) once a week in winter, twice a week in spring and autumn and 3–4 times a week during the summer. The distance between home and the most-used playground was the strongest factor explaining families’ visits to playgrounds in all seasons. Moreover, a home without a yard and a child’s young age were associated with more frequent visits to public playgrounds, despite the season. Public playgrounds should be located close to homes so that families can use them more regularly in all seasons.

Dreaming of 2053: Product design and the future of sleep

Commercial sleep products exhibit wide variety but share a common failing: they tend to frame sleep problems individually, ignoring the influence of systemic issues on human wellbeing. To discover whether speculative/critical design (SCD) might offer a more appropriate framing, we use the method of precedent analysis to assess nine examples of sleep related SCD practice. We apply Hale et al.’s socioecological model of sleep health to create a novel framework that classifies how products frame sleep problems and corresponding solutions. This reveals that SCD artefacts frequently recognise societal determinants in how they frame sleep, but their solution tend to focus on individual interventions. The paper questions whether SCD practitioners might benefit from adopting the concept of publics from political sociology to frame more effective solutions and mobilise action towards a more equitable sleep future. This paper presents an original synthesis of product design, sleep, sociology and politics.

Facilitators and barriers of accessing community health services for children in the early years: An Australian qualitative study.

Foundations for health are set in the first years of life, however many children in Australia do not attain optimal development due to inequitable access to specialist care through impacting social determinants of health. There is a research gap in evidence for sustaining early years services that address these barriers. This study aimed to understand experiences and priorities of parents/carers and service providers around access to specialist early years health services in low socioeconomic areas of Armadale, Western Australia. Thematic analysis was used to interpret meanings across focus group discussion data and find priorities for access to care and service delivery using a multilevel socio-ecologic model. Facilitators and barriers to access were identified related to each theme. Two major themes were identified. Within theme 'Finding Help', facilitators to access included extended family, community, and childcare. Barriers included social isolation, and overwhelm. In theme 'Structural Factors', facilitators included safe places and practices, political action and universal care. Barriers included social determinants of health, institutional bias, and fiscal policy. Findings will inform policy, service delivery, and research priorities toward facilitating timely access to integrated care for vulnerable families with young children. Health equity will focus on co-design to remove structural barriers using a "one-stop-shop" model with soft entry, triage capacity, and a key worker to coordinate care for at risk families. To promote structural equity, a focus on access will include continuing engagement with families, facilitated by relational models of care to scaffold and support families toward autonomy.

Exploring the factors that influence the delivery of physical education in alternative provision schools in England

There is currently no literature that considers the practicalities of delivering physical education (PE) in alternative provision schools, nor the challenges that this might entail. As such, this paper offers a unique contribution to knowledge by highlighting the key factors that influence the delivery of PE within alternative provision schools in England from the perspectives of practitioners (i.e. those tasked with delivering it). Following a Freedom of Information request, an online survey was distributed to all alternative provision schools in England ( n = 335, 48 responses). A purposive sample of practitioners ( n = 14) was then invited to take part in online semi-structured interviews. Qualitative responses from the survey (extracted into an Excel spreadsheet), along with the transcripts from the interviews, were analysed using inductive and deductive procedures. The data were subsequently mapped to the socio-ecological model ( McLeroy et al., 1988 ) to identify what influenced delivery at multiple levels. This included factors at the intrapersonal level (e.g. staff confidence and competence, their pedagogical and content knowledge and feelings of isolation), interpersonal level (e.g. pupil needs/abilities, their behaviour and trauma, confidence, negative experiences of mainstream PE and lack of motivation), institutional level (e.g. spatial constraints, the facilities and equipment available and class sizes), community level (e.g. stigma and a lack of engagement with National Governing Bodies), and public policy level (e.g. recruitment of staff, financial constraints and attainment pressures). This paper presents a range of intersecting factors that influence what happens and how in PE in the context of alternative provision schooling.

Factors influencing type 2 diabetes self-management practices in rural Bangladesh: a qualitative investigation.

Type 2 diabetes mellitus (T2DM) is a prevalent, chronic health condition of global significance, with low- and middle-income countries (LMICs) disproportionately affected. Diabetes self-management practices (DSMP) are the gold-standard treatment approach, yet uptake remains challenge in LMICs. This study aimed to explore the barriers to and facilitators of DSMP and preferences for intervention design and delivery in Bangladesh, an LMIC, with prevalent T2DM. Sixteen qualitative focus group discussions (FGDs) with adults with T2DM and their caregivers were conducted in rural Bangladesh to explore preferences, barriers, and facilitators for community DSMP-related intervention programs. Data were thematically analyzed using a deductive theoretical domains framework (TDF) underpinned by the socio-ecological model. Overall, 117 participants (n = 58 with T2DM and n = 59 caregivers) were included in the analysis. Five overarching themes were identified, including (i) implementation of DSMP, (ii) community spirit and interconnectedness, (iii) environmental influences, (iv) healthcare professionals' role in DSMP, and (v) government support. Key barriers to DSMP identified for T2DM patients include knowledge implementation gaps, cultural practices, limited resources, and financial constraints. Facilitators include motivation, support from family and peers, and religious practices. Rural Bangladeshis prefer programs delivered at community clinics, viewing them as reliable, culturally appropriate central 'hubs' to assemble. Barriers to and facilitators of DSMP were identified, and preferences for intervention design and delivery for implementing DSMP were explored. The findings provide a foundation for the critical need to implement programs that improve DSMP in Bangladesh, with the potential to translate to other LMIC settings.

Migrant parents' perceptions of the benefits, barriers, and facilitators of young children's physical activity and sedentary behavior: A systematic review of qualitative studies.

Despite increasing global migration, children from migrant backgrounds are underrepresented in physical activity research. This systematic review aimed to consolidate existing qualitative evidence on parental perceptions of the benefits, barriers, and facilitators of promoting physical activity and limiting sedentary behavior of their first- or second-generation migrant children aged 0-6 years. Six electronic databases (Medline, CINAHL, PsycINFO, SPORTDiscus, Global, and Health EMBASE) were searched for qualitative peer-reviewed English language studies using terms covering migrants, parents, perceptions, physical activity, and sedentary behavior. Analysis was guided by the best-fit framework synthesis approach and the socio-ecological model. Database searches yielded 6059 unique records, with 33 studies included in this review. Key parent perceived benefits of physical activity were better health outcomes, development, and long-term outcomes and perceived benefits of sedentary behavior were education, health and development, and a parenting tool to keep children calm and occupied. Eight themes (25 sub-themes) across four levels of the socio-ecological model (primarily interpersonal and community level) were identified as barriers and facilitators of physical activity. Seven themes (14 sub-themes: primarily interpersonal) were identified for sedentary behavior. Parents from migrant backgrounds perceived that their young children experienced some unique barriers to physical activity and sedentary behavior.

Factors Associated with Adherence to Diabetic Retinopathy Screening Among Patients Attending a Nurse-Led Community Clinic in Australia: A Qualitative Study.

Background/Objectives: Despite the availability of screening services, the rate of diabetic retinopathy (DR) screening continues to be suboptimal in Australia, necessitating improvement. However, improving DR screening rates requires a more comprehensive understanding of the factors influencing adherence to the screening recommendations. This study aimed to explore the factors that influence adherence to DR screening among people with diabetes attending a community screening clinic in Australia. Methods: This qualitative study included purposively patients with diabetes recruited from a nurse-led community screening clinic in Australia. Semi-structured interviews were conducted to explore barriers and enablers impacting patient adherence to DR screening recommendations. The interview data were analyzed thematically using NVivo based on the socio-ecological model, with salience identified by the frequency of the theme. Results: A total of 22 participants completed the interview, including 10 females with a mean age of 60 ± 16.2 years. The interviews identified several factors that improved adherence to DR screening guidelines, including (a) knowledge of the connection between DR and diabetes and the importance of the screening, (b) the care provider's recommendations, and (c) pre-booked appointments and automatic invitations. Beyond these factors, clinic staff interactions, family support, fear of vision loss, flexible clinic hours, and transportation accessibility also facilitate DR screening adherence. Conclusions: The present study identified key multi-level factors influencing adherence to DR screening. While these findings from a single clinic provide valuable insights to inform screening strategies, larger multi-center studies are needed to validate their broader applicability across diverse healthcare settings and populations.

Food Insecurity Predictors Differ for White, Multicultural, and International College Students in the United States.

Background: Higher education institutions and public health agencies in the United States (US) have recognized that food insecurity is pervasive and interferes with student learning on multiple levels. However, less research has examined food insecurity among culturally diverse college students. A cross-sectional online survey was conducted to estimate the prevalence and predictors of food insecurity for US-born White, US-born Multicultural, and International students aged 18-34 at a Midwest university. The secondary aims were to describe dietary and meal characteristics, and the use of food assistance programs, including the on-campus food pantry. Methods: In April 2022, 853 students completed the 10-item US Adult Food Security Module, and demographic, dietary fat intake, food attitude, food access barriers, and nutrition assistance program usage questions using a socio ecological model (SEM) framework. Results: Food security prevalence was 73.3% (54.7% high, 18.5% marginal) and food insecurity prevalence was 26.7% (14.4% low, 12.3% very low). Significantly more International (26.8%) and Multicultural (35.6%) students were classified as food-insecure compared to White students (19.9%; p < 0.001). Binomial and multinomial logistic regression models indicated that predictors of food insecurity were intrapersonal factors of race/ethnicity, poor self-reported health, being an undergraduate, and the community barriers of high food costs and limited transportation. Conclusions: Dietary characteristics differed more by nativity-ethnicity groups than they did by food security levels. Food cost emerged as a strong influence on food choice for the food-insecure students. International students utilized more nutrition assistance programs, including the on-campus food pantry, than other groups.

Social Vulnerability and Child Food Insecurity in Developed Countries: A Systematic Review.

Food insecurity (FI) is a serious public health concern in economically developed countries, mainly due to unequal resource distribution. Identifying social vulnerability factors [i.e., characteristics of a person or group regarding their capacity to anticipate, cope with, resist, and recover from the effects of child FI (CFI)] and their positive or negative relationship with CFI is important to support targeted action with a scale and intensity that is proportionate to the level of disadvantage. This review aimed to systematically and comprehensively identify key social vulnerability contributors to CFI in economically developed countries and discuss the factors in the context of the socio-ecological model. Five research databases were searched for observational studies published in 2000 assessing social vulnerability factors related to FI in children residing in developed countries. Data screening and extraction were independently conducted by 2 reviewers who recorded factors related to CFI. The QualSyst tool was used to assess risk of bias. From the studies identified (N = 5689), 49 articles, predominantly from the United States and Canada, met the inclusion criteria. The identified social vulnerability factors associated with CFI were grouped into 5 based on the socio-ecological model: 1) individual child, 2) parental, 3) household, 4) community, and 5) societal factors. The most frequently reported contributors to CFI were income (household factor). Other social vulnerability factors were identified, including the child's age, parental depression, household crowdedness, social connection, poverty, and residential instability. The lack of consistent measures to define both social vulnerability and CFI in diverse population subgroups impeded meaningful pooling and interpretation of factors interacting with CFI. Recommendations for future studies are to use comparable measures to estimate the extent and severity of CFI and to investigate the relation between social vulnerability, severity, and trajectories of CFI in developed countries. This trial was registered at PROSPERO as CRD42022291638.