"This tough love sh*t is just not love": Exploring harm reduction in Massachusetts homeless shelters.

In the United States, Black women are three to four times more likely to die from pregnancy-related complications than White women and experience disproportionately higher rates of maternal mental health issues across pregnancy, childbirth, and the postpartum period. Structural racism, healthcare bias, and inequitable access to culturally responsive care position Black women among the most underserved and undertreated populations in the nation and contribute to intergenerational impacts on Black families and communities. This study aimed to understand how Black communities conceptualize perinatal mental health and wellbeing and identify barriers and facilitators to care, with the goal of informing culturally responsive, community-centered, and family-focused interventions that promote safety, confidence, and agency. Semi-structured virtual interviews were conducted with Black pregnant and postpartum mothers, fathers, and community members (N = 17) using a qualitative, descriptive approach while noting recurring themes. Participants were English-speaking, residents of the United States, aged 18 years or older, and recruited through purposive sampling via community networks and social media. We analyzed data using reflexive thematic analysis to examine multilevel influences on perinatal mental health. The Social-Ecological Model (SEM) was used as a guiding framework to understand how individual, interpersonal, community, and structural factors shape perinatal mental health and wellbeing as well as access to care. Among the four levels of the Socioecological model, including individual, interpersonal, organizational, and community/policy, ten subthemes emerged, including perinatal health literacy, supportive networks, collective resilience, healthcare harm and advocacy, medical institutional environments, parenting while Black, and perinatal health climate. Findings highlight the need for multilevel, culturally responsive, and community-centered strategies to advance Black perinatal mental health and wellbeing.

Complete breastfeeding cessation is an important maternal-child health transition and is distinct from complementary feeding, which the World Health Organization defines as providing foods in addition to milk when milk alone is no longer adequate (generally from 6 to 23 months). Evidence on how mothers decide to stop breastfeeding and which practices they use remains limited in LMICs. This study described breastfeeding cessation timing, decision-making, practices, and support-seeking among mothers in Tehran, Iran, using a Social Ecological Model to organize influences at individual, interpersonal, healthcare/organizational, and broader contextual levels. We conducted a cross-sectional online survey from March to August 2021 among mothers of healthy singleton children aged 6 months to <4 years, recruited from 28 public health centers in Tehran. The final analytic sample included 420 mothers. Data were collected using a 42-item questionnaire with structured items and optional open-text questions; open-text responses were provided by 98-380 mothers, depending on the item. Quantitative data were summarized descriptively, and associations were examined using bivariate tests. Open-text responses were analyzed using thematic content analysis to contextualize the survey findings. Findings were organized using the Social Ecological Model across individual, interpersonal, healthcare/organizational, and broader contextual levels. Most mothers were aged 25-34 years (69.3%), reported average financial status (79.8%), and held a university degree (45.5%); children were primarily aged 42-48 months. Breastfeeding cessation was mainly mother-initiated (86.4%), and 56.2% reported complete cessation between 18 and 24 months. Traditional practices to discourage breastfeeding were common, including applying bitter or adhesive substances (41.2%) and using medicinal products without prescription (32.9%). Only 34.8% consulted healthcare providers during cessation, most often for emotional reassurance. Family advice influenced some decisions (22.3%). Mothers reported mixed experiences after cessation, including relief as well as guilt and breast discomfort, while many reported child behavioral challenges (e.g., irritability and clinginess) alongside perceived increases in independence. In this Tehran sample, breastfeeding cessation was largely mother-initiated but frequently involved traditional practices and limited professional support. Findings suggest a need for clear, culturally sensitive guidance and counseling on breastfeeding cessation within routine maternal-child health services, including family engagement and practical support for gradual cessation. Not applicable, as this study did not involve a health care intervention.

Early Childhood Education (ECE) educators experience high levels of stress, burnout, and job turnover, contributing to workforce instability. Efforts to better understand how interpersonal and environmental work-related factors contribute to burnout and job turnover intentions are essential to improving ECE educator wellbeing. Grounded in the social ecological model, this study quantitatively examined how stress, the social climate (social support and social strain), and health behaviors contribute to burnout and job turnover intentions in ECE educators. The StayWell ECE (Staff and Youth Wellness for Early Childhood Educators) project administered two online surveys to licensed ECE educators in New York: the Health Behaviors Survey (n = 1,423), assessing burnout, stress, turnover intentions, and health behaviors (diet, physical activity, and sleep), and the Social Environment Survey (n = 263), assessing workplace social climate (social support and social strain). Multiple linear regression analyses examined associations between burnout, the social climate, and health behaviors. Path analysis was conducted to test relationships among perceived stress, the social climate, burnout, and turnover intentions, controlling for age, income, and education; model fit was evaluated using chi-square, comparative fit index, root mean square error of approximation, and standardized root mean square residual. Higher burnout was significantly associated with poorer diet quality and lower physical activity and sleep. Lower workplace social support was also associated with poorer diet quality and sleep. Path analysis demonstrated adequate model fit and showed that stress was associated with lower social support, higher social strain, and higher levels of burnout. Social strain was strongly associated with two burnout subdomains (lower emotional exhaustion and depersonalization; p < 0.01 and p < 0.01), while social support was associated with one (greater personal accomplishment; p < 0.01). All burnout subdomains were associated with higher turnover intentions. Findings highlight burnout as a key mechanism linking stress and workplace social climate to health behaviors and turnover intentions among ECE educators. Interventions that reduce perceived stress and address both social support and social strain may improve wellbeing, support healthier behaviors, and reduce job turnover in this workforce.

Unintended pregnancy (UIP) remains a persistent public health concern among young women in sub-Saharan Africa, including Tanzania. This study examined Sexual Health Literacy for Pregnancy Prevention (SHLPP) and engagement in Sexual Behaviours potentially leading to UIP (referred to in this study as Risky Sexual Behaviours [RSB]) among female university students using a Social Ecological Model (SEM). Specifically, it assessed (i) levels of SHLPP and RSB, (ii) differences across individual, interpersonal, and contextual factors, and (iii) the predictive effects of these factors on SHLPP and RSB, including the influence of SHLPP on RSB. A cross-sectional study was conducted involving 255 female university students at Sokoine University of Agriculture, Tanzania. Data were collected using a structured questionnaire and analysed using descriptive statistics, factorial ANOVA, and hierarchical multiple regression. Most participants (75.6%) exhibited low-to-moderate SHLPP, while 63.7% reported moderate-to-high RSB. Upbringing environment significantly influenced both RSB (F(1,165) = 17.817, p < .001, η2 = .097) and SHLPP (F(1,218) = 4.124, p < .05, η2 = .019), with urban students reporting higher levels of both. Year of study showed a small, albeit significant effect on RSB (F(2,165) = 3.246, p < .05, η2 = .038) only. Parental education and accommodation type did not have significant independent effects on SHLPP and RSB. However, they exerted significant interaction effects between: (i) parental education and upbringing environment, and between parental education and accommodation type on RSB and (ii) upbringing environment and accommodation on SHLPP. Parent-daughter communication emerged as the strongest predictor of both SHLPP (β = .318, p < .001) and RSB (β = .402, p < .001). Notably, SHLPP did not significantly predict RSB (β = .088, p = .221), indicating a disconnect between knowledge and behavior. CONCLUSIONAND IMPLICATIONS: Sexual behaviour among FUS is more strongly shaped by interpersonal and contextual factors than by individual knowledge alone. These findings underscore universities' need to enhance parent-child communication, deliver targeted sexual health education, and consider student backgrounds when allocating housing.

Equity in U.S. Solid Organ Transplantation for People Living With HIV: An Integrative Review of Barriers, Policies, and Interventions.

ABSTRACT This Voces essay reflects on a recurring longitudinal journaling assignment in a graduate public health course at a Hispanic-Serving Institution (HSI). Grounded in the Social-Ecological Model and Culturally Sustaining Pedagogy, the assignment tasks students with interrogating a personal health behavior through expanding layers: from individual to family, community, and structural. Students recognize the structural drivers of health that shape their daily lives. These reflections serve as a “pedagogical mirror” for the instructor, providing insights into the pressures affecting the Latinx community. Ultimately, the assignment transforms abstract health theory and cultivates reflective skills essential for community practitioners.

Individuals living with type 2 diabetes and vision loss experience unique, under-researched barriers to physical activity, despite the important role exercise plays in diabetes management. This study examined physical activity participation among blind and low-vision adults with type 2 diabetes (n = 30). Participants, ages 44–83, resided in Bexar County, Texas. Closed-ended surveys (conducted in English or Spanish) were administered to participants, followed by in-depth, semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and double-coded. Participants’ physical activity levels were determined using the Exercise Behaviors Scale. Data were analyzed using a convergent inductive-deductive design. Consistent with the Social-Ecological Model, five main themes and 11 subthemes emerged, depicting how individual/intrapersonal, interpersonal, institutional/organizational, community, and policy-level factors influenced participants’ physical activity participation. These factors can be specifically targeted both at local and broader levels to promote physical activity among individuals with concurrent type 2 diabetes and blindness/vision loss.

Cervical cancer is a significant public health issue in Thailand. Despite the implementation of a national screening program, its coverage remains suboptimal. This study aims to systematically review local Thai evidence and comprehensively analyze the multi-level barriers affecting women's participation in cervical cancer screening using the social ecological model (SEM). Systematic searches were conducted in PubMed, Scopus, CINAHL and ThaiJO databases from inception to 2025. Literature was screened according to pre-defined inclusion and exclusion criteria, resulting in the inclusion of 11 studies. The Newcastle-Ottawa scale and a mixed-methods assessment tool were used for rigorous quality appraisal. Thematic synthesis was used to categorize screening barriers into five levels: individual, interpersonal, community, health system and public policy. The key obstacles identified include: at the individual level, lack of knowledge, fear, shame and insufficient risk perception; at the interpersonal level, the influence of family and social norms; at the community level, cultural, religious and regional factors; at the health system level, poor service accessibility and system inefficiencies; and at the public policy level, incomplete health insurance coverage and insufficient awareness campaigns. Many of these obstacles show distinct characteristics of Thai society and culture. Barriers to cervical cancer screening among Thai women constitute a complex, multi-level system. Future intervention strategies must move beyond single-level health education, and should develop cross-level, culturally-appropriate, comprehensive measures. These include promoting HPV self-sampling, conducting community empowerment education, optimizing the health service system and strengthening policy support to systematically increase screening participation.

Background: In Nigeria, HIV prevalence among men who have sex with men (MSM) continues to rise due to sociocultural barriers hindering prevention efforts. Aim: This study investigated the barriers MSM face in HIV prevention. Methods: Informed by the social ecological model (SEM), a qualitative study was conducted with 12 participants via online semi-structured interviews. Participants were men over the age of 18 years who were HIV negative and recruited from a non-governmental organisation (NGO) in Lagos, Nigeria. Results: Using a thematic analysis approach, six themes appeared as common barriers to HIV prevention, including (i) adult violence and extortion, (ii) perceptions of HIV biomedical approaches, (iii) condom attitudes, (iv) access to HIV and sexually transmitted infection services and education, (v) internalised stigma, and (vi) externalised stigma. These themes reflected the systemic and multipart sociocultural environment that inhibits MSM from seeking HIV prevention resources. Conclusion: There is a need to improve access to community-based NGOs and trauma-informed mental health resources. Furthermore, until policy reforms are implemented and homophobia is significantly reduced, the development of intersectional, community-informed interventions is particularly important for addressing inadequacies in healthcare for MSM.

Women, Black, and Hispanic patients bear a disproportionate burden of cardiovascular disease yet remain underrepresented in clinical trials. Understanding patient perspectives is essential to developing inclusive recruitment strategies in cardiovascular research. The RECHARGE trial (Revascularization Choices Among Underrepresented Groups Evaluation) is an ongoing comparative effectiveness study comparing percutaneous coronary intervention and coronary artery bypass grafting among women, Black, and Hispanic patients. To inform recruitment strategies, we conducted a qualitative study using in-person and virtual focus groups and semistructured interviews. Participants were US adults who identified as Black or Hispanic and had a history of percutaneous coronary intervention, coronary artery bypass grafting, or advanced cardiovascular disease. Interviews were guided by the Social-Ecological Model and analyzed using directed content analysis with a constant comparative approach. The sample included 42 participants (35 women, 7 men); 29 identified as Hispanic and 13 as Black. Barriers and facilitators to trial participation spanned multiple levels of the Social-Ecological Model. At the individual and interpersonal levels, barriers included complex study materials, excessive medical jargon, and mistrust of randomization, with concerns about being assigned a less effective treatment. At community and societal levels, participants cited limited recruitment outreach, lack of culturally and linguistically appropriate materials, and mistrust stemming from historical research injustices. Facilitators included trust in healthcare providers, reassurance regarding treatment appropriateness, and involvement of family or support systems. At the community and societal levels, accessible, visual, and multilingual materials were highlighted to support understanding. Participants emphasized the value of plain language, visual, and multilingual materials, adequate time for shared decision-making, and transparent communication about study goals. Increasing representation of underrepresented populations in cardiovascular trials requires transparent, accessible communication and trust-centered recruitment strategies. Leveraging trusted healthcare providers and community-based outreach is critical to advancing equity in cardiovascular research. URL: https://www.clinicaltrials.gov; Unique identifiers: NCT06399705 and NCT06399692.

Purpose: The primary purpose of this study was to describe the experiences of African American adults with mobility disabilities accessing and navigating physical activity facilities in rural communities. A secondary purpose was to identify alternative physical activity locations used by participants who do not utilize traditional facilities. Methods: This descriptive qualitative study was guided by the Social Ecological Model and an intersectionality framework. Participants were five African American adults with mobility disabilities residing in rural Georgetown and Williamsburg Counties, South Carolina. Data was collected through semi-structured interviews and photovoice and analyzed using thematic and constant comparative approaches. Results: Three themes emerged: (a) Ain’t Gonna Let Disability Turn Me Round, reflecting resilience and commitment to physical activity; (b) Ease on Down de Road, describing navigation of and travel to facilities; and (c) We Are Family, highlighting the role of social networks. Conclusions: Findings emphasize the need for culturally relevant, accessible, and community-based physical activity opportunities in rural rehabilitation and public health contexts.

To develop a digital health equity questionnaire for rural elderly and test its reliability and validity. The initial questionnaire items were based on the social ecological model. They were identified by systematically reviewing the literature and conducting semi-structured interviews. Delphi expert consultation was used to screen and revise the items, resulting in a pre-test questionnaire for digital health equity among rural older adults. A total of 206 rural older adults were selected to complete item analysis and exploratory factor analysis on the pre-test questionnaire. Another group of 227 rural older adults were selected to evaluate the reliability and validity of the formal questionnaire. The developed Digital Health Equity Questionnaire for rural older adults includes five dimensions: individual level, interpersonal level, organizational level, community level, and policy level, with a total of 31 items. Exploratory factor analysis extracted 5 common factors, with a cumulative variance contribution of 75.120%. The results of the confirmatory factor analysis indicate that the overall fit of the constructed model is good: χ2/df = 2.19, TLI = 0.916, IFI = 0.903, CFI = 0.912, RMSEA = 0.064. The overall Cronbach's α coefficient of the questionnaire is 0.903, the split-half reliability is 0.879, and the test-retest reliability after a two-week interval is 0.857. The Digital Health Equity Questionnaire for rural older adults has good reliability and validity and can be used as a standardized tool for the preliminary assessment of digital health equity among rural older adults.

Guided by the social-ecological model, we employed growth mixture models in this study to examine (a) the trajectories of student perceived schoolwide bullying perpetration, and the prevalence of traditional bullying victimization and cyberbullying victimization aggregated at school level and (b) the longitudinal impact of four domains of social-emotional learning (SEL) competencies, school level, ethnic diversity index, and school size, on these trajectories. Through results of the latent class growth modeling on four years (2017-2020) of longitudinal data collected from 142 schools with an average of 36,403 students in the state of Delaware, United States, we found that schoolwide bullying perpetration followed four growth trajectories: high-start-high-growth, moderate-start-high-growth, moderate-start-low-growth, and low-start-low-growth. Schoolwide cyberbullying victimization showed two growth trajectories, including high-start-low-growth, and low-start-high-growth. Schoolwide traditional bullying victimization followed a linear growth over four years. In terms of the longitudinal impact of SEL competencies, only social awareness negatively contributed to the growth of schoolwide bullying perpetration. School levels and ethnic diversity index were also associated with some growth trajectories for schoolwide bullying and cyberbullying victimization. Practical implications for schoolwide efforts in bullying interventions and programming are discussed.

"So what's gonna happen when I get out of here?" Qualitative barriers and facilitators to MOUD continuity post-release from jail.

Multifaceted interventions to enhance patient's adherence to self-monitoring blood glucose: A systematic review.

This study systematically examines how school-community cultural norms shape young people's reproductive health behaviors in China. Using the PRISMA 2020 framework, a systematic review of empirical studies published between 2010 and 2022 was conducted to synthesize evidence from educational and behavioral research. Multiple international and Chinese databases were searched to identify qualitative, quantitative, and mixed-methods studies examining the influence of cultural norms within school and community settings on youth reproductive health knowledge, attitudes, and behaviors. Thematic synthesis, guided by the Social Ecological Model, was employed to integrate findings across studies. The review reveals that school-community cultural norms-particularly norms of silence, stigma, and gendered expectations-play a critical role in shaping reproductive health behaviors and in moderating the effectiveness of school-based interventions. Schools function both as reinforcers of prevailing community norms and as potential agents of change when culturally sensitive education is implemented. The findings underscore the need for context-specific, community-engaged reproductive health interventions tailored to the Chinese socio-cultural environment.

ObjectiveThis study aimed to identify the factors influencing transition readiness among adolescents with systemic lupus erythematosus, thereby providing a foundation for the development of targeted intervention programs.MethodsGuided by the Social-Ecological Model of Adolescent and Young Adult Readiness for Transition, a descriptive qualitative study was conducted from September 2024 to October 2025. Using purposive sampling, we recruited 17 adolescent patients with systemic lupus erythematosus, their respective caregivers, and 12 healthcare providers from a tertiary hospital in Guangdong Province, China. Semi-structured interviews were performed, and the data were analyzed using directed content analysis.ResultsSix themes and sixteen subthemes were identified: (1) knowledge, encompassing both the active acquisition of disease-related information and a general lack of transition awareness; (2) skills/efficacy, characterized by poor medication adherence and insufficient competence in navigating healthcare systems; (3) beliefs/expectations, reflecting recognition of the importance of transition preparation; (4) goals, primarily defined by the absence of clear transition objectives; (5) relationships, incorporating barriers such as communication challenges between patients and healthcare providers or caregivers, a lack of coordination between pediatric and adult care departments, as well as facilitators like support from healthcare providers, emotional support from caregivers, and peer encouragement; (6) psychosocial functioning, manifested as emotional distress, caregiver over-involvement, substantial family financial burdens, alongside experiences of social stigma and discrimination.ConclusionThis study highlights that transition readiness in adolescents with systemic lupus erythematosus is influenced by multiple interacting factors. Healthcare providers should implement tailored interventions to improve treatment adherence and self-care during the transition process.

ABSTRACT South Africa has the highest number of adolescents living with HIV (AHIV) globally, many of whom face disengagement and virologic failure when transitioning from pediatric to adult care. Using the Social-ecological Model of Adolescent and Young Adult Readiness to Transition (SMART) and the Technology Acceptance Model (TAM), we evaluated the acceptability, feasibility, and perceived effectiveness of an in-person and virtual adolescent support intervention (InTSHA VIP). We conducted eight focus groups with 41 AHIV aged 15-19 who received the intervention (mean age: 18.5 years, 70.1% female) and 20 in-depth interviews with youth-facing healthcare workers (HCWs) at participating clinics (mean age 43.3 years). Transcripts were coded and thematically analyzed, framed by SMART and TAM. Participants reported improved knowledge, self-efficacy, psychosocial wellness, and relationships with family and HCWs. HCWs perceived InTSHA VIP as highly useful for improving retention in care and viral suppression. Barriers included technology challenges, scheduling conflicts, and transportation access. Future implementation should address structural barriers to access while leveraging the intervention’s adaptability to optimize impact and sustainability.

PurposeThis study aimed to explore the challenges faced by Chinese multidisciplinary teams in transitioning patients with life-limiting illnesses to palliative care, utilizing the social-ecological model as a framework.Participants and MethodsA descriptive qualitative study was conducted involving 39 multidisciplinary team members, including physicians, nurses, psychologists, social workers, rehabilitation therapists, nutritionists, traditional Chinese medicine therapists, nursing attendants, and volunteers from six health institutions. Data were collected through semi-structured focus group interviews and analyzed using both inductive and deductive thematic analysis.ResultsFour themes were identified: 1) dilemmas in individual end-of-life decision-making rights, with three subthemes: irrational perceptions hindering rational decision-making, the agony of life-and-death decision-making, protective medical practices inducing decision-making rights squeeze; 2) multiple constraints in the family fields, with three subthemes: external stigma of “unfilial” oppression, intrafamilial disparities in palliative care perceptions, distorted emotional connection among family members; 3) Intrinsic barriers in healthcare provision, with three subthemes: institutional deficits in palliative care literacy, professional competence gaps in palliative care delivery, and deficiency in quality control system for palliative care; and 4) constraints shaped by social environment, with four subthemes: insufficient funding support for palliative care, ambiguous palliative care pricing mechanisms, absence of practitioner safeguards in palliative care, and entrenched perceptions of life and death.ConclusionPalliative care transition were shaped by multi-layered challenges across micro-macro systems, rooted in cultural norms, healthcare provision, and structural inequities. Challenges such as protective medical care, stigma around “unfilial” behavior, and emotional connection within families offer novel perspectives on promoting palliative care transition. Addressing these challenges necessitates targeted strategies across patients (eg., implementing advance care planning consultations), families (eg., the reconceptualization of filial piety and its recalibration), healthcare institutions (eg., establishing evidence-based standards, guidelines, and screening tools), and social environment (eg., implementing universal death education to dismantle stigma). These strategies could promote culturally sensitive and sustainable palliative care transitions within similar healthcare and sociocultural contexts.