Social Influence Research Articles

Is epistemic injustice a worthy application to mental health nurse education?

This paper explores the philosophical concept of epistemic injustice and contends its significance and relevance to mental health nurse education and clinical practice. The term epistemic injustice may be unfamiliar to mental health nurses, yet the effects are readily visible in the dismissing, silencing, and doubting of service users' knowledge, testimony, and interpretation. Existing professional values and clinical standards lack depth and critical exploration pertaining to epistemology and associated ethical concerns. Despite central tenets of person-centred care and valuing the service users' voice, epistemic injustice continues to occur. Epistemic injustice cannot be summed up merely by asking nurses to listen to service users. This represents an oversimplification of epistemology, ignoring the complexities of social influence and knowledge exchanges. Epistemic injustice brings something new and innovative to the nursing curriculum and fits within the principles of heutagogy. It encourages deep reflexivity surrounding the ethical issues of power inequalities and intersectionality. Inclusion in mental health nursing education allows for the social and political powers of psychiatric diagnosis as a form of silencing and stigma to be examined. Practical application is made to mental health nursing education and practice with epistemological values and ethical reflexive prompts. These can be utilised by educators and lecturers for pre-registration mental health nurse education, post-registration, and continued professional development.

Consumer behavior and spending patterns on cultural goods and services

This study investigates the factors influencing consumer behavior and spending patterns on cultural goods and services. Using a quantitative research approach with Partial Least Squares Structural Equation Modeling (PLS-SEM), data were gathered through a structured survey of 350 respondents from diverse demographic backgrounds. The results reveal that cultural interest, social influence, and perceived value have a significant and positive impact on consumer spending behavior, with cultural interest showing the strongest influence (β = 0.45, p < 0.01). Additionally, the study highlights the mediating role of perceived value in the relationship between social influence and spending behavior. These findings provide practical insights for marketers and cultural institutions aiming to better understand consumer motivations in the cultural sector. Future research should consider expanding the sample size and exploring other potential mediating variables.

The eMoney revolution: how culture and technology drive adoption and use?

Purpose The use of electronic money (eMoney) as a noncash payment method is gaining popularity globally. However, the usages of eMoney are culturally influenced and can vary within a country. These cultural disparities can result in divergent patterns of eMoney adoption and use. This study aims to investigate the factors influencing the adoption and use of eMoney in Indonesia. This study integrated the unified theory of acceptance and use of technology model with Hofstede’s cultural dimensions to develop a framework examining both technological and cultural perspectives. Design/methodology/approach Data was collected through an online survey of 484 Indonesians and analyzed using partial least squares structural equation modeling. Findings The results showed that the constructs of the unified theory of acceptance and use of technology model, namely, performance expectancy, effort expectancy, social influence and facilitating conditions, all had a significant impact on behavioral intention to adopt eMoney as well as actual usage. However, not all of Hofstede’s cultural dimensions moderated these relationships as hypothesized. Surprisingly, masculinity/femininity and power distance emerged as important moderators of eMoney usage. Practical implications This integrated model provides valuable insights into how to consider cultural influences when designing strategies to promote new payment technologies in Indonesia. The findings point to both technological and cultural factors shaping patterns of adoption and use of eMoney in the country. Originality/value Although many research has looked at how culture affects the acceptability of technology in banking, few studies have looked at how culture affects the use of mobile money. This study offers a valuable contribution by investigating how Indonesian culture moderates the relationship between behavioral intentions and actual use of eMoney. The findings provide guidance for practitioners seeking to facilitate eMoney services in developing markets by elucidating the cultural factors that most influence customer adoption. As such, this research fills an important gap regarding the understudied domain of mobile money and its intersection with national culture.

Investigating factors influencing AI customer service adoption: an integrated model of stimulus–organism–response (SOR) and task-technology fit (TTF) theory

PurposeArtificial intelligence (AI) customer service has grown rapidly in recent years due to the emergence of COVID-19 and the growth of the e-commerce industry. Therefore, this study employs the integration of the stimuli–organism–response (SOR) and the task-technology fit (TTF) frameworks to understand the factors that affect individuals’ intentions towards AI customer service adoption in Malaysia.Design/methodology/approachThe study utilised a survey-based research approach to investigate the factors that affect individuals’ intentions towards AI customer service adoption in Malaysia. The data were collected by conducting an online survey targeting individuals aged 18 or above who had prior customer service interaction experience with human service agents but had not yet adopted AI customer service. A sample of 339 respondents was used to evaluate the hypotheses, adopting partial least squares structural equation modelling as a symmetric analytic technique.FindingsThe PLS-SEM analysis revealed that social influence and anthropomorphism have a positive direct relationship with emotional trust. Furthermore, communicative competence, technology characteristics and perceived intelligence were positively correlated with TTF. Moreover, emotional trust significantly impacts AI customer service adoption. In addition, AI readiness positively moderates the association between task technology fit and AI customer service adoption.Practical implicationsThe study provides insights to individuals, organisations, the government and educational institutions to improve the features of AI customer service and its development in Malaysia.Originality/valueThe originality of this study is found in its adoption of the SOR theory and TTF to understand the factors affecting AI customer service adoption. Additionally, it incorporates moderating variables during the analysis, adding depth to the findings. This approach introduces a new perspective on the factors that impact the adoption of AI customer service and offers valuable insights for practitioners seeking to formulate effective strategies to promote its adoption.

Human vs. AI Influencer Activism: Exploring Self-Branding and Issue Advocacy Effectiveness Through Social Influence Processes

Human vs. AI Influencer Activism: Exploring Self-Branding and Issue Advocacy Effectiveness Through Social Influence Processes

Hearts and minds: a community-based systems diagram exploring mental health following a cardiac event

Abstract Background/Introduction Following an acute cardiac event, individuals commonly face multiple emotional and mental health challenges. For many people, this change in their mental health will resolve over time. However, one in five will go on to develop major depressive disorder. The development of major depressive disorder is a complex co-morbidity that, if left unchecked, can increase the risk of subsequent cardiac events and mortality. Systems thinking methodology offers a novel approach to investigating factors that contribute to mental health following a cardiovascular event. Purpose This project aims to (1) unravel the complex system influencing mental health after a cardiac event and (2) pinpoint priorities for supporting individuals' mental well-being following a cardiac event. Methods Group model building workshops using Deakin University’s purpose-built STICKE software were conducted over Zoom to explore the interrelationships contributing to mental health following a cardiovascular event. Twelve participants, including consumers (n = 3) and healthcare professionals (n = 9) from across Australia, engaged in two 1.5-hour workshops. Guided by the prompt "Reflect on factors influencing a person’s mental health post-cardiac event", participants worked together to construct a systems diagram. This facilitated exploration, visual mapping, and identification of factors and priority areas influencing mental health post-cardiac event. The diagram was then analysed using the theoretical domains framework. Results The STICKE diagram developed demonstrates the interplay of various factors impacting mental health across the cardiac healthcare journey at both patient and system levels (see Figure 1). Using the theoretical domains framework, eight domains were identified: knowledge, skills of healthcare professionals, environmental context, personal context, emotional response to event and recovery, social influences, behavioural regulation, and beliefs about individual capacity. Knowledge (including health literacy and staff training), environmental context (addressing gaps in care and navigating the system), and social influences (such as social isolation) were domains that were consistently raised in the workshop (see Figure 2). Stakeholders also identified the following key priority areas: highlighting the need for additional support for staff and intervention to increase health literacy and knowledge around mental health. Conclusion(s) Supporting mental health post-cardiac events is a multifaceted challenge requiring a comprehensive community-level intervention, particularly in the initial weeks post-hospitalisation. The insights gained from this study will inform the co-design of an intervention aimed at increasing health literacy and knowledge around mental health following a cardiovascular event.

Examining the Relationship Between Socio-Demographic Variables and Eco-Anxiety A Systematic Review

Abstract Background Eco-anxiety is a rising concern among young people, characterized by persistent feelings of fear, helplessness, and despair stemming from the looming and uncertain threats of climate change. Understanding how socioeconomic status and demographic factors influence the development of eco-anxiety is crucial in addressing this issue. This study aimed to analyze the literature to elucidate this relationship and its public health implications. Methods We conducted a systematic literature review using PubMed, Scopus, Web of Science, and APA PsycInfo databases. A total of 1,170 articles were initially retrieved, with 10 meeting the inclusion criteria. Quality assessment was performed using the AXIS Tool modification for cross-sectional studies. Data extraction was systematically carried out to analyze the relationship between socioeconomic and demographic determinants and young people’s emotional responses to climate change. Results Preliminary findings indicated that various socioeconomic and demographic factors influence young people’s emotional responses to climate change. Family stressors, economic instability, cultural beliefs, and social influences were identified as significant determinants, contributing to eco-anxiety, ecological distress, and climate change grief among youth. Conclusions The study underscores the importance of considering socioeconomic and demographic factors in addressing eco-anxiety among young people. By recognizing these influences, policymakers, educators, and mental health professionals can develop tailored interventions to mitigate the adverse effects of eco-anxiety. Public health actions may include enhancing mental health services, implementing educational programs, and addressing social determinants of health to alleviate eco-anxiety and promote resilience among youth facing climate-related challenges. This review is produced as part of the PRIN P2022JJ3LB project, funded by the Italian Ministry of University and Research. Key messages • Socioeconomic and demographic factors significantly influence young people’s emotional responses to climate change, including the development of eco-anxiety and ecological distress. • Understanding family stressors, economic instability, and social influences is crucial for tailored interventions for youth.

Influencers as a new source of health information: Insights from an Austrian youth survey

Abstract Background Social media influencers (SMIs) have become the dominant source of health information for youth. While some SMIs may share valuable content, critics raise concerns that they lack expertise, have commercial motives, or hold personal biases. Yet, little is known about the epidemiology of the health influencer phenomenon. This study offers first insights into the reach of SMIs among Austrian youth, informing public health strategies to promote positive health behaviors in young populations. Methods A cross-sectional study was conducted with a representative sample of 1003 Austrian adolescents and young adults aged 15-25. Key research questions focus on the epidemiology of health influencers, engagement with SMIs, prevalent health topics, advertising, and perceived impact of SMIs on health. Preliminary results Participants estimate that over 51% of social media posts they see are from SMIs, and 75.37% follow at least one SMI. Additionally, 37.19% follow SMIs who specifically share health content, and 30.91% have purchased health products recommended by them (e.g., foods, supplements, beauty products). Moreover, 40.27% trust their followed SMIs for health information, similar to trust in traditional media (43.47%). Finally, over a third find SMI content beneficial for health (32.34%), while 29.20% find it harmful, and 33.83% neither. Conclusions The study provides first insights into the epidemiology of health influencers, revealing their extensive reach and positive reception among young people. Despite concerns about conflicts of interest or expertise, SMIs are perceived as trusted sources for health information and product purchases. This research enhances our understanding of influencers’ impact and informs public health strategies aimed at promoting positive health behaviors among youth. The insights from Austrian youth can inform future studies across Europe, deepening our understanding of the health influencer phenomenon and its implications for public health. Key messages • This cross-sectional study shows the high reach of social media influencers among youth and their important role as emerging sources of health information. • The study breaks new ground by investigating adolescents’ engagement with health influencers, offering insights for public health to promote positive health outcomes among young populations.

Marketing or health promotion? A citizen science study of social media influencers’ health content

Abstract Background Social media influencers (SMI) became the dominant source of health information among adolescents, exerting influence through appealing content and para-social relationships. Personalized social media feeds of adolescents paired with latent platform algorithms result in myriads of individual information environments, which remain closed to researchers. Citizen science offers a solution to peek inside this black box and identify: What health content is disseminated by social media influencers and consumed by adolescents? Methods The citizen science study adopted a contributive approach, where adolescents collected and categorized SMI profiles and posts from their own feeds with a pre-tested survey tool which was available on Google Tabs. Data collection was conducted on Instagram, TikTok, and YouTube between April and May 2023 and subsequently analyzed by the research team. Results The study involved 19 school classes, containing 326 students, aged 12 to 19 years. They documented 255 SMI profiles and 2147 posts, primarily on Instagram and TikTok. Key topics included fitness, beauty ideals, and nutrition, while mental and sexual health received less attention. Although 41.5% of the posts contained advertising, the citizen scientists classified 63.5% as health-promoting. Topics relating to dietary supplements (84.1%), addictive substances (55.6%), nutrition (53.8%) and sport (47.2%) were particularly ad-heavy. Despite mental and sexual health having the lowest advertising rates at 35.4% and 37.7% respectively, this still accounts for over one third of the documented posts. Conclusions SMI present a distorted image of health that emphasizes nutrition, fitness and beauty ideals, while topics such as mental and sexual health are neglected. The positive reception of posts containing ads indicates a lack of critical reflection. Policies for advertising practices and balanced health education, including media literacy, are necessary to address these trends. Key messages • Social media influencers propagate a distorted health image, defined by nutrition, fitness, and beauty ideals. • Adolescents lack the necessary skills to critically reflect on ad littered social media influencer health content.

Social influence on post-drinking risky sexual behaviours: evidence in France and South Korea

Abstract Background Post-drinking risky sexual behaviours are at the conjunction of the dual risks of sexually transmitted infections and further problematic substance use, necessitating contextual analysis for determinants that promote these behaviours. This study examines the influence of social groups on post-drinking risky sexual behaviours in different cultural samples. Methods A cross-sectional survey was conducted among young adults aged 18-30 in France and in South Korea in 2023-2024 (n = 998). A construct of post-drinking risky sexual behaviours includes 3 types: having sex without condoms, having sex with occasional partners, and having transactional sex. Perceived drinking norms were measured as a proportion. Multivariate logistic regression was conducted after controlling for sociodemographic factors. Results Young adults who reported that their social group had a higher proportion of drinkers were more likely to engage in a wider range of post-drinking risky sexual behaviours (aOR=1.02 [95%CI 1.01-1.03] in France; 1.01 [1.01-1.03] in Korea). Young adults in social groups who had experienced two types of risky sexual behaviours were more likely to engage in risky sexual behaviours after drinking (5.13 [2.21-14.1] in France; 10.65 [5.86-19.8] in Korea), compared to young adults in social groups with no experience. Young adults in social groups who had experienced all three types of risky sexual behaviours had a 10 times higher likelihood of engaging in post-drinking risky sexual behaviours in the French sample (10.12 [3.69-31.4]) and a 16 times higher likelihood in the Korean sample (16.0 [7.31-35.8]). Conclusions Alcohol-related risky sexual behaviours among young adults were found to be significantly associated with their social group’s drinking and risky sexual behaviours, across different cultural settings. More attention should be paid to direct/indirect influence of social groups on health risk behaviours. Key messages • The influence of social groups on alcohol-related risky sexual behaviours is significant regardless of cultural setting. • Peer and social norms-based health promotion is recommended to prevent IST and HIV/AIDS.

Adoption of Cashless Payment Among Undergraduate Students: A Case Study

The increasing acceptance of cashless payment systems has led to a significant transformation in the global financial transaction landscape in recent years. As technology evolves and consumer preferences shift, digital payment methods are gradually taking the place of traditional cash transactions. This change not only facilitates financial transactions for individuals and businesses but also has significant implications for convenience, security, and financial inclusion. This paper investigates the key factors driving the transition to cashless transactions during this period, along with the benefits and drawbacks associated with society's growing embrace of this innovative approach to managing finances. The primary focus of research in this area revolves around the adoption and use of digital or cashless payment methods. A quantitative methodology was employed, and a questionnaire was administered to 113 participants. The data were analyzed using the Statistical Package for Social Science (SPSS) Version 27. The findings indicated that Performance Expectancy (PE) and Perceived Technology Security (PT) played significant roles in the adoption of cashless payments among undergraduate students while Facilitating Condition (FC) and Social Influence (SI) did not significantly affect their adoption of such payment methods. This study provides valuable insights into assessing individuals' willingness, intentions, or actual behaviors regarding various electronic transaction forms, including mobile wallets, credit/debit cards, online payments, and contactless methods. Additionally, researchers can utilize these variables to explore the factors that influence users' acceptance or rejection of cashless payment systems.

Utilization of, Perceptions on, and Intention to Use AI Chatbots Among Medical Students in China: National Cross-Sectional Study.

Artificial intelligence (AI) chatbots are poised to have a profound impact on medical education. Medical students, as early adopters of technology and future health care providers, play a crucial role in shaping the future of health care. However, little is known about the utilization of, perceptions on, and intention to use AI chatbots among medical students in China. This study aims to explore the utilization of, perceptions on, and intention to use generative AI chatbots among medical students in China, using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. By conducting a national cross-sectional survey, we sought to identify the key determinants that influence medical students' acceptance of AI chatbots, thereby providing a basis for enhancing their integration into medical education. Understanding these factors is crucial for educators, policy makers, and technology developers to design and implement effective AI-driven educational tools that align with the needs and expectations of future health care professionals. A web-based electronic survey questionnaire was developed and distributed via social media to medical students across the country. The UTAUT was used as a theoretical framework to design the questionnaire and analyze the data. The relationship between behavioral intention to use AI chatbots and UTAUT predictors was examined using multivariable regression. A total of 693 participants were from 57 universities covering 21 provinces or municipalities in China. Only a minority (199/693, 28.72%) reported using AI chatbots for studying, with ChatGPT (129/693, 18.61%) being the most commonly used. Most of the participants used AI chatbots for quickly obtaining medical information and knowledge (631/693, 91.05%) and increasing learning efficiency (594/693, 85.71%). Utilization behavior, social influence, facilitating conditions, perceived risk, and personal innovativeness showed significant positive associations with the behavioral intention to use AI chatbots (all P values were <.05). Chinese medical students hold positive perceptions toward and high intentions to use AI chatbots, but there are gaps between intention and actual adoption. This highlights the need for strategies to improve access, training, and support and provide peer usage examples to fully harness the potential benefits of chatbot technology.

What matters in the linkage between value orientations and usage behavior of electric ride hailing service?

PurposeThis research aims to investigate the relationship between value orientations, attitude, behavioral intention and usage behavior of electric ride hailing service in Vietnam through the moderating role of social influences.Design/methodology/approachIn total, 552 valid questionnaires were collected using the survey questionnaire to analyze the effects of value orientations on attitude toward electric ride hailing and behavioral intention. Besides, this study investigates the mediating effect of attitude toward electric ride hailing and behavioral intention in the relationship with the behavior usage of electric ride hailing service as well as the moderating effect of social influence.FindingsThree types of value orientations stimulate attitude toward electric ride hailing service and behavioral intention. In addition, attitude toward electric ride hailing service and behavioral intention play the mediating role in the effect of value orientations on behavior usage. Specifically, social influence plays a negative moderating role in the linkage between attitude towards and behavioral intention of electric ride hailing service and between intention and the behavior usage.Originality/valueWhile numerous studies have investigated the influence of customers’ value orientations on multiple green purchase behaviors, this study offers new insights into the moderating role of social influence in the linkages between attitude, behavioral intention and usage behavior of electric ride hailing service.

Innovating Community Engagement: The Role of Micro-Influencers in Promoting Sustainable Behaviors among Malaysian Millennials

Social Influencers as environmental leaders utilize social media platforms to enhance community engagement in advocating sustainability. This study explores the underexplored role of micro-influencers in fostering pro-environmental behaviors among Malaysian youths and innovating community engagement by employing a qualitative approach in conducting semi-structured interviews with five micro-influencers. Our findings indicate the critical role of micro-influencers in raising awareness and actively engaging communities in adopting sustainable practices. The findings reveal three key themes: leadership qualities, pro-environmental behaviors, and persuasive narrative strategies. Through the innovative use of social media, these influencers overcome linguistic and geographical barriers, fostering enhanced community engagement in the pursuit of environmental stewardship. However, the sample size of five micro-influencers may limit the generalizability of the findings, as it may only partially represent the diverse range of micro-influencers. The result of this research can be used as recommendations for organizations, non-governmental organizations and governmental bodies that can leverage the insights from this study to strategically engage micro-influencers in environmental campaigns, recognizing their unique ability to reach and resonate with specific communities, particularly Malaysian youths. This study offers a novel perspective on digital environmental leadership by uncovering the unique role of micro-influencers in fostering community engagement and cultivating a culture of sustainability. It provides original insights into how these emerging leaders not only inspire but also empower communities to take meaningful action toward environmental preservation. The study highlights the underexamined potential of micro-influencers in exceeding traditional barriers to community engagement, offering valuable implications for future strategies in environmental advocacy.

Factors predicting innovation-decisions: The effects of performance expectancy, social influence, and facilitating conditions on U.S. Extension’s promotion of precision agriculture technologies

Factors predicting innovation-decisions: The effects of performance expectancy, social influence, and facilitating conditions on U.S. Extension’s promotion of precision agriculture technologies

Needs and perceptions regarding healthy eating among people at risk of food insecurity in the Netherlands

Abstract Background Healthy eating behaviour is an essential determinant of overall health. This behaviour is generally poor among people at risk of experiencing food insecurity, which may be caused by many factors including perceived higher costs of healthy foods, financial stress, inadequate nutritional knowledge, and inadequate skills required for healthy food preparation. Few studies have examined how these factors influence eating behaviour among people at risk of experiencing food insecurity. We therefore aimed to gain a better understanding of the needs and perceptions regarding healthy eating in this target group. Methods We conducted a qualitative exploration with 10 participants at risk of experiencing food insecurity in the Netherlands. Results and conclusions The analysis using an inductive approach identified four core factors influencing eating behaviour: Health related topics; Social and cultural influences; Influences by the physical environment; and Financial influences. Overall, participants showed adequate nutrition knowledge. However, eating behaviour was strongly influenced by social factors and physical environmental factors. Perceived barriers for healthy eating behaviour included poor mental health, financial stress, and high food prices. Participants had a generally conscious attitude towards their financial situation, reflected in their strategies to cope with a limited budget. Participants were familiar with several existing resources to reduce food-related financial strain and generally had a positive attitude towards these resources. An exception was the Food Bank, of which the food parcel content was not well appreciated. Proposed interventions to reduce food-related financial strain included facilitating social contacts, increasing healthy food supply in the neighbourhood, and lowering prices of healthy foods. The insights from this study increase understanding of factors influencing eating behaviour of people at risk of food insecurity.

Food depiction in posts of the most popular Lithuanian influencers on Instagram and Facebook

Abstract Background Considering that content published in social networks might act as risk factor to health, we aimed to assess the prevalence of posts depicting food published by Lithuanian influencers on Facebook and Instagram. Materials and methods All publicly available posts (6425 in total) created by 21 most popular Lithuanian influencers on Facebook and Instagram in 2022 were included. The content analysis of the posts was performed and information about food and other health-related factors was registered. Distribution of the posts depicting food was assessed according to social networks, gender, age, and number of followers of influencers. Results Every fourth (22.6%) post presented foods. Among these posts, fast food was presented in 10.2%, sweets - in 35.5%, vegetables - in 59.5%, fruits and berries - in 40.7%, cereals - in 39.2%, dairy products - in 36.8%, meat - in 26.6%, sea food - in 12.1%. Overall, women, older influencers, influencers with higher number of followers more frequently posted posts depicting vegetables (respectively, 21.0% vs 5.5%, 18.6% vs 6.7%, 18.3% vs 9.3%), fruits and berries (respectively, 14.5% vs 3.8%, 12.0% vs 6.4%, 11.4% vs 8.3%), cereals (respectively, 13.7% vs 4.7%, 12.2% vs 5.6%, 11.2% vs 8.2%), dairy products (respectively, 13.0% vs 3.2%, 11.0% vs 5.0%, 10.8% vs 6.3%), meat (respectively, 8.6% vs 4.1%, 7.9% vs 4.4%). Women and older influencers more frequently depicted sweets (respectively, 13.3% vs 7.1%, 12.6% vs 7.1%), sea food (respectively, 4.4% vs 1.5%, 3.8% vs 2.0%). More posts portraying food in general, fast food, vegetables, milk and dairy products were posted on Instagram (respectively, 27.5% vs 19.8%, 3.4% vs 2.1%, 16.6% vs 13.4%, 10.0% vs 8.3%) (p ≤ 0.05). Conclusions Every fourth post depict food, more frequently on Instagram. Healthy and unhealthy foods are presented with similar frequency. Female influencers, older influencers and influencers with higher number of followers more frequently depict foods. Key messages • Both healthy and unhealthy foods are presented with similar frequency on social networks – this might lead to the overconsumption of unhealthy foods. • Differences in depiction of foods between social networks and influencers with different gender, age and number of followers should be taken into account when implementing public health interventions.

The Effect of Social Media on the Decision to Have Aesthetics or Cosmetic Procedure: A Case-Control Study.

Aesthetics or cosmetics procedures are among the most commonly performed procedures. More people are getting cosmetic treatments because of social media use. The study looked into the influence of social media on cosmetic dermatology decisions in Jordan. We conducted a community-based comparative case-control study among the adult Jordanian population through an online structured questionnaire. The total number of participants was 2704 (1629 cases vs. 1084 controls). The mean age was 26.3 years. Females constituted 90.4% of the aesthetic procedures group and 80.6% of the non-aesthetic procedures group. Participants who underwent aesthetic procedures were likelier to use social media, report that social media helped them, and post photographs on Instagram, Snapchat, and WhatsApp more than those who did not (p < 0.001 for all). The majority of participants underwent aesthetic procedures obtained from their thoughts. The aesthetic procedure group was influenced more by Instagram (p < 0.001), Facebook (p = 0.034), and Snapchat (p < 0.001). Self-satisfaction with one's appearance was the main reason not to pursue an aesthetic procedure (58%) while repairing damage was the most common reason to undergo the procedure (76%). Acne scarring treatment (49.9%) was the most popular procedure. About 52.7% of procedures were performed by a dermatologist. Social media directly affects people's decisions to perform aesthetic procedures. Facebook, Snapchat, and Instagram showed more influencing effects on aesthetic procedures. People who have done aesthetic procedures were likelier to utilize social media, follow aesthetic dermatologists, practitioners, or social media influencers, and support aesthetic procedure advertisements. To achieve better outcomes, the rising numbers of cosmetic procedures based on social media necessitate the dermatologist or practitioner to develop a good understanding of patients' motivations to seek aesthetic dermatological procedures. Level of Evidence III, case-control study This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Record linkage as a vital key player for the COVID-19 syndemic

Abstract Chronicity, comorbidities, and social context influence COVID-19 risk and prognosis, drawing attention to a syndemic dimension. We discuss how linking routinely collected data and data collected through observational population-based cohorts can contribute to advance knowledge on the association between COVID-19 and chronic diseases and social indicators. Record linkage as a multidimensional tool may ultimately enable defining and optimizing of integrated strategies, which may create multilevel public health measures to foster solidarity on health in all policies when ethical and legal barriers under prerequisite data protection and privacy can be overcome. Legal discrepancies have been proving detrimental to research in member states, including those which already had established a margin for research for the common good without explicit consent. We hence call for further harmonization of data protection requirements for scientific research activities in the EU/EEA, focusing in particular on health-related research. A proposed framework demonstrates the role of record linkage as a trailblazing key player in research optimization due to its multidimensional possibilities calling for harmonization. Key messages • Further harmonization of data protection requirements for scientific research may create multilevel public health measures. • As a multidimensional tool, it optimizes integrated strategies and fosters solidarity on Health in All Policies (HiAP).

Role of Innovation, Policy, Social Media, and Environmental Munificence for Sustainable Ecotourism Development in Punjab, India

Sustainable ecotourism is tourism that meets the prerequisites of responsible travel and environmental conservation and improves the financial well-being of local businesses. This study investigates the role of ecotourism policy, innovation, and social media as direct antecedents of sustainable ecotourism development and the moderating role of environmental philanthropy. A quantitative process was used, and existing validated scales were used to develop the survey instrument. A partial least squares path modeling technique was utilized to test the model. The study results show that ecotourism policy, innovation, and social media significantly influence ecotourism development, and environmental munificence determines the moderating role. This study suggests that tourism firms and local businesses should focus more on innovations and their applications. The role of social media and influences should also be extensively promoted amongst locals, tourists, and firms to achieve sustainable ecotourism development. This study extends the research by using the sustainable tourism theory as the theoretical foundation and validating the moderating role of environmental munificence between innovation and sustainable ecotourism development.