Socio-ecological Model Research Articles

Men's mourning experiences for the death of a loved one: An integrative review.

To analyze the current state of knowledge regarding men's mourning experiences following the death of a loved one. An integrative review was conducted using quantitative, qualitative, and mixed-methods studies published in English or Spanish between 2017 and 2022 that investigated men's mourning experiences. Studies focused on grief in participants with different sexes or gender identities, maladaptive grief, persistent complex bereavement disorder, prolonged grief disorder, bereavement over pets, or losses other than a human death were excluded. Additionally, reviews, books, theses, editorials, and opinion pieces were not included. The search was conducted in CINAHL, PubMed, and Scopus in 2023. JBI tools were used for quality appraisal, and the analysis employed the constant comparative method. Our analysis of eight English-language documents with evidence levels IV-VI, informed by the Socioecological Model of Men's Grief, revealed that factors at individual, interpersonal, community, and public policy sublevels interact significantly to shape men's grief experiences. Themes emerged along a continuum of intuitive and instrumental coping responses, including adaptive and maladaptive coping strategies, loneliness and social support needs, the influence of societal constructions of masculinity and the grieving process in men. Men's mourning experiences are complex and multifaceted, influenced by diverse expressions of masculinity and the interaction of various contextual factors. The Mental Health Nursing Process should prioritize understanding and addressing the unique experiences of bereaved men.

Abstract 4120312: Patient Perspectives on Barriers and Facilitators to Familial Hypercholesterolemia Cascade Testing Through the Lens of the Socio-Ecological Model

Background: Low uptake of Familial Hypercholesterolemia (FH) cascade testing, the stepwise identification of at-risk relatives, leads to missed opportunities for atherosclerotic cardiovascular disease (ASCVD) prevention. The IMPACT-FH study offered strategies (packet, chatbot, and direct contact) to support FH cascade testing. Hypothesis: We hypothesized that IMPACT-FH strategies would facilitate cascade testing uptake and overcome persistent barriers to cascade testing. Aim: We aimed to understand barriers and facilitators to FH cascade testing in the context of the socio-ecological model (SEM) which provides a framework to examine the interconnected influences of intrapersonal, interpersonal, institutional, community, and policy levels. Methods: Semi-structured interviews were conducted with IMPACT-FH study participants. The SEM informed qualitative analysis to identify barriers and facilitators to FH cascade testing. Results: A total of 15 FH probands (initial family member tested) and 12 relatives were interviewed, of whom the majority (59%) were female with an average age of 55.7 years. All relatives completed cascade testing. At the interpersonal level, probands reported that relatives’ attitudes about high cholesterol, including seriousness and treatability, were a barrier or facilitator to cascade testing. Probands explained how relatives’ beliefs were informed by interactions with their clinicians and societal beliefs about cholesterol (i.e., medication stigma). Interpersonally, probands described challenges overcoming relatives’ beliefs and a reluctance to encourage relatives to complete testing despite the availability of novel strategies. Probands and relatives reported that insurance policies and concerns about testing costs informed cascade testing decision-making. Institutional strategies to provide low-cost testing and cost transparency were described as facilitators. Variable access to clinicians with genetics expertise and licensure laws were described as barriers by out-of-state relatives. Probands and relatives agreed that strategies providing direct access genetics expertise (i.e., direct contact, chatbot) helped address these barriers. Conclusion: The IMPACT-FH study ameliorated barriers at higher levels of the SEM related to access to genetics expertise and cost. Intra- and interpersonal barriers remained challenging to overcome. To improve FH detection and ASCVD prevention, it is important to address barriers at all levels of the SEM.

A multi-method feasibility trial of a multi-component behaviour change intervention to reduce sedentary behaviour and increase physical activity among ethnically diverse older adults

IntroductionEvidence suggests that sedentary behaviour (SB) and physical activity (PA) are important indicators of well-being and quality of life in older adults (OAs). However, OAs are the least active and...

Ask Your Relative: A mixed method analysis of the Sexual Health and Healthy Relationship Q&As submitted by American Indian Alaska Native young adults

BackgroundDisparities in sexual health outcomes persist among American Indian and Alaska Native (AIAN) youth due to intersectional challenges accessing youth-friendly health services. AIAN youth have an increased prevalence of STIs and teen pregnancy. To address disparities in sexual health outcomes, the Ask Auntie/Ask Your Relative (AYR) Q&A service has been used by AIAN youth and young adults for over seven years as a trusted resource for information on sensitive health topics. There is a continued need to better understand the health-seeking behaviors of AIAN youth, especially those related to healthy relationships and sexual health, to improve the alignment of health resources to their needs.MethodsThis mixed-method study began with two phases. Phase 1 involved an analysis of all AYR data using Google Analytics and basic frequency counts. Phase 2 reviewed all questions and answers related to sexual health and healthy relationships (N = 240) using thematic analysis, NVivo 12.0, and intersectionality, guided by the social determinants of health. All AYR answers were coded based on type, name/location, number of times viewed, and examples. The final step of the analytic process was to utilize an intersectional approach and socioecological model (Individual, Community, Tribe/Nation, and World) to create a visual model with results.ResultsPhase 1—Since We R Native began tracking AYR data, the service has been utilized by 2.37 M users, with 1.16 M unique pageviews. The average time on the page was 4 min and 46 s. The number of AYR questions submitted varied by year, and were most frequent in 2016, then decreased in subsequent years. In Phase 2, the main themes identified in AYR questions were (1) Reaching Out for Help, (2) Identity and Physical Development, and (3) Healthy Relationships. Analysis of the Q&A answers identified 244 resources, and of these, 100 were Native-specific. The context-specific resources represented 21 uniquely coded health topics, ranging from women's health to behavioral health.ConclusionsThe broad range of healthy relationship and sexual health questions submitted to the AYR service reflects the types of health information that AIAN young adults want to know about. Resources provided in response to their questions connected Q&A viewers to a wide variety of organizations and programs designed to support AIAN young adults in their health and wellness journey. Findings from this study may be useful for creating additional culturally tailored resources.

The internal relationship of college students’ physical exercise behavior and related factors based on ecological model

Background: The persistence of college students’ physical exercise behavior has an important impact on their physical health level and their positive psychological effects. The health behavior ecology model is more comprehensive and progressive than other exercise psychology theories in explaining the effect of physical activity intervention on long-term maintenance. Based on this, In this study, using the socio-ecological model theory as the entry point, applying five different levels of influencing factors in the theoretical model to the field of adolescent physical exercise behavior, The aim is to seek the internal connection between the ecological factors that promote college students’ physical exercise behavior through the investigation, so as to provide corresponding intervention strategies for promoting the healthy development of their physical fitness. So as to promote the formation of college students’ physical exercise habits. Methods: In 2023, 1015 college students were surveyed by questionnaire and measurement scale, followed by descriptive statistical analysis of college students’ current physical exercise behavior, and factor analysis of ecological factors affecting college students’ physical exercise. Results: From the behavior characteristics of college students’ physical exercise, different gender of college students in physical exercise, weekly exercise, exercise time is very significant difference (P < 0.001), the boys in sports participation higher than girls 15.2%, choose occasionally exercise boy’s ratio 10% higher than girls, girls do not participate in exercise more than boys. In terms of exercise time, a few boys choose to do physical exercise on weekends; the proportion of boys in more than 60 min of physical exercise is 7 percentage points higher than girls. In the time of extracurricular exercise, support of parents and physical exercise (P < 0.05), there was no significant difference between male and female students in the aspects of intensity of each exercise, participation in sports competition and reasons for not exercise (P > 0.05). The principal component analysis of the influencing factors of college students’ physical exercise behavior was conducted from the individual, family, school, community, and policy levels. The KOM value was 0.984, which met the judgment criteria of factor analysis. Through principal component analysis of the above five levels, according to the requirements of factors greater than 1, the individual level, family level, school level and policy level respectively two factors, corresponding cumulative contribution rate is 56.545%, 595.350%, 64.870% and 85.700% respectively, community level three factors, corresponding to the cumulative contribution rate of 76.450%. Conclusion: The advantage of the health behavior ecology model is that the comprehensive intervention strategies based on multi-level, multi-level effects greatly expand people’s understanding of the intervention. This model is applied to the field of physical health promotion of college students, to study human exercise behavior through the joint action of physiological, psychological and environmental factors, so as to more comprehensively reveal the various factors of exercise behavior, as well as the mutual relationship and influence between them. The results of this study indicate that: among the ecological factors that affect the physical exercise behavior of college students, the individual factors of college students are a necessary condition for physical exercise, while family, school and community factors affect the direction of the change and development of college students’ physical exercise behavior. Policy factors are a powerful driving force for college students’ physical exercise behavior. Only by considering the relationship between the relevant factors can we better understand the characteristics of college students’ physical exercise development, put forward the corresponding intervention strategies, and promote the formation of college students’ physical exercise habits through effective ways.

Factors Associated with Suicidal Behavior in Adolescents: An Umbrella Review Using the Socio-Ecological Model.

Adolescent suicide is a critical social issue with profound and lasting individual and collective consequences. This umbrella review examines factors associated with adolescent suicidal behavior through the socioecological framework of prevention and seeks to identify gaps in the existing literature. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included a comprehensive search of the of the Web of Science, Scopus, and Cochrane databases in both English and Spanish, covering the period from 2018 to 2024, using terms related to adolescence and suicidal behavior. Out of 6,138 articles identified, 37 met the quality criteria and were selected for analysis. The studies highlighted individual risk factors such as age, gender, belonging to ethnic or gender minorities, emotional disorders, self-destructive behavior, emotional regulation, and experience of physical or emotional pain. Interpersonal factors such as parental relationships, sexual abuse, social isolation, peer pressure, and loneliness were also found. However, the review revealed a worrying lack of studies on societal and community factors and a paucity of research focusing on protective factors. The study highlights the need to include factors related to the physical and social environments that influence health and behavior in future research, as well as to enhance the resources and strengths of adolescents.

Perceived patient navigator services and characteristics to address barriers to linkage to hepatitis C care among people released from provincial prison in Quebec, Canada

BackgroundPatient navigation increases linkage to hepatitis C virus (HCV) care following release from prison; however, little is known about the services patient navigators should provide to maximize linkage to care. We aimed to identify perceived barriers and facilitators to linkage to HCV care post-release, and to determine patient navigator services and characteristics best suited to address barriers to linkage to care among people released from prison. MethodsTen semi-structured interviews were conducted with adult (age ≥ 18 years) men living with chronic HCV, released from the largest Quebec provincial prison, and linked to HCV care by a patient navigator. Interviews were guided by the Socio-Ecological Model (SEM) and aimed to explore the multi-level barriers and facilitators to linkage to HCV care post-release. Interviews were audio-recorded, transcribed, and analyzed using a deductive, thematic approach. ResultsThe median age of participants was 54 years. Barriers to linkage to HCV care included competing priorities post-release (e.g., substance use, mental health issues, unstable housing), stigma (related to HCV, injection drug use, and incarceration), and lack of transportation. Facilitators included social support, established relationships with existing healthcare providers, prior cure with direct-acting antivirals, and HCV-related health literacy and knowledge. Perceived essential patient navigator services to enhance linkage included pre-release discharge appointments, housing assistance, and facilitated transportation to HCV appointments. Ensuring a consistent, non-judgemental, and empathetic patient navigator were considered important characteristics; lived experiences of incarceration and/or HCV were not felt to be essential for a patient navigator. ConclusionsInterventions that seek to improve linkage to HCV care for people following release from prison should address many levels (individual, interpersonal, and policy) of the SEM. While people experience several competing priorities post-release, having an empathetic and consistent patient navigator, regardless of their lived experiences of HCV and/or incarceration, may improve linkage to HCV care post-release.

Associations Between Personality Traits and Emotional Experiences as Predictors of Obesity During the COVID-19 Pandemic: A Cross-Sectional Study

This quantitative cross-sectional descriptive research aimed to investigate the relationship between personality traits, emotions, and obesity among Saudi adults during the COVID-19 pandemic. The study recruited 383 participants from Riyadh using non-probability sampling. A validated online survey, including the PANAS-SF and BFI-10 measures, was used and hosted on Qualtrics. Descriptive and multiple regression analyses were performed on the data. The study found that conscientiousness was the highest personality trait among the sample, with an average score of 7.74, while the mean for openness was the lowest. The incidence of obesity was high among participants, with a rate of 29.2%. Furthermore, there was a significant relationship between negative affect and obesity (p=0.033). Based on these findings, public health specialists and health promoters should design programs using the socio-ecological model as a guide to address the important factors at every level of the model.

Using citizen science to explore barriers and facilitators for healthy and sustainable lifestyles in office environments

The socio ecological model states that individual behaviors at work are shaped by the interactions between individual employees and their work environments. This study used citizen science to gain insights into which elements of the built, social, and organizational environment in an office and surrounding neighborhoods in two Swedish cities were perceived as barriers to or facilitators of healthy and sustainable behaviors at work. Participants in the eight-week Sustainable Office Intervention pilot study (SOFIA) (n = 33) were cluster-randomized into an experimental arm (sustainable lifestyle) or a control intervention arm (healthy lifestyle). They used the Our Voice Healthy Neighborhood Discovery Tool mobile app to document contextual elements at their workplaces. In total, 114 photos and text-based narratives were recorded, and four themes emerged: built environment, building design, office ergonomics, and food and beverages. Eighteen percent of the photos were linked to pro-environmental behaviors, all exclusively captured by the experimental arm. Twelve barriers and solutions for improving the workplace environment were identified during discussions with participants in both arms. The findings provide insights for designing or renovating office spaces and urban planning to promote healthier and more sustainable lifestyles for office workers.

A behavioural perspective on pandemic preparedness

Abstract Driven by lessons learned from the COVID-19 pandemic, the RIVM Behavioural Unit is working on the preparedness of social and behavioural sciences. This includes establishing and maintaining a stakeholder network and a knowledge base on pandemic preparedness and behaviour. Using the socio-ecological model and the emergency management cycle, we propose a conceptual framework for a behavioural perspective on pandemic preparedness. The multilevel (individual, community, organisational, national and supra-national), time-dependent (cold, acute, recovery phase) structure of the framework can be helpful in explicating who has to do what, when. In addition, to explain and understand what different actors require for those behaviours prior to or during a pandemic, we propose an adapted version of the COM-B model (Michie et al., 2011), including determinants of behaviour related to motivation, capabilities and opportunities. Based on these frameworks, various monitoring tools are developed. Here we present the Pandemic Preparedness and Behaviour (PPb) survey aimed at cold phase monitoring behaviour on an individual level (i.e. hygiene behaviours, social activity, preparedness behaviours) and their determinants. With this survey we will obtain baseline measurements ahead of a possible future pandemic and will have developed the appropriate tools to be used in a hot phase for as much as possible. In addition, results on cold phase determinants can help to identify where communities, organisations and governments can provide support to improve pandemic preparedness. In this presentation, the proposed conceptual framework and the PPb survey will be discussed, together with their relevance for preparedness of the social and behavioural sciences.

Out of sight, into mind: a socioecological model-informed qualitative study on barriers and facilitators to hepatitis B care among West African immigrants in the Bronx, New York

BackgroundThere is a high burden of hepatitis B virus (HBV) in West Africa. Over the past 20 years, West African immigration to the United States (U.S.) has been increasing. Prevalence of HBV infection in West Africa has been reported to be as high as 5–10%.MethodsWe sought to understand knowledge and attitudes of and barriers and facilitators to HBV screening, vaccination, and treatment in a cohort of West African immigrants in the Bronx living with or at risk for HBV through a series of one-on-one qualitative interviews. We interviewed 23 West African immigrants and analyzed transcripts for recurring themes using Applied Thematic Analysis. We situated our analysis in the socioecological model (SEM) and adhered to the consolidated criteria for reporting qualitative research (COREQ).ResultsMultiple themes emerged, most prominently themes relating to HBV knowledge/awareness, trust in U.S. healthcare providers and the U.S. healthcare system, positive social support improving healthcare access, knowledge sharing, stigma towards those with HBV, issues concerning immigration status, insurance status, and access to healthcare services.ConclusionRaising awareness of HBV, addressing social and structural barriers such as stigma and health insurance, and improving access to culturally sensitive programs among West African communities are needed to increase HBV screening, vaccination, and linkage to care.

Strategic Communication and Socio-Ecological Imperatives for Re-Marketing the Nigerian Brand

The thrust of this paper is to examine select factors within the social and ecological realms that are attributed to the image crises of Nigeria and to proffer sustainable strategic communication solutions to re-marketing the nation as a brand. The de-marketing process of the brand Nigeria is a function of some obvious factors like corruption, bribery, ethnicity, communal and ethno-religious clashes. Consequently, almost everything ‘Nigerian’, whether human beings or products, is questioned or received with greater comparative scepticism, especially within the international community. Nigeria is no doubt in dire need of a corporate reformation and a review of the nation’s socio-ecological posture and experience will offer a headway for the re-marketing of the brand. This paper adopts the analytical methods for the review of strategic communication and the Socio-Ecological Model, using selected scenarios in Nigeria as units of analysis. Findings reveal that Nigeria’s albatross as an unattractive brand is the moral decadence of her citizens occasioned by a lack of adequate information of citizens, absence of motivation and ability to act, and the inherent norms that the people live with. This has thwarted the nation’s (re)branding management efforts. This paper recommends that the Federal government of Nigeria should re-orient her citizens from the now youngest generation and re-order her communication architecture to communicate a renewed Nigerian brand that will help the nation’s image to be attractive for a convincing patronage within the international market.

Moving toward a decolonial and intersectional notion of justice for socio-ecological problems: the urban agroecology of the Buckets Revolution

ABSTRACT This article analyses the Buckets Revolution, an urban agroecological movement in a Brazilian favela that emerged to address waste management issues. We aim to explore the movement’s achievements in promoting socio—cological justice in a vulnerable community of the Global South through agroecology, investigating: i) what socio-ecological problems and intersected demands for justice boosted the emergence of the Buckets Revolution? and ii) what demands for justice the BR has been dealing with to overcome the socio-ecological injustices borne by the Chico Mendes community? We apply the socio-ecological justice model as our theoretical framework, with a decolonial and feminist intersectional approach to embrace the complexity of the case study. The research methods focus on embracing the local reality and the community views, encompassing bibliographical research, a focus group, and semi-structured interviews. The findings reveal that this agroecological movement has effectively addressed organic waste management, food insecurity, and other socio-ecological issues, contributing to socio-ecological justice in the Chico Mendes community. The study emphasizes the importance of considering the a) interconnections of social and ecological problems, b) intersected dimensions of justice, and c) needs and views of the community when developing environmental urban policies to achieve social justice and ecological sustainability.

Health promotion at local level in Portugal: is childhood obesity a concern in municipal programs?

Abstract Health promotion programs targeted at distinct health outcomes such as childhood obesity, at local level are increasingly used worldwide. There is a need to better understand the role of local governments (municipalities) as key public health promoters namely in the prevention of obesity in children. This study aims to provide some input regarding this issue in Portugal. In order to achieve this goal, health enhancing programs promoted by Portuguese municipalities in which children could participate were identified. The search of such programs was limited to the municipalities that were part of the Portuguese Network of Healthy Municipalities in 2021 (N = 57). A subsequent document analysis was conducted to describe how municipalities conceptualized children’s health by retrieving information on which topics the programs were focused on, or acted upon, and identify which socio-ecological model levels of health determinants were addressed (or not) by each program. The 77 identified programs were promoted by 30 municipalities and only 11 programs addressed childhood obesity. Most programs focused on the individual health determinants (N = 27) and provided limited information overall, which hindered a more in-depth analysis. The findings suggest that Portuguese municipalities seem to disregard their potential as public health promoters. Childhood obesity is a major public health concern at national level, as reflected in the National Health Plans, but not perceived as such locally. Municipalities are the closest government entities to the population, and it is their responsibility to ensure the population’s quality of life, by addressing the social and environmental determinants of health. Hence, municipalities should instill health concerns in all their actions/interventions, taking in consideration the most recent evidence, specifically in the case of childhood obesity. Key messages • This study findings suggest that, despite childhood obesity being a major public health concern at national level, as reflected in the National Health Plans, it is not perceived as such locally. • There is a need to better understand the role of municipalities as key public health promoters considering they are responsible to intervene on the social and environmental determinants of health.

Exploring Individual Components of Sport Persistence in the Light of Gender, Education, and Level and Type of Sport

Background/Objectives: Sport persistence can be coded as an indicator of sport performance and commitment, incorporating personality traits such as resilience, adaptive coping, and positive personality traits. Thus, athletes do not merely persist in sporting activities but are qualitatively committed to them. Methods: In the present research, we used a qualitative methodology to investigate the factors underlying sport persistence, using Bronfenbrenner’s socio-ecological model. In total, 133 high school and college student-athletes were surveyed in a semi-structured interview study. We set the following research question: How do the factors involved in developing sport persistence vary across athletes’ gender, level of study, and level and type of sport? Data were analyzed along the lines of grounded theory. ATLAS.ti and IBM SPSS 22.0 statistical software were used for the analysis. Results: Our analysis divided individual motivation into intrinsic (health promotion, habituation, becoming a competitive athlete, self-improvement, self-actualization, relaxation, and sport enjoyment) and extrinsic motivation (family-related motivation, coach, social relationships, competition, livelihood, recognition). The cross-tabulation analysis revealed that contrary to the general trend, no significant differences can be experienced in the core motivational patterns contributing to sport persistence. However, significant differences could be detected concerning the level of education, level of sporting activity, and type of sport. Conclusions: Our findings not only shed light on the unique factors underlying sport persistence, but also challenge the trends observed in traditional sport motivation analyses. This insight could potentially revolutionize how we approach youth sport promotion and physical activity among young people, making our research highly relevant and impactful.

The role of emotion regulation in decreasing alcohol harm for veterans

Using the socio-ecological model, this study aims to understand factors associated with alcohol misuse in veterans of the New Zealand Defence Forces, and identify approaches for reducing harm. Using interviews, veterans were asked to recount their relationship to alcohol, and provide a narrative of its use before, during and after military service. Seven themes were identified including bars and drinking as 1) social hubs; and 2) social lubrication; providing others with 3) duty of care; the military 4) consequences of harmful drinking; and use of alcohol as 5) emotion regulation strategies; with the impact of that on 6) Civvy street, and 7) family impacts. Duty of care in military drinking environments is a new theme to the literature. Introducing emotion regulation training throughout the personnels’ career, from transition to becoming civilians and beyond, was identified as key to effective health marketing interventions.

Assessing the state of infection prevention and control in cameroon: a cross-sectional workshop evaluation using socioecological models

ObjectivesInfection prevention and control (IPC) contributes to the reduction of healthcare associated infections. Notwithstanding the global attention with available guidelines and tools, low- and middle-income countries (LMICs) still struggle to put into place effective IPC programmes. Here, we use a socioecological approach to summarize the findings of a recent workshop on the implementation of IPC activities in Cameroon. Study designWe conducted a cross-sectional study on the assessment of the IPC in Cameroon. MethodsExperts and key stakeholders involved in IPC in Cameroon evaluated the implementation of infection prevention and control during a 4-day workshop. Detailed summaries of workshop discussions and recommendations were created. Data were clustered into themes guided by the WHO core component of IPC. Results were analyzed using the socioecological model of Bronfenbrenner, McLeroy and the theory of Grol and Wensing on successful implementation of practices in healthcare settings. ResultsCameroon does not have an effective IPC programme in place but has developed some areas of the World Health Organization (WHO) IPC core components across the guideline level, the individual level, the organizational level, and the political level. ConclusionCameroon is still far from the norms and standards laid out by the WHO. The evidence generated from the current analysis should contribute to improve policies and strategies towards an effective IPC programme in Cameroon and other LMICs.

Tackling inequalities in preconception health and care: barriers, facilitators and recommendations for action from the 2023 UK preconception EMCR network conference.

Reducing inequalities in preconception health and care is critical to improving the health and life chances of current and future generations. A hybrid workshop was held at the 2023 UK Preconception Early and Mid-Career Researchers (EMCR) Network conference to co-develop recommendations on ways to address inequalities in preconception health and care. The workshop engaged multi-disciplinary professionals across diverse career stages and people with lived experience (total n = 69). Interactive discussions explored barriers to achieving optimal preconception health, driving influences of inequalities and recommendations. The Socio-Ecological Model framed the identified themes, with recommendations structured at interpersonal (e.g. community engagement), institutional (e.g. integration of preconception care within existing services) and environmental/societal levels (e.g. education in schools). The co-developed recommendations provide a framework for addressing inequalities in preconception health, emphasising the importance of a whole-systems approach. Further research and evidence-based interventions are now needed to advance the advocacy and implementation of our recommendations.

Interaction of perceived Chinese campus walkability and psychosocial factors on college students’ walking behavior

Walking, a physical activity beneficial for both physical and mental health, is influenced by various factors. Although previous studies have acknowledged that walking behavior is influenced by environmental and psychosocial factors, little is known about their interactions. Based on a socio-ecological model and focusing on Chinese college students, the purpose of this study was to examine the influence of campus walkability and psychosocial factors on college students’ walking behavior, including the interactions between these factors. This study seeks to enhance understanding of how to promote walking behavior through campus environmental design and psychological interventions. Multiple regression analysis was conducted on the questionnaire data. Findings revealed that campus walkability significantly influenced both walking behaviors, alongside psychosocial factors such as attitude, self-efficacy, perceived benefits, perceived barriers, and subject norms. Additionally, significant differences in interaction effects between these factors were observed for purposeful versus recreational walking behaviors. These interactions suggest that campus walkability more substantially promotes walking behavior in students with negative psychosocial factors, whereas its impact is less pronounced in those with positive psychosocial factors. The results underscore the need to focus not only on developing walkable environments but also on understanding the synergies with the psychosocial factors of target populations, offering crucial insights for campus planning and health promotion practices.

“But then that's another barrier”: A qualitative study of parent and provider perspectives on rural versus urban disparities in adolescent vaccination

Purpose: Vaccination rates are significantly lower among adolescents living in rural areas compared to those living in urban areas. The objective of this study was to understand the factors contributing to disparities in vaccination between adolescents in rural compared to urban areas.Methods: Semi-structured qualitative interviews were conducted with parents and providers in 16 rural and 4 urban counties of Colorado. Interview questions followed the socioecological model of health and addressed personal, interpersonal, community, and environment/structural barriers and facilitators that impact adolescent vaccination rates. Qualitative content analysis with a directed content analysis approach was used. Urban and rural interviews were compared to identify barriers unique to rural communities.Findings: Reported barriers included lack of vaccine access at primary care, lack of routine preventive care utilization, the need to take off time from work and school, and misinformation about vaccines. Barriers that were unique to rural communities included structural barriers such as lack of evening and weekend appointments, providers not stocking vaccines, short provider tenures, and costs; logistical barriers such as the need for multiple visits to multiple locations and distance and travel time; and beliefs and behaviors such as an overreliance on sports physicals (in lieu of preventive visits) and natural lifestyle cultures.Conclusions: There are unique challenges to adolescent vaccination in rural areas that contribute to fewer adolescents receiving their recommended vaccines. Addressing structural barriers may address this disparity.