Socio-ecological Influences Research Articles

Socio-ecological influences on access to abortion care in Costa Rica: a qualitative analysis of key perspectives from clinical and policy stakeholders

Costa Rica prohibits abortion except under narrow circumstances to save the pregnant person’s life. The country boasts historically strong support for social policy and human rights, while also presenting a complex and restrictive abortion access landscape. From September 2021 to March 2022, we conducted 23 interviews with obstetrician-gynecologist (OB/GYN) physicians, OB/GYN medical residents, and policy stakeholders to explore the socio-ecological influences on abortion access in Costa Rica. We sampled clinicians and policy stakeholders from the Universidad de Ciencias Médicas listserv through snowball sampling and conducted semi-structured in-depth interviews in Spanish. We identified limited access to comprehensive sexual health education, lack of support from interpersonal networks, inadequate provider knowledge and training, financial and migratory status, and both provider and community stigma as substantial barriers to abortion access. This study addresses a gap in published research around the social determinants of abortion in Costa Rica and sheds light on the attitudes and opinions of the medical and policy stakeholder communities about abortion access. The results highlight the need for expanded access to comprehensive sexual health education, abortion-related training for healthcare providers, and increased programming efforts, such as funding, outreach, and implementation, to ensure comprehensive reproductive health services are available and accessible, especially for vulnerable populations in Costa Rica.

Perspective on salutogenic approaches to persistent pain with a focus on mindfulness interventions.

In this article, we provide a unique perspective on the use of mindfulness interventions in a whole health framework embedded within the theory of salutogenesis and the concept of painogenic environments. We argue that mindfulness is a valuable tool to bridge exploration of inner experiences of bodily pain with socio-ecological influences on thoughts and emotions. We outline research from neuroimaging studies that mindfulness techniques mediate neural processing and neuroplastic changes that alleviate pain and related symptoms. We also review evidence examining behavioural changes associated with mindfulness meditation providing evidence that it promotes self-regulatory activity, including the regulation and control of emotion and catalysation of health behaviour changes; both of which are important in chronic illness. Our viewpoint is that mindfulness could be a core element of salutogenic approaches to promote health and well-being for people living with pain because it rebuilds a fractured sense of cohesion. Mindfulness empowers people in pain to embrace their existence; shifting the focus away from pain and giving their lives meaning. We propose that integrating mindfulness into activities of daily living and individual or community-based activities will promote living well in the modern world, with or without pain; thus, promoting individual potential for fulfilment. Future research should consider the effects of mindfulness on people with pain in real-life settings, considering social, environmental, and economic factors using a broader set of outcomes, including self-efficacy, sense of coherence and quality of life.

Social group composition modulates the role of last male sperm precedence in post-copulatory sexual selection.

In many species, the order in which males mate with a female explains much of the variation in paternity arising from post-copulatory sexual selection. Research in Drosophila suggests that mating order may account for the majority of the variance in male reproductive success. However, the effects of mating order on paternity bias might not be static but could potentially vary with social or environmental factors. To test this idea, we used an existing dataset, collated from an experiment we previously published (Morimoto et al., PLoS One, 11, 2016, e0154468), with the addition of unpublished data from the same experiment. These previous experiments manipulated larval density in Drosophila melanogaster which generated variation in male and female body size, assembled groups of individuals of different sizes, and measured the mating success and paternity share of focal males. The data presented here provides information on each focal male's mating order and the frequency in which focal males remated with same females ('repetitive matings'). We combined this information with our previously reported focal male reproductive success to partition variance in paternity into male mating order and repetitive matings across groups that differed in the body size composition of males and females. We found, as expected, that male mating order explained a considerable portion of the variance in male paternity. However, we also found that the impact of male mating order on male paternity was influenced by the body size composition of groups. Specifically, males that tended to mate last had a greater paternity advantage, and displayed lower variance, in groups containing a heterogenous mixture male body sizes than in groups with a single male body size. Repetitive mating only had a minor contribution to the variance in male paternity share across all experiments. Overall, our findings contribute to the growing body of research showing that post-copulatory sexual selection is subject to socio-ecological influences.

Socio-ecological influences on adolescent dietary typologies.

Background: Dietary behaviours of adolescence are concerning, and this may impact long-term well-being. Aim: This study examined the socio-ecological determinants of dietary behaviours in a national prospective cohort study of English adolescents. Methods: Latent class analysis was used to identify the typologies of eight dietary behaviours: fruit, vegetable, breakfast, sugar-sweetened beverages, artificial-sweetened beverages, fast-food, bread, and milk from 7402 adolescents aged 13-15 years (mean 13.8 ± 0.45 years) (50.3% female and 71.3% white ethnicity) participating in the U.K. Millennium Cohort Study (sixth survey). Multinomial logistic regression and path analysis predicted associations between personal characteristics, individual, influential others, social environment and physical environment determinants and three distinct diet typologies: (1) healthy, (2) less-healthy and (3) mixed, (reference category = mixed). Results: Within Path analysis, the magnitudes of coefficients were small to moderate suggesting a relatively weak relationship between the variables. Model 1 reported adolescents within the less-healthy compared to mixed typology had lower levels of physical activity (β = 0.074, 95% CI = -0.115, -0.033), and have siblings (β = 0.246, 95% CI = 0.105, 0.387). Model 2 reported adolescents within the healthy compared to mixed typology had lower screen time (β = 0.104, 95% CI = 0.067, 0.141), and lower social media usage (β = 0.035, 95% CI = 0.024, 0.046). Conclusion: This study highlights the importance of considering multiple dietary determinants. These findings are likely to be useful in supporting the development of multi-faceted interventions. They emphasise the need to move away from investigating silo behaviours on individual diet components and a step towards more systems thinking to improve adolescent eating behaviours.

Housing instability: Exploring socioecological influences on the health of birthing people.

To describe how socioecological influences of housing instability affect pregnancy health among birthing and postpartum people. We used the socioecological framework to guide this exploratory descriptive study using semi-structured, in-depth interviews. We purposively recruited birthing people in the southern mid-Atlantic region. Seventeen one-time, semi-structured interviews were conducted between February 2020 and December 2021 with English-speaking unstably housed participants ≥18 years old, currently pregnant, or recently postpartum. Qualitative and quantitative content approaches were used to analyse transcribed interviews. Dedoose software was used to identify code patterns and refine the codebook until group consensus. The team examined code patterns, explored meaning in text and codified code-generated categories to describe experiences. Majority (82.4%) of participants were African Americans between 22 and 41 years, and most were postpartum (76.5%). Participants described multiple forms of housing instability, reasons for losing housing, challenges with finding housing and strategies for finding housing. Participants did not describe housing instability as a barrier to receiving prenatal care. Building and sustaining individual relationships and social support were prominent factors affecting their housing challenges. Participants also reported a lack of obstetric provider inquiry about housing status during pregnancy. Many reported that challenges with housing triggered mental health issues, especially depression. Nurses and other obstetric providers are key points of contact in the prenatal care setting for assessing housing stability. Additionally, refining social structures and funding support services within communities and prenatal health systems should be a strategy for future programme and policy planning improvement. This study highlights critical areas for consideration when addressing social determinants for birthing people and reinforces the need for more comprehensive assessment in the prenatal setting. Members of the public participated in this study as key informants for study interviews.

Using Plan, Do, Study, Act Cycles to Improve a Maternal Self-Care Intervention With Audience Input.

Maternal self-care, including healthy eating, physical activity, and stress management behaviors, is influenced by environmental, social, and individual factors. Plan-Do-Study-Act (PDSA) Cycling is an effective quality improvement process using rapid cycling to refine interventions to fit audience-specific contexts and to address socioecological influences on behavior change. To refine components of the Healthy EnviROnmentS Self-Care intervention, a mindful self-care program for mothers of preschool-aged children in rural communities, PDSA cycles were used to examine: (A) acceptability of content, (B) suitability of implementation strategies, and (C) feasibility of digital supports across three stages of program development. Stage 1 included a group discussion with an expert panel (n = 8). Stage 2 used brief interviews and group discussion with a convenience sample (n = 5). Stage 3 included in-depth interviews with the focal population (n = 6). In-depth interviews were transcribed and analyzed using a directed approach, and data were compiled from group discussion notes and assessed for congruence and analyzed for emergent themes. PDSA cycles relating to content led to the addition of activities to introduce mindfulness and foster social support and the revision of handouts. Implementation strategies were refined with respect to workshop duration, activity order, and meeting type. Digital supports resulted in refinement to the study website and tablet applications. Utilization of PDSA cycles allowed for input from the focus population at every point of intervention design and considered socioecological factors that can influence behavior change.

A socio-ecological framework for examining foodborne parasitic infection risk

Human liver fluke infection through the consumption of raw freshwater fish is one of the foodborne parasitic infections of global concern. Despite decades of health campaign efforts, high prevalence of infection remains in different areas of the Lower Mekong Basin. This necessitates the consideration of the infection differences between places and the human-environment complexities of disease transmission. This paper used the socio-ecological model as a framework to unraveled the social science dimensions of liver fluke infection. We conducted questionnaire surveys in Northeast Thailand to gather participants’ knowledge on liver fluke infection and reasons for raw fish consumption. We synthesized our findings with prior work to identify factors influencing liver fluke infection at four socio-ecological levels. At the individual level, gender and age differences in food consumption habits and personal hygiene of open defection presented the behavioral risks. At the interpersonal level, family tradition and social gathering affected the disease risk. At the community level, physical-social-economic environments of land use and modernization, community health infrastructure and health volunteer support accounted for the varying degree of infection. At the policy level, impacts of regional and national regulations on disease control, health system organization structure, and government development projects were of concerned. The findings provide insights into how infection risks are shaped by people's behavior, social connectedness, interactions with places, and the interplay of these multi-level socio-ecological influences. The framework therefore allows a more comprehensive understanding of liver fluke infection risks to inform a culturally sensitive and sustainable disease control program.

Mixed-species flock composition matters: interspecific influences on finding novel food in North American parids.

Individuals of a wide range of species are sensitive to the presence of other species, and can often benefit from associations with other species in mixed-species groups (MSGs) through food-finding or avoiding predation. In an earlier field study, we found that both Carolina chickadees, Poecile carolinensis, and tufted titmice, Baeolphus bicolor, were better able to solve a novel feeder task when their MSGs were more diverse in terms of species composition. Like most studies of MSGs, however, that earlier study did not experimentally manipulate MSG size and composition. We did that manipulation here, providing experimental flocks of chickadees and titmice with three novel feeder tasks in semi-natural aviary environments. We found that successful titmouse flocks generally had a higher proportion of titmice in them, going against the findings of our earlier field study. Conversely, successful chickadee flocks solved one of the novel feeder tasks more quickly with a higher proportion of titmice in them, corroborating the findings of our earlier field study. We now need to assess socio-ecological influences on MSG size and composition, and how those relate to individual behaviour. This article is part of the theme issue 'Mixed-species groups and aggregations: shaping ecological and behavioural patterns and processes'.

Land cover change and socioecological influences on terrestrial carbon production in an agroecosystem

Land cover change and socioecological influences on terrestrial carbon production in an agroecosystem

God(s)’ Mind(s) across Culture and Context

This paper explores dimensions of culture and practice that shape the cognitive pathways leading to different beliefs about God(s)’ mind(s). Varying socio-ecological sources of insecurity are linked to types and modes of cognitive processing, which in turn promote different constellations of beliefs about supernatural agents dubbed the heuristic and non-heuristic models of God(s)’ mind(s). The heuristic model is suggested to take prominence when relatively few cognitive resources are available to devote to thinking about God(s)’ mind(s); these conceptions of God(s) should be shaped by the socio-ecological pressures believers face. Conversely, when cognitive resources are available, differences in modes of processing (experiential-intuitive vs. analytical-rational) lead to different mystical and theological/philosophical models of God’s mind as a product of more deliberate, effortful processing. By linking beliefs to socio-ecological influences, this paper suggests phenomenological experiences of the supernatural vary across societies as a direct function of the diverse environmental constraints in which people. By linking belief to socio-ecological pressures individuals in societies face, this approach provides a bridge between the intrinsic meaning systems within communities of belief and the cognitive evolutionary approach to parsing the diversity of belief across societies.

Socio-Ecological Influences on HIV Care Engagement: Perspectives of Young Black Men Who Have Sex with Men Living with HIV in the Southern US.

Young Black men who have sex with men (MSM) living with HIV evidence the lowest rates of linkage to care and viral suppression of all US MSM. Kentucky, identified by the US Department of Health and Human Services as a “hot spot” state with elevated HIV incidence compared to the rest of the country, exhibits similar racialized outcomes. Structural, interpersonal, and individual drivers of engagement along the HIV care continuum among people living with HIV have been identified, primarily through quantitative designs. However, the mechanisms by which these factors shape HIV care engagement, and the ways they may combine or reinforce each other, as well as from the lived experience of young Black MSM living with HIV, have been studied to a lesser extent. In this study, a purposive sample of n = 29 HIV-positive young Black MSM (age M = 25 years old; 38% retained in care) residing in Kentucky participated in in-depth interviews. Factors that were most influential on engagement varied along the continuum, with health insurance status and knowledge of HIV being relatively more influential to diagnosis, and housing stability, psychological processes, and interpersonal relationships being more influential on retention. For some participants, barriers to care at multiple levels had a mutually influencing and intensifying impact on care engagement. Additional efforts to center the voices of young Black MSM living with HIV will help illuminate acceptable and sustainable interventions for increasing their care engagement and narrowing persistent racial disparities in HIV morbidity and mortality.

Sustainable Entrepreneurship and Protected Areas: Influences of Embeddedness in a Semi-remote Context

This study examines the interaction between sustainable entrepreneurs and their socio-ecological environment. Previous studies postulate that fragile socio-ecological contexts by and large promote sustainable entrepreneurial practices. By being embedded in place, nature and culture, and communities, the entrepreneurs are able to revitalise semi-remote areas and drive development. However, how being embedded in fragile socio-ecological influences sustainable entrepreneurial activities is less understood. Using an exploratory qualitative study, we collected data from 15 sustainable entrepreneurs, operating in a protected area. We found that the entrepreneurs exhibited different forms of embeddedness. Embeddedness was either social, spatial or both. Further, the form of embeddedness determined the activities the sustainable entrepreneurs engaged in (adaptive versus transformative). Our study exemplifies that in addition to previously identified positive influences, the interaction between sustainable entrepreneurs and context in the form of embeddedness, results in certain negative influences on sustainable entrepreneurial activities, such as conforming.

Disaggregating How Asian Americans Define a Healthy Diet: Exploring Generational and Intra-family Differences Through Dyadic Interviews

ObjectivesAsian Americans (AAs) experience a complex and growing non-communicable disease burden linked with dietary behaviors. Dietary norms, which significantly contribute to eating behaviors, face a complex set of Western and Asian socio-ecological influences in AA communities. However, little is known of how dietary norms (such as definitions of a “healthy diet”) are transmitted, intersect, and differ in a multigenerational family environment. MethodsAA young adults and family members were recruited to participate in dyadic, 60-minute Zoom interviews (Jun - Dec 2021). Young adults and family members were interviewed separately on their respective eating behaviors, including perceived definition of a healthy diet. Recordings were inductively analyzed to identify themes related to different facets of a conceptualized healthy diet. ResultsA total of 41 AAs were interviewed (76% female, 61% US-born, age 19–69), including 20 young adults and 21 family members (10 parents, 9 siblings, 2 cousins). Diet healthfulness was defined in three dimensions: types of food, cooking methods, and intersection of diet with holistic wellbeing. Young adults consistently emphasized the role of their parents in shaping their idea of a healthy diet, particularly Asian-specific conceptualizations of balance (e.g., “yeet hay”). However, while these ideas were particularly influential among older participants, younger participants also emphasized the intersection of diet with emotional and spiritual well-being. Both stressed cooking methods as indicators of healthfulness. While a “healthy diet” was conceptualized through intake of food groups such as fruits, vegetables, and proteins, foreign-born and older participants put a larger emphasis on dietary restrictions (e.g., completely cutting out food groups, such as fast food), while US-born and younger participants stressed enjoying foods in moderation. ConclusionsThe differential understanding and impact of AA norms related to diet healthfulness highlights the need for a disaggregated understanding of dietary attitudes and behaviors in health-based interventions for AAs of different generations, particularly family-based programs. Findings call for future mixed-methods research to explore the complex dietary norms identified. Funding SourcesSouth Asian Health and Research Group (SAHARA).

Integrating Diversity, Equity, and Inclusion Approaches Into Treatment of Commercial Tobacco Use for Optimal Cancer Care Delivery.

Tobacco-related cancer incidence and mortality and commercial tobacco use have decreased steadily in recent decades, but improvements have not been equitably experienced across population subgroups. A complex interaction across socioecological domains of individual, interpersonal, community/organization, and societal/policy factors influence disparities in tobacco use, treatment, and related health outcomes. NCI's Cancer Center Cessation Initiative (C3I) provides an ideal platform to examine and intervene on multilevel influences across the cancer control continuum to reduce any disproportionate tobacco-related burden and eliminate tobacco-related disparities. The C3I Diversity, Equity, and Inclusion (DEI) Working Group encourages cancer centers to develop, evaluate, and adopt evidence-based practices regarding DEI for prevention and treatment of commercial tobacco use across the cancer control continuum. This paper highlights how 3 C3I sites intervene to address socioecological influences on tobacco use among racially, ethnically, socioeconomically, and geographically diverse patient subgroups. It then outlines ways in which DEI considerations could be integrated into research with patients with cancer who use tobacco and practices related to standards of cancer care. Incorporating DEI considerations in the pursuit of optimal tobacco treatment could facilitate elimination of inequities in population-level cancer outcomes, spanning the full continuum of cancer care from prevention to survivorship.

Where Do Online Games Fit into the Health Behaviour Ecology of Emerging Adults: A Scoping Review.

Online video games are a common pastime for emerging adults (EAs). EAs are an age group that is of interest in health communication because habits formed during this life stage can cause or prevent disease later in life. Guided by three research questions, this scoping review identifies the current state of research into socio-ecological influences on physical activity and diet behaviours of EAs. The review also examines the role that online video games play within this behavioural ecology. In total, 112 articles were found that focused on behavioural ecological influences for physical activity and diet behaviour among EAs. Seven of these articles focused on the impact of online video games, although only in conjunction with their influence on physical activity, identifying a gap in understanding the influence of online games on diet. Results show that online video games are currently under-researched in terms of impacts on physical activity and diet despite the prevalence of the use of these games within the EA cohort.

Proximal versus distal ecological stress: Socio-ecological influences on political freedom, well-being, and societal confidence in 159 nations

Previous work from a socio-ecological perspective reveals that ecological stress has important effects on political, cultural, and psychological outcomes. However, that work has been limited by (1) a focus on distal forms of ecological stress that are hard for societies to control, and (2) a lack of large-scale conceptual replications. The present study aims to fill in these gaps by simultaneously testing the effects of both more distal ecological stress (e.g., climate) and more proximal ecological stress (e.g., water quality) on political restriction, political freedom, well-being, and societal confidence measurements. In a sample from the Gallup World Poll spanning over one and a half million participants and 159 nations, we found that while both kinds of ecological stress measurements predicted greater vertical political restriction, reduced horizontal political restriction, reduced well-being, and reduced freedom, only proximal forms of ecological stress predicted a loss in societal confidence. These results not only provide key conceptual replications of prior studies on new data, they also add previously unstudied outcomes and new ecological stressors. As a result, they help us better understand contributing factors to key societal issues such as freedom, well-being, and societal confidence.

Socio-ecological influences of leisure-time physical activity among Nepalese adults: a qualitative study

BackgroundWith economic and social changes, participation in occupational and transport-related physical activity is declining among Nepalese adults, highlighting the growing importance of leisure-time physical activity. However, limited information is available to guide public health policies and interventions to promote leisure-time physical activity in Nepal. This study aimed to qualitatively explore the socioecological influences of participation in leisure-time physical activity among Nepalese adults aged 40 years and above.MethodsA total of 51 adults (30 females and 21 males) participated in one of the nine focus groups conducted in Kathmandu, Nepal. A semi-structured guide based on the social-ecological model of physical activity was used to facilitate these focus groups. Data were analysed using a reflexive thematic analysis approach in NVivo 12.ResultsParticipation in leisure-time physical activity was minimal and leisure time was mostly spent resting, socialising, or engaging in sedentary activities such as watching television. Walking was the most common form of leisure-time physical activity, and men reported being more active than women. Individual-level barriers included lack of knowledge, lack of skill, lack of motivation, considering oneself as sufficiently active and engagement in sedentary screen activities. Family and household responsibilities, lack of support and fear of being judged constituted the interpersonal barriers while environmental barriers included an absence of a supportive social norm, lack of open spaces, weather conditions and perceived lack of safety. Health benefits, prioritising physical activity, social support, provision of group-based activities and age-appropriate public exercise facilities were identified as major facilitators.ConclusionCritical issues that need to be addressed to increase leisure-time physical activity among Nepalese adults include traditional gender roles, family and social support, and social norms. Modifications of the built environment, such as public exercise facilities, offer further opportunities and will require coordination beyond the health sector.

Integrating socioecological indexes in multiobjective intelligent optimization of green-grey coupled infrastructures

Ecological conservation is an important objective in urban runoff management today. Maintaining a sustainable ecological system is as equally important a task as to ensure the safety of drainage systems and runoff management cost control. Thus, the socioecological influences of runoff control infrastructure are innovatively included in a uniform evaluation framework with the control functions and capital investments in this study. These indexes are quantified through hydrological model simulation, life cycle cost analysis, and life cycle assessment. Traditional grey infrastructure and rapidly developing green infrastructure for runoff control are optimized simultaneously. For the trade-off between multiobjectives and configurations of multi-infrastructures, nondominated sorting genetic algorithm-II is utilized to achieve automatic optimization of runoff control infrastructure scale, thereby avoiding the dilemma where manually arranged schemes cannot perform optimally. This multiobjective intelligent optimization is applied to a sponge city pilot region in Wuhan, China, and trade-offs are made in the Pareto optimal solution set. A breakthrough is claimed in quantifying the respective contribution of green and grey infrastructures to the optimal scenario in terms of runoff control function, cost input, and socioecological influence. For socioecological influence, the paybacks can meet the investment in the aspect of toxicity health hazard, pathogenic matter, global warming, terrestrial acidification, and water eutrophication (average socioecological paybacks are 2.0, 2.1, 2.9, 1.9, and 2.1 times to the investments respectively). Results prove the necessity of considering multiobjective optimization and green-grey couple infrastructures in a uniform framework.

Ecological Systems Affecting Urban Childbearing Puerto Rican Women in the City of Philadelphia.

The purpose of this study was to explore socio-ecological influences affecting the daily lives of urban, pregnant Puerto Rican women and factors negatively influencing their health seeking behaviors related to prenatal care. Qualitative, descriptive methods were used including individual interviews and focus groups to obtain maximum understanding of the women's lives. The interviews and focus groups were conducted using a semi-structured interview guide based on various components of the study's conceptual framework. Content analytic strategies included rigorous and systematic processes to increase trustworthiness: training, supervision, audits, electronic technologies, and ongoing input of the research team. Factors on all levels of the study's conceptual framework compound the effects of stressors and restrictions on the lives of urban, childbearing Puerto Rican woman. The intersectionality of issues for Puerto Rican women can either mitigate or heighten the pressure on their daily lives. This initial research sets the groundwork for further studies, such as narrative analysis, to better understand how to build appropriate and relevant interventions. Uncovering the women's stories gives them the opportunity to be a critical part of cross-sector partnerships towards the development of sustainable interventions.

Socio-ecological influences of adolescence marijuana use initiation: Qualitative evidence from two illicit marijuana-growing communities in South Africa.

BackgroundAdolescence has been identified as a critical risk period for substance use initiation, such as marijuana. Although several factors have been cited for adolescent marijuana use, those that influence initiation, especially in an African setting where illicit marijuana activities are rife, have not been contextually explored.AimWe ascertained the factors that influence adolescent marijuana use initiation in two marijuana-growing communities in the Eastern Cape province of South Africa, based on the constructs of the socio-ecological model.SettingThe study was conducted in two selected illicit marijuana growing communities in the Ingquza Hill Local Municipality of the Eastern Cape province of South Africa.MethodsFocus group discussions (FGDs) were conducted among 37 participants, grouped into four focus groups. Purposive and snowball sampling techniques were used to select the communities and participants, respectively. An FGD guide was used to collect the data. The data were analysed using thematic content analysis approach and presented under various themes.ResultsTwelve influences of adolescent marijuana use initiation, grouped under three main levels of socio-ecological influence, personal characteristics (curiosity, shyness and fulfilment of personal need), micro-level influences (peer pressure, negative school climate, presence of marijuana in households and parental or sibling marijuana use) and macro-level influences (child labour, poverty, presence of marijuana in communities, presence of negative adult role models and breakdown in communal restrictions against marijuana use), were found.ConclusionHealth promotion programmes, targeting socio-ecological motives of adolescent marijuana use initiation in the two communities, should be intensified to break the cycle of adolescent marijuana use. Also, alternative livelihood schemes should be implemented in the affected communities to break the cycle of illegal marijuana cultivation that promotes adolescent marijuana use.