Low birth weight (LBW) is a major public health concern globally. Despite its negative social and economic impact on the family and community at large, it has remained relatively unexplored at population level in Zimbabwe. The purpose of the study was to establish determinants of LBW using data from the 2015 Zimbabwe Demographic and Health Survey. The socioecological model was the conceptual framework for the study. A secondary analysis was conducted on 4,227 mother-infant dyads. Independent variables were duration of pregnancy, number of births within the past 5-year period, exposure to mass media, type of fuel used for cooking in the household, and intimate partner violence. Covariates were maternal age at delivery, place of residence, anemia, marital status, education, wealth index, ever terminated pregnancy, infant sex, and alcohol consumption. For parsimony, statistical significance was set at p < 0.05 at the 95% confidence interval (CI). Multivariable logistic regression analysis showed that mild maternal anemia (adjusted odds ratio [aOR] 1.83 CI 1.17-2.87 p = 0.01), moderate to severe anemia (aOR 1.80 CI 1.01-3.19 p = 0.05), and being a female neonate (aOR 1.48 CI 1.17-2.87 p = 0.008) had higher odds for LBW. Pregnancy duration of 8 months (aOR 0.01 CI 0.003-0.039 p < 0.001) and of 9 months (aOR 0.12 CI 0.04-0.33 p = 0.001) had lower odds for LBW. Birth of 2 infants within a 5-year period (aOR 2.40 CI 1.24-4.66 p = 0.01) was associated with LBW. Implications for positive social change include coming up with a health policy on the management of anemia during pregnancy and health promotion messages to promote optimal birth spacing, including strategies that reduce chances for preterm deliveries.

A community initiative to develop and sustain a farmer's market can address insufficient access to fresh and affordable fruits and vegetables for individuals working and residing in a United States Department of Agriculture (USDA) designated food desert. This project addressed a particular USDA food desert in South Wood County, Wisconsin. The purpose of this project was to develop and plan for implementation and evaluation of a community-supported farmers market in South Wood County, with the goal to increase access to fruits and vegetables. Project objectives included development of a sustainable community infrastructure to support the market, development of policies and guidelines for creation and sustainment of the market, and development of implementation and evaluation plans for the overall market initiative. In collaboration with an interdisciplinary project team of community stakeholders, the above objectives were met and necessary products and plans were developed to direct the initiative over a 5-year period, with long-term evaluation planning extending to 10 years. The plan has been validated by external scholars with content expertise in the area, approved by the project team, and formally endorsed and approved by the Wood County Health Department. The market initiative has been approved for establishment in the community for the 2015 market season. Rooted in the socioecological model, a community supported farmers market can be a key catalyst for positive social change by improving the health of underserved populations who lack access to fresh, affordable fruits and vegetables. By using existing evidence relevant to the population's needs, the market will address disparities surrounding food access and affordability in a rural community affected by food desert conditions.

Across Australia and other developed nations, morbidity and mortality follows a socioeconomic gradient whereby the lowest socioeconomic groups experience the poorest health. The dietary practices of low socioeconomic groups, which are comparatively less consistent with dietary recommendations, have been thought to contribute to the excess morbidity and mortality observed among low socioeconomic groups, although this phenomenon is not well understood. Using a socioecological framework, this thesis examines whether the local food retail environment and confidence to cook contribute to socioeconomic differences in fruit and vegetable purchasing. To achieve this, four quantitative analyses of data from two main sources were conducted. The food retail environment was examined via secondary analysis of the Brisbane Food Study (BFS) and confidence to cook was examined in a cross-sectional study designed and carried out by the author. The first three manuscripts were based on findings from the BFS. Briefly, the BFS was a multilevel cross-sectional study, designed to examine determinants of inequalities, that was conducted in Brisbane in the year 2000. A stratified random sample was taken of 50 small areas (census collection districts, CCDs) and 1003 residents who usually shopped for their households were interviewed face-to-face using a schedule that included a measure of fruit and vegetable purchasing and three socioeconomic markers: education, occupation and gross household income. The purchasing measure was based on how often (never, rarely, sometimes nearly always or always) participants bought common fruits and vegetables for their households in fresh or frozen form, when in season. Food shops within a 2.5 km radius of the CCDs in which survey respondents lived were identified and audited to determine their location, type, their opening hours, and their price and availability of a list of food items. The first publication demonstrated there was minimal to no difference in the availability of supermarkets, greengrocers and convenience stores between areas that were most and least disadvantaged, in terms of the number of shops, distance to the nearest shop, or opening hours. Similarly, the second publication showed the most disadvantaged and least disadvantaged areas had no large or significant difference in the price and availability of fruits and vegetables within supermarkets, greengrocers and convenience stores, but small differences were consistently apparent, such that on average, low socioeconomic areas had lower prices but also lesser availability than more advantaged areas. The third submitted manuscript presents results of multilevel logistic regression analyses of the BFS data. While there were some associations between environmental characteristics and fruit and vegetable purchasing, environmental characteristics did not mediate socioeconomic differences in purchasing the fruit and vegetable items since there was no substantial socioeconomic patterning of the price or availability of fruits and vegetables. The fourth submitted manuscript was based on the cross-sectional study of cooking skills. A stratified random sample of six CCDs in Brisbane was taken and 990 household members ‘mostly responsible’ for preparing food were invited to participate. A final response rate of 43% was achieved. Data were collected via a self-completed questionnaire, which covered household demographics, vegetable purchasing (using the same measure employed in the BFS for continuity), confidence to prepare these same vegetables, and confidence to cook vegetables using ten cooking techniques. Respondents were asked to indicate how confident they felt (ranging from not at all- to very- confident) to prepare each vegetable, and to use each technique. This fourth study found respondents with low education and low household income had significantly lower confidence to cook than their higher socioeconomic counterparts, and lower confidence to cook was in turn associated with less household vegetable purchasing. Collectively, the four manuscripts comprising this thesis provide an understanding of the contribution of food accessibility, affordability and cooking skills to socioeconomic differences in fruit and vegetable purchasing, within a socioecological framework. The evidence provided by this thesis is consistent with a contributory role of confidence to cook in socioeconomic differences in fruit and vegetable purchasing, but is not definitive. Additional research is necessary before promoting cooking skills to improve population nutrition or reduce nutritional inequalities. An area potentially useful to examine would be how cooking skills integrate with psychosocial correlates of food and nutrition, and socioeconomic position. For example, whether improvement of cooking skills can generate interest and knowledge, and improve dietary behaviours, and whether a lack of interest in food and nutrition contributes to a lack of both fruit and vegetable consumption and cooking skills. This thesis has demonstrated that an inequitably distributed food retail environment probably does not contribute to socioeconomic variation in fruit and vegetable purchasing, at least in contemporary Brisbane, Australia. Findings are unlikely to apply to other time periods, rural and regional settings, and perhaps other Australian cities as residential and retail development, and the supply and pricing of produce vary substantially across these dimensions. Overall, the main implication for public health is that interventions targeting the food supply in terms of ensuring greater provision of shops, or altering the available food and prices in shops may not necessarily carry a great benefit, at least in major cities similar to Brisbane. Future studies of equitable food access may need to look beyond mapping the distribution of shops and prices, perhaps to more personal and subjective facets of accessibility and affordability that incorporate individuals’ perceptions and ability to access and pay for foods.

<p><b>Objectives</b> The study will assess patterns of known individual, interpersonal, and community-level circumstances leading to suicide to understand how these factors can co-occur. These patterns will help focus on prevention strategies.</p><p><b>Methods</b> Data was collected from the Iowa Violent Death Reporting System, Census data from the American Community Survey, and 2010 rural-urban commuting area codes from the Economic Research Service. The study consisted of three steps. The first step latent class analysis was conducted on data from suicide deaths from Iowa in 2016-2018 to create classes of patterns of circumstances leading to suicide. The second step maximum probability assignment was used to assign the sample of 1,276 to the created latent classes. Finally, in the third step bivariate regressions were ran to understand the relationship between the created latent classes and the rurality variable (nonmetropolitan vs metropolitan).</p><p><b>Results </b>Five latent classes of distinct patterns of suicide factors emerged. Class 1 is physical health problems living in areas that are average on all community-level variables. This class 1 is seen to happen with higher odds in nonmetropolitan areas. Class 2 is interpersonal problems in areas where living alone is high. This class 2 happened with higher odds in nonmetropolitan areas. Class 3 is mental health problems or depressed mood with no legal problems in areas that had lower educational attainment. This class 3 did not indicate greater odds based on rurality. Class 4 is history of mental health treatment in well-off areas. This class 4 was seen to happen with higher odds in metropolitan areas. Class 5 is substance abuse problems in poorer areas. This class 5 did not indicate greater odds based on rurality. All the classes shared a common theme of experiencing mental health issues or being in a depressed mood.</p><p><b>Conclusions </b>Suicide is a complex concern that could be classified into several classes that have distinct patterns of suicide factors. These classes and patterns help with identifying what services and interventions are needed in certain communities. Overall, providing support in regards to mental health as well as intervening in childhood to support positive development may provide substantial mitigation to the odds of committing suicide. In investigating these patterns, future prevention and intervention effort can take into consideration these patterns to tailor to the individual and the environments where they live.</p>

Introduction The beggars are one the most vulnerable and stigmatized groups in the European society and are determined to live in substandard conditions, characterized by lack of sanitation and overcrowdings, and bare the harsh weather conditions to earn their living. Often, they have limited access to healthcare and their lifestyle has a great impact upon their health. However, little is known about their own perceptions of their health and their strategies to keep it. Aim The aim was to explore the Romanian beggars’ perceptions of their health prior to and during begging, the perceived consequences of begging on their health, and their coping strategies to maintain health while begging in Uppsala, Sweden. Method Data was collected from 8 semi-structured interviews in Uppsala, Sweden during March 2015. The collected data was then analysed using manifest qualitative content analysis. Findings The Romanian beggars in Uppsala perceived their health status to be affected through their activity. Physical consequences involved developing new illnesses and conditions, but also aggravating previous health conditions, and mental consequences included degrading and marginalizing effects of begging, but also harassment from passersby. Access to healthcare in Sweden was limited and determined the beggars to develop alternative strategies for health management or to return to Romania for treatment.     Conclusion The health status was found to be both negatively and positively affected through complex interactions between the individual and the surrounding levels: social network, community, institutions and society. More attention should be given to this group from all levels to improve their health status.

Bakgrund: Samhälls-och hälsoorienteringen till nyanlända är en av de hälsofrämjande insatserna som bedrivs över hela landet och är även lagstadgad. Trots det etableras det inte på samma sätt eller nivå i varje län och forskning visar för att de nyanlända ska kunna finna möjligheterna att etablera sig bör det finnas ett arbete som förhåller sig till den nivån av behov som krävs. Syfte: Syftet med studien är att undersöka hur aktörer arbetar och upplever samhälls-och hälsoinformation för nyanlända och personer med utomnordiskt påbrå samt vilka förutsättningar finns för att genomföra samhälls-och hälsoinformation på modersmål. Metod: En kvalitativ metod användes för att besvara studiens syfte och frågeställning. Kvalitativa semi-strukturerade intervjuer var studiedesignen som valdes för att smala in data. Urvalet bestod av tio intervjupersoner och alla intervjupersoner är aktörer med olika yrken, som är kopplade till integration och nyanlända. Resultat: Studiens resultat påvisade att befintliga samhälls-och hälsoorienteringen upplevs ge både möjligheter och svårigheter när det gäller aktörerna som arbetar med det och deras upplevelse av nyanlända som deltar. En ständig utveckling, ökade resurser och behovsanpassade insatser krävs för en lyckad samhälls-och hälsoorientering som hjälper till att främja hälsan. Slutsats: Resultatet redogjorde att den befintliga samhälls-och hälsoorienterings insatsen har två olika upplevda perspektiv. Det studerade perspektivet som var aktörerna och det andra var mottagarna av insatsen vilket är de nyanlända. Aktörerna upplevdes ha olika behov, upplevelser och uppfattningar av samhälls-och hälsoorienterings insatsen. Studiens fynd redovisade att samhälls-och hälsoorientering på modersmål kommer att gynna och påverka samhället på ett främjande sätt lika mycket som individen själv, samt att förutsättningarna är positiva trots de olika nivåerna av utmaningar som kan påträffa insatsen. / Background: Community and health orientation to immigrants is one of the health promotion efforts conducted across the country and is also statutory. Despite this, they do not hold the same quality in each county, which is required to give immigrants the same opportunities to integrate themselves in the new contest. Aim: The purpose of the study is to examine how sectors experience social and health information for immigrants and people with non-Nordic ancestry and the conditions for implementation of social and health information in the native language. Method: A qualitative method was used to answer the questions of the study. Qualitative semi-structured interviews were used. The sample consisted of ten interviewees and all respondents are sectors with different professions, that work with immigrant integration. Results: The results of the study show that existing social and health orientation is perceived to provide both opportunities and difficulties in terms of both perspectives, the actors working with it and immigrants participating. Continuous development, increased resources and needs-based efforts are needed for a successful community and health orientation that helps to promote health. Conclusion: The existing social and health orientation has two different perceived perspectives. The studied perspective was the sectors working with the orientation. Each perspective has different needs, experiences, and perceptions of the orientation. The study's findings showed that orientation in the native language will benefit and influence society as much as the individual, and that the conditions are positive despite the different levels of challenges that may be encountered.