BackgroundPeruvian adolescents are at high nutritional risk, facing issues such as overweight and obesity, anemia, and pregnancy during a period of development. Research seeking to understand contextual factors that influence eating habits to inform the development of public health interventions is lacking in this population. This study aimed to understand socio-cultural influences on eating among adolescents in periurban Lima, Peru using qualitative methods.MethodsSemi-structured interviews and pile sort activities were conducted with 14 adolescents 15–17 years. The interview was designed to elicit information on influences on eating habits at four levels: individual (intrapersonal), social environmental (interpersonal), physical environmental (community settings), and macrosystem (societal). The pile sort activity required adolescents to place cards with food images into groups and then to describe the characteristics of the foods placed in each group. Content analysis was used to identify predominant themes of influencing factors in interviews. Multidimensional scaling and hierarchical clustering analysis was completed with pile sort data.ResultsIndividual influences on behavior included lack of financial resources to purchase food and concerns about body image. Nutrition-related knowledge also played a role; participants noted the importance of foods such as beans for anemia prevention. At the social environmental level, parents promoted healthy eating by providing advice on food selection and home-cooked meals. The physical environment also influenced intake, with foods available in schools being predominantly low-nutrient energy-dense. Macrosystem influences were evident, as adolescents used the Internet for nutrition information, which they viewed as credible.ConclusionsTo address nutrition-related issues such as obesity and iron-deficiency anemia in Peruvian adolescents, further research is warranted to elucidate the roles of certain factors shaping behavior, particularly that of family, cited numerous times as having a positive influence. Addressing nutrition-related issues such as obesity and iron-deficiency anemia in this population requires consideration of the effect of social and environmental factors in the context of adolescent lifestyles on behavior. Nutrition education messages for adolescents should consider the cultural perceptions and importance of particular foods, taking into account the diverse factors that influence eating behaviors.

Background: Conceptual literature has consistently noted that health literacy exists within a social context. This review examined how the intersection of social context and health literacy has been operationalized in quantitative, empirical research. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched seven databases, including PubMed and CINAHL (The Cumulative Index to Nursing and Allied Health Literature), using a range of potentially relevant keywords, and we hand-searched bibliographies. Inclusion criteria were quantitative studies of any design in which measurement of health literacy and measurement of social context intersected. We identified 1,052 unduplicated articles; 34 met inclusion criteria. Key Results: We found three distinct perspectives on the intersection between health literacy and social context. Most common ( n = 23) were studies measuring an association between individual health literacy and individual social capital, social support, or social engagement, particularly whether social support varied by health literacy and/or if this relationship mediated health outcomes. Another group of studies ( n = 6) took the perspective that being health literate by definition included social context, including access to and/or use of social support as a domain in individual health literacy assessment. Five studies considered the social context of health literacy as an independent property measured beyond the individual level; two measured community-level health literacy and three measured health literacy capacity/concordance in caregiving dyads. The studies showed significant definitional and measurement complexity and overlap. In the most dramatic example, a similar question was used across various studies to measure (1) health literacy, (2) a social support domain in health literacy, (3) social support, and (4) a study outcome distinct from, but associated with, health literacy. Potential useful methods, such as social network analyses, were missing from the literature. Discussion: Existing quantitative research on health literacy in a social context supports more attention to this topic. This review quantified evidence, revealed gaps, noted limitations, and identified important questions for future research. [ Health Literacy Research and Practice . 2017;1(2):e41–e70.] Plain Language Summary: This study systemically compiles existing quantitative empirical research (34 articles) focusing on the intersection of health literacy in the social context. We find considerable measurement complexity in the current body of work on this topic and identify three distinct perspectives that researchers have taken while consid...

Background:Physical inactivity is a growing problem in the United States, one that is being addressed through the development of active living communities. However, active living promotion requires collaboration among organizations that may not have previously shared goals.Methods:A network analysis was conducted to assess Hawaii’s active living promotion network. Twenty-six organizations playing a significant role in promoting active living in Hawaii were identified and surveyed about their frequency of contact, level of collaboration, and funding flow with other agencies.Results:A communication network was identified linking all agencies. This network had many long pathways, impeding information flow. The Department of Health (DOH) and the State Nutrition and Physical Activity Coalition (NPAC) were central nodes, but DOH connected state agencies while NPAC linked county and voluntary organizations. Within the network, information sharing was common, but collaboration and formal partnership were low. Linkages between county and state agencies, between counties, and between state agencies with different core agendas were particularly low.Conclusions:Results suggest that in the early stages of development, active living networks may be divided by geography and core missions, requiring work to bridge these divides. Network mapping appears helpful in identifying areas for network development.

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Background: To design effective nutrition education interventions for college students, research is needed to determine the factors influencing food choices. The purpose of this study was to identify perceived barriers and enablers of healthy eating in college students ages 18-24 at the University of Hawai'i at Mānoa. Methods: Prior to conducting focus groups, an interview guide was developed based on a literature review of relevant studies. The interview guide was successfully tested in the first focus group and used in the rest of the focus groups. Eleven focus groups with group sizes of two to six were conducted (n = 44). Focus groups were audio-recorded and transcribed. Transcripts were coded in NVIVO11 using content analysis, and additional codes were added to the codebook based on emergent ideas from the transcripts. After completion of the final codebook, transcripts were recoded with the new codebook. Final code counts were used to identify overarching ideas based on the socio-ecological model of health, consisting of four levels of influence: individual (intrapersonal), social environmental (interpersonal), physical environmental (community settings), and macrosystem (societal).