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Introduction In this work, we propose a new paradigm for studying the well-known TARGET SET SELECTION problem (TSS for short) of Kempe, Kleinberg, and Tardos (2015), which is a fundamental problem in the area of viral marketing and the spread of opinion on social networks. Nevertheless, applications in medicine, social and life sciences, distributed computing, and other areas were found. The TARGET SET SELECTION problem can be, following the threshold formulation of Kempe, Kleinberg, and Tardos (2015), described as follows. We are given a social network modelled as a simple undirected graph G = (V, E), where V is a set of agents, a threshold function f : V → N that represents the resistance of an agent v ∈ V to be influenced by our marketing, and a budget k ∈ N. An agent v ∈ V is willing to buy our product if at least f (v) of his neighbours already have this product. Our goal is to select at most k agents that initially receive the marketed product (e.g., for free) to ensure that, in the end, all agents are influenced and own the product. We observe that the static graph as a model of a social network is perforce simplistic. Real-life networks are seldom static; they change quite often over time -new connections appear and some old ones disappear again; they are sort of dynamic or time-varying. This forces us to initiate the study of the TARGET SET SELECTION problem in more dynamic environments, which, according to us, captures the real-life behaviour of agents and social networks more realistically. G 1 : G 2 : G ↓ : 1 1 2 1, 2 1 , 2 2 It is worth mentioning that the generalisation of fundamental problems from AI, ML, and computer science to more dynamic settings have occupied the attention of both theorists and practitioners in the last years; to name at least a few, see, e.g., recent works of Hamm et al. (2022); Deligkas and Potapov (2020); Mertzios, Molter, and Zamaraev (2019) and the references therein. --- Temporal Graphs We model time-varying networks as temporal graphs. Roughly speaking, a temporal graph is a graph that is subject to discrete changes over time. Temporal graphs have also been studied under different names, such as dynamic, evolving, or time-varying graphs. Formally, the temporal graph is a pair G = (G ↓ , λ), where G ↓ = (V, E) is a simple undirected underlying graph and λ : E → 2 N is a time labelling function that assigns to each edge a set of discrete time-labels in which the edge is active. In this paper, both the underlying graph and the sets of time labels are finite. It follows that there exists ℓ = max{t ∈ λ(e) | e ∈ E} called a lifetime of G. We call the graph G i (G) = (V, E i ), where E i = {e | i ∈ λ(e)}, the i-th layer of the graph G. We omit (G) if the temporal graph is clear from the context. For an illustration of a temporal graph, we refer the reader to Figure 1. G 1 : v G 2 : v G 3 : Figure 2: A running example of the TEMP-TSS influence process. All agents have threshold 2 and the budget is set to k = 2. Influenced agents are filled and the agents in T are depicted as square boxes. In the first round, the bottom left agent becomes influenced as two of his neighbours are already influenced. In the second round, there is no additionally influenced agent since v has only one neighbour in this time-step. In the last round, the agent v becomes finally influenced. --- The Model We formally capture a notation of TARGET SET SELECTION in temporal graphs using the TEMPORAL TARGET SET SE-LECTION problem (TEMP-TSS for short) which is defined as follows. The input of the problem is a temporal graph G = (G ↓ = (V, E), λ), a threshold function f : V → N, and a budget k ∈ N. Our goal is to decide whether there is a targetset T ⊆ V of size at most k such that the following dynamic process: P 0 = T and P i = P i-1 ∪ {v | f (v) ≤ |N Gi (v) ∩ P i-1 |}, where N Gi (v) represents a set of neighbours of agent v in the graph G i , influences all the vertices in V , that is, P ℓ = V . For a running example of the process, we refer the reader to Figure 2. --- Our Results We mainly study the problem from a computational complexity perspective. Since the static TSS problem is notoriously hard both from the computational complexity and approximation algorithms' perspective, it is not surprising that the TEMP-TSS problem is also computationally hard. In particular, we are able to show that the TEMP-TSS problem is NP-complete. To show the hardness, we reduce from the original TSS problem. It is known that every spreading process in static TSS ends in at most n rounds. Therefore, we can reduce the static case to TEMP-TSS by creating n-layer temporal graph such that all layers are equal to the static social network of the TSS problem instance. It follows from the reduction that all lower-bounds known for the TSS problem directly carry over to our problem. However, this is not the case for algorithmic upper-bounds. Therefore, we mainly focus on studying the computational complexity of restrictions, where static TSS is solvable in polynomial time. The first way to tackle the complexity of the TSS problem is to restrict the threshold function. If the thresholds of all agents are equal to 1, then the static variant is trivially solvable by adding one agent from every connected component to the target-set. For the temporal case with the same setting, we have the following result. Theorem 1 It is NP-complete to solve TEMP-TSS even if all thresholds are equal to 1 and the lifetime of the temporal graph is 2. To show this lower-bound, we give a reduction from the SET COVER problem. Assuming the SETH, we also obtain, as a corollary of Theorem 1, that for all ϵ < 1 TEMP-TSS cannot be solved in time 2 ϵk n O(1) . Next, we turn our attention to cases where the underlying graph is restricted. For example, there is a trivial polynomial-time algorithm for TSS on complete graphs.For TEMP-TSS, we show that a polynomial-time algorithm is unlikely. Theorem 2 It is NP-complete to solve TEMP-TSS even if all thresholds are at most 2 and the underlying graph is a complete graph. --- Conclusions and Future Work In this paper, we initiated the study of the TEMPORAL TAR-GET SET SELECTION problem, which is an analogy of TSS in dynamic social networks. We provide intractability results from the computational complexity perspective for fairly limited settings. As our results are mostly negative, it follows that a different perspective is needed in order to obtain some tractability results. In particular, as a natural next step, we would like to investigate the problem deeply from the viewpoint of parameterised complexity and approximations. Last but not least, our variant of the problem is arguably the simplest generalisation of static TSS to dynamic networks. One of the versions that researchers should not overlook is a variant in which even the preferences of the agents may vary over time. In many real-world scenarios, the launch of a new product is accompanied by an advertising campaign designed to convince people to buy. However, this purchase conviction declines over time. Sellers can raise interest again, for example, by providing a discount.

Modern social networks are dynamic in their nature; new connections are appearing and old connections are disappearing all the time. However, in our algorithmic and complexity studies, we usually model social networks as static graphs. In this paper, we propose a new paradigm for the study of the well-known TARGET SET SELECTION problem, which is a fundamental problem in viral marketing and the spread of opinion through social networks. In particular, we use temporal graphs to capture the dynamic nature of social networks. We show that the temporal interpretation is, unsurprisingly, NP-complete in general. Then, we study computational complexity of this problem for multiple restrictions of both the threshold function and the underlying graph structure and provide multiple hardness lower-bounds.

INTRODUCTION Poverty remains a stubborn fact of life. Across the globe, rural populations are overwhelmingly poor. In developing countries, living in rural households increases the odds of being poor as opposed to urban counterparts. Statistically, Malaysia successfully reduced the poverty rate to 0.6% in 2014, and hardcore poverty is nearly eradicated. However, there still exists a small community of poor households that are still far from development and modernisation, especially in the less developed states such as Perlis, Kedah, Kelantan, Terengganu, Pahang, Sabah, and Sarawak. Pahang is one of the states in Malaysia based on agriculture, industry, and tourism activities. It should provide more opportunities to the communities to help poor households exit poverty. Based on the statistics provided by the Pahang Economic Planning Unit (EPU) in 2019, the poverty rate in Pahang was 4.3%. --- Incidence of Poverty in Malaysia Poverty refers to a state of deprivation faced by an individual or family to cope with the survival of daily life. According to the global definition, poverty is a difficult situation faced by an individual or family to meet the needs of human rights. Poverty is a phenomenon of deprivation, inadequacy, or instability experienced by every household (Siti Hadijah, 2012). Poverty in Malaysia is measured in absolute and relative terms. Absolute poverty is measured in terms of income level, which is the Poverty Line Income (PLI). Under absolute poverty, there are two types of PLI. They are the food PLI and non-food PLI. According to the Department of Statistic's 2019 new methodology, the value of food PLI was RM1,169, and non-food PLI was RM1,038. Thus, the total PLI was RM2,208 (DOSM, 2020). On the other hand, relative poverty is measured as a proportion of households earning income less than half the mean or median income. However, poverty should be a relative concept and not just constricted to income levels. When we discuss the poor, they should be considerably worse off than the majority of the population -a level of deprivation heavily out of line with the general living standards enjoyed by the majority of the population. That being said, the issue of poverty has yet to be fully addressed either globally or at the local level despite various efforts and strategies to eliminate it. Hence, poverty in Malaysia should also be defined by the prevalence of social exclusion. The lack of regular access to basic services such as education, healthcare, nutrition, housing, water supply and sanitation is an important dimension of poverty (Jayasooria, 2016, Nor Faraini et al., 2016). This is especially predominant in rural communities, particularly Sabah, Sarawak, Pahang, Kedah, Kelantan, and Terengganu. Therefore, this study aims to examine the factors that cause poverty in rural communities and investigate the socio-economic position and level of educational achievement of parents and children in Bera District, Pahang, Malaysia. --- LITERATURE REVIEW The definition of poverty is deprivation, lack of basic necessities, and very poor conditions. Meanwhile, education is a process of educating, guiding, forming, and nurturing. The income level received by households increases in tandem with the achievement of human capital. This is because the amount of income the household receives in rural areas is defined as what is received from the production of farming and agriculture. Nor Diana et al. (2010) argued that households with a low socio-economic status could be described as having low levels of educational attainment, employment status, and small land holdings. Asan et al. (1999) stated that most household heads in the FELDA area have children who work outside the agricultural sector and provide monthly financial assistance to the head of the household. This is because most rural communities primarily focus on income from the agricultural sector they work in. Marwan et al. (2012) stated that rural communities' education has become the focus of the government in the implementation of the Education Development Plan 2013-2025. Their study found that rural education is still lagging in quality due to factors such as lack of infrastructure, awareness of parents and students, information technology and telecommunications skills, socio-economic conditions, poverty, and quality of rural areas' educators. According to Zalika, Faridah, and Mohamad (2009), rural economic activities such as traditional agriculture offer low value to income. This contributes to low development and reduces competitive and high-level employment opportunities, decreasing household income. According to Narimah S. et al. ( 2018), the issue of poverty can lead to low educational attainment and cause poverty to be passed on from parents to their children. This is because low parental education makes their children more likely to get a low level of education. The cause of poverty due to lack of education or having a low level of education has made it harder for the poor to escape the shackles of poverty and get better job opportunities in the agricultural sector (Aini Samani & Suriati Ghazali, 2018). According to Zurina et al. (2018), the lack of education and low standard of education is the cause of the economic downturn of the household as well as a lack of permanent employment. A study by Siti Masayu (2009) found that poor families could not afford to provide adequate education to their children, causing a low level and low quality of education in the rural community. When families could not afford to send their children to school, the latter had to work to help earn additional income for their parents, affecting the children's education. The study found a correlation between a person's level of education and the income earned where the community in rural areas has a low socio-economic level, thus affecting the level of education and income earned by these poor rural households. Based on the above facts, the focus of this study is to identify the socio-economic background and the factors of poverty in rural communities in Bera District, Pahang. Through this study, the researchers sought to understand the reality of rural poverty by identifying the factors causing poverty in Bera District, Pahang. --- METHODOLOGY This study used primary data obtained from a questionnaire using a random sampling technique with the selected respondents in Bera District, Pahang. One hundred respondents were selected from the List of Poor Families in the Bera district area. The method of analysis included descriptive statistics on the poverty, education, and income variables. Chi-square tests were conducted to examine the relationship between education level and income earned. Figure 1 shows the conceptual framework of this study. --- RESULT AND DISCUSSION --- Demographic Profile Table 2 summarises the demographic profile of the respondents. It shows that 61 respondents are between 20 and 30 years old, 20 respondents are between 31 and 40 years old, 10 respondents are between 41 and 50 years old, and 9 respondents are between 51 and 60 years. Regarding academic qualification, 22% had completed tertiary education, 37% had secondary education, 31% had primary education, and 4% had no formal education. Table 2 also shows that 33 respondents work in the agriculture sector, 25 respondents are students, 21 work in the private sector, 8 respondents are factory operators, 8 respondents are hawkers, and 8 are housewives. Only 2 respondents work in the public sector. Meanwhile, 2 respondents do not work nor re looking for a job. The table also indicates that 41% of the respondents have a household size of 6 or more, 30% have a total of 5 family members, and 14% have a total of 4 family members. Meanwhile, 8, 5, and 2 have a household size of 3, 2, and 1, respectively. As for household income, 58% earned between RM1000 and RM2000 per month, while 28% earned between RM2001 and RM3001 per month. Nine percent had an income of between RM3001 and RM4000 per month, and 5% had an income of RM4000 and above. These findings indicate that based on the sample of rural communities in Bera District, almost 95% were in the B40 income group. --- Relationship between Education and Income Level Table 3 shows a significant difference between education level and income distribution. The finding of this study is in line with a study conducted by Narimah et al. (2018), who found that poverty could lead to low educational attainment and cause poverty to be passed on from parents to their children. Zurina et al. (2018) also found that the absence of education and low standard of education cause an economic downturn in the household as well as poverty due to the absence of a permanent job. Therefore, the finding obtained clearly shows that the low education of the household affects the poverty of rural communities. Table 3 Result of the chi-square analysis for the relationship between education and income level Chi-Square df Asymp. Sig. 36.260a 2 0.000 --- CONCLUSION This study examines the socio-economic background, the level of education, and factors that drive poverty in rural communities in Bera District, Pahang. The authors propose that the government emphasise education, income, and employment opportunities, particularly in rural areas, to develop the communities in rural areas and improve their standard of living. By reducing poverty, the well-being of rural communities will be indirectly improved, and they will not be left behind in national development.

Low levels of education and low income are often associated with communities located in rural areas. This is because rural communities have many constraints in obtaining education, employment opportunities, and earning a high income. This study aims to examine the factors that cause poverty in rural communities and investigate the socio-economic position and level of educational achievement of parents and children in rural communities in Bera District, Pahang, Malaysia. This study used a quantitative method for data collection. Questionnaires were administered to 100 respondents from the community living in the Bera district. Data obtained from respondents were analysed using Microsoft Excel and SPSS software through the Chi-square method. The study found that almost 51 percent of respondents agreed that the factors that drive poverty in rural families are the low education of household heads and the income earned by household heads based on their education level. In addition, a total of 59 respondents agreed with the issue of low education standards affecting the low level of income; 74 respondents agreed with the lack of employment opportunities in rural areas; and 59 respondents agreed that the education of the household heads makes it difficult for the children to get a good and higher education. As a result, the emphasis and opportunities on education, income, and employment opportunities, particularly in rural areas, must be increased more precisely.

INTRODUCTION COVID-19 which was first emerged in Wuhan city of China was a distinct clade from the beta coronaviruses related to human severe acute respiratory syndrome (SARS). 1,2 Covid-19 has more powerful pathogenicity and transmissibility than SARS. 3,4 The main transmission methods were droplets and contact which can be confirmed within a very short exposure time in the absence of personal protective equipment (PPE) like masks. 4,5,6 The World Health Organization (WHO) recognized COVID-19 outbreak as a Public Health Emergency of International globe raced to develop safe and effective vaccines. According to WHO: "vaccine must provide a highly favorable benefit-risk contour; with high efficacy, only mild or transient adverse effects and no serious ailments." The vaccine must be suitable for all ages, pregnant and lactating women, and should provide a rapid onset of protection with a single dose and confer safety for at least up to one year of administration. 13 The fight against COVID-19 has seen vaccine development move at record speed, compared to traditional vaccines. Many people understand the complexity of vaccine development and concerned that the vaccine was rushed. Therefore, it is natural to have some vaccine hesitancy and apprehension over the effectiveness and safety of the vaccine. Starting from March 2021, Iraqi people have the opportunity to receive the vaccine (Sinopharm, AstraZeneca, Pfizer). Therefore, this study aimed to investigate community perceptions towards COVID-19 vaccinations in Iraq and to explore factors associated with the hesitation in the receiving of the vaccine. --- MATERIALS AND METHODS A cross-sectional study was conducted in Iraq from March 2021 to June 2021, enrolling 9,620 participants of which 3,160 men and 6,460 women adults aged 18 years-old or older living in Iraq during the period of study conduct. The participants responded to an online survey on COVID-19 vaccination uploaded via the web-based Survey Monkey platform distributed all over the Iraqi governorates. A link to an online survey was sent via social media platforms (WhatsApp, Facebook). The questionnaire was administered in Arabic, and non-citizens who do not understand the Arabic language showed no response. The questionnaire was pretested in a pilot study involving 50 participants. The questionnaire consisted of three sections, section A on demographic characteristics of respondents included age, gender, occupation, level of education, and residency, section B on the respondent's perception toward COVID-19 vaccine, with nine inquiries (the vaccine is not effective, doesn't provide long-term immunity, not safe, at risk of COVID-19 after vaccination, cause death, may cause infertility, can alter genes, may cause congenital infection and anomalies, women at reproductive age should postpone pregnancy after vaccination). A "yes' and 'no' questions to assess the participants' perception towards COVID-19 vaccine. In section C, participants were asked about the type of vaccine they prefer to receive, once it's available. The analysis of data was performed using SPSS Statistic 22.0. Data were expressed in numbers and percentages; Chi-square was used and a p-value of <0.05 was considered significant. Ethical approval was obtained from the Scientific Committee at Al-Zahraa Medical College, University of Basrah. --- RESULTS A total of 9,620 Iraqi adults had responded to the survey. Majority of the respondents were female (67.16%), aged between 18 to 30 years-old (59.66%), graduated from college or above (88.97%), government employees (42.80%), and lived at Southern governorates (83.78%). Table 1 displayed the demographic characteristics of respondents. Out of 9,620 respondents, 70.68% (6,800 respondents) were not keen for COVID-19 vaccination. Table 2 presented the demographic characteristics of respondents who were not willing to get the covid-19 vaccination. Out of 3,160 male respondents and 6,460 female respondents, 2,180 male respondents (68.98%) and 4,620 female respondents (71.51%) were not keen for covid-19 vaccination. Thus, there was no statistically significance in different gender for covid-19 vaccination receptiveness (P-value=0.608). Out of 1,440 healthcare worker respondents and 8,180 public respondents, 820 of healthcare (56.94%) and 5980 of public respondents (73.1%) not keen for vaccination . Thus, the result shown that the unwillingness for covid-19 vaccination was high in both healthcare workers group and public group. However, it was statistically different (p-value <0.05). The survey also shown that the healthcare workers who keen for covid-19 vaccination preferred and trusted Pfizer vaccine than Sinopharm and AstraZeneca (29.16% vs 18.05% vs 9.72 %) respectively, whereas the public trusted Sinopharm than Pfizer and Astra Zeneca (14.91% vs 11.49% vs 6.84%). The results are displayed in Figure 1. --- DISCUSSION The emergence of covid-19 vaccination gives hope to the world in mitigating the covid-19 pandemic, However, many people were hesitant and had no intentions to be vaccinated. Our online survey observed that nearly three -quarters of the respondents had no willingness to be vaccinated and only 29.32% were keen for vaccination. There were several studies conducted to determine the intention of the public for COVID-19 vaccination had demonstrated high acceptance rates compared to our study. 14,15,16 The high acceptance rates in those studies were associated with better knowledge regarding the severity of COVID-19 and high trust in the vaccines by the respondents. In our study, majority of the respondents were women (67.16%) which is similar to a study conducted in Malaysia (65.9%) but slightly higher than those conducted in United States by Paul et al (56%) and Malik et al (57%). 9.15,16 In our study, majority of our respondents were aged between 18 to 30 years (59.66 %). A similar result was shown in a study by Hassan et al where more than 75% of respondents were in the age group of 18-29. 17 Healthcare workers accounted for 15% of our study respondents. Our study result demonstrated that 56.94% of the healthcare workers were not willing for vaccination in which the result was higher than reported result of a study conducted in Egypt (21%) and in Turkey (20.7%). 16,18 Our study result also demonstrated that majority of healthcare workers and public were not convinced that the vaccine is effective to prevent the covid-19 infection (55.55% vs 69.43%), provide long-term immunity (75.00% vs 80.68%), or safe (59.72% vs 74.59) respectively . In comparison to our finding, a study by Sandooja et al showed that 75% of the participants believed in the vaccine's efficacy, 75% thought people can be protected from COVID-19 by vaccination and 87.9% considered the COVID-19 vaccine to be safe. 19 In our study, 70.83% of healthcare workers and 66.92% of public were worried of being infected with covid-19. Our study results were consistent with a study conducted by Parikh PA. et al in which 80% of healthcare professional and 82% of the general public worried of being infected with the covid-19 post vaccination. 20 In our study also, 34.72% of healthcare workers and 64.05% of public were feared of death. Our study shown that 16.66% of healthcare workers and 38.38% of the public believed that the vaccine may cause infertility. In a study in Germany, 21.9% of participants concerned about impact of vaccines on own fertility. 21 Our results showed 5.55% of healthcare workers and 12.95% of public believed that it could alter their genes. A similar study conducted in Nigeria demonstrated that 15% of their respondents worried that the vaccine could alter their genes or genetic makeup. 22 Our study revealed that the healthcare workers and the general public believed that the covid-19 vaccine may cause congenital infection and anomalies (29.16% vs 25 . A study in Poland demonstrated 20% of participants believed that the vaccine causes defects in the fetus. 23 Our study also revealed that the healthcare workers and the general public believed that women at reproductive age should postpone pregnancy after vaccination (47.22% vs 17.23 %). Our study demonstrated that the healthcare workers trusted Pfizer vaccine than Sinopharm and AstraZeneca (29.16% vs 18.05% vs 9.72 %) respectively whereas the public trusted Sinopharm over Pfizer and Astra Zeneca (14.91% vs 11.49% vs 6.84 %). A previous study in Iraqi Kurdistan region reported that AstraZeneca and Pfizer vaccines frightened the most people (39.9% and 34.01%, respectively). 24 WHO and the Ministry of Health in Iraq raised the challenge to vaccinate the maximum number of people possible to control the COVID19 Pandemic as soon as possible. Iraq prioritizes the high-risk populations through a multi-phase roll-out plan and it is mandatory for all government employees to receive at least two doses of the vaccine. One study limitation was the use of social media in collecting the information, the sample was not generalized, may not represent the population, as this might affect people who have limited access to the internet made them unable to take part in this study. Other limitation is that the questionnaire was in google forms and using Arabic language , non-citizens who do not understand the Arabic language showed no response. These limitations could be addressed in future research. --- CONCLUSION AND RECOMMENDATION Hesitancy for vaccination is a major threat to vaccination success. A rapid development of a new vaccine contributes to the hesitancy, fear, and doubt of COVID-19 vaccine. An increase numbers of people being vaccinated should increase the belief that the vaccines are safe and decrease the fear and hesitancy among the general population. The Ministry of Health needs to address this public health challenge and ensure public confidence in COVID-19 vaccines. Various strategies are recommended to overcome vaccine hesitancy. The healthcare providers and community leaders should play a key role in increasing awareness and knowledge by providing an effective education on the vaccine and clear communication approaches to address vaccine hesitancy. --- FUNDING INFORMATION There was no specific grant or funding received for the study. --- DECLARATION OF COMPETING INTEREST There are no conflicts of interest.

Concern (PHEIC) that endangers international public health with cases ranging from individuals who are asymptomatic to those who experience severe respiratory distress, pneumonia, and death. 7,8,9 The global efforts to lessen the effects of the pandemic, and to reduce its health and socio-economic impact rely to a large extent on the preventive efforts. 10,11,12 Many efforts have been directed toward the development of the vaccines against COVID-19 and several prophylactic vaccines against COVID-19 are currently in development phase researchers across the

Objective In 2012, an estimated 41 million US households paid more than 30% of their pre-tax income for housing (1). High housing costs make it difficult to afford other necessities, including food, transportation, and medical care. Housing affordability is associated with housing insecurity or stress related to affording rent or mortgage (2,3). Studies have reported associations between housing insecurity and mental health problems or avoiding medical care, but questions remain about the association with health risk behaviors and outcomes (4)(5)(6). This study characterizes adults who report housing insecurity and the relationship of housing insecurity to selected unhealthy behaviors and outcomes. --- Methods We analyzed data from the 2011 Washington State Behavioral Risk Factor Surveillance System (BRFSS). BRFSS is a randomdigit-dialed telephone survey conducted annually in all 50 states, DC, and US territories. The Washington State BRFSS response rate for 2011 was about 47%. Data from 8,415 respondents responding to the state-added Social Context Module were used to assess the frequency of housing insecurity, which was defined as respondents answering "always," "usually," or "sometimes" to "How often in the past 12 months would you say you were worried or stressed about having enough money to pay your rent/mortgage?" (6), and the associations between housing insecurity and health risk behaviors and outcomes. We calculated unadjusted prevalence estimates with 95% confidence intervals (CIs) for housing insecurity, stratified by socioeconomic measures and demographics. Categorical variables representing socioeconomic and demographic measures were educational level, income (when available), home ownership, sex, health insurance coverage, Hispanic ethnicity, age, marital status, veteran status, presence of children in the home, and self-report of experiencing 3 or more adverse childhood experiences (ACEs) (eg, physical abuse) from 11 questions included in the state-added ACE module. Unadjusted prevalence ratios (PRs), PRs adjusted for socioeconomic measures and demographics (aPRs), and 95% CIs using predicted marginals were estimated to assess the relationship between housing insecurity and the following measures: current smoking, binge drinking during the past 30 days (defined as consuming 5 or more drinks on an occasion for men and 4 or more drinks on an occasion for women), delaying doctor visits because of costs in the last year, poor or fair self-reported health status, as well as 14 days or more in the past 30 days of poor physical health, poor mental health, or poor health limiting daily activity. These health risk behaviors and outcomes were chosen as a sample of quality of life indicators that are associated with different types of stressful events. All estimates used Washington State-specific raked and trimmed weights and were performed using SUDAAN version 11 (RTI International) to account for sampling weights and to adjust variance estimates for the complex sampling design. --- Results Among all Washington respondents, 29.4% reported housing insecurity. Respondents with the following characteristics reported a prevalence of housing insecurity higher than the state prevalence: high school education or less, annual household income less than $50,000, women, Hispanic ethnicity, aged 25 to 44 years, unmarried, living in households with children, or 3 or more ACEs (Table 1). The groups with the highest frequency of always being worried or stressed about having enough money to pay their rent or mortgage were respondents with incomes less than $25,000, people without health insurance at the time of survey, renters, and people with a self-reported history of 3 or more adverse childhood experiences. We categorized the frequency of housing insecurity into those who were housing insecure (reported being always, usually, or sometimes worried about making housing payments) and those who were housing secure (reported never or rarely worried). Among people reporting housing insecurity, 33.3% also reported delaying doctor visits because of costs, 26.9% were current smokers, and 26.3% had poor or fair health (Table 2). People who were housing insecure were more likely to be current smokers than people who were not insecure (aPR = 1.4). Binge drinking in the past 30 days was not significantly associated with housing insecurity. Those who were housing insecure were nearly 6 times as likely as those who were not insecure to delay doctor visits because of costs (PR = 5.7). This association was attenuated but still significant after adjusting for socioeconomic measures and demographics (aPR = 2.6). Compared with people who were not housing insecure, respondents who were insecure were about twice as likely to report poor or fair health status (aPR = 1.9), 14 days or more of poor mental health (aPR = 2.3), or poor health limiting daily activity in the past 30 days (aPR = 2.0). A weaker association was found between housing insecurity and 14 days or more in the past 30 of poor physical health (aPR = 1.5). --- Discussion We found that respondents who were housing insecure were more likely than those who were not to report the following even after adjusting for demographics and socioeconomic measures: delaying doctors' visits, poor or fair health, and 14 days or more of poor health or mental health limiting daily activity in the past 30 days. This is not the first study to show an association between housing insecurity and health (2)(3)(4), but to our knowledge, it is the first to show that such associations exist even after controlling for various socioeconomic and demographic measures. This study also shows the value of using data from both the ACE and Social Context state-added BRFSS modules. The findings in this report are subject to at least 4 limitations. First, because the BRFSS is a cross-sectional survey, it is not possible to determine if housing insecurity and health outcomes are causally related. Second, the BRFSS excludes participants who are homeless. People who experienced housing insecurity and then became homeless would not be included, perhaps leading to an underestimation of the association between housing insecurity and poorer health. Third, even though possible confounders were controlled for in the model, residual confounding from using categorical variables could still exist, and not all possible confounders could be controlled. Finally, BRFSS data are self-reported and subject to recall and social desirability bias. This analysis supports a call to action among public health practitioners addressing disparities to focus on social determinants of health risk behaviors and outcomes as barriers for people to achieve optimal health (7,8). The National Prevention Council's Action Plan, for example, emphasizes that affordable housing can help make healthy lifestyle choices easier (8). Such engagement represents an expansion of public health's traditional housing-related efforts that focused on environmental health and safety (9,10) and encourages multisector collaboration as well as nuanced approaches toward health equity. (continued) --- Author Information Corresponding Author: Mandy Stahre, PhD, Chronic Disease Epidemiology Supervisor, Epidemic Intelligence Service Officer (Class 2012), Washington State Department of Health, PO Box 47835, Olympia, WA 98504-7835. Telephone: 360-236-4247. Email: mandy.stahre@doh.wa.gov. --- PREVENTING CHRONIC DISEASE

Few studies of associations between housing and health have focused on housing insecurity and health risk behaviors and outcomes. We measured the association between housing insecurity and selected health risk behaviors and outcomes, adjusted for socioeconomic measures, among 8,415 respondents to the 2011 Washington State Behavioral Risk Factor Surveillance System. Housing insecure respondents were about twice as likely as those who were not housing insecure to report poor or fair health status or delay doctor visits because of costs. This analysis supports a call to action among public health practitioners who address disparities to focus on social determinants of health risk behaviors and outcomes.

Physicians' Consideration of Race in the Clinical Context A straightforward understanding of how physicians employ race in medicine is complicated by the fact that they are exposed to highly varied and often competing narratives about the role of race in health. Today, many scientific studies aim to highlight genetic differences between racial groups, while an equal volume of literature adamantly criticizes the notion of race as having any biological basis. Epidemiological literature clearly shows that disease prevalence differs between racial groups, although the mechanisms behind these differences are not always clear. Additionally, racial stereotypes and assumptions are a source of unquestioned logics about who belongs to which racial group and how their culture, values, and habits influence health. In our efforts to understand how physicians incorporate or reject these narratives in their own practice, we and others have conducted qualitative and quantitative studies with physicians about the clinical relevance of race (Sellers et al. 2018, Hunt et al. 2013, Snipes et al. 2011, Bonham et al. 2009). In these studies, we see that race frequently becomes a proxy for a variety of unobservable characteristics that may increase the risk of poor health outcomes. For example, physicians in focus-group studies have made connections between race and health behaviors by explaining that certain groups prefer unhealthier foods or larger body sizes, have alternative cultural practices surrounding health, or prioritize health in Disclaimer The opinions expressed in this article are those of the authors. No statement in this article should be construed as an official position of the National Human Genome Research Institute, National Institutes of Health, or Department of Health and Human Services. different ways (Hunt et al. 2013). They also discuss a relationship between race and class, suggesting that certain racial groups may be at higher risk for many conditions because of their low health literacy, lack of quality health care, or limited access to the resources required to live a healthy lifestyle (Hunt et al. 2013, Bonham et al. 2009, Snipes et al. 2011). Finally, physicians have reported that certain racial groups may be genetically predisposed to specific conditions (Bonham et al. 2009, Hunt et al. 2013). In some cases, these narratives about the relationship between race and health differences are codified into race-specific clinical guidelines. Physicians discuss examples of a number of race-specific recommendations (Hunt et al. 2013, Snipes et al. 2011, Bonham et al. 2009), such as those to screen for diabetes at a lower body mass index (BMI) for Asian Americans (American Diabetes Association 2018), adjust for race in measurements of lung function (Braun 2014), and consider the increased risk for prostate cancer in African American men when making decisions about prostate-specific antigen screening (U.S. Preventive Services Task Force 2018). Such guidelines adjust for differential disease risk based upon patients' perceived ancestral background and social characteristics, which are described using the construct of "race." The scientific and clinical basis for some of these guidelines have previously been critiqued through a broader examination of the history of the relationships between race, science, and medicine (Braun 2014). --- Intersectionality and the Role of Race in Clinical Medicine We recognize that race and other social identities can be important to consider in the clinical context, but the improper use of race lends itself to imprecise and inadequate care. Many contemporary critiques of the use of race in medicine have centered around the complex relationship between racial categories and genetic variation. Race is fluid, contextual, and does not map neatly onto genetic variation, and assuming that it does risks missing diagnoses, giving inappropriate treatment recommendations, and reinforcing the debunked notion of discrete biological races. In this context, intersectionality adds another lens through which to challenge the uncritical consideration of race in the clinic. Underlying physicians' manifold explanations for the medical relevance of race, or the "adjustment" for race in clinical guidelines, can be the assumption that members of a racial group share the experience of race and its associated burdens, risks, and contexts in similar ways. However, intersectionality posits, and intersectional research has shown, that this is not the case. At its core, intersectionality theorizes that multiple social identities interact to create wholly unique experiences of marginalization and privilege. Therefore, even individuals who share in an axis of identity such as race will have diverse experiences based on their unique social positions along other axes (Crenshaw 1989). In the biomedical realm, we see these ideas play out in the differential risks for diseases that are revealed through intersectional analyses of epidemiological data. For example, the relationship between hypertension and race is well established and is one that physicians frequently raise in discussions about race and medical treatment (Hunt et al. 2013, Bonham et al. 2009, Snipes et al. 2011). However, the prevalence of hypertension has been reported to be even higher in women of color than their male counterparts, and in line with the intersectional reality of these women's lives, this effect is multiplicative rather than additive (Richardson and Brown 2016). For physicians, these findings and intersectional thinking more broadly do not mean that they should simply use more complicated sets of heuristics or reference values that involve multiple social identities. As Wilson and colleagues write, "attention to intersectionality does not necessarily demand finer and finer grained distinctions in order to create new analytic categories of similarity…Rather, intersectionality requires a shift in thinking from dominant frameworks to frameworks that are mindful of how one's social identity contributes to one's experience of the world" (Wilson et al. 2019). We concur, and add that this "shift in thinking" for physicians can involve a revisiting of how they conceptualize race. Under an intersectional framework, race is not a constellation of social contexts, behaviors, or genomic information that can be packaged into a proxy or reference value. Rather, it is one of many identities that determine patients' unique location within interlocking societal structures, and it is the whole experience of this social position that shapes health. What follows from this reconceptualization is that physicians, when they consider race, would consider it in conjunction with the entirety of a patient's identity and social context. They would be open to working through the many ways in which race, together with other social identities and structures, might make a patient more vulnerable in the healthcare system, susceptible to an illness, or suited for a treatment plan. We recognize that intersectionality is ambiguous in methodology and application -it certainly does not spell out the precise health consequences of specific combinations of identities. However, like Wilson and colleagues, we do not see this ambiguity as a weakness. To the contrary, it simply leaves room for health care providers to be open-minded, expansive, and even creative in how they consider the relationship between a patient's social context and health. Our vision for the role of intersectionality in clinical decision making mirrors that of Wilson and colleagues in many ways. However, thinking through the implications of their proposal specifically for physicians' consideration of race highlights the ways in which intersectionality can address at least some of the tensions surrounding the relationship between race and medicine. First, the use of race in medicine is criticized for seeking the rationale for differences in health in biology, which can distract from efforts to address social health inequities. However, an intersectional framework unequivocally foregrounds the role of race in structural social inequities. Second, the use of race as a proxy or heuristic has been criticized for leading to inappropriate care when the assumptions underlying the heuristic are not necessarily true. An intersectional framework is not based upon assumptions about the relationship between a patient's race and disease risk, as it recognizes that social identities and structures can converge in unique and unexpected ways. In this way, intersectionality can foster a truly expansive and thoughtful consideration of a patient's social context in clinical decision making. This research is supported in part by the Intramural Research Program of the National Human Genome Research Institute.

propose intersectionality as a framework that can make clinical medicine more attentive to the complexity of patients' and health care providers' social identities. We agree that "intersectionality acknowledges how multifaceted differences shape the patient-clinician interaction and forces a re-framing that can lead to improved outcomes" (Wilson et al. 2019, 8). In this commentary, we extend Wilson and colleagues (2019) by highlighting the significant influence of one social identity in medicine and the clinical encounter: race. In the midst of deliberations about the appropriate role of race in science and medicine, intersectionality can challenge an uncritical use of race and foster a more expansive consideration of social identities in clinical decision making.

the harmful side effects. Anger that I would adjust or change their treatment regimen to include non-opioid therapies. These patient encounters felt like a negotiation in futility. Within 3 months, I was facing burnout, feeling disillusioned as I combated an inner war between best practice and trying to meet the wants of my patients. These intensifying feelings of self-doubt and frustration climaxed in a distinct moment of weakness. I was standing outside of a patient's room mentally preparing for the upcoming discussion of her pain medication regimen after an inconsistent drug screen. I was 40 minutes behind in the middle of a 12-hour clinic shift and I knew this was going to be an intense and time-consuming clinic visit. There was a sick feeling in the pit of my stomach, a feeling that had been occurring more frequently on a daily basis, and I wondered how I had gotten to this point. Difficult discussions are common in medicine, but not discussions in which the physician is made to consistently feel the villain. I started questioning whether the inevitable confrontation and conflict was worth it. Should I just sign another prescription? There would be no denial, no anger, no questioning of clinical judgement, and no conflict if I just said yes. I realized, however, that acquiescing would create 2 problems: it would potentiate the denial that this patient had an addiction, and would eventually place the prescribing burden on another physician. I suddenly saw the source of my frustration and self-doubt: I lacked the experience and tools to treat this overwhelming and dangerous health condition. A colleague of mine noted my despair and invited me to a meeting at the Substance Abuse Treatment Unit of Central Iowa (SATUCI). The director of SATUCI expressed a need for a physician in our community to offer medication-assisted treatment (MAT), in particular buprenorphine and naltrexone for those addicted to opioids. I realized I could learn how to treat opioid addiction through MAT and at that moment felt the sick feeling in my stomach dissipate for the first time in months. Opioid addiction treatment with the combination of MAT and therapy has a 60% success rate and a 12% success rate with therapy alone. In our rural community, we had very limited resources and there were no MAT providers within a 60-mile radius. Without access to medication assisted treatment, patients had little incentive to self-identify as having an opioid use disorder. The fear and discomfort of withdrawal in addition to the social stigma associated with addiction was a barrier that could not be overcome without changing the way we as a clinic approached this disorder. I realized we could provide a treatment option to help stabilize those who were found to have addiction through our chronic pain program or self-identified as being addicted to opioids while they undergo addiction counseling and therapy. Following MAT training and initiation of our program, my role transformed from villain to coach as we became a key component to our patients' treatment of addiction. As we developed our program and began enrolling patients for treatment, we began to heal our patients and our community. Mrs Smith's story was not unique; a significant amount of the opioid addiction in our community began following a prolonged prescription of opioids. Patients within our clinic began coming forward expressing their desire to be free of the destruction that follows the wake of addiction. Following the demand we had in our clinic, we wanted to expand the program to all patients in the community. We received a federal Health Resources and Services Administration (HRSA) MAT community expansion grant; however, acceptance by the local medical community proved difficult. Some providers denied opioid addiction as a problem and declined information on the program. One clinic manager stated their clinic had had 1 patient in the past 20 years with an opioid addiction. I was in shock and disbelief. After discussion with community leaders, we came to 2 possible scenarios: either patients were not being screened for addiction or there was a lack of awareness by clinicians. Many clinics have a low addiction-screening rate due to the pressure on physicians to increase productivity and patient satisfaction. Responsible opioid prescribing with random urine drug screens and pain agreements opens a door to conflict that practices may choose not to undertake. Lastly, that moment of weakness where I had contemplated avoiding the discussion and signing a script is a daily struggle for many physicians. Whether the reasons are productivity, patient satisfaction, avoidance of confrontation or lack of resources, this professional and community self-denial is as dangerous as the epidemic itself. As family physicians, if we are not recognizing addiction and recommending appropriate treatment, we will not be doing our part to curtail the opioid and heroin crisis, and, even worse, we will contribute to the opioid epidemic. On our path toward change, it is imperative that we acknowledge many of the barriers that affect our fellow physicians. What support do we have for our solo or small practice physicians who rely on patient interaction and feedback for the survival of their practice and their own professional satisfaction? Who coaches these physicians and supports them before and after an aggressive patient encounter? Who exposes primary care physicians to the prospect and feasibility of becoming a medication-assisted treatment provider? Chronic opioid dependence and addiction has permeated all socioeconomic and geographical levels of our society. Despite the statistics, public health announcements, and litany of celebrities who die of an overdose-denial is still the predominant response. Denial is the single largest threat in addressing the opioid epidemic-denial by patients, denial by physicians, denial by families, denial by communities, and denial through lack of access to MAT treatment. I chose not to deny the opioid epidemic, and the lack of resources and training led to burnout. The decision to provide my patients and community access to MAT led to my professional healing. In the community, our clinic created a culture of recognition of opioid addiction, openness to challenge current prescribing habits and encouragement of treatment of opioid addiction. I implore our profession to develop a similar culture and network of support for physicians to engage in when they are compared with "my old doctor." To read or post commentaries in response to this article, see it online at http://www.AnnFamMed.org/content/15/4/372. Key words: substance-related disorders; opioids; opiate substitution treatment; addiction Submitted June 3, 2016;submitted, revised, December 5, 2016;accepted December 13, 2016.

Why can't you be like my old doctor?" This essay explores my experiences as a new family physician in a rural town endemic with liberal opioid prescribing practices and opioid addiction. I detail my inner turmoil while overcoming resistance to change, the influence of these experiences on my professional growth, and my decision to offer medication-assisted treatment.

INTRODUCTION Online dating is a way for people to meet and form romantic relationships over the internet. It typically involves the use of a dating website or app where users can create a profile and search for potential matches. With the introduction of smartphones and tablets, people can now connect with potential partners from anywhere in the world. Online dating apps such as Tinder, Bumble, and OkCupid have made it easier than ever to find a match. Technology has also enabled users to filter potential matches based on their interests, location, and other criteria. Additionally, online dating sites have implemented safety measures such as background checks and photo verification to ensure that users are who they say they are. Although recent studies and media reports indicate that it may also be a good environment for deceit, online dating is a well-liked new method for starting love relationships. The current study in a contrast to other ones that only used self report data, establishes ground truth for 8-online daters height, weight and age and contrasts it with information given in dating profiles. The findings imply that although dishonesty is regularly notices, it typically occurs at a low level. It was revealed that more people are engaging in dating online as indicated by a 7 month rise in the percentage of conventional traditional daters which increased from 41% to 1 69% . The fact of portraying oneself as attractive might encompass from the way dating software works, it includes a set of photographs that is swiped through in order to find a suitable dating partner which catches the individual's eye thereby physical appearance becomes a key factor in choosing dating 2 partner . Some of the factors that would be looked into is social desirability and self-image, here social desirability means one can quantify desirability by the number of messages a user receives and specifically the number of initial messages, since it is the first contact between a pair of individuals that most reliably indicates who finds whom 3 attractive . It was estimated that the mate preferences used information by utilizing the Gale-Shapley algorithm to forecast stable pairings using data on user traits and interactions from an online dating service. The real matches are roughly as efficient as the anticipated matches, which are close to the actual matches the dating service has been made. Out-ofsample forecasts of offline matches, or marriages, show assortative mating patterns that are consistent with those seen in real marriages. As a result, sorting in marriages might be caused be mate preferences without the need of search frictions. However, the correlation patterns; search frictions 4 could be a factor in this discrepancy's explanation . --- METHOD Sample distribution The sample size was 206 which is based on whether the individuals are using online dating apps currently Inclusion Criteria: Individuals who are in the age range of 18 to 30 and who are currently using online dating apps. --- Exclusion Criteria: Individuals who haven't used dating sites and who used dating sites previously. --- Procedure The questionnaire approach was employed as the primary source of primary data. The standard scales that were used are Marlowe-Crowne Social Desirability scale -short form and Body Self-Image Questionnaire-short form Tools used for the study 1. Marlow -Crowne Social Desirability scale -short form. --- Body self-image questionnaire by David Rowe (2005, June) --- Statistical Analysis The statistical Package for Social Sciences (SPSS) version 26.0 was used to evaluate the hypotheses using Pearson Correlations and Regression Analysis. --- RESULTS AND DISCUSSION --- Table 3: Correlation Between Social Desirability And Body Self-image The Pearson Correlation was done to analyze the correlation between social desirability and Overall Appearance Evaluation and correlation coefficient r was found to be 0.188 which is statistically significant at 0.01 level, since there is a low positive correlation and the p value obtained is 0.007 (p<0.05), indicating that the null hypothesis which states that there is no significant relationship between social desirability and overall appearance evaluation is rejected. The Pearson Correlation was done to analyze the correlation between social desirability and Height Fitness Influence. The correlation coefficient r was found to be 0.123 which is statistically insignificant at 0.01 and 0.05 levels, since there is a low positive correlation and the p value obtained is 0.078 (p>0.05), thus indicating that the null hypothesis is accepted. The Pearson Correlation was done to analyze the correlation between social desirability and Investment in Ideals. The correlation coefficient r was found to be -0.38 which is statistically insignificant at both 0.01 and 0.05 levels. Since there is a low negative correlation and the p value obtained is 0.585 (p>0.05), thus the null hypothesis is accepted. The Pearson Correlation was done to analyze the correlation between social desirability and Height Fitness Evaluation. The correlation coefficient r was found to be 0.075 which is statistically insignificant at both 0.01 and 0.05 levels. Since there is no significant correlation and the p value obtained is 0.285 (p>0.05), thus the null hypothesis which states that there is no significant correlation between social desirability and height fitness evaluation is accepted. The Pearson Correlation was done to analyze the correlation between social desirability and social dependence. The correlation coefficient r was found to be -0.184 which is statistically significant at both 0.01 and 0.05 levels. Since there is a low negative correlation and the p value obtained is 0.008 (p<0.05), thus the null hypothesis is rejected. The Pearson Correlation was done to analyze the correlation between social desirability and Height Fitness Evaluation. The correlation coefficient r was found to be -0.152 which is statistically significant at 0.05 level. Since there is a low negative cor relation and the p value obtained is 0.029(p<0.05), thus the null hypothesis is rejected. The Pearson Correlation was done to analyze the correlation between social desirability and Attention to Grooming. The correlation coefficient r was found to be -0.188 which is statistically not significant at both 0.01 and 0.05 level. Since there is a low negative correlation and the p value obtained is 0.91, thus the null hypothesis is accepted. The Pearson Correlation was done to analyze the correlation between social desirability and negative affect. The correlation coefficient r was found to be -0.398 which is statistically significant at both 0.01 and 0.05 level. Since there is a low negative correlation and the p value obtained is 0, thus the null hypothesis is rejected. The Pearson Correlation was done to analyze the correlation between social desirability and negative affect. The correlation coefficient r was found to be -0.320 which is statistically significant at both 0.01 and 0.05 level. Since there is a low negative correlation and the p value obtained is 0, thus the null hypothesis is rejected. --- Table 4: Linear Regression To Assess The Impact Of Social Desirability On Aspects Of Body Self-image Table 4 shows the regression analysis of social desirability on overall appearance evaluation with Beta value of 0.188, t value 2 of 2.727. The model summary indicates that the r value is 0.035, F is 4.831 and the result was found to be significant with p<0.05. This indicates that there is a significant impact of social desirability on overall appearance evaluation among 2 young adults on online dating. The r value indicates that 3.5% change in overall appearance evaluation is predicted by social desirability. Thus, rejecting the hypothesis. The regression analysis of social desirability on height dissatisfaction with Beta value of -0.232, t value of -2.198. The 2 model summary indicates that the r value is 0.023, F is 4.831 and the result was found to be significant with p<0.05. This indicates that there is a significant impact of social desirability on height dissatisfaction among young adults on 2 online dating. The r value indicates that 2.3% change in height dissatisfaction is predicted by social desirability. Thus, accepting the hypothesis. --- Variables --- CONCLUSION With the use of descriptive and inferential statistics, it was shown that social desirability had positive correlation with overall appearance and negative affect in terms of body selfimage, but a negative correlation with height dissatisfaction, fatness evaluation and social dependence. Regarding the impact of social desirability on the variables of overall appearance, fatness evaluation, negative affect, and social dependence in the area of body self-image, it was seen that there was an impact on the aforementioned variables. --- REFERENCES:

The current study "social desirability and body self-image among young adults using online dating apps" looks into the relationship between social desirability and body self-image and how social desirability influences body self-image. A total of 206 participants from both male and female genders belonging to the age group of 18-30. The tools used were Marlowe-Crowne Social Desirability -Short Form(CMSDS) and Body self-image questionnaire -Short Form(BSIQ-SF). The statistical technique for correlation was used to identify the association between social desirability and body selfimage, in which the body self-image consists of 9 subscales. The findings of the study indicate there is a negative relationship between social desirability and fatness evaluation, height dissatisfaction and social dependence with respect to body self-image and a positive relationship between social desirability and overall appearance evaluation and negative affect in body self-image. Lastly, there is a significant impact of social desirability on negative affect and fatness evaluation with minimal impact on overall appearance evaluation, social dependence and height dissatisfaction in relation to body self-image.

Introduction In September 2022, 45 Clinical Psychologists (in training) and scientistpractitioners paid a working-visit to colleagues in Lisbon, Portugal as part of their post academic education program. Public, private medical and psychiatric hospitals, public mental healthcare facilities, the university, start-ups and innovation centers were visited. During this working-visit, Prof. Dr. D. Neto, lecturer and researcher in ISPA (the first school of Psychology in Portugal, a private University, https://www.ispa.pt/) provided a global view of the presence of clinical psychologists and psychotherapists in health care contexts. He substantiated the need for the integration of an increasing number of professionals in hospitals and primary care. In Portugal some rural regions have very little support with respect to other regions. The differences in the organization of the healthcare system between the Netherlands and Portugal were explained. These (cultural) differences inspired the trainees. At the end of the working-visit there was clear agreement on future international cooperation and exchanges of knowledge [1]. Both the Portuguese and Dutch colleagues agreed that several topics require constant attention to promote the relevance of psychology in different domains such as (public) healthcare and scientific research. In addition, the importance of uniformity in education and training, examination and implementation of the profession of psychologists in a European context was supported. --- Continuing the collaboration To perpetuate the interconnection and new cooperation, collaboration between the Dutch and Portuguese Clinical Psychologists continued digitally in 2023 to prepare a live working-visit in the autumn of 2024 with a new group of Clinical Psychologists (in training). A first part of the collaboration involved a masterclass on EMDR treatment on trauma in June 2023 which was organized together with the Psychiatric Hospital Júlio de Matos. The Portuguese colleagues N. Canudo and P. Diegues., both Clinical Psychologists, arranged a two-day conference on several topics (Jornadasdo Serviçode Psicologia Clínica: Um Serviço, várias especialidades (min-saude. pt), including trauma therapy. As part of this conference, a Dutch delegation organized an online lecture on EMDR offered by a Dutch expert, Clinical Psychologist Drs. R. van Diest. According to Kaats and Opheij (2012), 5 impactful indicators are important for the effectiveness of cooperation, which they integrate into the so-called Lens Model: Ambition, Interests, Relationship, Process and Organization [2]. In the preparation of the masterclass, we used this model as a frame to optimize the results of the collaboration. A small workgroup was formed and a close contact with colleagues from Psychiatric Hospital Júlio de Matos was attained online, to discuss ambitions and organizational details of the masterclass and the precise content of the program involving EMDR practice in general. were considered and ensured by a pre-conference meeting. Intercultural cooperation requires effort from both parties to get to know each other's habits and self-evidence, allowing mutual trust to grow. --- The process and the technical conditions EMDR therapy is being practiced in the Netherlands extensively, and is also rising within the Portuguese health care system. The main goal of this masterclass was to inform the Portuguese colleagues about the applicability and current scientific status of EMDR in the treatment of trauma and other psychiatric disorders. The Portuguese colleagues were expected to be enthused about the possibilities of EMDR and referred to the national professional association to become EMDR therapists. The masterclass was well visited by approximately 70 Portuguese professionals; both live present in the Portuguese lecture-hall as well as online. The attendants appeared to be well engaged and multiple questions about the treatment technique were asked after the lecture. The digital form of the lecture did not seem to limit interactive communication and engagement. In return, the Portuguese colleagues inspired the Dutch delegation in the advisory function they built up on national level and in their experience with for example community based care [3]. In the autumn of 2023 more innovative events will take place. In collaboration with Hospital CUF Tejo, Lisbon city, an exchange of scientific research will take place during a conference. Further, the Ordem dos Psicólogos Lisboa will exchange experiences with the Dutch Institute of Psychologists (NIP). At the end of the year an event will be organized in collaboration with Manicómio art outsider studio with respect to Experiential Expertise. Both the Dutch and Portuguese delegation stimulate young professionals to join the events and prepare them to be the key figures that contribute to the fusion of psychologists and use the power of community on a global scale [4]. --- Young professionals and mental healthcare challenges over the world The digital opportunities to discuss and exchange knowledge create positive implications for cooperation between countries, which can lead to innovation and creative solutions. Advantages of digital exchange include for example time efficiency, especially compared to live communication. The digital possibilities have grown extensively over the last several years. Especially since the COVID-19 pandemic, advanced technology supports the expansion of digital health entrepeneurship [5]. Maintaining digital collaboration also creates new opportunities and pathways for future work and helps to be flexible in rapidly changing environments [6]. Moreover, young professionals are more used to working with digital resources and may prefer this method of working over face-to-face communication. Also, and importantly, digital cooperation provides the benefit of sustainability. Innovation and creative solutions that are expected to be created through these developments are urgently needed to address larger, global issues within mental health care. Mental health systems around the world are under pressure due to different factors such as aging and an increasing workload [7]. Young professionals have to deal with big global challenges on different levels, as well as maintaining their own mental health. Research shows that mental health professionals report more sick leave and frequent absences post-pandemic, which highlights the importance of the focus on their resilience [8]. This may be particularly challenging for them considering the current global issues that may affect their work on direct or indirect level, including climate change, war, and staff shortages due to aging. International collaboration provides chances to unite on a larger level, to learn from each other, and to exchange evidence based, uniform knowledge. To conclude, it can be interesting to expand international cooperation on mental health. --- Conclusion and clinical relevance In order to expand the new cooperation between clinical psychologists (in training) in The Netherlands and Portugal, an online EMDR masterclass was provided by Dutch psychologists as part of a two-day conference at the Portuguese psychiatric hospital Júlio de Matos. The main goal of the masterclass seems to be achieved; colleagues have been enthused, relevant and evidence-based information about EMDR has been exchanged, and the cooperation has been continued to prepare for a new working-visit in 2024. These achievements would have been far less feasible without the use of current digital opportunities, in a time when international collaboration seems to be increasingly important given the rising global issues that affect mental health care. By all means the collaboration between the Dutch and the Portuguese Clinical Psychologists will be continued in the future. There is a common hope for a long-term cooperation and exchange of knowledge which can be inspiring for intercontinental collaboration as well. As we stated before [1] and in accordance with our expectation, a lot of lessons in mental healthcare are to be learned abroad. It's work in progress. --- Conflicts of Interest All authors declare that they have no conflicts of interest.

Background: The international working visit of a Dutch delegation of 45 clinical psychologists (in training) and science-practitioners in September 2022 to their colleagues in Lisbon, Portugal as part of their post academic education program inspired young psychologists to realize a masterclass. Purpose: Exchanging information on specific treatment between the Dutch psychologists and the colleagues from the Portuguese Psychiatric Hospital Júlio de Matos. Method: A digital masterclass on EMDR treatment. Results: A mutual ambition for a long-term cooperation over the borders and exchange of knowledge which provides more uniformity and positive solutions for future challenges. Conclusion: Digital opportunities create positive implications for cooperation between countries which can lead to innovation and creative solutions.

importance of corporeal attributes and the embodied dispositions of workers during service encounters. However, the theory is also challenged for its dominating feminist scope and the one-sided accentuation of the dysfunctions of society. A growing volume of research has diverted the attention on the experiences of male workers in aesthetic labor, and some, at the same time, are attempting to justify the prevalence of aesthetic labor by examining the agency of workers during the labor process. Comparative case studies, as well as the scope of cultural approach, are considered two promising research methodologies for aesthetic labor studies. Although the pursuit of beauty has always accompanied human development, the value of a "good look" has never been more prominent in our age. The booming of beauty industries such as make-up, modeling, and fashion has witnessed how a desirable physical appearance helps countless men and women ascend the social ladder from almost the bottom to the top. An increasing volume of literature focuses on the phenomenon, among which the term "aesthetic labor" stands out as one of the most influential theories that capture the characteristic of occupations based on the never-ending polishment of physical appearance. After two decades of development, the theory of aesthetic labor has stimulated volumes of research examining the role of the body and physical beauty in interactive service work. The review essay aims to sketch the breakthroughs that the theory have made, the debates centered on the theory and the future directions that might fill the gap. --- Keywords: Aesthetic Labor; Economy; Strathclyde Group; Sociology of Work --- Aesthetic Labor in the Millennium Aesthetic labor is introduced alongside the discussion of the "new economy" at the advent of the millennium. In their book "Looking good, sounding right: Style counselling in the new economy", Warhurst C, et al. [1] contend that it is not the "thinking" and technical skills in the IT industry, but the "aesthetic skills" possessed by front-line workers in service sectors, hold the key to employability and the key to economic success during the industrial transformation of UK at the dawning of the 21st century. Using the successful shift of Glasgow as an example, they illustrate how the recruitment of employees with stunning looks and consonant dispositions vitalizes the service market and the city's economy. Generally, aesthetics refers to the sensual components of people's daily encounters. Aesthetic labor is "the mobilization, development, and commodification of embodied dispositions" [2]. By accentuating the corporal attributes and a set of embodied dispositions of workers that arouse the visceral sensibilities and aesthetic experiences of customers, Warhurst C, et al. [3], who are later known as the "Strathclyde group", discover the "aesthetic" dimension of service work and its influence on re-defining the service interaction. Later on, the "Strathclyde group" subsequently initiate a series of research surrounding the theory of "aesthetic labor", with the ambition to re-conceptualize the work and employment structure of service organizations [3]. The theory shines out its greater empirical competence nowadays, given the omnipresent beauty images enhanced by the well-developed visual technologies and the lucrative beauty economies [4]. Apart from its empirical significance, the theory has its theoretical stick points to emotional labor. By foregrounding the body and bodily presentations in service encounters, the "Strathclyde group" challenges the theoretical and even the epistemological basis of emotional labor, which has been generally accepted as the dominant research paradigm in studies of interactive service work for decades. --- Beyond Emotions: The "Aesthetic Turn" In the Study of Service Work In her pioneering work "The managed heart: Commercialization of human feeling", Arlie Russell Hochschild AR [5] states that besides the physical and mental labor, a flight attendant is also required to "induce or suppress feeling to sustain the outward countenance that produces the state of mind in others" [5]. This requirement is termed as emotional labor by her and has been widely acknowledged by the academia. The empirical applications spread out to different disciplines from organization and management to the sociology of work, and the core interest of the discussion centers around the dynamic power relations in service encounters and the consequences of the commercialization of emotions [6][7][8][9]. After three decades of development, scholars' attention has returned from empirical explorations to theoretical reflections of emotional labor. One of the most often-heard critics among emotional labor theorists is that the empirical research has been theoretically fragmented and case-specific, lacking the potency to provide coherent theoretical guidance for academia [10]. Recent studies are trying to compensate for the inadequacy by providing an integrative framework to conceptualize and operationalize emotional labor [11]. More than the lack of theoretical coherence, critics from the literature stream of aesthetic labor make a breakthrough by pointing out the theory's analytical drawbacks. In their article "The labour of aesthetics and the aesthetics of organization", Witz A, et al. [2] address the deficiencies of the analytic frame of emotional labor and theorize aesthetic labor. The first one lies in the overlook of corporeality. By theorizing the labor in service work as "the war of smiles", Hochschild AR [5] dives into the inner struggle in the course of labouring while "analytically abandoning" the precise status of the flesh and blood that makes the acting possible. Moreover, the inheritance of the Goffmanian tradition, which leads to the surface-deep acting analysis, adds to the dichotomy of body-soul in the analysis. As a result, the surface "becomes synonymous with the body that is devoid of authenticity, where depth becomes synonymous with the soul as the authentic, feeling core of the self" [2]. Drawing from the "embodied disposition" that Bourdieu brings about in his practice theory, aesthetic labor is capable of resolving the body-soul dichotomy while foregrounding bodily presentation in service encounters. The re-conceptualization further prompted the "aesthetic turn" in service work studies [12]. From 2000 to the present, a series of studies have been carried out successively, led by "the Strachy Group". Case studies in retail and hospitality sectors, along with statistical analysis, are the primary research approach in their thread of research. Their research investigates how organizations perpetuate and institutionalize the importance of appearance not only through the recruitment and selection of "stylish" employees, but also through the cultivation of aesthetic skills underpinned by the training and supervision process [13,14]. The consequences of which are also scrutinized. Employees possessing a sense of "middle classness" gives rise to a new labor aristocracy and the prevalence of "lookism" [15], making physical appearance another important social category in employment discrimination. In their latest book, Warhurst C, et al. [16] gives a systematic theorization and application of aesthetic labor by dialoguing with theories from the sociology of work and body. --- Debates and what's Next Apart from focusing on the general routine interactive service jobs, a growing number of researchers have diverted their attention to professions where the management and commercialization of the body lie at the heart of the work process. The study of the modelling industry is amongst the most typical. Drawing from the fashion industries of New York and London, Entwistle J, et al. [17] argue that aesthetic labor entails the ongoing production of body/self. Besides staying physically attractive, freelancer fashion models must also invent distinctive "personalities" to survive in the industry. In "Pricing beauty: The making of a fashion model", Mears A [18] incorporates her own experiences of being a model to unpack the seemingly glamorous while precarious work conditions of fashion models. The edited work of Elias AS, et al. [4] are worth mentioning for its global vision in providing readers with worldwide empirical studies of aesthetic labor regarding various occupations encompassing the beauty industry from cosmetics, beauty make-up to wellness, social media entertainment. The collection mainly discusses how the ideology of neoliberalism facilitates the association between aesthetic labor and "entrepreneurial labor" and helps female workers re-interpret gender relations, femininity, and the relationship between work and self-transformation. As the majority stance of aesthetic labor, the previously mentioned research takes beauty as a feminist issue. It is not only because "looking good" has been intuitively reckoned as the mission for women [19], but also due to the fact that the politics of appearance has long been an ineluctable topic in feminist studies. Facing the concentration on female workers in aesthetic labor studies, a group of scholars starts to argue that it is essential for researchers to recognize that "gender is not just about women" [20]. It is not the first reminder. Researchers have proposed that "while there are indeed gendered and sexualized dimensions in aesthetic labour, it is by no means only female labour that is subject to commodification via aestheticization" [2]. --- By examining the work experiences of men who cross into what is conventionally defined as "women's work", Cross S, et al. [21] uncover men's struggle with their gender identity when masculinity is challenged. Drawing from ethnographic observations and interviews of two men's hair salons, Barber K [22] examines how organizations strategically habituate their employees with heterosexual masculine aesthetics that cater to their male clients. Elfving Hwang JK [23] interviews middle-aged urban men in South Korea and discovers that rather than emulating the hegemonic masculinity, men's aesthetic practices in the workplace are subject to the "homosocial gaze" of other male workers. Besides the feminist perspective dominance of the theory, there are also oppositions towards the dysfunction of what aesthetic labor poses on the selfhood of workers. For example, using the case of fashion modeling, Holla S [24] argues that the modification and commercialization of the body do not always lead to the separation of the body and the soul. Instead, models make efforts to justify their bodily practices by using moral repertoires that motivate themselves to be "natural" and "healthy". The debates above reveal the necessity to bring new analytical perspectives to unearth more nuanced explorations in aesthetic labor. Mears A [19] suggests that introducing comparative scope to examine the similarities and differences in different workplaces can help offer variable experiences that might be included in aesthetic labor. Another contribution may come from the perspectives of cultural sociology. Most of the contemporary analyses that emphasize the destruction of the commodification of the body in service work can be summarized, according to what Alexander JC [25] calls, as the materialist point of view that presupposes "human beings would be unable to experience their subjectivity in human-made objects until commodity exchange were overcome" [25,26]. This anti-commodification model has hindered a deeper understanding of how meaning is made by actors during the labor process. Instead of holding a material-positivist viewpoint, a hermeneutical approach that allows for a thick description of the meaning-making process of actors might be a refreshing scope for scholars to discover the dynamics underneath bodily performances.

Aesthetic labor refers to the process in which workers' appearances make the core of employability. After two decades of development, the theory has yielded outstanding theoretical and empirical achievements. The review briefly investigates the trajectory of the construction, the debates, and the unfinished agenda of aesthetic labor. Introduced at the dawn of the 21st century, aesthetic labor ambitiously re-conceptualizes the emotional labor paradigm by accentuating the role "looking good and sounding right" plays in the new economy. It challenges the analytic frame of emotional labor by foregrounding the Copyright© Wan R.

One or two kinds of social glue? As an anthropologist who studies religion, I am always an outsider looking inalbeit sympathetically. And that is often how I feel when trying to untangle the intricacies of the social identity perspective on group psychology, which appears (again, from the outside) to be forcibly reminiscent of a religious organization. Although the social identity perspective has two branches -Social Identity Theory (SIT) and Self-Categorization Theory (SCT) -all followers subscribe to a mainstream orthodoxy with varying degrees of piety and commitment. Core beliefs include that everything in group psychology, including the phenomenon of identity fusion discussed in my target article, falls within the ambit of the social identity perspective. As such, fusion appears to be just one more sect under the infinitely extendable umbrella of the mother church and her encompassing doctrines. Of course, outsider impressions can be misleading and I cannot claim to have conducted long-term ethnographic research among social identity theorists. So my comments on this topic will be as tentative as they are curious and well intentioned -and no doubt shaped to a degree by my having been trained to recognize the trappings of religious fervour no matter how subtly it is expressed. Field notebook in hand, I have spent the last few days tracking down informants. Let's begin by giving some space to their voices (it's standard practice in ethnographic research to disguise sources): "A while back, advocates of SIT and SCT (self-categorization theory) realized that many of their own workers didn't believe in the main tenets of one or more cardinal doctrines, e.g. functional antagonism (that activation of personal self reduces salience of social self and viceversa) and depersonalization (that groups members are categorically interchangeable when the group is salient)." Another informant described what happened next: "Instead of providing a formal revision to the theory, some researchers simply endorsed arguments that were in direct opposition to the original tenets. The result was that the informally revised 'theory' now embraced both the original theoretical ideas (e.g. functional antagonism and collective ties) and their opposites (e.g. identity synergy and relational ties). The resulting 'social identity perspective' was immune to falsification." Unfalsifiable? This sounds like a set of beliefs that can't be resolved on empirical grounds. Like a religious system perhaps? Let's explore this in more detail… According to Ingram and Prochownik identity fusion is probably just an "extreme form of social identification." Reeve and Johnson agreed with this take on things, arguing that the notion of identity fusion merely "expands the SIT paradigm." But as Kavanagh and Buhrmester carefully argued in a series of posts, the empirical evidence points to systematic differences between fusion and identification. Kavanagh cited a body of empirical evidence showing that existing measures of social identification simply cannot subsume identity fusion. If, for example, personal and social identities are hydraulically related, what is one to make of evidence that activating a personal identity enhances the tendency for fused individuals to enact pro-group behaviour? Building on this, Buhrmester pointed out that fusion theory focuses on the causal role of relational ties to other group members as well as collective ties to the group whereas the social identity perspective is only concerned with the latter. The two kinds of social glue predict different psychological and behavioural outcomes. What motivates efforts to make identity fusion part of the social identity perspective rather than, as the evidence suggests, an alternative theory of how groups are glued together? The motivation doesn't appear to stem from either empirical or logical considerations but from a desire to maintain the sovereignty of a tradition. It is easy to underestimate the extent to which academics (including good scientists) can form distinctive cultural traditions that, just like any other traditions, can glue adherents to each other and to a set of values and beliefs. And this makes the study of social glue all the more complicated. If we think of the social identity perspective as a kind of church it is a relatively new one. There is of course a much bigger and older church, called 'social science'. As Michael E. Smith reminded us, in an informative post entitled somewhat indignantly "You Folks Should Pay Attention To Social Science", there is a grand tradition out there, one that has a more illustrious history than the social identity perspective and a greater plethora of special terms for things, ways of talking about them, and other special customs and beliefs. When I started to read Smith's commentary, I thought at first he was going to say that we'd made a basic error that could have been avoided if only we'd known about some previous research on the topic. But as I read on it became clear that his main point was something quite different -that there is another academic tradition over the hills that has lots of doctrines about social glue, including what to call it and how to think about it. To my mind, however, the most thought-provoking response of all, from a bigpicture perspective, was the one written by Lanman. He reminded us that when we're asking questions about human psychology we should ask about both mechanism and function. To put this in the language of the evolutionary sciences, we should address both proximate and ultimate causation. The social identity perspective has taught us much of importance about the proximate level but when we broaden the focus of groups research to consider issues of ultimate causation we begin to understand social glue rather differently. To appreciate why fusion and identification may be different it could help to unpack their evolutionary histories. Lanman and I hypothesize that the categorical ties studied by social identity theorists evolved to bind together tribes and ethnic groups whereas identity fusion emerged to hold kin groups together: two functions, two psychological mechanisms, and two kinds of social glue. Kin psychology (on this view) regulates behavior among genetically related individuals, facilitating exceptionally high levels of altruism towards the group, rooted in the fusion of personal and social selves. Ethnic psychology, by contrast, solves collective action problems using categorical ties based on identification with groups. As Lanman succinctly put it: "Whitehouse's account of identity fusion as 'psychological kinship'… which lies at the heart of the imagistic mode of cohesion… utilizes the findings of both evolutionary psychology and socio-cultural anthropology and can serve as a reminder of the insights we can reach when we move past the more exclusionist rhetoric sometimes used by scholars in these fields." --- How important is social glue? Several contributors to this discussion pointed out that a range of factors contributes to altruistic behavior and that 'social glue' is only one of them. Bill Swann, for example, mentioned shared interests, top down incentives and deterrents, and ideologies that appeal to our capacities for empathy or right and wrong. Arguably, however, social glue has a special role in motivating altruism. You and I might share similar concerns about social problems, discover common vested interests, and even agree on the best courses of collective action, but I doubt whether any of this would motivate most of us to make big sacrifices for the greater good. Not everyone shares my hunch. Some prominent activists insist, for example, that morality rather than social glue is the best way to address the major collective action problems faced by our species. One of my three wishes for the world was to eliminate extreme poverty. The moral philosopher Peter Singer famously gives away a third of his income to the charity OXFAM and he urges everyone else to do the same. I vividly remember a lecture given by Singer in Oxford, at which he pointed out the wrongness of allowing extreme poverty to persist in the world and the fact that we could eliminate the problem overnight if we all set our minds to it. But that's the problem. We won't all do it. And since we know that other people won't all do it, we typically decide not to do it ourselves. After the lecture, I sat next to Singer at lunch and I put it to him that the moral argument wasn't going to change things. His response? It simply had to -there was no other way. But as Swann points out there are indeed other ways. Aside from moralizing we've seen many efforts to solve world problems using a diversity of strategies. For example, over several decades concerted effort has been made via high level international initiatives to redistribute wealth from the world's wealthiest countries to help the poorest and there has long been broad agreement that 0.7% of GNP is a realistic target for provision of aid. But apart from some outliers like Scandinavia, we have fallen woefully short in achieving these kinds of targets. Swann mentions various mechanisms of regulation in modern states that can be used to solve collective action problems without relying directly on social glue -we can incentivize, legislate, tax, subsidize, and do other things in a top-down fashion to tackle poverty. But I would argue that none of these approaches works very well without the right kinds and quantities of social glue. Social glue plays a vital role in solving collective action problems in a sustainable fashion. Without it, other mechanisms deteriorate and fail. Examples are legion but to take just one from my own country: social glue was essential to setting up the welfare state in the UK but it is now eroding because of a culture of sponging and entitlement symptomatic of a progressive weakening of national cohesion. Whereas the social sciences have traditionally provided quite sophisticated ways of understanding systems of regulation -in economics, law, governance, politics, and so on -a more basic aspect of coordination in societysocial glue -has not been understood so well, and figures less prominently in the thinking of policy makers and advisors. I think it's time to rectify the neglect. --- Closing remarks After much debate on points of detail, Gordon Ingram concluded an informative thread in this debate by taking issue with my suggestion that "when we fight back against injustice it's because we believe that its victims share our suffering. The victims are, in an important sense, one with us." Ingram retorted: "This, I think, is quite wrong: I predict that it is not necessary to feel fused with someone in order to feel a duty of care towards them… it comes down to the need for more empirical research: these are two testable predictions and I hope that someone will test them soon. Until then, Harvey is not really justified in making this sort of claim." Ingram's call for more data is well taken. And I should have been careful to emphasize repeatedly that my fusion-based explanation for altruism (including parochial altruism) is no more than a working hypothesis rather than an established fact. But by the same token Gordon is offering a counter-prediction rather than demonstrating the wrongness of mine. Although we do need more evidence, the idea that empathizing and moral reasoning are sufficient to motivate extreme sacrifice for the group warrants skepticism. By contrast, there is already quite compelling evidence that when compassion and morality are bolstered by a visceral belief that the group is me, self-sacrificial commitment markedly increases

The discussions in this forum have raised some big issues, ranging from the implications of two types of social glue for the evolution of groups (e.g. Waring; Smith) to the practical and ethical challenges of seeking public policy interventions based on our scientific theories and findings (e.g. Lanman; Waring). I agree with most of the comments that have been posted and as everybody points out we need more evidence before much more can be said. But there are two issues I'd like to pick up. The first is a very basic question about whether there really are two kinds of social glue (Kavanagh; Buhrmester) or just one with varying degrees of 'stickiness' (Ingram and Prochownik; Reeve and Johnson). The second is about whether social glue is really the most important issue in addressing my three wishes for the world or if other sources of altruistic behaviour should receive equal or greater priority (e.g. Swann; Smith). Altruism has many sources but in my view social glue plays an especially important role in solving collective actions problems that carry high individual costs.

INTRODUCTION The emergency committee has stated that the spread of COVID-19 can be stopped if protection, early detection, isolation, and rapid treatment are carried out to stop the spread of COVID-19. In view of this, as an effort to protect against COVID-19, various countries from all over the world have committed together by involving governments, biotechnology companies, scientists, and academics to be able to create a Covid-19 vaccine. So far, many vaccine candidates have been launched against the SARS-CoV-2 virus, the cause of Covid-19. 1 On October 6, 2020, the president signed and issued a Presidential Regulation regarding the procurement of vaccines and the implementation of the vaccination program to tackle the COVID-19 pandemic. 2 The National Immunization Expert Advisory Committee (Indonesian Technical Advisory Group on Immunization/ITAGI) has evaluated the situation related to COVID-19 vaccination and provides a number of recommendations regarding After a survey was conducted on the acceptance of the Covid-19 vaccine in Indonesia, which took place from 19 to 30 September 2020. Around 65% of respondents said they were willing to accept the COVID-19 vaccine if provided by the government, while eight percent of them refused. The remaining 27% expressed doubts about the Government's plan to distribute the COVID-19 vaccine. This situation needs to be understood carefully; the public may have different levels of confidence in the COVID-19 vaccine due to limited information about the type of vaccine, when the vaccine will be available and its safety profile. 4 Factors that influence people's behavior in participating in Covid-19 vaccination are influenced by predisposing factors related to individual characteristics, vaccine service providers, and reinforcing factors that are realized with the support of family or community leaders. Individual factors include knowledge of the Covid 19 disease, economic status, religion and belief, age, working in the health sector, income level, education, fear of vaccines, the thought that there is a lot of hoax news about the covid 19 vaccine, thoughts on vaccine safety, and thoughts of danger. vaccine. 5 This study was conducted to find risk factors based on individual characteristics on the behavior of receiving the Covid-19 vaccine. By knowing the risk factors for receiving the Covid 19 vaccine, it can be used as information in providing education, especially to people who have not decided to take part in the Covid-19 vaccination so that they can follow the vaccinations as recommended by the government to break the chain of disease transmission. --- METHOD This research is an analytic descriptive study with cross sectional design. This research was conducted by distributing surveys via google form to all respondents covering all regions of Indonesia. Data collection was carried out in January 2021. The number of samples was 411. The sample inclusion criteria were Indonesian people aged more than 17 years and were able to access and fill out google forms independently. The sampling technique was purposive sampling. The independent variables include age, gender, history of working in the health sector, education, family history of being affected by Covid, feeling afraid of vaccines, thinking that there are a lot of hoax news about the COVID-19 vaccine, thoughts on vaccine safety, and thoughts of dangerous vaccines. The dependent variable is public acceptance of the Covid-19 vaccine. The questionnaire uses the Public Perception Survey questionnaire for the Covid-19 Vaccine in Indonesia published by WHO and the Ministry of Health of the Republic of Indonesia. Analysis using Chi Square test. --- RESULTS The results showed that the majority of respondents were in the age range of 18-24 years (62.8%). Likewise, the group of respondents who decide, refuse, or have not decided to implement the vaccine are the majority of respondents in the 18 --- DISCUSSION The results of this study indicate that most of the respondents received and will carry out the Covid-19 vaccine (53,7%). This is similar to the results of studies in other countries such as China, Sudan, Europe and America which state thet most received the Covid-19 vaccine. 6 There is a relationship between age, gender, history of working in the health sector, education level, family history affected by Covid-19, feelings of fear Hema Dewi Anggraheny / Factors Affecting Public Acceptance of the Covid-19 Vaccine in Indonesia of vaccines, the thought that there are many hoax news regarding the Covid-19 vaccine, thoughts on vaccine safety, and the thought that vaccines are dangerous to the behavior of receiving the Covid-19 vaccine. The above factors are included in the predisposing factors in Lawrence Green's theory. Despite the support from the government and even provisions for the Indonesian people to be obligated to vaccinate against Covid-19, there are still quite a number of respondents who choose not to vaccinate. The results of this study are in line with several other studies related to the acceptance of the Covid-19 vaccine which state that the idea of vaccines is dangerous, fear of vaccines, the idea of vaccine safety, and the protective effect of the vaccine on the acceptance of the Covid-19 vaccine. [7][8][9][10] Similar things emerged from this study and other similar studies in Indonesia and other countries, namely that most felt that the Covid-19 vaccine was important to do as protection for themselves and others against Covid-19. Most of them already believe that to break the chain of transmission of Covid-19 and to create herd immunity is by vaccination. 11,12 Most respondents who have a history of contact with Covid-19, either their family or themselves who are infected with Covid-19 tend to receive the Covid-19 vaccine. The experience of himself or his family being exposed to Covid-19 will be a strong enough reason for him to take the Covid-19 vaccine. This is in contrast to respondents who did not have contact with Covid-19, who stated that they had not received the Covid-19 vaccine (46.8%). Similar results were obtained in other studies. 11,13 Most of the respondents who refused vaccination were respondents who did not work in the health sector. These results reflect that people who do not work in the health sector need to get information or education about the importance of the covid 19 vaccine. These results are not directly proportional to the respondents' education. Although quite many respondents graduated from high school and university (more than 95%), there were also quite a large number of respondents who refused or had doubts about the Covid 19 vaccination. also respondents who reject vaccines who do not work in the health sector, and are highly educated. 14 This proves that information regarding the importance of Covid-19 has not spread widely in Indonesian territory in January 2021. The majority of respondents who refused vaccines in this study stated that the COVID-19 vaccine was not safe. Similar results were obtained in other studies both in Indonesia and abroad. 11,13,[15][16][17][18][19] . These results appear probably because the data collection was carried out before the vaccine was widely circulated in the community. So that people need information in the form of real proof of how the effects that arise from vaccines after being injected in most people in the world. If most are not problematic, people will tend to believe in and comply with the vaccine's obligations. It is proven that after most of the community took the vaccine in mid-2021 and the conditions were proven safe, people flocked to vaccinate and many even waited for the vaccine stock to be ready because health facilities providing vaccines often ran out of vaccine stock. --- CONCLUSION Public acceptance of the Covid-19 vaccine is related to several factors, including age, gender, education level, history of being exposed to Covid-19, perceptions of vaccine safety, and working in the health sector. Acceptance of the Covid-19 vaccine is gradually increasing after the public ensures that the vaccine is safe enough for most people in the world, and the pandemic conditions improve.

One of the efforts to protect the community against Covid-19 cases is vaccination. However, in the preparation of vaccination, there are several negative issues related to vaccines, which make people doubt and even reject the effort. Predisposing factors include age, gender, occupation, income, education level, history of contact with people with COVID, and knowledge of vaccines, which can affect acceptance of vaccines. The purpose of this activity is to find out what factors affect public acceptance of the Covid-19 vaccine. The research was conducted by distributing questionnaires via google form to the general public in January 2021. The total respondents were 411 respondents. The questionnaire uses the Public Perception Survey questionnaire for the Covid-19 Vaccine in Indonesia published by WHO and the Ministry of Health of the Republic of Indonesia. Analysis using Chi-Square test. The survey results showed that 46.2% of respondents had not decided on and refused the vaccine, and 94.2% wanted to get information about the vaccine. Factors related to vaccine acceptance include age, work in the health sector, income level, education, fear of vaccines, the thought that there are many hoaxes regarding the COVID-19 vaccine, thoughts on vaccine safety, and thoughts on the dangers of vaccines. Accurate and scientific information, accompanied by easy access to receive the Covid-19 vaccine, is needed so that people with self-awareness carry out vaccinations to reduce the morbidity and mortality of COVID-19 in Indonesia.

Introduction Covid-19 has globally caused 12,964,809 death cases, including 570,288 confirmed deaths report-ed by WHO [1]. The number of cases and the death toll proceeded to grow, with India also contributing majorly to this increase. India, the second most popular country globally, with high rising cases due to Covid-19, is worrisome. There are approximately 0.9 million confirmed cases and 24915 deaths in India on 16 July 2020 [2]. There could be invisible numbers due to asymptomatic cases and other factors like non-reporting symptoms due to fear [3] and stigma related to the disease. --- Fear and Stigma In Covid-19 The psyche of Individual fear As per [3] , the study says that the individuals fear getting admitted to Isolation centers. Their family members will be sent to quarantine centers, discrimination, and Ill-treatment at these centers. They will fear dying alone and not being cremated as per rituals. A study conducted on suicides in India shows that the most common causes were fear of infection, loneliness, social boycott, the pressure to be a quarantine, and inability to return home post lockdown. A proportionate increase in fear and stigma is pragmatic with increasing cases. --- The Psyche of Mass Fear Many experts and non-experts give their opinions in news media for self-image building to add to scientific knowledge. Multiple mathematical prediction models presented across the world are confusing the masses. The latest MIT study says, 'India may come across 2.87 lakhs COVID-19 cases per day within the time of winter 2021 [4] , which mainly flashes on the Internet on the news media. Data presented by media flashing it as 'Breaking news' in negative comportment adds to the fear. Also, frequent changes in the guideline of prevention and scientific knowledge are creating bewilderment amongst the masses. --- Literature Survey Besides, the transmission of medical knowledge to en masses through social media and its use for circulating saddening and negative news are increasing fear and stigma related to the disease. "Is this a Pandemic of Covid-19 or a Pandemic of Panic and fear?" [5]. Thus, the first step is to throttle the fear and stigma related to Covid-19. Covid-19 has perplexing epidemiology; varied pathophysiology; unknown natural history being a novel disease; diagnostic tool with low sensitivity; [6] and cautiously evolving treatment protocols. The general reasons of subconscious tension throughout the Covid-19 pandemic include the fear of falling ill or spread of infection and mortality, dodging wellness support because of the dread of infection in support, job loss and economical backwardness based on the dread of loss of livelihood, fear of living in social exclusion, the dread of quarantine, feeling powerlessness in guarding themselves and their family and relatives [16]. The dread of being isolated from custodians, the dread of helplessness, loss of pride to do things in their day-to-day life [7] , isolation, and despair because of staying lonely and re-experiencing a previous pandemic [8]. In addition to the above difficulties, coronavirus disease-19 can create subconscious answers like the threat of being afflicted during the spreading phase of the disease is never fully cleared, general indications of additional wellness issues increased the concern of the kids staying at residence due to lockdown and online classes as the school closed. However, the parents need to be at work. So the physical and mental health problems for children due to vulnerable gadgets and care reduction leads to a high risk of health issues [9]. The untrained non-medicos, volunteers, affiliated with political parties across cities, towns, and villages have certainly restricted using the science of prevention, which has led to the baffling use of scientific terms of isolation and quarantine. It has also created poor and chaotic dissemination of medical knowledge. Every small medical trial became public before the experts established it. The greatest examples are the use of Hydroxy-chloroquine and arrivals of the vaccine [11]. The SGTM prediction of people who suffered and died of COVID-19 is measured and supervised using a neural-like structure [10]. The prediction of the covid-19 transmission behavior in Indonesian countries utilizes various parameters like the distribution of a virus, mortality rate, cure rate, movement, and communication rate. Compared with other countries to Indonesia, the appropriate parameters are measured by WHO [12]. "Do not get carried away by social media news unless there is scientific evidence. " Let us embrace the science of prevention. " The ongoing COVID-19, with many deaths, forced the experimental populations to increase the Research and Development (R&D) projectson the undergoing pandemic situation [13]. To guide the scientists in the comprehensive research, the committees, regulators, policymakers, andfunders are in the deliberate studies regarding the SARS-CoVid-2 challenges [14]. --- Results and Discussions Embracing the science of prevention • Embracing the science of prevention based on current knowledge of the disease [7] • Physical distancing -Minimum 3 feet distance [15] • Avoid Gatherings, crowded places, and unnecessary travels and meetings. • Appropriate use of Mask • Hand Hygiene • Good Respiratory Hygiene • Avoid touching eyes, nose, and mouth • Seek medical attention • Self -Isolation • Get information from trusted sources. Total alignment to the above advisory and acknowledgment of a pandemic's social game may help control ituntil the vaccine is available. --- Specific Measures • Training and deployment of social volunteers to stringently implement prevention strategy in the field • Restricted use of social news media spreading unscientific knowledge, negative news. • Governments and healthcare [2] --- Conclusions Increased GDP allocation to the health sector for the robust public health system; Population Control; Improved Literacy rates; Stronger economic reforms to accommodate the Covid-19 like situation; Improved Lifestyle and Mental Health says restricting medical knowledge to the medical fraternity is a key intervention required to reduce confusion and fear among the population. An over the dissemination of medical knowledge not authenticated through scientific research, news, and social media adds fuel to fear and stigma. The spread of COVID-19 disease Prevention in the common space is suggested with an AIbased smart system of gate and website alliance can be established. However, there is a lack of systematic dissemination of scientific knowledge to the medical fraternity. Circulation of multiple prevention and treatment methods on social media, news media without scientific published data is a heinous crime in this pandemic. --- Conflict of Interest Not applicable Funding Self-funded --- Ethical approval Taken from Symbiosis Medical College for Women (SMCW) Symbiosis International (Deemed University) (SIU), Pune

Covid-19 is creating a flurry of fear and stigma across the globe. The individual fear is of discrimination at isolation centers, fears of dying alone with no funeral as per rituals. The mass fear is fueled by social and news media through negative news, disseminating medical knowledge, and confusing multiple mathematical projection models. Hence, firstly need to impede this pandemic of fear and stigma. Equally vital is to embrace the science of prevention by stringently following WHOguidelines. The general population should not fall prey to non-scientific news on social media. There should be restricted, systematic, and timely dissemination of medical knowledge to the medical fraternity. Identify limited expert spokesperson to present factual positive data and strategies of prevention. Disengaging politics and conflicts of commercial interests and educating the population for social changes and norms are required to control the pandemic. Increased GDP allocation to the health sector; Population Control, Improved Literacy rates are other long-term measures.

Introduction --- D espite efforts to reduce health inequalities within Europe, since the beginning of the 1990s regional inequalities in life expectancies have remained broadly stable, and increased among males within Eastern Europe. 1 Migration could be one factor contributing to spatial differences in mortality within Europe [2][3][4] as more and less healthy populations may have distinct migration patterns and substantial population growth or decline could effect determinants of population health. This possibility is supported by analysis of net population change over 10 years in municipalities and districts in Spain, 5 20 years in local authority districts in the UK 6,7 and municipalities in Sweden, 8 and 40 years in communes and cantons in France. 9 These studies found an ecological association between death rates and population change, with higher death rates in areas with shrinking populations. The relationship between population change and death rates has, however, not been assessed across Europe as a whole. 2 Migration could be of growing significance to health inequalities in Europe because the substantial expansion of the European Union (EU) has increased rights to free movement within the continent. 10 The largest single expansion of EU population took place in May 2004 when the EU grew from 15 to 25 member states with the accession of seven former Eastern Bloc countries (Estonia, Czech Republic, Hungary, Latvia, Lithuania, Poland and Slovakia), plus Cyprus, Malta and Slovenia. Furthermore, since 2007 some European countries have experienced significant new migration trends following the global financial crisis. 10 While in 2015 the EU experienced a 'migrant crisis' with a large increase in refugees arriving from conflict-ridden countries. This short report considers 'migratory population change' or net migration balance-net change in population size resulting from migration-across the regions of Europe. It assesses if there is an association between migratory population change and death rates, whether any relationship is independent of area socioeconomic status, and compares Eastern and Western European regions. --- Methods 'Nomenclature of Statistical Territorial Units' geography level 2 (NUTS2 2010) areas were used for the analysis. All NUTS2 regions for which data could be obtained were included, with the exception of regions that were not situated in the European mainland or had very small populations (A ˚land, Ceuta, Melilla, the Canary Islands, Madeira, the Azores and the French overseas territories). In total, 250 NUTS2 regions in 26 countries were analysed (regional population in millions, annual average 2008-2010: minimum = 0.13; maximum = 11.72; mean =1.90; standard deviation = 1.56). The analyses included 196 regions in 16 'Western' countries (Austria, Belgium, Cyprus, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Norway, Portugal, Spain, Sweden and UK, excluding Scotland) and 54 regions in 10 'Eastern' countries (Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia). All regional data were obtained from Eurostat. Age-and sexstandardised death rates per 100 000 were accessed for the most recently available 3-year average period, 2008-2010. Proportional net change in population resulting from migration was calculated for 2000-2010 using total population in 2000 and 2010 (at 1 January) and annual data for births and deaths. Population change was considered over 10 years as this was sufficient to capture a significant period of migration while short enough to ensure that data were available for most European regions. Socio-economic status was represented by primary income of private households in 2005 (mid-way through the migratory period). This was estimated using Purchasing Power Consumption Standard units per capita to allow for comparison between countries. Up to 2 years of missing data for births, deaths, population and income were imputed using straight line estimates. The relationships between death rates and migration were first described by Pearson's correlations and then assessed with linear regression models which were adjusted for income. Analyses were weighted using average population, 2008-2010. --- Results The regions with the highest death rates in 2008-2010, were concentrated in Eastern countries, in particular Bulgaria and Romania (Figure 1). The highest rates of population loss due to migratory change, 2000-2010, were also found in regions of Bulgaria and Romania and in the former German Democratic Republic regions of Sachsen-Anhalt, Mecklenburg-Vorpommern and Thu ¨ringia, and Northern French regions of Nord-Pas-de-Calais and Champagne-Ardenne. In contrast, regions that had experienced large gains in population though migration were more likely to have low death rates. Death rates and migratory change were significantly negatively correlated (P < 0.001), with Pearson's r of À0.487, À0.530 and À0.346 for all, East and West regions respectively. The linear regression model, containing migratory change and household income, for all European regions combined, suggested that across European regions there was a significant and independent association between migration and standardised death rates (P < 0.001), with a coefficient of À0.258. This indicated that for every 1% migratory loss of population there were 11.4 more deaths per 100 000. The coefficient for migration was, however, much smaller than the À0.707 found for income. In the Western regions' model the migration and income variables had similar significant coefficients of À0.354 and À0.333, respectively. In contrast, among the Eastern regions the association between migration and death rates was not statistically significant (coefficient = 0.045), but there was a strongly significant coefficient for income of À0.726. Migration and mortality patterns among European regions --- Discussion Across regions of Europe after adjustment for income, there was a strong association between migratory population change (2000-2010) and death rates (2008-2010) which suggests that migration could contribute to the well-established regional health inequalities. 1 These findings were consistent when Europe was considered as a whole and also 'within' the group of Western European regions. Hence, the association between mortality and migration is not driven solely by East-West differences in these variables. This relationship between migration and mortality may result from health selective patterns of migration. It could also indicate that population loss has contextual effects upon health, damaging social relationships and services that support well-being. 4,6,7 Eastern regions account for most of the areas of Europe with the highest death rates, lowest incomes and greatest population loss. An independent association between population change and death rates was not found among these regions but income was strongly associated with mortality. This suggests that while the recent expansion of the EU has increased population decline in some East European regions 10 it is low income 4 which continues to drive their poor health. Among these regions low income may also underlie population loss, which in turn could have important socioeconomic consequences. It is notable, however, that while immigration has long been prominent within international political debates regarding EU policy the problems of European sender countries, experiencing the combined effects of low income, high rates of emigration and poor health, have received less attention. The analyses were limited by the availability of European-wide regional data. While NUTS2 regions are intended to contain approximately similar populations significant variation remains. As migratory change was considered only over 10 years the full impacts of migration upon population health will not have been captured. In particular, some East European countries, such as Romania and Bulgaria, have experienced major population decline since the end of communism in the early 1990s. 10 Population data error are likely to be significant in regions with substantial migration. The 'independent' associations found between migration and death rates after adjustment for income are likely to reflect residual socio-demographic confounding. The relationship between migration and mortality may also vary by age group and with geographical scale. More detailed European data describing the health characteristics of in-and out-migrants and the impacts of population change upon the social determinants of health would aid understanding of these relationships. Analysis of more recent data could assess whether new associations between migration and mortality have emerged from the 'migrant crisis' in Europe. This short report is the first to describe the association between migratory population change and death rates across the regions of Europe. It suggests migration could contribute to inequalities in mortality within Europe, and highlights the acute problems of Eastern regions with the worst health, lowest incomes and declining populations. --- Conflicts of interest: None declared. --- Key points Among 250 European regions population loss 2000-2010 was correlated with higher death rates in 2008-2010. The association between migration and mortality was independent of household income among all European regions and Western regions but not among Eastern areas. In Eastern Europe low income may drive both high mortality and migration patterns. Migration patterns could contribute to the persistent inequalities in death rates within Europe. Policies to reduce health inequalities within Europe should address the potential impacts of population loss upon health.

Geographical inequalities in mortality across Europe may be influenced by migration between regions. The relationship between age-and sex-standardised death rates, 2008-2010, and population change resulting from migration 2000-2010, was analysed in 250 'Nomenclature of Statistical Territorial Units' (NUTS) level 2 regions in 26 European countries. Across Europe death rates were significantly higher in regions experiencing population loss. This association continued after adjustment for 2005 household income among all regions and Western regions but not among Eastern areas. This analysis suggests migration could contribute to Europe's persistent inequalities in mortality, and highlights the problems of Eastern regions with the highest death rates, lowest incomes and declining populations.

Public health must necessarily be concerned with social conditions at the root of many inequities (Braveman, 2006). Public policy that seeks to achieve sustainable improvements in the social determinants of health-income, education, housing, food security and neighborhood conditions, can contribute to positive health outcomes (Anderson, Scrimshaw, Fulilove, & Fielding, 2003). One approach lies in building capacity for communities to increase their participation and effectiveness in civic engagement, to generate collective action, and to engage private and public institutions to create systems that protect health (Wallack, 2003). Community health workers (CHWs) are members of the communities they serve, have intimate knowledge of community needs and resources, and are considered leaders among their peers (Rosenthal, Wiggins, Ingram, Mayfield-Johnson, & De Zapien, 2011). While recognized for their role in impacting health downstream (Viswanathan et al., 2009), there is evidence that CHWs can also successfully facilitate community efforts to impact social and structural issues related to health (Eng & Young, 1992;Kent & Smith, 1967;Perez & Martinez, 2008) In fact, advocating for individual and community needs is a core competency of CHWs in the U.S. (Rosenthal et al., 2011). This report describes preliminary results from Acción Para La Salud (Action for Health) an intervention that relied upon CHWs to engage community members in three Arizona border communities in pursuing public policy contributing to sustainable health improvements. The Arizona border population is much poorer, attends fewer years of school, and suffers a higher rate of unemployment than the population of any State. Not surprisingly, these conditions translate into greater health risks, which are exacerbated by the lack of insurance and health care resources (U. S.-Mexico Border Health Commission, 2003). --- Theoretical Background Two theories guide Acción. The first centers on the importance of community engagement in addressing relevant and meaningful policy change. The second postulates an avenue through which CHWs can engage communities in the policy process. --- Community engagement: Gaventa and Barrett (2010) presented the results of an international meta-case study that surveys types of citizen engagement (Gaventa & Barrett, 2010). Analysis of 100 studies from 20 countries found that people engaged civically through local associations, social movements/campaigns, and as members of formal participatory spaces such as advisory committees. Outcomes with implications for public policy development include: 1) construction of citizenship; 2) strengthening practices of participation and capacity for collective action; 3) strengthening responsiveness and accountability of states and institutions; and 4) development of inclusive and cohesive societies. Acción used this framework to describe ways CHWs engage their communities as precursors of changes in social determinants of health. --- Policy development: Kingdon's conceptual framework for policy change (2003) envisions three streams, problem, policy, and political, which operate independently (Kingdon, 2003). In the problem stream, issues are identified and defined based on various indicators or events. The policy stream represents solutions generated about an issue. The political stream describes factors that bring a particular problem into focus or favor a specific policy solution, such as national mood. Policy change most likely to occurs when conditions in all three streams are interconnected. Kingdon calls this alignment a policy window. Change agents can act to open policy windows and/or take advantage of those that have opened. In Acción, CHWs serve as catalysts for change on a local level in all three streams. In the problem stream they interact with community members to identify salient issues. In the policy/solution stream they engage them in creating ideas to improve their community. In the political stream they develop relationships and advance the community's policy agenda with such entities as school districts, health care delivery system(s), or municipalities. Thus, CHWs both create and seek to capitalize on policy windows in diverse systems. (Figure 1) --- Methods Members of an academic-community partnership Community Action Board (CAB) developed Acción through a community-based participatory research process. The five partnering organizations, which have CHWs as core to their health efforts, included two community health centers, a county health department, a grassroots clinic and a grassroots organization. Each agency identified experienced CHWs on their staff to work on Acción. The eleven Acción CHWs had at least five years of experience. --- Intervention: The CAB training committee developed the Acción community advocacy curricula guide using strategies from existing advocacy and leadership tools. The 18-month training consisted of four participatory and reflective workshops with the Acción CHWs and their supervisors (http://azprc.arizona.edu/resources/curricula). The CHW supervisors were strategically included to ensure that the CHWs had organizational support for advocacy activities. Activities to foster community advocacy were initiated during the training in which Acción CHWs were asked to talk to community members about issues and identify existing power structures within their communities. After the first year, the CHWs began to identify community advocacy projects based on needs they identified in their contact with clinic patients and participants in CHW prevention activities, during outreach efforts, and in community conversations and meetings. In ongoing technical assistance, CHWs were then assisted in using strategy maps to identify steps to their desired policy outcome (Zacoks, Dobson, Kabel, & Briggs, 2010). Acción CHWs met regularly with their supervisors and engaged in monthly peer network conference calls to share challenges and successes with their colleagues. --- Data Collection: Acción data collection instruments were determined through a participatory process with partners (Israel, Schulz, Parker, Becker, & Health, 2001). The data were primarily qualitative and collected systematically across all five intervention sites to capture the span of their activities. Acción CHWs used encounter forms to document conversations and meetings with community members, groups, and local officials. On the forms they described the issue being discussed, their next step(s) in addressing it, and which of Kingdon's streams they were working in. The strategy maps identified the advocacy outcome and corresponding strategies. Corroborating data sources included quarterly program narratives and technical assistance notes. --- Analysis: Three members of the research team were responsible for analysis. Information on the forms was validated using program narratives and technical assistance notes. The description of the encounter was used to verify whether the CHWs had categorized it in the correct stream(s). Among the 211 encounter forms, approximately 29% was re-categorized as individual advocacy, community programming or education, leaving 150 forms for analysis. Content from the encounter forms and strategy maps was coded to types of community engagement. --- Results The remaining 150 encounter forms across the five partner agencies were analyzed to ascertain the extent to which CHW advocacy activities were related to Kingdon's theory. The number of forms per agency was 17-55. CHWs most often reported working only in the problem stream (61% of total encounters) reflecting the first step of engaging community members in identifying issues of importance. Many of these encounters were conversations between the CHWs and community members during normal job activities in clinic visits, health education classes, and support groups, and reflected concern over a broad range of issues such as the adequacy of public services, community safety and cleanliness, and activities for youth. Over time, the encounter forms documented a shift from individual to group encounters in the problem stream; e.g., CHWs brought community members together in house meetings or community forums to discuss a problem. Encounters in the problem stream were coupled with the policy stream in 20% of total encounters reflecting activities in which CHWs began identifying and working on solutions to a previously identified problem. A small percentage of policy encounters were activities (10%) not connected to a problem identified through Acción (attending an anti-tobacco coalition). The policy stream and political stream overlapped in 3% of encounters, all of which occurred in one organization in which CHWs had the opportunities to discuss organizational policy change not directly connected to a previously identified problem. In 3% of encounters CHWs began engaging in all three streams, taking their community-generated solution to decision-makers in their agency or town. The remaining 3% of total encounters were political, in which CHWs in one agency held informational meetings with political or organizational leaders (Table 1). Critical to the Acción intervention is community engagement to address the power relationships that underlie disparities in the social determinants of health. To describe strategies CHWs used to involve community members in the policy development process, we also analyzed encounters by type of engagement. Most often, CHWs used local associations to strengthen practices of participation (70%), typically by engaging their clients in conversations about the wellbeing of their community and what might be done to improve it. The CHWs also involved community members in efforts to increase access to services and to make systems more accountable to community needs (27%), for example through petitions and group meetings with public officials. In two instances (3%), CHWs engaged in activities related to the construction of citizenship, one informing community members of their rights under immigration law, and the other discussing the potential impact of proposed state redistricting on community members. Finally, the strategy maps further documented advocacy strategies and desired outcomes including plans to address transportation infrastructure, clinic hours, safe routes to schools, the safety net for domestic violence victims and sales of energy drinks to minors. --- Discussion Using theories of community engagement and policy change, Acción sought to empower CHWs and their communities to advocate for sustainable change targeting underlying social determinants. To varying degrees across organizations, Acción CHWs encouraged community members to think ecologically about their health and identify advocacy-oriented solutions to improve neighborhood conditions, enhance community opportunities, and increase access to services. In three organizations, Acción CHWs initiated activities in the political stream, in several cases directly involving community members. In looking at types of community engagement, CHW advocacy activities most often focused on strengthening practices of participation, and the majority of these took place within the problem stream. Our findings indicate the value of long-term testing of effectiveness of Acción in identifying specific advocacy activities leading to policy development, and potential policy and environmental changes impacting community health. In the future, it will be important to investigate organizational factors that facilitate or discourage CHW advocacy and determine optimal conditions for successful CHW public health advocacy activities. CHWs community advocacy activities in the Kingdon (2003)

Objectives: Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive, sustainable health impacts. This paper describes preliminary results of Acción Para la Salud, a public health intervention in which Community Health Workers (CHWs) from five health agencies engage their community in the process of making positive systems and environmental changes. Methods: Acción CHWs were trained in community advocacy and received ongoing technical assistance in developing strategic advocacy plans. Acción CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Results: Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environmental-related factors that impact health, and identified solutions that improve neighborhood conditions, create community opportunities, and increase access to services.

Introduction The unique combination of computer-mediated and face-to-face communication gives rise to significant risk of harm against youth and young adults. Examples from popular media include doxing (the unwanted release of one's personal information, which can lead to online harassment and physical safety risks [17]) and swatting (pranks against Twitch live streamers and online gamers that involve calling the police with false reports in hopes of triggering a SWAT team dispatchat least one case has resulted in a fatality [2]). A context of online-to-offline risk to youth and young adults that we focus on in this position paper is mobile social matching apps [18], such as Tinder, Bumble, and Grindr. As of 2020, 48% of adults under the age of 30 have used a social matching app [1]. These apps enable users to discover strangers in their geographic vicinity, interact with them online, and then meet faceto-face. While once known predominantly for dating and sex, their use and design have expanded to all aspects of social interaction including friendship, activity partners, and even employment [9,13,19,20], making them a predominant avenue for young people to construct their social lives. Research has repeatedly connected social matching app-use with online and offline harms, including sexual harassment through online messaging, and sexual assault during subsequent face-to-face meetings [1,5,7,8,[14][15][16]22]. Safety has seldom been a motivating force behind social matching app design, however. AI serves as an valuable material for detecting and mitigating risk, and it has long served as a core component of social matching apps in the form of user-matching algorithms. Yet the use of AI for user safety, rather than user discovery, is rare. Our work looks into how AI can be incorporated into social matching apps for user safety across online and in-person interaction. In this position paper we review some of our ongoing participatory AI design efforts with young women, a demographic at disproportionate risk of harm during social matching app-use. Our co-designers conceptualize roles that AI can play pursuant to risk detection in social matching apps, and build directly explainable models for how AI can detect risk in this context. We use this review to promote participatory AI design as a way to directly involve stakeholders in AI interventions for safety, and also to highlight challenges to the method. We are committed to supporting MOSafely in any capacity that is most meaningful. --- Author Bios --- Douglas Zytko is an Assistant Professor in Oakland University's Department of Computer Science and Engineering, and director of the Oakland HCI Lab. Hanan Aljasim is a PhD student researcher in the lab. As a woman of color she utilizes methods that involve direct interaction with women and other at-risk demographics to empower them in articulating their visions of safety and design trajectories that can fulfill those visions. The lab's research broadly focuses on computer-mediated risk of harm against marginalized identities. Recent work from the lab has studied computer-mediated consent to sex to understand how application design perpetuates sexual violence online and offline [23], prototypes to support women in mitigating harm in social matching contexts [24], and participatory design with woman-and LGBTQidentifying young adults to understand their conceptualizations of safety and ideas for safetyconscious social matching apps of the future [4,6]. We typically collaborate with public health experts in the academic and non-profit sectors to inform our research. --- Participatory AI Design for Safety in Social Matching Systems With the use and design of social matching apps expanding to ever-myriad social interaction goals, more users are likely to be exposed to harms historically perpetuated through matching app-use such as harassment, rape, and bodily harm. We are in the midst of conducting participatory design studies with young women to explore how they envision AI intervening in the matching app user experience to support their safety. Women under the age of 30 are our target demographic because they are disproportionately the victims of matching appfacilitated harm (most of our participants have been in their late teens and early 20s). --- Risk detection models: In one such study we are supporting women in crafting directly explainable models, with supporting activities similar to those in [11], for how AI can predict the risk associated with a discovered social opportunity in a user's geographic vicinity, whether that opportunity be an individual person with a matching interest, an emergent activity, or an organized group event. See Figure 1 for an example social opportunity shown to participants to prompt their reflection on possible features in a risk detection model. The example social opportunities are tailored to the participant based on answers to a screening survey. Participants have proposed drastically different models that reflect their varying conceptualizations of what constitutes risk. Some example factors in participants' models include crime rate at the proposed meeting location, gender of the discovered person, the number of people attending the social opportunity, and reviews from other women who have interacted with people involved in the social opportunity. Variation in participants' models suggests that social matching systems should craft user-specific models of risk detection that take into account how the user conceptualizes risk and which factors in the model they may trust more than others. --- Risk has been identified…now what?: The notion of a risk detection AI for social matching apps was borne out of a preceding participatory design study, with woman-identifying college students in their early 20s, in which participants conceptualized different roles that AI could play in the social matching app experience pursuant to safety. In addition to risk detection, two other roles pertained to what the AI should do once a social risk is detected. One idea, dubbed the "cloaking device," refers to the AI altering a woman's visibility on the app depending on the general risk of their geographic location, and the presence of specific users in the area deemed high risk. When a woman's "cloaking device" is enabled other users would not be able to discover or interact with her on the app. This idea reflected a desire for the AI to not only detect risk, but attempt to mitigate potential harm on behalf of the user. The other idea was dubbed a "human support network" and refers to the AI proactively alerting trusted contacts about a risky interaction (either online or offline). Trusted contacts could include friends, family members, and in some cases police. This is reminiscent to "panic button" designs discussed in prior literature [10,21], but with two key differences: the AI autonomously responds to a risky situation without the user needing to deliberately click a button, and the barrier for AI intervention is must lower. Rather than requiring that harm already have occurred, the AI would reach out to a woman's support network when the likelihood of harm occurring in an interaction reaches a threshold set by the user. --- Challenges to Participatory AI Design Participatory design has long been heralded in its capacity to involve stakeholders in technology design [12]. Yet AI incurs unique challenges on the participatory design process, as became evident to us in our ongoing research. One issue involves background knowledge of AI (also discussed in [3]). Most of our participants have had little to no familiarity with AI, and so we have to incorporate activities to prime them on AI possibilities such as Powerpoint presentations and interactive exercises. In addition to this taking vital time away from participants expressing their own designs, it risks biasing participants since this priming often involves us providing examples of AI and models. Relatedly, time itself is another limitation. We divided our first participatory design study into four recurrent sessions so as not to rush participants. Yet we were still unable to proceed to model building in that time frame and needed a separate study, with mostly new participants. The capacity for participants to remain consistently involved in each stage of the design process (e.g., articulating a new AI use case > creating a model > designing an interface) is severely limited because of the time each step takes and other life responsibilities that participants have. As a result, a certain level of "translation" is needed to apply participant ideas to a subsequent design activity that they are not directly involved in.

In this position paper we draw attention to safety risks against youth and young adults that originate through the combination of online and in-person interaction, and opportunities for AI to address these risks. Our context of study is social matching systems (e.g., Tinder, Bumble), which are used by young adults for online-to-offline interaction with strangers, and which are correlated with sexual violence both online and inperson. The paper presents early insights from an ongoing participatory AI design study in which young women build directly explainable models for detecting risk associated with discovered social opportunities, and articulate what AI should do once risk has been detected. We seek to advocate for participatory AI design as a way to directly incorporate youth and young adults into the design of a safer Internet. We also draw attention to challenges with the method.

The aim of this study was to identify predictors of longevity using retrospectively coded autobiographical stories written and recorded from N = 1,858 deceased centenarians (M = 102.79 years; SD = 2.25 years) from the state of Oklahoma. Using the Developmental Adaptation Model as a conceptual framework, total number of years lived, the developmental outcome was regressed on socio-demographic characteristics including sex, race, and education, as well as retrospectively coded variables reflecting parental occupation, total years married, age at retirement, engagement in international travel, and self-attributions of longevity. Results confirmed three key predictors of living to 100 years and beyond. First, race was confirmed as a strong predictor of longevity (β = -.65, p < .001). Fatherhood agricultural occupation emerged as second key predictor of living 100 years and longer (β = .42, p < .10). Finally, total years spent in a marriage represented a third predictor of longevity (β = .47, p < .01). Results suggest being a person of color, being raised by a father who made a livelihood working in the agricultural industry, and remaining within a long-term marital union are contributing variables linked to living 100 years and longer. Further detail regarding descriptive and methodological evaluation of retrospectively coded centenarian biographies will be highlighted. Results have implications relative to how gerontological researchers and aging service professionals may evaluate and link autobiographical information of long-lived adults to developmental outcomes such as longevity. Abstract citation ID: igad104.3021 --- EXTREME WEATHER PREPAREDNESS AND CLIMATE ACTIVISM AT AGE 85+ Taylor Patskanick, Sophia Ashebir, Lisa D'Ambrosio, and Joseph Coughlin, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States Current projected shifts in climate suggest extreme weather events and disasters will become increasingly common and severe. Older adults are a population vulnerable to the impact of extreme weather due to complex mobility, health, and financial situations in later life, affecting their ability to prepare for and respond to extreme weather emergencies. These compound vulnerabilities demonstrate the importance of adequate emergency preparedness among older adults, particularly among the oldest of older adults or the age 85+ demographic. This paper shares findings from a mixed methods study with the MIT AgeLab 85+ Lifestyle Leaders panel, a research panel of U.S. octogenarians and nonagenarians, on climate change, including their perceptions of generational contributions to climate change, extreme weather preparedness, and engagement in climate justice. Utilizing a survey (n=23) and five virtual focus groups (n=19) conducted in July 2022, findings underscore differences in themes related to weather-event-related emergency preparedness among Lifestyle Leaders living in senior housing versus those community-dwelling. Additional themes note a perceived lack of individual agency and control around impacting climate change locally (including a potential life stage effect) and the urgency of climate change as a societal-level and voting issue. The implications of these findings for effective engagement with the over-85 age demographic in conversations about climate change and emergency preparedness will be highlighted.

we conducted both an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Our EFA identified three interpretable factors, including a 3-item sexual abuse factor (α = .80), a 3-item physical/emotional abuse factor (α = .69) and a 5-item household dysfunction factor (α = .64). Results of our CFA supported the 3-factor solution, X2 (DF = 11) = 14.289, p < .001. A series of 1-way ANOVAS examined age differences in childhood adversity, where middle aged adults reported experiencing more sexual abuse relative to younger and older adults, and younger adults reported experiencing more physical/emotional abuse and household dysfunction compared to middle-aged who reported more than older adults. Additional analyses examined the influence of adverse childhood experiences on physical and mental health outcomes, including depression. Our analyses highlight the persistent effect of ACEs across the lifespan and identify a need for intervention resources for younger and middle-aged adults in order to mitigate effects of ACEs at late life.

of sense of belonging on campus" and experience "marginalization and alienation" (p. 127). In the concluding chapter, the editors summed up that "Indigenous research is imperative to healing our communities and fostering our overall well-being" (p. 210). They noted also the importance of "honoring our collective voices" and entering "our writing space with good thoughts and intentions." They remarked on the "fluid" nature of "Indigenous methodologies" and say that there is "not a singular approach to Indigenous methodologies" (pp. 207-208). This collection of essays is important for anyone with an interest in current Indigenous perspectives on higher education and research. In chapter 13, Pearl Brower, president of Iḷisaġvik College, the only tribal college in Alaska, provided a list of traditional Inupiaq values to live by, including when doing research, that include sharing, knowledge of language, cooperation, humility, and respect. Similar lists can be found for many other groups of Indigenous peoples, and I would argue that these values should be central to any scholarly pursuit.

The contributors emphasized researchers' responsibility to the group versus research being just an individual quest, and they emphasized the need for getting beyond a deficit perspective and acknowledging the need for reciprocity, responsibility, and relationships. As Adrienne Keene wrote in chapter 4, "In many ways, Indigenous methods are 'just good research,' but they also constitute a level of responsibility, accountability, and commitment that many non-Native researchers may not be able to understand" (p. 51). Citing Wilson, Natalie Youngbull wrote in chapter 9, "Through an Indigenous paradigm, knowledge is not created or owned; rather, it is relational and shared" (p. 128). In the lead chapter entitled "The Need for Indigenizing Research in Higher Education Scholarship," Charlotte Davidson, Heather Shotton, Robin Minthorn, and Stephanie Waterman noted that they and other "Indigenous scholars do not ignore or dismiss Western epistemologies," however, they interpret them through their own lenses (p. 16). Adrienne Keene wrote in chapter 4 how "[r]esearch has often been the tool of colonialism, offering justifications for polices of assimilation and cultural eradication" (p. 50), and Sweeney Windchief commented in chapter 6 on the incidental and passive assimilation faced by Indigenous students in academia today. Theresa Stewart remarked in chapter 7 on the "dehumanizing nature of education" (p. 88) and she was echoed in chapter 9 by Natalie Youngbull who examined the support Indigenous students need as they face "feelings of invisibility and/or isolation and a lack

Introduction Cinema, a visual storytelling medium, has a rich history of enthralling, enlightening, and inspiring viewers. Among the several cinema genres, documentaries stand out and have a significant impact on society since they aim to do more than just amuse. a thorough investigation of how documentary filming is interactive and how it impacts social activism. This article explores the ways in which films impact the contemporary activism landscape by expressing societal issues and motivating audiences to act. Documentaries are one subgenre of filmmaking that has made a name for itself in recent years. They provide marginalised communities a platform to speak out, expose injustice, and demand change by combining the art of storytelling with the analytical rigour of social commentary. In this article, we delve into the various ways documentaries influence the discourse around social change, highlighting their capacity to inform viewers, rally communities, and influence policymakers. historical progression of activism as depicted in documentaries. From the innovative films of early nonfiction filmmakers to the age of immediate internet access and global distribution, we trace the development of documentary styles and methodologies. As a result of adapting to new technology and audience engagement, documentaries have continued to serve their original mission of illuminating societal issues. Throughout our voyage, we cover a diverse array of documentary topics and themes, each offering a fresh insight on how these things have influenced activism. Whether the topic is cultural awareness, political reform, human rights, or environmental preservation, documentaries have the ability to evoke strong emotions, stimulate critical thinking, and motivate viewers to take action. We look at cases that demonstrate how movies have affected legislative policy choices and inspired grassroots initiatives. We also delve deeply into the complicated relationship that exists between documentary filmmakers and the subjects they show. We explore the weight of duty and the moral dilemmas that arise when we record authentic stories and stand up for social causes. the power of documentary storytelling to elevate the voiceless and the importance of telling tales with integrity. We also become aware of the challenges faced by documentaries as they attempt to influence society as we make our way through this complex terrain. Concerns about public reaction, a lack of funding, and ethical dilemmas are just a few of the challenges that the documentary faces as a weapon for change, so it's crucial to understand its strengths and weaknesses in detail. cinema's ability to motivate viewers to take part in social change. It recognises their function as channels through which society tackles important problems by raising consciousness, evoking empathy, and mobilising people. It praises the ability of movies, particularly documentaries, to do more than just entertain; it may motivate positive social change. --- Evolution of Documentary Filmmaking as Activism Documentary filmmaking has gone a long way from being only a storytelling and entertainment medium; it is now a potent instrument for social change. In this fascinating journey through time, we trace the evolution of documentary filmmaking as a tool for societal transformation, education, and action. In Hollywood, documentaries hold a unique status as a subgenre of cinema. They skillfully blend the compelling stories of storytelling with the ethical imperative to address pressing societal issues. Our understanding of society and politics, as well as technological advancements, have all contributed to the evolution of documentary filmmaking. a journey through the pioneers of documentary cinema... The media that aimed to portray the world as it actually was was born with the "Actualités" by the Lumière brothers and continued with Robert Flaherty and Dziga Vertov. These early documentaries gave audiences a glimpse into other cultures and countries via the use of the observational technique. Furthermore, we traverse the tumultuous 1900s, a time marked by major social and political upheavals. During this time, documentary filmmakers started getting more involved in political movements. Two filmmakers who used cinema to advocate for social change and environmental conservation, Leni Riefenstahl and Pare Lorentz, respectively, used quite different methods. the '60s and '70s, when documentaries were most popular. The term "cinéma vérité" was used to characterise the increase of politically tinged documentaries during this period. By capturing the essence of social movements, political protests, and cultural revolutions, filmmakers such as D.A. Pennebaker and Frederick Wiseman cemented the documentary's place as a lens through which to see the processes of social change. --- Documentaries as Catalysts for Awareness In the realm of visual storytelling, documentaries have emerged as powerful catalysts for change, capable of awakening consciousness, inspiring introspection, and quickening collective understanding. documentary films have an essential role in drawing public awareness to pressing social issues. It delves at how documentaries may shed light on hidden corners of our world and motivate viewers to make a difference. Documentaries offer an unfiltered picture of the world as it truly is, which is a major benefit when compared to other narrative filmmaking styles. By utilising these tools, filmmakers have the opportunity to step into the shoes of storyteller, activist, and human condition observer. One of documentaries' greatest strengths is the way it boldly tackles taboo themes, making viewers confront uncomfortable truths. offering viewers a glimpse into the complexities of the globe via the film. These films may open people's eyes to other cultures, shed light on environmental problems, and call attention to injustices that deserve our attention. Using compelling narratives and striking visuals, documentaries transport viewers to the heart of situations and shed light on perspectives they would have missed otherwise. We also get into the emotional depths that people may go to watch documentaries. The foundation of many of their works are true stories, detailed recollections, and anecdotes. As a result of the profound connection established by the authenticity, the viewer is able to sympathise and have compassion towards the subject matter. Documentaries have the power to evoke strong emotions, provoke profound contemplation, and prompt viewers to question their place in the grand scheme of things. We also look at how documentaries may be platforms for marginalised voices; these films offer a platform to marginalised people, activists, and communities who have been historically disadvantaged. Documentaries provide a forum for diverse perspectives, which in turn encourage viewers to relate to tales that challenge and broaden their worldview. the power of documentaries to tackle systemic issues. They serve as mirrors, reflecting both the successes and failures of society. Documentaries have shed attention on political corruption, violations of human rights, and global issues such as climate change and healthcare disparities. They want to see problems resolved, not only identified. --- Conclusion Documentaries have consistently demonstrated the power of artistic filmmaking to inspire social transformation throughout human history. How have documentaries influenced audiences to become activists? That is the central question of this research report. In bringing attention to injustice, inspiring action, and planting the seeds of a new consciousness, it proves that film can do more than just show us the world; it can also change it. Documentaries, as a form of film, have several uses outside of the entertainment sector. They are more than simply narratives; they mirror society's triumphs and tragedies, demand fairness, and elicit compassion. Our research has shown the many ways in which films may be utilised to organise people, bring about change, and increase awareness. Documentaries have come a long way, baby, from the daring early adopters of factual filmmaking who wanted to show the world as it actually is to the ubiquitous digital technology that has democratised the filmmaking process. Documentaries have evolved in tandem with societal shifts, reflecting a heightened awareness of diversity, social justice, and the urgent need for swift action. Our study has shown that documentaries have the potential to be a powerful tool for raising awareness. They offer a platform to marginalised people, shed light on injustices that often go unnoticed, and teach us about different cultures. Watching a documentary may bring viewers to tears, prompt profound reflection, and motivate them to take action on meaningful issues. Considerations of ethics in documentary storytelling serve as invitations to empathy, drawing the audience into the stories

When it comes to activist stories and social change, documentaries are powerful tools in the visual storytelling toolbox. an in-depth exploration of the intricate connection between films, particularly documentaries, and their influence on activism. By doing so, it delves into the ways in which films are influencing contemporary activism via bringing attention to important issues, motivating viewers to take action, and fostering societal transformation. In its ability to give a platform to marginalised communities, expose injustices, and demand societal change, films bridge the gap between art and activism. The multifaceted role of documentaries as agents of social transformation, illuminating their far-reaching impacts on issues as varied as cultural awareness, political shifts, and human rights.

Introduction The term socioeconomic status (SES) refers to the position that a person or family has in relation to the community's typical standards for cultural and material goods, income, and involvement in social activities. 1 It is a crucial factor in determining an individual's nutritional status, mortality, and morbidity since it affects the cost, acceptability, accessibility, and use of medical facilities. The disparities between socioeconomic position (SES) and health status follow a gradient, or a step-by-step pattern, between where one sits in an SES hierarchy and most health outcomes. Even though not all health issues are correlated with socioeconomic class (a few diseases are more common in higher SES groups than in lower SES groups), the tendency is persistent throughout time and is evident in both men and women of all ages across countries. However, recent studies have demonstrated that health disparities accumulate over a lifetime and have an impact on health at every stage of life. Poor social and economic circumstances early in life have a long-term effect on health. 2 3 The criteria that are most frequently utilized in these scales are total income, educational achievement, and occupation. In India, the most well-known and extensively used scale for determining the socioeconomic status of an individual or a family in urban areas is the "Modified Kuppuswamy SES Scale". Originally intended to assess an individual's SES, the scale was later modified to assess the SES of a family rather than an individual. Kuppuswamy created the original scale in 1976. It has three index factors viz; education, occupation, and total income. Each parameter has been further divided into subgroups, and each subgroup has been given a score. The Kuppuswamy SES Scale categorizes families into five groups (upper class, upper middle class, lower middle class, upper lower class, and lower class) based on their overall score, which ranges from three to twenty-nine (03-29). 3 Yet, due to the dynamic nature of macroeconomic indices viz; inflation, per capita, etc., the SES is ineffectual in reaching their main objective. To fulfill their objective of determining the SES of an individual or a family, they must undergo consistent changes over time. This work aims to update and provide an "Updated Modified Kuppuswamy SES" scale for the year 2023. --- Revision of Income Parameters in Modified Kuppuswamy Scale The Kuppuswamy socioeconomic survey's parameters, including education and occupation, have remained constant over time. However, the third parameter i.e. income loses its pertinence following the Indian rupee (INR) sensitivity to inflation. 5 The income scale in Kuppuswamy SES is therefore adjusted in accordance with changes in the Consumer Price Index (CPI) for industrial workers as projected by Labour Bureau, Ministry of Labour and Employment Govt. of India 6 and the Central Ministry of Statistics and Programme Implementation 7 on their website. The values of the CPI are explained in reference to a base year. 8 As per the Labour Bureau, Government of India, the current base year to be considered is 2016. Here in this paper, we will use 2016 base year for calculating the income level of families to determine their socioeconomic status. 9 For calculation inflation rate (conversion factor), of February 2023 is 6.16 has been considered. If we multiply the generated income scale values of the year 2016 with the conversion factor of 6.16 that will update the Kuppuswamy SES scale for February 2023. The conversion rate or inflation rate is calculated using the formula. Inflation Rate = b -a a × 100 b is the CPI of the current year & a is the CPI of previous year --- Limitations Although researchers most frequently use it in community, and hospital based investigations, the Kuppuswamy socioeconomic survey has significant limitations that decrease its sensitivity in predicting a family's socioeconomic level. These include determining socioeconomic class by taking into account the employment history and educational background of the family's head, which is wholly inappropriate in the current context. Furthermore, the scale is subject to variations in income levels because it depends on shifting CPI values and needs to be updated frequently. --- Source of Funding None. --- Conflict of Interest None.

Socioeconomic status SES is one of the most important indicators to consider when assessing a family's health and nutritional status. It is a position that any person can achieve within a hierarchical social framework. Academicians and medical researchers have made several attempts in the past to create a collection of composite indices to assess an individual's or a family's socioeconomic status (SES) whether they reside in a rural or urban location. The Hollingshead, Nakao, and Treas, Blishen, Carroll, and Moore, Tiwari, Kumar, and Agarwal, Jalota, and Kuppuswamy scales are a few of the notable scales. The scales have several factors that account for information about a person or a family. Among all the SES, the most widely used scale in India is 'The Modified Kuppuswamy SES'. Based on the total score of the Kuppuswamy scale, which ranges from 3-29, families are categorized into five classes, from upper class to lower class. Owing to constraints, the Kuppuswamy SES requires frequent updates for income levels that are dependent on shifting consumer price index (CPI) values, making the scale susceptible to changes over time. This paper aims to update and provide an "Updated Modified Kuppuswamy SES" for the year 2023.

We are well aware that if we concentrate on STEM alone to the detriment of the humanities and the social sciences, we are likely to miss an essential dimension of human existence. The sciences of human beings through which man can reflect on himself as a human being, on the meaning of his existence and the existence of another world, are absolutely essential to him. This takes us to the following statement by Pascal: In other words, the so-called hard sciences alone cannot capture all the dimensions of a human being. The humanities and the social sciences are also needed capture this plural dimension. They remind us of our past and show us the way forward. This, however, does not imply that the humanities and the social sciences are competing with the so-called hard sciences, in particular STEM. It is the opposite. Scientific and technological progress has so much accelerated for the humanities and the social sciences to ignore that both STEM, the humanities and the social sciences have become closely interlinked. "Digital humanities" is even a term used to mean that the humanities cannot shut itself off from omnipresent digital uses; even thinking has also been instrumented. Besides, issues that were traditionally handled by the humanities and the social sciences are now at the core of research and STEM innovations. This paper purports to show that instead of shying away because they perceive STEM as a threat, both the humanities and the social sciences must stand up to the challenges posed by new themes and issues in view of the tenuous link they have with STEM. Indeed, the humanities was once defined through a number of questionings such as "what's a human being ?", "What's thought ?", or "what's conscience" "what's memory, perception, learning, etc.". Now, these questionings are no longer their exclusive concerns. Cognitive sciences are wondering about the meaning of "knowledge", "having convictions", "to ignore" or "being mistaken". They raise questions about the perception of objects and subjects in the surrounding world, source of knowledge as well as learning, memorising and rationalising mechanisms. They are wondering over differences between individuals when it comes to learning, remembering, etc. What are the impacts of brain damage on memory, speech, thinking... Furthermore, knowledge engineers are wondering about various knowledge materials: what's a shape, an image, a concept, a word? As Howard Gardner1 put it, cognitive sciences, "this new science" dates back to the Greeks because they were desirous of discovering the nature of human knowledge. However, this science is a radically new one because knowledge engineers exclusively use empirical methods to test their theories and hypotheses, relying mainly on the most recent scientific and technological discoveries of various disciplines. Computer science is one major part, with computer emerging as the best model for understanding how the human brain operates. Indeed, computers are not only indispensable for doing all sorts of research but also because computer is modelled on the operation of the human brain. Is computer omnipresence not likely to impact the themes of the humanities and the social sciences? New disciplines like artificial intelligence have emerged and research is stimulated by new questioning like the potential knowledge-acquiring capacity that manbuilt machines may have. Cognitics or knowledge engineering, or the automatic processing of knowledge and relationship between man and information and communication technologies blends the humanities and the social sciences with automation, computer science, ergonomics, cognitive sciences and life sciences. Equally in health matters, cutting-edge technologies are being increasingly widely used sending a message of hope on potential victory over diseases while also posing new challenges. Are questions about life, death, pain and age not assuming new meaning with the emergence of all this technology? So, the point here is not for the humanities and the social sciences to take a defensive attitude and wonder, from the outside so to speak, whether or not STEM constitutes a threat a source of alienation and. Far from being a threat to the humanities and the social sciences, STEM, on the contrary, form a major challenge. If African researchers can raise their awareness of this trend and stand up to the challenge, the humanities and the social sciences which are well rooted in social, technological and scientific realities, can play a decisive role in building a veritable African research space. CODESRIA, which has always upheld a broad social sciences concept, would then be a key agent for this convergence of STEM and the humanities and the social sciences in Africa. --- Note --- The Social Sciences and Humanities in the Age of STEM --- Ramatoulaye Diagne Mbengue Cheikh Anta Diop University Dakar, Senegal

t may sound paradoxical, at a time when the orientation towards Sciences, Technology, Engineering and Mathematics (STEM) has become mainstream for all to also unanimously recognise the importance of the humanities and the social sciences.

PATIENT-CLINICIAN RELATIONSHIPS IN HOME HEALTH CARE Ayomide Bankole 1 , Tyra Girdwood 2 , Dorothy Addo-Mensah 3 , and Mark Toles 1 , 1. Chapel Hill,North Carolina,United States,2. Duke University,Durham,North Carolina,United States,3. University of North Carolina at Chapel Hill,Chapel Hill,North Carolina,United States Patient-clinician relationships are fundamental attributes of high-quality home health care (HHC); yet little is known about patient-clinician relationships in HHC (where 5 million Medicare beneficiaries receive care annually). The objective of the study was to describe perspectives of HHC patients and HHC clinicians about patient-clinician relationships in HHC. We conducted a secondary qualitative analysis of semistructured interviews (n=34) from a completed qualitative study investigating perspectives of older adult HHC patients (or caregivers as proxy) and their HHC clinicians (17 pairs) on discharge preparedness in a large HHC organization in North-Carolina. A conceptual model of patient-clinician relationships guided content analysis of the interview data. HHC patients identified as White (65%) and black (35%). Most HHC patients reported female sex (53%) and average age was 83 years (range= 69-93). Clinicians were registered nurses and physical therapists. Across the patient-clinician pairs, HHC patients valued relationships with clinicians with shared commonalities and those who provided reciprocal informational exchange and respected their autonomy. HHC clinicians valued relationships in which they felt helpful and respected as a healthcare professional. Relational conflicts arose when there was discordance in expectations of care (e.g., type of HHC services provided). Conflicts also arose when organizational constraints, such as disruptive scheduling, limited HHC visit time, and when limited continuity of care prevented the formation of patient-clinician relationships. Relational conflicts and organizational constraints influence patient-clinician relationships in HHC. Multi-level interventions (targeting modifiable factors at the patient, clinician, and organizational levels) are needed to improve the patient-clinician relationships and the quality of HHC. Abstract citation ID: igad104.1724 --- PERCEIVED FEASIBILITY TO IMPLEMENT A TASK-ORIENTED EXERCISE PROGRAM BY FITNESS STAFF AT SENIOR LIVING COMMUNITIES Chiung-ju Liu 1 , and Lauren Mansuy 2 , 1. University of Florida,Gainesville,Florida,United States,2. University of Central Florida,Orlando,Florida,United States Older adults who relocate to senior living communities have a desire to maintain their independence. The fitness infrastructure within these communities is a great platform to deliver evidence-based exercise programs to support residents' independence, especially for those who have experienced activity limitations. Task-oriented exercise incorporates daily activities into exercise strategies and has been recommended as an approach to reduce late-life disability. The current study used an interview research design to determine the feasibility of implementing 3-Step Workout for Life, a taskoriented program, in senior living communities. The 3-Step Workout for Life program consists of gym-based group resistance exercise and home-based one-on-one activity exercise. Fourteen fitness instructors from different communities, with independent living units, in the state of Florida completed the study. Interviews were transcribed, coded, and underwent thematic analysis. Instructors perceived the screening procedure to select and enroll residents in this program could help match residents to the right fitness program. The gym-based group resistance exercise is compatible with existing instructor-led fitness programs. Although instructors perceived the homebased one-on-one activity exercise positively, such as the potential benefits for frail residents who do not attend the gym, they acknowledged several barriers to implementing this exercise. Major barriers include their job responsibility

were also risk factors. Patient risk factors included prior hospitalization, health conditions such as cancer and renal disease), functional limitations, certain medication classes (e.g., anticoagulants, diuretics), the use of oxygen, and the use of a urinary catheter. This study demonstrates that clinician behaviors and documentation patterns can be incorporated in risk models to yield important insights.

Caregiving; Health Equity; and Community Linkages. Health departments offered input through facilitated listening sessions and an open input period. Their feedback emphasized the importance increased information on health equity and partnerships in the Road Map. The Leadership Committee also advised continued partner engagement through the review process. This translated to review by the Alzheimer's Association, CDC subject matter experts, external health equity experts, the Leadership Committee, workgroup members, the Healthy Brain Initiative Collaborative, the Alzheimer's Association Early Stage Advisory Group and ultimately CDC leadership. This presentation will explore important themes that emerged throughout this process that shaped the design and evolution of the HBI Road Map series to its most recent iteration, as a guiding document with health equity and multi-sector collaboration action at its core. --- SESSION 3060 (SYMPOSIUM) Abstract citation ID: igad104.0854 --- A HISTORICAL-CONTEXTUAL PERSPECTIVE ON GRANDPARENTS' ACTIVITIES WITH GRANDCHILDREN Chair: Jill Juris Discussant: Amy Rauer Grandparenting is one of the most positive roles for many older adults, yet there is limited understanding of what activities grandparents and grandchildren actually engage in together or how these may vary based on both context (e.g., residential grandparenthood, grandparents' marriage) and historical events (e.g., . Drawing from multiple theoretical frameworks and methodological approaches, this symposium begins with Flood providing a broad view of time grandparents and grandchildren spend together using large-scale populationlevel data from IPUMS. Illustrating how such activities may vary based on context, Stephan and Chan provide insights into how activity engagement varies by caregiver status and whether activity engagement with grandchildren is related to grandparents' perceived roles. Extending this examination of context to consider specific processes, Juris and Zvonkovic will then describe the process of family leisure among grandparent couples by examining how both individuals in a couple experience family leisure with their grandchildren. Providing a historical perspective on these experiences, Fruhauf and colleagues reveal the challenges of raising grandchildren in the context of COVID-19 and the importance of engaging in different and new activities with their grandchildren during this time. Finally, as discussant, Rauer will draw upon Bronfenbrenner's socioecological framework to illustrate how grandparenting is situated within a complex network of interdependent systems and dynamic contexts. Together, this symposium will highlight the implications of grandparenting for catalyzing development and enhancing well-being across multiple generations. Abstract citation ID: igad104.0855 --- LARGE-SCALE POPULATION-LEVEL DATA FOR STUDYING GRANDPARENTING IN THE UNITED STATES Sarah Flood, University of Minnesota, Minneapolis, Minnesota, United States The questions we can answer about grandparenting in the United States are shaped by the availability of data. This presentation will review previous research on trends and sociodemographic variation in grandparenting in the United States based on large-scale population-level data from IPUMS (www.ipums.org). It will highlight the various ways that researchers have measured families that include grandparents (e.g., three-generation families, grandfamilies). It will also discuss the limitations of these data, specifically the focus on coresidence, for studying grandparents. The presentation will then review research on grandparents using the American Time Use Survey, the only data in IPUMS that enables analyses of grandparents time spent with both their resident and non-resident grandchildren. These analyses will focus on the leisure activities that grandparents share with their grandchildren and how this varies by living arrangements and sociodemographic characteristics. Though the grandparent population varies across virtually all sociodemographic characteristics, caregiver status (i.e., whether grandparents are raising grandchildren), may be most salient in how grandparents engage in activities and perceive their roles in relation to their grandchildren. Informed by the bioecological process-person-context-time model, this mixed-methods study explores how activity engagement varies by caregiver status and whether activity engagement with grandchildren is related to grandparents' perceived roles. A convenience sample of 86 mid-life and older adults (Mage=65.12 years, range=42-82) completed an online survey with open-and closed-ended items related to their grandparenting experience. 22% of grandparents selfidentified as grandparent caregivers (GC), or those who have been raising their grandchildren for six months or longer; the remaining 78% self-identified as non-caregiving grandparents (NCG). Comparative analyses did not yield statistically significant results, revealing GCs and NGCs largely engaged in similar activities with their grandchildren. However, activity engagement intervals differed by group (i.e., daily basis for GCs vs. weekly or monthly basis for NGCs), and a greater proportion of NCGs reported digital activity engagement with their grandchildren. Both GCs and NGCs identified their roles as emotional supporters to their grandchildren, though GCs also identified with instrumental roles (e.g., surrogate parent, anchor, financial supporter). These findings shed light on the connection between self-reported activity engagement and subjective role perceptions across just one sociodemographic characteristic-caregiver status-and suggest both groups share a similar grandparenting foundation, with an additional, "dual-roles" component for GCs. Implications for future research and practice will be discussed. Abstract citation ID: igad104.0857 --- HOW GRANDPARENT COUPLES ENGAGE IN FAMILY LEISURE WITH GRANDCHILDREN Jill Juris 1 , and Anisa Zvonkovic 2 , 1. Appalachian State University, Boone, North Carolina, United States, 2. --- University of Georgia, Athens, Georgia, United States There is limited understanding of how grandparent couples negotiate time with grandchildren. Family leisure is often purposive by being planned, facilitated, and executed by parents or grandparents to achieve goals such as improved interaction, communication, and family cohesion. Moving beyond studies of counting time in leisure, few studies of family leisure have included how people experience leisure as couples. Guided by a life course approach, this qualitative study provides insight to an understanding of the process of family leisure among grandparent couples by examining how both individuals in a couple experience family leisure with their grandchildren. Grandparent couples (n=10) ranged in age from 60 to 75 years old (M=66.8, SD=5.01). The grandparents interviewed were not providing custodial care to their grandchildren. Participants completed individual interviews that were then analyzed at the couple level. Through constructivist grounded theory, this study developed a process model of grandparents' decision-making that unfolded into four options for engaging in family leisure with grandchildren. The four options included: wanting a grandparent fix, going with the flow when invited by children, hosting grandchildren in their homes, and meeting expectations for family gatherings. Grandparent couples often described more than one option of family leisure based on their life course dimensions (i.e., individual, family, and sociohistorical). Implications for application in the fields of recreation and family sciences will be discussed. Managing COVID-19 demands may exacerbate caregiving responsibilities of custodial grandparents raising grandchildren. This presentation aims to discuss qualitative data obtained from 14 custodial grandmothers who participated in virtual focus groups to understand their parenting experiences in conjunction with meeting COVID-19 demands. Participants were recruited from a larger sample (N=145, age range 30-79 years, Mage = 61.4 years, SD = 8.5) of custodial grandparents who completed a quantitative survey on COVID-19 stressors. Guided by McCubbins and Patterson's Family Stress and Adaptation model, three researchers conducted open coding of the focus group data. The analysis revealed distinguishing patterns related to managing challenges of grandchild caregiving brought on by COVID-19. Some grandparents discussed the demands of COVID-19 as difficult, but not as challenging as the day-to-day experiences of raising grandchildren. This was reflected when grandparents discussed raising grandchildren with special needs in the pandemic environment, advocating with schools to adjust virtual learning expectations, managing custody cases and

has near nationwide uptake, and, in 2023, a new project, Data for Action, launched in four states to support the use and dissemination of BRFSS and other data. Together, these projects improve assessment, planning and measurement of community health outcomes related to brain health. The 4th edition of the HBI Road Map has an accompanying evaluation tool offering common measures for state and local health departments to track their success as they implement the new actions. This session will explore the past impact of Road Map actions and opportunities for future measurement.