Since the 1980s, ecological models of health promotion have generated a great deal of enthusiasm among researchers and interventionists. These models emerged from conceptual developments in other fields, and only selected elements of the ecological approach have been integrated into them. In this article, we describe the tenets of the ecological approach and highlight those aspects that have been integrated into ecological models used in health promotion. We also analyze how ecological models have been applied to the study of two important public health issues, namely physical activity promotion and the increased consumption of fruits and vegetables, by conducting an archival study of published research. Finally, we make a statement regarding the usefulness of ecological models for research and practice and propose recommendations for future research, program planning, and evaluation.

Alongside community involvement, promoting social participation has been identified as a key strategy of fostering empowerment, one of the central tenets of the health promotion movement. Engagement in social and productive activities appears to be particularly beneficial to older adults, as it has been found to be associated with positive outcomes on a variety of health indicators. It is therefore critical to identify factors that might lead to greater social participation within these age groups. The objective of this study was to investigate the relationship between perceptions of neighbourhood user-friendliness and social participation while controlling for personal characteristics in a sample of seniors living in an urban environment. A convenience sample of older adults (n = 282) was recruited through community organizations located in high- average- and low-income Montreal neighbourhoods. Data were collected via an interviewer-administered questionnaire assessing social participation and various variables at the neighbourhood level (e.g. housing and social environment, walking environment and transportation, and services and amenities) and at the individual-level (e.g. health status and socio-demographic characteristics). Five variables emerged as independent predictors of social participation. Positive predictors retained in the final regression model included frequent walking episodes (almost every day), higher Vitality and General Health SF-12v2 scores, and perceived accessibility to key resources for older adults. Also included was a negative predictor: age (R² of the final model = 0.28). Implications of the findings for research and action pertaining to ecological, health promotion interventions for older adults are identified.

Background: People with a recent history of homelessness are believed to be at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and, when infected, complications of coronavirus disease 2019 (COVID-19). We describe and compare testing for SARS-CoV-2, test positivity and hospital admission, receipt of intensive care and mortality rates related to COVID-19 for people with a recent history of homelessness versus community-dwelling people as of July 31, 2020. Methods: We conducted a population-based retrospective cohort study in Ontario, Canada, between Jan. 23 and July 31, 2020, using linked health administrative data among people who either had a recent history of homelessness or were dwelling in the community. People were included if they were eligible for provincial health care coverage and not living in an institutionalized facility on Jan. 23, 2020. We examined testing for SARS-CoV-2, test positivity and complication outcomes of COVID-19 (hospital admission, admission to intensive care and death) within 21 days of a positive test result. Extended multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) in 3 time periods: preshutdown (Jan. 23–Mar. 13), peak (Mar. 14–June 16) and reopening (June 17–July 31). Results: People with a recent history of homelessness (n = 29 407) were more likely to be tested for SARS-CoV-2 in all 3 periods compared with community-dwelling people (n = 14 494 301) (preshutdown adjusted HR 1.61, 95% confidence interval [CI] 1.22–2.11; peak adjusted HR 2.95, 95% CI 2.88–3.03; reopening adjusted HR 1.45, 95% CI 1.39–1.51). They were also more likely to have a positive test result (peak adjusted HR 3.66, 95% CI 3.22–4.16; reopening adjusted HR 1.76, 95% CI 1.15–2.71). In the peak period, people with a recent history of homelessness were over 20 times more likely to be admitted to hospital for COVID-19 (adjusted HR 20.35, 95% CI 16.23–25.53), over 10 times more likely to require intensive care for COVID-19 (adjusted HR 10.20, 95% CI 5.81–17.93) and over 5 times more likely to die within 21 days of their first positive test result (adjusted HR 5.73, 95% CI 3.01–10.91). Interpretation: In Ontario, people with a recent history of homelessness were significantly more likely to be tested for SARS-CoV-2, to have a positive test result, to be admitted to hospital for COVID-19, to receive intensive care for COVID-19 and to die of COVID-19 compared with community-dwelling people. People with a recent history of homelessness should continue to be considered particularly vulnerable to SARS-CoV-2 infection and its complications.

Objective: This article examined the associations between proximity to selected locations considered to be conducive to social participation, and social participation itself, in urban-dwelling seniors. Methods: A sample of 520 older adults residing in the Montreal area provided reports of social participation and information about health, sociodemographic characteristics, social networks, and perceptions about features of their residential environment. Information about the distance between their home and five locations deemed to be conducive to social participation were obtained from a geographic information system. Results: Analyses showed a significant association between proximity to selected locations and social participation while accounting for individual characteristics and perceptions of neighborhood features (β = 0.37; SE = 0.17; p < 0.05). Discussion: Findings were consistent with contributions highlighting the impact of the built environment on seniors’ health-related behavior. Future work would benefit from the use of longitudinal designs and examinations of social participation through alternate channels.

Objectives To validate case ascertainment algorithms for identifying individuals experiencing homelessness in health administrative databases between 2007 and 2014; and to estimate homelessness prevalence trends in Ontario, Canada, between 2007 and 2016. Design A population-based retrospective validation study. Setting Ontario, Canada, from 2007 to 2014 (validation) and 2007 to 2016 (estimation). Participants Our reference standard was the known housing status of a longitudinal cohort of housed (n=137 200) and homeless or vulnerably housed (n=686) individuals. Two reference standard definitions of homelessness were adopted: the housing episode and the annual housing experience (any homelessness within a calendar year). Main outcome measures Sensitivity, specificity, positive and negative predictive values and positive likelihood ratios of 30 case ascertainment algorithms for detecting homelessness using up to eight health service databases. Results Sensitivity estimates ranged from 10.8% to 28.9% (housing episode definition) and 18.5% to 35.6% (annual housing experience definition). Specificities exceeded 99% and positive likelihood ratios were high using both definitions. The most optimal algorithm estimates that 59 974 (95% CI 55 231 to 65 208) Ontarians (0.53% of the adult population) experienced homelessness in 2016, a 67.3% increase from 2007. Conclusions In Ontario, case ascertainment algorithms for identifying homelessness had low sensitivity but very high specificity and positive likelihood ratio. The use of health administrative databases may offer opportunities to track individuals experiencing homelessness over time and inform efforts to improve housing and health status in this vulnerable population.