There are 376 million migrants, which account for more than 25% of the population in China according to the newest national demographic census, most of whom are from undeveloped areas to developed urban regions. Migrants’ social integration was one of the most important issues when the country aimed to build an inclusive society. As a form of human capital, the effect of migrants’ health status on social integration has rarely been explored until now, especially empirically. Previous studies have usually ignored health indicators when discussing the determinants of migrants’ social integration, and understanding the role of migrants’ physical health and mental health on their social integration is significant for efforts to ensure inclusive urbanization. For filling this research gap, the China Migrants Dynamic Survey dataset was used to uncover the role of migrants’ health status, including physical health and mental health, in their degree of social integration, and a further comparison of impact was conducted among rural–urban and urban–urban migrants. Through the empirical analysis, our results indicated the following. First, both better physical and mental health lead to higher social integration levels, and a one-point increase in physical and mental health improves the odds of good social integration by 33.27% and 5.98% for belonging and 66.05% and 6.35% for harmony, respectively. Second, health status is equally important for rural–urban and urban–urban migrants’ social integration, and the significant positive effect was consistent across groups, although some other impact factors may exhibit differences. Third, the effect of health status on social integration was moderated by social participation, which was more obvious for mental health than physical health. According to our findings, we discuss the measures to promote migrants’ health status and additional countermeasures to improve their social integration level. China’s rapid urbanization has concentrated the population in urban regions caused mainly by a large number of migrants from underdeveloped regions . MigrantIn China, migrants have an irreplaceable role in the country’s economic development, which will continually promote further integration of urban–rural areas for coprosperity. However, migrants are also the most vulnerable group in cities due to the institutional discrimination and urban–rural discrepancies, especially for rural–urban migrants. Inefficient social services, poor living conditions and potential discrimination may affect their health; because of their poor socioeconomic status and limited access to public services, they may be discriminated against by others ,10,11. HWith the large number of migrants living and working in cities, which will further increase in the future, the government and researchers have begun to pay more attention to these marginalized groups. In addition, the Chinese government aimed to ensure so-called “people-centered” urbanization and society, which means that more consideration needs to be given to marginalized groups, such as the large number of migrants in metropolis regions ,20. MigrThere are two classic theories about migrants’ health, including the “salmon bias” hypothesis and the “health migrant” phenomenon. The “salmon bias” hypothesis, which is usually utilized to explain the “health migrant” paradox, implies that migrants with better health status may have a greater desire to settle down in host cities, and according to other studies, health status also plays a crucial role in other areas, such as individual income, life satisfaction and subjective well-being ,25,26. TTo the best of our knowledge, few studies have discussed the effect of health status on the degree of social integration among various categories of migrants. Therefore, this study may provide a deep understanding of the effect of health status on migrants’ social integration and may have policy implications for the government to facilitate social integration and achieve the goal of an inclusive society and urbanization. The rest of this article is as follows: Previous studies on the social integration of migrants in China, the largest developing country in the world, initially began because a large number of rural workers were leaving their hometowns and migrating to cities for job opportunities and a better life . One of To date, existing studies have made some efforts to explore the factors impacting migrants’ social integration to find ways to increase migrants’ social integration level. For example, housing conditions have been discussed by several studies, and these studies indicated that people with better housing conditions may have higher social integration levels than those in poor housing conditions ,37,38. SWhen discussing migrants’ social integration, we need to confirm the categories of migrants and measure the degree of social integration. The Chinese population, divided by the hukou system, consists of rural and urban residents, so there are two kinds of migrants in cities: rural–urban and urban–urban migrants . The maiThe measurement of social integration is complicated and has no consistent measure. For migrants, social integration is usually defined as a process of fusion between them and natives. According to previous studies, social integration has been divided into subjective social integration and objective social integration from two different perspectives, and subjective social integration is more important and directly originates from social interaction . ResearcHealth status is the general performance of individual’s health, and which is usually regarded as the one of the most important human capitals ,45. AccoThe “healthy migrant” paradox implies that migrants may have a better health status than natives when they first came to cities, although they have a lower socioeconomic status . AccordiEvidence has indicated that migration experiences may affect migrants’ health, which increases their health costs, which are already a serious challenge in cities . AlthougMigrants are vulnerable to health risks, which indicates that health issues are too important for migrants to ignore. According to Xie’s research, both physical and mental health status significantly impact migrants’ settlement intention, and we can conclude that mental health and physical health are associated with migrants’ decisions . AlthougMoreover, as we discussed above, social discrimination, social ties and social interactions can all impact migrants’ health during the migration experience, which has been proven by a large number of studies ,67,68,69The data utilized in this paper were taken from the Chinese Migrants Dynamic Survey (CMDS), which was collected by China’s National Health and Family Planning Commission (NHFPC) in 2014. This dataset focused on migrants in urban regions without a local urban hukou, and this dataset was widely used in research on Chinese migrants. In this dataset, all migrants are aged between 15 and 59 years old and have lived in urban areas for more than one month. The stratified and multistage probability proportionate to size (PPS) sample method was used in this survey to make the dataset more representative. These data from 2014 were chosen based on a sub-survey about “social integration and psychological health” conducted in eight large Chinese cities: Guangzhou city, Zhongshan city, Zhengzhou city, Shenzhen city, Chengdu city, Jiaxing city, Qingdao city and Chaoyang district in Beijing city. The sub-survey not only measures the same basic information as the main questionnaire, but also includes questions about social participation and related questions about migrants’ social sense and integration. To increase the credibility of our study, individuals who responded with default values were excluded before conducting the empirical study, and the final dataset included 12,686 rural–urban migrant individuals and 2037 urban–urban migrant individuals, which were the basic data for further empirical analysis.The key independent variable in our study was the degree of migrants’ social integration, which is a crucial aspect of building an inclusive society and is closely related to migrants’ objective well-being. To quantitively measure this variable, we adapted two core indicators to represent social integration: “belonging” and “harmony”. First, belonging was used to describe the migrants’ sense of belonging to the city, which is an important aspect of social integration and has been used in many studies for the measurement of social integration . UsuallyIn our study, two indicators were used to measure the health status of migrants: physical and mental health. Self-rated health has been widely used to calculate individual physical health and is usually rated on a Likert scale. In our study, the quantitative description of physical health was consistent with previous studies. The question about self-rated health was “How would you rate your current state of overall physical health?” The respondents used a 5-point Likert scale, coded as “very poor”, “poor”, “fair”, “good” and “excellent”.Migrants’ mental health was measured based on a series of related questions surveying the migrants’ unhealthy emotions. According to Xu’s study, we used the same approach to record individuals’ mental health . The sixTo test the moderating effect of social participation in the empirical study, we built a social participation index that contained seven aspects. These aspects were measured by seven questions which focused on migrants’ social activities or organizations, including chambers of commerce, labor unions, voluntary associations, floating party branches, local party branches, fellow-student associations and townsmen associations. Social participation was treated as a dichotomous variable: “1” for participating and “0” for not participating, and the overall score was the sum of these seven items. A higher score represented a higher level of social participation. Additionally, we assumed that the social participation process was stable and persistent for migrant individuals during the period living in the host cities.To improve the accuracy of the model, our study also added series of related control variables in all regression models. Previous studies have provided guidance for control variable selection, which may affect migrants’ social integration ,79. In oΡ is the probability of migrants having a good social integration level. Z in Equation (2) is the linear combination of Ρ. n is the number of observations, b0 is the constant term and Equation (1) is the response probability. The regression was carried out using a maximum likelihood estimation (MLE). Additionally, city-fixed effects were controlled when running the regression models because the data were collected from eight cities.For the empirical research, we selected the binary logistic regression model according to our variables’ characteristics. Because the level of social integration was recorded as either “1”  or “0” (others), a traditional multiple linear regression was less suitable than the logistic model. The logistic model can reflect how ceteris paribus changes in the independent variables influence the independent variable, which was the degree of social integration in our research. The probability function of the logistic model is shown below:The characteristics of the variables we chose are shown in With respect to individual characteristics, there were more male migrants than female migrants, which indicates that males prefer to move to large cities for job opportunities and higher incomes in urban China. The mean income of the migrants was 3694 yuan; however, approximately 65% of migrants reported values below this level. Insurance participation can promote migrants’ social integration according to a previous study, but approximately 70% of the migrants did not have insurance, which is a serious issue for our society. Additionally, having no stable residence was another important feature for migrants reported by approximately 80% of all migrants. The average age of migrants was 32.66, with an average migration length of 4.22 years in host cities.The results of the basic regression model using logistic regression are shown in First, all effects of health status, including physical health and mental health, were statistically significant at the 1% level and positive on the representative social integration index (belonging and harmony), as expected. This indicates that migrants who have better physical and mental health are more likely to have a higher degree of social integration, including a higher sense of belonging and a harmonious relationship with others. Specifically, a one-point increase in physical and mental health will improve the odds of good social integration by 33.27% and 5.98% for belonging and 66.05% and 6.35% for harmony, respectively. Our findings show that physical health status plays a more important role than mental health status for migrants’ social integration, although both health statuses significantly impact migrants’ social integration. Additionally, a series of individual control variables, such as employment category, individual income and length of migration, were significantly related to the level of social integration. Migrants who have native neighborhoods, live in a stable home and participate in social insurance may have higher social integration levels. Intercity migration, which represents near-distance migration, may lead to a higher social integration level than migrations of greater distance, consistent with previous studies. The reason shorter migration distances result in higher social integration is that such migrations entail fewer challenges, such as differences in dialects and customs ,82. AddiThere are two groups of migrants in China: rural–urban migrants and urban–urban migrants. However, these two groups have many differences, and the biggest is that urban–urban migrants have an urban hukou and have lived in urban regions before. Rural–urban migrants have no urban hukou and have previously lived in rural regions, unlike urban migrants. Of the two groups, rural–urban migrants are in a more serious marginal position. It is of great significance to distinguish these two groups and analyze their heterogeneity in terms of health to enable more precise policies. For this purpose, we divided the 14,723 migrants into two groups, according to their hukou status. After separating the migrants, there were 12,686 rural–urban migrants and 2037 urban–urban migrants, which were added to our logistic model for further analysis. Before that, we compared their social integration levels using their mean values of the degree of social integration. The mean values of belonging for rural–urban and urban–urban migrants were 0.34 and 0.41, respectively, and the harmony values were 0.28 and 0.35, respectively. We found that both social integration indexes were obviously lower among rural–urban migrants than among urban–urban migrants because urban–urban migrants have lived and worked in urban regions before their current migration experiences, and they are more familiar with city environments. However, rural–urban migrants may face a new environment, which becomes a huge hurdle to integration.The results of the heterogeneity analysis are shown in There were also meaningful findings for other factors. For the two migrant groups, although the effect of health was stable and consistent, some variables revealed interesting changes that require more attention. For example, rural–urban migrants’ social integration was more sensitive to employment features, individual income, neighborhood features and housing conditions, which means that policies need to be designed for specific groups according to their needs for social integration.To test whether social participation moderated the effect of health status on social integration, a stepwise strategy was used. Several interaction items were added into the regression model to avoid multicollinearity. The results are shown in To test our research’s robustness, in this section, according to previous studies, we chose three common methods to do this. For example, replacing the key independent variable of the model was the most commonly used method. First, health status, including physical health and mental health, could be summarized by one indicator using the question “Do you agree that you are more likely to get sick than others”, with the possible answers of “Yes” and “No”. Therefore, we built another indicator to represent migrants’ health status, and this indicator was tightly associated with physical and mental health. We replaced the two health indicators in our study with the new indicator and ran the basic logistic regression model again; the regression results are shown in Second, apart from the logistic regression model, we adopted the OLS regression model, which can indicate robustness. Therefore, to utilize the OLS model, the independent variables were not divided into binary values, as in the logistic model. The social integration values, including the values for belonging and harmony, all ranged from 1–4 and 1–5, respectively, and the other key dependent variables and control variables were the same as those described above. The OLS regression results are also shown in Third, according to previous studies, dividing samples before running regression models is useful for completing the test. As far as we know, it is a natural law that young people are more likely to have better health than elderly people. However, in our dataset, the range of the migrants’ ages was 18–60, which is very large. Therefore, the health statuses of the participants might have differed sharply, and we divided the dataset based on migrant age. According to the World Health Organization (WHO), adults younger than 44 years of age are considered young, and those between 44 and 59 years of age are considered middle-aged. We ran the regression model on the two groups of migrants (dividing by 44 years old). The results of the regression are presented in Although some studies have attempted to identify the determinants of migrants’ social integration in cities, few studies have taken migrants’ health into consideration. Our study explored the impact of migrants’ health status on their social integration level. Based on classical theories and previous related studies, we proposed our hypothesis about the impact of health on social integration and utilized a large-scale migrant survey dataset to test our hypothesis. The main goal of our study was to provide insights into the determinants of migrants’ social integration level and facilitate the construction of an inclusive society.The results of this paper show that migrants’ health is a vital factor in their social integration in terms of both their sense of belonging to cities and their harmonious relationship with their surroundings. Our results provide empirical evidence on the effects of migrants’ health at the social integration level, which is a new pathway to improve migrants’ social integration that has not been widely investigated before. Our results are similar to those of some studies focusing on migrants’ intention to settle in cities, which indicated that better health status may lead to higher settlement intention and that settlement intention is impacted by many factors. Because social integration is associated with settlement intention, a low social integration level may influence migrants to return to their hometowns. If migrants are in poor health, on the one hand, it will impact their individual income and increase the cost of medicine or medical services; thus, low economic status or economic integration is an important aspect for migrants. On the other hand, poor health leads to less interaction with one’s surroundings, which decreases one’s social integration level. Therefore, when a migrant is in poor health and lacks high-quality public healthcare, he or she may easily feel a low degree of social integration.Moreover, our results indicate that migrants with better health, including physical and mental health, may have a higher social integration level and be jointly impacted by the two indicators. One of the most important findings of the current study is that the effect of health is equally important for rural–urban and urban–urban migrants. This finding highlights that health status plays a crucial role in the social integration of migrants of both types. This finding has a clear policy implication for facilitating migrants’ social integration level, which requires that the government solve the challenge of low social integration. Another important finding is that social participation can significantly moderate the effect of mental health on the social integration level and cannot moderate the effect of physical health. As indicated in previous studies, social discrimination was the main factor impacting migrants’ mental health and indirectly impacting migrants’ social integration ,56,68,69Our results have important theoretical implications for inner migrant research, because previous studies, when discussing the factors impacting social integration, have generally ignored migrants’ health issues. In this study, both physical and mental health were discussed to provide a comprehensive understanding, which has important implications not only for related research, but also for our government. Traditional theories usually consider health to be an important factor in migrants’ intentions to settle but ignore the effect on social integration level. This study emphasizes the effect of health on social integration and clarifies the mechanism of social participation in this process.Our findings have several policy implications for improving migrants’ social integration levels in the future. First, migrants are marginalized in cities, do not have a local hukou, face substantial health risks and have health vulnerabilities due to low-quality health services; thus, city governments should initially pay more attention to health services and improve the working and living environments of migrants. However, in some metropolises, the hukou system has been shown to be resistant to quick reform, and the government should implement creative policies for these migrants; for example, migrants with a rural hukou usually access medical services in rural areas, so the government can design an institution for them to transfer their rural medical insurance to urban medical insurance or a special insurance policy for migrants to cites. For living and working environments, the government needs to provide more affordable houses, especially for migrants. Additionally, to improve migrants’ physical and mental health, policymakers should take migrants’ physical and mental health care into consideration when discussing the pathway of inclusive urbanization in the future. The government should ensure related services, such as psychological counselling agencies, to monitor and treat migrants’ physical and mental issues. Second, social participation can play a positive role in the process by which health status impacts social integration; however, migrants, especially those with a poor economic status, may live in urban villages and have limited opportunities to participate in social activities and organizations. It is difficult for them to build social ties on their own. The government should help them join social organizations and activities. For example, in some settlements or communities with large-scale migration, the government or city administrators should enable migrants to join local activities or organizations and design activities to include migrants. Third, we found that migrants with children and undergoing short-distance migration can have a higher social integration level; however, in some metropolises, it is difficult for migrants’ children to obtain high-quality education without a high cost ,83. ConsBriefly, in previous studies, institutional barriers were widely discussed as a main factor impacting migrants’ social integration. This paper emphasizes the impact of health on social integration, which is more related to the individual level and should not be ignored when discussing migrants’ social integration. In the future, more migrants will move to cities for jobs and better lives, and the government should take actions to implement more targeted policies, not only protecting migrants’ physical and mental safety, but also ensuring inclusive urbanization.By utilizing the Chinese Migrant Dynamic Survey dataset and logistic regression model, this study investigated the association between health status, including physical and mental health, and the degree of social integration in Chinese metropolises, and it also explored the impact among rural–urban and urban–urban migrants, which has rarely been studied before. Our results indicate that both physical and mental health status are vital to migrants’ social integration level. The effect of health status is moderated by migrants’ social participation. Additionally, we also found that the impacts of both mental and physical health on social integration level are consistent, significant and positive among rural–urban and urban–urban migrants. Based on our results, we highlight the significance of health status, whether physical or mental health, which is vital for migrants to cities due to the high level of social integration. Therefore, we can conclude that improving migrants’ health status can significantly facilitate their social integration level and make them feel that they belong to society and better adapt to the living conditions of their new cities. Migrants, especially rural–urban migrants, usually face difficult working and living environments that lack sufficient health care and need the government to pay more attention to their health status and to implement countermeasures to solve these problems, such as upgrading the healthcare system for people who have no local hukou, breaking the hukou system in more cities and improving the health status monitoring institutions for migrants. Moreover, social participation has been proven to mediate the impact of mental health on social integration. Migrants are discriminated against in cities because of their marginalized positions, and participating in social activities and organizations can be hard for them. Therefore, local governments should implement more targeted policies to push migrants to join social activities and build tight social relationships to improve their degree of social integration. In brief, our study highlights the importance of health status on migrants’ social integration, which is a new pathway for addressing migrants’ social integration problems for a “people-centered” society. Meanwhile, we explored the mechanism by which health affects social integration and found that social participation plays a key role in this process for mental health.Although we explored the impact of health on migrants’ social integration and showed the importance of migrant health from a new perspective, there were also several limitations to this study. First, we used self-rated health status in our study rather than the objective indicators due to the difficulty of data acquisition, which may have biased the estimation of the migrants’ real health status. Second, this large-scale survey of more than 10,000 migrants focusing on social integration was conducted in 2014, so the findings may not be generalized to more recent migration events. However, in 2014, there was already a large number of migrants in Chinese cities, and the hukou system still exists in metropolises; thus, the study design can be feasibly applied in today or in the future if the hukou system is not eased in metropolises.


In this article, we report on action research in the Canadian province of Alberta, based on forging alliances with officers who enforce federal, provincial, and municipal legislation involving animals. Some of these officers worked in rural areas, and others worked in urban areas. Some mainly enforced Alberta’s Animal Protection Act, while a few specialized in enforcing Canada’s Criminal Code. For the most part, however, participating officers had a mandate to enforce animal-related local bylaws. Such ordinances or rulebooks exist because Alberta’s Municipal Government Act allows local councils to enact legislation regarding domestic and wild animals, particularly as regards people’s health, property, safety, and welfare. Many professionals refer to policies such as these, which are deeply rooted in the western legal tradition, such as “animal control.” Our findings illuminate how animal-control policies and personnel can help to protect domesticated animals, not just people. Even so, our research highlights that animal-control policies as well as animal-protection policies routinely fail to protect officers who enforce legislation involving animals. Furthermore, whenever officers who enforce legislation involving animals work in unsafe conditions, this endangers human as well as non-human lives.Across Canada and internationally, laws exist to protect animals and to stop them from becoming public nuisances and threats. The work of officers who enforce local bylaws protects both domestic animals and humans. Despite the importance of this work, research in this area is emergent, but growing. We conducted research with officers mandated to enforce legislation involving animals, with a focus on local bylaw enforcement in the province of Alberta, Canada, which includes the city of Calgary. Some experts regard Calgary as a “model city” for inter-agency collaboration. Based on partnerships with front-line officers, managers, and professional associations in a qualitative multiple-case study, this action-research project evolved towards advocacy for occupational health and safety. Participating officers spoke about the societal benefits of their work with pride, and they presented multiple examples to illustrate how local bylaw enforcement contributes to public safety and community wellbeing. Alarmingly, however, these officers consistently reported resource inadequacies, communication and information gaps, and a culture of normalized disrespect. These findings connect to the concept of “medico-legal borderlands,” which became central to this study. As this project unfolded, we seized upon opportunities to improve the officers’ working conditions, including the potential of relational coordination to promote the best practices. We prepared this article for a Special Issue devoted to the protection of animals, and our intention is to illuminate the contributions that can be made by officers who enforce “local laws” regarding animals. Local laws go by various names, including “bylaws” or “ordinances,” depending on the country and the languages spoken there . NotwithAdvocates for animals often hold diverging views on local laws regarding animals, and the scholarly literature reflects these differences. Perhaps the most contested element concerns the definition of animals as property in local laws, in keeping with western legal tradition . Local lBefore proceeding any further, however, we must draw attention to key insights from other scholars whose work helped us to develop this project. First, we subscribe to a broad understanding of legislation involving animals because we believe narrower definitions may, however inadvertently, undermine the interests of non-human beings. Following Huss (2009), we understand legislation involving animals to encompass all “legal issues that relate to or impact nonhuman animals”  ,Our project did not unfold as sequenced steps, but rather as a dynamic collaboration. Over a period of seven years, from 2012–2019, we worked with our research partners as a community of practice . Near thAction research is “…located in professional, cultural, and social contexts”  (p. 35).Purposive sampling allowed us to consider the variations among officers working in different geographical and legal jurisdictions across the continuum of law enforcement. In total, we recruited twenty participants. Of these, ten served partly or entirely as managers, and nine officers had been enforcing legislation involving animals for a decade or more. Their respective mandates included the enforcement of legislation involving animals at federal, provincial, and local levels. In addition, some had professional experience with law enforcement at other levels than represented by their current appointments. The first author took care to recruit both male and female officers, as well as officers who worked in cities and in towns dotting rural areas. Additional officer demographics were not collected, but this matter warrants further discussion. In the larger centres, some of the participating officers specialized in enforcing legislation involving animals. For most of the participants, however, local bylaw enforcement varied shift-by-shift and seasonally. For example, the officers who enforced local laws tended to field more complaints about dogs being aggressive or roaming without adequate supervision in the spring, summer, and fall than in the winter months.The participating officers were responsible for enforcing legislation involving animals in three cities and five towns. The smallest town had a population of 9386, while the largest city had 1,235,171 residents . The firDuring the period of intensive fieldwork, descriptive fieldnotes were composed as an initial level of analysis. To complement the field notes, analytic memos were composed throughout as a second level of analysis. Analytic memos enabled the team to “reflect on and interpret what [we had] experienced and observed” in the field  (p. 100)Our approach to the thematic analysis was iterative and reflexive ,34. The We aspired to a democratized process of research  (p. 257)During the ride-alongs and interviews, participating officers discussed the risks and rewards of law enforcement at length. Consistently, they said that law enforcement can contribute positively to community well-being and public safety, and they presented numerous examples drawn from their professional experience. This work included both officers who enforce local laws, and those whose mandate is exclusively to enforce animal-protection laws. The first author also witnessed the officers’ commitment to animals and people firsthand, during ride-alongs. This commitment positively impacts people, their pets, and more broadly, communities.Sadly, officers who investigate animal-related complaints often feel undervalued within the law enforcement hierarchy. One officer stated, “people want us doing this job, but they might not show the greatest respect for what ya do…I guess you’re not out catching a murderer…but you’re actually helping somebody.” As a counterbalance to feeling disrespected, officers felt valued when citizens provided positive feedback regarding the importance of their role in law enforcement. For example, Officer Laura worked hard to establish relationships in the community by using “positive tickets.” Positive tickets were coupons from local business for free goods, such as ice cream, chocolate, and coffee. They were handed out when community members were “caught in the act” by picking up their dogs’ waste, for example. Officer Laura explained that the use of positive tickets helped build a rapport with the community and enabled officers to interact with community members in a friendly way. Officer Laura remarked, “…you’re kind of like an ambassador for the town.” Officer Laura was one of seven participants who had previously worked as police officers. These officers brought a wealth of knowledge and experience to their work in enforcing provincial statutes and local laws, but they still experienced disrespect from the public and some law enforcement personnel. Feeling disrespected is not unique to law enforcement; tensions exist in interspecies and multispecies labour more generally ,37,38,39Recognition from citizens and police officers for their skills in handling aggressive dogs also meant a great deal. In an incident involving an aggressive dog, Officer Dylan, who had two sons of his own, calmed the children while also collecting information from the parents. After the case was closed, Officer Dylan mentioned obtaining feedback from the family, saying, “…it’s nice to get feedback from the kids’ parents who email into your bosses to say how good of a job you’d done, thank you for all the help, and then I just think it’s part and parcel of the job, you’re there to do a job, that is my job to be a public servant.” Officer Dylan, who had previously worked as a police officer, told another story about an aggressive dog. That dog was loose in a community, terrorizing the residents. The dog’s behavior was so concerning that numerous police units were called to respond and the police helicopter was deployed to track the dog’s movements. With his expertise in dog handling, Officer Dylan humanely secured the dog. Until that point, the police officers thought they might have to shoot the dog. This incident demonstrates how the officer was deployed to protect the safety of the community, but ended up saving a dog that would have otherwise been destroyed.Officer Daniel’s employer was an animal welfare charity that typically receives over 1300 calls per year about animal abuse and neglect, and the handful of peace officers on staff diligently work with police services so that family violence involving animals can be prosecuted efficiently and effectively. One day, the first author was riding with Officer Daniel when he was tasked with picking up a deceased cat from a veterinary clinic. The cat had died as a victim of family violence. Given that domestic animals, such as cats, qualify as property under the law, Officer Daniel would subsequently hand over the cat’s body to the police of jurisdiction to serve as evidence in legal proceedings. Officer Daniel remarked, “Sometimes the animals are like a canary in a coal mine for domestic violence, or mental health issues, or other organized crime, that sort of thing, right?” By effectively collaborating with the police of jurisdiction, Officer Daniel recognized and responded to the human–animal violence link and had worked hard to foster a relationship of collaboration across multiple agencies . This coThe animal welfare charity that employed Officer Daniel depends upon donations and grants to enforce Alberta’s Animal Protection Act. In principle, police officers can enforce this legislation, but in practice, peace officers employed by animal welfare charities have taken on most of the responsibility for enforcing the Animal Protection Act in Alberta . All enfThe officers and managers who made this study possible spoke about their work in law enforcement with pride, yet they repeatedly expressed concerns about the risks entailed by this type of work to their own mental health and physical safety. Several units report to local councils, and some council members underestimate the risks associated with enforcing local bylaws. Similar problems exist amongst administrators. For example, a supervisor reportedly told a participating manager, “The day dogs carry guns, you’ll get body armor.” Another municipal manager, in describing his struggle to secure protective vests for front-line officers, told the first author, “…one of the first things that I did as a sergeant is I worked with my coordinator and put a lot of pressure on management to get us ballistic armor. Um, and body armor really was one of the first protective tools that we finally got authorized.” Discussions with officers and managers about occupational health and safety were dominated by references to the themes of resource inadequacies, information gaps, poor patterns of communication, and a culture of normalized disrespect for them in the law enforcement hierarchy see .Below, to elaborate on these themes, we highlight two cases that received extensive media attention. Additionally, with reference to the ride-alongs and interviews conducted for this study, we show that these cases do not represent isolated incidents. All officers who enforce legislation involving animals, including local and animal-protection laws, face risks that are often not fully recognized.The death of an officer in August of 2012 profoundly impacted officers and managers involved in law enforcement, just as this study began. The officer’s name was Rodney Lazenby, and he died by strangulation while investigating a dog-barking noise complaint in rural Alberta, Canada.Prior to taking up an appointment to investigate and enforce local laws in rural Alberta, Officer Lazenby had served thirty-five years with the Royal Canadian Mounted Police (RCMP). As a seasoned law enforcement professional, Officer Lazenby’s death in the line of duty could not be chalked up to inexperience. At the time, the accused and his over 30 dogs were living in a trailer parked inside a quonset. Eventually the accused was found not criminally responsible on account of a mental disorder .In a recorded interview, one officer told the first author that Officer Lazenby’s death “…was a wake-up call for a lot of agencies, you know there’s so many peace officers working out there alone, working remotely, working without proper safety equipment.” Another officer’s employer had reportedly “…invested in some better communication equipment, so we now have the phones and the two-way radios, dispatch keeps a better eye on us at this point, we invested in some ballistic vests, so that we are personally more safe out in the field.” Officer Lazenby should have received mandatory officer training, access to two-way radio communication and intelligence sharing (including with dispatch), and worn standardized personal protective equipment. In addition, no officer should have attended the residence alone.Officer Lazenby’s death was subject to a fatality inquiry, which occurred in June 2017. Behind the scenes, the first author helped to ensure that officers were represented at the fatality inquiry, could participate impactfully, and received recognition for their expertise in media coverage. Towards the end of the fatality inquiry, the president of one of the professional associations for officers chose to read a summary of the main themes from this study into the official record see . These tThe fatality inquiry highlighted communication and information gaps between the local RCMP detachment and Officer Lazenby, even though Officer Lazenby had been a RCMP officer for much of his career. Officer Lazenby had investigated numerous complaints about the accused’s dogs and their barking, sometimes with RCMP officers in attendance  (p. 5). Judge Fraser presided over the fatality inquiry, and his report contained recommendations regarding occupational health and safety for peace officers: (1) that no officer should attend a place where there is a known threat or interact with a person known to be mentally unstable without police back-up; (2) that all employers should know the whereabouts of their field officers at all times through central dispatch; and (3) that officers over the age of 40 years should be given additional time to complete the physical aptitude test . SpecifiAlthough Fraser’s recommendations are sound, in principle, several barriers exist to their implementation. First and foremost, officers who enforce legislation involving animals at provincial or local levels only cannot access the Police Reporting and Occurrence System , so it is unlikely that they would be apprised of information pertaining to suspects’ mental health or any concerns about violence . Some auAlthough some variation exists, for the most part, officers investigate and enforce legislation involving animals “blindly,” without any information about a residence or the persons who reside there. Officer Lily disclosed that she will often conduct an initial screen over the phone to gauge if there are any overt signs of aggression or mental illness:“People who have been really abusive on the phone and threatening, or the complainant said, ‘Oh they’re drug dealers and the police are there all the time,’ that kind of thing. Cuz we’re not proxy to calls that the police have done, right? So we can go into a lot of places blind and not know what, if there’s any markers [concerns] on the address”.Managers, meanwhile, reported that “flying blind” was a systemic problem. One manager said, “All I want to know [from police] is my officer going to be threatened by this person? Is this guy known to have weapons or be aggressive towards your [police] officers?” This manager worried that front-line officers would unknowingly interact with a person prone to violence or with a deep hatred for law enforcement of any kind. Another officer confirmed this concern, saying “…probably the biggest challenge that we run into…[is] access to information to keep our officers safe.” A colleague of that manager told a story about attending a property in response to a dog complaint, only to later learn from the police of jurisdiction that the property was under surveillance for drug and gang activity.Inadequate information was especially problematic for officers who worked in smaller towns and rural areas. Officer Marianne, who must cover a large geographical area, often without radio or cell-phone coverage, told the first author that, in lieu of formal intelligence, she relies heavily upon her “spidey senses” to gauge the potential risk of a situation.As another example, consider the working conditions of Officer Renee, who works for a privately-run enforcement agency that provides animal-control services to over 12 towns and communities. Officer Renee always worked alone, so she felt vulnerable, especially as a single parent of two small children.During a ride-along, the first author accompanied Officer Renee on a drive out to a small town to deliver a ticket to a family residing in a mobile-home park. The complaint was that the family’s dogs were running at large and behaving aggressively towards neighbors. Officer Renee reported numerous interactions with this family, specifically for violations of the town’s animal-control legislation. In other words, this call was the latest of many complaints pertaining to the numerous dogs belonging to the family. Officer Renee described this family as “weird” and found communication to be a challenge. Members of the family had erected homemade no-trespassing signs explicitly warning people to stay off their property. The mobile-home itself was in disrepair and had materials stacked fully in the interior window wells, in a way reminiscent of hoarding as a mental disorder . The famOfficer Lazenby’s investigation into dog-barking complaints occurred under the label of nuisance, a catch-all category in municipal legislation, which purports to protect the public interest . NonetheIn addition, with more than 30 dogs in poor condition at the scene, animal hoarding seems likely to us in the Lazenby case. Hoarding disorder has recently gained recognition as a distinct disorder, and interventions into animal hoarding are amongst the most difficult and dangerous cases . The notTwo years after the death of Officer Lazenby, in August 2014, three officers were threatened—verbally and physically—while investigating an animal hoarding case in Calgary, Alberta. At the time, the officers were inside the residence of Anthony and Christine Berry, a couple known to breed and show rabbits. The officers were acting on a tip from a concerned citizen, which had been lodged with the Calgary Humane Society, alleging animal abuse and neglect. One of the three officers was with the Calgary Police Service, while two were peace officers employed by the Calgary Humane Society. In addition, officers with the City of Calgary’s unit for animal services and bylaw enforcement were at the scene to assist with removing the animals inside the suspects’ home. Hence, animal-control officers could provide back-up support for the officers inside the home. This case provides an interesting exemplar for inter-agency coordination and collaboration.Once the officers entered and began to uncover abject conditions of the rabbits and other animals in the home, Mr. Berry became agitated. He became verbally abusive with the officers, and then physically aggressive. The officers attempted to de-escalate the situation, but in vain. Rather, Mr. Berry produced an eight-inch rusted kitchen knife. Mr. Berry then stabbed the knife into the wall. Next, he grabbed an empty bottle, broke the bottle, and then stabbed himself in the neck. Meanwhile, Mr. Berry begged the police officer to shoot him .Both Anthony and Christine Berry were later convicted under Alberta’s Animal Protection Act for causing their animals to suffer. In addition, Mr. Berry pleaded guilty to an assault charge under the Criminal Code. In conjunction with these proceedings, a forensic assessment of Mr. Berry’s mental state took place . To the Notwithstanding the abuse and distress entailed in the Berry case, the investigation qualifies as a “near miss,” especially in comparison with the Lazenby case and inquiry . The “moThe enforcement of federal, provincial, and municipal legislation involving animals takes place in a medico-legal borderland  for seveMeasures to safeguard officers’ health and safety are crucial to maximizing their potential in the medico-legal borderland of law enforcement. For officers, “the threat of physical harm is the most dramatic threat” that they face  (p. 32).Throughout this project, we explored ways in which Relational Coordination (RC) can help ameliorate some of the challenges experienced by officers who enforce legislation involving animals. RC plays a critical role in managing interdependence between people who perform tasks where high output, efficient collaboration predicated on respect, and safety are required . In sum,There are promising initiatives from around the world that conform to the propositions found in relational coordination theory. This paper explores two such programs to highlight the potential that exists in the field of law enforcement within the Canadian context. Specifically, Humane Canada have two initiatives that address one or more of the themes addressed in this paper relating to inadequate resources, intelligence, and a culture of normalized disrespect. First, the National Centre for the Prosecution of Animal Cruelty (NCPAC) “...is a community of Crown Prosecutors and allied professionals from across Canada who are working together in the service of the public interest to ensure that crimes against animals are prosecuted effectively and efficiently” . The NCPRelated to this initiative, and also facilitated by Humane Canada, is the Canadian Violence Link Coalition . The CoaIn order for collaborative practices to become normative, we have articulated the importance of recognizing and respecting the work of officers both in public health and across the law enforcement continuum. We believe positive and encouraging changes are happening that will improve the working conditions and recognition of officers across the spectrum of law enforcement.Throughout this project, we sought to close the “knowledge to action gaps” that often persist, despite the best efforts of academics and practitioners  (p. 97).Overall, we sought to promote respect for the work entailed by local law enforcement. Yet, despite the legal requirements to protect workers, numerous agencies have yet to assess workplace hazards or to adopt appropriate procedures for local bylaw enforcement. Similar problems have been documented for officers employed by animal welfare organizations in Nova Scotia  and OntaIn this study, we explored the many risks and rewards involved in the enforcement of legislation involving animals, including both animal-control and animal-protection work. Whenever animal law enforcement is marginalized and poorly resourced and coordinated, vulnerability heightens for all concerned, including the officers and the animals themselves. These impacts ripple further into communities and neighborhoods.The death of Officer Lazenby in the line of duty tragically taught us that when the working conditions for officers are unsafe, it endangers human and non-human lives. Although the Lazenby investigation originated as a barking complaint, it could have been any number of agencies that attended that residence. Because of the complex nature of officers’ work across the medico-legal borderland, increased communication and coordination within and between agencies is recommended to improve the desired outcomes for each organization.The “near miss” story involving the Berrys examined the potential and power of inter-agency collaboration and cross-sectoral cooperation. The agencies involved in this case shared goals, knowledge, and, importantly, mutual respect. This reciprocity helped to facilitate timely communication, which likely prevented a more serious violent encounter. Since the Berry case, the agencies involved have formalized their partnership, serving as an exemplar for other jurisdictions looking to effectively coordinate.Measures to safeguard officers’ health and safety are crucial to maximizing their potential in the medico-legal borderland of law enforcement and animal protection. We hope that this article will help to spur action on occupational health and safety in law enforcement, at all levels of government as well as in the charitable sector, throughout Canada and in other countries.


Overweight and obesity among college students have become an emergent public health concern, which may be effectively prevented by diet self-management (DSM). The purpose of this explorative study was to explore college students' experiences and perspectives on diet self-management (DSM), as well as its influencing factors.Thirty-three college students were recruited from different universities in China. A qualitative method was used to conduct semi-structured interviews with audio recording to explore their DSM experience and factors that influence DSM. Data were analyzed using thematic analysis to develop themes related to DSM.In the perception of what "good DSM" means, three themes and ten subthemes were identified: characteristics of good DSM , method of good DSM , and content of good DSM (including two subthemes: nutrition management and safety management). The influencing factors of DSM can be categorized into four levels of themes and 34 subthemes: individual, family, school, and social levels.The results of this qualitative research highlighted the complexity and multi-dimension of DSM and its influencing factors. Our findings may help to inform diverse and needs-based intervention approaches to improve DSM and promote healthy diet among college students so as to prevent overweight and obesity. The World Health Organization (WHO) defines overweight as BMI≥25 and obesity as BMI ≥30 , which is defined as a person's weight in kilograms divided by the square of a person's height in meters  refers to an individual's control of his or her eating behavior particularly to pursue a specific objective such as weight loss. It is a will to change one's unhealthy eating behaviors into a healthy diet and supports one's ambition, seriousness, and reliability . DSM repThe protective role of DSM in preventing overweight and obesity may be explained by Ajzen's Theory of Planned Behavior . AccordiAlthough previous studies have shown the essential role DSM plays in informing healthy eating behaviors and preventing overweight and obesity among college students –38, theyGiven the study aims, a qualitative descriptive research methodology was chosen to obtain a detailed understanding of college students' views of DSM. Qualitative semi-structured interviews were conducted one-on-one with college students. An interview guide with open-ended questions and probes was developed based on a review of the literature, and the interview guide was pilot-tested in a group of six college students. Based on the results from the pilot interviews, some minor modifications were made to better set up the interview. The final interview guide was divided into two themes: what “good DSM” means and what factors affected their DSM. Each interview began with opening questions about DSM in general, followed by more specific questions from the two themes in order to probe the participants for more information. For example, an opening question would be “Do you know anything about DSM?” and a more probing question would be “Can you list some examples of good DSM?” According to the different answers made by the participants, we further construct different follow-up questions during the interviews. The interview guide is shown in Inclusion criteria were college students residing in China, exclusion criteria were first-year college students because of their “limited” experience as college students. Purposive sampling was used to obtain a diverse sample of college students with maximum variation in key demographic factors in order to get as rich and diverse information as possible. Students from 5 different regions , 26 different universities , 31 different majors , and in 3 different school years (2–4 years) were recruited to ensure heterogeneity. The lead researcher (L.Z.) confirmed the eligibility and scheduled an interview. Before every interview, written consent and permission for audio recording were obtained from each participant. Each participant was reimbursed with a Chinese Renminbi of 30 Yuan as compensation for their time and participation. We recruited a final sample size of 33 college students for data saturation, which means no new findings or themes occurred from an analysis of newly collected data .The semi-structured interviews were conducted online using Tencent QQ/WeChat by two researchers (L.Z. and Y.C.) who had experience in conducting qualitative interviews and did not have a relationship with the interviewees. Interviews were audiotaped with the permission of the participants and transcribed. Transcripts were translated into English and back-translated into Chinese for accuracy. The English-translated versions were then used for data analysis. All transcripts were not returned to participants for comment. Interviews ranged from 46 to 66 min with an average duration of 55 min.Data were managed using NVivo Version 12. Thematic analysis  was usedn = 33) consisted of 13 male and 20 female students with a mean age of 20.9 (range: 19–23 years). Participants varied in major, school, and college years. In terms of the degree of DSM, most reported poor or no management at all (69.7%), and most expressed their worry about the effects of an unhealthy diet on health (75.7%).Thirty-five college students from different universities in China expressed their interest in the study and were recruited. Two withdrew due to time constraints. The characteristics of students who participated in the interview were displayed in In the perception of what “good diet self-management” means, three themes and ten subthemes were identified : charactIn my opinion, the best DSM was to eat on time. For example, breakfast should be eaten before 9 am. Breakfast and lunch should not be eaten at the same time, and eating after 11 pm should be reduced.” (S22).A key element of good DSM that was mentioned most frequently by participants was regularity, which included regularity in time and quantity. Participants believed good DSM means you need to intake an appropriate quantity of food at a fixed time every day to keep your body healthy. “Good diet management means that we should pay attention to the combination of meat and vegetables, the daily diet should include cereals, vegetables and fruits, beans, livestock, and poultry, etc.” (S15).Another characteristic of good DSM that was also mentioned frequently by participants was a balanced diet. According to the participants, a balanced diet means you need to intake a variety of healthy foods from different food groups to guarantee balanced nutrition. “In addition, participants also reported, “no picky eating”, “good eating habits”, and “scientificity” as the other three equally important characteristics of good DSM. They believed people with good DSM should not have preference over certain kinds of food and avoid other kinds of food. They should have a healthy lifestyle with good diet habits. They also highlighted the importance of following scientific guidance for food intake.Having some self-control over overeating, very sweet or spicy food.” (S11).One major method of good DSM that has been most frequently mentioned was self-control. According to the participants, self-control is the ability to resist the temptation of unhealthy food such as those with high fat and high sugar but no nutrition. “In my opinion, good DSM is based on one's body weight. If someone is slightly overweight, he/she will reasonably control his/her diet so as to achieve a normal weight and vice versa.” (S27).Another way of good DSM was to adjust the diet according to physical or weather conditions, which was also frequently mentioned by the participants. “Good diet management requires a clear plan and a list of food that is right for you.” (S26).In addition, making plans has also been mentioned as a good DSM. One student explained that a good way of DSM should involve making a clear plan and choosing the correct food. “A good dietary self-manager will strictly control nutrients intake at a healthy level that is neither exceeding nor falling short.” (S14). “Good dietary management requires us to understand the nutritional content of different foods and pay attention to reasonable nutritional collocation.” (S25). In addition, participants also emphasized the importance of managing the nutrition of three meals a day. Specifically, one should not only have three meals a day but also have a different focus on the nutrition of each meal. “Follow the principle of having a good breakfast, a full lunch, and a light dinner.” (S18).A major content of good DSM that has been most frequently mentioned by the participants was nutrition management. According to the participants, good DSM means strict control of food to ensure an appropriate level of nutrition. “Good DSM is to eat less high-cholesterol and non-fresh food, eat less high oil and sugar food.” (S6).Safety management was also identified as an important content of good DSM. Participants believed people with good DSM should avoid unhealthy food that will harm their health. “When asked about what factors may affect their DSM, students listed a wide variety of influencing factors, which can be generally categorized into four levels of themes: individual, family, school, and social levels. Under each level, there are multiple subthemes, adding up to a total of 34 subthemes .n = 32), personal preferences (n = 12), self-management awareness (n = 10), self-discipline (n = 10), emotion (n = 8), physical condition (n = 7), laziness (n = 4), weight management (n = 4), dietary habit (n = 4), economic factors (n = 3), thinking that young people's bodies are less prone to illness (n = 2), lack of interest (n = 1), and low dietary requirement (n = 1).Individual-level factors included 13 sub-themes: knowledge of DSM .Most participants mentioned the knowledge of DSM as an important influencing factor, with several participants reporting that their knowledge of DSM was limited, not thorough, or not comprehensive. “I had no self-discipline and chose food according to my personal preference, so it was difficult for me to manage my diet.” (S13).Participants expressed that personal food preferences also greatly influenced their DSM. They couldn't control their preferences, so they made food choices primarily based on preferences. “Self-management awareness was very important in the face of all kinds of delicious food.” (S8).Self-management awareness was another frequently mentioned factor that affected how well they managed their diet. Participants believed that good self-management awareness could help them make healthy choices or improve their diet. “I didn't have enough self-control; people could not always operate in an established process like a machine. Today, I had my period, but I just wanted to eat sweet, icy, and spicy food, although they should be avoided, I wanted it so I ate it.” (S25).Participants also reported good self-discipline as an important influencing factor of DSM. Good self-discipline means that you should have full control over the quantity, structure, and regularity of the food you intake, which affects how well you manage your diet. However, some participants expressed difficulty in maintaining good self-discipline. “If I had a bad day, I didn't spend too much time on diet management and ate more casually.” (S15).Participants frequently reported that mood affected whether they would eat and how much they would eat. When they were under stress, they were more likely to engage in unhealthy eating behaviors to cope with stress, which affected their DSM. “If my body was not feeling well or weak, it would definitely affect my diet. I would eat less or even skip meals.” (S1).Participants revealed that physical condition was also an important factor that may affect their DSM. According to the participants, their health condition can affect their self-regulation of eating, either positively or negatively. “It was hard for me to manage my diet because I was lazy”. (S30). They also reported that concern about body weight made them neglect diet management. “When I wanted to lose weight after overeating, I would choose to eat less, or even eat nothing, and pay special attention to the calories of food, so that I would forget the nutrition and the regular diet would be disrupted.” (S18). When participants stick to certain eating patterns for a long time, it will become difficult to change that pattern even though they knew it was not good. “My eating habits predisposed me to certain foods and increased my cravings for those foods.” (S24). Economic factors also affected what and how much participants ate. “If my parents gave me enough money for living expenses, I would eat whatever I wanted, order a variety of meals with better structure and nutrition.” (S8).In addition, some participants cited “laziness”, “weight management”, “dietary habits”, and “economic factors” as important influencing factors for DSM that may restrict their ability for diet management. Students reported that when they are lazy they could not manage their diet well. “Other less frequently mentioned but equally important factors that may affect DSM included belief in illness resistance, lack of interest, and low dietary requirements. Two participants reported that young people's bodies were less prone to illness, so there was no need to manage diet and they delayed healthy choices until experiencing negative consequences. Some students viewed healthy eating as something that could be postponed. One participant reported a lack of interest in diet management as a reason for not managing it. Another participant reported low dietary requirements as a reason for not managing his diet.n = 9), family eating habits (n = 8), parents being in charge of family diet (n = 6), special dietary needs of sick family members (n = 4), family diet knowledge (n = 3), parents' demands to eat more (n = 1), and economic level of the family (n = 1).Family-level factors included 7 sub-themes: family supervision, reminder and education . Participants with loose family supervision on eating habits were likely to have poor management of their diet. “They always told me to pay attention to the quantity and quality of diet, but they just told me orally without putting pressure, so I didn't pay much attention to diet management.” (S25).Family supervision, reminder, and education has been frequently reported as an important factor affecting DSM. Participants reported that family members' monitoring and suggestion of food intake would affect how well they manage their diet, and their home environment affected their eating behaviors. “Influenced by my mother, I usually paid attention to food collocation and balancing meat and vegetables. I would specially prepare vegetarian and meals, usually eat a little fruit after dinner.” (S26). However, participants also complained about the difficulty in satisfying the diverse diet needs of various family members, especially for a big family, making it hard to maintain good DSM. “When there were a large number of family members, it was difficult to fit one diet style to all family members. Family members vary in their perception and preference of diet, which may lead to variance in their actual diet management and thus cannot guarantee reasonable diet collocation.” (S2).Family eating habits were also frequently mentioned by participants as affecting their DSM. In most families, moms are responsible for preparing meals and thus have a major impact on children's eating habits. “The food was prepared by my parents, if there would be meals I didn't want to eat, diet nutrition would definitely be affected.” (S15).Participants emphasized the important role parents played in forming their eating habits when they were in charge of the family diet. For most families, parents were responsible for preparing food and cooking meals, which would affect participants' diet management. “For example, my father's blood sugar was 6 points higher than the normal level, so he had to control his diet every day. Therefore, the meals made at home were targeted at diabetic patients, which affected my diet management.” (S12).Participants revealed that the special dietary needs of sick family members may also affect their DSM. “In addition, family diet knowledge, parents' demands to eat more, and family economic level may also have an impact on participants' DSM. Participants from rural areas mentioned the lack of health literacy in their families led to their poor diet management. One participant complained about the pressure of eating more from his mom, which affected his DSM. Another participant emphasized the importance of family income in determining their diet management.n = 9), busy study (n = 6), school schedule (n = 6), the taste of the food prepared by the canteen (n = 5), peer influence (n = 4), provision of a set meal (n = 2), time spent waiting in line (n = 2), meal service hours in the canteen (n = 1), and price (n = 1).School-level factors included 9 sub-themes: the variety of meals in the canteen . Participants also complained of limited food choices due to the lack of food diversity in the school canteen, which affected their DSM. “School would affect my DSM because the food in school was not diverse enough, which limited my choice of food”. (S31).The variety of meals in the canteen has been frequently cited as an important factor that influenced participants' DSM. Students may adapt their diet habits according to food types in the school canteen. “Because I was busy with my studies and had not enough time to eat, I would not pay attention to balancing diet but only focus on the speed of eating.” (S15).The busy study has also been frequently mentioned as an important influencing factor of DSM. College students are constantly challenged by academic responsibilities and may prioritize study over healthy food choices. Participants reported that a busy study would disturb their DSM, they only paid attention to the speed of eating without considering a healthy diet. “School had regular hours, so my meals were regular too.” (S26).Participants stressed the importance of school schedules in affecting DSM. According to the participants, a regular school schedule means you have to come to classes at a fixed time and have meals before and after classes, which makes them stick to regular diet habits. “When there were many things that tasted bad in the canteen, I would choose take-out food.” (S23).Participants reported that the taste of the food prepared by the canteen would affect their choices, such as whether to eat in the canteen or what to eat. Participants were more likely to eat take-out food that was usually high in calories when they were not satisfied with the taste of food from school, which may lead to poor DSM. “My roommates could supervise each other, so each can form a good DSM.” (S28).Peer influence was also an important factor that couldn't be ignored, such as modeling behavior, encouragement, and peer support. Peers' good eating habits may help participants form good DSM, while bad eating habits of peers may lead to poor diet management of the participants. “Sometimes the canteen on campus was so crowded that I didn't care too much about what I ate, as long as it was convenient.” (S19). One participant reported that meal service hours in the canteen would make them more willing to eat in the canteen. Another participant reported that the reasonableness of the price will affect DSM.In addition, participants mentioned their DSM was also affected by “provision of a set meal”, “waiting in line”, “service hours in the canteen”, and “price”. Participants expressed a high willness to have a set menu, which will facilitate better DSM. Participants also complained of the crowded waiting line at the school canteen made them prioritize convenience over health and led to poor diet management. When there was a long waiting line in the school canteen, participants may focus only on convenience and speed in order to save time. “n = 12), food advertising (n = 11), social occasions and festivals (n = 7), food-related news reports (n = 2), and price of food (n = 1).Social-level factors included 5 sub-themes: food culture and customs . In addition, food culture varies according to various regions, and people from certain regions may have some special diet habits and preferences for food, which may affect their DSM. “In Guizhou, there was a custom of eating preserved meat and sausage in winter, but this kind of food was pickled, it was not very good for health, but I also ate it, so it had a great influence on me.” (S27).Participants reported that food culture and customs would affect DSM. Culture has long been recognized as a key factor that profoundly affected people's dietary decisions. “If an advertisement for a food continued to appear, my acceptance of that food would increase.” (S18).Food advertising was also frequently mentioned as an important influencing factor that would affect DSM. Food advertisements, due to their repeated appearance and good visual effects, would arouse their curiosity and increase their acceptance of the food. “Partying completely disrupted my eating habits and sometimes I may drink.” (S17).Participants reported that their DSM may also be affected by social occasions and festivals and mostly in a negative way. When family and friends get together, they are more likely to engage in overeating and overdrinking behaviors, which may disrupt their usual normal diet management plan such that regularity, safety, and quantity would be ignored. “When some news about some food safety investigation was disclosed, I would not choose it, I would choose the food with good evaluation.” (S24). One participant reported that the price of food would affect DSM.In addition, food-related news reports and prices would also affect participants' DSM and choice of food. Disclosure of food problems may lead to participants' avoidance of certain food and change in their dietary choices. “The purpose of this explorative study was to understand the perception of DSM and what constitutes good DSM among college students in China. Furthermore, we aimed to identify influencing factors that may affect college students' DSM. In the perception of what “good DSM” means, three themes and ten subthemes were identified: characteristics of good DSM , method of good DSM , and content of good DSM (including 2 subthemes: nutrition management and safety management). When asked about the influencing factors of DSM, participants identified a wide range of various factors that may affect DSM, which can be categorized into four levels: individual level , family level , school level , and social level  Our findings provide comprehensive and in-depth information on college students' perception of DSM and help us better understand their knowledge, attitudes, and behaviors regarding diet. In addition, we identified multiple influencing factors of DSM across the individual, family, school, and social levels. Our results provide important guidance for future intervention programs to improve college students' DSM by taking comprehensive and targeted measures. Improvement of DSM will help college students to engage in and sustain healthy eating behaviors, which will eventually help them to prevent overweight and obesity.In terms of what is good DSM, participants were able to identify various elements of good DSM that cover the characteristics, method, and content of DSM. In a word, good diet management requires individuals to use a variety of effective management methods, to pay attention to the management of nutrition and safety. In addition, good DSM has unique characteristics that distinguish itself from bad management, which will help us understand the concept better and provide guidance to implement good DSM. DSM is a complex concept that involves multiple aspects, and our findings showed that college students had some understanding of the multidimensionality of good DSM. A core element underlying the conceptualization of DSM is self-efficacy, defined as an individual's belief in his or her ability to execute behaviors necessary to produce positive health outcomes . Self-efAs for the influencing factors of DSM, four levels of themes have been identified, including individual, family, school, and social factors. These findings align with Bandura's Social Cognitive Theory (SCT), the most widely used model to explain health-related motivations and behaviors . SCT proIndividual level factors included a wide range of personal factors such as knowledge, awareness, preferences, self-discipline, etc., which were consistent with previous studies. For instance, in Deliens et al.'s  qualitatFamily level factors included several factors such as knowledge, supervision, reminder, special needs, and economy. These findings suggest that family also plays an essential role in helping college students to form good DSM and are in line with the Individual and Family Self-Management Theory (IFSMT) . AccordiSchool-level factors such as meals provided by the school canteen, school schedules, and peer pressure also affected college students' DSM, which was consistent with previous studies , 62, 63.Similar to previous studies , 66, ourThere are several strengths to this study. First, this is the first study to explore and report on college students' DSM in China, which fills in the research gap and provides valuable insights into this topic to inform the development of intervention strategy. Second, the qualitative methodology allowed for the generation of in-depth and rich data to gain a deep and thorough understanding of college students' experiences and perspectives on DSM. Some limitations of this study should also be noted. First, actual diet behaviors were not assessed in this study, we cannot link college students' eating behaviors to their perceptions of good DSM, which warrants further research to establish such associations in the future. Second, selection bias may exist since the sample was recruited from certain universities and participants joined the study voluntarily. The findings from this sample may not represent the experiences and perspectives of other students not sampled in this study. Third, all interviews were conducted online instead of face-to-face, which may affect the quality of data collection due to the lack of efficient real-person interaction.This study provides important insights into the perceptions of college students' DSM and the influencing factors of their DSM. Our results showed that college students were able to identify various characteristics, methods, and contents of good DSM, indicating their basic understanding of the complex and multi-dimensional concept of DSM. In addition, college students' DSM was shaped by the interaction of multiple factors that covered individual, family, school, and social levels, suggesting that multi-level, diverse, and comprehensive intervention approaches are needed to improve DSM among college students. Results from this study identify potential areas of intervention, such as improving students' self-regulation and self-discipline skills , promoting family members' role model behaviors (family level), extending school canteens' opening hours (school level), and limiting advertisement for unhealthy diets . Future research is warranted to identify the most cost-effective line of interventions to improve DSM among college students.The original contributions presented in the study are included in the article/The studies involving human participants were reviewed and approved by Zunyi Medical University Medical Ethics Committee. The patients/participants provided their written informed consent to participate in this study.LZ obtained funding and designed and led the implementation of the study. LZ and YC wrote the first draft, analyzed the data, and conducted the interviews. LZ, YC, and LW developed the interview guides. LZ, YC, LW, and JW contributed to interpretation of the results. LZ, YC, JW, and XZ revised the manuscript. All authors have read and agreed to the published version of the manuscript.