In the medical humanitarian context, the challenging task of collecting health information from people on the move constitutes a key element to identifying critical health care needs and gaps. Médecins Sans Frontières (MSF), during its long history of working with migrants, refugees and mobile populations in different contexts, has acknowledged how crucial it is to generate detailed context-related data on migrant and refugee populations in order to adapt the response interventions to their needs and circumstances. In 2019, the Brazilian Medical Unit/MSF developed the Migration History Tool (MHT), an application based on the life history method which was created in close dialogue with field teams in order to respond to information needs emerging from medical operations in mobile populations. The tool was piloted in two different contexts: firstly, among mobile populations transiting and living in Beitbridge and Musina, at the Zimbabwe-South Africa border; and, secondly, among Venezuelan migrants and refugees in Colombia. This article describes the implementation of this innovative method for collecting quantitative retrospective data on mobility and health in the context of two humanitarian interventions. The results have proven the flexibility of the methodology, which generated detailed information on mobility trajectories and on the temporalities of migration in two different contexts. It also revealed how health outcomes are not only associated with the spatial dimensions of movement, but also with the temporalities of mobility trajectories. Economic instability, conflict, political, religious and gender-based persecution, environmental change, humanitarian crisis and the ultimate search for work and better living conditions are all reasons, among many others, that compel people to leave their homes, thus shaping mobility dynamics in the world . With anMigrant and refugees’ health outcomes tend to be negatively influenced by bureaucratic, economic and linguistic barriers to healthcare access; poor living and working conditions; and weak social support networks. Inequalities in the access to health services tend to become more acute over the course of migration processes, as migrants face discrimination and lack of information and are particularly vulnerable to infectious diseases and events of violence. Although the ‘healthy immigrant effect’ is well established in today’s global health literature, research has shown how immigrants’ health advantages tend to be gradually lost as mobile populations endure multiple forms of exclusion in host societies . It is aAlthough most prior research has focused on the health needs of migrants in destination countries, it is also important to discuss access to care in transit sites. As the result of border externalisation processes and lengthy asylum procedures, scholars have been calling attention to the growing complexity of migration trajectories. The different types of procedural hindrances created by destination countries to curb permanent settlement have generated at least two parallel processes: growing ranks of people who undertake long and dangerous journeys to seek asylum in high-income countries; and a large contingent of persons who must wait for unpredictable lengths of time in camps, or informal shelters, before having their claims judged or being resettled in a third country . People It is vital to acknowledge the particularities of cross-border mobility in terms of healthcare. This includes the pendular, seasonal and circular movement of people across national frontiers that do not necessarily fall within the category of migration. Cross-border mobility is often motivated by the search for healthcare (patient mobility), although it can also encompass traditional circulation patterns across neighbouring countries. These types of movement are particularly relevant in Africa and Latin America, where national boundaries have divided territories occupied by the same ethnic group. Although cross-border mobility is often a constitutive part of these societies, it also often poses unique challenges to states in terms of surveillance, planning and organisation of healthcare services .As a medical-humanitarian organisation working with mobile populations in different contexts, Médecins Sans Frontières (MSF) relies heavily on the available health data to design evidence-based interventions, yet detailed information on mobility trajectories and access to health care are not always readily available, particularly in low and middle-income countries ,10. To dTo circumvent the limitations of traditional questionnaires, in 2019, the Brazilian Medical Unit/MSF piloted the Migration History Tool (MHT), an application based on the Life History Calendar method, which was tailored to MSF projects focused on mobile populations and their specific information needs. This paper aims to describe how the method and software have been implemented in two different settings and how it has contributed to the design of evidence-based medical humanitarian interventions.The MHT was based on the Life History Calendar methodology (LHC), the primary purpose of which is to gather high-quality, detailed biographic information. Traditionally, migration histories in quantitative research are usually collected through one or two simple questions, such as: ‘Where did you live in 2006?’ and “Where did you live before being in your current place of residence?’. However, in using these questions alone, researchers would miss all the mobility steps that occurred between the chosen date threshold and the last place of residence, as well as what happened prior to that date. When dealing with highly mobile populations, this could represent a significant loss of information.While looking for a quantitative methodology ‘as flexible as migration itself’, the literature review process led researchers towards the Life History Calendar (LHC) methodology. The LHC aims to gather information on an individual’s previous places of residence in a visually optimised table format. In the model proposed by Carling in 2012 , the LHC1The software was created with the sponsorship of MSF’s Transformational Investment Capacity.Whilst the LHC methodology can be readily used to generate and analyse biographical narratives of mobility from a micro-scalar, qualitative perspective, the use of this method in a quantitative fashion stumbles upon the challenge of collecting and processing data on the detailed migration trajectories of hundreds or even thousands of people. Based on the main aspects of the LHC, the MSF team therefore created a new quantitative data collection tool structured around the collection of time and location data, which could be linked with health information. As it has been named, the Migration History Tool, aimed to generate information on three dimensions of a person’s history: their lifetime migration experiences, the most recent migration experience (focused on migration routes), and plans and destination. The questionnaire corresponds then to a series of subordinate tables used according to each participant’s migration and life experiences. Following an assessment of the available survey applications that could be used to design the questionnaire, the team decided to develop a unique software, which could be specifically tailored to the LHC methodology. The questionnaires inserted into the program comprised several modules on health issues, such as sexual and reproductive health, chronic conditions, infectious diseases, exposure to violence, and mental health. These modules are linked to the person’s past migratory experiences, current migratory experiences and future plans. The surveyed individuals were asked to report all the places where they had lived for more than three months  and, in some cases, all the places they had passed through in the most recent international journey (Current Migration). This data was inputted into a table, allowing researchers to capture not only people’s places of first and last residence, but the internal migration processes preceding their international migration, as well as return and remigration patterns. All migration-specific questions comprised a georeferenced component, which automatically pinpointed places on a map and generated specific geographic coordinates that could later be analysed in the form of maps or geostatistical models.One of the main advantages of the software developed by MSF in relation to other applications or paper-based alternatives is that the grid format allows researchers to add questions related to each of the columns, which, in turn, could be linked to a specific place of residence or point of transit. So, for example, when reporting where they lived in 2007, participants were asked who they lived with and why they had moved to that specific place. For each subsequent place reported, the same questions were asked so that the instrument was standardised across all interviews. Unlike paper-based alternatives, the program allowed interviewers to add an unlimited number of columns, depending on each person’s history. Given the amount of data generated through this method, the grid-type questions tended to be short and focused solely on capturing participants’ mobility trajectories. The interview was then coupled with traditional multiple-choice or open-ended questions. Often, traditional questions were followed by date questions, which, in the analysis phase, enabled researchers to link specific health events to the data gathered through the grid format.Notably, the grid questions could be tailored in accordance with the population studied. If this is a highly mobile population, it is not always necessary to know all the places the participants had lived in since birth, and date thresholds could be defined by researchers in the study design stage. Similarly, the criteria for the inclusion of places can also be defined in relation to the study’s objectives. For example, when studying migrants, the Global Migration module was generally focused on the places where the person had lived for at least three months. In contrast, for mobile populations who were not necessarily migrants, the calendar format could focus on which places a person had been in the past month (or in any chosen timeframe), and the approximate date when they had travelled to the destination. The Current Migration module followed a similar logic, and it was generally centred on the sites the migrant had passed through since the beginning of their journey. Additional features of the software include audio pre-recorded questions for gathering sensitive information.The tool was developed in close dialogue with field teams, to ensure that it responded to the information needs emerging from operations. Once the software application was finalised, the tool was piloted in two different contexts. The first setting chosen to conduct a mobility survey using the MHT was a project spanning Zimbabwe and South Africa, which focused on providing primary healthcare to mobile populations in transit, or who had recently arrived in Beitbridge and Musina, border cities in the Limpopo region. In sequence, a second survey using the same methodology was conducted in Colombia focused on Venezuelan migrants and refugees. The rationale behind the choice of such different research settings was to evaluate the adaptability of the method and software in relation to various information needs, and to assess the extent to which the tool was aligned with local ethical and cultural requirements.The Beitbridge-Musina border is currently one of the busiest in the Southern Africa region, receiving daily groups of migrants from Zimbabwe, Malawi, Zambia, the Democratic Republic of Congo (DRC), Burundi and more distant countries, such as Pakistan, Somalia and Ethiopia. MSF activities in the region explicitly addressing displaced populations date back to the year 2007 and have included the provision of antiretroviral treatment (ART) and tuberculosis (TB) treatment to remote rural populations in South African farms and, more recently, the delivery of primary healthcare to Zimbabwean returnees from South Africa and mobile populations across the Limpopo River.Although the Limpopo area is a very well-known context for MSF, information on migrants’ needs in the region is limited. The available IOM data was neither updated nor comprehensive in terms of health demands. The mobility context at the Beitbridge-Musina border is highly complex, as it comprises groups of different nationalities with distinct migration trajectories. While some migrants, refugees, and asylum seekers hoped to settle permanently in South Africa, groups of Zimbabwean small farmers and farmworkers also crossed the border daily in search of work, products, and medical help. In addition, the project also encompassed Zimbabwean returnees who had previously been detained in South Africa, and who presented particular healthcare needs. Considering this diversity, the research team decided to separate the study into five different modules, each of which was centred on a distinct target population. Through the use of the Migration History Tool, a total of 1.735 people were interviewed in several catchment areas in the region from January to March 2020. The survey instruments were fully translated into Shona, Venda, Ndebele, and Swahili, and the interviews were conducted in the language which the respondent felt most comfortable with. This was the first known survey to describe the socio-demographic profile, health-seeking behaviour, and migratory trajectories of migrants and refugees in the Limpopo area.In the case of Colombia, the stark increase in the number of Venezuelan migrants and refugees in recent years constitutes an unprecedented situation not only for the country but in Latin America (UNHCR-R4 V). The migratory dynamics in Venezuela have undergone a huge and markedly observable transformation over the last five years, from being a country that historically attracted migrants  to one that in just three years (from 2016 to 2018) reached a negative balance in emigration terms . VariousThere is still great difficulty in establishing the precise numbers and specific profiles and needs of the Venezuelan migrants and refugees crossing borders mainly due to the large number of non-official crossing points . AdditioIn 2018, MSF established basic healthcare projects in three of Colombia’s border states . MSF’s activities with Venezuelan migrant and refugees’ populations cover two work fronts: firstly, institutionalised medical activities, in-hospital spaces where primary health care services are provided  and secondly, with mobile teams providing the same services described above, adding points of care for long-distance walkers. MSF activities in the border areas were established as a starting point upon which explore the distribution and conditions of the Venezuelan population in the territory and to refine a research analysis adapted to projects’’ information needs. The overall research activity had 516 Venezuelan migrants and refugees participants.It is important to highlight that in the implementation of the survey in the three countries, the municipalities and specific sites chosen corresponded to a selection based on MSF’s activities and operational criteria. Once the locations were chosen, independent, statistically significant samples were then drawn as representative of those specific populations. Thus, the results of this research activity cannot be applied to migrants and refugees on a national scale. Also, the original scope of the project was reduced due to COVID contingency causing the loss of qualitative data that had been intended to be collected to help the interpretation of findings.As states’ strategies of deterrence multiply, scholars have started to look deeply into the temporal dimension of migration beyond its more commonly acknowledged spatial dynamics . The timIn the case of Musina (South Africa), one of the main added values of the implementation of the MHT has been the estimation of the length of time migrants and asylum seekers stay in the city. The research at this site revealed that mobile populations remain, on average, for nine months in Musina, with the duration of stay rising to 16 months among Zimbabwean women. The reasons for staying for so long in a place that is often considered to be a transit point varied by nationality, with Zimbabweans more often giving work-related reasons, whilst Congolese generally pointed out the lengthiness of asylum application procedures. By linking up the residence times with the times of meaningful events, the survey revealed that protracted periods of residence in the city were associated with greater exposure to violence, particularly sexual violence. It also revealed that this association was stronger among men living in the city’s shelter, which indicated the need for the organisation to strengthen programs for this demographic, including the design of evidence-based advocacy strategies.Time has also been a key variable in exploring the trajectories of detention among Zimbabwean migrants in South Africa. Following the sequential queuing technique enabled by the tool, the MSF team asked every person who arrived at the Beitbridge Reception Centre in Zimbabwe about the places they had been sent to after their arrest in South Africa, which included detention centres, police cells and prisons. Contrary to common sense, we found that detention pathways in the country were far from straightforward. The respondents had been to 2.6 facilities on average, with some passing through six different places, and 25% of them had spent more than three and a half years incarcerated before being deported. These figures represent a serious violation of the maximum length of time an unauthorised migrant can rightfully be detained in South Africa − 120 days. The findings showed that conditions in police stations were poorer when compared to those in Lindela, and that migrants sent to police stations rarely had access to health care, including continuous care for chronic conditions. Whilst most advocacy in relation to the detention of migrants in South Africa has been focused on large centres, such as Lindela, the survey revealed the need to also look at much less visible settings, particularly police stations.There are important aspects to highlight too. The survey conducted in South Africa evidenced the differences in migration trajectories of migrants of various nationalities. Whilst living conditions in South Africa were similar across all the groups analysed, Burundians had been in transit for longer periods of time, which also increased their chances of having been exposed to violence in the years preceding the survey. Operationally, the identification of points of transit, border crossing sites, and places of habitual residence through the study helped the organisation to pinpoint locations where further needs assessments could be conducted, whether in South Africa, Zimbabwe or third countries.Also, in relation to the Colombian experience, the implementation of the MHT methodology allowed the exploration of mobility dynamics among Venezuelan migrants and refugees in a highly volatile environment. The analysis of the data collected from the Venezuelan population interviewed population evidenced a migration profile characterized mainly by family groups with more extended permanence plans, who were searching for better living conditions, access to sources of employment, education, and health services. This group migration characterisation reflects that more than half of the influx were young people under 20 years old, with a striking 20% of children aged under five years old. Therefore, MSF operations in Colombia, working with Venezuelan migrants, are then called to shape solutions to guarantee longer-term access to health services for these populations.On average, interviewees reported having lived for more than three months in between one and six different cities, towns, or villages, with an average of 1.6 locations per respondent. The calculated mean time of stay in the current residence was four months, revealing that Venezuelan migrant populations at the interview sites have a low mobility profile and a tendency for long-term stay. In addition, when analysing the routes per country, it is interesting to note in the recent migration process that 91% of the travellers did not make a stop inside Venezuela. This is most probably related to the fact that most interviewees were previously residing in bordering states. For those who did stop along the route inside Venezuela, the maximum number of places reported was two. In contrast, a wider mobility pattern can be identified when analysing Colombian locations, where people had made travel travel stops in up to ten different places, many of them in the interior of the country, with a return trip to settle down later in one of the border cities where they were interviewed. This information indicated the importance of evaluating the provision of health care in border municipalities.In terms of access to health care, the survey found that, among people who searched for health care in their place of residence, 27% received assistance in less than one hour; 37% were assisted between one and three hours after seeking the service and 21% were assisted three or more hours after requesting help, but within the same day of searching for services. However, when long-term care is considered, the survey found that 49% of the people afflicted by chronic diseases were out of treatment, with a set average time of not having received medication of approximately 3.6 years at the time of the interview. The main reasons given by respondents to explain their treatment discontinuation included not having the money to buy the treatment (30%) and not having access to a proper health service (15%). This data confirmed need to establish a comprehensive package of care for Venezuelan migrants and refugees that would ensure not only emergency attention , but that guarantees the long-term provision of care.Finally, it is important to highlight that the use of the Migration History Tool has generated intense debate within MSF regarding the ethical implications of the information generated, and to the data collection process itself. The main concern was that the documentation and dissemination of detailed migration routes could be used by national states to stiffen their border controls at crossing points. To counter this possibility, several data protection measures have been adopted, including restricting the results that would be published and shared externally. There was also apprehension that the in-depth exploration of life trajectories – including events of violence – could lead to the re-traumatisation of people included in the study. To minimise the risk to participants, some very sensitive questions were not included in the research. In addition, data collection teams were accompanied at all times by mental health staff.This article has sought to describe the application of a novel software, based on the life-history calendar methodology, in the collection of quantitative retrospective data on mobility and health in the context of two humanitarian interventions. Particularly, it has revealed how health outcomes are not only closely linked with the spatial dimensions of movement, but also with the temporalities of mobility trajectories. Whilst taking key ethical considerations into account, the information generated through this method could enable organisations working with mobile populations, in health-related activities and beyond, to better define their scope of action, target demographics, attention sites and advocacy strategies.


Objectives: Generation Z, defined as “post-millennial,” is considered to be the first generation that could end smoking. The objective is also to take into account the evolutionary aspect of the smoking and attitudes of the Generation Z. The aim of this study was to explore the willingness of Generation Z in Slovakia to comply with the legislation adopted in the field of anti-tobacco policy and to investigate some selected social factors—intention, subjective norm and percevied behavioral control—that contribute to a lower rate of compliance.Methods: Global Youth Tobacco Survey (GYTS) data on cigarette smoking among 3,557 adolescents (age range 13–15) in 2016 as well as on attitudes towards tobacco use and control measures were used to explore the level of compliance of adolescents with anti-tobacco regulations in Slovakia within the Framework Convention of Tobacco Control (FCTC). We used the concept of intention as explained in Ajzen’s theory of planned behaviour (1985), focusing on the role of subjective norm and perceived behavioural control.Results: We found a decrease in ever smoking, current smoking and frequent smoking. We found that these adolescents start experimenting with dependence-causing substances, such as tobacco, regardless of existing rules.Conclusion: Adolescents were attracted to smoking, although they were aware of health effects of passive smoking, and a vast majority liked smoke-free places. They are also influenced by their peers and parental models. Generation Z, also defined as “post-millennials,” includes people born between the years 1995—2010. They represent approximately 32% of the world population [Furthermore, this generation was in line to inherit a strong economy with a record low unemployment rate. However, Generation Z is also likely to self-harm, to suffer from poor body image, to skip sleep and to be overweight . Their bMore recent statistics reveal that they are much more likely to start smoking as adolescents . In respIn this context it is relevant to ask the question of how adolescents comply with the law. The concepts of “compliance” and “non-compliance” come from international law –13, and Valid epidemiological data are crucial for planning, implementing and evaluating effective preventive measures. The Global Youth Tobacco Survey (GYTS), as part of the Global Tobacco Surveillance System (GTSS), is developed by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), Atlanta, USA. GYTS uses standard sampling method and uniform questionnaire providing reliably and representative epidemiologic data. This study focuses on monitoring adolescents’ tobacco use and related factors as well as key tobacco control indicators . SlovakiThe tobacco industry is a business like any other, so its main goal is to make a profit. Advertising and promoting tobacco products are its most important tools. The Framework Convention on Tobacco Control (FCTC) defines them in article 1(c) as “any form of commercial communication, recommendation or action with the aim, effect or likely effect of promoting a tobacco product or tobacco use either directly or indirectly” . The maj Our research question is primarily focusing on the interconnection between TPB and smoking (by GYTS). The objective is also to take into account the evolutionary aspect of the smoking and attitudes of the Generation Z. The aim of this study was to explore the willingness of Generation Z in Slovakia to comply with the legislation adopted in the field of anti-tobacco policy and to investigate some selected social factors—intention, subjective norm and percevied behavioral control—that contribute to a lower rate of compliance.The GYTS consists of a school-based questionnaire study using a cross-sectional design. It employs a standardized protocol for creating samples, developing questionnaires, carrying out field procedures and processing data. A two-stage cluster sample design is used to produce representative samples of students in grades associated with the age range from 13 to 15 years , i.e., in Slovakia grades 7–9 in primary schools and grades 2–4 in eight-year grammar schools. The sampling frame consists of all primary schools and eight-year grammar schools incorporating the above-mentioned grades . At the first sampling stage, schools are selected with a probability proportional to the school enrolment size. At the second stage, classes are randomly selected from each school included in the first stage. All students in the selected classes are eligible to participate. Student participation is voluntary and anonymous, using self-administered data collection procedures. The used methodology and its details have been described in previous publications analysing GYTS data –25.In Slovakia, four waves of the GYTS have been carried out, namely in the period April—June of the years 2003, 2007, 2011 and 2016. The survey procedures were designed to protect the students’ privacy by allowing for anonymous and voluntary participation. The questionnaire was self-administered in classrooms. Students were first informed by trained field administrators about the purpose of the study and were reassured about voluntary participation and the privacy of their answers. Students recorded their responses directly into special answer sheets. During data collection, trained field administrators were present to maintain standard procedures and to provide assistance and further explanations, if needed. The surveys were approved by the Ethics Committee of the Jessenius Faculty of Medicine, Comenius University, Bratislava .The basic characteristics of the samples is as follows : in 2003The further design of this study was based on the ideas of Ajzen (Theory of Planned Behaviour—TPB) as the most important starting point. We worked with publications explaining the TPB . Officia• Ever tried cigarette smoking, measured as the proportion of respondents who had tried or experimented with cigarette smoking, even one or two puffs.• Current cigarette smoking, measured as the proportion of respondents reporting smoking cigarettes on one or more days in the past 30 days.• Frequent cigarette smoking, measured as the proportion of respondents reporting smoking cigarettes on 20 or more days in the past 30 days.• Attractiveness of smoking, measured as the proportion of respondents sharing the attitude that smoking helps people feel more comfortable at celebrations, parties and social gatherings.• Awareness of the health effects of environmental tobacco smoke, measured as the proportion of respondents definitely thinking other people’s tobacco smoking is harmful to them.• Positive attitude towards a smoke-free environment, measured as the proportion of respondents favouring banning smoking inside enclosed public places.The uniform, internationally-based GYTS questionnaire, adapted to local conditions, was used to cover categories such as tobacco use, knowledge and attitudes regarding tobacco, environmental tobacco smoke exposure, media and advertising, desire for cessation, availability of and access to tobacco, and teaching in schools on tobacco , 29. TheWe used the TPB developed by Ajzen . We measThe concept of (non-)compliance with the law was also crucial when searching for our scientific sources. We concentrated particularly on papers that provided us with enough information appropriate for their assessment in the light of the above-mentioned concept of TPB.First, a weighing factor was applied to each student record to adjust for non-responses and variation in the probability of selection at the school, class and student levels. Then frequencies of the variables were presented as weighted percentages with the respective confidence interval of 95%. Differences between prevalence estimates were considered statistically significant if the 95% confidence intervals did not overlap.SUDAAN, a software package for statistical analysis of correlated data , as wellFirst, we established the occurrence of smoking among adolescents. We then compiled an overview of legislation in the field of Slovak anti-tobacco policy. Next, we explored the willingness of Generation Z to comply with the officially adopted regulations in the field of that anti-tobacco policy and examined the factors that influence the higher rate of compliance using Ajzen’s TPB . Then, wMost Slovak adolescents have personal experience of cigarette smoking . At the Current cigarette smoking has declined among Slovak adolescents, from over one-fourth in 2003 to less than one-fifth in 2016 . HoweverFewer than 1 in 10 students reported smoking cigarettes 20 or more days in the last month . AlthougSlovak Act No. 377/2004 on the Protection of Non-smokers, as amended, and Act No. 106/2004 on Excise Duty on Tobacco Products, as amended, together with Act No. 147/2001 on Advertising, are the main legal instruments in the field of anti-tobacco policy. Tobacco legislation changed in 2016 and imposed new obligations on tobacco manufacturers and distributors in Slovakia. In February 2016, as a reaction to the adoption of Directive 2014/40/EU by the European Parliament and the European Council, a new amendment came into force, focusing on the size of cigarette packs , 32.In its article 16  the FCTCSlovak Act No. 377/2004 on the Protection of Non-smokers deals with these obligations in section 6 ; it statAbout one-half of all respondents considered smoking attractive, sharing the view that this behaviour helps people feel more comfortable at celebrations, parties and social gatherings . Boys siHowever, adolescents are less compliant with health laws when they are surrounded by their peers and they need to feel better . This isMost of the respondents held the view that other people’s tobacco smoking was harmful to them, maintaining almost the same rates in boys and girls . The perAn overwhelming majority of students, similarly in boys and girls, favoured banning smoking inside enclosed public places . The perWe explored the willingness of Generation Z in Slovakia to comply with the regulations officially adopted in the field of anti-tobacco policy in line with the FCTC, and we investigated selected social factors contributing to a lower rate of compliance. When it comes to compliance with the law, Generation Z appears to be influenced by certain social factors: young people are more open to smoking in relation to various social gatherings, such as parties, although they are aware of the harmful effects of tobacco use, regardless of their knowledge of legal regulations.The GYTS Slovakia findings show that tobacco use remains very popular among adolescents, since the majority of them reported personal experience with cigarette smoking. As Fidler et al.  present,The findings indicate—contrastingly—a declining trend, particularly since 2011, especially remarkable among boys. This development is gradually leading to the disappearance of the traditional predominance of males, although this is still present in the adult Slovak population .This situation corresponds to the overall decline in substance use in Europe . HoweverWe further found that Slovakia’s legal regulation of selling tobacco products to minors and the regulation of advertising tobacco products is in line with the FCTC. The set rules are clear and are the subject of state control. Violating them is punished in accordance with the applicable legislation. Our finding is consistent with other studies , 43, whiAs the GYTS Slovakia findings show, about half of adolescents in Slovakia consider regular smoking as an effective social mediator. We should therefore consider this attitude as a common motivational factor promoting tobacco use in this age group. On the other hand, the overwhelming majority of them are aware of the dangers of passive smoking and share positive views towards smoke-free control measures. However, the trends in these two indicators are different. While awareness of the dangers of passive smoking has decreased noticeably since 2011, positive views towards smoke-free measures have been gradually increasing. This apparently inconsistent development can be explained in terms of reduced awareness of the topicality of smoking as its prevalence has declined. On the other hand, as smoking plays a less important role among adolescents, they do not perceive restrictions against it as affecting their activities .Finally, the risk of smoking among adolescents is influenced by the incidence of smoking in their surrounding social environment. Teens go through great developmental changes, forming their own identities and taking more risks than their elders. Cigarette-smoking may make teens feel popular, sophisticated, attractive or tough , and as Our study aimed to explore how the adolescents called “Generation Z” behave in the area of compliance with health laws, and which factors are most influential in terms of their decision to take up smoking or not. First, we described the occurrence of smoking among schoolchildren using a large representative sample. The survey questions were those previously used in the GYTS Slovakia study. Then, we considered the analysis of this issue through the lens of Ajzen’s TPB. This approach enabled us to find a new perspective when it came to searching for the reasons for smoking. We have no information about other studies carried out in the field of non-compliance which apply the concept of selected aspects of the TPB in other age groups, and we regard this as the one of the strengths of this work. The small number of studies dealing with the issue of adolescent approaches to smoking from various points of view in general is one of the limitations of our study. Furthermore, we can mention some limitations related to the TPB, such as the assumption that behaviour is the result of a momentary decision-making process, ignoring the possibility that it can change according to inner or external circumstances, or that it involves attention to environmental and economic factors.Our findings confirm the significance of group rules. This supports the idea that community-level health-promotion intervention programmes can be an effective tool with a real impact on the current and future health of youngsters, but only if applied properly.We still need more relevant and demand-oriented research in this area to be able to provide evidence-based recommendations for policy and practice. As part of the general effort to reduce smoking among adolescents, the most effective ways of really influencing older members of that age group need to be addressed. Research should also be done in the field of the impact of new social media  on the lifestyle of adolescents and the possibilities of their application in the process of building awareness of healthier living in this age group. Research into the application of a participatory approach in this age group also shows interesting potential. We need to look for opportunities to influence youngsters through the attitudes of other young people.The GYTS Slovakia study revealed that smoking has a decreasing trend among boys. The vast majority of respondents perceive the legislation to limit smoking positively. It further shows that attitudes towards smoking do not change during the observed period. Changes in smoking indicators do not correspond to changes in legislation, this indicates the importance of other social factors.


M = 2.17). On the internal dimension, learning easy adaptation (M = 2.165) is average, and cognitive strategy adaptation (M = 2.642) is average, whether the average learning adaptability of English majors is significant (P = 0.001 < 0.05), and it is significant in the dimensions of learning attitude, learning interaction, and learning environment (P < 0.05). In view of the improvement of college students' English learning adaptability under BFLTM, this paper puts forward some strategies to further cultivate students' English autonomous learning ability by creating a suitable classroom atmosphere for autonomous learning, establishing an English autonomous learning center and a virtual community.The issues with traditional teaching methods in current English education are becoming more and more evident in college classrooms, which significantly impedes the innovative growth of college English education and does not promote the development of college students' all-around English proficiency. This essay focuses on the English learning adaptability and intervention tactics of college students using BFLTM (Blended Foreign Language Teaching Model). This study employs the individual-centered approach to choose college students as its primary subjects and conducts a cluster analysis of the adaptability of various college students' English learning based on the classification indicators. The study makes the following deductions: the general state of students' adaptability to studying English is average ( In recent years, in order to strengthen students' awareness of autonomous learning and improve their ability of innovation, practice, and cooperation, universities have explored and established BFLTM (Blended Foreign Language Teaching Model), which combines online teaching with traditional face-to-face teaching. Teachers of each course are encouraged to combine their own actual situation and needs and the actual needs of students to carry out the flip teaching of the course . BFLTM aWith the acceleration of economic globalization, people pay more and more attention to BFLTM, and more and more universities in China begin to consider implementing BFLTM. It is difficult to achieve this goal in exam-oriented classroom teaching. Therefore, English teachers' teaching philosophy and teaching methods must be changed. Students should be the main body in the classroom to cultivate students' self-awareness and cultivate students' autonomous learning ability through equal communication . CollegeFor a long time, our foreign language teaching has generally neglected the contents of other humanities, natural sciences, and other related disciplines in the arrangement of curriculum and teaching contents. Specialties are divided too carefully, and language learners seldom touch things other than language, resulting in the imbalance of students' knowledge structure. Teaching is the core work of universities. Results can not only evaluate the quality of teaching but also evaluate the learning effect of students. This article analyzes the hidden information that lies behind student grades by using DM (data mining) technology, with the goal of advising school authorities on how to place value on teaching work and enhance teaching environments. In order to increase college students' English learning adaptability and advance their English learning, it is important to look into the scenario and factors influencing their capacity to learn the language. Once these factors have been identified, specific countermeasures can be proposed.By using the methods of comparison, reasoning, and abstract generalization, this paper studies how to make college students adapt to BFLTM better and faster in terms of teachers, curriculum, and original English textbooks, etc. under the BFLTM environment and comes up with a more realistic strategy of implementing BFLTM in Chinese universitiesAs a psychological characteristic, motivation is usually connected to particular activities since English learning motivation is diverse in nature. This study employs an individual-centered approach, chooses college students as its primary subjects, and conducts a cluster analysis of the degree to which various college students are able to acquire English in accordance with the classification indicatorsResearch innovation:Learners at the beginning stage are usually nervous or uncomfortable because they are not adapted to the environment of autonomous learning. They will judge their situation according to external standards or past experience and then take corresponding actions. Because they put too much emphasis on themselves, they often express some negative opinions, thus falling into conflict with others. At the proactive stage, learners can confidently improve their relationships with others. They can understand the importance of cooperation and consultation with others in order to achieve common goals.Shi et al. believe that proactive autonomous learning means that learners can manage their own learning, decide their own learning goals, choose appropriate learning methods, and evaluate their own learning process and results . KarthikIt demonstrates that social relationships and learning adaptability are related that peer exclusion has a detrimental impact on learning adaptability and that peer acceptance has a favorable impact. Peer exclusion and pupils' adaptable learning are two of them. According to research by Willis et al., a positive teacher-student relationship promotes students' positive psychological well-being and academic success, whereas a negative teacher-student relationship marked by conflict and dependence will result in students' behavioral issues, which will eventually cause learning fatigue . CollegeThe rapid development of education information makes the boundary between online learning and traditional classroom learning blurred. The emergence of BFLTM has changed the traditional college English classroom structure. Supported by Internet big data, BFLTM provides more abundant teaching materials for college English classroom and also points out a new direction for the innovation of college English teaching methods.Yu et al. believe that “mixed teaching” refers to the optimal selection and combination of all teaching elements for the purpose of teaching objectives . PamplonRienties et al., taking college students as the object, summed up four kinds of motivation groups by cluster analysis and summarized their motivation characteristics . The enlResearch on second language acquisition has always been motivated. Learning experiences in a second language can be either beneficial or detrimental depending on the circumstances . According to the self-system theory of second language motivation, learners are motivated by closing the gap between their real selves and their potential selves  , 16. TheBFLTM, a novel teaching approach for the modern period, possesses the qualities of high-level information technology and Internet technology, considerably enhancing university classroom teaching materials and better aligning with the conceptual frameworks of modern young students. Colleges and universities should actively develop online English teaching platforms, gradually improve English online classrooms, upload college English textbooks to online classrooms, and concurrently plan teachers' online explanation boards and upload teachers' classroom explanation videos to the Internet platform in order to better develop and use BFLTM. Help students take the initiative to contact English learning resources other than textbooks, configure teaching materials in normal lessons to best suit students' varying levels of ability, align course materials with actual instruction, and update and maintain online teaching materials on a regular basis.Change the college English course from a single course to an audio-visual course and a comprehensive English course. Audio-visual speaking class mainly exercises students' ability of listening and speaking English and shows language teaching materials in class. Teachers ask students relevant questions about the materials, and students find out the answers to the questions through thinking and communication . TraininIn BFLTM, the stronger the motivation of learning, the better the students' learning adaptability. Teachers can indirectly influence students' learning adaptability by influencing their self-efficacy or stimulating their learning motivation. According to the research hypothesis, a model of influencing factors of college students' English learning adaptability under BFLTM is preliminarily constructed, as shown in The classes that are present in the target database are known to the classification module. We need to indicate to which class each record belongs. The individuals in each cluster found by cluster analysis can often be treated equally in many applications. The following subcategories of clustering algorithms can be made: split technique, hierarchical method, density-based method, grid-based method, and model-based approach.i, j is the simple matching correlation coefficient, which is defined as follows:A binary variable is symmetric if its content represented by 0 or 1 is equally important. At this time, the difference parameter describing the object m is the number of matched attributes in the object xi, xj and p is the number of all attributes.Nominal variable is the generalization of binary variable. It can have multiple state values, and the states are out of order. Attributes with this data type are also called classification attributes. Its difference can be calculated by simple matching method:It is simply understood that the density of points inside a cluster is relatively large, while the density of points on the edge of the cluster is relatively small. As long as you change the unit, it will change the influence ability of attribute values, which will lead to a big deviation of clustering results.The distance between data objects can most succinctly be used to express how similar two data objects are since the experimental data is a numerical attribute. Here, we employ the Euclidean distance, specifically:To represent the entire data collection, sampling selects some data from a huge data set. The process is easy. An essential technique for signal processing is the wavelet transform. To approximate the original signal, it makes use of a few wavelet parameters that were produced after the modification. If the bucket's height is higher than the upper limit, the splitting procedure is activated, and the bucket is divided evenly into two little buckets. The merging operation is carried out, however, and the bucket and the adjacent bucket are merged into a new bucket so that the height of the new bucket is between the upper threshold value and the lower threshold value if, however, the height of the bucket is lower than the lower threshold value.X be a random variable with expectation of μ and variance of Var(X). For any ε(ε > 0), Chebyshev inequality can guarantee:Chebyshev inequality describes the probability of a random variable deviating from its mathematical expectation. Let The significance of this observation lies in the fact that in order to achieve a certain correct rate of evaluation, the required sampling size actually changes drastically and increases with the increase of standard deviation.Learning maladjustment not only affects students' learning effect but also directly affects the effectiveness of BFLTM-enabled English learning , 19. TheAt present, many language exercises in college classroom are focused on students' language training, which are rarely used in real life. As a result, the college classroom seems to be the same as the high school classroom teaching mode, and it is just a process of learning the basic knowledge of English, to cope with the college English teaching and the final exam. College students who attend universities can access extensive and fascinating educational materials. Many college students gradually lose interest in English study since it is tedious and challenging. We cannot fully exploit the potential of new media in promoting college English and enhancing the standard of English instruction unless we are in close proximity to the needs of students in the modern classroom.After students enter the university, it is not suitable to implement BFLTM at the beginning, so bilingual teaching should be the transition; under the current conditions of our country, using English as the mainstream language on campus does more harm than good, and it is easy to have the situation that the mother tongue and English are not well learned. Studies have pointed out that if the whole English teaching is carried out on a large scale, students will have some difficulties in professional literature and communication with others in reading Chinese . BFLTM hk itemsets by using the last transaction set Ck∗ to calculate the support degree of candidate data itemsets, which reduces the I/O operation time and the size of the database to be scanned.Iterative design is a method. Machine learning came to the forefront at that time as people tried various approaches to get automatic decision assistance in the early stages of electronic data processing. The main distinction between DM and traditional data analysis is that DM searches for knowledge and information without making firm assumptions. AprioriTid algorithm is an improved algorithm of Apriori algorithm, which aims to reduce the size of transaction set for future scanning. AprioriTid algorithm only scans the database once when calculating frequent itemsets and then calculates frequent s are generated; then, for each nonempty proper subset of 1, judge the formula:The process of generating association rules is as follows: firstly, for each frequent itemset 1, all nonempty proper subset s⇒1 − s, min_conf is the minimum confidence threshold.If the above formula is satisfied, the output rule The generalization error measures how frequently the classifier misclassifies data outside of the training set. The correlation between any two trees in the forest and the classification effectiveness of a single tree in the forest determine the generalization error of RF (random forest). To improve RF's ability to lessen the association between noise and trees, a new training set is created using the bagging approach, which also uses random selection to choose feature splitting.K classifiers h1(X), h2(X), ⋯, hK(X), input vector X, and corresponding output y, the edge function of sample point  is defined as:I(·) is an indicative function and avk(·) is the average value. mg measures the degree to which the average number of votes obtained under the correct classification of vector X exceeds that of any other class.Given RF is a classification and prediction model and a combined classifier. RF gets the input feature vector, classifies or predicts it with each tree in the forest, and outputs it as the average of the predicted values of the class or each tree that gets the most votes. This paper applies it to the prediction of students' achievement. If CART (Classification and Regulation Tree) algorithm is regarded as a teacher's prediction of a student's achievement, RF means that many teachers are together to predict the student's achievement.X, we take the average We combine the generated CART trees to form RF. What is to be predicted here is the students' computer literacy basic course achievement, which is a continuous value. For each input vector The mining aim should be predictable even though the mining outcome is unexpected. The foundation of DM is a sizable amount of detailed and rich data. Data are necessary for discussing DM. The task of gathering data is time-consuming and labor-intensive. Data preparation is therefore required. Additionally, by simply generalizing the data through data preprocessing, greater data information can be produced based on the original data, aiding the following DM's smooth progression. The algorithm is a more suitable algorithm to handle this problem if the features of the data satisfy the assumptions of the algorithm.P to indicate the difficulty of test question i. Then, the definition formula of the difficulty coefficient Pi of a certain test question is:Ri is the number of people who have correctly answered the test question i; Ni is the total number of people who responded to question i.In the classical test theory, the difficulty of test questions indicates the difficulty of test questions, which is measured by the score rate. Set The difficulty coefficient of the test paper indicates the overall difficulty of the test paper. It is defined as:A is the full score of the test paper.Normalization transformation is also a data processing method similar to normalization transformation for numerical values and dimensions of variables. Firstly, each variable is transformed centrally and then standardized by the standard deviation of the variable. That is:After standardized transformation, the average value of each variable, that is, each column of data in the data matrix, and the variance is, no longer has dimensions, which also facilitates the comparison between different variables.This study performed a questionnaire survey among college students in the author's institution and made an analysis and summary on the basis of the results in order to really comprehend the current situation of college students' perspectives on BFLTM and their skills. Language psychologists' idea of metacognitive knowledge and metacognitive strategies, which they use to define autonomous learners, served as the foundation for the questionnaire's construction. 200 questionnaires were given out for this study, and 185 of them were collected, yielding a recovery rate of 92.5%. There were 160 valid surveys with an effective rate of 80% after invalid ones were eliminated. Additional interviews were also performed with 20 students, 10 parents, and 10 teachers.M = 2.17). On the internal dimension, the learning easy adaptation (M = 2.165) is average, the cognitive strategy adaptation (M = 2.642) is average, the learning environment adaptation is poor, and the physical and mental health adaptation is average  is average, and their English learning motivation and learning mood are poor. The family environment adaptation and peer relationship adaptation are poor, and the classroom environment adaptation is serious. On the dimension of physical and mental health adaptation of English learning, the emotional adaptation of English learning is average, and the poor adaptation of English learning means learning anxiety.T-test and one-way ANOVA were used to evaluate the variations in college students' BFLTM-supported English learning adaptability and whether they are English majors or not in order to thoroughly comprehend the specific scenario of their English learning adaptability under BFLTM. The analysis findings are displayed in T test to investigate the variations in English learning adaptability.Independent sample P = 0.001 < 0.05), that is, there are differences between English majors and non-English majors in learning English supported by BFLTM. From the specific dimension, English and non-English majors are consistent in terms of “autonomous learning ability” and “physical and mental health,” but there is no significant difference (P > 0.05). However, it is significant in the dimensions of learning attitude, learning interaction, and learning environment (P < 0.05).It can be seen whether the average learning adaptability of English majors is significant . On the internal dimension, learning easy adaptation (M = 2.165) is average, and cognitive strategy adaptation (M = 2.642) is average, whether the average learning adaptability of English majors is significant (P = 0.001 < 0.05), and it is significant in the dimensions of learning attitude, learning interaction, and learning environment (P < 0.05). Therefore, it is necessary to help students change their ideas, stimulate their learning motivation, and cultivate their interest in learning through consciousness cultivation. Teachers use task-based language teaching to provide students with the opportunity and environment for autonomous learning, improve their self-confidence, and achieve psychological autonomy.One of the main areas of study in college instruction, college English, has a significant impact on how well students integrate into society and engage in social activities. Because the delivery of college-level English depends so heavily on the Internet, it makes sense to use BFLTM to combine offline and online teaching techniques. This not only preserves the benefits of online instruction but also compensates for its drawbacks, improving the effectiveness and efficiency of instruction. However, at present, there are some problems in college English teaching in many universities that need to be solved urgently. Based on the English learning environment supported by BFLTM, this study analyzes the current situation of college students' learning adaptability and its influencing factors. The results show that students' English learning adaptability is general (


Many health research policies invoke the construct of Social Determinants of Health, and more recently the construct of Social Determinants of Mental Health. While frequently referred to in the literature, it is unclear how these constructs relate to each other. Some commentators conceptualise the Determinants of Mental Health as a subgroup of the Determinants of general Health and others describe the Determinants of Mental Health as an autonomous construct. The current review investigates the relationship between both constructs.Comprehensive literature searches were conducted for both constructs separately within seven electronic databases. A template analysis was conducted to compare the conceptualisations of the Social Determinants of Health and the Social Determinants of Mental Health.Of 4250 search results, 50 papers (25 for each construct) fulfilled our inclusion criteria and were incorporated into a narrative synthesis. Discussions of the Social Determinants of both general and Mental Health listed the same determinants. Both constructs were conceptualised on multiple levels and factors. Stress and health behaviour were also described as mediators for both constructs. The constructs differed, however, with respect to two components of their aetiologies and epistemologies. First, the causal mechanisms invoked for the Determinants of general Health followed predominantly direct pathways, in contrast to indirect pathways for the Social Determinants of Mental Health. Second, the Social Determinants of Mental Health were reported to influence mental health mediated through individuals’ perceptions and appraisal processes. Appraisal processes were considered of far less relevance in the construct of Social Determinants of Health.The constructs of Social Determinants of Health and Social Determinants of Mental Health align in many respects but differ on important aetiological and epistemological grounds. Similar social factors are considered important, but whereas physical health conditions are primarily conceptualised to be driven by objective realities, mental health is explained mainly in terms of perception of these realities. This differentiation between physical and mental health is in line with a modern understanding of mind-body-dualism, the naturalistic dualism after Chalmers. Differentiating the Social Determinants of Mental Health from the Social Determinants of Health might bear relevance for policy making and research. Commission on the Social Determinants of Health which delivered its final report in 2008, stressing the significance of social conditions for health. Further evidence of the broad acceptance of the SDH construct can be found in highly impactful publications  are defined as “the conditions in which people are born, grow, live, work and age” . Health ications , 6 and sications , 8. In tications  has led ications , 10. Recications . Applicaications .Starting around 2010, the construct of Social Determinants of Mental Health  began to gain the attention of researchers. Examples of SDMentH are low income, social support, and education . The SDMTo date, the constructs of SDH and SDMentH have not been compared. This is a significant shortfall on three accounts. First, an unclear delineation between SDH and SDMentH hinders improved aetiological understanding. Using the two terms interchangeably  implies 1.)What are considered to be determinants in the conceptualisations of Social Determinants of Health and Social Determinants of Mental Health?2.)Which epistemological assumptions underpin both constructs (SDH and SDMentH)?3.)What does the literature tell us about potential pathways from Social Determinants of Health and Social Determinants of Mental Health to specific experiences of individuals?4.)What are the similarities and differences between SDH and SDMentH in relation to these questions?gov.uk and Nice evidence. This selection of grey literature sources was in line with a review that had a similar literature target  . In linee target . EligiblThe literature on SDH is so extensive that the scope of this systematic literature search had to be constrained. We focused on papers that deal with SDH-assessment tools as measuring presupposes a good understanding of the object of interest, and we only included those papers that explicated this underlying understanding. Moreover, measuring itself is arguably a form of definition . FurtherThere is less literature on the construct of Social Determinants of Mental Health than the Social Determinants of Health. A preliminary systematic search for assessment methods specific to the SDMentH revealed no relevant results. We therefore included literature relating to theoretical groundwork, without limiting the search more. A well-grounded theory is the condition of construct validity  and thusTwo reviewers (FH and MS) independently reviewed the first 50 citations in order to test the reliability of the inclusion/exclusion criteria. Discrepancies between reviewers were resolved collaboratively following full text screening and with the advice of second and fourth reviewers (PK and ST). The agreement rate between both primary reviewers was 96% (SDH) and 98% (SDMentH) for the title/abstract screening; and 98% (SDH) and 84% (SDMentH) for the full text-screening. These good to excellent agreement rates were understood as confirmation of the reliability of the criteria . The priSynthesis and analysis differed for the four questions.Question 1, the factors identified as social factors determining health and mental health, were compiled as they appeared in the literature. Subsequently they had to be summarised on a less concrete level to make them more easily comprehensible and comparable between the different papers and between the two constructs. To this purpose we used the domain classification of a recent review of SDH-assessment methods as a template . Moen anQuestions 2, 3, and 4 required a comparison of theories within a scoping review. The issue of comparing theories in systematic and scoping reviews has gained prominence more recently, particularly in public health –37, thou“1. Synthesis preparation: the clarification of existing theories, the extraction of what is useful, plausible and relevant to the purpose of the synthesis. 2. Synthesis: making theories comparable by breaking them down into simple propositions and rendering them abstract; comparison of the theories for points of convergence and divergence; bringing together those aspects that converge” .We conducted a template analysis in order to reveal the “simple propositions” Pound and Campbell recommend. Template analysis is a particularly flexible form of thematic analysis, conducted in the following steps: data familiarisation; coding; organising these codes into themes; development of a coding template on the basis of a data sample; application of this template to a wider sample of the data; adaption of the template to better cover the data; application of the final template to the whole data set . TemplatThe 25 included articles relating to Social Determinants of Health consisted of: five papers reporting on the development of a tool –46, two The 25 identified articles reporting on the Social Determinants of Mental Health included seven papers providing an unspecified overview of theories with accompanying policy recommendations –71 or acThe results of the analysis of the 50 included articles will be presented in order of the questions. Questions 1 to 3 will firstly be answered for the construct of Social Determinants of Health and subsequently for the Social Determinants of Mental Health. The answer to question 4 will compare both constructs in an overview.Question 1: What are considered to be determinants in the conceptualisations of Social Determinants of Health and Social Determinants of Mental Health?We used the findings of a recent review on assessment tools for the Social Determinants of Health  as a temIn the analysed literature we found all 15 domains previously revealed by Moen and colleagues ? What does the literature tell us about potential pathways from Social Determinants of Health and Social Determinants of Mental Health to specific experiences of individuals?We conducted template analyses to answer these questions for underlying epistemologies and aetiological assumptions. Our analysis revealed seven themes that were deemed “useful, plausible and relevant to the purpose of the synthesis” : multifaAll analysed papers conceptualised health by recognising multiple factors involved in aetiology. This conceptualisation was sometimes explicitly stated and, at other times implied. Moreover, health was explained as being socially determined on multiple levels. Thus, health is conceptualised by multiple factors on multiple levels. Single publications differed in the number of levels they distinguished and how these levels were named. For example, Suzy Barcelos Winchester  differenThe majority of the analysed papers referred to the interdependence of different Social Determinants of Health. Some explicitly mentioned the interdependent dynamics of SDH , 47, 58,Several determinants were described as directly shaping  health. Most often, toxins in the housing environment were understood to cause respiratory diseases or allergies directly , 64, 90.“Stress” was considered a determinant itself in several papers, but it was also conceptualised as a pathway mechanism through which social conditions affect health. Social conditions that lead to chronic stress, were considered especially detrimental for health , 46, 62.Health behaviour was, like stress, frequently considered to be a determinant itself and was additionally seen as one mechanism through which social determinants affect health , 47. GenThe dynamic between poverty and health was occasionally described as bidirectional, generating vicious cycles , 61, 62.Perception and appraisal processes were only sporadically thematised in the literature on the Social Determinants of Health. One example of the consideration of perceptual processes in an illness development was the perceived support of God, which was conceptualised as a part of religious social capital that shapes coping behaviours . MoreoveAll analysed papers presumed a multifactorial aetiology of mental health that is influenced by biological, social, psychological, environmental, genetic, and behavioural factors. Additionally, all papers explained SDMentH in a multilevel frame, more or less explicitly. Explicitly were the levels divergently categorised. Some only outlined two levels: an “individual and a societal/political” , 80, or The vast majority of the analysed papers described the interdependent dynamics of different determinants of SDMentH. This interdependence was sometimes explicitly expressed , 88, accSocial Determinants of Mental Health (SDMentH) were defined, by some, as the determinants that directly affect mental health , 72. HowStress was considered to function as a mediator between social conditions and mental health in the majority of analysed papers , 84, 89.Health behaviour was less commonly identified as a social determinant of mental as opposed to physical health (see domains). It was, however, occasionally described as a mechanism through which social determinants affect mental health. Behaviour associated with deteriorating mental health was conceptualised as stemming from restricted choices , 80, 84 The relationship between social determinants and mental health in general was conceptualised as bidirectional , 69, 87.Many of the analysed papers emphasised the importance of perceptual processes. Perception and appraisal become particularly important in the translation of objective stressors to long term mental health impact , 84, 88.Question 4: How do SDH and SDMentH compare to each other?Potential differences between SDH and SDMentH were, sporadically, directly addressed in the analysed papers. Some suggested that the two concepts are not necessarily distinct from each other , or evenOverall, the range of determinants considered for the constructs SDH and SDMentH were similar. So were three domains  featuring in the top five of most frequently considered determinants for both constructs. Antipodal considerations of certain domains, domains considered highly relevant for one construct and irrelevant for the other, were rare. However, there were differences between SDH and SDMentH regarding their prioritisation of single domains. These differences pertained to the absolute number of papers considering a certain domain, as well as the relative position certain domains had in the hierarchy of the most prominent domains. “Social support” and “income” were much more frequently considered in the literature of SDMentH, both in the absolute number of papers considering the domains and in the relative position of the domains in relation to the other domains. On the other hand, “housing utilities,” “transport,” “health behaviour” and “childcare” were far more often represented in the SDH literature, again absolutely and relatively.Social Determinants of Health (SDH) and SDMentH were both conceptualised as multifactorial on multiple levels. Yet, little agreement and clarity existed regarding the number of levels and what these different levels were. Significant differences between SDH and SDMentH were not made apparent in this context.The single determinants in the SDH as well as the SDMentH construct were depicted to be interconnected and interdependent in various forms. Starting points for retracing the interdependencies of determinants were for both constructs’ socioeconomic status, gender, race, or employment. There were no significant differences in this context.In the analysed literature, SDH was more often described to follow direct pathway mechanisms compared to SDMentH. One of the main identified sources of direct impact on health were toxins in the housing environment. This was only once suggested for the SDMentH and caveated by a call for supportive evidence in that instance . FurtherStress was described as a mediator for both, SDH and SDMentH. The turning point of acute to chronic stress was, in both conceptualisations, described as a pivotal moment in health deterioration. Stress was predominantly explained in biological terms for SDMentH and SDH, and deemed to partly affect health and mental health through the motivation of behaviour. In contrast to SDH, stress was not considered to be a determinant itself in the context of SDMentH. Other than that, there were no significant differences between SDH and SDMentH regarding the consideration of stress.Generally, health behaviour was construed to play a role for SDMentH and SDH. However, health behaviour as one determinant or explanation was more pervasive in SDH literature. Furthermore, the recognition of behavioural factors in SDMentH tended to be more specific, such as learned behaviour was determined to be relevant in the aetiology of depression or parenting styles for the mental health of children. Behaviour directly related to mental healthcare management did not crop up as a component in SDMentH. In sum, there were minimal differences between the role of behaviour in SDH and SDMentH.Both, SDH and SDMentH were claimed to reify partially in vicious cycles, especially between poverty and health/mental health. The literature on SDMentH outlined vicious cycles more often and more extensively. Thus, SDH and SDMentH did not differ in principle with respect to vicious cycles, but this pathway mechanism was of more prominence for SDMentH.Appraisal and perceptual processes played a minor role in SDH, contrary to SDMentH. Where perception was taken into account in the analysed SDH literature, the outcome was often in the mental health realm , 62 als, becauseThere is conceptual ambiguity regarding the relationship between the Social Determinants of Health and Social Determinants of Mental Health. Some consider these two public health constructs to be categorically different from each other . Others Analysis of the 25 papers retrieved for each construct indicated some differences and many similarities regarding the determinants. Overall, the same determinants were described in both literature sets but differed in how they were prioritised. For example, the three determinants (-domains) most commonly identified for SDH were in tendency concrete in their nature . At least food insecurity and housing can be seen as tangible categorical factors, a person has enough food or does not, has access to housing, or does not. The equivalents for SDMentH were on the other hand rather immaterial . All these factors are social constructions contrary to the physical realities of housing, food, and violence. Furthermore, of these factors social support and education are dimensional factors. Education like social support exists to degrees and on a spectrum. This contrast is important because it speaks to the differences between direct pathways and effects shaped by appraisal processes, discussed in more detail below.In short, Social Determinants of Mental Health are often conceptualised to affect mental health filtered through the perception of individuals. It is in line with this finding that two of the three most frequently considered determinants for SDMentH are of a dimensional nature where it matters to what degree one feels socially supported or educated. The Social Determinants of Health are not theorised to affect health mediated through appraisal or perception, but to work through direct pathway mechanisms. This corresponds to all three most frequently considered determinants referring to physical realities and two of the three most frequently considered determinants of SDH being either absent or present, with not much room for debate. However, the juxtaposition of determinants most frequently considered should not be overinterpreted, as many social determinants (like housing) are particularly prevalent for both constructs. Moreover, how often a determinant was considered in the analysed literature is certainly one indicator of significance for the construct, but it is not the only one. It is striking that the mental health domain featured in nearly half (12 out of 25) of the analysed SDH-papers. This speaks to the high relevance of mental health as a component of, or as a condition for health, but it does not necessarily imply that SDMentH would be conceptualised as sub-construct of SDH. This is because it would be conceivable that interconnected constructs could function through different mechanisms for health or mental health contexts. The same observation holds for physical health as a Social Determinant of Mental Health (six out of 25 papers in the SDMentH literature). It seems reasonable to suppose that mental health is affected by our physical health, and vice versa, each could be a determinant of the other. It would be inappropriate therefore, to conclude that this dynamic relationship confirms that either one construct is a sub-component of the other.The template analysis revealed seven interrelated patterns of theoretical explanations, or themes : multifaSome of these themes exposed similarities between both constructs. Specifically, SDH and SDMentH were conceptualised in multifactorial and multilevel models, with interconnected determinants. Both constructs, are subject to some of the same potential logical flaws. In discussion of SDH and SDMentH, the interdependence of different determinants was regularly used as an explanation of a pathway mechanism. In fact, explaining the effect of certain determinants by pointing out that they are connected with other determinants is not an explanation, but merely an observation that could result in an “infinite causal regress” .The remaining five themes revealed slight to more significant differences between SDH and SDMentH.Health behaviour appeared both as a mechanism explanation and as a determinant for SDH and SDMentH. The prominent consideration of health behaviour as determinant in the analysed SDH-literature contradicts the call to focus on distal and fundamental determinants –95. FocuStress was described as a pivotal mechanism in the translation of social condition into health for SDH and SDMentH. In particular the transition of acute to chronic stress was emphasised to be a critical aetiological moment. It is striking that SDH and SDMentH did not differ significantly in the consideration of stress. Because although stress is equivocally defined , it is wIt seems appropriate to discuss three themes in tandem , as they conjointly tell one epistemological and aetiological story. SDH was frequently described to follow direct pathways, whereas SDMentH tended to be more often depicted in vicious cycles. Furthermore, SDMentH conceptualisations outlined perceptual and appraisal processes as particularly important in aetiologies. The differences between SDH and SDMentH in respect to the two themes “direct pathway mechanisms” and “role of perception” were especially unequivocal and indicate diverging epistemologies, which will be outlined in the following paragraphs.Direct pathway mechanisms in the SDH context were for example explained in the following way: toxins in the housing environment causing respiratory diseases, or hazardous neighbourhoods leading to injuries, implying one given reality that has common repercussions. This aetiological stance, in which material objects such as housing, transport, food insecurity etc. affect health directly, can be subsumed under neo-materialism , 102. NeOn the contrary to this direct, materialist perspective lies the focus on perception and appraisal in the conceptualisation of SDMentH. The dominant aetiological understanding for SDMentH is that social determinants affect mental health filtered through individuals’ perception, a stance in line with the assumptions of the psychosocial pathway , 106. WiSocial Determinants of Mental Healths (SDMentH’s) focus on psychosocial pathways is not surprising. Mental health is defined by the WHO primarily in the context of realising potentials and coping with stressors; a stance that clearly implicates perception and appraisal. The ICD 11 defines mental, behavioural, or neurodevelopmental disorders as significant disturbances in cognition, emotional regulation, or behaviour—that is, with an emphasis on appraisal and perceptual processes. Hence, the dominance of the psychosocial pathway was to be expected. Furthermore, the pathway explanation of Social Determinants of Mental Health in vicious cycles is in line with postulations of critical realism that causality occurs within complex systems rather than linear constellations . MoreoveThus, SDH and SDMentH appear to differ in their fundamental epistemology and explanatory approach. A remark that has been implied 30 years ago already:“Socio-economic inequalities in health cannot be wholly accounted for in terms of increased exposure to physical, chemical and organic dangers and dis- advantages. This is most obvious in those causes of death (such as suicide) and those illnesses (psychiatric and psychosomatic disorders) where conscious states of the person have an acknowledged causal or mediating role” .However, it is without doubt that SDH is not only conceptualised in a neo-materialism-framework . ConversDifferentiating mental from physical illness, even only tentatively, has far reaching philosophical consequences because it implies a mind-body dualism , 122. ThThis review has a number of potential limitations. First, we compared literature on the assessment of SDH with literature on the theoretical groundwork of SDMentH. We chose this strategy for several reasons. The literature-scops of the two constructs are incommensurable, with the SDH-literature being too extensive to be fully comprehensible. To render this vast body of literature manageable we were forced to restrict the SDH literature, and focused specifically on material related to assessment, as this can be regarded as the nexus of theoretical frameworks and practical application. The data that is collected under a certain construct, in this case SDH, affects the understanding of the construct . Hence iSecond, the theories and assessment methods have not been analysed on the basis of quality, or compared, and have consequently all been considered coequally. Arguably, several indices would have been conceivable. Theories and assessment methods could have been appraised regarding their impact or measured, for example, in citations. Further criteria could have been the quality of the theories, as done by Bonell and colleagues , or the Third, the confinement of SDH-literature to assessment literature brought the advantage that considered determinants were readily enlisted, but it also meant that aetiologies and epistemologies were not always the main foci of the papers.Fourth, although there were no restrictions on publication date, language was restricted to German and English, which might have resulted in relevant papers being excluded and a potential selection bias. However, both constructs are as public health issues internationally discussed in English. Therefore, we deemed the selection bias to be not too significant.Fifth, the literature search scheme retrieved initially a much higher number of results for SDMentH compared to SDH. This might indicate a higher sensitivity of the SDMentH-search strategy (and by that matter definitely a higher specificity of the SDH-search strategy considering the number of eligible papers). The potentially decreased sensitivity has been accepted because several recent SDH-assessment tool reviews offered readymade comparative selections of papers.Sixth, the seven revealed themes are not claimed to cover the constructs of SDH and SDMentH exhaustively. Both constructs are highly complex and too multifaceted to be all-encompassing subsumed in a few themes. Furthermore, the applied method of Pound and Campbell  does notThe findings of this review have several implications for future research and give first indications for policy making and mental health care. First, it is important and reassuring to confirm that the considered determinants of SDH are by and large the same as SDMentH. That means that taking actions to improve these determinants promises to improve physical as well as mental health. This double benefit of single measures can provide a convincing argument in a policy remit that is guided by cost-benefit analyses.However, the current review also revealed differences between the pathway mechanisms of the two constructs, differences that have several potential consequences. The perception or appraisal of certain social factors appears to be more important in the causal pathways leading to mental health problems compared to physical health, while physical health appears to be mainly driven by the factual presence or absence of these certain social factors. This again supports the development of a specific assessment method for the SDMentH, potentially based on the current review.There is a danger that an emphasis on individual appraisal processes could limit political and structural opportunities and responsibilities to tackle health inequalities  because We would like to call these factors the Social Determinants of Perception. Political or educational interventions might positively influence such Social Determinants of Perception and therefore support public health measures rather than impede them. Examples could include trying to support a changed beauty ideal that would be less prone to resulting in overly critical and unhealthy self-perception or trying to establish a more positive failure-culture that affects how individuals appraise their own successes and failures. Moreover, measures could be taken to tackle the mental health stigma, which eventually might trickle down to individuals and how they perceive their own mental health problems, potentially changing their help seeking behaviour. We do not claim that these interventions would be new. But they can show that an assumed psychosocial pathway for Social Determinants of Mental Health is not necessarily limiting structural and political interventions but, on the contrary, has the potential to enabling new ones. In line with the assumptions of critical realism, we would argue that interventions are needed to tackle both the Social Determinants of Mental Health and the Social Determinants of Perception, that is the objective realities and the way we make sense of them. Unfortunately, the “structural and cultural origins of meaning”, what we described as the Social Determinants of Perception are still understudied . More reThis scoping review compared the construct of SDH with the construct of SDMentH. Both constructs considered by and large the same determinants, although in different prioritisation. A template analysis revealed seven common themes regarding aetiological and epistemological assumptions. SDH and SDMentH resembled in that both were conceptualised in multilevel models, and that stress was declared to be a mediator between social conditions and health outcomes. Furthermore, both constructs were akin in describing health behaviour as mediator and to outline some dynamics in vicious cycles, even though there were minor differences regarding these themes. Significant differences manifested regarding the considerations of “direct pathways” and the “role of perception”. SDH was tendentially described to follow direct pathways on a (neo)-materialism-epistemological foundation. The SDMentH concept on the contrary rested preponderantly on more psychosocial pathways, considering social determinants affecting mental health mediated through perception. This implies significant differences on epistemological and aetiological grounds, in tendency. Hence, this scoping review indicates that SDMentH is distinct from SDH. This might yield relevant implications for policy and prevention planning and eventually also for treatment.FH has carried out the data collection and analysis and wrote the manuscript. MS screened a selection of the manuscript. PK, MS, and ST edited the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.