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Background People living in more deprived areas of high-income countries have lower cancer survival than those in less deprived areas. However, associations between individual-level socio-economic circumstances and cancer survival are relatively poorly understood. Moreover, few studies have addressed contextual effects, where associations between individual-level socio-economic status and cancer survival vary depending on area-based deprivation. Methods Using 9276 individual-level observations from a longitudinal study in England and Wales, we examined the association with cancer survival of area-level deprivation and individual-level occupation, education, and income, for colorectal, prostate and breast cancer patients aged 20–99 at diagnosis. With flexible parametric excess hazard models, we estimated excess mortality across individual-level and area-level socio-economic variables and investigated contextual effects. Results For colorectal cancers, we found evidence of an association between education and cancer survival in men with Excess Hazard Ratio (EHR) = 0.80, 95% Confidence Interval (CI) = 0.60;1.08 comparing “degree-level qualification and higher” to “no qualification” and EHR = 0.74 [0.56;0.97] comparing “apprenticeships and vocational qualification” to “no qualification”, adjusted on occupation and income; and between occupation and cancer survival for women with EHR = 0.77 [0.54;1.10] comparing “managerial/professional occupations” to “manual/technical,” and EHR = 0.81 [0.63;1.06] comparing “intermediate” to “manual/technical”, adjusted on education and income. For breast cancer in women, we found evidence of an association with income (EHR = 0.52 [0.29;0.95] for the highest income quintile compared to the lowest, adjusted on education and occupation), while for prostate cancer, all three individual-level socio-economic variables were associated to some extent with cancer survival. We found contextual effects of area-level deprivation on survival inequalities between occupation types for breast and prostate cancers, suggesting wider individual-level inequalities in more deprived areas compared to least deprived areas. Individual-level income inequalities for breast cancer were more evident than an area-level differential, suggesting that area-level deprivation might not be the most effective measure of inequality for this cancer. For colorectal cancer in both sexes, we found evidence suggesting area- and individual-level inequalities, but no evidence of contextual effects. Conclusions Findings highlight that both individual and contextual effects contribute to inequalities in cancer outcomes. These insights provide potential avenues for more effective policy and practice.

The importance of context in behavioral interventions is undeniable, yet few intervention studies begin with a systematic investigation of the contextual factors that influence the behavior in question. This is largely due to the lack of a reliable method for doing so. In recognition of this gap in the field, we have developed a procedure called the Choice Context Exploration that uses machine learning tools to examine the contextual factors that influence a targeted behavior. We demonstrate the steps of Choice Context Exploration using the example of the behavioral choice between using stairs or an elevator. Potential contextual factors were identified by laypeople and experts, and two surveys were created to measure both the behavior and choice, as well as the beliefs of participants. We estimated the effect of contextual factors on participants’ behavior and were able to identify the most influential ones in relation to the studied choice. We achieved an accurate prediction of whether participants would choose the stairs or the elevator based on contextual information in 91.43% of cases on previously unseen data. We also found that participants had different beliefs about what influenced their choice in this situation and that they could be divided into different groups based on these beliefs. Our results suggest that the Choice Context Exploration is a useful procedure for collecting and assessing contextual factors in a given choice setting, which can aid in the planning of behavioral interventions by significantly reducing the number of potential interventions that are likely to be effective. Plain Language Summary Examining Contextual Factors in Behavioral Choices This study aimed to address the lack of systematic investigation into contextual factors influencing targeted behaviors in interventions. The researchers developed a procedure called Choice Context Exploration, which employs machine learning tools to examine such factors. Using the example of choosing between stairs and an elevator, potential contextual factors were identified, and surveys were administered to measure behavior, choice, and beliefs. The analysis revealed influential contextual factors and achieved a 91.43% accurate prediction of participants’ choices based on unseen data. Participants held different beliefs, and can be grouped by these beliefs. The study concludes that Choice Context Exploration is valuable for collecting and assessing contextual factors, aiding in behavioral intervention planning by reducing potential interventions. However, limitations include a narrow focus on one behavior and the need for further investigation into generalizability.

The contextual fit of abehavior support plan refers to the extent that the procedures of the plan are consistent with the knowledge, values, skills, resources, and administrative support of those who are expected to implement the plan. This study used a concurrent multiple baseline design across four participants to assess the presence of a functional relation between introduction of the Contextual Fit Enhancement Protocol, an intervention designed to improve contextual fit, and (a) an increase in fidelity of support plan implementation and (b) improved student behavior. Results indicate that following implementation of the Contextual Fit Enhancement Protocol, support plan implementation fidelity increased and student problem behavior decreased. In addition, teachers participating in the study rated the contextual fit intervention process as effective and efficient. Limitations and implications for future research, practice, and training are discussed.

Background HIV Pre‐Exposure Prophylaxis (PrEP) has been available in Wales since 2017. The coronavirus disease (COVID‐19) pandemic impacted UK sexual health services, leading to a reduction in service provision. There is a lack of research on the experiences of PrEP users during this time. Objective We aimed to explore the experiences of PrEP users in Wales following the introduction of COVID‐19 pandemic measures. Methods We conducted a secondary data analysis of two prior interview studies (DO‐PrEP and UPrEP). Data collection was undertaken between May 2020 and February 2021 using remote interviewing. Semi‐structured interviews were conducted. Participants were ≥18 years of age, residents of Wales, current or previous PrEP users, and men who have sex with men (MSM). Reflexive thematic analysis was conducted. Results A total of 32 interviews were included in the analysis. Themes include the following: (1) PrEP use during COVID‐19, (2) sexual behaviour and relationship changes following COVID‐19 restrictions, (3) NHS service provision during the COVID‐19 pandemic, and (4) wider contextual effects of the pandemic. Participants reported a change in PrEP use (pausing or switching to event‐based PrEP). Participants reported reduced access to clinics and appointments. Support for changing to event‐based PrEP was varied. Social isolation resulted in varied responses to lockdown rules, especially in later lockdowns. Conclusion This study provides patient perspectives on the challenges the COVID‐19 pandemic posed to PrEP use and access. It offers insights into the broader support needs around PrEP use when an individual's circumstances change. Flexible models of PrEP provision, which can be adapted to the patient's needs, will be essential as PrEP delivery extends into the wider community. Patient and Public Contribution Both the DO‐PrEP and UPrEP studies received input from various stakeholders in the design of the topic guides for the study; these included public lay members, PrEP users, PrEP providers, and individuals involved with HIV advocacy and policy.

We use an empirically grounded simulation model to examine how initial smoking prevalence moderates the effectiveness of potential interventions designed to change adolescent smoking behavior. Our model investigates the differences that result when manipulating peer influence and smoker popularity as intervention levers. We demonstrate how a simulation-based approach allows us to estimate outcomes that arise (1) when intervention effects could plausibly alter peer influence and/or smoker popularity effects and (2) across a sample of schools that match the range of initial conditions of smoking prevalence in U.S. schools. We show how these different initial conditions combined with the exact same intervention effects can produce substantially different outcomes—for example, effects that produce smoking declines in some settings can actually increase smoking in others. We explore the form and magnitude of these differences. Our model also provides a template to evaluate the potential effects of alternative intervention scenarios.

Background Contextual cues play an important role in facilitating behaviour change. They not only support memory but may also help to make the new behaviour automatic through the formation of new routines. However, previous research shows that when people start a new behaviour, they tend to select cues that lack effectiveness for prompting behaviour. Therefore, it is important to understand what influences cue selection, as this can help to identify acceptable cues, which in turn could inform future behaviour change interventions to help people select cues that best fit their context and so ensure continued repetition. Methods We conducted a qualitative study to investigate what cues people select, how, and what influences their decisions. We recruited 39 participants and asked them to take vitamin C tablets daily for 3 weeks and later interviewed them about their experience. Quantitative habit strength and memory measures were taken for descriptive purposes. Results Cue selection was primarily influenced by a desire to minimise effort, e.g. keeping related objects at hand or in a visible place; prior experience with similar behaviours (regardless of whether the cues used in the past were reliable or not); and beliefs about effective approaches. In addition, we found that suboptimal remembering strategies involved reliance on a single cue and loosely defined plans that do not specify cues. Moreover, for many participants, identifying optimal cues required trial and error, as people were rarely able to anticipate in advance what approach would work best for them. Conclusions Future behaviour change interventions that rely on routine behaviours might fruitfully include the provision of educational information regarding what approaches are suboptimal (single factors, vaguely defined plans) and what is most likely to work (combining multiple clearly defined cues). They should also assess people’s existing beliefs about how to best remember specific behaviours as such beliefs can either enhance or inhibit the cues they select. Finally, interventions should account for the fact that early failures to remember are part of the process of developing a reliable remembering strategy and to be expected.

The present investigation extends research on Gene × Environment interactions and youth risk behavior by linking multilevel contextual factors, such as community disadvantage and protective parenting practices, to both parental and youth dopamine D4 receptor (DRD4) genotypes. We expected community disadvantage to influence youth risk behavior via a series of indirect effects involving protective parenting and youth's planful future orientation when both parents’ and youth's DRD4 status was considered. Genetic moderation processes also were tested to determine whether they conformed to a diathesis–stress or a differential susceptibility model. Hypotheses were investigated with data from 361 rural African American youth and their parents assessed 3 times when youth were ages 16 to 19. Community disadvantage interacted with parental DRD4 status to predict low levels of protective parenting. Protective parenting, in turn, interacted with youth DRD4 status to forecast increases in youth's planful future orientations, a proximal influence on changes in risk behavior. The Parental DRD4 × Community Disadvantage interaction, but not youth DRD4 × Protective Parenting, conformed to a differential susceptibility model. Indirect effect analyses revealed a significant indirect path linking community disadvantage to youth risk behavior through a series of multilevel Gene × Environment interaction processes.

International climate accords like the Paris agreement set the broad agenda for climate action. To realize their potential however, it is vital to ‘get the context right’ so that environmentally significant behaviors can be repeated over time. This paper reviews the extant interdisciplinary literature to outline how a richer understanding of the interrelationships between individual and contextual factors is required to cultivate behavioral change. In this manner, 18 distinct behavioral determinants are identified. We argue that the likelihood of behavioral change and overall environmental impact are thereby reliant on the complex interaction between individual behavior and the multiple distinct layers of context that frame its expression. Our behavior-informed approach thus helps to explain processes of behavioral change more fully, establish the types of obstacles that exist, and delineate a fuller and more substantial role for individual-driven behavioral change that is able to build on the initial impetus of global-level frameworks.

The present studies examined implicit contextual cueing in adolescents and adults with Autism Spectrum Disorder (ASD). In Study 1, 16 individuals with ASD and 20 matched individuals with typical development completed a contextual cueing task using stimulus-identity cues. In Study 2, 12 individuals with ASD and 16 individuals with typical development completed a revised version of the contextual cueing task, using both stimulus-identity cues and global spatial-configuration cues. The results suggest that when only stimulus-identity cues were provided, individuals with ASD had difficulty with implicit contextual cueing (Study 1). However, when both stimulus-identity and spatial-configuration contextual cues were provided, individuals with ASD demonstrated successful contextual cueing (Study 2). Nuances in implicit learning and clinical implications are discussed.

Characterizing the relationship between form-based linguistic knowledge and representation of context has long been of importance in the study of on-line language processing. Recent experimental research has shown evidence of very rapid effects of referential context in resolving local indeterminacies on-line. However, there has been no consensus regarding the nature of these context effects. The current paper summarizes recent work covering a range of phenomena for which referential contrast has been shown to influence on-line processing, including prenominal and post-nominal modification, focus operators, and intonational focus. The results of the body of work suggest that referential context effects are not limited to situations in which the linguistic form of the utterance directly specifies the point of contact with context. Rather, context effects of a pragmatic, Gricean nature appear to be possible, suggesting the relationship between linguistic form and context in rapid on-line processing can be of a very indirect nature.