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Konsumsi UPF dalam jumlah besar yang terjadi secara terus menerus dalam jangka waktu panjang dapat berdampak pada peningkatan risiko obesitas dan berbagai penyakit tidak menular seperti diabetes tipe 2, kardiovaskular, sindrom metabolik, dan kanker. Penelitian ini bertujuan untuk mengetahui hubungan paparan iklan media sosial, kebiasaan membaca label pangan, dan teman sebaya dengan konsumsi UPF pada mahasiswa gizi Universitas Halu Oleo. Penelitian ini merupakan penelitian observasional analitik dengan pendekatan kuantitatif dan menggunakan desain cross sectional. Populasi penelitian adalah mahasiswa aktif Program Studi gizi Universitas Halu Oleo. Sampel penelitian ini terdiri dari 165 mahasiswa gizi yang diambil menggunakan teknik stratified random sampling. Data dikumpulkan dengan pengisian kuesioner. Data dianalisis secara univariat dan bivariat. Analisis bivariat menggunakan uji Chi-Square. Hasil penelitian menunjukkan 62,4% responden terpapar iklan media sosial, 69,7% responden memiiki kebiasaan membaca label pangan baik, 57% responden terpengaruh teman sebaya, dan 52,1% responden sering mengonsumsi produk UPF. Analisis bivariat menunjukkan terdapat hubungan antara paparan iklan media sosial (p=0,024) dan teman sebaya (p=0,013) dengan konsumsi UPF. Tidak terdapat hubungan kebiasaan membaca label pangan dengan konsumsi UPF (p=0,3397). Paparan iklan media sosial dan teman sebaya memiliki hubungan signifikan dengan konsumsi UPF. Kebiasaan membaca label pangan tidak ada hubungan dengan konsumsi UPF.

Program Makanan Bergizi Gratis (MBG) merupakan salah satu upaya pemerintah dalam meningkatkan status gizi anak sekolah dasar melalui penyediaan makanan sehat dan bergizi. Namun, keberhasilan program ini tidak hanya ditentukan oleh ketersediaan makanan, tetapi juga dipengaruhi oleh perilaku konsumsi siswa. Perilaku konsumsi makanan pada anak sekolah dipengaruhi oleh berbagai faktor, seperti pengetahuan gizi, pengaruh teman sebaya, peran guru, rasa makanan, dan kebiasaan makan di rumah. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang memengaruhi perilaku konsumsi Makanan Bergizi Gratis (MBG) pada siswa Sekolah Dasar Negeri 66 Kota Jambi. Penelitian ini menggunakan pendekatan kuantitatif dengan desain cross sectional. Populasi penelitian adalah seluruh siswa kelas IV dan V SDN 66 Kota Jambi sebanyak 231 siswa. Sampel penelitian berjumlah 96 responden yang dipilih menggunakan teknik stratified random sampling. Data dikumpulkan melalui kuesioner yang telah diuji validitas dan reliabilitasnya. Analisis data dilakukan secara univariat dan bivariat menggunakan uji Chi-Square. Hasil penelitian menunjukkan bahwa sebagian besar siswa memiliki pengetahuan gizi yang baik. Analisis bivariat menunjukkan bahwa tidak terdapat hubungan yang signifikan antara pengetahuan gizi (p=0,868) dan pengaruh teman sebaya (p=0,229) dengan perilaku konsumsi MBG. Namun, terdapat hubungan yang signifikan antara peran guru (p=0,005), rasa makanan (p=0,045), dan kebiasaan makan di rumah (p=0,005) dengan perilaku konsumsi MBG. Faktor yang paling memengaruhi perilaku konsumsi siswa adalah rasa makanan dan dukungan lingkungan sekitar

Perilaku merokok pada remaja masih menjadi permasalahan kesehatan yang dipengaruhi oleh rendahnya motivasi serta kurangnya dukungan positif dari teman sebaya. Edukasi kesehatan melalui media audio visual dinilai efektif karena mampu menyampaikan informasi secara menarik, mudah dipahami, dan meningkatkan kesadaran siswa terhadap bahaya rokok.Penelitian ini bertujuan untuk mengetahui pengaruh edukasi kesehatan melalui media audio visual terhadap motivasi, dukungan teman sebaya, dan perilaku merokok pada siswa SMPN 12 kendari tahun 2026. Jenis penelitian ini adalah penelitian kuantitatif dengan pendekatan pre-experimental menggunakan rancangan one group pretest-posttest design. Populasi penelitian berjumlah 796 siswa dengan sampel sebanyak 89 responden yang diambil menggunakan teknik proportional random sampling. Pengumpulan data dilakukan menggunakan kuesioner pre-test dan post-test, kemudian dianalisis menggunakan uji Paired Sample T-Test. Hasil penelitian menunjukkan rata-rata motivasi meningkat dari 18,18 menjadi 28,75, dukungan teman sebaya meningkat dari 19,72 menjadi 27,93, serta perilaku merokok meningkat dari 19,30 menjadi 29,47 setelah diberikan intervensi. Hasil uji statistik diperoleh nilai (p-value = 0,000) (<0,05) yang menunjukkan adanya pengaruh edukasi kesehatan melalui media audio visual terhadap motivasi, dukungan teman sebaya, dan perilaku merokok pada siswa SMPN 12 Kendari Tahun 2026. Kesimpulan penelitian ini adalah edukasi kesehatan melalui media audio visual efektif dalam meningkatkan motivasi, dukungan teman sebaya, dan perubahan perilaku merokok pada siswa.  

This study aims to determine the effect of digital literacy and peer conformity on the critical thinking of grade X students at SMKN 31 Jakarta. The study used a quantitative method with a survey approach. The study population was 217 students, while the research sample was 141 respondents obtained using the Slovin formula. The data collection technique was carried out by distributing questionnaires using a Likert scale. Data were analyzed using the Structural Equation Modeling-Partial Least Square (SEM-PLS) method with the help of the SmartPLS application. The results showed that digital literacy had a positive and significant effect on students' critical thinking. This was evidenced by the path coefficient value of 0.436, the T-statistic value of 6.988, and the P-value of 0.000. Peer conformity also had a positive and significant effect on students' critical thinking with a path coefficient value of 0.447, the T-statistic value of 7.290, and the P-value of 0.000. Furthermore, the R-square test results obtained a value of 0.445, indicating that digital literacy and peer conformity variables were able to explain 44.5% of the critical thinking variable, while the remaining 55.5% was influenced by other factors outside the study. Based on these results, it can be concluded that digital literacy and peer conformity have a positive and significant influence on the critical thinking of 10th-grade students at SMKN 31 Jakarta.

Adolescents are considered a vulnerable group to nutritional problems because they experience rapid physical growth accompanied by lifestyle changes and unhealthy eating habits. The increasing prevalence of overweight and obesity among teenagers has become a major public health concern that requires serious attention. This study was conducted to examine the relationship between peer influence, the frequency of eating out, and fast-food consumption habits with the incidence of overweight among students at SMAN 1 Surabaya. The research applied a quantitative approach using an analytical observational design with a cross-sectional method. A total of 81 students participated in the study and were selected through proportional random sampling. Data were collected using questionnaires, SQ-FFQ forms, and anthropometric measurements, then analyzed using the Chi-Square statistical test. The findings revealed significant associations between peer influence, eating out frequency, and fast-food consumption habits with the occurrence of overweight among adolescents. Students who more frequently consumed meals outside the home and regularly ate fast food showed a greater tendency to experience overweight and obesity. These results indicate that social environments and modern dietary patterns contribute to the increasing prevalence of overweight among adolescents. Therefore, nutrition education and healthy lifestyle promotion should be strengthened through the involvement of schools, families, and peer groups.

This research explores hedonistic lifestyle patterns as a social reality that grows within peer interactions, both in adolescence and adulthood. The investigation applies a qualitative descriptive literature review by examining national scholarly publications issued from 2016 to 2026. The findings indicate that hedonistic tendencies should not be interpreted merely as individual choices to seek enjoyment. Instead, they emerge from social processes shaped by interaction, peer influence, and shared norms that develop within a group. In this context, peer circles function as influential socialization agents, encouraging conformity so individuals can be accepted and avoid social exclusion. The study also identifies differences in underlying motivations across life stages. Among adolescents, hedonistic behavior is closely linked to identity exploration and self-definition. For adults, however, it is more associated with maintaining self-image, signaling social standing, and displaying markers of achievement. Overall, environmental dynamics, the expansion of consumer-oriented culture, and intensive exposure to social media play significant roles in strengthening this phenomenon in Indonesia.

Burnout merupakan masalah kesehatan mental yang semakin meningkat dan dapat berdampak pada kualitas hidup serta produktivitas individu. Salah satu faktor yang diduga berperan dalam kejadian burnout adalah dukungan sosial. Namun, hasil penelitian terkait hubungan keduanya masih menunjukkan ketidakkonsistenan. Penelitian ini bertujuan untuk menganalisis hubungan antara dukungan sosial dengan kejadian burnout. Penelitian ini menggunakan desain observasional analitik dengan pendekatan cross-sectional. Sampel penelitian berjumlah 324 responden yang dipilih menggunakan teknik total sampling. Data dikumpulkan melalui kuesioner dan dianalisis menggunakan uji Chi-square serta perhitungan Odds Ratio (OR). Hasil penelitian menunjukkan bahwa sebagian besar responden memiliki dukungan sosial kurang baik (75,3%) dan mengalami burnout (60,5%). Analisis bivariat menunjukkan bahwa tidak terdapat hubungan yang signifikan antara dukungan sosial dengan burnout (p = 0,87), dengan nilai OR sebesar 1,03 yang menunjukkan hubungan sangat lemah. Disimpulkan bahwa dukungan sosial tidak berhubungan secara signifikan dengan kejadian burnout. Oleh karena itu, diperlukan penelitian lebih lanjut untuk mengidentifikasi faktor lain yang lebih berpengaruh terhadap burnout.  

This study aims to determine the relationship between peer socialization and the level of discipline among high school students. The method used in this study is a quantitative survey research method. The data analysis technique uses the Kendall’s Tau correlation statistical test. The research results show a coefficient value of 0.119 with a p-value (sig.) of 0.026 (< 0.05). This means there is a positive and significant relationship between peer socialization and students’ level of discipline. The operationalized hypothesis that there is a positive relationship between the two variables is proven. The higher the intensity of students socializing with their peers, the higher their level of discipline. Peer socialization is one of the factors influencing students’ discipline because high-intensity socialization between students and their peers can lead to behavioral imitation. When students are in a disciplined peer environment, they are likely to become disciplined themselves. Conversely, when students are in a less disciplined peer environment, they are likely to be less disciplined. So, respondents with high levels of student discipline are those who have a high intensity of socialization with peers.

This study examines the influence of peer groups on impulsive buying, with financial anxiety as a mediator among college students using e-commerce or social media in Paser Regency. A quantitative cross-sectional design was employed and analysed using PLS-SEM with SmartPLS. The sample consisted of 282 active students selected through purposive sampling. Three reflective constructs were measured using a 5-point Likert scale: peer influence (8 items), financial anxiety (8 items), and impulsive buying (9 items). The measurement model assessment confirmed adequate convergent and discriminant validity (AVE = 0.545–0.715; Cronbach’s alpha = 0.883–0.954; Composite Reliability = 0.905–0.957; HTMT < 0.25). The structural model results showed that H1 was supported, indicating that peer influence had a significant positive effect on financial anxiety (β = 0.252; T = 4.036; p < 0.001). However, H2 was not supported, as financial anxiety had no significant effect on impulsive buying (β = 0.069; T = 0.815; p = 0.415). H3 was also not supported, showing that peer influence had no significant direct effect on impulsive buying (β = −0.007; T = 0.076; p = 0.939). Furthermore, H4 was not supported, indicating that financial anxiety did not mediate the influence of peer groups on impulsive buying (indirect effect = 0.017). These findings suggest that, in the context of students in remote areas, the hypothesised SOR mechanism does not operate fully: peer pressure triggers financial anxiety, but this anxiety does not translate into impulsive buying.

This study aims to analyze the dynamics of peer pressure as a factor that forms problematic behavior in adolescents. This study uses a literature review method with more than 19 relevant journals. The selected journals followed inclusion criteria that focused on adolescents, peer pressure, and problematic behaviors within a specific time frame. The results of the study showed that peer pressure contributes to problematic behaviors such as aggressive behavior and social violence (bullying, cyberbullying, aggressiveness, disruptive behavior), addictive and health-risking behaviors (smoking, alcohol consumption/drinking behavior), violations of academic/school norms (truancy, juvenile delinquency), online/sexual risky behavior (cybersex), and internal psychological problems (decreased self-confidence). The psychosocial dynamics found included the need for acceptance, group conformity, low self-control, and weak family support. These influences can be direct or indirect through the internalization of group values. These findings confirm that problematic behaviors are not formed singularly, but from complex interactions between individual factors and the social environment. Therefore, prevention efforts require a collaborative approach between families, schools, and the community.

Bullying in school environments is a crucial issue that causes physical and emotional harm to victims and perpetuates cycles of aggression, with peer pressure identified as one of the main predictors. This study aims to address gaps in the literature regarding the specific role of peer pressure in shaping bullying behavior in Indonesian schools through a Systematic Literature Review (SLR) approach, analyzing 21 research articles published between 2021 and 2026 from Google Scholar. The findings indicate that adolescents with high peer pressure are 3.48 times more likely to engage in bullying, and high peer conformity contributes to 44.4% of bullying cases. However, peer influence is dual-sided—positive interactions based on empathy and mutual respect can reduce bullying behavior. The impacts of bullying include depression, anxiety, and declining academic performance in victims, as well as legal issues and difficulties in interpersonal relationships in perpetrators. The study concludes that collaboration among various stakeholders is essential to manage peer group norms and dynamics as part of culturally contextual bullying prevention efforts in Indonesia.

This study aims to synthesize various research findings regarding the role of peer support in increasing adolescent self-confidence and synthesize various guidance and counseling interventions and the role of social support in increasing self-confidence. The method used is a comprehensive review of the results of action research (PTBK), experiments, and correlational studies from various levels of education. The findings show that classical guidance services with Problem-Based Learning (PBL) and brainstorming methods, group guidance with creative media, peer support significantly increase students' courage in expressing opinions using a literature review from several scientific journals, this study analyzes how social interaction, peer counseling, and social support from peers contribute to the formation of positive self-concepts in students. The results can be seen that peer support plays a significant role in increasing adolescent self-confidence through various forms of support, such as respect for opinions, social acceptance, and positive interactions in groups. Adolescents who receive high social support from peers often have better courage and confidence than those with low support. This study provides implications that schools need to develop peer-based interaction programs to create an environment that supports students' psychological development. In conclusion, a holistic approach that combines professional services and strengthening the social environment is very effective for students' personal development.

First-year university students undergo a transitional phase from the school environment to the academic, social, and emotional demands of higher education. This transition often triggers stress when not supported by an adequate social environment. Peer support plays an essential role in this adaptation process by providing emotional support, information, and a sense of belonging. Positive peer relationships can help students manage academic pressure, whereas poor peer interactions may increase the risk of stress. Therefore, peer support serves as a protective factor in maintaining the psychological well-being of first-year students. This study employed a quantitative approach with a cross-sectional design. Data were collected using the Peer Support Questionnaire (PSQ) and the Student-Life Stress Inventory (SSI) from 130 first-year students of the Faculty of Pharmacy, UNISSULA. The sampling technique used was simple random sampling. Data were analyzed using the Gamma correlation test to determine the relationship between the variables. The Gamma test revealed a p-value of 0.000 (<0.05), indicating that the alternative hypothesis was accepted, meaning there is a significant relationship between peer support and stress levels among first-year students. The correlation coefficient of –0.737 indicates a strong negative relationship, suggesting that higher peer support is associated with lower stress levels. There is a significant and strong relationship between peer support and stress levels among first-year students at the Faculty of Pharmacy, UNISSULA.

Anemia merupakan suatu kondisi dimana jumlah sel darah merah atau hemoglobin (Hb) seseorang kurang dari normal. Anemia adalah suatu keadaan dimana jumlah sel darah merah atau konsentrasi pengangkut oksigen dalam darah (hemoglobin) tidak mencukupi kebutuhan fisiologis. Remaja putri dikatakan anemia apabila dari hasil pemeriksaan kadar Hb kurang dari 12 gr%. Tujuan kegiatan ini adalah untuk mencegah anemia pada remaja dengan pemberian tablet penambah darah yang terintegrasi dengan olahraga pada remaja. Metode yang dipakai pada kegiatan ini adalah edukasi langsung dan diskusi kelompok terfokus, olahraga/senam terjadwal yang dipandu kader remaja, pembagian tablet Fe dan pemantauan kadar Hb berkala. Hasil dari kegiatan ini yaitu peserta yang hadir berumur 12 tahun dengan prosentase 30,43%, peserta dengan umur16 tahun  prosentase 21,74%, selebihnya peserta berumur 13 tahun (13,04%), 14 tahun (8,70%), 15 tahun (13,04%), 17 tahun (4,35%) dan 18 tahun (8,70%). Jumlah target posyandu remaja di Desa Randusari yaitu 35 peserta, tetapi yang hadir hanya 23 peserta. Hal ini terjadi karena ada beberapa peserta yang belum bisa menghadiri posyandu remaja karena teman sebaya tidak bisa hadir di posyandu remaja. Peserta posyandu di Desa Randusari memiliki kadar hemoglobin normal sejumlah 73,91%, anemia ringan 13,04% dan anemia sedang 4,35%.

The transition period from adolescence to early adulthood is marked by a search for identity and life direction, which often triggers a quarter-life crisis among Gen Z students. This qualitative research with a case study approach explores how peer social support helps Gen Z students navigate the quarter-life crisis in the Social Youth Community. The findings reveal that students experience seven dimensions of the quarter-life crisis: difficulty in making decisions, loss of hope, negative self-perception, feeling stuck, restlessness, psychological stress, and excessive anxiety. Peer social support is manifested in three ways: affective assistance through empathetic listening, informative support through advice and guidance, and tangible help through physical presence and time commitment. The perceived benefits include feeling valued, emotional strength through care and affection, peace of mind that reduces restlessness, and an understanding of friendship networks that foster optimism. This research contributes to the development of a peer-based mentoring approach in higher education to effectively help Gen Z cope with the quarter-life crisis.

The purpose of this study was to determine whether there is an influence of parental income and peer environment on the consumer behavior of students studying in the Management Study Program at the Indonesian Christian University of Toraja. Data collection procedures for this study included observation, questionnaires, and documentation. The method used in this study was a quantitative method using the Simple Linear Regression method and processed using SPSS 26. The sample collection technique used was nonprobability sampling with a purposive sampling technique where the sampling technique was based on certain criteria or considerations. The results of the study showed that the t-test on the Parental Income variable had a calculated t value > t table with a value of (3.409) < (1.664). The Parental Income variable has a positive and significant influence on the Consumer Behavior of Students Studying in the Management Study Program at the Indonesian Christian University of Toraja. The t-test on the Peer Environment had a calculated t value > t table with a value of (4.279) < (1.664). The Peer Environment has a positive and significant influence on the Consumer Behavior of Students Studying in the Management Study Program at the Indonesian Christian University of Toraja. The f-test has a significance value of 0.000 < 0.05, which means that parental income and peer environment have a simultaneous and significant influence on the consumer behavior of students in the Management Study Program at the Indonesian Christian University of Toraja.

Permasalahan yang menimpa remaja dikatakan kompleks yang berkaitan dengan pergaulan, perilaku pacaran, prestasi yang bermasalah di sekolah, dan lain-lain. Berdasarkan hasil survei didapatkan data bahwa seperempat remaja menyatakan mulai berpacaran pada usia 15 tahun dan gaya pacaran yang dilakukan seperti berpegangan tangan, ciuman, dan ada beberapa remaja yang pernah meraba bagian tubuh yang sensitif pada pasangannya. Faktor dominan perilaku seksual di pedesaan adalah teman sebaya sedangkan di perkotaan dipengaruhi oleh pengetahuan. Kurangnya bimbingan dan konseling dari orang tua menyebabkan remaja melakukan perilaku seksual yang berakibat pada kehamilan, akibat yang lain seperti remaja tertular peyakit mematikan, dan tingginya kasus kriminalitas. Berdasarkan analisa tersebut maka dukungan keluarga berbasis family centered care yang melibatkan orang tua dalam mengatasi permasalahan remaja. Tujuan dari PKM ini adalah meningkatkan dukungan kelurga berbasis family centered care dalam mencegah perilaku seksual beresiko pada remaja. Metode yang digunakan adalah ceramah dan konseling tentang dukungan keluarga berupa emosional, informasional, penghargaan dan instrumental. Hasil kegiatan menunjukkan bahwa peserta baru mengetahui bentuk-bentuk dukungan yang harus diberikan kepada anak remaja, selain itu ada beberapa peserta yang membiarkan anaknya pacaran tanpa dibekali pengetahuan yang cukup, selama pelaksanaan peserta antusias sehingga banyak pertanyaan yang muncul tentang perilaku seksual beresiko pada remaja. Hasil kegiatan tersebut diharapkan dapat menjadi salah satu strategi dalam mencegah dan menguarangi perilaku seksual beresiko pada remaja.

Komunikasi adalah cara menyampaikan informasi kepada orang lain. Dalam berkomunikasi, etika sangat penting, terutama bagi mahasiswa saat berinteraksi dengan dosen. Namun, terdapat beberapa mahasiswa saat ini yang menganggap dosen sebagai teman sebaya, sehingga penerapan etika yang seharusnya dilakukan kepada dosen semakin terabaikan. Penelitian ini bertujuan untuk mengetahui bagaimana komunikasi antara mahasiswa FPMIPA UPI dan dosen, serta bagaimana etika bisa mencegah ketidakharmonisan komunikasi. Metode yang digunakan adalah kuantitatif dengan kuesioner Google Form. Hasil dari penelitian ini 1) mengetahui waktu menghubungi dosen, 2) hambatan yang dirasakan mahasiswa, 3) mengetahui dampak setelah berkomunikasi dengan dosen. Sebagai kesimpulan, etika dalam berkomunikasi dengan dosen dapat mempererat hubungan serta membangun kepercayaan, yang akan mengurangi konflik.

Indonesia's adolescent pregnancy prevalence necessitates comprehensive determinant identification for evidence-based preventive strategy formulation. This research analyzes correlations between reproductive health knowledge, parental role functioning, and peer influence on teenage pregnancy among female adolescents in Ciseeng Health Center, Bogor Regency, West Java Province. Cross-sectional design employed among 65 adolescents aged 15-19 years during October 2024-January 2025 using stratified random sampling. Data collection utilized validated questionnaires based on WHO Adolescent Sexual and Reproductive Health Indicators, Parental Monitoring and Support Scale, and Peer Pressure Inventory with Cronbach Alpha (α=0.84; 0.81; 0.79). Demographic characteristics showed 60% aged 17-19 years, 40% aged 15-16 years, with 55.4% experienced pregnancy validated through medical records. Univariate analysis identified knowledge deficiency (64.6%), parental dysfunction (63.1%), and high peer influence (66.2%). Chi-Square analysis confirmed associations of low knowledge (p=0.001; OR=3.5; 95% CI=1.8-6.7), inadequate parental roles (p=0.002; OR=3.2; 95% CI=1.6-6.1), and dominant peer influence (p=0.001; OR=3.8; 95% CI=1.9-7.2) with adolescent pregnancy. Multivariate logistic regression identified peer influence as strongest predictor (AOR=3.80; 95% CI=1.67-8.65).

This study investigates the role of peer social support in enhancing self-confidence among adolescents at the Amal Wanita An-Nur Orphanage in Depok, Indonesia. Adolescents living in orphanages often experience psychological challenges, including low self-confidence and limited social interaction, which can affect their personal growth and future orientation. The objective of this research is to explore how peer social support contributes to strengthening self-confidence and to identify the forms, driving factors, and obstacles of such support. A qualitative descriptive method was applied through observation, interviews, and documentation, involving seven informants consisting of the orphanage head, caregivers, and adolescents. Findings show that three types of support emotional, appraisal, and informational play a dominant role in fostering self-confidence. Emotional support was expressed through empathy and active listening, appraisal support was provided through recognition of achievements and encouragement, while informational support involved advice and constructive feedback. Meanwhile, instrumental and network support were less emphasized due to limited resources. Despite the presence of barriers such as feelings of inferiority, miscommunication, and differences in emotional readiness, peer support proved effective in motivating adolescents, strengthening their resilience, and fostering positive self-perception. The implications suggest the need for structured peer-support programs, facilitated by caregivers and social workers, to maximize adolescents’ potential and prepare them for future challenges. Thus, this study demonstrates that peer social support serves not only as a protective factor but also as a social learning tool that shapes adolescents' interpersonal skills. Targeted programs can increase self-confidence, expand social relationships, and create a more supportive and inclusive nursing home environment.