A scoping review of definitions and conceptualizations of ecosyndemics in syndemic research

BackgroundEcosyndemic research focuses on the role of environmental contextual factors in syndemics. However, there is no consensus on the difference between syndemics and ecosyndemics, as the physical environment is often also included in syndemic studies. This review aims to describe the definitions used, environmental aspects included, and methods employed in ecosyndemic and syndemic studies with an environmental contextual focus. MethodsWe conducted a literature search across five databases. We screened articles in two phases: software-assisted screening and manual full-text screening. To distinguish common elements, ecosyndemic and syndemics definitions were coded. Information regarding methods, factors related to the physical environment, and study results were extracted from the empirical articles. ResultsA total of 169 publications were included, 16 used an ecosyndemic definition, 137 a syndemic one, and 16 a global syndemic definition. Most articles were nonempirical (n=112). Two types of ecosyndemic conceptualizations were distinguished: the extension conceptualization (n=10), which emphasizes the role of the physical environmental context in combination with other contextual factors, and the trigger conceptualization (n=6), which focuses on how environmental factors can trigger a syndemic. The built environment was studied most frequently (n=48), the food environment the least (n=18). ConclusionThe ecosyndemic framework highlights the role of the physical and social environment in worsened population-level health outcomes, which could inform health policies. Ecosyndemic research should focus on a multidisciplinary understanding of it through knowledge triangulation derived from different scientific disciplines to ensure that all aspects of ecosyndemics--clustering, interaction, and social and environmental contextual drivers--are included.