Introduction Children diagnosed with a pediatric brain tumor (PBT) are at risk for deficits that can affect their quality of life (QoL). One potential avenue to target the QoL of these patients is physical activity (PA). This study aimed to evaluate the association between parent and child PA levels, and the unique contributions of these outcomes to children’s overall and domain-specific QoL in children with PBT, including those in active treatment and remission. Methods In this cross-sectional study conducted in a hospital setting, we measured PA levels of 36 parent-child dyads through self-reported weekly minutes of PA. We assessed children’s overall and domain-specific (i.e. physical, emotional, social, school functioning) QoL with the PedsQL Generic Core Scales. We analyzed our data descriptively and using correlation analyses to explore relationships between child and parent PA levels. We used an Actor-Partner Interdependence Model (APIM) to evaluate whether child and parent PA were associated with children’s QoL. Results In 36 parent-child dyads, we found a strong positive correlation between parent and child (mage = 10.44 ± 4.09; range 5−18 years) PA levels (r = 0.802, p < 0.001). The APIM revealed excellent model fit indices (χ²(8) = 3.40, p = 0.907, CFI = 1.000, TLI = 1.208, RMSEA = 0 (90% CI[0, 0.079]), SRMR = 0.077) and a significant actor effect, with child PA being significantly positively associated with the child’s overall QoL (β = 0.779, FDR-corrected p = 0.05, 95% CI[0.019, 0.108]). There was no partner effect, however, as parents’ PA was not associated with the child’s overall or domain-specific QoL (median FDR-corrected p = 0.290). Conclusion This study demonstrated that in children diagnosed with a PBT, child PA levels are significantly associated with their overall QoL, and parents’ PA is not associated with their child’s QoL. These findings highlight the need for clinical interventions that promote PA that is tailored to the needs of this population. Future research should explore approaches for family-based interventions to enhance QoL.

ABSTRACT Background Mobile health (mHealth) applications are becoming increasingly popular for delivering mental health support, yet insights on how to tailor them effectively for autistic individuals remain limited. Methods This paper describes the co-creation process of the Stress Autism Mate (SAM), a free, evidence-based stress management application for autistic adults. Results Development was guided by the five stages of the Design Thinking framework: Empathise, Define, Ideate, Prototype, and Test. Various challenges encountered over seven years of development are outlined, along with the iterative refinements made to address them. Based on continuous feedback from autistic adults, development emphasised a minimalist, predictable interface, essential personalisation options, and stress-related insights readily applicable to daily life. Discussion The lessons learned may offer practical guidance for designing tailored mHealth applications for autistic adults and other populations with specific needs or preferences.

ABSTRACT Objective: A key concept in health psychology is behavioral maintenance. However, previous research has struggled to establish shared conceptualizations and operational definitions. This study aimed to contribute to this debate by examining whether a simple conceptual proposition of physical activity maintenance as ‘the performance of physical activity according to an intended target threshold over a specific period of observation’ can be empirically supported, and under which boundary conditions. Specifically, we explored different formulations of two boundary conditions: activity threshold and timescale of change. Methods: We analyzed 350 time series (length = 182 days) of moderate-to-vigorous physical activity (MVPA) collected daily with Fitbit from participants in a weight loss intervention. All participants reported an intention to engage in at least 150 min of MVPA per week over the following six months. Activity thresholds were defined based on each participant’s baseline MVPA. Generalized Additive Models were used to model individual trajectories across varying timescales (7, 14, 28, and 56 days). Results: At short timescales (7–14 days) trajectories crossed the threshold frequently, indicating high variability. At longer timescales (28–56 days) trajectories were more stable, with participants tending to stay either above or below their threshold, aligning with our target conceptualization of maintenance. Relaxing the threshold by 10–20% relatively increased the proportion of participants classified as maintainers, though maintenance remained uncommon for participants with higher thresholds. Conclusions: Our findings provide initial evidence on which boundary conditions support detecting physical activity maintenance as conceptually defined. These results underscore the importance of systematically testing boundary conditions to advance understanding of behavioral maintenance. Trial registration: ClinicalTrials.gov identifier: NCT03907462.

Objective Non-adherence to immunosuppression medication (ISM) is common in kidney transplant recipients (KTRs), despite being associated with poor clinical outcomes. Understanding potentially modifiable contributors to non-adherence is essential for developing effective interventions. This study explored the relationship between components of the Common-Sense Model (CSM), including illness perceptions (graft-specific and of kidney disease more broadly) and beliefs about ISM, as well as perceived behavioural control (PBC), and total, intentional and unintentional ISM non-adherence in KTRs. Methods and measures A cross-sectional observational study was conducted with N = 296 KTRs. Participants completed self-report measures including the Brief Illness Perception Questionnaire, Beliefs about Medicines Questionnaire, questions assessing PBC, and the Medication Adherence Report Scale. Hierarchical binary logistic regression analyses were conducted to examine the explanatory value of variables on adherence outcomes. Results Over half of participants (57%) reported any indication of non-adherence. Unintentional non-adherence was reported more frequently (54%) than intentional non-adherence (14%). Combining CSM components with PBC best explained variance in total (Nagelkerke R 2 = 19.8%), intentional (Nagelkerke R 2 = 15.5%), and unintentional non-adherence (Nagelkerke R 2 = 19.3%). Conclusion Enhancing PBC around taking ISM may offer a valuable intervention target, particularly when addressed alongside CSM components to reduce both intentional and unintentional non-adherence.

ABSTRACT Background Despite the benefits smartphone technology offers, our phones are available to us almost all of the time and excessive smartphone use may be linked to problematic behaviours and mental illness symptoms. Therefore management of our daily screen time is integral to wellbeing in the digital era. Design A recent randomised controlled trial (NCT06353451) randomised university students (N = 111) to either reduce their daily phone use (intervention) or continue use as normal (control). Using a cross-over design, the control group later received the intervention. The results demonstrated that reducing smartphone use to <2hrs/day improved self-reported mental health, as compared to a control group with no change in screentime. Methods The aim of this paper was a secondary analysis of daily heart rate variability data (HRV) measured with Fitbit devices to assess physiological changes during the intervention. A total of 45 participants provided baseline, intervention and follow-up HRV data. Mental health variables were measured using standardised questionnaires. Results A linear multilevel regression indicated HRV significantly declined during the intervention compared to baseline. HRV during the intervention significantly correlated with craving and sleep quality. Conclusions: This may suggest that participants are experiencing a response akin to withdrawal from a behavioural addiction. Importantly, participants reported improved mental wellbeing, suggesting benefits of controlled smartphone use, but our findings provide a deeper insight into the processes underlying reduction in smartphone use and suggest craving and sleep hygiene may be important factors to additionally consider in future studies. Trial registration: ClinicalTrials.gov identifier: NCT06353451.

Background This randomized pilot study examined the relationships between objectively measured sleep characteristics and food cravings in adolescents and examined whether a brief sleep intervention would reduce food cravings from baseline to post-intervention compared to an active control group. Methods A community sample of 51 adolescents aged 13−17 years old were randomized to complete a cognitive behavioral therapy (CBT) sleep intervention or a study skills control intervention. The sleep intervention involved one telehealth CBT session, while the control group completed one telehealth CBT session to improve study skills. Sleep was assessed using actigraphs and adolescents reported on food cravings using a validated questionnaire at baseline and post-intervention. Results Sleep fragmentation, but not sleep duration, was a significant predictor of food cravings at baseline, controlling for age, β = 0.35, t = 2.41, p = 0.02, 95% CI [0.01–0.11]. The sleep intervention significantly reduced food cravings from baseline to post-intervention compared to the control group (significant time × intervention interaction, F(1, 45) = 4.30, p = 0.044, partial η² = 0.09, medium effect). Conclusions The results of this study support the relationship between poor sleep quality and more frequent food cravings, as well as the preliminary efficacy of a brief, CBT-based sleep intervention in reducing food cravings. The brief and digital delivery of this intervention enhances its accessibility.

ABSTRACT Background Clinical guidelines recommend addressing alcohol and tobacco use simultaneously, but few providers offer brief alcohol interventions routinely, and these behaviours are often treated separately. While several interventions targeted dual use, there remains a gap in identifying behaviour change techniques (BCTs) designed to modify processes controlling dual use. Objective To identify commonly used BCTs in interventions targeting both alcohol and tobacco use, their modes of delivery, and explore which BCTs are associated with smoking cessation and/or alcohol reduction. Methods Following Cochrane recommendations, a rapid review to identify BCTs showing promise for reducing dual use was conducted. Using an eligibility criteria, we retrieved relevant papers from databases and used the Behavioural Change Taxonomy V1 tool to identify BCTs showing promise. Results Thirty-eight articles of the initial systematic search of 2987 papers met the criteria for full article review. Goal setting, action planning, and pharmacological support were the most common BCTs identified. Most studies (33, 87%) had a low or moderate risk of bias. Of these 33 studies, 13 studies (39%) reported statistically significant outcomes of reduction or cessation in smoking behaviour and alcohol consumption. Face to face (25, 76%) was the most common intervention delivery method. Conclusion Clinical trials identify goal setting, action planning and problem solving to address the dual use of tobacco and alcohol. Systematic reviews and meta-analyses are needed to evaluate the true impact of these programmes. Future studies should minimally include these BCTs and study the interactional effects of these BCTs on the efficacy of the intervention.

ABSTRACT Background Disordered eating behaviors are a growing public health concern among adolescents, with implications for both physical and psychological well-being. The availability of culturally valid assessment tools is critical for early identification and prevention. Objectives This study aimed to (i) examine how self-esteem, sport participation, and Body Mass Index (BMI) predict eating disorder symptoms in a large cohort of Tunisian schoolchildren, and (ii) assess the psychometric properties of the Arabic version of the Eating Disorder Examination Questionnaire (EDE-Q). Methods A total of 1,748 adolescents (629 boys, 1119 girls; mean age ≈ 16.8 years) from Zaghouan, Tunisia, completed self-report assessments of BMI, self-esteem (Rosenberg Self-Esteem Scale), physical and sports activity, and disordered eating (Arabic EDE-Q). Correlation, regression, and confirmatory factor analyses were conducted. Results Eating disorders were negatively associated with physical activity (boys: r = −0.456; girls: r = −0.260; p < 0.01) and self-esteem (β = 0.651; p < 0.001) and positively associated with BMI (β = 0.219; p < 0.001). The Arabic EDE-Q demonstrated a robust four-factor structure and high internal consistency (CFI = 0.996; RMSEA = 0.026). Gender differences were observed, with girls reporting higher disordered eating scores. Conclusions Self-esteem and BMI are significant predictors of disordered eating, underscoring the need for integrated public health strategies that promote mental well-being and healthy body image among adolescents. The validated Arabic EDE-Q offers a reliable tool for screening and monitoring disordered eating in Arabic-speaking youth populations, enabling early intervention in school-based mental health programs.

ABSTRACT Background and objective Overweight and obesity have been associated to metabolic and psychological diseases, even at young ages. Most studies have analysed separately the physical and mental correlates of high BMI and global approaches are required for detailed comprehensive descriptions of the diverse endophenotypes. This study aimed to identify empirical clusters among overweight and obese young adults based on their nutritional patterns and mental well-being (depression, anxiety and stress levels). Methods The sample comprised N = 188 university students. Two-Step cluster explored the existence of empirical groups based on dietary intake, psychological and cardiometabolic state, and gender. Results The 4-cluster model was selected as the optimal solution. Men and women were separately distributed within the clusters. Cluster 2 obtained the highest mean in carbohydrates eating, while cluster 1 achieved the highest mean in fats and sodium ingesting. The worse psychopathological state was associated to cluster 4, nearly followed by cluster 2. The highest BMI and metabolic risks were associated to clusters 2 and 4 (also the highest proportion of metabolically unhealthy obese individuals). Conclusions Evidence-based and cost-effective public health programs aimed at preventing obesity should promote healthy eating patterns, as well as mental well-being and resilience.

Background Only a small number of research have evaluated marital dissatisfaction and adverse health and psychosocial outcomes in lower-resourced countries. The aim of the study was to estimate the long-term associations of marital dissatisfaction with adverse health outcomes using four waves (7 years) of the national community-dwelling Health, Aging, and Retirement in Thailand (HART) study in people 45 years and older (also stratified by sex) from 2015 to 2022. Methods HART data from the 2015, 2017, 2020, and 2022 waves were analysed, including community-dwelling individuals aged 45 and above (average age 65.1 years) who indicated marital dissatisfaction (analytic pooled sample: n = 10790 observations). Marital dissatisfaction was measured using validated scales. The time-variant causes and outcomes were evaluated using linear fixed effects regression. To determine the hazard ratios (HRs) and evaluate the associations between marital discontent and 7-year mortality in the entire sample, a Cox proportional hazards regression model was applied. Results The average marital dissatisfaction score (0−10) was 1.8 (SD = 2.3). Fixed effects regressions showed that marital dissatisfaction was associated with low self-reported mental health, depressive symptoms, low quality of life, loneliness, functional limitations, poor self-rated physical health, low mastication, low exercise frequency, low meal skipping, and high subjective life expectancy. In addition, marital dissatisfaction was associated with all-cause mortality. Conclusions Our knowledge of the connection between marital discontent and negative health outcomes—four markers of physical and mental health, including mortality—is improved by this longitudinal study. Measures of marriage happiness and the health advantages of marital education programs for couples should be part of health promotion initiatives for the aging population as a whole.