Alcohol Behaviors Research Articles

Examining the Utility of the Theory of Planned Behavior in Studying Intention to Reduce Drinking Among High-Risk College Students in the U.S.

ABSTRACT Background Alcohol consumption remains a significant public health issue among U.S. college students. Though prior research has examined behavioral and theoretical factors that predict heavy drinking, less attention has focused on exploring factors concerning alcohol reduction. Purpose The current study identified Theory of Planned Behavior (TPB) constructs associated with high-risk college students’ intent to reduce alcohol use. Methods High-risk college students (n = 822) from a large U.S. public university completed an online survey assessing their alcohol behaviors and the following TPB constructs: attitude, norms, perceived behavioral control, and intention to reduce alcohol use. Results After accounting for important covariates, a multivariate regression demonstrated that students’ attitude and norms were significantly associated with their intention to reduce alcohol use, while perceived behavioral control was not. Altogether, the TPB model explained 61% of the variance in their intention. Discussion The findings underscore the significant role theory, more specifically student’s attitudes and norms, can play in influencing intention to reduce alcohol use. Translation to Health Education Practice Incorporating norms and TPB communication strategies into campus alcohol intervention programs and aligning these efforts with competencies from the National Commission for Health Education Credentialing Inc. can enhance the design, implementation, and evaluation of theory-driven interventions.

Supply of Alcohol in Early Childhood Leads to Higher Rates of Drinking in Adolescence

Abstract Background Adolescents often experience their first encounter with alcohol at home, provided by parents who perceive it as a means of safeguarding their children against later alcohol-related issues. However, research shows that parental supply of alcohol is a risk factor for adolescent drinking. Notably, existing studies solely focused on parental supply during adolescence, neglecting the prospective evaluation of parental alcohol provision during early childhood on later alcohol use. Methods The data came from the Czech part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC), a longitudinal birth cohort study (N = 5,777). Mothers reported on the frequency of offering alcohol to children when children were 3, 5, 7, and 11 years old. The outcome was adolescent alcohol use at ages 15 and 18, reported by adolescents, mothers, and pediatricians. Control variables included sex, maternal education, family structure, and parental alcohol consumption. Results Three classes of children were identified based on parental alcohol supply: abstainers (75.5% of sample), infrequent sippers (16.2%), and frequent sippers (8.3%). Parental drinking increased the risk of both infrequent and frequent sipping. These classes were entered into two structural models (age 15 and age 18 alcohol use modeled as latent factors), alongside covariates. Compared to abstainer class, infrequent and frequent childhood sippers exhibited significantly higher alcohol consumption at age 15 (β = .21, p < .001; β = .25, p < .001, respectively) and age 18 (β = .11, p < .05; β = .24, p < .001, respectively). Conclusions This study represents the first prospective investigation quantifying early childhood alcohol exposure and its subsequent association with adolescent alcohol consumption. Findings emphasize the influence of family dynamics on alcohol behaviors, underscoring the necessity for targeted preventive measures, particularly within families with higher parental alcohol consumption. Key messages • Offering alcohol to children at ages 3-11, even infrequently, significantly increases the risk of more frequent drinking at ages 15 and 18, compared to those with no early exposure. • Parents who drink are more likely to have children who sip alcohol early, leading to higher alcohol consumption in adolescence. Prevention efforts should focus on family habits and early education.

A global research agenda for understanding the role of alcohol consumption in older women’s lives

Abstract Background The alcohol industry has targeted women for profit and resisted global efforts to address the impact of alcohol on women’s health. Scholars have called for research that moves beyond individual determinants of alcohol consumption in women, to investigate the range of social, environmental, and commercial factors that may contribute to women’s alcohol attitudes, risk/benefit perceptions, and consumption behaviours. While qualitative research has explored younger and midlife women’s perspectives on alcohol consumption, there is a notable lack of research focusing on older women. Methods This study investigated the factors that influence how older Australian women drinkers conceptualised the role of alcohol in their lives, using data collected from an online qualitative survey with n = 144 women aged 60-88 years. Qualitative responses were analysed using a ‘Big Q’ reflexive approach to thematic analysis. Results Participants perceived alcohol consumption as a socially accepted and normalised activity within Australian culture. For some women, alcohol served as a coping mechanism for life changes, such as retirement, and for managing stressful situations. Alcohol also formed part of daily routines and rituals, such as having wine with dinner. Participants had personal expectancies regarding ‘responsible drinking’, often aligning with alcohol industry messaging and resulting in a reduced perception of alcohol-related risks. Conclusions This research provides global lessons for future public health research examining the factors that may shape older women’s alcohol consumption beliefs and behaviours. The authors consider the unique needs and potential vulnerabilities of older women drinkers, and how these may be potentially exploited by the alcohol industry. Further public health research and policy attention should focus on the impact of alcohol industry messaging on older women’s knowledge, attitudes, and behaviours about alcohol risks and harms. Key messages • This research highlights the role of alcohol in older women’s lives, urging further public health research and policy attention to prevent alcohol-related harms in older women. • Older women’s perceptions of responsible alcohol consumption mirror the ambiguous messaging employed by the alcohol industry, highlighting the necessity for targeted interventions.

Two personalities of an alcoholic (alcoholic disease from the point of view of the doctrine of psychic realities)

The article examines the phenomenon of two personalities of an alcoholic. Research into alcoholism has shown that in alcoholic reality a person behaves differently than in ordinary life. He commits a number of acts that he usually avoids for various reasons; at the same time, the alcoholic experiences unusual sensations and states. If we look at these observations from the point of view of the teaching developed by the author about "psychic realities", then an assumption about a certain similarity between the reality of dreams and alcoholic reality suggests itself. Indeed, in both realities a person realizes desires that he usually cannot realize for a number of reasons (the so-called "blocked desires"); in both cases, a person's consciousness is weakened and altered; to realize blocked desires in both cases, the psyche builds in consciousness the events necessary for this, which the person experiences. In both cases, there is an unusual logic of "life" (in the first case, the logic of dreams, in the second, the logic of alcoholic experiences). Just as after dreams a person wakes up in another (ordinary) world, and often does not remember at all what he dreamed about, after intoxication a person also comes to his senses without any particular consequences. The features of alcoholic behavior considered here can be attributed to the phenomenon of multiple personality. A sober person is one personality, and a drunk person is another. Other features of the two personalities of an alcoholic are also considered.

Association Between Diet and Mental Health Outcomes in a Sample of 13,887 Adolescents in Canada.

The high prevalence of mental disorders among adolescents calls for community-based and population-level prevention strategies. Diet is an important intervention target for primary prevention of mental disorders among adolescents. We used data from a large longitudinal study of Canadian adolescents (aged 14-18 y) to examine prospective associations between diet and mental health outcomes. We estimated the effect of diet (ie, consumption of vegetables and fruit and sugar-sweetened beverages [SSBs]) at baseline on depressive symptoms, anxiety symptoms, and psychological well-being (measured by the Center for Epidemiologic Studies Depression Scale-Revised, Generalized Anxiety Disorder 7 scale, and Flourishing Scale, respectively) and at 1-year follow-up in a sample of 13,887 Canadian secondary school students who participated in the 2017-2018 and 2018-2019 cycles of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary (COMPASS) behavior study. We applied linear mixed-effects methods informed by a directed acyclic graph. Sensitivity analyses assessed the robustness of the effect estimates to unmeasured confounding variables. Baseline SSB consumption was associated with greater severity of depressive (β = 0.04; 95% CI, 0.01-0.06) and anxiety (β = 0.02; 95% CI, 0-0.05) symptoms, particularly among male students, and poorer psychological well-being (β = -0.03; 95% CI, -0.05 to -0.01) at follow-up. Baseline vegetables and fruit consumption was positively associated with psychological well-being (β = 0.06; 95% CI, 0.03-0.10) but not other mental health outcomes at follow-up. Our results support the notion that diet should be part of comprehensive mental health prevention and promotion interventions to reduce the prevalence of mental health disorders among adolescents.

Local area crime and alcohol consumption: longitudinal evidence from Australia

BackgroundAlcohol misuse is a major public health issue. Understanding factors that contribute to alcohol misuse or risky drinking behaviour is important for policy. This study examined if crime rates in...

Closing the gaps in alcohol behavior change: A real-world study of a digital intervention.

Closing the gaps in alcohol behavior change: A real-world study of a digital intervention.

Characteristic of High-Risk Behaviours Related to Alcohol and Illicit Drug Use and their Associated Factors among Adolescents in Middle and High School

<div class="WordSection1"><p><strong>Background:</strong> Use of narcotics, psychotropic and addictive substances (NPA) in adolescents has become one of the major social problems we are facing in society and it gives a negative impact. This study was done to determine the characteristics and factors that influence high-risk behaviour of NPA use in adolescents in middle and high school, also introducing CRAFFT questionnaire as an early screening tool for alcohol an illicit drugs use.</p><p><strong>Methods:</strong> Quantitative study (validated questionnaire) was conducted among 514 subjects aged 12-18 years old. CRAFFT questionnaire was used to detect a high-risk behavior of alcohol and illicit drugs use and self-reported questionnaire used to determine the risk factors of NPA.</p><p><strong>Result:</strong> Most participants (19,6%) were involved in high-risk behaviour of alcohol and illicit drugs, with the majority was males (12,4%). This study showed smoking behaviour (23,8%), drinking alcohol (15,8%) and illicit drugs use (13,6%). The type of drugs being used were cannabis (52,7%), tramadol (15,2%), dextromethorphan (10,7%) and methamphetamine (6,3%). CRAFFT questionnaire has a good internal consistency with Cronbach’s α 0,73. Education level, authoritarian parenting style, unharmonious parents, peer pressure or threat, and extracurricular activities were factors that influenced high-risk behavior of alcohol and illicit drug use</p><p><strong>Conclusions:</strong> Early detection, comprehensive treatment, and intervention of risk factors of NPA use are needed. CRAFFT can be use as one of the screening tools for detection of alcohol and illicit drugs use in adolescents.</p></div>

Income inequality and comorbid overweight/obesity and depression among a large sample of Canadian secondary school students: The mediator effect of social cohesion

BackgroundComorbid overweight/obesity (OWO) and depression is emerging as a public health problem among adolescents. Income inequality is a structural determinant of health that independently increases the risk for both OWO and depression among youth. However, no study has examined the association between income inequality and comorbid OWO and depression or tested potential mechanisms involved. We aimed to identify the association between income inequality and comorbid OWO and depression and to test whether social cohesion mediates this relationship. MethodsWe used data from the 2018–2019 Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking and Sedentary behavior (COMPASS) project. Our sample was composed of 46,171 adolescents from 136 schools distributed in 43 census divisions in 4 provinces in Canada (Ontario, Alberta, British Columbia, and Quebec). Gender-stratified multilevel path analyses models were used to examine whether income inequality (Gini coefficient) was associated with comorbid OWO and depression and whether the association was mediated by school connectedness, a proxy measure for social cohesion. ResultsThe direct effect between income inequality and OWO-depression comorbidity was not significant. However, income inequality was significantly associated with increased risk of comorbidity via social cohesion. One standard deviation increase in the Gini coefficient was associated with a 9% and 8% increase in the odds of comorbidity in females (OR=1.09; 95% CI=1.03, 1.16) and males (OR=1.08; 95% CI=1.03, 1.13). ConclusionPolicies aimed at reducing income inequality, and interventions to improve social cohesion, may contribute to reducing the risk of OWO-depression comorbidity among adolescents.

Electromagnetic interference shielding behavior of flexible PVA composite made using betel nut husk biocarbon and steel microwire in E, F, I, and J band spectrum

AbstractThis study investigates the electromagnetic interference (EMI) shielding behavior of a flexible polyvinyl alcohol (PVA) composite fabricated using betel nut husk biocarbon and steel microwire in the E, F, I, and J band spectrum. The incorporation of steel microwire into the PVA based composite is novel approach since it provides flexibility along with good mechanical strength. The fabrication process involves the solution casting method, and the composite is characterized according to American society of testing and materials (ASTM) standards. The research focuses on analyzing dielectric behavior, EMI shielding effectiveness, and mechanical properties. Results indicates that, the composite with 5 vol.% of biocarbon and 5 vol.% of micro metal wire, exhibits exceptional relative permittivity of 7.6, 6.9, 6.3, and 1.5 for E, F, I, and J frequency bands and same composition delivers exceptional electromagnetic shielding with total shielding values of 17.7 dB, 25.5 dB, 31.7 dB, and 38.6 dB for E, F, I, and J frequency bands. In mechanical characteristics, composite with 5 vol.% of biocarbon and 5 vol.% of micro metal wire, exhibits high tensile strength of 73 MPa with lower elongation percentage of 109.2% and shore‐D hardness of 40, respectively. Thus, the inclusion of betel nut husk biocarbon and steel microwire into the PVA matrix enhanced the overall EMI shielding properties along with mechanical properties. These flexible EMI shielding composites could be used in applications such as defense, telecommunication, drones, and electronic gadget making segments.Highlights Flexible polyvinyl alcohol (PVA) composite is made with steel microwire and betel nut husk biocarbon. Biocarbon is derived from betel nut husk for first time and used as EM wave absorber. Composites were made via simple solution casting method for high flexibility index. Composite contains 5 vol.% biocarbon and 5 vol.% micro metal wire, shows high relative permittivity 7.6 for E frequency bands. The composites have high tensile strength of 73 MPa with a low elongation percentage of 109.2% and a shore‐D hardness of 40.

A cue reactivity experiment: Exposure to images of alcoholic beverages and social contexts on alcohol cravings, motivations, attitudes, approval, and behavior

The incentive-sensitization theory of addiction postulates that relevant cues can trigger alcohol cravings, tendencies, and related outcomes. Additionally, consistent with the encoding specificity principle and social impact theory, social contexts depicting people can activate pro-alcohol reactions and tendencies. This randomized experiment tested the cue reactivity effects of exposure to images depicting variations in the number of people consuming alcoholic or nonalcoholic beverages on alcohol-related cravings and outcomes. The sample consisted of 594 adult alcohol users who passed manipulation checks. Participants were randomly assigned to a condition in a 2 (beverage type cue manipulation: alcoholic vs. nonalcoholic) × 3 (social context cue manipulation: beverage-only [no people] vs. solitary drinking [1 person] vs. social drinking [2 or more people]) factorial design and primed with a series of photographs. Dependent variables measured alcohol cravings, alcohol motives, alcohol attitudes, alcohol approval, and alcohol behavior. Factorial MANCOVA and ANCOVAs were performed. Main effects for the social context manipulation were found. Specifically, the social drinking condition compared to the beverage-only condition induced significantly higher pro-alcohol cravings, attitudes, and behaviors. The beverage type manipulation did not influence the dependent variables. The findings offer insights that visual cues depicting social drinking scenarios activated alcohol-related cravings and outcomes, regardless of whether the beverages shown were alcoholic or nonalcoholic. This priming experiment helps to understand the social mechanisms underlying cue reactivity and offers implications for advancing cue-based alcohol interventions.

Electrical behavior of polyvinyl alcohol filled by neodymium oxide and cadmium oxide nanoparticles synthesized via laser ablation for optoelectronic devices

Electrical behavior of polyvinyl alcohol filled by neodymium oxide and cadmium oxide nanoparticles synthesized via laser ablation for optoelectronic devices

Alcohol, Violence, and Injury-Induced Mortality: Evidence from a Modern-Day Prohibition

Abstract This paper evaluates the impact of a sudden and unexpected nationwide alcohol sales ban in South Africa. We find that this policy causally reduced injury-induced mortality in the country by at least 14%. We argue that this estimate constitutes a lower bound on the true impact of alcohol on injury-induced mortality. We also document a sharp drop in violent crimes, indicating a tight link between alcohol and aggressive behavior in society. Our results underscore the severe harm that alcohol can cause and point toward a role for policy measures that target the heaviest drinkers in society.

Alcohol marketing on social media: young people’s exposure, engagement and alcohol-related behaviors

Aim Alcohol promotions in conventional channels are associated with subsequent alcohol consumption in young people, but little is known about young people’s exposure to digital alcohol marketing. This exploratory study investigated young people’s exposure to, and engagement with, alcohol marketing on social media platforms, variations across sociodemographic groups and associations with alcohol-related behaviors. Method An online survey was conducted with 3698 participants aged between 14 and 20 years (M = 17.1; SD = 1.8) in New Zealand. The survey asked about social media use and exposure to and engagement with alcohol product marketing on their preferred platforms, alcohol consumption patterns, hazardous drinking (AUDIT-C scores) and purchasing alcohol online. Results Nearly three-quarters of the sample who responded to questions about exposure to alcohol marketing (70.6%; n = 1541) reported seeing marketing on at least one social media platform, with older respondents (18–20 years) more likely to report exposure than younger respondents (14–17 years); no differences were found across gender, ethnicity or socioeconomic groups. Over one-third of those who responded to questions about engagement (40.7%; n = 850) reported engaging with alcohol marketing and this varied by age, gender and ethnicity. Recall of exposure to alcohol marketing was less strongly associated with online purchase and having ever drunk alcohol than was engagement with alcohol marketing, which was also associated with hazardous drinking. Conclusions Engagement with alcohol marketing was more strongly related to alcohol behaviors, including online purchasing, having ever drunk alcohol, and drinking at hazardous levels, than exposure. These findings also demonstrated inequitable patterns of engagement with alcohol marketing on social media associated with these novel algorithmic marketing methods.

The thermodynamic behavior of binary systems isoamyl acetate and alcohol through experimental measurements and modeling

The thermodynamic and transport properties are experimentally determined for three binary liquid mixtures consisting of isoamyl acetate and different alcohols at ambient pressure and in temperature range. From measured density, viscosity and refractive index are calculated excess molar volume, viscosity and refractive index deviations. Isentropic compressibility and excess molar Gibbs free energies of viscous flow are determined combining density with speed of sound and viscosity data. All mentioned derived properties are used to analyze the changes taking place in investigated binary systems causing deviations from the ideal mixture. Additionally, partial molar volumes and excess partial molar volumes, as well as thermal expansion coefficient, were calculated. The results are discussed in terms of chemical structure of used compounds and the influence of the alcohol present in the mixture on the mixture behavior. The study showed that higher influence has branching of the alcohol molecule and position of the –OH group rather than the length of the primary alcohol chain. Beside the experimental part, the modeling of the excess molar volume and viscosity was also performed, and the percentage deviations are used as the indicator of model performance in terms of model approach, predictive or correlative, and number of model parameters, one to three parameters optimized.

Parental health risk preferences, socio-economic status and offspring's alcohol behavior in South Africa

Alcohol consumption represents a widespread behavior with detrimental effects on both individuals and society. Understanding the factors influencing offspring alcohol consumption is crucial for identifying potential risk factors and informing prevention and intervention strategies. Existing empirical literature underscores the intricate interplay of biological, environmental, and social factors in shaping offspring alcohol consumption. Building upon this foundation, this study investigates the determinants of health risk preferences, such as alcohol consumption, among South African offspring, utilizing a dataset comprising the 2008, 2010, 2012, and 2014 waves of the National Income Dynamic Study (NIDS). Logistic regressions are employed to model the determinants of offspring alcohol consumption, while ordered logits are utilized to assess the impact of parental drinking on offspring drinking frequency. The findings indicate that parental drinking significantly influences offspring alcohol intake. Specifically, daughters' alcohol consumption is influenced solely by maternal drinking, whereas sons are affected by both parents' alcohol consumption. Furthermore, while daughters from currently disadvantaged backgrounds may exhibit higher tendencies towards alcohol consumption, those with mothers from such backgrounds and fathers from more affluent backgrounds are less likely to engage in such behavior. Additionally, the results suggest that male offspring from higher-income brackets are less likely to consume alcohol, yet sons of wealthy fathers are more likely to adopt such lifestyles.

Heart rate variability: A primer for alcohol researchers

Problem alcohol drinking remains a major cost and burden for society. Also, rates of problem drinking in women have dramatically increased in recent decades, and women are at risk for more alcohol problems and comorbidities. The purpose of this commentary is to discuss the potential utility of cardiac measures, including heart rate (HR) and HR variability (HRV), as markers of individual and sex differences in the drive to drink alcohol. We recently used cardiac telemetry in female and male adult rats to determine whether different cardiac markers, including HR and HRV, would differently predict alcohol and anxiety-like behavior across the sexes. Indeed, female behaviors related to HRV measures that indicate more parasympathetic (PNS) influence (the “rest and digest” system). In contrast, male behaviors are associated more with sympathetic (SNS) indicators (the activation system). Remarkably, similar sex differences in PNS versus SNS engagement under challenge are seen in several human studies, suggesting strong cross-species convergence in differential autonomic regulation in females and males. Here, we describe the larger challenges that alcohol addiction presents, and how HRV measures may provide new biomarkers to help enhance development of more individualized and sex-specific treatments. We briefly explain the physiological systems underlying cardiac PNS and SNS states, and how specific HRV metrics are defined and validated, especially why particular HRV measures are considered to reflect more PNS versus SNS influence. Finally, we describe hormonal influences and sex differences in brain circuits related to cardiac autonomic regulation. Together, these findings show that HR and HRV have potential for uncovering key underlying mechanisms of sex and individual differences in autonomic drivers, which could guide more personalized treatment.

The electrical transport property and gas detection behaviour of polyvinyl alcohol and γ-Fe2O3 nanocomposite film

This paper presents the electrical and gas detection behaviour of polyvinyl alcohol (PVA)/γ-Fe2O3 nanocomposite films. The physical characterization includes X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), energy-dispersive X-ray spectroscopy (EDX), and UV–Visible spectroscopy. The analysis of both the dc resistivity and ac conductivity using Correlated Barrier Hoping (CBH) conduction process shows that the conductivity enhances with the decreasing of activation energy in case of the PVA/γ-Fe2O3 nanocomposite film which is the indication of interfacial defect states. The current voltage study at various temperatures follows the thermoionic emission model of Schottky Barrier diode. Moreover, the dielectric constant enhances for PVA/γ-Fe2O3 nanocomposite film, which indicates homogeneous distribution of γ-Fe2O3 nanoparticles within PVA matrix and the aggregation of trapped charges found in interface develops an interfacial polarization. As a result, the gas adsorption capacity of the nanocomposite film increases which improves the signal-to-noise ratio, leading to higher gas detection sensitivity.

Recovery from Addiction on a University Campus – a UK Perspective

ABSTRACT Between 30 and 40% of 18-year olds in England, Wales and Northern Ireland enter tertiary education (university) each year. Young adulthood (ages 15 to 25) is the usual period in which problems with alcohol, drugs or other behaviors begin to emerge, and yet these issues have received limited study in the UK. Government policy dictates that a full continuum of treatment and recovery services should be available in each area of the country, but uptake of these services by university students appears to be limited. In this discussion paper we describe the background to, and components of, the Collegiate Recovery Program (CRP), an initiative that has grown rapidly in the USA in the past decade. We then describe how the first UK University-led CRP was set up, before outlining what has been learnt so far and the potential challenges facing this approach.

Barriers, facilitators, and other factors associated with health behaviors in childhood, adolescent, and young adult cancer survivors: A systematic review.

Healthy behaviors are paramount in preventing long-term adverse health outcomes in childhood, adolescent, and young adult (CAYA) cancer survivors. We systematically reviewed and synthesized existing literature on barriers, facilitators, and other factors associated with health behaviors in this population. MEDLINE and PsycInfo were searched for qualitative and quantitative studies including survivors aged 16-50 years at study, a cancer diagnosis ≤25 years and ≥2 years post diagnosis. Health behaviors included physical activity, smoking, diet, alcohol consumption, sun exposure, and a combination of these behaviors (defined as health behaviors in general). Barriers, facilitators, and other factors reported in ≥2 two studies were considered relevant. Out of 4529 studies, 27 were included (n = 31,905 participants). Physical activity was the most frequently examined behavior (n = 12 studies), followed by smoking (n = 7), diet (n = 7), alcohol (n = 4), sun exposure (n = 4), and health behavior in general (n = 4). Relevant barriers to physical activity were fatigue, lack of motivation, time constraints, and current smoking. Relevant facilitators were perceived health benefits and motivation. Influence of the social environment and poor mental health were associated with more smoking, while increased energy was associated with less smoking. No relevant barriers and facilitators were identified for diet, alcohol consumption, and sun exposure. Barriers to healthy behavior in general were unmet information needs and time constraints whereas lifestyle advice, information, and discussions with a healthcare professional facilitated healthy behavior in general. Concerning other factors, women were more likely to be physically inactive, but less likely to drink alcohol and more likely to comply with sun protection recommendations than men. Higher education was associated with more physical activity, and lower education with more smoking. This knowledge can be used as a starting point to develop health behavior interventions, inform lifestyle coaches, and increase awareness among healthcare providers regarding which survivors are most at risk of unhealthy behaviors.