Behavioral Risk Factor Research Articles

Association between mental and physical health with poly-substance use among adults in 33 U.S. states

Abstract Leveraging national data from 33 states in the U.S. for adults 18 and over (N = 347,060), from the 2020-2022 Behavioral Risk Factor Surveillance System (BRFSS), we investigated the association between current self-reported physical and mental health outcomes and substance use, focusing on alcohol, nicotine, cannabis, and all combinations of poly-substance use. Specifically, we conducted multiple weighted linear regression analyses using self-reported outcomes for poor mental and physical health in the last 30 days to examine seven mutually exclusive combinations: alcohol (A) only, nicotine (N) only, cannabis (C) only, A+N, A+C, N+C, and A+N+C. We adjusted for race, sex, age group, education level, and marital status in our analyses. For poor mental health, mean number of days ranged from 3.49 (SD = 7.07) for A-only to 10.39 (SD = 11.54) for N+C and for poor physical health, means ranged from 2.38 (SD = 6.24) to 7.17 (10.61) for N+C. All adjusted β coefficients were significant for poor mental health days, notably with the three highest being 4.36 (95%CI: 3.72-5.00) for C-only, 5.68 (95%CI: 5.06-6.30) for N+C, and 5.27 (95%CI: 4.76-5.79) for A+N+C. For poor physical health, all adjusted β coefficients were significant except for A+N, with the two highest being 2.88 (95%CI: 2.31-3.45) for C-only, 3.16 (95%CI: 2.62-3.69) for N+C, and 1.83 (95%CI: 1.54-2.11) for N-only. Recent poly-substance use containing nicotine and cannabis was both associated with 5+ days of poorer mental health and 3+ days of poorer physical health. Overall, our findings hold implications for informing future policy discourse, shaping public health campaigns, and designing educational initiatives aimed at the link between mental health and substance use. Understanding the dynamics of poly-substance use involving the three most commonly utilized substances globally among adults is critical for crafting targeted interventions. Key messages • Recent poly-substance use (alcohol, nicotine, and cannabis) is related to poorer mental and physical health in the past 30-days. • Recent nicotine and cannabis co-use is associated with 5+ days of self-reported poorer mental health and 3+ days of physical health.

Substance use and risk behaviour patterns among people who inject drugs

Abstract Background Substance use and injecting drug use in particular are related to health damages, reduced quality of life and life expectancy. Injecting drug use is a risk factor for acquiring infectious diseases among people who inject drugs (PWID). The aim of the study was to assess the risk behavior related to the use of intravenous psychoactive substances among PWID in Lithuania. Methods In 2023 a cross sectional study using respondent driven sampling (RDS) of active intravenous drug users (n = 370) was conducted in 5 different sites across Lithuania. RDS is a sampling methodology based on peer-referral in underserved populations that cannot be sampled randomly. Descriptive statistical and regression analyses were conducted using SPSS 23.0. Results 78% of the sample were males, 22% - females. Age mean is 40.6 years, SD-7.7. The first injecting drug was used at the age of 18 (mode). 69% of PWID received drug dependance treatment at least once in life. 70% of the PWID in harm reduction services are also in the substitution therapy programmes. Fentanyl is the main substance for every second respondent which is injected 3 times a day and commonly used with alcohol (64%). 79% of PWID during the last injection used sterile needles and syringes. 45% of respondents reported overdosing during the last 12 months and half of all PWID had naloxone for death prevention. Nearly 70% were tested for TB and syphilis during the last 12 months. Conclusions PWID are mainly males who began injecting drugs at 18 years. Unsafe injecting behaviour (frequency and mode), using alcohol were related to lower participation in health care services for PWID. Main messages • Lower participation in health care services is related to behavioural risk factors. • Ongoing research is needed to assess the factors determining engagement into healthcare of PWID.

Assessment of poor cardiovascular health metrics and related disparities among cancer patients in the United States: a nationwide analysis of over 1.5 million individuals

Abstract Background Cancer, a major health challenge and a leading cause of mortality in the United States, significantly impacts cardiovascular health (CVH). The American Heart Association (AHA) emphasizes several CVH metrics to improve health outcomes, yet disparities in CVH persist nationwide. The specific impact of these disparities on the CVH of individuals with cancer, however, has yet to be fully explored. Purpose This study aims to utilize a detailed and nationally representative dataset from the U.S. to assess the prevalence of poor CVH among adults with a cancer diagnosis, focusing on uncovering sociodemographic disparities. Methods We utilized self-reported data from the Behavioral Risk Factor Surveillance System (2011 to 2019). This system, a state-based telephone survey, gathering data on cancer diagnoses, CVH metrics, and sociodemographic characteristics. We measured CVH through a composite score (0-7) based on the AHA’s seven CVH indicators: hypertension, high cholesterol, smoking, body mass index, diabetes, physical activity, and fruits and vegetables consumption. Individuals scoring between 0 and 2 were defined as having poor CVH. Multivariable generalized linear models within a binomial framework was applied to estimate adjusted prevalence ratios (aPRs) for poor CVH among cancer patients. Results Of 1,575,187 U.S. adults (representing an estimated 154.5 million; 50.7% female, 10.9% non-Hispanic black), 7.8% reported a cancer diagnosis between 2011 and 2019. Adjusted* findings show that having cancer (vs without) associated with a 16% higher prevalence of poor CVH (aPR=1.16; 95% CI [1.12-1.19]). Age-specific analysis revealed increased prevalence of poor CVH in middle-aged (45-64; aPR=3.55) and elderly (≥65; aPR=3.58) cancer patients, indicating a 255% and 358% rise, respectively, with p_interaction <0.001. Female cancer patients experienced a 22% lower prevalence of poor CVH than males (aPR=0.78; p_interaction <0.001). Non-Hispanic black cancer patients faced a 42% higher prevalence of poor CVH than their non-Hispanic white counterparts (aPR=1.42; p_interaction=0.001). Higher-income and education levels associated with 52% and 53% reduced prevalence of poor CVH, respectively (p_interaction <0.001; Table). Conclusions Our research identifies a strong correlation between cancer and deteriorating CVH metrics across U.S. adults, with pronounced variations based on sociodemographic factors. Specifically, the prevalence of poor CVH is substantially higher among cancer patients who are middle-aged, elderly, or identify as non-Hispanic Black, compared to other groups. Conversely, female cancer patients and those with a higher socioeconomic status appear to have a reduced risk of poor CVH. These outcomes stress the critical need for targeted, equitable public health initiatives that address both the cardiovascular and broader health needs of cancer patients, particularly among those most vulnerable.Table1

Exploring the Relationship Between Health Literacy and Alcohol Consumption Patterns in Tuscany

Abstract Introduction Alcohol consumption is a prevalent aspect of social and cultural life worldwide. However, high and binge consumption has become a significant public health concern. Inadequate health literacy (HL) may contribute to poor awareness and/or knowledge regarding the risks of alcohol-related behaviors. However, to date, only a few studies have examined the relationship between HL and different types of alcohol consumption. This study aimed to investigate the relationship between HL, other sociodemographic determinants, and their influence on high and binge consumption among the general population aged 18-69 in Tuscany. Methods The study analyzed data from 2017 to 2022 from a Tuscan population subsample in the Italian Behavioral Risk Factor Surveillance System PASSI. HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6). Results Among the 12,953 interviewees, binge drinking was reported by 8.3%, while high consumption by 3.6% of the entire sample. In the multivariate logistic regression, participants aged between 50 and 69 years with problematic or inadequate HL levels had an increased adjusted odds ratio for high alcohol consumption. Instead, females, individuals older than 34 years, and those of foreign nationality had a reduced odds ratio for binge drinking. Low HL was a predictor of high alcohol consumption but not of binge drinking. Discussion As expected, young males are more likely to engage in binge drinking, while older individuals are more likely to have high consumption. In a challenging period for healthcare system sustainability, it is mandatory to use economic resources efficiently and target the right population with tailored interventions: given that HL impacts on high consumption, research and policy should focus HL interventions specifically on high alcohol consumers. Conversely, educational campaigns aimed at increasing HL in binge drinkers risk to have a lesser impact. Key messages • Health literacy does not influence binge drinking. • Inadequate levels of health literacy predict high alcohol consumption.

Prevalence and Correlates of Cannabis Use among Cancer Survivors

Abstract Background Delaware has legalized marijuana use for both medical and recreational use. This study identified factors associated with cannabis use among adults with chronic relative to individuals without a history of cancer in the First State. Methods Combined data (2020, 2021 and 2022) from the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed for Delaware. Multivariable logistic regression examined individual-level demographic, socio-economic, clinical, and behavioral predictors associated with marijuana use stratified by history of cancer. Results Cannabis use was lower among cancer survivors compared to individuals with no history of cancer (6.76% vs. 13.43%). However, a higher proportion of cancer survivors reported use for medical purposes (75.13% vs. 64.28%). Marijuana use prevalence decreased with age among cancer survivors. After adjusting for sex, age, educational attainment, self-reported race/ethnicity, mental health status and physical health status, current smoking (odds ratio [OR], 4.24 vs. 2.74) and binge drinking (OR, 2.45 vs. 1.75) were associated with cannabis use in both groups. Conclusions Adults with cancer were more likely to use marijuana. Marijuana use prevalence decreased with age. Public perceptions of marijuana is becoming more acceptable. Risk of medical conditions such as cancer increase with age. As such, older adults might also become consumers of marijuana. Clinicians should screen for marijuana use among patients and initiate open discussions with patients about the benefits and risks associated with marijuana. Key messages • Need for ongoing cannabis research to better understand and inform its use for medical purposes. • Development of high-quality standardized education materials and clinical practice guidelines for marijuana use.

8.M. Skills building seminar: Mental health and substance use in Europe

Abstract The impact of social factors on individual and population mental health are well established (Kirkbride, et al., 2024). The same social factors may trigger the substance use behavior developing into substance use disorders. Mental health disorders can contribute to the substance use and substance use disorders with worsening effects over time (EMCDDA, 2016). This association between substance use, substance use disorders and mental health disorders is a key objective for the scientific consideration and policy development. Respective phenomena are universal and a broader perspective would be useful for a better understanding of how the issue of comorbidities of substance use and mental disorders are addressed on a European level. Identification of the substance use problem, especially among populations in vulnerable situations, like migrants, becomes utterly important. Heterogenous systematic reviews show that there is a need for socially and culturally refugee sensitive instruments to measure the substance use in migrants. Oftentimes substance use is followed by the substance use disorders and drug use related infections. Injecting drug use is also a risk factor for having drug use related infections, such as hepatitis B and C, HIV, tuberculosis. Assessment of risk behaviour patterns among people who inject drugs may contribute to a higher participation in treatment and health programmes, reduce the burden of substance use and tackle comorbidities of substance use and mental health disorders. The skill building seminar aims to increase the knowledge and capacities on substance use and comorbidities, applied methodological approaches and tools in different European contexts. This workshop will support researchers, policy makers, public health planners by providing evidence base to address substance use and mental health issues. The added value of this workshop is based on the structure, content and mode of presentations - presentations will be followed by questions from participants and short discussions. The workshop will start with the general introduction to the topic of comorbidities of substance use and mental health disorders (EUPHA-PMH and EUDA). Then the European level perspective on comorbidities of substance use and mental health disorders will be presented including recent policy developments (1 presentation by Linda Montanari, EUDA). It will be supported with research results from the study conducted in Germany on substance use assessment tool development in migrant population (2 presentation by Kim-Julian Behr, Germany) and behavioural risk factor assessment study among people who inject drugs in Lithuania (3 presentation by Marija Jakubauskiene, Lithuania). Key messages • Participatory approach is useful to address the substance use problem in assessment tool development and further monitoring. • Better understanding of comorbidity of substance use and mental disorders leads to a more effective prevention.

Functional disabilities and adverse well-being by COVID-19 and Long COVID history and employment status: 2022 Behavioral Risk Factor Surveillance System.

Long COVID can lead to functional disabilities and decreased well-being and limit the ability to work. No study has yet assessed associations of SARS-CoV-2-infection and Long COVID with specific measures of well-being and functional disabilities among workers by employment status. Using data from the U.S. Behavioral Risk Factor Surveillance System, we assessed the prevalence of functional disabilities and well-being measures among adults of prime working age (25-54 years) by employment status and self-reported COVID-19 and Long COVID history. Within each employment status, we generated adjusted prevalence ratios (aPRs) comparing respondents from each 2022 COVID-19/Long COVID category to respondents in that employment status before the pandemic (2019). In 2022, prevalences of each functional disability except vision and all adverse well-being measures were highest among the 9.2% of respondents reporting a history of Long COVID. For each outcome, prevalences were lowest for workers and highest among those unable to work. 2022 prevalence of cognitive disability (16.4% of employees, 21.4% of the self-employed) and depression (31.2% and 36.4%, respectively) among workers reporting a history of Long COVID were more than double 2019 levels. Increases in cognitive disability and depression were lower but statistically significant among workers not reporting a history of Long COVID. The high prevalence of functional disabilities and adverse well-being among workers reporting a history of Long COVID have implications for workers and employers. Also concerning are smaller increases among workers not reporting a history of Long COVID, given the large number of affected workers. Mitigating the effects of Long COVID on workers will involve efforts in multiple domains: reducing incidence, increasing healthcare practitioner awareness, improving diagnosis and treatments, and increasing employer awareness of best practices for accommodating workers with Long COVID.

Hypertension and diabetes control: faith-based centres offer a promise for expanding screening services and linkage to care in Ghana

BackgroundHypertension and type 2 diabetes mellitus (T2DM) are important contributors to noncommunicable disease related morbidity and mortality. Health systems could benefit from exploring the use of Faith-Based Centres (FBC) to screen and link suspected cases for further care in order to help achieve Sustainable Development Goal (SDG) 3. The study investigated the role of faith-based screening for T2DM and hypertension and the linkage of cases to the healthcare system and examined the care cascade in the Kassena Nankana Districts of Northern Ghana.MethodsWe screened individuals from 6 FBCs for elevated blood pressure and hyperglycaemia. Suspected hypertension and T2DM cases were referred to health facilities for confirmation and subsequently followed them up for 3 months. We assessed the prevalence of behavioural and metabolic risk factors, including hypertension and T2DM, and the retention of referred cases in the healthcare system over follow up period. We further assessed levels of awareness, treatment and adequate control of hypertension and T2DM.ResultsA total of 631 participants were screened, (mean age 49 ± 16years, 73% female) from 6 Faith based Centres. More males than females reported smoking tobacco (14.5% vs. 0.7%) and been physically active (64.5% vs. 52.7%) while more females were obese (29.6 kg/m2 vs. 14.5 kg/m2) and had a higher mean waist circumference (89.0 cm IQR 75-116 cm vs. 84.2 cm IQR 72–107 cm), hip circumference (101.5 ± 10.6 cm vs. 96.4 ± 8.6 cm) and waist-to-hip ratio (0.86 ± 0.1 cm vs. 0.87 ± 0.1 cm) than males. The prevalence of confirmed hypertension and T2DM was 27.9% and 3.5% respectively with no observed sex differences. We observed deficits in the hypertension and T2DM care cascade with reported low awareness, treatment and uncontrolled levels. A 3-month follow up showed a retention in care of 100% in month one and 94.9% in the third month. There was an increase in treatment (39.4% in month-1 and 82.8% in month-3) and control (26.3% in month-1 and 76.3% in month-3) of hypertension and T2DM combined.ConclusionFaith-based centres have the potential to enhance the screening, linkage to the healthcare system, and management of hypertension and T2DM. This improvement over the routine system could lead to earlier diagnoses, a reduction in complications, and decreased premature mortality from cardiovascular diseases. Consequently, these efforts would contribute significantly to achieving SDG 3.

Environmental Justice and Sustainable Development: Cumulative Environmental Exposures and All-Cause Mortality in Colorado Counties

(1) Background: Colorado’s (CO) Environmental Justice mapping tool, CO EnviroScreen, quantifies environmental injustices through “EnviroScreen Scores”, highlighting areas likely affected by environmental health disparities. Identifying the specific scores most strongly associated with mortality could help prioritize interventions and allocate resources to address these issues. This study contributes to sustainable development goals by examining the relationship between environmental justice indicators and population health outcomes. By utilizing the CO EnviroScreen tool, we assess how cumulative environmental exposures and vulnerabilities impact mortality rates, providing insights for sustainable planning and public health policies. (2) Methods: We assessed the cross-sectional association between county-level all-cause mortality rates in CO, using 2019 data from the Colorado Department of Public Health and Environment, and three county-level component scores obtained from CO EnviroScreen: sensitive populations (i.e., health-related outcomes), environmental exposures (e.g., from air, water, noise), and climate vulnerability (i.e., risk of drought, flood, extreme heat, wildfire). A quasi-Poisson generalized linear model was utilized, incorporating covariates (county-level metrics for insufficient sleep, alcohol overconsumption, physical inactivity, and smoking) to explore associations adjusted for behavioral risk factors (n = 64 counties). (3) Results: The analysis revealed that a 10% increase in the “Environmental Exposures” component score was associated with a 3% higher all-cause mortality rate (95% CI: 1.00, 1.05), highlighting the importance of addressing environmental determinants for sustainable community health. No significant associations were observed for the “Sensitive Populations” or “Climate Vulnerability” component scores. (4) Conclusions: This study provides novel evidence of an association between the CO EnviroScreen score, particularly the environmental exposure component, and all-cause mortality rates at the county level in Colorado in 2019. The findings suggest that cumulative environmental exposures may contribute to geographic disparities in mortality risk, even after adjusting for key behavioral risk factors. These results underscore the importance of integrating environmental justice considerations into sustainable development strategies to promote equitable health outcomes and resilient communities. While our study demonstrates the utility of CO EnviroScreen in identifying areas at risk due to environmental factors, it does not establish a direct link to broader environmental justice outcomes. Further research is needed to explore specific environmental exposures and their direct impacts on health disparities to provide a more complete picture of environmental justice in Colorado.

Teeth, Health, and Mind: Understanding the Interplay of Social Determinants and Cognitive Decline in Older Adults.

The study examines the association between social determinants of health, tooth loss, and cognitive decline. Using regression models, the 2020 Behavioral Risk Factor Surveillance data examined the study objective; it included 32,663 older adults who reported on cognitive status. Results suggested that older adults missing more than five teeth or unable to work are 1.61 times and 6.84 times more likely to report cognitive decline, respectively. Older adults with higher education and higher household incomes are less likely to report cognitive decline. Results suggested that older adults with no diabetes or who never smoked are 31% and 39% less likely to report a cognitive decline. The results suggested a significant association between tooth loss and cognitive decline among social determinants of health. A comprehensive approach to affect cognitive decline should include oral and social health strategies.

Young Black Women's Breast Cancer Knowledge and Beliefs: A Sequential Explanatory Mixed MethodsStudy.

Black women under the age of 50 have a 111% higher breast cancer mortality rate than their White counterparts. The breast cancer mortality disparities among young Black women may be due in part to the fact that they are more likely to be diagnosed with late-stage, invasive breast cancer tumors. Psychosocial factors, such as lack of perceived risk for breast cancer, lack of awareness of breast cancer risk factors, and ambiguity about breast cancer screening guidelines are areas that are under investigated among young Black women. The purpose of this study was to identify young Black women's cancer beliefs and level of breast cancer risk knowledge. A sequential explanatory mixed methods study was conducted using quantitative data from the Health Information Trends Survey 6 (HINTS 6) (n = 25) and qualitative data from interviews with young Black female college students (n = 13). The results of the quantitative data analysis were used to guide the development of the qualitative interview guide. Data regarding participants' cancer beliefs, cancer risk factor knowledge, perceived cancer risk, and ambiguity about cancer screening behaviors were analyzed. The findings indicated young Black women have low perceived risk of developing cancer. Most participants were not aware of cancer recommendations that were targeted towards women under the age of 40. In addition, knowledge about lifestyle behavior risk factors for breast cancer was relatively low. Our findings underscore the importance of developing, disseminating, and implementing breast cancer education interventions that are targeted towards young Black women.

General hospital patients’ attitude towards systematic health risk behavior screening and intervention

BackgroundSystematic counseling on behavioral health risk factors (HRFs) may be suitable to promote health among general hospital patients. This study aimed to investigate the openness of patients towards systematic screening and intervention of HRFs, its relation to actual participation in a multi-behavioral intervention, and whether socio-economic characteristics, HRFs and health indicators are related to approval.MethodsAll 18- to 64-year-old patients hospitalized in five medical departments at the University Medicine Hospital Greifswald in Germany were asked between May and July 2022 to participate in a survey and in a subsequent pre-post intervention study. Among all eligible patients, 225 (78.9%) participated in the survey. Patients’ approval of systematic screening and intervention of HRFs was assessed using five statements with a total sum score of 0–20 (i.e., scores of 0–6, 7–13, 14–20 referring to low, medium and high approval). Associations with intervention participation, socio-economic, behavioral and health-related patient characteristics were analyzed using logistic and multivariable linear regression analyses.ResultsThe mean total approval of screening and intervention was 13.8 (SD = 4.8). Of the 125/ 73/ 16 patients with high/ medium/ low approval, 88.0%/ 78.1%/ 50.0% participated in the subsequent intervention, respectively. Approval was independent of socio-demographic and -economic characteristics and self-rated general health. Current tobacco smoking was the only HRF negatively (p = 0.02) and diabetes mellitus was the only disease positively (p = 0.01) associated with approval.ConclusionHigh approval of HRF screening, which was rather independent of socio-economic characteristics and worse self-rated general health, speaks in favor of proactively approaching and motivating all general hospital patients to participate in health behavior change intervention. Tobacco smokers might need higher efforts to motivate participation than non-smokers.Trial registrationClinicalTrials.gov Identifier NCT05365269 on May 9, 2022.

An expert consensus on the most effective components of integrated motivational interviewing and cognitive behavioural therapy for lifestyle behaviour change: protocol for an online modified Delphi study

IntroductionBehaviour change interventions are advocated as a key approach to manage behavioural risk factors such as insufficient physical activity, poor diet and smoking. Integrated motivational interviewing and cognitive behavioural therapy...

Adverse Childhood Experiences and Suboptimal Self-Rated Health in Adulthood: Exploring Effect Modification by Age, Sex and Race/Ethnicity.

This study examined whether the relationship between adverse childhood experiences (ACEs) and self-rated health among adults in a nationally representative population is modified by age, sex, or race/ethnicity. Cross-sectional study. United States. Data from the 2020 and 2021 Behavioral Risk Factor Surveillance System were obtained from 185731 (weighted N = 47862016) persons 18years or older. The ACE cumulative score (range: 0-11) was calculated using 11 questions about childhood emotional abuse, physical abuse, sexual abuse, and household dysfunction before age 18 and classified as 0 (reference), 1, 2, 3, or ≥4. Self-rated health was divided into (excellent/very good/good [reference]) and suboptimal (fair/poor) categories. Multivariable-adjusted logistic regression was conducted to test for the interaction with age, sex, and race/ethnicity with ACEs. After adjustment for potential confounders, an increasing number of ACEs had statistically significantly higher odds of suboptimal self-rated health in a graded manner except for 1 ACE (1 ACE: aOR:1.09; 95% CI: 1.00-1.20, 2 ACEs: 1.16; 1.03-1.30, 3 ACEs: 1.17; 1.03-1.32 and ≥4 ACEs: 1.39; 1.26-1.53). There was a significant interaction between ACEs and age. Younger age (18-24years) had the strongest association for ≥4 ACEs compared to the older age groups. There was no effect modification by sex or race. ACEs should be considered when creating health-promoting interventions to improve health.

Perspectives on the Dementia Public Health Exposome.

Dementia is a public health concern in the aging population with an estimated 55 million people impacted globally. Public health initiatives that focus on minimizing dementia risk factors may support efforts to reduce the incidence of dementia in at-risk populations. Exposomics considers both modifiable and non-modifiable risk factors for disease, including genetic changes with age and lifetime exposures to environmental, social, and behavioral risk factors. Dementia precursors may remain undetected for up to 20years. An understanding and application of the dementia exposome may promote healthy brain interventions, screening, and risk mitigation. The proposed dementia public health exposome (DPHE) provides a framework for understanding and addressing the complex interactions between genetics, health behavior, and environment (natural, built, and social) linked to modifiable and non-modifiable risk factors for dementia. The DPHE may be used to inform public health strategies and advancements in healthy brain initiatives.

학교폭력 가해자에 대한 경찰다이버전 정책 기반 다중체계치료 사례연구

Objectives This purpose of the study was conducted to explore the effectiveness of Multisystemic Therapy for school violence perpetrators as part of the police diversion policy. Methods The subject of the study was a 14-year-old male student who was reported to have school violence, which is extortion and intimidation, and was released on the condition of participating MST. In accordance with the multisystemic therapy manual, five key goals were derived by analyzing risk factors for adolescents' problematic behaviors through evaluation of various systems surrounding him. An intervention strategies were established to achieve the core goals(i.e., stop smoking and alcohol, controlled use of SNS, making pro-social friends, stay away from delinquents, promoting positive parenting skills of parents). The essential parts of MST as like the therapy team, the visiting service, and weekly supervision were implemented. In order to measure pre-post changes, Children Behavior Checklist 6-18, the Parenting Stress Index, the Parenting Attitude Test, and the MMPI-A were conducted. The package of scales was implemented at 3 points as pre-time, post-time, and 8 months follow-up. Results First of all, the level of the externalization problem scale of CBCL 6-18, which was at the clinical range at the pre-test, recovered to the level of the normal range in the post-test, and these results were maintained even at the 8 months follow-up. Regarding MMPI-A, the score was lowered by nearly 2 standard deviations in the scale of Pd compared to pre-test. Then, parenting stress decreased and positive parenting attitudes of parents increased. In addition, all the five core goals were achieved. Conclusions The results of this study showed that multisystemic therapy for school violence perpetrator can help decrease adolescents’ problematic behaviors including school violence.

Tobacco consumption behavior change during the COVID-19 pandemic is associated with perceived COVID threat

RationaleTobacco use is a risk factor for COVID-19 adverse outcomes. Despite health implications, data conflict regarding COVID-19 and tobacco consumption. We present results from a survey of health behaviors during the pandemic to identify how COVID-19 influenced tobacco behaviors.MethodsA nationally administered, internet-based survey was deployed between May–September 2020. Of respondents, we analyzed participants who reported current smoking and/or vaping. Our primary outcome of interest was change in tobacco or vape use using measures from the Behavioral Risk Factor Surveillance System, as well as whether participants reported that these changes were related to COVID-19. Our principal exposures were previously psychometrically evaluated measures of anxiety, depression, and novel perceived COVID-19 threat scale with additional adjustment for age. We employed multinomial logistic regression to determine associations between these factors and tobacco consumption.ResultsWe identified 500 respondents who reported ever smoking in their lifetime, 150 of which reported currently smoking at the time of the survey. Of 220 participants who reported any use of vapes, 110 reported currently vaping. Increased perceived threat of COVID-19 was associated with both increased (aRRincrease 1.75, 95% CI [1.07–2.86], P = 0.03) and decreased (aRRdecrease 1.72 [1.04–2.85], P = 0.03) tobacco consumption relative to no change. There were no significant relationships found between perceived threat of COVID-19 and vaping behavior.ConclusionsAs perceived COVID-19 threat increased, people were more likely to increase or decrease their smoking as opposed to continue at the same amount of use, even after controlling for anxiety and depression, both of which are known to affect smoking in either direction. Further study into motivators of changing tobacco consumption behaviors, and how barriers to care from safer-at-home policies and changes in care delivery moderate change in tobacco use will aid planning tobacco reduction interventions during the ongoing and future respiratory viral pandemics.Trial registrationThis manuscript is derived from baseline survey data obtained in the “Understanding Community Considerations, Opinions, Values, Impacts, and Decisions in COVID-19” study. ClinicalTrials.gov registration NCT04373135, registered 04/30/2020.

A Retrospective Observational Study Examining Physical Activity Among Adults in the United States With Angina or Coronary Heart Disease.

Coronary heart disease (CHD) involves inadequate blood supply to the myocardium by the coronary arteries due to the formation of atherosclerotic plaque in the vessel lumen. It has a complex etiopathogenesis. Physical activity (PA) and exercise lead to vascular remodeling and improved endothelial function, which, in turn, improves the arterial blood supply to the myocardium. The study aims to determine the prevalence of self-reported PA among CHD patients in the United States based on demographic, socioeconomic, and healthcare access variables for the year 2021. The data for the study on CHD were extracted using the Behavioral Risk Factor Surveillance System (BRFSS) Web-Enabled Analysis Tool database of the U.S. The control variables used broadly include demographics, socioeconomic, and healthcare access. In 2021, 433,615 people in the USA participated in the BRFSS study. Among them, 22,819 self-identified as having angina or CHD. In the past month, 62.2% of participants with the disease were involved in PA, and 37.8% were not. Among participants without angina or CHD, 76.5% were involved, and 23.5% were not involved in PA in the past month. This study highlights the need for specific interventions to overcome obstacles preventing PA among CHD patients.

Changes in Breast Cancer Screening Prevalence in the US During the COVID-19 Pandemic, 2018-2022.

Annual mammography screening declined year-on-year during the COVID-19 pandemic through 2021. This study examined changes in 2022 compared to 2018 in the national prevalence of self-reported up-to-date mammography. Using 2018-2022 data from the Center for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), we assess relative changes defined as annual prevalence ratios (aPR) in the SR receipt of past-year and up-to-date (UTD) breast cancer screening (bi-annual mammography in women ages 50-74 years) during the third year of the COVID-19 pandemic overall and by sociodemographic characteristics. UTD BC screening declined for the first time since 2018 (2018 compared to 2022, from 78.7% to 76.6%; aPR, 0.97; 95% CI, 0.96-0.98), despite a small increase in past-year breast cancer screening from 2020 and 2022 (57.9% to 59.6%; aPR, 1.03; 95% CI, 1.01-1.05). This translated to 747,791 fewer women reporting UTD with recommended BC screening in 2022 vs. 2018. UTD BC screening declines between 2018-2022 were largest for American Indian/Alaska Native women (74.8% to 62.2%; aPR, 0.83; 95% CI, 0.74-0.93), women with less formal educational attainment (< high school: 73.1% to 65.5%; aPR, 0.9; 95% CI, 0.85-0.95), and women without a usual source of care (48% to 42.9%; aPR, 0.85; 95% CI, 0.78-0.92). Previously noted pandemic-related declines in past-year BC screening now reflect in women reporting being UTD, with the largest declines in AI/AN and lower SES women. Future studies should monitor screening prevalence in relation to BC diagnostic stage, overall and by sociodemographic groups.

Adverse childhood experiences and myocardial infarction: Analysis of United States Behavioral Risk Factor Surveillance System (BRFSS) data

Adverse childhood experiences (ACEs) have been linked to an increased risk of disease in adulthood and a range of other negative health outcomes, including cardiovascular disease (CVD). This study aims to build on previous research on ACEs and CVD by investigating the association between ACEs and heart attack or myocardial infarction diagnosis. Our analysis used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) annual survey and ACE Module questionnaires. Responses included data from a national sample of 52,492 adults aged 18 years or older in the United States. ACEs value is a composite score of physical, emotional and sexual abuse, household dysfunction, neglect, and other childhood traumas. The study population had a mean number of 1.75 ACEs (SD 2.25), with 61% experiencing at least one ACE and 17% experiencing four or more ACEs. Almost 6% of adults in the sample reported a previous myocardial infarction (5.7%). Multiple logistic regression analysis demonstrated that, after adjusting for a variety of sociodemographic and health covariates, every one-event increase in the number of ACEs was significantly associated with 6% increased odds of myocardial infarction in adulthood (adjusted odds ratio [aOR] = 1.06, 95% confidence interval [CI] = 1.04 &amp;ndash; 1.09, p &lt;0.001). Efforts to decrease the incidence of myocardial infarction and reduce cardiac-related mortality in the U.S. should include policies that reduce the occurrence of ACEs and provide resources for adults to address their childhood traumas.