Modifiable Health Risk Behaviours Research Articles

Trends in social inequality in mortality in Denmark 1995–2019: the contribution of smoking- and alcohol-related deaths

BackgroundDuring the past decades, social inequality in mortality has increased in several countries, including Denmark. Modifiable risk factors, such as smoking and harmful alcohol consumption, have been suggested to moderate...

Lifetime risk of cardiovascular-renal disease in type 2 diabetes: a population-based study in 473,399 individuals

BackgroundCardiovascular and renal diseases (CVRD) are major causes of mortality in individuals with type 2 diabetes (T2D). Studies of lifetime risk have neither considered all CVRD together nor the relative contribution of major risk factors to combined disease burden.MethodsIn a population-based cohort study using national electronic health records, we studied 473,399 individuals with T2D in England 2007–2018. Lifetime risk of individual and combined major adverse renal cardiovascular events, MARCE (including CV death and CVRD: heart failure; chronic kidney disease; myocardial infarction; stroke or peripheral artery disease), were estimated, accounting for baseline CVRD status and competing risk of death. We calculated population attributable risk for individual CVRD components. Ideal cardiovascular health was defined by blood pressure, cholesterol, glucose, smoking, physical activity, diet, and body mass index (i.e. modifiable risk factors).ResultsIn individuals with T2D, lifetime risk of MARCE was 80% in those free from CVRD and was 97%, 93%, 98%, 89% and 91% in individuals with heart failure, chronic kidney disease, myocardial infarction, stroke and peripheral arterial disease, respectively at baseline. Among CVRD-free individuals, lifetime risk of chronic kidney disease was highest (54%), followed by CV death (41%), heart failure (29%), stroke (20%), myocardial infarction (19%) and peripheral arterial disease (9%). In those with HF only, 75% of MARCE after index T2D can be attributed to HF after adjusting for age, gender, and comorbidities. Compared with those with > 1, < 3 and ≥3 modifiable health risk behaviours, achieving ideal cardiovascular health could reduce MARCE by approximately 41.5%, 23.6% and 17.2%, respectively, in the T2D population.ConclusionsFour out of five individuals with T2D free from CVRD, and nearly all those with history of CVRD, will develop MARCE over their lifetime. Early preventive measures in T2D patients are clinical, public health and policy priorities.

Associations of positive and negative affect on health risk behaviors among Latinos.

Negative affect is widely emphasized in behavior modification interventions. However, positive affect is associated with smoking cessation, physical activity, and healthy dietary habits and may be an important treatment target. Few studies have examined the relationship between positive affect and health behaviors among Latinos, who disproportionately experience modifiable health risk behaviors. This study examined the independent associations of positive affect and negative affect on modifiable health risk behaviors among Latino adults. Data came from 432 persons who participated in one of two studies examining determinants of modifiable health risk behaviors among Latino adults. Primary outcomes were current smoking, at-risk drinking, insufficient physical activity, and insufficient fruit and vegetable consumption. Predictors were positive and negative affect as measured by the Positive and Negative Affect Schedule. Associations between positive and negative affect and health risk behaviors were examined using multiple logistic regression. Positive affect was associated with lower odds of insufficient physical activity and insufficient fruit and vegetable consumption and lower odds of engaging in multiple health risk behaviors. Negative affect was associated with higher odds of at-risk drinking and current smoking. Emphasis on increasing positive affect may be warranted for multiple health risk behavior interventions targeting Latinos. Intervention development efforts may also consider prioritizing positive affect for physical activity and dietary interventions, and negative affect for at-drinking and smoking cessation interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Health-risk behaviours among Indigenous Australians with diabetes: A study in the integrated Diabetes Education and Eye Screening (iDEES) project.

To assess the prevalence of modifiable health-risk behaviours among Indigenous Australian adults with diabetes attending a regional Victorian Indigenous primary-care clinic. A cross-sectional observational single-site study. As part of a multi-study project we administered the Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional wellbeing (SNAPE) survey tool during the study baseline visit to methodically capture health-related behavioural data in the nurse-led integrated Diabetes Education and Eye Screening (iDEES) project in a regional Indigenous primary healthcare setting between January 2018 and March 2020. This descriptive SNAPE study helps address the lack of health behaviour data for Indigenous people with diabetes. Of 172 eligible adults, 135 (79%) were recruited to the iDEES study, 50 (37%) male. All participated in at least one survey. Median (range) age was 56 (46-67) years; 130 (96%) had Type 2 diabetes of median [IQR] duration 6 (2-12) years. All 135 provided smoking data; 88 (65%) completed all surveys. Forty-nine (36%) and 29 (22%) were current or former smokers, respectively; 5 (6%) met vegetable intake guidelines, 22 (25%) met fruit intake guidelines; 38 [43%] drank alcohol in the past year. On average, participants walked for ≥10min at a time 4days/week and sat for an average of 8h on weekdays; 35 (40%) had minimal-mild, and 30 (34%) had moderate-severe depressive symptoms. Suboptimal modifiable health-risk behaviours and depressive symptoms are common in Indigenous Australian adults with diabetes. Orderly assessment and reporting of health-risk behaviours using a single multi-component survey instrument (SNAPE tool) during a nurse-led diabetes education clinical visit is feasible and efficient. Such data may facilitate personalised interventions and improve diabetes management at both individual and health service levels.

Effectiveness of referral to a population-level telephone coaching service for improving health risk behaviours in people with a mental health condition: study protocol for a randomised controlled trial

BackgroundPeople with a mental health condition have a shorter life expectancy than the general population. This is largely attributable to higher rates of chronic disease and a higher prevalence of modifiable health risk behaviours including tobacco smoking, alcohol consumption, poor nutrition, and physical inactivity. Telephone support services offer a viable option to provide support to reduce these health risk behaviours at a population-level; however, whilst there is some research pertaining to Quitlines, there is limited other research investigating whether telephone services may offer effective support for people with a mental health condition. This protocol describes a randomised controlled trial that aims to evaluate the referral of people with a mental health condition to a population-level telephone coaching service to increase physical activity, healthy eating, or weight management, and increase attempts to do so.MethodsA parallel-group randomised controlled trial will be conducted recruiting participants with a mental health condition through community mental health services and advertisement on social media. Participants will be randomly assigned to receive either a health information pack only (control) or a health information pack and a proactive referral to a free, government-funded telephone coaching service, the NSW Get Healthy Coaching and Information Service® (intervention), which offers up to 13 telephone coaching calls with a University Qualified Health Coach to assist with client-identified goals relating to physical activity, healthy eating, weight management, or alcohol reduction. Data will be collected via telephone surveys at baseline and 6 months post-recruitment. Primary outcomes are as follows: (1) minutes of moderate to vigorous physical activity per week, (2) serves of fruit consumed per day, (3) serves of vegetables consumed per day, and (4) a composite measure assessing attempts to change at least one health risk behaviour (any attempts to change physical activity, fruit consumption, vegetable consumption, or other parts of nutrition). Secondary outcomes include weight and body mass index.DiscussionThis study is the first to evaluate the effectiveness of referral to a population-level telephone support service for reducing health risk behaviours relating to physical activity, healthy eating, and weight in people with a mental health condition. Results will inform future policy and practice regarding the delivery of telephone-based behaviour change coaching services and the management of physical health for this population to reduce health inequity and the burden of chronic disease.Trial registrationThe Australian New Zealand Clinical Trials Registry ACTRN12620000351910. Retrospectively registered on 12 March 2020

Child Maltreatment Severity and Sleep Variability Predict Mother-Infant RSA Coregulation.

Regulatory processes underlie maternal-infant interactions and may be disrupted in adverse caregiving environments. Child maltreatment and sleep variability may reflect high-risk caregiving, but it is unknown whether they confer vulnerability for poorer mother-infant parasympathetic coordination. The aim of this study was to examine mother-infant coregulation of respiratory sinus arrhythmia (RSA) in relation to child maltreatment severity and night-to-night sleep variability in 47 low-income mother-infant dyads. Maternal and infant sleep was assessed with actigraphy and daily diaries for seven nights followed by a mother-infant Still Face procedure during which RSA was measured. Higher maltreatment severity was associated with weakened concordance in RSA coregulation related to the coupling of higher mother RSA with lower infant RSA, suggesting greater infant distress and lower maternal support. Additionally, higher infant sleep variability was associated with infants' lower mean RSA and concordance in lagged RSA coregulation such that lower maternal RSA predicted lower infant RSA across the Still Face procedure, suggesting interrelated distress. Findings indicate that adverse caregiving environments differentially impact regulatory patterns in mother-infant dyads, which may inform modifiable health-risk behaviors as targets for future intervention.

Telephone-delivered health behaviour change support for people with a mental health condition: the coaches\u2019 perspective

BackgroundPeople with a mental health condition experience a greater prevalence of chronic disease and reduced life expectancy compared to the general population. Modifiable health risk behaviours, such as physical inactivity and poor nutrition are major contributing factors. Population-level health coaching delivering behavioural change support via telephone for healthy eating, physical activity, and weight management is an opportunity utilised by this group to support improvement in healthy lifestyle behaviours. Health coaches offer a valuable perspective into the provision of services to this high-risk group. This study aims to qualitatively explore coaches’ experiences in providing support to these participants, consider factors which may contribute to engagement and outcomes; and potentially inform future service improvement.MethodA qualitative study design was employed involving semi-structured telephone interviews with six coaches employed in a telephone-based behaviour change support service in New South Wales, Australia, between April and July 2019. Interview data was analysed using an inductive thematic analysis.ResultsCoaches believed that the service was of benefit to people with a mental health condition, however making changes to health risk behaviours was potentially more difficult for this group of service users. Coaches indicated that in supporting this group there was a greater focus on building confidence and readiness to change. They noted that improvement in mental health as a result of physical health changes was an additional ‘measure of success’ of particular relevance. Coaches expressed a desire to receive more mental health training to better deliver coaching to participants with a mental health condition. Program variables such as limited call length were posed as possible barriers to care.ConclusionFurther training and additional support for coaches, in additon to considering variations to aspects of service delivery may assist in improving engagement and outcomes for participants with mental health conditions. Examining mental health consumers’ experiences when engaging with telephone coaching services would be an important area to address in further research.

Examining service participation and outcomes from a population-level telephone-coaching service supporting changes to healthy eating, physical activity and weight: A comparison of participants with and without a mental health condition

Population-level telephone coaching services provide accessible behaviour change support for modifiable health risk behaviours. The NSW Get Healthy Information and Coaching Service® (GHS) is a free telephone-based coaching service in Australia, supporting improvements in healthy eating, physical activity and achieving or maintaining a healthy weight. This study compared measures of participation (such as program completion) and outcomes achieved immediate post-program (including changes in fruit and vegetable consumption, physical activity and weight) for GHS participants with and without a self-identified mental health condition (MHC). Secondary data analysis was conducted on service data collected at program intake and completion for individuals who enrolled in a coaching program between January 2018 and October 2019 (n = 5,629); 33% identified as having had an MHC. While those with and without an MHC had similar rates of completion, those with an MHC were less likely to complete a coaching program (31% vs 36%, p = .003). Participants with an MHC made significant positive changes to their fruit and vegetable consumption, physical activity (walking and moderate), weight and BMI, but not to waist circumference or vigorous physical activity. When comparing the magnitude of change for those with and without an MHC, individuals without made greater improvements to their weight (adjusted mean difference −0.623 kg, p = .034) and daily vegetable intake (adjusted mean difference −0.199 serves; p = .01). There were no differences for other variables. The GHS is an effective means of supporting behaviour change for people with an MHC who complete a coaching program. Further research should consider means of improving retention rates.

Relationship between Health Risk Behaviors and Physical Inactivity in Montana Adults

Background: Evidence supports the interrelationships between modifiable health risk behaviors (HRBs) in adults. However, few studies have specifically examined the extent to which HRBs relate to physical inactivity (PIA). The aim of this research was to fill this aforementioned gap. Methods: Data for this study came from the 2020 Montana Behavioral Risk Factor Surveillance System (BRFSS). Six different binary (yes/no) HRB variables were created and included overweight (OVERWEIGHT), obese (OBESE), current smoking (SMOKING), heavy drinking (DRINKING), not always using seatbelt (SEATBELT), and driven after drinking too much (DDRIVING). PIA status was assessed from a question asking adults if they participated in any physical activities or exercises during the past month. Logistic regression was used to examine the relationship between each HRB and PIA. Results: Bivariate analyses indicated a significantly (ps p = .046) and indicated substantially greater odds of PIA for those considered high risk for OBESE and DDRIVING (OR = 5.98, 95% CI: 2.08 – 17.18), as compared to their OBESE counterparts who are not high risk DDRIVING (OR = 1.78, 95% CI: 1.40 – 2.27). Conclusion: This study found that several HRBs relate to PIA in adults from Montana. Health promotion specialists concerned with increasing physical activity should consider interventions that target multiple HRBs.

Economic costs of terminal care for selected non-communicable diseases from a healthcare perspective: a review of mortality records from a tertiary hospital in Nigeria

IntroductionWHO revealed that morbidity and mortality from non-communicable diseases (NCDs) are on the increase and NCDs accounted for approximately 29% of all deaths in Nigeria in 2016. This study was...

Should Runners Pay Less Life Insurance

PURPOSE: An ad “Can You Run An 8 Minute Mile?” (so that you could qualify for lower rates on life insurance) has brought lots of public attention and discussions, and the purpose of this study was to examine the scientific basis for this claim by estimating the impact of physical fitness on modifiable health risk behaviors and related health care expenditures. METHODS: Using keywords “Physical Fitness,” “Cardiorespiratory,” “Health Risks,” “Health Care Costs.” etc., a comprehensive literature search was conducted, and identified publications were reviewed and analyzed. RESULTS: Over 45 research publications were documented, and 15 articles were included in this review, focusing mostly on 10 modifiable health risks. Over 23 components were found in influencing the future medical costs, e.g., emotional health, stress, blood glucose levels, extreme bodyweight, tobacco user, sedentary lifestyle, per metabolic equivalents (METs) increase, and so on. Amount them, the key components rising the potential health care costs are high blood glucose levels ranging from 12.5% to 111.5%, high stress ranging from 17.45% to 70%, depression ranging from 8.5% to 46%, etc. The most effective measure to reduce potential health care costs is increasing metabolic equivalents (METs) per unit by aerobic exercises ranging from 5.4% to 13.4%. CONCLUSION: A set of measures has been developed to assess the relationships between health risks and aerobic fitness, and there is a foundation to support the claim that a fit runner will likely have better aerobic fitness, less likely to have health risks, therefore spend less money in health care and medical expense. Yet, significant work is still needed to develop specific and accurate prediction equations so that the cost of life insurance can be determined based on aerobic fitness and other risk factors.

Substance use treatment clinician attitudes to care for chronic disease health risk behaviours and associations of attitudes with care provision.

People who use substances have a high prevalence of modifiable chronic disease health risk behaviours. Preventive care to address such risks has not traditionally been provided during substance use treatment. This study aimed to assess clinicians' attitudes towards preventive care and their association with care provision. A cross-sectional study utilising computer-assisted telephone interviews was undertaken with clinicians (n = 54) of community-based substance use treatment services in one health district, Australia. Clinicians indicated their agreement with 10 attitudinal statements regarding their perceived role and self-efficacy in providing preventive care and perceptions of client interest in modifying behaviours. Logistic regression analyses examined the association between clinician attitudinal items and self-reported care provision. Fifty-four clinicians (74%) agreed to participate. The most positive attitudes were preventive care being part of their role (100%), and they have the knowledge and skills to provide preventive care (100%). The least favourable attitude was clients were interested in changing their health risk behaviours (60%). Clinicians who reported that preventive care left little time to undertake acute care were more likely to assess for smoking (OR 8.06 [95% CI 1.31, 49.46]) and less likely to provide brief advice for all risks combined (OR 0.11 [95% CI 0.02, 0.63]). Overall, clinicians reported positive attitudes regarding the preventive care provision for modifiable health risk behaviours in substance use treatment settings. Further research is required to investigate why, despite such positive attitudes, clinicians in substance use treatment settings do not routinely provide preventive care.

A survey of the prevalence of modifiable health risk behaviours among carers of people with a mental illness

BackgroundFamily carers provide significant support to people with a mental illness; yet may experience poor mental and physical health themselves. Among limited research addressing the physical health of carers, studies of carers of people with dementia and young people with psychosis suggest increased risk of chronic diseases in conjunction with higher levels of potentially modifiable lifestyle risk behaviours. This exploratory study, conducted with carers of people with various mental illnesses, aimed to determine: carer prevalence of health risk behaviours (inadequate fruit and vegetable consumption, inadequate physical activity, harmful alcohol consumption, and tobacco smoking); interest in changing ‘at risk’ behaviours; and potential associations of socio-demographic characteristics with risk status and interest in change.MethodsA cross-sectional survey was conducted among family carers of people with a mental illness (N = 144) residing in New South Wales, Australia. Analyses explored risk behaviour prevalence and interest in change, and associations with socio-demographic variables.ResultsInadequate fruit and vegetable consumption was most prevalent (74.8%), followed by engaging in inadequate amounts of physical activity (57.6%); harmful alcohol consumption (36.3%) and smoking (11.8%). The majority of carers were interested in improving ‘at risk’ behaviours (56.3–89.2%), with the exception of alcohol consumption (41.5%). Previously or never married participants were more likely to consume inadequate amounts of fruits and/or vegetables compared to those married or cohabiting (Odds Ratio [OR]: 4.1, 95% Confidence Interval [CI]: 1.3–12.9, p = .02). Carers in the workforce were more likely to be engaging in inadequate physical activity (OR: 2.6, 95% CI: 1.2–5.7, p = .02); and male participants were more likely to engage in harmful alcohol consumption (OR: 2.9, 95% CI: 1.1–7.9, p = .03). Working carers were approximately five times more likely to report interest in improving their alcohol consumption (OR: 5.1, 95% CI: 1.3–20.5, p = .02) compared to those not currently in the workforce.ConclusionsResults suggest high engagement in health risk behaviours among carers of people with a mental illness, particularly with regards to harmful alcohol consumption. Findings suggest a need to develop and implement chronic disease prevention strategies. Further research with larger representative samples is needed to confirm findings.

Development of an online secondary prevention programme for stroke survivors: Prevent 2nd Stroke

BackgroundStroke events often result in long-term negative health outcomes. People who experience a first stroke event are 30%–40% more likely to experience a second stroke event within 5 years. An...

Prospective patterns of modifiable health risk behaviors and the utilization of healthcare services in the "Health Workers Cohort Study" in Mexico.

IntroductionWe still lack information about how changes in modifiable health risk behaviors influence the utilization of healthcare services. This study assesses the relationships between prospective patterns of modifiable health risk behaviors and the utilization of healthcare services.Material and methodsThis was a prospective study among men and women participants in the Health Workers Cohort Study, aged 18 years and older. The following data about modifiable health risk behaviors was collected in two waves of the study (2004–2006 and 2010–2012): 1) physical activity, b) consumption of fruit and vegetables, 3) alcohol, and 4) tobacco consumption, to determine the association between the utilization of healthcare services after 6 years of follow-up (period 2010–2012). Information was collected through self-administered questionnaires; clinical and anthropometric variables were measured following standard procedures. Analyses were conducted using zero-inflated negative binomial regression models.ResultsParticipants with a pattern of consumption of < 3 portions of fruits and vegetables per day (p = 0.035) and did not meet recommended levels of PA (p = 0.013) during the two waves of the study had fewer preventative consultations; those who quit smoking reported a higher frequency of preventative consultations (p = 0.021) and more visits with a medical specialist (p = 0.048). Participants who reduced alcohol consumption to low or completely stopped its consumption reported fewer visits to the general physician (p = 0.031), p < 0.05.ConclusionsChanges in prospective patterns of modifiable health risk behaviors influenced the use of healthcare services after 6 years of follow-up. Findings in this study could be useful to determine possible demands of healthcare services among populations with specific modifiable health risk behaviors.

Modifiable Health-Risk Behaviours and Mental Health Indicators in University Students in Croatia

Objective – The aim of this study was to investigate the connection between mental health indicators and nutritional status, physical activity and eating habits in first-year university students in Croatia. Materials and Methods – The data about body weight, body height, eating habits, psychical activity and mental health indicators were obtained retrospectively from preventative care medical records of first-year university students (N=1035). The statistical analysis was performed using the R statistical software. Statistical significance was considered as P<0.05. Results – Out of 1035 participants (68% female), significantly more female, compared to male students, reported depressive mood (7.9% vs. 4.3%, P=0.03), low self-esteem (4.1% vs. 2.4%, P<0.01) and were underweight (12.6% vs 4.6%, P<0.01). Significantly more male students reported regular eating of a cooked meal (94.2% vs. 90.5%, P=0.04), engaging in physical activities in general (99.4% vs. 92.9%, P<0.01), active sport (51.1% vs. 30.2%, P<0.01), recreational sport (89.1% vs. 71.2%, P<0.01) and walking (90.9% vs. 80.7%, P<0.01). Significantly more physically active participants and those who practiced active sport, recreational sport and walking had high self-esteem. Significantly more participants with a healthy eating pattern, regular consumption of a cooked meal and breakfast had high self-esteem and absence of depressive mood. Conclusion – The results of the study showed significantly better mental health indicators in students who reported regular physical activity and a healthy dietary pattern. The results implied that physical activity and a healthy diet, as modifiable health-risk behaviors, could be an important part of public health programs for improving mental health of university students.

Accounting for employee health: The productivity cost of leading health risks.

"Workplace health promotion and protection" broadly refers to an integrated approach to workplace health and safety initiatives. There are substantial benefits to adopting such an approach, including the potential for: improvements to individual employees' health and well-being; increased productivity; and reduced safety risks and expenses. Yet many employers remain reluctant to shift from traditional safety initiatives and spending. This paper aims to demonstrate the value of investing in an integrated health promotion and protection approach by calculating the productivity costs associated with 11 modifiable health risks and 14 chronic conditions in an Australian mining company. Eight hundred and ninety-seven employees participated in a self-report health survey aimed at investigating employee health behaviours, health conditions and productivity. Overall, modifiable health risks and chronic health conditions were calculated to contribute to an estimated $22.15million (AUD) and $7.95million (AUD) in lost productivity per 1000 employees per annum, respectively. Although employee stress was identified as the third highest prevalence health risk across the employee sample (at 42%), it accounted for the highest financial burden. Employee health plays a vital role in the profitability, productivity, and safety outcomes of an organisation. For modifiable health risks and chronic conditions, ailments that affected cognition resulted in the highest financial burden (ie, stress and migraine headaches). SO WHAT?: These findings make a strong financial and business case for the integration of preventative health and safety initiatives, with particular emphasis on modifiable health risk behaviours.

Providing routine chronic disease preventive care in community substance use services: a pilot study of a multistrategic clinical practice change intervention

ObjectivesTo evaluate the potential effectiveness of a practice change intervention in increasing preventive care provision in community-based substance use treatment services. In addition, client and clinician acceptability of care were...

The HealthKick Study: Modifiable Lifestyle Factors in Primary Caregivers of Primary School Learners from Two School Districts in the Western Cape Province, South Africa.

The HealthKick (HK) study showed that educators (teachers) had a high prevalence of risk factors for the development of non-communicable diseases (NCDs). Little data are available on parents or other primary caregivers of learners from disadvantaged schools. The aim of our study was to determine modifiable risk factors for the development of NCDs in a sample of caregivers of schools included in the HK intervention program. Caregivers of grade 4 children from 25 schools were invited to take part in the study and 175 participated. Caregivers were Black Africans and of mixed ethnic origin. Dietary intake was measured using a validated frequency questionnaire. Physical activity was measured by completing the Global Physical Activity Questionnaire (GPAQ). Caregivers described their smoking habits and alcohol usage. Weight and height were measured for each participant and body mass index (BMI) was calculated. Eighty percent women and 50% men had a BMI ≥25 (overweight or obese). The most frequently consumed categories of foods were processed foods, energy-dense foods, and high-fat foods representing unhealthy food choices. More than half of the total group (81.7%) and both males and females were meeting physical activity recommendations of 600 METs/week. Many caregivers, particularly men (53%), smoked cigarettes and reportedly consumed alcohol during the week and on weekends. Caregivers of children in the HK study population presented with a large number of modifiable health risk behaviors. These results highlight the importance of engaging caregivers, as part of a whole school intervention, to promote healthy eating and physical activity.

Increased Substance Use and Poorer Mental Health in Adolescents With Problematic Musculoskeletal Pain.

Study Design Cross-sectional study. Background Adolescents with musculoskeletal pain are thought to be at greater risk of modifiable health risk behaviors, but little is known about these behaviors in adolescents with problematic pain. Objective To describe the prevalence of substance use (tobacco smoking, alcohol consumption, and illicit drugs) and poor mental health in adolescents with problematic musculoskeletal pain, compared to those without such pain. Methods Data on self-reported pain, substance use, and poor mental health were collected from 1831 year 9 students (age range, 14-16 years). Participants were considered to have problematic pain if they reported experiencing pain at least monthly over a 6-month period that also required medication or impacted 1 or more of the following: school or work, daily activities, and leisure or sporting activities. Results Almost half (46%) of the participants experienced problematic pain. Adolescents with problematic pain, compared to those without pain, reported higher substance use and poorer mental health: tobacco smoking in the last 4 weeks, 12% versus 7% (odds ratio [OR] = 1.76; 95% confidence interval [CI]: 1.25, 2.28); alcohol consumption in the last 4 weeks, 30% versus 20% (OR = 1.68; 95% CI: 1.34, 2.11); illicit drug use, 13% versus 6% (OR = 2.18; 95% CI: 1.55, 3.07); lower Mental Health Inventory scores (β = -11.43; standard error [SE], 0.96; P<.05), indicating poorer mental health; and higher Strengths and Difficulties Questionnaire total scores (β = 3.67; SE, 0.29; P<.05), indicating greater difficulties. Conclusion Adolescents with problematic pain report higher smoking, alcohol use, and use of illicit drugs and poorer mental health than adolescents without problematic pain. The experience of problematic pain could be an important consideration for substance use and chronic disease prevention. This trial is registered with the Australian New Zealand Clinical Trials Registry (reference number ACTRN12611000606987). J Orthop Sports Phys Ther 2017;47(10):705-711. doi:10.2519/jospt.2017.7441.