Poor Health Behaviors Research Articles

Sleep Problems, Cumulative Risks, and Psychological Functioning in Early Childhood.

Sleep problems and cumulative risk factors (e.g., caregiver depression, socioeconomic disadvantage) have independently been linked to adverse child development, but few studies have examined the interplay of these factors. We examined whether cumulative risk exposure moderated the link between sleep problems, including insomnia and poor sleep health, and child psychological outcomes. 205 caregiver-child dyads (child Mage = 3.3 years; 53.7% girls; 62.9% Black, 22.4% non-Latinx White, and 4.4% Latinx; 85.4% maternal caregiver reporter) completed child sleep, family sociodemographic, and child psychological functioning (internalizing, externalizing, and executive functioning) questionnaires. Indexes of cumulative risk exposure, insomnia symptoms, and poor sleep health were created. Ninety percent of children had ≥1 cumulative risks, 62.9% had ≥1 insomnia symptom, and 84.5% had ≥1 poor sleep health behavior. Increased insomnia symptoms were significantly associated with increased child internalizing, externalizing, and global executive functioning impairments controlling for child age, race/ethnicity, and sex. Poor sleep health behaviors were associated with internalizing concerns. Cumulative risk exposure was not associated with outcomes but moderated the association between insomnia symptoms and all psychological outcomes, such that children with higher cumulative risk exposure and insomnia symptoms had the greatest impairments. Children with the poorest sleep health behaviors and highest cumulative risks had the greatest internalizing concerns. Insomnia symptoms in particular are associated with poor child outcomes, which are exacerbated when accompanied by greater cumulative risk exposure. Clinicians should assess sleep when treating early psychological concerns, especially within the context of increased cumulative risks.

Attitudes of Bulgarian students toward the introduction of health education as a new discipline in the high school curriculum

Introduction: Health Education as a school subject presents to high-school students knowledge about health and develops attitudes for responsible health behaviors. The school system is the second-best place, after the family, where children are be socialized and educated. Health promotion is an effective method to improve or change our health-related lifestyles. The aim of this study was to research the attitudes and opinions among school students in Bulgaria toward having Health Education as an additional subject in their school curriculum. Materials and Methods: Existing health education frameworks and programs for students were researched. Existing data on the state of children’s well-being and health attitudes among students in Bulgaria were studied using official policy and normative documents. New data were collected via a survey among school students in Bulgaria from diverse locales. In total, 720 students participated in the survey, aged 9 to 19, from the 5th to the 12th grades. The students were asked to fill in a questionnaire developed by the first author. The collected data were analyzed with statistical tools and conclusions were drawn based on the results. Results: Results from the survey show that a healthy lifestyle is quite popular among young people. Overall, they trust the information given by healthcare specialists and health institutions. Health issues are discussed formally in school several times during the school year. The students think that a new Health Education subject would be very useful and they would take part in the classes, especially if healthcare specialists present the subject. The study shows Health Education is most desired and needed by the students in the 7th grade (14 years of age). Conclusion: Existing studies show that health education in Bulgaria is still far away from what should be expected. Only the students from the largest cities are well-informed about health and healthy behaviors. Furthermore, Bulgarian youth consistently report poor health behaviors and low health status. On the other hand, in this study children underscored the importance of health education and reported high motivation to broaden their health-related knowledge.

Health Behaviors Among Service Members Injured on Deployment: A Study From the Wounded Warrior Recovery Project.

Service members (SMs) who are injured on deployment are at risk for myriad long-term health problems that may be ancillary to their physical injury, including high rates of depression and posttraumatic stress disorder, and poor health behaviors (e.g., problem drinking, cigarette and tobacco use, poor sleep quality, and sedentary lifestyle). As the specific health behaviors injured SMs engage in have been largely ignored, the primary aim of this study was to compare health behavior patterns among those with and without mental health problems in a large, representative sample of SMs injured on combat deployment. Participants (N = 3,303) completed behavioral health assessments between September 2018 and April 2019 as part of the Wounded Warrior Recovery Project. Multivariate linear regressions and binary logistic regressions were used to evaluate differences between mental health screening status and health behavior outcomes, adjusting for injury severity, age, and years since injury. Overall, about half of participants screened positive for posttraumatic stress disorder and/or depression (49%). Participants reported high rates of alcohol use and problems, cigarette and tobacco use, inadequate sleep and poor sleep quality, and low levels of physical activity. With the exception of number of drinking days and likelihood of current tobacco use, participants who screened positive for a mental health disorder evidenced significantly worse health behavior outcomes. The results provide a preliminary glance into the mental health and health behaviors of SMs roughly a decade after injury, and underscore the importance of examining the interplay between mental, physical, and behavioral health outcomes among wounded warriors to promote health and wellness.

Psychological and Behavioral Predictors of Vaccine Efficacy: Considerations for COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine candidates are being evaluated, with the goal of conferring immunity on the highest percentage of people who receive the vaccine as possible. It is noteworthy that vaccine efficacy depends not only on the vaccine but also on characteristics of the vaccinated. Over the past 30 years, a series of studies has documented the impact of psychological factors on the immune system’s vaccine response. Robust evidence has demonstrated that stress, depression, loneliness, and poor health behaviors can impair the immune system’s response to vaccines, and this effect may be greatest in vulnerable groups such as the elderly. Psychological factors are also implicated in the prevalence and severity of vaccine-related side effects. These findings have generalized across many vaccine types and therefore may be relevant to the SARS-CoV-2 vaccine. In this review, we discuss these psychological and behavioral risk factors for poor vaccine responses, their relevance to the COVID-19 pandemic, as well as targeted psychological and behavioral interventions to boost vaccine efficacy and reduce side effects. Recent data suggest these psychological and behavioral risk factors are highly prevalent during the COVID-19 pandemic, but intervention research suggests that psychological and behavioral interventions can increase vaccine efficacy.

Cancer Curriculum for Appalachian Kentucky Middle and High Schools.

BackgroundAppalachian Kentucky faces the highest cancer incidence and mortality rates in the country due to poor health behaviors and lifestyle choices. These poor health behaviors are facilitated by a lack of cancer education. Youth represent a vulnerable population that could be greatly impacted by increased cancer education. Teachers have the power to facilitate this learning.PurposeThis study examined the need for cancer education curriculum in Appalachian Kentucky middle and high schools from the perspective of educators.MethodsAn online survey was conducted with science and health teachers (n=21) in Appalachian Kentucky, consisting of questions that investigated existing cancer education efforts, relevance of cancer education, and feasibility of such curriculum being delivered in the classroom. Content analysis was used to analyze teacher comments. A 3-part cancer education curriculum was developed that is culturally relevant and aligned with science and health education standards.ResultsAll participating teachers agree that cancer education is important to students’ lives. Teachers also agree that there is an inconsistent amount of cancer education within schools, and qualitative content analysis revealed that cancer education likely fits best in certain course subjects. Cancer education could feasibly be integrated into science and health classrooms, although the perception of needing to teach to the academic standards and having limited time to teach additional lessons outside of the standards are significant barriers. To combat this, a cancer curriculum that aligns with state and national science and health education standards was developed.ImplicationsCancer education curriculum could play an important role in improving the cancer outlook in Appalachian Kentucky. Teachers have expressed a desire for increased cancer education in the classroom. By disseminating and implementing cancer curriculum in schools in the region and revising the curriculum-based on teacher and student feedback to better fit their needs, it has the potential to increase cancer literacy and improve related health behaviors and outcomes.

From culture to chromosomes: A mother-child dyadic study of acculturation, telomere lengths and body fat

Studies suggest that telomere lengths, a biomarker of aging, could also capture the physiological weathering attributable to poor health behaviors and adverse experiences, particularly those experienced in early life. For these reasons, we propose that telomere lengths may be a pivotal biomarker for measuring the heightened susceptibility to illness resulting from the cumulative exposure to acculturation to the US culture. This binational study used an Actor–Partner Interdependence Model to test if maternal acculturation to the US moderates the cross-sectional associations of telomere lengths with percentage of body fat (PBF) among Mexican women, among their children, and the intergenerational associations of mother and children telomere lengths with each other’s PBF. Low income Mexican child–mother dyads (n ​= ​108 dyads) were recruited to participate in this cross-sectional study in Mexico and the US. The pooled dataset included measurements of maternal acculturation to the US, mother and children’s salivary telomere lengths, PBF measured through bioelectrical impedance, and demographic characteristics. Results showed that the influences of maternal acculturation in the associations of telomere lengths with PBF were different for mothers and their children: Among mothers with higher maternal acculturation to the US, longer salivary telomere lengths were associated with lower PBF. In contrast, among mothers with lower maternal acculturation to the US, salivary telomere lengths were not associated with PBF. There were no significant associations between children’s salivary telomere lengths and PBF, and the null associations did not vary across different levels of maternal acculturation to the US. Future longitudinal studies are needed to determine whether acculturation to the US (experienced through immigration or remotely) influences the association of telomere length attrition with obesity risks among immigrant and non-immigrant Mexican children and adults.

Does Student Loan Debt Hinder Community Well-Being?

How the growth in student debt is impacting the well-being of the larger community is explored using U.S. county level data. Using tax return data from the Internal Revenue Service (IRS) we find that higher levels of student debt tends to be associated with lower levels of community well-being. Specifically, lower rates of home ownership, higher rental market stress, lower rates of entrepreneurship and poorer health behaviors. While the decision to take on student debt is an individual decision, local communities are uniquely positioned to help students make decisions around taking on debt and repayment options.

The cross-cutting psychosocial and systemic barriers to holistic rehabilitation, including educational re-engagement, of incarcerated adolescents: Realities in and perspectives from Africa

The present study identifies the potential barriers to holistic rehabilitation, including educational re-engagement, of justice-involved youth in Africa. This was done using quantitative data on the educational and other psychosocial problems presented by a cohort of justice-involved youth and qualitative data on the realities on ground in the correctional school within a youth correctional facility in Lagos, Nigeria, as an illustrative example. Findings showed a lot of cross-cutting psycho-social and systemic barriers to holistic psycho-social rehabilitation of justice-involved adolescents. These include pre-existing psychosocial problems such as, educational disengagement prior to incarceration, high prevalence rates of untreated intercurrent behavioral disorders such as conduct disorders and attention-deficit/ hyperactivity disorder among detained youth, and lack of community- or school-based pre-emptive interventions for school-related indicators of delinquency within the juvenile justice system. Others are lack of non-incarcerating correctional system with focus on psychosocial and educational rehabilitation, poor standard of human/ infrastructural resource-capacity within the facilities, and low level of school-engagement occasioned by poor mental and behavioral health among those enrolled in correctional schools. Context-appropriate pre-emptive and responsive strategies to address cross-cutting psycho-social and rehabilitative needs of justice-involved youth were discussed.

Factors Associated With Health-Related Quality of Life Among Cancer Survivors in the United States.

With increasing prevalence of cancer survivors in the United States, health-related quality of life (HRQOL) has become a major priority. We describe HRQOL in a nationally representative sample of cancer survivors and examine associations with key sociodemographic, clinical, and lifestyle characteristics. Cancer survivors, defined as individuals ever diagnosed with cancer (N = 877), were identified from the 2016 Medical Expenditure Panel Survey-Experiences with Cancer Survivorship Supplement, a nationally representative survey. Physical and mental health domains of HRQOL were measured by the Global Physical Health (GPH) and Global Mental Health (GMH) subscales of the Patient-Reported Outcomes Measurement Information System Global-10. Multivariable linear regression was used to examine associations of sociodemographic, clinical, and lifestyle factors with GPH and GMH scores. All statistical tests were 2-sided. Cancer survivors' mean GPH (49.28, SD = 8.79) and mean GMH (51.67, SD = 8.38) were similar to general population means (50, SD = 10). Higher family income was associated with better GPH and GMH scores, whereas a greater number of comorbidities and lower physical activity were statistically significantly associated with worse GPH and GMH. Survivors last treated 5 years ago and longer had better GPH than those treated during the past year, and current smokers had worse GMH than nonsmokers (all β > 3 and all P < .001). Cancer survivors in the United States have generally good HRQOL, with similar physical and mental health scores to the general US population. However, comorbidities, poor health behaviors, and recent treatment may be risk factors for worse HRQOL. Multimorbidity management and healthy behavior promotion may play a key role in maximizing HRQOL for cancer survivors.

Health behaviors and patient-practitioner communication in cancer patients and the general population: an analysis of the National Health and Nutrition Examination Survey (NHANES) 2005-2014.

The purpose of the study was to investigate the prevalence of poor health behaviors (low dietary quality, low physical activity (PA), and high body mass index (BMI)) in cancer patients and the general population and its relationship with receipt of patient-physician recommendations. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005-2014 to compare 1846 patients with a history of cancer to 16,641 with no cancer history. BMI was measured during physical exam. Dietary quality and PA were obtained from a questionnaire, along with receipt of physician recommendations for each behavior. Cancer patients had dietary quality that "needs improvement," were not meeting PA recommendations, and were overweight. Compared to the general population, dietary quality (54 vs. 54, p = .80), prevalence of physical inactivity (34% vs. 31%, p = .01), and BMI (28 vs. 28, p < .01) were similar. Among cancer patients, prevalence of physician recommendations to improve dietary quality (33.5%), increase PA or exercise (47.7%), and lose or control weight (32.1%) were low. Physicians recommended health behavior change to cancer patients more frequently than the general population (p < .01). Overweight and physically inactive cancer patients were more likely to receive physician recommendations (ps < .01). Physician recommendations were not associated with dietary quality (p = .65). Prevalence of poor diet, physical inactivity, and obesity is high in both populations with less than 50% of patients receiving physician health behavior recommendations. These findings underscore the need for increased frequency and efficacy of patient-physician health behavior recommendations, especially in cancer patients, to improve patient outcomes.

Questionnaire-based Survey of Demographic and Clinical Characteristics, Health Behaviors, and Mental Health of Young Korean Adults with Early-onset Diabetes.

BackgroundThe incidence of early-onset diabetes is increasing among young adults. However, there are limited data on the characteristics and management of young Korean adults with diabetes. This study assessed the clinical and demographic characteristics, health behaviors, and mental health among young Korean adults with diabetes mellitus.MethodsThis cross-sectional study included young Korean adults with diabetes (n = 225) with an onset age of 20–39 years from four university hospitals. Demographic characteristics, management of diabetes, and mental health were assessed using a questionnaire survey.ResultsType 2 diabetes was the most common type (73.3%), and 13.8% of participants were classified as other types or unknown. Approximately, 64.7% of participants had a strong family history of diabetes, and 76% had treatment within three months of diagnosis. Approximately, 11.1% of participants had diabetic complications; 39.1% of participants received insulin injections, including oral anti-diabetic medications. Additionally, 30.4% were smokers, and only 28% had active physical activity; 26.5% of participants had >3 hours of screen time. One third of participants never had breakfast, and 60.5% went out to eat at least three times a week. Half of the participants showed moderate to severe stress perception, and 21.4% of patients had moderate to severe levels of depression based on the Korean version of Beck Depression Inventory score.ConclusionEarly-onset diabetes was associated with a strong family history and early insulin treatment. Young adults with diabetes had poor health behaviors and frequent mental depression. These findings suggest the necessity of health policies for improving health behaviors and mental distress.

Exploring the impact of a large gender-sensitised health promotion program: the Sons of the West program.

Evaluation of the outcomes of gender-sensitised programs that target men with poor health behaviours is lacking. The purpose of this study was to provide an understanding of the psychosocial changes related to participation in the Sons of the West (SOTW) men's health promotion program run by the Western Bulldogs Community Foundation. All men who participated in SOTW during 2017 were asked to complete surveys at the beginning and end of the program. The surveys were quantitative measures of psychological wellbeing (Kessler Psychological Distress Scale, K10), social connectedness and loneliness (UCLA Loneliness Scale, UCLA-L), and resilience (Brief Resilience Scale, BRS). In addition, we analysed participants' responses to an offer within the program to provide psychological support to any participant in need. Men were provided with a participant code so that data could be matched at the beginning and end of the program. A high participation rate (776/1003) was achieved. There were statistically significant improvements in mean K10 scores from pre- (population mean [M] = 17.34; standard deviation [SD] = 6.98) to post-program (M = 14.98; SD = 6.27), and for matched samples (p < 0.001). Matched samples also showed significant improvements in mean UCLA-L scores from pre- (M = 38.58; SD = 10.87) to post-program (M = 37.42; SD = 10.87), and mean BRS scores from pre- (M = 3.44; SD = 0.79) to post-program (M = 3.62; SD = 0.74). Results from the psychological help-seeking question showed that one-third of participants were open to the concept of receiving additional psychological support. This preliminary data shows that a broad-ranging, gender-sensitised health promotion program can have a significant effect on psychosocial health of male participants. The findings provide insights for future research, and suggest the program has potential for generalisation to other populations.

Facets of Impulsivity in Relation to Diet Quality and Physical Activity in Adolescence.

Although the construct of impulsivity has generally been found to be associated with obesity and health behaviors in adults, research among adolescents is more limited and studies have yet to elucidate which facets of impulsivity may be most salient with regard to different eating and physical activity behaviors. Therefore, the present cross-sectional study assessed facets of impulsivity, measured by the UPPS-P questionnaire, in relation to health behaviors among adolescents. A sample of 2797 high school students from Los Angeles, California completed self-report measures during the ninth grade. The UPPS-P subscales (i.e., (lack of) premeditation, sensation seeking, (lack of) perseverance, negative urgency, positive urgency) were examined as predictors of unhealthy diet quality (i.e., frequency of consumption of high-fat foods and sweet food and drinks, measured by the National Cancer Institute (NCI) Quick Food Scan) and frequency of vigorous physical activity (measured by the Youth Risk Behavior Surveillance System). Greater sensation seeking, positive urgency, and negative urgency was associated with greater unhealthy diet quality (ps < 0.001). Greater negative urgency and lack of perseverance was associated with less frequent vigorous physical activity, whereas greater sensation seeking, lack of premeditation, and positive urgency was associated with more frequent vigorous physical activity (ps < 0.05). While negative urgency (i.e., impulsivity in the context of negative emotions) was consistently associated with poor health behaviors, other facets of impulsivity may potentiate vigorous physical activity in youth. Together these findings underscore the importance of considering the multidimensional nature of impulsivity in relation to adolescents’ health behaviors and highlight areas for future longitudinal research.

Health Status of Left-Behind Children and Parenting Behaviors of Caregivers in Poor Rural Areas - 6 Provinces, China, 2018.

Summary What is already known about this topic? China has a significant population of left-behind children, and their health and living environments remain a major public health challenge. Children under 6 years old are especially vulnerable to poor health knowledge and behaviors of their caregivers. What is added by this report? The prevalence of stunting, being underweight, and often sick were 13%, 3.4%, and 5%, respectively. Only 53.9% of left-behind children could eat meat often, and 59.5% could control their intake of sugary drinks. The proportions of children who had a safe home environment, a safe play environment, and no family violence were 22.5%, 75.3%, and 45.9%, respectively. The percentages of caregivers who ensured that they rarely left their children alone and were always in their sight are 76.1% and 92.4%, respectively. What are the implications for public health practice? The implementation of early home visits is necessary to improve the physical health and safety of the living environment of left-behind children. Primary health workers should pay attention to improving the health knowledge and behaviors of caregivers.

1415. A qualitative study of intersectional stigma among older adults living with HIV who are victims of childhood sexual abuse

BackgroundIntersectional stigma is based upon co-occurring and intersecting identities or conditions and occurs at multiple levels of influence. Intersectional stigma has been repeatedly associated with poor health behaviors and outcomes. The effect of intersectional stigma among older adults are particularly challenging due to issues related to ageism, loss of social support, and comorbidities. We examined the impact of multiple stigmas on older adults living with HIV who are victims of childhood sexual abuse.MethodsSemi-structured interviews were conducted with a purposefully selected heterogeneous sample of 24 adults living with HIV who are 50 years and older in South Carolina. Interviews were audio-recorded, transcribed verbatim, and coded using thematic analysis.ResultsParticipants shared experiences and perceptions of stigma and discrimination most commonly related to their HIV status and sexuality at the interpersonal/familial and community levels. Four themes emerged to explain the impact of intersectional stigma: depression, lack of HIV disclosure, limited support, and reduced intimacy.ConclusionThe complexity of multiple stigmas profoundly shapes life experiences, opportunities, and mental health of older adults living with HIV. This study highlights that public health programs need to consider the impact of intersectional stigma in order to promote the wellbeing of and improve quality of life for older adults living with HIV.Disclosures All Authors: No reported disclosures

Oral Health Attitudes among Preclinical and Clinical Dental Students: A Pilot Study and Self-Assessment in an Egyptian State-Funded University.

Dentists should present to patients as good role models in their oral health behaviour. Previous studies have demonstrated how education can improve dental students’ oral health. This pilot investigation aimed to compare and evaluate the features of the oral health behaviour and attitudes of preclinical and clinical dental students at Ain Shams University, a public Egyptian university. The Hiroshima University-Dental Behaviour Inventory (HU-DBI) survey was provided to 149 (78 female/71 male) dental students. Dichotomised (agree/disagree) answers to 20 HU-DBI items were possible, with a maximum conceivable score of 19. An estimation of oral health behaviour and attitudes was calculated by the sum of correct oral health answers to every item by the study groups and evaluated statistically. The score of oral health-favouring answers was higher in clinical (11.50) than preclinical students (10.63) and was statistically significant (p < 0.05). Single-item evaluations showed no statistical significance, except in one survey item. This survey exhibited weak differences in the improvement of oral hygiene behaviour and attitudes between participating preclinical and clinical students, as well as overall poor oral health behaviour in both groups. This inadequacy of Egyptian public dental education in terms of sufficient student oral health progress emphasises the necessity for supplementary courses and curricular reviews that accentuate the need for future dentists to display the correct oral health behaviour.

A Cross-Sectional Study of Psychological Flexibility as a Mediator for the Relationship Between Acculturative Stress and Cardiovascular Health Behaviors Among Second-Generation Arab Americans.

Second-generation Arab Americans may be at risk for poor cardiovascular health behaviors, but these behaviors are poorly understood. The purpose of this study was to examine the effects of acculturative stress and psychological flexibility on cardiovascular health behaviors among second-generation Arab Americans. In a cross-sectional study, survey data were collected in 2018 at local mosques, churches, and a university campus. Cardiovascular health behaviors were measured with a questionnaire based on the American Heart Association Life's Simple 7. Acculturative stress and psychological flexibility were assessed using reliable and valid measures. Participants (n = 325) with higher acculturative stress were significantly more likely to report intermediate overall cardiovascular health behaviors (p = .01) and poor to intermediate diet (p = .00). Psychological flexibility partially mediated poor/intermediate smoking (p = .02) and intermediate diet (p = .00) scores. Nurses may consider the role of acculturation when designing culturally sensitive interventions to promote cardiovascular health in second-generation populations.

Understanding adolescent males' poor mental health and health-compromising behaviours: A factor analysis model on Swedish school-based data.

Aim: The aim was to develop a factor model of the clustering of poor mental-health symptoms and health-compromising behaviours (HCBs) in adolescent males. Methods: The study was based on two cross-sectional school-based Swedish surveys in 2011 (response rate 80%, N=2823) and 2014 (response rate 85%, N=2358), both of which comprised questionnaires from males aged 15–16 and 17–18 years. A factor model was developed by exploratory factor analysis on the 2011 survey and validated by confirmatory factor analysis on the 2014 survey. Results: Four aspects of poor mental health and HCBs emerged in the exploratory factor analysis: (a) deviancy as a tendency to substance use and delinquency, (b) unsafety as an inclination towards feelings of unsafety in different environments, (c) gloominess as a tendency towards pessimism and feeling unwell and (d) pain as an inclination to experience physical pain. The model was validated with good model fit. Age did not affect the model structure, but older adolescent males were more influenced by deviancy and gloominess and less by unsafety compared to their younger peers. Conclusions: Separating symptoms of poor mental health and HCBs into four areas – deviancy, unsafety, gloominess and pain – brings new perspectives to the understanding of adolescent males’ health. To the best of our knowledge, our factor model is the first to include unsafety and pain in this context. Whenever a comprehensive approach to the health of adolescent males is needed in the clinic or in the field of public health, this factor model may provide guidance.

Distinguishing the Effects of Life Threat, Killing Enemy Combatants, and Unjust War Events in U.S. Service Members.

Although previous studies have identified behavioral health risks associated with combat exposure, it is unclear which types of combat events are associated with these risks, particularly regarding contrasts among the risks associated with life-threatening experiences, killing combatants, and exposure to unjust war events, such as killing a noncombatant or being unable to help civilian women and children. In the present study, we examined surveys from 402 soldiers following deployment (i.e., baseline) and again 13 months later (i.e., Year 1). Regression analyses were conducted across a range of behavioral health (e.g., posttraumatic stress disorder, depression, suicide ideation, anxiety, somatic, insomnia, aggression) and benefit-finding measures, each controlling for two combat event categories while assessing the predictive utility of a third. The results suggested that life-threatening events were associated with poor behavioral health at baseline, relative risk (RR) = 10.00, but not at Year 1, RR = 2.67. At both baseline and Year 1, killing enemy combatants was not associated with behavioral health, RRs = 1.67-3.33, but was positively associated with benefit-finding, RRs = 26.67-40.00. Exposure to unjust war events was associated with a transdiagnostic pattern of behavioral health symptoms at baseline, RR = 40.00, and Year 1, RR = 23.33. Overall, the results suggest unjust war event exposure is particularly injurious, above and beyond exposure to other combat-related events. Future research can build on these findings to develop clearer descriptions of the combat events that might place service members at risk for moral injury and inform the development of assessment and treatment options.

Using qualitative and co-design methods to inform the development of an intervention to support and improve physical activity in childhood cancer survivors: a study protocol for BEing Active after ChildhOod caNcer (BEACON)

IntroductionChildhood cancer survivors (CCSs) treated with cardiotoxic cancer treatments are at increased risk of developing cardiometabolic complications. This risk is further exacerbated by poor health behaviours. In particular, CCSs are...