Poor Health Behaviors Research Articles

A Brief Educational Intervention Enhances Basic Cancer Literacy Among Kentucky Middle and High School Students

Kentucky experiences the highest overall cancer incidence and mortality rates in the USA with the greatest burden in the eastern, Appalachian region of the state. Cancer disparities in Kentucky are driven in part by poor health behaviors, poverty, lack of health care access, low education levels, and low health literacy. Individuals with inadequate health literacy are less likely to participate in preventive measures such as obtaining screenings and making healthy lifestyle choices, thus increasing their chances of developing and dying from cancer. By increasing cancer literacy among youth and adults, it may be possible to decrease cancer disparities across Kentucky. This study aimed to establish connections with middle and high schools in Kentucky that would facilitate pilot implementation of a brief cancer education intervention and assessment of cancer health literacy among these student populations. A baseline pretest cancer literacy survey consisting of 10 items was given to 349 participants, followed by the delivery of a cancer education presentation. Immediately following the presentation, participants were given a posttest with identical items to the pretest. Participants were primarily Caucasian (89.4%), female (68.7%), and in 10th through 12th grade (80.5%). Significant (p < 0.0001) increases in both average and median percent of correctly marked items were observed between the pretest and posttest (average, pretest = 56% versus posttest = 85%; median, pretest = 60% versus posttest = 90%). The scores for all individual items increased after the brief intervention. The results demonstrated a significant increase in cancer literacy levels immediately after the pilot educational intervention. We suggest that it may be possible to improve cancer literacy rates in Kentucky by integrating cancer education into middle and high school science and/or health education curricula. This could ultimately drive changes in behaviors that may help lower cancer incidence and mortality rates. Plans for future interventional studies measuring long-term cancer knowledge retention and resultant behavioral changes among middle and high school students as well as the feasibility of integrating cancer education into middle and high school curricula are also discussed.

Oral health status and oral health care use among formerly incarcerated people

BackgroundIncarceration carries adverse consequences for health, yet there is limited research on the association between incarceration and oral health outcomes. The authors examined the relationship between former incarceration and 2 self-reported oral health outcomes—periodontal disease and oral health care use—and assessed the degree to which postrelease factors mediate the relationship between former incarceration and oral health outcomes. MethodsThe authors analyzed nationally representative observational data from the National Longitudinal Study of Adolescent to Adult Health by using multivariate logistic regression. Karlson-Holm-Breen mediation analysis was used to assess how much former incarceration and oral health outcomes are confounded by material hardship, health insurance coverage, and poor health behaviors. ResultsIncarceration history is associated with periodontal disease (odds ratio [OR], 1.454; 95% confidence interval [CI], 1.042 to 2.029) and oral health care use (OR, 1.433; 95% CI, 1.248 to 1.646) after control variables are taken into account. However, the confounding variables fully mediate the association between incarceration and periodontal disease (OR, 1.143; 95% CI, 0.815 to 1.605) and oral health care use (OR, 1.133; 95% CI, 0.980 to 1.309). ConclusionsFormerly incarcerated people in the United States have worse oral health outcomes than their never-incarcerated counterparts, and much of this relationship can be explained by socioeconomic status and health behaviors. Practical ImplicationsFormerly incarcerated people have scarce resources and lack knowledge about oral health care. Health care professionals should encourage formerly incarcerated people to focus on oral health care. Because modifiable risk behaviors confound much of this relationship, targeted interventions may provide benefits for improving oral health care among this vulnerable population.

Poor Sleep Is Related to Metabolic Syndrome Severity in Adolescents With PCOS and Obesity.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder and is associated with metabolic syndrome (MS). Development of MS in PCOS is likely multifactorial and may relate to poor sleep. The objective of this research is to investigate differences in objective markers of sleep in adolescents with obesity and PCOS with and without MS. We also aimed to examine the relationships between markers of sleep with MS markers. A cross-sectional study was conducted. Participants included adolescents with PCOS and obesity with MS (N = 30) or without MS (N = 36). Hormone and metabolic measurements, abdominal magnetic resonance imaging for hepatic fat fraction, actigraphy to estimate sleep, and overnight polysomnography (PSG). Adolescents with obesity and PCOS who also had MS had significantly worse sleep-disordered breathing including higher apnea-hypopnea index (AHI, P = .02) and arousal index (P = .01) compared to those without MS. Actigraphy showed no differences in habitual patterns of sleep behaviors including duration, timing, or efficiency between groups. However, a greater number of poor sleep health behaviors was associated with greater number of MS components (P = .04). Higher AHI correlated with higher triglycerides (TG) (r = 0.49, P = .02), and poorer sleep efficiency correlated with higher percentage of liver fat (r = -0.40, P = .01), waist circumference (r = -0.46, P < .01) and higher TG (r = -0.34, P = .04). Among girls with PCOS and obesity, sleep-disordered breathing was more prevalent in those with MS, and poor sleep behaviors were associated with metabolic dysfunction and more MS symptoms. Sleep health should be included in the assessment of adolescents with PCOS and obesity.

Predictive factors of chronic lower back pain risk in women: population-based study

ABSTRACT BACKGROUND AND OBJECTIVES: Low back pain is a common condition in women. In addition to that, women have a higher risk of chronic pain. However, the factors associated with chronic low back pain are still controversial. Thus, this study’s objective was to evaluate the predictive factors associated with a higher risk of chronic low back pain. METHODS: A cross-sectional population-based study was conducted on a sample of 636 Brazilian adult women aged 20-69 years who reported symptoms of low back pain in the last two weeks. The level of risk of chronic low back pain was measured by the validated Brazilian version of Subgroups for Targeted Treatment (STarT) score. RESULTS: The risk of chronic low back pain was classified as low, medium, and high in 330 (51.9%), 202 (31.8%), and 104 (16.4%) women, respectively. After adjustments, the main factors associated with a higher risk of chronic low back pain were: aged 50 years or older (OR=2.67; 95%CI: 1.43-4.96), low household income (OR=2.23; 95%CI: 1.34-3.72), 4 years of education or less (OR=2.17; 95%CI: 1.35-3.48), sedentary lifestyle (OR=2.97; 95%CI: 1.59-5.55), smoking (OR=1.61; 95%CI: 1.07-2.44), and multiparity (OR=2.84; 95%CI: 1.45-5.57). Skin color, marital status, and obesity were not associated with a higher risk of chronic low back pain. CONCLUSION: This study indicates that the predictive factors associated with a higher risk of chronic low back pain in women included advanced aged, socioeconomic disadvantage, poor health behaviors and multiparity.

Characterizing the weight-glycemia phenotypes of type 1 diabetes in youth and young adulthood

IntroductionIndividuals with type 1 diabetes (T1D) present with diverse body weight status and degrees of glycemic control, which may warrant different treatment approaches. We sought to identify subgroups sharing phenotypes...

The association between functional oral health literacy and periodontal disease among adults with type 2 diabetes mellitus in the northeast region of Thailand

Aim: To analyze the association between functional oral health literacy (FOHL) and oral health behaviors with periodontal disease among adults with type 2 diabetes mellitus (T2DM). Materials and Methods: A cross-sectional analysis study was conducted among 1110 adults with T2DM who were selected by multistage random sampling from 10 hospitals of five provinces in the northeast region of Thailand. A structured questionnaire was developed, and face to face interview and also clinical oral examination and blood glucose investigation were carried out. Data distribution was performed by descriptive statistic and chi-square test. The multiple logistic regression was used to determine the association between variables after adjustment for confounders. Results: In this study, a total of 1110 adults with T2DM divided into two groups according to the severity of periodontal disease showed 51.89% of moderate–severe periodontal disease. The study examined the association of periodontal disease with the independent variables after adjusted odd ratios, it was found to be statistically significant with the FOHL level (adjusted odds ratio [AOR] = 1.80, 95% confidence interval [CI] = 1.30–2.40), toothbrushing frequency (AOR = 1.73, 95% CI = 1.24–2.40), smoking (AOR = 2.25, 95% CI = 1.45–3.40), and betel nut crewing (AOR = 2.13, 95% CI = 1.28–3.45). Moreover, the demographic characteristics of patients with T2DM associated with the severity of periodontal disease in variables of gender, age, education level, duration with diabetes, and health insurance were also statistically significant at P < 0.05. Conclusion: The FOHL level and oral behaviors among adults with T2DM were statistically significant with periodontal disease. However, the patients of T2DM with low FOHL and poor oral health behaviors need extra support from dental health personnel to reduce the risk of oral disease.

Reproductive Health Behavior of Street Youth Guided by Karya Putra Indonesia Mandiri Foundation in Central Jakarta Region

Background: Adolescents psychologically have a negative self-concept that is easily influenced and tends to behave freely. This study aims to determine whether there is a relationship between the role of parents and the role of friends with the reproductive health behavior of street adolescents. The problem with this research is the high rate of teenage pregnancy in Indonesia and adolescents account for 30% of unwanted pregnancies and unsafe abortions. Material and Method: Cross sectional research design. The sample in this study was YPKIM fostered adolescents aged 15-19 years. Data processing and analysis using chi square test and multiple logistic regression. Findings and Discussion: Poor reproductive health behaviors in YPKMI street adolescents by 33.3%. Based on the results of bivariate analysis found there is a relationship between the role of parents and the role of friends with reproductive health behavior. Multivariate analysis shows that knowledge is the most dominant risk factor associated with reproductive health behavior (OR = 6,610). Conclusion: The results of this study prove the need to increase reproductive health knowledge in street adolescents to improve reproductive health behavior better by creating programs specifically for the coaching of adolescents, especially street adolescents.

Behavioral Conformity of Physical Activity and Sedentary Behavior in Older Couples with One Partner Suffering from End-Stage Osteoarthritis.

PurposeThe present study investigates behavioral conformity regarding physical activity (PA) and sedentary behavior (SB) in older couples where one partner suffers from osteoarthritis (OA). Hereby the question is addressed whether and to what extent the typical physical limitations of OA patients have negative effects on their partners.Patients and MethodsThe habitual PA and SB of end-stage osteoarthritis patients (n = 32, 52–81 years | n = 14 gonarthrosis, n = 18 coxarthrosis), their spouses (n = 32, 50–83 years) and control couples (n = 26 subjects, 52–78 years) were assessed by accelerometry. Besides individual results of accelerometry hourly couple-specific performance ratios were calculated for four parameters of PA (number of steps, vector magnitude (VM), metabolic rate (MET), and total time in moderate-to-vigorous PA (MVPA)) and two parameters of SB (number of sedentary bouts and total time of sedentary bouts per hour). Analyses of covariance were used to explore differences in hourly couple-specific performance ratios between couples affected by osteoarthritis and control couples.ResultsSignificant differences in PA were observed between the three groups, whereby the patients showed the lowest PA and the subjects of the control group the highest PA. In contrast to this, SB did not differ between the three groups. The hourly analyses of couple-specific performance ratios revealed significant differences between the target couples (patients and spouses) and the control couples for all parameters of PA. Thereby, the deviance in PA between the patients and their spouses was always smaller than in control couples and also decreased with age. The investigation of SB, on the other hand, revealed larger deviations between the patients and their spouses as compared to control couples and no changes with age.ConclusionThis study confirmed the known negative impact of osteoarthritis on the PA and SB of elderly patients. More important, however, was the finding that the patients’ spouses adapt to this poor health behavior and show reduced PA as well. Consequentially, spouses of OA patients should be considered as a risk group for inactivity-related diseases in old age. This should be considered in interventions that aim to use the individual support of spouses to increase the PA of OA patients.

Lifetime History of Traumatic Brain Injury and Behavioral Health Problems in a Population-Based Sample.

To investigate the relationships between indices of lifetime history of traumatic brain injury (TBI) exposure and measures of behavioral health status among Ohioans. A random sample (n = 6996) of Ohioans contacted to complete the 2014 Ohio Behavioral Risk Factors Surveillance System (BRFSS). A cross-sectional survey. The Ohio State University TBI Identification Method adapted for BRFSS module and BRFSS behavioral indicators. After demographic adjustment, lifetime history of TBI was found to be associated with increased odds of binge drinking, heavy drinking, smoking, a depressive disorder, or mental health not being good (≥2 days and ≥14 days in last 30 days). Mixed findings across behavioral indicators were observed in regard to number and severity of injury. Age at first injury showed no remarkable associations with the behavioral health indicators. Ohioans who have sustained at least one TBI with loss of consciousness in their lifetime are at increased risk for poor behavioral health, including alcohol misuse, smoking, and depression. The findings underscore the need for community-based mental health treatment programs to screen for TBI history in their intake evaluations, and to train clinicians on the provisions of accommodations for cognitive and behavioral deficits.

High Carbonated Soft Drink Intake is Associated with Health Risk Behavior and Poor Mental Health among School-Going Adolescents in Six Southeast Asian Countries.

Carbonated soft drink (CSD) intake has been associated with various risk behaviors in adolescents in high-income countries, but there is lack of evidence of this association in cross-nationally representative samples of school adolescents in low- and middle-income countries. This study aimed to assess the association between CSD intake, health risk behavior, and poor mental health behavior among school-going adolescents in six Southeast Asian countries. Cross-sectional national “Global School-Based Student Health Survey (GSHS)” data from 36173 school-going adolescents from Bangladesh, Indonesia, Laos, Philippines, Thailand, and Timor-Leste were analyzed. Results indicate that across all six Southeast Asian countries, in the past 30 days 23.9% of study participants had consumed no CSD, 38.8% had consumed CSD <once/day, 19.9% once a day and 17.5% ≥ two times/day. In the final adjusted logistic regression model CSD intake was associated with increased odds of having been attacked, having sustained an injury, being in a physical fight, being bullied, school truancy, tobacco use, alcohol use, and lifetime drunkenness. In addition, the consumption of CSD ≥two times/day was associated with increased odds of ever used cannabis and ever used amphetamine. Higher intake of CSD was positively associated with a history of loneliness, anxiety, suicide ideation, suicide planning, and suicide attempts. CSD intake in low- and middle-income countries is associated with several health risk behaviors and poor mental health that are similar to those observed in high-income countries.

79 A Life Course Approach to Standing Balance: Risk Factors Across Life

Abstract Introduction Poor balance ability in mid and later life is associated with increased risk of adverse health outcomes. Understanding what factors across life contribute to balance ability in the ageing population is important in order to prevent, delay or minimise balance decline. Our aim was to identify socioeconomic indicators, health behaviours, health status indicators and cognition that are associated with balance and identify how these associations varied by age and sex. Methods Data from the MRC National Survey of Health and Development, a British birth cohort study, were utilised (n=3111). Multilevel models examined associations between twelve different factors across life (maternal education, paternal occupational class, education, own occupational class, physical activity, smoking, diabetes, respiratory symptoms, cardiovascular events, knee pain, depression and verbal memory) and one-legged standing balance (assessed at ages 53, 60-64 and 69). Results Men had better balance than women at age 53 (b=18.8% (95%CI: 13.6, 23.9), although this difference decreased with age (11.8% at age 60-64 and 7.6% at age 69). Low socioeconomic position, poor health behaviours, poor health status and lower cognition were associated with poorer balance at all three ages. For example, those from the lowest paternal occupational class had 29.6% (95% CI: 22.2, 38.8%) worse balance than those from the highest class. There were no sex differences in patterns of associations. Associations of balance with socioeconomic indicators, cognition and physical activity got smaller with age, while the associations with knee pain and depression increased. Discussion Factors across life that contribute to balance are multifaceted and complex. A multifactorial intervention to minimise balance decline and falls could be more appropriate than a single factor approach. Due to different patterns of association with age (i.e. knee pain or depression), different factors should be targeted depending on age.

Polytraumatization, Mental Health, and Delinquency Among Adolescent Gang Members.

Adolescent gang members are at high risk for polytraumatization (i.e., experiencing two or more types of trauma), which may contribute to behavioral problems, such as delinquency or drug distribution, and mental health symptoms, such as posttraumatic stress disorder (PTSD) and depression. The present study examined the associations between polytraumatization and these behavioral and mental health outcomes. We hypothesized that increased polytraumatization would lead to increased (b) mental health symptoms, (b) delinquency, and (c) drug distribution. Participants included 441 adolescent gang members (57.8% male; age range: 14-19 years) from a midsized city in the Midwestern United States. A path model was used to test hypotheses. A total of 88.0% of participants experienced polytraumatization, such as physical and sexual assault, involvement in accidents, or witnessing a death or injury. Polytraumatization was uniquely and positively associated with depressive and PTSD symptoms, delinquency, and drug distribution, βs = .25-.50, ps < .001, explaining an additional 5.9%-22.5% of the variance in these outcomes beyond covariates. Untreated traumatic exposure among adolescent gang members may subsequently lead to poor behavioral and mental health outcomes. These results may inform prevention and intervention efforts focused on mental health and social justice among a high-risk adolescent population.

LONELINESS AND HEALTH AMONG OLDER ADULTS: RESULTS FROM THE UNIVERSITY OF MICHIGAN NATIONAL POLL ON HEALTHY AGING

In October 2018, the University of Michigan National Poll on Healthy Aging conducted an online survey using a nationally representative household sample of adults age 50 to 80. One in three respondents (34%) reported feeling a lack of companionship and 27% reported feeling isolated from others some of the time or often during the past year. Those with fair or poor self-reported physical health, mental health, or hearing were more likely to report feeling a lack of companionship or feel isolated as were those who reported less frequently engaging in healthy behaviors. More than one in four (28%) reported social contact with people outside of their household once a week or less. Given the high prevalence of loneliness and its connection to poor health and health behaviors, research on this important issue and efforts to increase social engagement among older adults deserve increased attention.

Do poor health behaviors have an impact on the transition from sick leave to disability pension?

Abstract Background High age, being a woman, and having low socioeconomic status are among the important risk factors for transitioning from sickness absence (SA) to disability pension (DP). But, little is known about the effect of poor health behaviors, although there are indications that poor health behaviors increase the risk of both SA and DP. The aims were to study the associations between three poor health behaviors (current smoking, high alcohol consumption and low physical activity levels) and DP among individuals who recently been sickness absent, and to explore whether having multiple poor health behaviors increased the risk of transitioning from SA to DP. Methods This prospective cohort study included 1991 twin individuals aged 20-46 who participated in a survey in 2005 and who had been on long-term SA in the two years preceding baseline (date of answering the survey) data collection of health behaviors (smoking, alcohol and physical activity) and relevant covariates. The participants were followed up for incident all-cause DP until the 31st of December 2012 (mean follow-up 5.2 years). National register data of SA and DP were used, and the association between each health behavior and DP was estimated using Cox proportional hazards regression analyses. The results are presented as Hazard Ratios (HR) with 95% Confidence Intervals (CI). Results Results showed that compared to never smoking, current smoking was associated with a higher risk of transitioning from SA to DP (HR 1.76, 95%CI 1.08-2.84). Alcohol use, lack of physical activity or having several poor health behaviors showed no significant associations. Conclusions Being a current smoker influences the risk of transitioning from SA to DP. Poor health behaviors are well established risk factors for poor physical and mental health. Hence, from a public health perspective it is important to emphasize the value of improving health behaviors in general but also among people with a history of SA. Key messages Many factors including health behaviors influence the risk of transitioning from sickness absence to permanent work incapacity in terms of disability pension. Supporting people on sickness absence to improve their health behaviors, e.g. smoking cessation, could be a promising approach to prevent exit from the labor market through disability pension.

Transitioning from sickness absence to disability pension—the impact of poor health behaviours: a prospective Swedish twin cohort study

ObjectivesTo investigate the association between three poor health behaviours (current smoker, high consumption of alcohol and low physical activity levels) and the transition to disability pension (DP) among individuals who...

Applying behavioural science to improve physicians’ ability to help people improve their own health behaviours

Abstract Issue/problem Poor health behaviours are at the centre of most non-communicable chronic diseases and account for a significant amount of morbidity and mortality. Healthcare professionals, and especially physicians, are in a unique position to be able to positively influence their patients and aid them in changing poor health behaviours. However, most physicians report having low confidence or a lack of skills to effectively achieve this. Description of the problem The main approach that physicians take to influence their patients’ poor health behaviours is to provide them with advice and evidence about the impact of the poor health behaviours. This strategy has been shown to have limited impact on changing patient behaviour. As such, there is a need to develop effective interventions that target changing physician health behaviour counselling behaviours, effectively, a behaviour change intervention for physicians so that they are better at helping patients change their behaviour. Results Using a structured stakeholder-oriented approach (the ORBIT model for developing behavioural interventions) we have systematically developed a robust behaviour change-based continuing medical education curriculum (leveraging motivational communication), and online assessment tool to improve physician competency. These were developed by a pan-Canadian team with notable international input through the IBTN. Lessons The use of a structured stakeholder-driven process, we have developed an intervention which seems to have greater relevancy to the target audience, lead to greater engagement, and a higher probability of implementation than a researcher led approach. Whilst the studies are still ongoing, it is anticipated that this intervention will be able to dramatically improve the health of individuals through effective health behaviour change interventions by healthcare professionals.

Social Gradients in Alcohol Use Disorders with and without Depression: Immigrants vs Norwegians

Abstract Background The social gradient in health runs from top to bottom of the socioeconomic spectrum. Poverty is associated with poor health and problematic unhealthy behaviors. Depression is strongly associated with social inequalities, while alcohol use disorders are not necessarily associated with a low socio economic status. Immigrants often have a lower social economic status than the host population. Research regarding alcohol use disorders, depression and a social gradient among immigrants is scare. The present study explores social gradients in persons with alcohol use disorders with and without depression and examines potential discrepancies between immigrant and native Norwegian patients receiving public specialist health care. Methods Data of 2.4 million native Norwegians and 468.496 immigrants, registered in the national mandatory Norwegian Patient Register and population data from Statistics Norway were analyzed. ICD 10 main diagnoses were used to identify patient groups - at least diagnosed once during 2008 - 2016. Immigrants had been pooled into 5 world regions. Logistic regression models have been applied to show associations between socio demographics/regions and alcohol use disorders and/or depression. Results African (OR = 0.35; 95%CI:0.27-0.44) and Asian (OR = 0.23; 95%CI:0.16-0.32) immigrants had a lower risk of developing alcohol use disorders with depression than Western Europeans (OR = 0.76; 95% CI:0.60-0.98), using native Norwegians as a reference. In general, persons with a lower socioeconomic status are more often affected of alcohol use disorder only (OR = 3.77; 95%CI:3.64-3.91) than with alcohol use disorder and concurrent depression (OR = 3.52; 95%CI:3.25-3.83). Conclusions To detect possible deficits in patient care, knowledge of social gradients in a marginalized group such as persons with alcohol use disorders and/or depression is essential. This may contribute to targeted and individualized health care- regardless of immigrant status. Key messages The risk of developing alcohol use disorders with depression varies between immigrants according to their origin. Persons with a lower socioeconomic status are more often affected of alcohol use disorder only than with alcohol use disorder and concurrent depression.

A primary care-led intervention to reduce cardiovascular disease risk in people with severe mental illness (PRIMROSE): a secondary qualitative analysis

BackgroundDespite various initiatives, the mortality rate in people with severe mental illness increased between 2004 and 2014. Poor health behaviours contribute, including poor diets, physical inactivity, smoking, and excessive alcohol consumption. Evidence is scarce regarding how primary care interventions can influence health behaviour change in people with severe mental illness. We aimed to explore how health behaviours were supported and changed in people with severe mental illness via an intervention (PRIMROSE) informed by the behaviour change wheel. MethodsPRIMROSE was delivered over 6 months in primary care across England. We did a secondary qualitative analysis of semi-structured interviews with staff and patients describing their experiences of PRIMROSE. The sample were selected from a random 20% of primary care practices in England. Topic guides were based on the capability, opportunity, motivation, and behaviour (COM-B) model of behaviour and the Theoretical Domains Framework. We identified how behaviour change techniques were applied by mapping the coded data to the behaviour change technique taxonomy (version 1). We explored barriers, facilitators, and processes of supporting or making health behaviour changes using thematic analysis. Themes were further informed by COM-B. FindingsBetween April 27 and Dec 19, 2016, 15 patients and 15 health-care professionals participated from a broad range of backgrounds across England, but with limited ethnic diversity. We identified 20 behaviour change techniques being used. Six factors affected supporting and changing health behaviours: motivation, motivated patients were more proactive to action advice, which was affected by witnessing physical health benefits; health knowledge or perceptions, developing knowledge on how to change health behaviour facilitated motivation but negative health perceptions could be difficult to change; difficulties with patient capability, mental and physical health status affected motivation; staff proficiency, previous experience with mental health and motivational interviewing skills aided supporting patients; social influences, patients felt pressure to achieve goals to avoid staff disappointment—creating healthy social (peer) norms facilitated motivation whereas unhealthy norms prevented changes; and environmental level influences, access to time and resources were perceived as critical. Making use of existing opportunities for behaviour change, such as open spaces for walking, facilitated positive changes. InterpretationThe value of the application of behaviour change techniques and primary health-care professionals in supporting health behaviour change in this population was variable. For some, such techniques helped to increase motivation, capability, and opportunity to change health behaviours. In others, complex challenges that people with severe mental illness experienced prevented behaviour change. Our findings suggest that with training and appropriate resources, primary care health-care professionals can facilitate health behaviour change in some cases, but policy makers and commissioners should consider enabling more interdisciplinary involvement. FundingUK National Institute for Health Research School for Primary Care Research.

Analysis of substance use and its outcomes by machine learning I. Childhood evaluation of liability to substance use disorder

BackgroundSubstance use disorder (SUD) exacts enormous societal costs in the United States, and it is important to detect high-risk youths for prevention. Machine learning (ML) is the method to find patterns and make prediction from data. We hypothesized that ML identifies the health, psychological, psychiatric, and contextual features to predict SUD, and the identified features predict high-risk individuals to develop SUD. MethodMale (N = 494) and female (N = 206) participants and their informant parents were administered a battery of questionnaires across five waves of assessment conducted at 10–12, 12–14, 16, 19, and 22 years of age. Characteristics most strongly associated with SUD were identified using the random forest (RF)algorithm from approximately 1000 variables measured at each assessment. Next, the complement of features was validated, and the best models were selected for predicting SUD using seven ML algorithms. Lastly, area under the receiver operating characteristic curve (AUROC) evaluated accuracy of detecting individuals who develop SUD+/- up to thirty years of age. ResultsApproximately thirty variables strongly predict SUD. The predictors shift from psychological dysregulation and poor health behavior in late childhood to non-normative socialization in mid to late adolescence. In 10–12-year-old youths, the features predict SUD+/- with 74% accuracy, increasing to 86% at 22 years of age. The RF algorithm optimally detects individuals between 10–22 years of age who develop SUD compared to other ML algorithms. ConclusionThese findings inform the items required for inclusion in instruments to accurately identify high risk youths and young adults requiring SUD prevention.

PTSD symptom decrease and use of weight loss programs

ObjectivePosttraumatic stress disorder (PTSD) is associated with poor health behaviors, including low utilization of Veteran Health Affairs (VHA) weight loss programs. It is not known if clinically meaningful PTSD improvement is associated with increased use of weight loss programs. MethodsMedical record data was obtained from VHA patients who received PTSD specialty care between Fiscal Year (FY) 2008 to FY2012. Clinically meaningful PTSD improvement was defined as ≥20 point PTSD Checklist (PCL) decrease between the first PCL ≥ 50 and a second PCL at least 8 weeks later and within 12 months of the first PCL. Eligible patients, n = 993, were followed through FY2015. Propensity scores and inverse probability of exposure weighting controlled confounding. Cox proportional hazard models estimated the association between clinically meaningful PCL decrease and weight loss clinic utilization. Supplemental analysis compared both PTSD groups vs. no PTSD. ResultsPatients were 44.8 (SD ±14) years of age, 88.9% male and 66.8% white. Patients with vs. without a clinically meaningful PCL decrease were more likely to use a weight loss clinic (HR = 1.37; 95%CI:1.02–1.85). Among those with a weight loss encounter, PCL decrease was not associated with the number of encounters (RR = 1.13; 95%CI:0.70–1.81). Compared to no PTSD, patients with PTSD improvement had more weight loss encounters. ConclusionsLarge improvements in PTSD are associated with increased utilization of weight loss programs, and PTSD is not a barrier to seeking weight loss counseling. Research to understand why improvement in PTSD is not related to better weight loss outcomes is needed.