Investigating the Degree to Which Unstructured Socializing With Peers and Delinquency Are Nonlinear.

Since the formulation of Cohen and Felson's (1979) routine activity theory (RAT), Osgood et al. (1996) established a reformulated theory to better explain patterns of situational offense and coined the RAT of general deviance or more commonly known as unstructured socializing with peers (USWP). The present study seeks to explore whether spending more time in USWP may increase antisocial behavior in a nonlinear manner, either accelerating or decelerating. Results showed that the relationship between USWP and property delinquency was found to be nonlinear in a decelerating manner. Similar results were found for the association between USWP and substance use. Finally, the relationship between USWP and violent delinquency was significant, although no evidence was found for nonlinearity. The present study concludes with theoretical implications, limitations, and directions for future research.

The gaming disorder test and gaming disorder scale for adolescents: translation and validation among Vietnamese young adults.

BACKGROUND: Previous studies have shown that the Gaming Disorder Test (GDT) and Gaming Disorder Scale for Adolescents (GADIS-A) have promising validity and reliability when assessing symptoms of gaming disorder among young adults. However, validity and reliability properties of the two scales have not been established among a Vietnamese population. OBJECTIVE: The present study translated the GDT and GADIS-A into Vietnamese and examined their factor structures, measurement invariance, convergent validity, concurrent validity, and divergent validity among university students. METHODS: A total of 610 young adults (mean age = 21.09 years; 63.4% females) were recruited using convenience sampling and who completed a paper-and-pencil survey between April and June 2023. All participants completed a demographic questionnaire, GDT, GADIS-A, and six standardized scales related to gaming disorder, social media addiction, smartphone addiction, and psychological distress. Confirmatory factor analysis (CFA), internal consistency testing, and Pearson's correlations were performed. RESULTS: CFA showed that the GDT had a one-factor structure and the GADIS-A had a two-factor structure. The internal consistency was excellent for both scales among this population. Moreover, both GDT and GADIS-A showed convergent, concurrent, and divergent validity with other standardized scales. CONCLUSION: The Vietnamese versions of the GDT and GADIS-A have good psychometrics, which may be utilized in future research regarding gaming disorder among Vietnamese populations.

Associations of parenting styles with substance use in the offspring-A systematic review and meta-analysis.

ISSUES: Parenting styles have been suggested to predict the use of psychoactive substances in the offspring, although the size of associations might vary between cultures. The present meta-analysis tested whether parenting styles show concurrent and longitudinal associations with substance use and whether this association is moderated by study characteristics. APPROACH: A systematic search in electronic data bases resulted in 184 studies that were included in multi-level meta-analysis. KEY FINDINGS: An authoritative parenting style correlated with lower substance use (r =-0.12, confidence interval [CI] -0.14 to -0.10) while the reverse was found for neglectful (r = 0.10, CI 0.08 to 0.13), permissive (r = 0.04, CI 0.01 to 0.07) and authoritarian parenting (r = 0.03, CI 0.00 to 0.05). Analysis of cross-lagged effects found only an effect of authoritative parenting on decline of substance use (r = -0.06, CI -0.12 to -0.00). The size of associations varied, in part, by levels of horizontal and vertical collectivism or individualism, assessment of three versus four parenting styles, type of substance, and use of same versus different informants for assessing parenting and substance use. IMPLICATIONS: Parenting styles show small to very small associations with substance use. CONCLUSIONS: Although parents are recommended to behave in an authoritative manner, we should have only modest expectations about the effects of parenting styles on substance use in the offspring.

Engaging Diverse African American/Black and Latine Youth and Emerging Adults Living with HIV into Research: Description of Recruitment Strategies and Lessons Learned.

Improving engagement along the HIV care continuum and reducing racial/ethnic disparities are necessary to end the HIV epidemic. Research on African American/Black and Latine (AABL) younger people living with HIV (LWH) is essential to this goal. However, a number of key subgroups are challenging to locate and engage, and are therefore under-represented in research. Primary among these are persons with non-suppressed HIV viral load, severe socioeconomic disadvantage, transgender/gender expansive identities, and refugee/migrant/immigrant populations. Research in community settings is needed to complement studies conducted in medical institutions. The present study describes the efficiency of recruitment strategies used in the community to enroll AABL young and emerging adults LWH ages 19-28 years. Strategies were designed to be culturally responsive and structurally salient. They were: peer-to-peer, social media, classified advertisements (newspaper, craigslist), subway ads, dating apps (Jack'd, Positive Singles), and direct recruitment in community-based organizations. Data were analyzed using mainly descriptive statistics and interpreted using a consensus building approach. We screened 575 individuals in a first step, 409 were eligible (71%), of these 297 presented to the second screening step (73%), but 112 were lost. Almost all presenting at the second step were eligible (98%, 291/297) and 94% enrolled (274/291). Peer-to-peer, dating app (Jack'd), direct recruitment, and craigslist were the most efficient strategies. Recruitment on dating apps was superior to the peer-to-peer approach in yielding eligible participants (OR = 1.5; 95% CI: 0.98-2.3; p = 0.06). The sample enrolled was diverse with respect to HIV viral suppression, gender identify, sexual orientation, immigration status, and barriers to HIV care engagement. We discuss the advantages and disadvantages of each strategy. Recruitment is a vital aspect of research and warrants attention in the empirical literature.

Racism-related experiences and substance use: A systematic and meta-analytic review.

Examinations highlighting interpersonal racism-related experiences as risk factors for substance use are well documented, particularly for alcohol use. The associations between racism-related experiences across other levels of influence (e.g., historical trauma, online, internalized) and use of other types of substances, while emerging, have yielded mixed findings. The present systematic review and meta-analyses examined the associations between multilevel racism-related experiences and different types of substances including substance use overall, alcohol, binge drinking, tobacco/nicotine, cannabis, illicit drugs, and polysubstance use among ethnoracially minoritized adolescents and emerging adults (12-29 years old). A systematic literature search and the Newcastle-Ottawa Scale (NOS) were used to identify, assess quality, and bias of included articles. Random-effects meta-analyses estimated pooled effect sizes for seven substance use outcomes and by age, sex, and race/ethnicity. Out of a total of 3190 articles, 91 (N = 190,065 participants) met inclusion criteria, 79 of which were included in the meta-analysis. The studies included were predominantly cross-sectional, school-based samples, and focused on Black individuals. Most examined interpersonal racism and few examined online and historical forms of racism. Meta-analyses demonstrated a significant positive association, with a small pooled effect size, between racism-related experiences and each substance use outcome. Moderations by age, sex, and race/ethnicity were found. Racism-related experiences are a risk factor for substance use among ethnoracially minoritized adolescents and emerging adults. Interventions addressing racism-related experiences across multiple dimensions are critical for the prevention and treatment of substance use among ethnoracially minoritized communities.

Initial Witnessing on Future Witnessing: A Mediation Analysis of Chronic Community Violence, Post-Traumatic Stress, and Delinquency in Urban, African American Youth.

Witnessing community violence can predict negative mental health outcomes for youth such as post-traumatic stress symptoms and delinquent behavior. Such outcomes differ by gender. Variables that predict witnessing community violence in youth are less understood. This study aims to explore potential pathways between initial witnessing and continued witnessing for early adolescents. The relationship between witnessing as a predictor and witnessing as an outcome is hypothesized to be mediated by both post-traumatic stress and delinquency and moderated by gender. A sample of 153 African American, sixth-grade students (M= 11.65, 59% female) in high crime, high poverty areas completed self-report surveys at baseline, 12 and 24 months. Moderated serial mediation was used to assess longitudinal associations. For the full model, delinquency at Time 3 was associated with a positive change in witnessing at Time 3. Gender moderated several paths. For girls, witnessing at Time 1 was predictive of high post-traumatic stress (aggregate) at Time 2 and high delinquency at Time 3. For girls, witnessing at Time 1 also was predictive of higher hyperarousal and higher intrusion subscale symptoms than other symptoms at Time 2. Analyses also indicated that hyperarousal at Time 2 significantly predicted witnessing at Time 3 for girls only. Lastly, delinquency at Time 3 was associated with a positive change in witnessing at Time 3. For boys, no analyses indicated witnessing at Time 1 as a significant predictor. Results contribute to our understanding of the trajectory of witnessing community violence and the roles both post-traumatic stress subscales and delinquency play in that trajectory, especially among girls.

Cancer fatalism is associated with HPV vaccine uptake among Hispanic emerging adult women in the US.

OBJECTIVE: Despite the availability of the Human Papillomavirus (HPV) vaccine, only a small percentage of Hispanic emergent adults in the United States have actually had the vaccination. Due to cancer fatalism, some Hispanic emerging adults may perceive fewer benefits from the HPV vaccine, regardless of its positive health effects. The aim of this study was to determine the relationship between cancer fatalism, knowledge of HPV-associated cancers, and HPV vaccination among Hispanic emerging adult women. STUDY DESIGN: Between August and December of 2020, a cross-sectional study was conducted among Hispanic college women aged 18 to 26. A complete case study was conducted with 689 participants. Using an adjusted logistic regression model, the potential factors associated with HPV vaccine uptake were identified. The current research was approved by the Institutional Review Boards of the participating universities. RESULTS: Only 55.6 % of the study population had received at least one dose of the HPV vaccine. The study found that HPV vaccine uptake was positively associated with HPV associated cancer knowledge (aOR = 1.32; 95 % CI = 1.18, 1.47) and was inversely associated with cancer fatalism (aOR = 0.97; 95 % CI = 0.94, 1.00). CONCLUSION: According to the results of our study, the HPV vaccination rate among Hispanic emerging adult women is low, and it is necessary to identify the factors that influence vaccination rates. There is a critical, unmet need for innovative approaches to improve HPV vaccination in this population and mitigate the incidence of HPV-related cancers. IMPLICATIONS: Multiple intervention strategies are required to increase vaccination rates among this population. This study suggests implementing culturally tailored health promotion initiatives that reduce fatalistic beliefs among this population. Furthermore, developing a culturally tailored, age-specific HPV vaccine education and promotion program to increase HPV-associated cancer knowledge among Hispanic emerging adults.

Profiles of Black Emerging Adults Exposure to Racism-Based Police Violence and Associated Mental Health Outcomes.

This study characterizes the profile of Black emerging adults aged 18-29 generated from sociodemographic characteristics and indicators of police contact and exposure to racism-based police violence (RPV), and the relationship between profiles and traumatic stress symptoms. A purposive sample of 300 Black emerging adults was recruited for this exploratory study. Cluster analysis (CA) was performed to generate profiles of this sample. Two distinct profiles emerged from the CA. Cluster 1 is characterized by participants with low rates of police contacts and direct RPV exposure, whereas Cluster 2 consists of participants with higher rates of police contacts and direct RPV exposure. Regression analysis revealed that being in Cluster 2, as opposed to Cluster 1, was associated with increased scores for depression, avoidance, and intrusion symptoms. Findings provide guidance for mental health intervention strategies to combat the psychological impact of RPV exposure for Black emerging adults.

Vulnerable Narcissism and Emotion Dysregulation as Mediators in the Link between Childhood Emotional Abuse and Binge Watching.

Individuals who have faced childhood emotional abuse (CEA) may develop vulnerable narcissistic tendencies and experience difficulties in regulating their emotions. These psychological vulnerabilities can contribute to the adoption of binge watching as a maladaptive coping mechanism. The present study aimed to investigate the potential mediating role of vulnerable narcissism and emotion dysregulation in the relationship between CEA and binge watching. Additionally, this study examined whether this model was gender-invariant. A sample of 1082 emerging adults, aged 18 to 25 (50% women), completed self-report questionnaires. The results revealed significant direct and indirect relationships among all the variables of interest, and the model was found to be invariant across genders. Notably, both men and women who experienced CEA and exhibited higher levels of vulnerable narcissism and emotion dysregulation reported engaging in higher levels of binge watching. These findings highlight the importance of the early identification of CEA, the implementation of targeted interventions, and the provision of trauma-informed care to address the negative consequences of CEA and mitigate the development of binge-watching behaviors. Moreover, the results emphasize the need for tailored prevention and intervention programs that address vulnerable narcissism and emotion dysregulation as potential pathways to inform effective therapeutic strategies.

Childhood emotional maltreatment and emerging adults' body dissatisfaction: Self-compassion and body surveillance as explanatory mechanisms.

The association between childhood emotional maltreatment and body dissatisfaction has been widely identified. However, the explanatory mechanisms for this association remain unclear. Guided by the Stress Process Model, the present study tested the potential mediating roles of self-compassion and body surveillance in the associations between emotional maltreatment (i.e., emotional abuse and neglect) and body dissatisfaction. Three-wave, self-report survey data were collected from 668 Chinese young adults (66.8 % female, Mage = 19.96 years old, SD = 1.25) with a 6-month between-wave interval. Results demonstrated that childhood emotional neglect (recalled at Time 1) was positively associated with body dissatisfaction (at Time 3) through a serial mediating pathway from self-compassion (at Time 1) to body surveillance (at Time 2). In contrast, no links involving childhood emotional abuse were identified. Findings suggest that the compromised emotion regulation capacity related to self-care and the subsequent self-objectification could be key processes through which childhood emotional deprivation would be positively associated with later body dissatisfaction. Accordingly, prevention and intervention efforts aimed at combating young adults' body image issues with early adversity of emotional deprivation could integrate emotion regulation training (that can enhance self-care) and cognitive-behavioral techniques (that may reduce body surveillance) into extant programs to enhance effectiveness.

Childhood Maltreatment and Physical Health in College Students: Physical Activity and Binge Eating as Moderators.

Child maltreatment leads to pervasive physical health problems. For individuals with a child maltreatment history, physiological risk factors for future disease are apparent by young adulthood. The current study explored the role that physical activity and binge eating may have in the trajectory from child maltreatment to poor adult health. We administered the following measures to 100 female and male college students: resting heart rate assessment, symptoms of illness, and the Childhood Trauma Questionnaire (CTQ-SF) to assess maltreatment history. After this session, participants wore a Fitbit that provided physical activity data (low, moderate, and vigorous activity, and total steps) in a free-living environment for a period of 10 days. Physical activity moderated the pathway between maltreatment history and both resting heart rate and symptoms of illness. In individuals with higher CTQ scores, more low-intensity physical activity and total steps were related to fewer symptoms of illness and lower resting heart rate, respectively. Binge-eating behavior moderated the pathway between maltreatment and symptoms of illness, such that greater binge-eating behavior was associated with more self-reported illness symptoms in participants with higher CTQ scores. These findings suggest that on-campus interventions targeting physical activity and healthy eating behaviors will improve the long-term health of young adults with maltreatment history.

Emotional Dysregulation in Emerging Adult ADHD: A Key Consideration in Explaining and Classifying Impairment and Co-Occurring Internalizing Problems.

OBJECTIVE: The current study sought to clarify and harness the incremental validity of emotional dysregulation and unawareness (EDU) in emerging adulthood, beyond ADHD symptoms and with respect to concurrent classification of impairment and co-occurring problems, using machine learning techniques. METHOD: Participants were 1,539 college students (Mage = 19.5, 69% female) with self-reported ADHD diagnoses from a multisite study who completed questionnaires assessing ADHD symptoms, EDU, and co-occurring problems. RESULTS: Random forest analyses suggested EDU dimensions significantly improved model performance (ps < .001) in classifying participants with impairment and internalizing problems versus those without, with the resulting ADHD + EDU classification model demonstrating acceptable to excellent performance (except in classification of Work Impairment) in a distinct sample. Variable importance analyses suggested inattention sum scores and the Limited Access to Emotional Regulation Strategies EDU dimension as the most important features for facilitating model classification. CONCLUSION: Results provided support for EDU as a key deficit in those with ADHD that, when present, helps explain ADHD's co-occurrence with impairment and internalizing problems. Continued application of machine learning techniques may facilitate actuarial classification of ADHD-related outcomes while also incorporating multiple measures.

Understanding Romantic Relational Aggression in Emerging Adults Using Latent Profile Analysis of Jealousy and Hostile Attribution Bias.

The present study sought to identify profiles of 753 emerging adults (62.5% females) with different levels of hostile attribution bias (HAB) and jealousy dimensions (i.e., cognitive, emotional, behavioral) and examined differences in their levels of romantic relational aggression (RoRAgg) across profiles. Participants were recruited from Greek universities and completed and online survey. Using a person-centered approach, Latent Profile Analysis indicated the presence of three profiles of participants: a) jealous and hostile intent attributers who had high scores on jealousy dimensions and HAB, b) low risk who scored low on jealousy and HAB, and c) emotionally jealous and moderate hostile intent attributers with moderate cognitive and behavioral jealousy as well as HAB, and high emotional jealousy. As predicted, jealous and hostile intent attributers scored higher on RoRAgg compared with emotionally jealous and moderate hostile intent attributers and low risk. The findings confirm previous research and are discussed in terms of their implications. Interventions targeting relational aggressor's hostile attributions, cognitive suspicions, and negative thoughts should be implemented to reduce RoRAgg.

Within-person and between-person associations of access to environmental reward with alcohol and cannabis use and consequences among young adults.

BACKGROUND: Recent behavioural economic models of substance use suggest that low access to environmental reward may increase risk for heavy substance use and associated harms. Most prior studies of these associations have been cross-sectional and have focused on alcohol. The current study extends this research using longitudinal data to examine the within-person and between-person associations of environmental reward access with both alcohol and cannabis outcomes. METHOD: Young adults (N = 119, 64.71 % female) completed an online survey at three time points, spaced six months apart. The survey included measures of alcohol and cannabis use and consequences, and two facets of environmental reward access: reward probability (i.e., likelihood of experiencing environmental reward) and environmental suppression (i.e., diminished availability of environmental reward). RESULTS: Multilevel models revealed that at the between-person level (i.e., averaged across time points), greater environmental suppression (but not reward probability) was significantly associated with more frequent cannabis use, and greater reward probability (but not environmental suppression) was significantly associated with heavier alcohol use. Higher environmental suppression (but not reward probability) was also associated with greater alcohol and cannabis consequences at the between-person level, over and above level of use. A significant within-person association also was observed, wherein participants reported relative increases in cannabis consequences during time periods when they also reported relative decreases in the availability of environmental reward. CONCLUSIONS: Results highlight environmental suppression as a risk factor for more frequent cannabis use and for both alcohol and cannabis consequences, and provide novel support for a within-person association between environmental suppression and cannabis consequences over time. Findings may inform contextual interventions for young adult substance use.

Meeting the Needs of Emerging Adults With Type 1 Diabetes Living in a Rural Area With Mobile Health Interventions: Focus Group Study.

BACKGROUND: Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D. OBJECTIVE: This study aimed to understand the diabetes management experiences of older adolescents and EAs (age 16-25 years) with T1D living in a rural area and to assess their perceptions of the acceptability of 4 fully automated mobile health (mHealth) interventions to support diabetes management. METHODS: EAs were identified by clinical staff through convenience sampling. In total, 8 EAs participated in 1 focus group and 1 EA completed an individual interview; all data were collected over Zoom. Facilitators explored EAs' experiences living in a rural community with T1D and discussed EAs' impressions of, feedback on, and recommendations for improving 4 mHealth interventions to meet the specific needs of EAs with T1D living in rural communities. Discussions were transcribed and analyzed using conventional content analysis. RESULTS: In total, 9 EAs (aged 18.8, SD 2.7 years; 5, 56% men; 8, 89% White) with a duration of diabetes of 8.6 (SD 4.3) years participated. They described experiences with diabetes stigma (attributing diabetes to poor lifestyle choices) and feelings of self-consciousness (hyperawareness) in their rural communities. They attributed these experiences to the small size of their communities ("everyone knows") and community members' lack of knowledge about diabetes (unable to differentiate between type 1 and type 2 diabetes). In contrast, EAs reported high levels of social support for diabetes and diabetes care from family, friends, and other community members, but low support for medical needs. The location of their diabetes care providers and the limited accessibility of diabetes-specific and general medical care services in their local community created a challenging medical care context. Overall, EAs found mHealth interventions appealing due to their digital delivery and highlighted features that increased accessibility (voiceovers and simple, jargon-free language), individualization (ability to tailor intervention content and delivery), and applicability to their own lives and other EAs with T1D (relatability of vignettes and other content). EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences (greater frequency and duration, ability to adapt content to emerging needs), increasing opportunities for peer support within the interventions (friend and significant other as identified support person, connecting with peers beyond their local community), and making the tone of intervention components more casual and engaging. CONCLUSIONS: mHealth interventions aligned with EAs' needs and preferences are a promising strategy to support EAs in communities where social support and resources might be limited. TRIAL REGISTRATION: N/A, not a clinical trial.

A mixed-methods longitudinal examination of weight-related self-monitoring and disordered eating among a population-based sample of emerging adults.

BACKGROUND: Weight-related self-monitoring (WRSM) apps are used by millions, but the effects of their use remain unclear. This study examined longitudinal relationships between WRSM and disordered eating among a population-based sample of emerging adults. METHODS: Participants (n = 138) were recruited from EAT 2010-2018 (Eating and Activity over Time study) to participate in a mixed-methods (quantitative and qualitative) longitudinal study to understand the impacts of WRSM. In 2018, participants (Mage=21.7 ± 1.9 years) reported motivations for use and types of WRSM apps used. Dependent variables collected in 2022 (Mage=25.7 ± 1.9 years) included past year total number of disordered weight control behaviors, disordered muscle building behaviors, compulsive exercise, and binge eating. Linear and logistic regressions were used adjusting for sociodemographics, body mass index, and baseline disordered eating. Semi-structured interviews (n = 25) were analyzed using inductive thematic analysis. RESULTS: Participants using WRSM apps for weight management demonstrated an increase in disordered weight control behaviors over time (ß = 0.894, p = .012). Using WRSM apps for "healthy" eating was marginally associated with an increase in disordered weight control behaviors. (ß = 0.673, p = .052). Qualitatively, participants reported varied temporality between WRSM and disordered eating, but believed that app use encouraged restriction/binge cycles and normalized disordered eating. CONCLUSIONS: Findings suggest there may be individual variation in the relationships between WRSM and disordered eating, but that using WRSM apps with the motivation of managing eating or weight may increase disordered eating in some. Additionally, WRSM apps may normalize or encourage disordered eating. Therefore, safeguards, including screening and monitoring, are needed to ensure WRSM does not cause or escalate harm among WRSM users.

For some, weight-related self-monitoring apps, like MyFitnessPal and Fitbit, may cause or worsen disordered eating over time among emerging adults. However, it seems as though the motivation for self-monitoring (e.g., for managing eating or weight) may be more important than what they are monitoring when it comes to disordered eating risk.

Pathways from Family Functioning to Internet Gaming Disorder: The Mediating Role of the Dark Triad.

With internet gaming disorder (IGD) becoming more common, there are growing worries about the health of those it affects. This study examines how traits like Machiavellianism, psychopathy, and narcissism might connect family functioning to IGD. The research involved 1190 young adults who answered an online survey, sharing their personal experiences. To examine the mediation effects, latent variable structural equation modeling (SEM) was used, revealing complex relationships among the variables under investigation. Although all direct and indirect paths were statistically significant, the mediation effects of narcissism were positive only when Machiavellianism and psychopathy were not included as parallel mediators, but negative otherwise. The findings suggest that individuals with strong family functioning could be less likely to internalize manipulative behaviors and show a lack of empathy, traits that could contribute to their involvement in IGD. The results underscore the importance of recognizing the multifaceted nature of this phenomenon and provide valuable insights for developing comprehensive strategies to prevent and tackle IGD. Therefore, prevention and intervention efforts should consider the combined influences of family functioning, personality traits, and individual and contextual factors in the online environment to effectively address this problem.

Association between Depressive Symptoms, Physical Activity, and Health Factors in Hispanic Emerging Adults.

Physical activity is a modifiable lifestyle behavior known for reducing symptoms of and being a risk factor for depression and mental health disorders. However, emerging adults (ages 18-25) struggle to meet recommended amounts. In this study, we explore the association between physical activity, depressive symptoms, and health factors in 137 Hispanic emerging adults. Using a cross-sectional survey design, sociodemographic information, depressive symptoms (CES-D score), physical activity (IPAQ score), body composition, and blood pressure measures were obtained. Statistical analyses included correlation and regression analyses. More than half of the participants demonstrated depressive symptomology (59.1%) and body fat percentage greater than 25% (64.2%). Body fat percentage, lean body mass, stress, and heart rate demonstrated notable associations with depressive symptoms and physical activity. When measured continuously and categorically, IPAQ was not a significant predictor of depressive symptoms. When used as a binary variable with a cutoff of 600 MET min/week, IPAQ score revealed a negative relationship with CES-D score (ß = -0.169, SE = 2.748, p = 0.034). Our results indicate that a threshold of physical activity, 600 MET min/week, may confer protective effects against depressive symptoms. Future research should investigate the context and quality of physical activity to address mental health disparities in this underrepresented population.

Is nicotine vaping associated with subsequent initiation of cannabis or other substances from adolescence into young adulthood?

Prior studies estimating longitudinal associations between nicotine vaping and subsequent initiation of cannabis and other substances (e.g., cocaine, heroin) have been limited by short follow-up periods, convenience sampling, and possibly inadequate confounding control. We sought to address some of these gaps using the nationally representative Population Assessment of Tobacco and Health Study (PATH) to estimate longitudinal associations between nicotine vaping and the initiation of cannabis or other substances among adolescents transitioning to adulthood from2013 to 2019, adjusting for treatment-confounder feedback. Estimands like the longitudinal average treatment effect were not identified because of extensive practical positivity violations. Therefore, we estimated longitudinal incremental propensity score effects, which were identified. We found that reduced odds of nicotine vaping were associated with decreased risks of cannabis or other substance initiation; these associations strengthened over time. For example, by the final wave (2018-19), cannabis and other substance initiation risks were 6.2 (95%CI:4.6-7.7) and 1.8 (95%CI:0.4-3.2) percentage points lower when odds of nicotine vaping were reduced to be 90% lower in all preceding waves (2013-14 to 2016-18), as compared with observed risks. Strategies to lower nicotine vaping prevalence during this period may have resulted in fewer young people initiating cannabis and other substances.

Empowering emerging adults with type 1 diabetes: crafting a financial and health insurance toolkit through community-based participatory action research.

BACKGROUND: Emerging adults aged 18-30 years face challenges during life transitions, with an added burden of navigating the health care system and additional costs associated with diabetes. This stress is compounded by overall low levels of health insurance literacy in this population, as people may not know about available financial and health care resources to minimize suboptimal diabetes outcomes. This study aimed to tailor a financial and health insurance toolkit to emerging adults with type 1 diabetes, including racially, ethnically diverse, and Medicaid-insured individuals, through community-based participatory action research. METHODS: An academic research team and community members from a national organization held six online community advisory board (CAB) content-creation meetings to understand how to tailor a financial and health insurance Toolkit. The CAB was comprised of six racially and insurance-diverse emerging adults with type 1 diabetes and four content experts (clinical, financial, and insurance). Six 60-minute online CAB meetings were held via University Hospitals (UH)-encrypted Zoom over five months. Pre-reading materials were emailed to CAB members before the meetings. A moderator established the purpose of each meeting and briefly discussed meeting rules before each meeting commenced. During the meetings, the moderator guided the discussions and provided the CAB members opportunities to respond and build on one another's feedback. A deductive thematic qualitative analysis was utilized. Three researchers independently coded the cross-referenced and de-identified CAB meeting transcripts and then convened to reach a group consensus. Two CAB members performed member-checking. RESULTS: The following key themes emerged to tailor the Toolkit: ensuring that content covers empowerment and self-advocacy, including genuine stories and multimedia visuals for aesthetics, addressing clinician bias, acknowledging racial and ethnic disparities in care, incorporating cultural representation, and demystifying Medicaid stigma. CONCLUSIONS: By successfully partnering with the CAB and a community organization through a community-based participatory action research approach, we will develop a financial and health insurance Toolkit tailored to the needs of racially and ethnically diverse and Medicaid-insured emerging adults with type 1 diabetes.

AIM OF THE RESEARCH: This study aims to tailor a financial and health insurance Toolkit to emerging adults, ages 18­30, with type 1 diabetes. Including the insight from racially and ethnically diverse and Medicaid-insured individuals in developing the Toolkit is essential. BACKGROUND TO THE RESEARCH: Emerging adults with type 1 diabetes have stressful challenges such as navigating the healthcare system, the costs of diabetes, and general diabetes self-management. This stress is worsened by low levels of health insurance literacy and leads to suboptimal diabetes outcomes. This issue affects many individuals but dramatically impacts those who are racially and ethnically diverse or Medicaid-insured. DESIGN AND METHODS USED: Six online content-creation meetings were held to understand the Toolkit content needs and preferences. We analyzed the meeting transcripts to uncover common themes. Patient and public involvement: An academic research team, a national organization (The Diabetes Link), and a Community Advisory Board (CAB) partnered together. The CAB members were racially and insurance-diverse emerging adults with type 1 diabetes and content (financial, insurance, clinical diabetes) experts. We will continue to collaborate with the CAB members to develop a research protocol to test the effects of the Toolkit. DISSEMINATION: The research findings will be shared with young adult type 1 diabetes stakeholders, healthcare providers, and community and professional organizations. Dissemination strategies will include publications, community and scientific conference presentations, community events, and social media resources and content. The finalized Toolkit will be publicly available on the Diabetes Link Resource Hub.