COVID-19 and changes in young adults' weight concerns.

The COVID-19 pandemic introduced fundamental challenges to nearly all aspects of college students' lives, yet changes in key domains of their health, including weight concerns, remain untested. The current study utilized a longitudinal project comprised of 355 young-adult college students (Mage=19.5, 66.8% female, 33.2% male) oversampled for recent substance use behavior. Participants completed multiple assessments (mode = 5) from September 2017 to September 2021. Piecewise growth-curve models tested whether COVID-19 onset was associated with changes in the trajectories of young adults' weight concerns. Analyses also examined participants' sex as a moderator of these trajectories. On average, participants reported a significant increase in weight concern levels around the start of COVID-19, although weight concern slopes were not significantly different before and after COVID-19. Additionally, moderation analyses showed that females (but not males) had a significant increase in weight concern levels after COVID-19 onset.

Other Momentary Substance Behaviors as Predictors of College Students' Prescription Drug Misuse in Daily Life: An Exploratory Study.

Background: Limited prior research to examine co-occurrence of prescription drug misuse with other substances among young adults has documented outcomes that are more problematic for those with higher rates of co-ingesting alcohol. There is a need to understand how college students in this period of heightened risk use other salient substances in moments of their prescription misuse in daily life. Method: Young-adult college students who engaged in recent prescription misuse (N = 297) completed ecological momentary assessment (EMA) over a 28-day period, resulting in 23,578 reports. Multilevel modeling examined within-person associations between other momentary substance use (including alcohol, nicotine, energy drinks, and marijuana) and prescription misuse in daily life. Analyses accounted for between-person characteristics, having a current focal prescription, and effects of reporting over time. Participant sex was also explored as a moderator. Results: In adjusted multilevel models, college students' momentary nicotine use and energy drink use each were associated with their greater likelihood of prescription misuse in daily life. In contrast, momentary marijuana use was linked with lower likelihood of misuse. Moderation results indicated that males (but not females) were less likely to engage in prescription misuse in moments of their alcohol use. Conclusions: Drawing from data obtained using EMA, findings provide novel insights about the real-world associations between prescription drug misuse and other salient substance behaviors during a developmental period that is important for establishing later substance use and health.

Bidirectional associations between nightly sleep and daily happiness and negative mood in adolescents.

This study examined bidirectional associations between daily happiness and negative mood and subjective and objective sleep measures. Participants were 311 adolescents (Mage  = 17.37 years; 51.8% female; 59.2% White/European American, 38.6% Black/African American, 1% Hispanic/Latinx American, 1.4% multi-racial; 19.3% below poverty line) observed over a 7-day period (2017-2018) using sleep diaries and actigraphy. Daily negative mood was related to greater subjective sleep/wake problems, and happiness was related to lower subjective sleep/wake problems. Conversely, shorter self-reported sleep duration was related to higher negative mood the next day. For actigraphy measures, daily negative mood was related to greater sleep duration and efficiency, whereas happiness was related to lower sleep efficiency. Differences in associations based on subjective versus objective sleep measures are discussed.

Dyadic Effects of Fluid Mindset on Psychological Growth in Immigrant Mothers and Their Children: Indirect Effect of Resilience.

Immigration research has recently investigated positive adaptation outcomes such as psychological growth. This study tested actor and partner effects between fluid mindset and psychological growth, mediated by resilience, in 200 migrant mother-child dyads from Mainland China to Hong Kong. Mothers' fluid mindset had significant actor and partner effects on their own and their children's psychological growth, whereas children's fluid mindset showed an actor effect. For mothers and children, fluid mindset had significant actor indirect effects on psychological growth via resilience. Mothers' fluid mindset had a significant partner indirect effect on children's psychological growth via children's resilience. The findings have implications for enhancing immigrants' psychological growth by strengthening fluid mindset and considering mothers and children as the intervention unit in resilience programs.

En las investigaciones sobre la inmigración se han analizado recientemente los resultados de la adaptación positiva, como el crecimiento psicológico. En este estudio se evaluaron los efectos del actor y la pareja entre la mentalidad flexible y el crecimiento psicológico, mediados por la resiliencia, en 200 díadas madre e hijo de emigrantes de China continental a Hong Kong. La mentalidad flexible de las madres tuvo efectos significativos del actor y la pareja en su propio crecimiento psicológico y el de sus hijos, mientras que la mentalidad flexible de los hijos demostró un efecto del actor. Para las madres y los hijos, la mentalidad flexible tuvo efectos indirectos significativos del actor en el crecimiento psicológico mediante la resiliencia. La mentalidad flexible de las madres tuvo un efecto indirecto de la pareja en el crecimiento psicológico de los hijos mediante la resiliencia de los hijos. Los resultados tienen consecuencias para mejorar el crecimiento psicológico de los inmigrantes mediante el fortalecimiento de la mentalidad flexible y la consideración de las madres y los hijos como unidad de intervención en los programas de resiliencia.

Couples' Perceptions of Each Other's Daily Affect: Empathic Accuracy, Assumed Similarity, and Indirect Accuracy.

This study examined couples' perceptions of each other's daily affect, using a daily diary methodology. Specifically, we tested the extent to which couples accurately inferred how their partner was feeling (empathic accuracy) and the extent to which spouses used their own feelings as a gauge for how their partner was feeling (assumed similarity). We also tested for indirect accuracy in couples' perceptions; that is, that assumed similarity in the context of actual similarity leads to empathic accuracy. Participants were 51 couples who completed daily diaries for seven consecutive nights. Results based on the Actor-Partner Interdependence Model indicated that couples showed both empathic accuracy and assumed similarity in their perception of their partner's positive affect; however, they used assumed similarity in rating their partner's hard negative (anger, hostility) and soft negative (sadness, fear) affect. Furthermore, tests of indirect accuracy found that wives were indirectly accurate in perceiving their husbands' positive affect and both husbands and wives were indirectly accurate in perceiving each other's hard negative affect because they were biased. Complementing laboratory studies, the present study highlights that examining couples' perceptions of each other's feelings in contexts of daily life, and differentiating positive and negative emotions, can further our understanding of the role of emotions for healthy relationship functioning.

Este estudio analizó las percepciones de las parejas del afecto diario mutuo utilizando una metodología de registro diario. Específicamente, evaluamos el grado en el que las parejas infirieron con precisión cómo se sentía su pareja (precisión empática) y el grado en el que los cónyuges usaron sus propios sentimientos como indicador de cómo se sentía su pareja (similitud asumida). También evaluamos la precisión indirecta de las percepciones de las parejas, es decir, que la similitud asumida en el contexto de la similitud real lleva a la precisión empática. Los participantes fueron 51 parejas que realizaron registros diarios durante siete noches consecutivas. Los resultados basados en el modelo de interdependencia actor-pareja indicaron que las parejas demostraron tanto precisión empática como similitud asumida en su percepción del afecto positivo de su pareja; sin embargo, usaron la similitud asumida para calificar el afecto negativo fuerte (ira, hostilidad) y el afecto negativo suave (tristeza, miedo) de su pareja. Además, en las evaluaciones de la precisión indirecta se descubrió que las esposas fueron indirectamente precisas para percibir el afecto positivo de sus esposos y que tanto los esposos como las esposas fueron indirectamente precisos para percibir el afecto negativo fuerte mutuo porque eran tendenciosos. Complementando los estudios de laboratorio, el presente estudio destaca que analizar las percepciones de las parejas de los sentimientos mutuos en los contextos de la vida diaria y diferenciar las emociones positivas y negativas puede mejorar nuestra comprensión del papel que desempeñan las emociones para el funcionamiento saludable de las relaciones.

Within-Family Relations in Objective Sleep Duration, Quality, and Schedule.

The current study examined within-family relations between mothers', fathers', and children's objectively assessed sleep. Participants were 163 children (Mage  = 10.45 years; SD = 0.62) and their parents. For 7 nights, families wore actigraphs to assess sleep duration (minutes), quality (efficiency, long wake episode, total wake minutes), and schedule (wake time). A sleep log assessed bedtime. Multilevel models indicated that children's sleep minutes, sleep efficiency, wake minutes, and wake time were associated with fluctuations in their mothers', but not fathers', sleep that same night. The duration and quality of mothers' sleep was associated with both fathers' and children's sleep that night, whereas fathers' sleep was positively associated with only mothers' sleep. Findings highlight the importance of examining sleep within a family context.

Predicting young adults' risk for engaging in prescription drug misuse in daily life from individual, partner, and relationship factors.

BACKGROUND: Mounting evidence based on retrospective and global assessments has established associations between prescription drug misuse and illicit drug use, alcohol abuse, mental health problems, risky sexual behaviors, and overdose deaths. However, there is a notable absence of identified risk and protective factors for an individual's likelihood of engaging in misuse in real-world environments. METHODS: Using an experience sampling approach, the authors collected repeated moments of young adults' (n = 95 participants drawn from 49 romantic couples) prescription drug misuse instances in daily life and tested multiple factors associated with the misuse. RESULTS: When examined in separate multilevel models, individual and relationship factors (but not partner factors) reliably predicted the likelihood of females' and males' prescription drug misuse in daily life. Specifically, females' elevated dysphoria symptoms, alcohol problems, and relationship closeness were linked with an increased likelihood of misuse, whereas cohabiting decreased the likelihood of their misuse. Males' higher levels of illicit drug use and relationship closeness were associated with increased likelihood of misuse, whereas their dysphoria symptoms were related to a lower likelihood of misuse. When examined in models that considered the predictors simultaneously, females' misuse was associated with individual, partner, and relationship factors, whereas males' misuse was not reliably associated with any of the factors. CONCLUSIONS: An experience sampling approach was effective for the near-real-time assessment of young adults' prescription drug misuse in daily environments, and the likelihood of misuse was associated with risk and protective factors from multiple levels of influence. Education and treatment efforts designed to reduce prescription drug misuse may need to be tailored to accommodate males' and females' distinct predictors of misuse.

Concurrent and Short-Term Prospective Relations among Neurocognitive Functioning, Coping, and Depressive Symptoms in Youth.

The present short-term longitudinal study examined the concurrent and prospective relations among executive functioning (i.e., working memory and cognitive flexibility), coping (primary and secondary control coping), and depressive symptoms in children. Participants were 192 children between 9 and 15 years old (M age = 12.36 years, SD = 1.77) recruited from the community. Youth were individually administered neuropsychological measures of executive functioning and intelligence and completed self-report measures of executive dysfunction, coping, and depressive symptoms in small groups; the latter two measures were completed again 4 months later (Time 2 [T2]). Linear regression analyses were used to examine direct associations among executive functions, coping, and depressive symptoms, and a bootstrapping procedure was used to test indirect effects of executive functioning on depressive symptoms through coping. Significant prospective relations were found between working memory measured at Time 1 (T1) and both primary and secondary control coping measured at T2, controlling for T1 coping. T1 cognitive flexibility significantly predicted T2 secondary control coping, controlling for T1 coping. Working memory deficits significantly predicted increases in depressive symptoms 4 months later, controlling for T1 depressive symptoms. Bootstrap analyses revealed that primary and secondary control coping each partially mediated the relation between working memory and depressive symptoms; secondary control coping partially mediated the relation between cognitive flexibility and depressive symptoms. Coping may be one pathway through which deficits in executive functioning contribute to children's symptoms of depression.

Daily mood and sleep: reciprocal relations and links with adjustment problems.

Children's sleep problems are common and associated with increased risk for adjustment problems. We examined daily links between children's sleep and mood, using a daily diary method and actigraphy. We also tested children's daily mood as a mediator of relations among sleep and children's broader internalizing and externalizing symptoms. A community sample of 142 children (mean age = 10.69 years; 57% girls; 69% European American, 31% African American) and their parents participated. For 1 week, children wore actigraphs and parents completed a daily telephone interview about their child's mood. Following the week of actigraphy, mothers and fathers reported on their child's adjustment. Multi-level models indicated within-person relations between children's mood and subsequent sleep fragmentation (indicated by increased activity) and sleep latency, and between-person relations between sleep latency and subsequent mood on the next day. Significant indirect effects were found such that a more negative daily mood (aggregated across diary days) mediated relations between poor sleep efficiency and longer sleep latency and parent-reported internalizing and externalizing symptoms. Findings extend previous research by highlighting disruptions to children's daily mood as a potential mechanism linking sleep problems to children's mental health.

Longitudinal relations between maternal depressive symptoms and child sleep problems: the role of parasympathetic nervous system reactivity.

BACKGROUND: We examined maternal depressive symptoms (MDS) as longitudinal predictors of actigraphy-measured sleep; children's respiratory sinus arrhythmia (RSA) was tested as a moderator of these relations. METHOD: A total of 271 children (145 boys and 126 girls) participated in a three-wave study (M age at T1 = 9.38 years), with a 1-year lag between waves. Children wore actigraphs to derive sleep parameters. RSA reactivity was assessed during a social stress test. RESULTS: Contrary to hypotheses, MDS were related to less sleep over time for children exhibiting greater RSA withdrawal. Consistent with hypotheses, MDS were related longitudinally to decreased sleep activity for children exhibiting less RSA withdrawal. CONCLUSIONS: Findings illustrate the importance of maternal influences and physiological regulation as predictors of children's sleep.

Two prospective studies of changes in stress generation across depressive episodes in adolescents and emerging adults.

The stress generation hypothesis was tested in two different longitudinal studies examining relations between weekly depression symptom ratings and stress levels in adolescents and emerging adults at varied risk for depression. The participants in Study 1 included 240 adolescents who differed with regard to their mothers' history of depressive disorders. Youth were assessed annually across 6 years (Grades 6-12). Consistent with the depression autonomy model, higher numbers of prior major depressive episodes (MDEs) were associated with weaker stress generation effects, such that higher levels of depressive symptoms predicted increases in levels of dependent stressors for adolescents with two or more prior MDEs, but depressive symptoms were not significantly related to dependent stress levels for youth with three or more prior MDEs. In Study 2, the participants were 32 remitted-depressed and 36 never-depressed young adults who completed a psychosocial stress task to determine cortisol reactivity and were reassessed for depression and stress approximately 8 months later. Stress generation effects were moderated by cortisol responses to a laboratory psychosocial stressor, such that individuals with higher cortisol responses exhibited a pattern consistent with the depression autonomy model, whereas individuals with lower cortisol responses showed a pattern more consistent with the depression sensitization model. Finally, comparing across the two samples, stress generation effects were weaker for older participants and for those with more prior MDEs. The complex, multifactorial relation between stress and depression is discussed.

Interactive models of depression vulnerability: the role of childhood trauma, dysfunctional attitudes, and coping.

OBJECTIVES: This prospective study investigated whether within-individual relations between depression vulnerability factors (childhood trauma, dysfunctional attitudes, maladaptive coping) and depressive symptom trajectories varied as a function of the number of prior major depressive episodes (MDEs) experienced in their lifetime. DESIGN: Participants were 68 young adults who varied with regard to their history of depression; 32 were remitted depressed and 36 were never depressed. METHODS: Depressive symptoms and disorders were assessed using semi-structured psychiatric interviews conducted twice over a 6-month period; interviews yielded weekly ratings of depressive symptoms during the follow-up interval. Childhood trauma, dysfunctional attitudes and coping were assessed with self-report measures. Data analyses were conducted using time-lagged multilevel models. RESULTS: Individuals with more previous MDEs who reported greater childhood trauma exposure, more dysfunctional attitudes, or greater use of maladaptive coping strategies experienced more rapid increases in depressive symptoms during the follow-up period. A significant interaction of coping, number of previous MDEs, and time was found indicating that among individuals with less adaptive coping (i.e., lower primary or lower secondary control coping scores), depressive symptoms rating (DSR) increased significantly in relation to number of prior depressive episodes; no change in DSR was observed for never-depressed individuals. Among individuals with higher primary control coping scores, significant increases in DSR scores were observed for individuals with ≥3 prior MDEs only. CONCLUSIONS: Findings highlight the need for treatment and prevention programmes that target stress reactivity and coping strategies early in the course of depression.

College Students' prescription drug misuse over time and links with their mental health and well-being.

Prescription drug misuse (PDM) is a mounting public health concern in the U.S., particularly among college students. The field's reliance on cross-sectional designs and limited controls for other substance use has failed to capture the specific role of misuse for longer-term health. Therefore, the present study tested associations between trajectories of PDM problems and college students' mental health and subjective happiness over time. Participants were 300 students who completed a baseline assessment (T1) and follow-ups every 6 months for two years (T2-T5). Participants self-reported problems associated with PDM and mental health. Results from univariate latent growth models indicated that problems with PDM were initially on an increasing trajectory. Based on parallel process models, problems with PDM were concurrently associated with higher levels of depressive symptoms, disinhibition, callousness/aggression, and lower levels of subjective happiness at T1. Further, we found support for parallel trajectories between PDM problems and both depressive symptoms and general disinhibition. Participants whose PDM problems were on an increasing (worsening) trajectory at baseline showed an increase in depressive symptoms and general disinhibition over the next two years. Participants whose PDM problems accelerated over time (got worse at a faster and faster rate over time) also showed a significant increase in their depressive symptoms over time. Most findings, however, were no longer statistically significant in sensitivity analyses that controlled for alcohol and other drug problems. Findings highlight college as an important time for interventions to prevent substance use and its associated negative consequence on later young adult mental health.

Examining enduring effects of COVID-19 on college students' internalizing and externalizing problems: A four-year longitudinal analysis.

BACKGROUND: College students' mental health has been a vital concern for researchers, policymakers, administrators, and educators since before the pandemic, and it is crucial to identify the extent to which the pandemic affected college students' mental health. METHODS: The current study utilized data repeatedly collected over more than four years (2017-2022) from N = 355 students enrolled at a large public research university in the Midwestern US. The data collection period coincided with the COVID-19 pandemic's onset, facilitating systematic examination of whether and how college students' trajectories (i.e., level and slopes) of depressive symptoms, social anxiety, general disinhibition, callous aggression, and problematic alcohol use changed as the pandemic progressed. Across seven waves, surveys assessed multiple outcome and predictor domains. Multilevel growth curve modeling was used to analyze all outcomes. RESULTS: Depression symptoms peaked mid-pandemic, whereas social anxiety first declined then continued rising. General disinhibition and callous aggression showed non-significant changes in trajectories. Problematic alcohol use decreased continuously with no significant pandemic-associated effects in the best-fitting model. LIMITATIONS: An important limitation is reliance on a sample from a single campus utilizing self-reported, non-clinical assessments. Another important limitation is the lack of location information from participants during the acute COVID-19 phase. CONCLUSIONS: Reported longitudinal analyses expand upon findings from previous limited repeated-measures and cross-sectional studies. In terms of clinical significance, some of the most harmful COVID-19 effects to mental health may be long-lasting and cumulative, making them difficult to detect in shorter-term or cross-sectional studies. Altogether, findings demonstrate complex changes in students' mental health that may have ongoing effects on well-being during key developmental stages.

A longitudinal examination of mental health and marital functioning of mothers and fathers of autistic adolescents during COVID-19.

LAY ABSTRACT: Parents of autistic children may be especially vulnerable to the negative effects of COVID-19. The current study examined changes in mental health and marital functioning of mothers and fathers of autistic children across three time points between April and October 2020. The study also explored whether pre-COVID factors could predict outcomes during the pandemic. Participants were 94 mothers and 58 fathers of autistic children drawn from a larger study about family relationships and autistic children's mental health that began prior to the pandemic. Results indicated that mothers reported higher levels of mental health problems compared to fathers in July and October 2020. Levels of mental health and marital functioning did not change between April and October 2020. Pre-pandemic child functioning and marital satisfaction predicted changes in mother's ratings of marital satisfaction. The findings have implications for ways to best support families during challenging periods.

Dynamic temporal relations between anxious and depressive symptoms across adolescence.

Symptoms of anxiety and depression are prevalent among adolescents and associated with impairment in multiple domains of functioning. Moreover, anxiety and depression frequently co-occur, with estimated comorbidity rates as high as 75%. Whereas previous research has shown that anxiety symptoms predict increased depressive symptoms over time, the relation between depressive symptoms and later anxiety symptoms has been inconsistent. The present study examined dynamic relations between anxiety and depressive symptoms across adolescence and explored whether these longitudinal relations were moderated by maternal history of anxiety, family relationship quality, or children's attributional style. Participants included 240 children (M age = 11.86 years; 53.9% female) and their mothers, who were assessed annually for 6 years. Children reported on their depressive symptoms and mothers reported on their child's anxiety symptoms. Dynamic latent change score models indicated that anxiety symptoms predicted subsequent elevations in depressive symptoms over time. Depressive symptoms predicted subsequent elevations in anxiety symptoms among children who had mothers with a history of anxiety, reported low family relationship quality, or had high levels of negative attributions. Thus, whereas anxiety symptoms were a robust predictor of later depressive symptoms during adolescence, contextual and individual factors may be important to consider when examining relations between depressive symptoms and subsequent change in anxiety symptoms.

Testing Similarity in Romantic Partners' COVID-19 Experiences at the Time of a Pain-Related Emergency Department Visit.

BACKGROUND: Research has established associations between romantic partners' health-related behaviors, although links between partners' experiences of the COVID-19 pandemic at the time of an important medical event remain untested. METHODS: The sample was drawn from an existing study of patients who received a new opioid prescription at an emergency department visit for acute pain. We assessed COVID-19 experiences of 97 patients and their romantic partners from April 2021 through June 2022. RESULTS: Romantic partners reported similar ratings of COVID-19 impact and were likely to agree on their coping with the pandemic by engaging in more time on activities like puzzles or books, using marijuana, and drinking alcohol. Partners also demonstrated high concordance in their COVID-19 vaccination statuses. CONCLUSIONS: These findings extend a robust literature showing romantic partners' concordance in a host of health-relevant behaviors to their COVID-19 experiences.

Remote vs. In-person Schooling during the COVID-19 Pandemic and Internalizing Symptoms among Children on the Autism Spectrum.

Background: Children on the autism spectrum encountered interruptions to their education due to the COVID-19 pandemic (White et al., 2021). This study examined the extent to which autistic children's anxiety and depressive symptoms during the pandemic were associated with the school format they attended in October 2020 (remote, in-person/hybrid, homeschool), controlling for their pre-pandemic symptoms. Pre-pandemic peer victimization and autism symptom characteristics were tested as moderators. Method: Participants were 81 verbally-fluent autistic children (Mage = 14.71 years, 77.8% males), without an intellectual disability, and their mothers; families were part of an ongoing, longitudinal study that began before the pandemic. Results: School format did not significantly predict children's anxiety or depressive symptoms. Results indicated that the only significant predictors of children's anxiety and depressive symptoms during the pandemic were their pre-pandemic symptom levels. Conclusions: School format did not significantly contribute to variability in children's anxiety and depressive symptoms during the pandemic, over and above their pre-pandemic symptoms. The results contribute quantitative findings to the growing body of research on pandemic-related effects on autistic children, and underscore the need to account for pre-pandemic child functioning when drawing conclusions about pandemic-level effects.

College students' momentary stress and prescription drug misuse in daily life: Testing direct links and the moderating roles of global stress and coping.

Prior survey-based research has documented associations between greater levels of stress and increased prescription drug misuse behaviour. These studies uniformly rely on assessments of both the stress experiences and the substance behaviour after they occurred (commonly spanning 6-12 month retrospective timeframes). Less is known about the extent to which variations in momentary stress predict the actual occurrence of prescription misuse in daily life among college students with elevated risk for engaging in the behaviour. In this study, 297 participants (69% females; Mage  = 19.5 years, SDage  = 0.71) completed a 28-day ecological momentary assessment procedure that collected self-reported stress and other contextual experiences in moments preceding prescription drug misuse. Analyses tested the within-person association between momentary stress and prescription drug misuse and examined the extent to which the relation between stress and misuse was moderated by participants' assigned sex or global stress and coping levels. Results from hierarchical generalised linear modelling indicated a significant within-person association between momentary stress (i.e., higher than usual relative to one's own mean) and greater likelihood of prescription misuse in daily life, accounting for the number of stressors and timing covariates. No significant moderation by participant sex was found, and moderation effects by global stress and coping levels were not in the expected directions. Direct results highlight the role of momentary stress experiences on health-relevant substance behaviours and provide future directions for research and applied efforts.

Predicting incident cardiovascular disease among African-American adults: A deep learning approach to evaluate social determinants of health in the Jackson heart study.

The present study sought to leverage machine learning approaches to determine whether social determinants of health improve prediction of incident cardiovascular disease (CVD). Participants in the Jackson Heart study with no history of CVD at baseline were followed over a 10-year period to determine first CVD events (i.e., coronary heart disease, stroke, heart failure). Three modeling algorithms (i.e., Deep Neural Network, Random Survival Forest, Penalized Cox Proportional Hazards) were used to evaluate three feature sets (i.e., demographics and standard/biobehavioral CVD risk factors [FS1], FS1 combined with psychosocial and socioeconomic CVD risk factors [FS2], and FS2 combined with environmental features [FS3]) as predictors of 10-year CVD risk. Contrary to hypothesis, overall predictive accuracy did not improve when adding social determinants of health. However, social determinants of health comprised eight of the top 15 predictors of first CVD events. The social determinates of health indicators included four socioeconomic factors (insurance status and types), one psychosocial factor (discrimination burden), and three environmental factors (density of outdoor physical activity resources, including instructional and water activities; modified retail food environment index excluding alcohol; and favorable food stores). Findings suggest that whereas understanding biological determinants may identify who is currently at risk for developing CVD and in need of secondary prevention, understanding upstream social determinants of CVD risk could guide primary prevention efforts by identifying where and how policy and community-level interventions could be targeted to facilitate changes in individual health behaviors.