Internet-based cognitive behavioural therapy in the real world: Naturalistic use and effectiveness of an evidence-based platform in New Zealand.

OBJECTIVE: Internet-based cognitive behavioural therapy (iCBT) is an efficacious, scalable intervention that could help meet the significant demand for psychological treatment. Yet, there is limited real-world evidence for its effectiveness. This study investigated the use and effectiveness of a free iCBT programme ('Just a Thought') in New Zealand. METHODS: We analysed 18 months of user data from the Just a Thought website to understand the characteristics of those who used the Depression and Generalised Anxiety Disorder courses, how many lessons they completed, how mental distress changed across each course and the factors associated with adherence and improvement in mental health. RESULTS: The results for both courses followed very similar patterns. Course adherence was low overall. There were small differences in adherence by age, gender and ethnicity, and larger differences for those who were 'prescribed' Just a Thought by a healthcare worker. Mixed models showed significant reductions in mental distress, with some tapering of improvement across latter lessons. Those most likely to show clinically meaningful reductions in mental distress had completed more lessons, were older and had a higher baseline level of distress. CONCLUSION: Alongside previous efficacy research, this real-world data indicate that iCBT is most likely to be effective at the population level and across different subgroups if users complete as much of the course as possible. Strategies to increase course adherence and maximise the public health benefits of iCBT include healthcare workers 'prescribing' iCBT and tailored solutions to meet the needs of young people, Maori and Pasifika.

Childhood Social Isolation as a Predictor of Retinal Neuronal Thickness in Middle Age: A Lifecourse Birth Cohort Study.

OBJECTIVE: We investigated whether childhood social isolation was associated with retinal neural layer changes in adulthood, and whether this association was independent of other childhood or adulthood risk factors, including adult social isolation. METHODS: Participants were members of the Dunedin Multidisciplinary Health and Development Study, a longitudinal population-based birth cohort from Aotearoa New Zealand ( n = 1037), born 1972 to 1973 and followed until age 45 years, with 94% of the living cohort still participating. Social isolation was recorded prospectively at ages 5, 7, 9, and 11 years, from teacher and parent report. Retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer thicknesses were measured via optical coherence tomography at age 45 years. RESULTS: Childhood social isolation was associated with thinner average RNFL ( B = -0.739, p = .02), nasal RNFL ( B = -1.118, p = .005), and inferior RNFL ( B = -1.524, p = .007), although only nasal RNFL remained significant after adjustment. These associations were not fully explained by other psychosocial or physical health risk factors in childhood or adulthood, nor were they mediated by adult loneliness or social support. CONCLUSIONS: Childhood social isolation was an independent predictor of RNFL thickness in middle age. Highlighting prospective links between childhood psychosocial adversity and retinal neuronal measures will help to inform future research into the utility of retinal neuronal thickness as a biomarker for neurodegeneration.

Plasma arginine metabolites in health and chronic kidney disease.

BACKGROUND: Elevated plasma asymmetric and symmetric dimethylarginine (ADMA and SDMA) are risk factors for chronic kidney disease (CKD) and cardiovascular disease. Using plasma cystatin C (pCYSC)-based estimated glomerular filtration rate (eGFR) trajectories, we identified a cohort at high risk of poor kidney-related health outcomes amongst members of the Dunedin Multidisciplinary Health and Development Study (DMHDS). We therefore examined associations between methylarginine metabolites and kidney function in this cohort. METHODS: ADMA, SDMA, L-arginine and L-citrulline were measured in plasma samples from 45-year-olds in the DMHDS cohort by liquid chromatography-tandem mass spectrometry. RESULTS: In a healthy DMHDS subset (n = 376), mean concentrations were: ADMA (0.40 ± 0.06 µmol/L), SDMA (0.42 ± 0.06 µmol/L), L-arginine (93.5 ± 23.1 µmol/L) and L-citrulline (24.0 ± 5.4 µmol/L). In the total cohort (n = 857), SDMA correlated positively with serum creatinine (Pearson's r = 0.55) and pCYSC (r = 0.55), and negatively with eGFR (r = 0.52). A separate cohort of 38 patients with stage 3-4 CKD (eGFR 15-60 mL/min/1.73 m2) confirmed significantly higher mean ADMA (0.61 ± 0.11 µmol/L), SDMA (0.65 ± 0.25 µmol/L) and L-citrulline (42.7 ± 11.8 µmol/L) concentrations. DMHDS members classified as high-risk of poor kidney health outcomes had significantly higher mean concentrations of all four metabolites compared with individuals not at risk. ADMA and SDMA individually predicted high-risk of poor kidney health outcomes with areas under the ROC curves (AUCs) of 0.83 and 0.84, and together with an AUC of 0.90. CONCLUSIONS: Plasma methylarginine concentrations facilitate stratification for risk of CKD progression.

Childhood sexual abuse and pervasive problems across multiple life domains: Findings from a five-decade study.

The aim of this study was to use longitudinal population-based data to examine the associations between childhood sexual abuse (CSA) and risk for adverse outcomes in multiple life domains across adulthood. In 937 individuals followed from birth to age 45y, we assessed associations between CSA (retrospectively reported at age 26y) and the experience of 22 adverse outcomes in seven domains (physical, mental, sexual, interpersonal, economic, antisocial, multi-domain) from young adulthood to midlife (26 to 45y). Analyses controlled for sex, socioeconomic status, prospectively reported child harm and household dysfunction adverse childhood experiences, and adult sexual assault, and considered different definitions of CSA. After adjusting for confounders, CSA survivors were more likely than their peers to experience internalizing, externalizing, and thought disorders, suicide attempts, health risk behaviors, systemic inflammation, poor oral health, sexually transmitted diseases, high-conflict relationships, benefit use, financial difficulties, antisocial behavior, and cumulative problems across multiple domains in adulthood. In sum, CSA was associated with multiple persistent problems across adulthood, even after adjusting for confounding life stressors, and the risk for particular problems incremented with CSA severity. The higher risk for most specific problems was small to moderate, but the cumulative long-term effects across multiple domains reflect considerable individual and societal burden.

Physical Activity Prevalence and Correlates Among New Zealand Older Adults.

The aim of this study was to provide up-to-date information about physical activity (PA) levels in New Zealand older adults to inform the development and targeting of relevant health promotion initiatives. Nationally-representative survey (N = 1,468) data were analyzed to assess in people aged ≥ 60 years the prevalence of physical inactivity and meeting PA guidelines, differences between 2012 and 2014, and sociodemographic correlates. One-fifth (20.7%) of respondents were inactive; 46.2% met PA guidelines. Multivariate analyses revealed lower PA in 2014 versus 2012, and identified self-rated health and education as correlates of both PA measures. Age and socioeconomic deprivation were associated with physical inactivity only, while sex and employment were correlates of meeting PA guidelines. Low PA among older adults signals a need to promote PA engagement in that age group. This analysis aids effective intervention design by identifying specific segments of the older adult population that tailored health promotion initiatives should target.

Impact on Smoking Behavior of the New Zealand Annual Increase in Tobacco Tax: Data for the Fifth and Sixth Year of Increases.

INTRODUCTION: New Zealand has implemented a series of seven annual increases in tobacco tax since 2010. All tax increases, except for the first in the series, were preannounced. It is unusual for governments to introduce small, persistent, and predictable increases in tobacco tax, and little is known about the impact of such a strategy. This paper evaluates the impact of the fifth and sixth annual increases. METHODS: Smokers' behaviors were self-reported during the 3-month period before, and the 3-month period after, the two annual increases. Responses to the two increases were analyzed separately, and generalized estimating equations models were used to control for sociodemographic variables, recent quit attempts, and the research design. RESULTS: Findings were consistent across years. The proportion of participants who made a smoking-related (54%-56% before and after each tax increase) or product-related change (fifth tax increase: 17%-19%; sixth tax increase: 21%-22%) did not significantly alter from before to after each tax increase. However, it should be noted that the proportion of participants making smoking-related changes was generally high, even prior to each increase. For example, before the 2015 tax increase, 1% reported quitting completely, 21% trying to quit, and 53% cutting down. CONCLUSIONS: In New Zealand, with its series of annual tobacco tax increases since 2010, there were no significant changes in smoking- or product-related behavior associated with the fifth and sixth increases. Nevertheless, overall cessation-related activity was high, with a majority of participants reporting either quitting and/or cutting down recently. IMPLICATIONS: Little is known about the impact of small, persistent, predictable tobacco tax increases on smoking behavior. This study evaluated the impact of the fifth (in 2014) and sixth (2015) tax increases in an annual series implemented in New Zealand. Although there were no detectable changes in smoking behaviors from before to after each tax increase, self-reported cessation-related activity was high overall (i.e., even prior to each increase). Given that there are multiple possible interpretations for these findings, more in-depth time-series analyses are needed to understand how such a tax strategy influences smoking behavior.

Resting EEG correlates of neurodevelopment in a socioeconomically and linguistically diverse sample of toddlers: Wave 1 of the Kia Timata Pai best start New Zealand study.

Development of communication and self-regulation skills is fundamental to psychosocial maturation in childhood. The Kia Timata Pai Best Start (KTP) longitudinal study aims to promote these skills through interventions delivered at early childcare centers across New Zealand. In addition to evaluating effects of the interventions on behavioral and cognitive outcomes, the study utilizes electroencephalography (EEG) to characterize cortical development in a subsample of participating children. Here, we present results of the baseline resting EEG assessment with 193 children aged 15 to 33 months. We identified EEG correlates of individual differences in demographics, communication abilities, and temperament. We obtained communication and behavior ratings from multiple informants, and we applied contemporary analytic methods to the EEG data. Periodic spectral power adjusted for aperiodic activity was most closely associated with demographic, language, and behavioral measures. As in previous studies, gamma power was positively associated with verbal language. Alpha power was positively associated with effortful control. Nonverbal and verbal language measures showed distinct associations with EEG indices, as did the three temperament domains. Our results identified a number of candidate EEG measurements for use as longitudinal markers of optimal cortical development and response to interventions in the KTP cohort.

The Dunedin study after half a century: reflections on the past, and course for the future.

Over the last 50 years Dunedin Study researchers have published more than 1400 peer-reviewed journal articles, books, and reports on many aspects of human health and development. In this 50th anniversary piece we reflect on (i) our historical roots and necessary re-invention through time; (ii) the underpinning principles that have contributed to our success; (iii) some selected examples of high-impact work from the behavioural, oral health, and respiratory domains; (iv) some of the challenges we have encountered over time and how to overcome these; and (vi) review where we see the Study going in the future. We aim to present some of the 'back story', which is typically undocumented and oft lost to memory, and thus focus on 'know-how'. Our hope is to humanise our research, share insights, and to acknowledge the real heroes of the Study - the 1037 Study members, their families and their friends, who have collectively given so much, for so long, in the hope of helping others.

Who Australasians trusted during COVID-19: lessons from the pandemic response.

AIM: Public trust in authoritative information sources is a key element of a successful public health response to a pandemic. This study investigated which sources of COVID-19 advice were most trusted by a primarily New Zealand-based cohort and considers implications for policy and practice regarding future pandemics. METHOD: Data were from a COVID-19 vaccine intention survey presented to Australia- and New Zealand-based members of the longitudinal Dunedin Study (n=832) between ages 48 and 49, immediately before vaccines became available for the general population within New Zealand. We assessed participants' trust in specific sources of COVID-19 advice and investigated whether the pattern of responses differed by sex, socio-economic status (SES) or education. RESULTS: Doctors and healthcare providers were the most trusted source of COVID-19 advice, over and above other institutional sources. This pattern was consistent across sex, SES and education. Institutional experts were trusted significantly more by those with higher SES compared to those with lower SES, and by those with formal qualifications compared to those without formal qualifications. CONCLUSION: Our findings suggest that it is important to empower healthcare providers early in a pandemic to share advice with the public alongside other trusted sources, such as the government.

Kidney-Function Trajectories From Young Adulthood to Midlife: Identifying Risk Strata and Opportunities for Intervention.

Introduction: Understanding normative patterns of change in kidney function over the life course may allow targeting of early interventions to slow or prevent the onset of kidney disease, but knowledge about kidney functional change before middle age is limited. This study used prospective longitudinal data from a representative birth cohort to examine common patterns of change from young to midadulthood and to identify risk factors and outcomes associated with poorer trajectories. Methods: We used group-based trajectory modeling in the Dunedin study birth cohort (n = 857) to identify the following: (i) common kidney function trajectories between the ages 32 and 45 years, (ii) early-life factors associated with those trajectories, (iii) modifiable physical and psychosocial factors across adulthood associated with differences in trajectory slope, and (iv) links between trajectories and kidney-related outcomes at age 45 years. Results: Three trajectory groups were identified and could be differentiated by age 32 years as follows: normal (58% of participants), low-normal (36%), and high-risk (6%) groups. Those from low socioeconomic backgrounds had higher odds of following a high-risk (vs. normal) trajectory. Modifiable factors (blood pressure, body mass index, inflammation, glycated hemoglobin, smoking, and socioeconomic status) across adulthood were associated with steeper age-related declines in kidney function, particularly among those in the low-normal and high-risk groups. Those in the low-normal and high-risk groups also had more adverse kidney-related outcomes at age 45 years. Conclusion: The current findings could be used to inform the development of early interventions and point to socioeconomic conditions across the life course and health-related risk factors and behaviors in adulthood as kidney health promotion targets.

Kia Timata Pai (Best Start): a study protocol for a cluster randomised trial with early childhood teachers to support children's oral language and self-regulation development.

INTRODUCTION: Oral language skills are associated with children's later self-regulation and academic skills; in turn, self-regulation in early childhood predicts successful functioning later in life. The primary objective of this study is to evaluate the separate and combined effectiveness of an oral language intervention (Enhancing Rich Conversations, ENRICH) and a self-regulation intervention (Enhancing Neurocognitive Growth with the Aid of Games and Exercise, ENGAGE) with early childhood teachers and parents for children's oral language, self-regulation and academic functioning. METHODS AND ANALYSIS: The Kia Timata Pai (Best Start) study is a cluster randomised controlled trial with teachers and children in approximately 140 early childhood centres in New Zealand. Centres are randomly assigned to receive either oral language intervention only (ENRICH), self-regulation intervention only (ENGAGE), both interventions (ENRICH+ENGAGE) or an active control condition. Teachers' and parents' practices and children's oral language and self-regulation development are assessed at baseline at age 1.5 years and approximately every 9 months to age 5, and academic performance at age 6. Teacher-child interactions will also be videotaped each year in a subset of the centres. Children's brain and behaviour development and parent-child interactions will be assessed every 6 months to age 6 years in a subgroup of volunteers. ETHICS AND DISSEMINATION: The Kia Timata Pai trial and the two substudies (Video Project; Brain and Behaviour Development) have been approved by the University of Otago Human Ethics Committee (Health; H20/116), and reviewed for cultural responsiveness by: the Ngai Tahu Research Committee (University of Otago), the Maori Advisory Group (University of Auckland, Liggins Institute) and an internal cultural advisory group. Results will be disseminated in international and national peer-reviewed academic journals and communicated to local, national and international organisations serving early childhood teachers, parents and young children. Data will be available via communication with the corresponding author. TRIAL REGISTRATION NUMBER: ACTRN12621000845831.

Associations Between Retinal Nerve Fiber Layer and Ganglion Cell Layer in Middle Age and Cognition From Childhood to Adulthood.

IMPORTANCE: The retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) have been proposed as potential biomarkers for Alzheimer disease (AD). Although a number of studies have shown that knowing the thickness of RNFL and GCL can help differentiate between patients with AD and healthy controls, it is unclear whether these associations are observable earlier in life. OBJECTIVE: To examine whether RNFL and GCL thickness was associated with global cognitive performance in middle age and in childhood and with a decline in cognitive performance from childhood to adulthood and whether RNFL and GCL thickness was associated with decline in specific cognitive domains over the same period. DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study involved members of the Dunedin Multidisciplinary Health and Development Study, a longitudinal representative birth cohort from New Zealand (n = 1037). Participants were born in 1972 to 1973 and followed up until age 45 years, with 94% of the living cohort still participating. MAIN OUTCOMES AND MEASURES: Cognitive performance (Full Scale IQ, processing speed, perceptual reasoning, and verbal comprehension) measured at ages 7, 9, and 11 years (mean value) and age 45 years, and RNFL and GCL thickness measured via optical coherence tomography (OCT) at age 45 years. RESULTS: Data were analyzed between August 2020 and April 2021. Data from 865 participants were included in the present study (50.2% male, 49.8% female; 92.2% of the 938 study members seen at age 45 years). Of the 73 participants who were excluded, 63 were excluded because of issues with OCT scans and 10 were excluded because of diseases affecting the retina. Thinner RNFL and GCL were associated with lower Full Scale IQ in childhood and at age 45 years. Thinner RNFL was also associated with a greater decline in processing speed from childhood to adulthood. CONCLUSIONS AND RELEVANCE: RNFL and GCL thickness in middle age was associated with cognitive performance in childhood and adulthood, and thinner RNFL with a decline in processing speed between childhood and adulthood. These data emphasize the potential utility of OCT measures as biomarkers of cognitive function; however, further longitudinal studies are needed to determine whether retinal thinning precedes cognitive decline and whether other confounding factors may account for this association.

Volunteering in older adulthood is associated with activity engagement and cognitive functioning.

Introduction: Given evidence that activity engagement in older adulthood can have protective effects on the aging brain, we investigated the idea that volunteering in the community, which often encompasses social, cognitive, and physical activity, might benefit cognition. Method: Ninety-one retired 65- to 75-year-olds reported their sociodemographic characteristics, wellbeing, volunteering, and activity engagement. They also completed computerized cognitive tests that tapped specific functions known to decline disproportionately with age. Results: Volunteering at least monthly was associated with better working memory and more social and cognitive activity. Mediation analyses indicated that volunteering was indirectly related to switching performance via cognitive activity. However, the volunteering-working memory association did not depend on activity engagement, leaving the underpinning mechanisms unclear. Conclusions: These findings provide new insight into positive associations between older people's volunteering, activity engagement, and cognitive functioning. However, further work is needed to understand the mechanisms that drive volunteering-cognition links, and to establish causality.

A tale of two countries: Increased uptake of digital mental health services during the COVID-19 pandemic in Australia and New Zealand.

BACKGROUND: Digital mental health services (DMHS) provide highly accessible psychological supports and interventions that can supplement existing mental health services. Concerns about the mental health impact of the COVID-19 pandemic have been widespread and provide a unique impetus to examine the utility and responsivity of DMHS. This study examined the service utilisation and user characteristics of two DMHS (THIS WAY UP and Just a Thought) in Australia and New Zealand before and during the early pandemic period in these countries (March to June 2020). METHODS: Service use indices (website visits, course registrations and prescriptions, clinician registrations) were compared across different time periods before (12, 6 and 3 months) and during the pandemic in Australia and New Zealand. The demographic and clinical characteristics of course registrants (anxiety and depression symptom severity and psychological distress) were also compared across the pre- and during-COVID periods. RESULTS: Comparing pre-COVID to during-COVID time periods, we observed substantial increases across all service use indices in both DMHS (increases of >100% on the majority of service use indices). For example, in the 3 months prior to the pandemic, 2806 people registered for a THIS WAY UP course and 1907 people registered for a Just a Thought course, whereas 21,872 and 5442 registered for a THIS WAY UP and Just a Thought course, respectively, during the first 3 months of the COVID pandemic. Slight differences in the demographic and clinical profiles of course registrants were found between pre- and during-COVID time periods, with limited evidence of elevated anxiety and depression symptom severity in the COVID period. CONCLUSIONS: Following the outbreak of COVID-19 in Australia and New Zealand, the volume of users accessing DMHS increased yet the demographic and clinical characteristics of course registrants remained stable. Results underscore how nimble and scalable DMHS can be during periods of high demand.

Investigating links between habitual physical activity, cerebrovascular function, and cognitive control in healthy older adults.

A growing body of evidence indicates regular physical activity benefits older adults' cognitive functioning, particularly when a high level of cognitive control is required. Recent research has pointed to improved cerebrovascular function as one mechanism through which such benefits might arise. This study built on previous research by investigating in 51 healthy older adults aged 60-72 years relationships between habitual physical activity, cerebrovascular function (indicated by resting cerebral blood flow velocity in the middle cerebral artery [n = 42], and its responsiveness to hypercapnia [n = 26] and hypocapnia [n = 25]), and cognitive control (inhibition and switching). Linear regression analyses showed moderate positive associations between physical activity and inhibitory control, but not cerebrovascular function. There were also no significant relationships between the cerebrovascular measures and cognitive control. These results indicate that regular engagement in physical activity is associated with superior inhibitory control in older adulthood, but cerebrovascular function was not found to explain those relationships. Taken together, the current findings reinforce reports of positive links between habitual physical activity and cognition in healthy older adults, but also signal that interrelationships with cerebrovascular function may be more complex than currently indicated by the literature, necessitating further research to elucidate the role cerebrovascular function might play in accounting for physical activity-cognition links in healthy older adults.

Volunteering in the Community: Potential Benefits for Cognitive Aging.

Objectives: This review aims to advance understanding of the potential benefits of volunteering in the community for older adults' cognitive functioning by taking an in-depth look at the relevant evidence to date. Method: This review describes the main pathways through which volunteering could plausibly benefit cognitive functioning and critically examines research that has specifically investigated links between volunteering and cognition. Fifteen articles that assessed in adults aged ≥ 55 years the relationship between volunteering (predictor) and cognitive functioning (outcome) were identified via literature database searches. Results: On balance, evidence from the small number of relevant studies to date supports the idea that volunteering can protect against cognitive aging with respect to global functioning and at least some specific cognitive domains. Studies that used robust designs and assessed domain-specific cognitive functioning produced the largest effect sizes. Discussion: To help advance the field, this review puts forward recommendations for future research, with an emphasis on the need for robust study designs and specific investigations into the nature and extent of the cognitive benefits of volunteering. Through that work, researchers can determine how a simple and accessible activity like volunteering can best be used to help reduce the burden of age-related cognitive decline.

Cognitive Difficulty Intensifies Age-related Changes in Anterior Frontal Hemodynamics: Novel Evidence from Near-infrared Spectroscopy.

Alongside age-related brain deterioration, cognitive functioning declines, particularly for more demanding tasks. Past research indicates that, to offset this decline, older adults exhibit hemodynamic changes consistent with recruitment of more anterior brain regions. However, the nature of the hemodynamic changes remains unclear. To address this knowledge gap, we used near-infrared spectroscopy in 36 young adults (aged 18-30 years) and 36 older adults (aged 60-72 years) to assess anterior frontal hemodynamic responses to engagement in three cognitive tasks of increasing difficulty. Behavioral results for all three tasks confirmed aging deficits (evidenced by slower reaction times and reduced accuracy rates) that progressively increased with task difficulty. Hemodynamic results showed opposing effects in young versus older adults, with oxygenated and total hemoglobin decreasing in young but increasing in older adults, particularly during the harder tasks. Also, tissue oxygenation increased only in older adults during the harder tasks. Among the older adults only, anterior frontal hemodynamic changes correlated with better cognitive performance, indicating that they were compensatory in nature. These findings provide novel evidence of age-related anterior frontal hemodynamic changes that intensify with cognitive demands and compensate for performance deficits.

Evidence for a young adult-targeted tobacco control campaign stimulating cessation-related responses among adult smokers and recent quitters.

AIMS: Young adults are an important group for tobacco control interventions because of their high smoking prevalence. In 2014, New Zealand launched a young adult-targeted tobacco control campaign: 'Stop Before You Start'. The evaluation undertaken with young adults (aged 18 to 24 years) showed that the campaign exerted positive impacts on this age group. This study aimed to investigate the collateral effects of this campaign on older adults. METHODS: Data were collected from a fortnightly survey of adult smokers and recent quitters, where respondents were maintained on a panel and interviewed every fortnight, up to six times. This paper reports on data collected over three consecutive fortnights (540 interviews). Ten measures were used to assess campaign effectiveness (eg, felt regret, tried to quit). RESULTS: After adjusting for recent quit attempt status and socio-demographic characteristics, age differences were not found in any of the outcome variables (aged 25-44 years and 45+ years were compared against 18-24 years). CONCLUSIONS: Internationally, little is known about the effectiveness of young adult-targeted tobacco control campaigns. Alongside data from the campaign evaluation with young adults, findings from the current study suggest that this young adult-targeted campaign also created a desirable impact on older adults.

Barriers to successful cessation among young late-onset smokers.

AIMS: To understand the barriers to cessation among young late-onset smokers (young adults who started smoking daily after turning 18). Such information is crucial to the development of interventions aimed at reducing the high smoking prevalence among young adults. METHOD: The New Zealand Smoking Monitor is a fortnightly telephone survey of current smokers and recent quitters. This study focused on responses from a group of late-onset smokers aged 18 to 28 years (N = 111), who were temporarily (for 11 fortnights) added to the monitor. RESULTS: Most respondents had low nicotine dependence and were actively trying to quit (81% had made at least one attempt that lasted 24 hours or longer in the last year). One-half had high self-efficacy to quit and three-quarters did not intend to use cessation aids. Smoking was tightly linked to drinking alcohol and conferred social benefits (eg, 51% agreed "smoking helped me to socialise"). CONCLUSION: The tendency not to use cessation aids, strong links between smoking and drinking, and the social benefits of smoking may act as barriers to successful cessation among young late-onset smokers. Policies and interventions aimed at breaking associations between smoking, drinking and socialising (eg, smokefree bars) could be effective for this group.

Evidence cerebral blood-flow regulation mediates exercise-cognition links in healthy young adults.

OBJECTIVE: Healthy young adults are presumed to be in their cognitive prime, yet emerging evidence indicates that regular engagement in physical activity can still benefit their cognitive functioning. The mechanisms supporting these exercise-related cognitive benefits remain unclear, but recent research points to cerebral blood-flow (CBF) regulation as potentially important. The current study investigated the possibility that efficacy of CBF regulation underpins exercise-cognition links in this high functioning population. METHOD: In 55 healthy young adults, cognitive control performance (inhibition and switching) was examined in relation to habitual physical activity, aerobic fitness, and CBF regulation (evidenced by blood-flow responsiveness to increases and decreases in carbon dioxide: hypercapnic reactivity, n = 43, and hypocapnic reactivity, n = 42). RESULTS: Multiple regression analyses revealed that more frequent physical activity, and to some extent better aerobic fitness, predicted both better CBF regulation and better cognitive inhibitory control. CBF regulation also predicted better cognitive inhibitory control. Moreover, mediation analyses indicated that more frequent participation in physical activity may bring about improvements in cognitive inhibitory control through improved CBF regulation. CONCLUSION: These results provide novel insight into the cognitive and cerebrovascular benefits that may be gained with regular engagement in physical activity, even in a high-functioning population. Moreover, they point to better CBF regulation as a specific mechanism that may drive physical activity-related cognitive benefits, which converges with recent data in older women (Brown et al., 2010).