Modeling Recovery Housing Retention and Program Outcomes by Justice Involvement among Residents in Virginia, USA: An Observational Study.

Living in recovery housing can improve addiction recovery and desistance outcomes. This study examined whether retention in recovery housing and types of discharge outcomes (completed, "neutral," and "negative" outcomes) differed for clients with recent criminal legal system (CLS) involvement. Using data from 101 recovery residences certified by the Virginia Association of Recovery Residences based on 1,978 individuals completing the REC-CAP assessment, competing risk analyses (cumulative incidence function, restricted mean survival time, and restricted mean time lost) followed by the marginalization of effects were implemented to examine program outcomes at final discharge. Residents with recent CLS involvement were more likely to be discharged for positive reasons (successful completion of their goals) and premature/negative reasons (e.g., disciplinary releases) than for neutral reasons. Findings indicate that retention for 6-18 months is essential to establish and maintain positive discharge outcomes, and interventions should be developed to enhance retention in recovery residents with recent justice involvement.

Visualizing the Influence of Social Networks on Recovery: A Mixed-Methods Social Identity Mapping Study with Recovering Adolescents.

Background: Social recovery capital (SRC) refers to resources and supports gained through relationships and is vital to adolescent addiction recovery. Much is known about how substance use relates to social networks, but little is known about how other dimensions of social networks influence recovery (e.g., network size/exposure, degree of conflict). Methods: This mixed-methods study sampled 28 adolescents who received treatment for alcohol and other drug (AOD) use disorder (14-19 yrs.: 71% male; M = 17.32 yrs., SD = 1.33; White 82%): 20 were recovery high school (RHS) students. Adolescents completed a social identity map for addiction recovery (SIM-AR), survey, and interview. Qualitative data were content analyzed and the data from the SIM-AR were quantified. Results: On average, participants reported belonging to five distinct groups within their network (Range, 2-9; SD = 1.63; M = 27.89 people, SD = 20.09). Of their social network connections, 51% drank alcohol and 46% used other substances, on average. Larger networks involved more conflict (r = 0.57). Participants were more likely to spend more time with groups that had greater proportions of non-substance-using members. These linkages were stronger for RHS than for non-RHS students. Qualitative analyses revealed that youth reported their recovery-oriented groups as supportive, but some reported that their substance-using friends also supported their recovery. Discussion: SIM-AR was a useful measurement tool, and, through qualitative interviews, we identified unique aspects of youths' social networks important for further examination. Research with recovering youth should examine SRC-related elements within their networks including relationship quality, belonging, and conflict, alongside the substance use behaviors of network members.

Implementing a Recovery Capital Model Into Therapeutic Courts: Case Study and Lessons Learned.

Recovery capital is a strengths-based and multi-level model for examining the process and outputs of recovery and desistance. Recovery capital posits that the more positive resources one accrues, the better the chances of recovery. Oftentimes growth of one's recovery capital must be initiated through identifying programs in the community to create supportive scaffolding: this may be especially true for individuals involved in the justice system who may experience additional barriers to accessing programming. This manuscript presents the results of a pilot evaluation of the REC-CAP, a recovery-capital oriented system of measurement, planning, and engagement in two drug treatment courts. We include a description of the implementation process and results from surveys and focus groups with the court staff. Results suggests that the trainings were useful and that court staff meaningfully engaged with the REC-CAP system. Court staff felt the REC-CAP provided important information about court clients' strengths and barriers and suggested next steps for staff to take to guide their clients. Future work should explore how the REC-CAP score profile may change with client progress through the court phases as well as how to incorporate more system level supports for a REC-CAP orientation among probation officers and other court staff.

A qualitative examination of social identity and stigma among adolescents recovering from alcohol or drug use.

Introduction: Alcohol and other drug (AOD) use disorders are stigmatized conditions, but little is known about youth's experience of this stigma, which may threaten their developing social identity and recovery process. This study investigates youth's perceptions of AOD use-related stigma in the context of their social identity. Methods: This study uses data from 12 youth (ages 17-19) who were in recovery from problematic AOD use. Participants completed a Social Identity Mapping in Addiction Recovery (SIM-AR) exercise, in which they created a visual map of their social groups, and semi-structured interview, in which participants were asked about their experience creating their SIM-AR and reflections on their social network. SIM-AR data were descriptively analyzed, and interviews were thematically analyzed for instances of stigma. Results: Using stigmatizing terminology, participants expressed some stigmatizing attitudes towards themselves and others in their network who used substances and perceived both positive and negative reactions from those who knew about their disorder. Findings suggest that youth may experience some internalized stigma and perceive stigma from others in their social networks, which may be a barrier to the development of a healthy social identity and engagement in recovery supports. Conclusions: These findings should be considered when seeking to engage youth in treatment and recovery programming. Despite the small sample, the findings suggest the importance of considering how stigma may influence adolescents' treatment and recovery experience in the context of their social environment.

"A lot better than it used to be": A qualitative study of adolescents' dynamic social recovery capital.

Background: Substance use recovery is a dynamic process for youth, and social networks are tied to the recovery process. The Recovery Capital for Adolescents Model (RCAM) situates the resources accessible through social networks - social recovery capital (SRC) - in a larger framework of developmentally-informed recovery resources. This study aims to investigate the social network experiences among recovering youth enrolled in a recovery high school to understand how social influences help to build, or act as barriers to building, recovery capital. Methods: To gain insight into these networks, Social Identity Maps and semi-structured interviews were conducted with ten youth ages 17-19 years (80% male; 50% non-Hispanic White). Study visits were conducted virtually, recorded, transcribed, and thematically analyzed using the RCAM as an organizing framework. Results: Results supported that adolescent social networks play a unique and multifaceted role in the recovery journey. Three key nuances emerged: change permeates adolescent networks throughout the treatment and recovery process; shared substance use history and non-stigmatizing attitudes play a key role in connecting with others; and SRC is interconnected with human, financial, and community recovery capital. Conclusions: With adolescent recovery receiving increased attention from policy makers, practitioners, and researchers, the RCAM may be a useful way to contextualize available resources. Findings suggest SRC as a crucial, yet complex component intertwined with all other forms of recovery capital.

Parenting to provide social recovery capital: A qualitative study.

Background: Although research demonstrates the necessity of social recovery capital (SRC) for youth in recovery, through having family that do not use substances and who support their recovery, the ways in which parents actually enact SRC have not been empirically examined. This qualitative study applied the Recovery Capital Model for Adolescents to group interview data from parent(s) of youth who resolved a substance use disorder (SUD) to explore the ways parents enacted SRC. Method: The interviews were conducted in a prior ethnographic study in which parents of alternative peer group (APG) alumni volunteered to participate in a group interview; five mothers and five fathers of APG alumni participated in the interviews (n=10). Three investigators analyzed the interview transcripts using the constant comparative method to identify family SRC and the specific components parents supported their child's recovery. Results: The primary themes of parent support of SRC included locus of control, parent growth, and sober/supportive home. Locus of control included parent strategies to leverage youth's participation in treatment/recovery. Parent growth focused on the process of change parents described: from denial to developing insight and learning how to parent a child in addiction. Supportive and structured family included time spent with youth in recovery-related activities and improved communication and relationships. Conclusions: Together, these themes suggest a process of parent change that supports an adolescent's recovery trajectory and increases parenting skills and coping. These themes also highlight how the APG structure enabled this process, generating potential hypotheses for future recovery-oriented research to address.

The evidence synthesis and meta-analysis in R conference (ESMARConf): levelling the playing field of conference accessibility and equitability.

Rigorous evidence is vital in all disciplines to ensure efficient, appropriate, and fit-for-purpose decision-making with minimised risk of unintended harm. To date, however, disciplines have been slow to share evidence synthesis frameworks, best practices, and tools amongst one another. Recent progress in collaborative digital and programmatic frameworks, such as the free and Open Source software R, have significantly expanded the opportunities for development of free-to-use, incrementally improvable, community driven tools to support evidence synthesis (e.g. EviAtlas, robvis, PRISMA2020 flow diagrams and metadat). Despite this, evidence synthesis (and meta-analysis) practitioners and methodologists who make use of R remain relatively disconnected from one another. Here, we report on a new virtual conference for evidence synthesis and meta-analysis in the R programming environment (ESMARConf) that aims to connect these communities. By designing an entirely free and online conference from scratch, we have been able to focus efforts on maximising accessibility and equity-making these core missions for our new community of practice. As a community of practice, ESMARConf builds on the success and groundwork of the broader R community and systematic review coordinating bodies (e.g. Cochrane), but fills an important niche. ESMARConf aims to maximise accessibility and equity of participants across regions, contexts, and social backgrounds, forging a level playing field in a digital, connected, and online future of evidence synthesis. We believe that everyone should have the same access to participation and involvement, and we believe ESMARConf provides a vital opportunity to push for equitability across disciplines, regions, and personal situations.

Advancing the science of evaluating Collegiate Recovery Program processes and outcomes: A recovery capital perspective.

Collegiate recovery programs (CRPs) offer resources and programming for postsecondary students in addiction recovery to ensure they can initiate or maintain their recovery and complete college. To achieve these goals, CRPs offer a variety of activities that research and theory suggests should produce positive outcomes among their students; yet the lack of systematic evaluation research in this area means it is unknown which programming components may drive outcomes. Recovery capital theory posits a variety of factors at multiple ecological levels that might influence students' recovery experience and their engagement and success in community programs like CRPs. To address this complexity in research and evaluation work on CRPs, we provide a recovery capital-oriented theory of change and logic model for CRP evaluations, and demonstrate how this model could be used with an exemplar case. This is followed by a recovery capital-oriented data collection toolkit for future research and evaluation. These efforts should help to inform program planners and evaluators interested in understanding the influence of the ecosystem of recovery-oriented systems of care in CRPs for emerging adults.

Ensuring Prevention Science Research is Synthesis-Ready for Immediate and Lasting Scientific Impact.

When seeking to inform and improve prevention efforts and policy, it is important to be able to robustly synthesize all available evidence. But evidence sources are often large and heterogeneous, so understanding what works, for whom, and in what contexts can only be achieved through a systematic and comprehensive synthesis of evidence. Many barriers impede comprehensive evidence synthesis, which leads to uncertainty about the generalizability of intervention effectiveness, including inaccurate titles/abstracts/keywords terminology (hampering literature search efforts), ambiguous reporting of study methods (resulting in inaccurate assessments of study rigor), and poorly reported participant characteristics, outcomes, and key variables (obstructing the calculation of an overall effect or the examination of effect modifiers). To address these issues and improve the reach of primary studies through their inclusion in evidence syntheses, we provide a set of practical guidelines to help prevention scientists prepare synthesis-ready research. We use a recent mindfulness trial as an empirical example to ground the discussion and demonstrate ways to ensure the following: (1) primary studies are discoverable; (2) the types of data needed for synthesis are present; and (3) these data are readily synthesizable. We highlight several tools and practices that can aid authors in these efforts, such as using a data-driven approach for crafting titles, abstracts, and keywords or by creating a repository for each project to host all study-related data files. We also provide step-by-step guidance and software suggestions for standardizing data design and public archiving to facilitate synthesis-ready research.

The science of recovery capital: where do we go from here?

BACKGROUND: The concept of recovery capital (RC) has emerged in studies and discussions of the addiction recovery process and as a potential metric and marker for recovery gains. Although conceptual and applied development of the concept in the 20 years since the term was coined has increased, there remains insufficient clarity of key domains, factors and best practice research and applications for populations experiencing addiction. We aimed to review progress around the conceptualisation and operationalisation of RC and to consider future directions for a science of recovery capital. METHOD: We provided a brief overview of theoretical foundations and advances, empirical measurement and application in treatment and continuing care settings. We next introduced four primary areas for addiction science to address, namely: (i) conceptual development (e.g. how RC domains are unique, but interrelated entities, valence of RC), (ii) empirical testing, adequacy of measurement and analysis, (iii) directions for novel application in treatment and recovery settings and (iv) dissemination and communication to policy, practice and lived experience groups. In this review, we also focussed on some of the challenges that must be addressed for a science of RC, which could produce long-term impact in treatment and policy. RESULTS: Despite burgeoning empirical work on RC, its application and translation has been unsystematic. The field currently relies on self-report questionnaires for the development of the theory and quantification of RC. Therefore, there is an urgent need for rigorous and systematic conceptual and empirical development of RC. CONCLUSIONS: A formal collaboration between scholars, practitioners and experts by experience worldwide would move recovery capital forward in an empirically driven and culturally appropriate manner, as would testing its applicability at individual, organisational and societal levels.

Best Practices for Meta-Reviews in Physical Activity and Health Research: Insights From the Physical Activity Guidelines for Americans Advisory Committee Scientific Report.

BACKGROUND: Systematic reviews (SRs) and meta-analyses (MAs) have proliferated with a concomitant increase in reviews of SRs/MAs or "meta-reviews" (MRs). As uncovered by the 2018 US Physical Activity Guidelines Advisory Committee (PAGAC), there is a paucity of best practice guidance on MRs on physical activity health-related research. This manuscript aims to fill this gap. METHODS: In total, the PAGAC conducted 38 literature searches across 3 electronic databases and triaged 20,838 titles, 4913 abstracts, and 2139 full texts from which 1130 articles qualified for the PAGAC Scientific Report. RESULTS: During the MR process, the following challenges were encountered: (1) if the SR/MA authors had limited experience in synthesis methodology, they likely did not account for risk of bias in the conclusions they reached; (2) many SRs/MAs reviewed the same primary-level studies; (3) many SRs/MAs failed to disclose effect modifier analyses; (4) source populations varied; (5) physical activity exposures were nonstandardized; and (6) dose-response effects or effect modification of the physical activity exposure could not be identified. CONCLUSIONS: Using examples from the PAGAC Scientific Report, we provide (1) a high-level introduction to MRs; (2) recommended steps in conducting a MR; (3) challenges that can be encountered; and (4) guidance in addressing these challenges.

Community-level factors and incidence of gun violence in the United States, 2014-2017.

RATIONALE AND OBJECTIVE: In the United States, gun violence claims thousands of lives each year and is a pressing public health issue. To gain a better understanding of this phenomenon, this study spatially analyzed county- and state-level predictors of yearly gun violence rates and gun-related casualty rates. METHODS: This study modeled hypothesized predictors of gun violence incidence and casualties across four years. Data sources included the Gun Violence Archive (gun violence data in the United States for 2014-2017), the U.S. Census Bureau (socioeconomic, demographic, geologic features), ICPSR (crime reports), the U.S. Geologic Survey (elevation data), and U.S. gun laws and ownership. Random forest analyses identified relevant additional interaction terms to include. RESULTS: The extent to which counties are urban was the most robust predictor of both gun violence incident and casualty rates. Similarly, places characterized by greater income disparity were also more likely to experience higher gun violence rates, especially when high income was paired with high poverty. CONCLUSIONS: Community- and state-level features are markedly associated with gun violence. Gun violence is higher in counties with both high median incomes and higher levels of poverty; poverty did not seem related to gun violence rates in counties with relatively low median incomes. Some of these findings may well be due to racial segregation and concentrated disadvantage, due to institutional racism, police-community relations, and related factors.

A multi-site study of emerging adults in collegiate recovery programs at public institutions.

BACKGROUND: Collegiate Recovery Programs (CRPs) are campus-based support programs for substance use and recovery needs among college students. These CRPs utilize a variety of program activities and components aimed at promoting healthy development and sobriety while encouraging college retention among participants. OBJECTIVES: Describe the types of activities and administrative structures used in CRPs, examine the characteristics of students involved in this sample, and explore changes in students' outcomes after they have enrolled in a CRP. METHODS: This multi-site study collected de-identified data from six CRPs on participating students' sociodemographic characteristics, academic performance, substance use, and socioemotional well-being. One CRP administrator from each participating site completed a survey on CRP programming. Data were harmonized across sites and descriptively summarized. RESULTS: Participating CRPs had been in operation since 2007 to 2012. Five of the six sites provided individual-level student data for a total of 861 students (56% male, 89% White, 91% undergraduate). Student histories indicated the majority had received treatment for a substance use disorder (82%) or mental health concern (77%), 56% had criminal justice involvement, and the majority were in recovery less than five years. Student GPA improved in three of the four sites that provided student GPA data. CONCLUSIONS: CRPs collect diverse types of data on participating students, but more effort is needed to focus on systematic data collection. Findings from this study suggest that CRPs play an important role in providing needed services for this vulnerable population of college students.

Disruptions in the management and care of university students with preexisting mental health conditions during the COVID-19 pandemic.

Students with preexisting mental health conditions or disabilities may fair worse due to virus mitigation strategies during the COVID-19 pandemic. This study was conducted to understand the experiences of students with preexisting mental health conditions or disabilities at a public university during COVID-19. We examined disruptions in the management of preexisting mental health conditions or disabilities and its impact on psychological well-being. Students were surveyed about their health care experiences during the COVID-19 pandemic between June and September 2020. Linear regressions and mediation analyses were conducted to examine the relationships between disruption to care, mental health self-efficacy, and four psychological well-being outcomes (stress, anxiety, depression, and overall distress). Of the total (N = 1,082) study participants, 258 (24%) reported having a preexisting mental health condition(s) or disabilities (81% female; Mage = 23.47). Of those, 155 (61%) reported that COVID-19 disrupted health care delivery and management of their conditions or disabilities. Of those who reported this disruption, 51% (n = 109) of participants reported a disruption in their ability to see a health care professional and 58% (n = 69) reported either that they lost care or that the quality of the new telemedicine care was not sufficient. A series of linear regressions revealed significant relationships between disruption to care and the four psychological outcomes. Mediation analyses revealed that depression, stress, anxiety, and overall distress were mediated by self-efficacy in managing mental health. University administrators and health care providers should evaluate the scope of mental health care and telemedicine services for students to help long-term psychological effects of COVID-19.

Self-regulatory behaviour change techniques in interventions to promote healthy eating, physical activity, or weight loss: a meta-review.

Poor quality diet, physical inactivity, and obesity are prevalent, covariant risk factors for chronic disease, suggesting that behaviour change techniques (BCTs) that effectively change one risk factor might also improve the others. To examine that question, registered meta-review CRD42019128444 synthesised evidence from 30 meta-analyses published between 2007 and 2017 aggregating data from 409,185 participants to evaluate whether inclusion of 14 self-regulatory BCTs in health promotion interventions was associated with greater improvements in outcomes. Study populations and review quality varied, with minimal overlap among summarised studies. AMSTAR-2 ratings averaged 37.31% (SD = 16.21%; range 8.33-75%). All BCTs were examined in at least one meta-analysis; goal setting and self-monitoring were evaluated in 18 and 20 reviews, respectively. No BCT was consistently related to improved outcomes. Although results might indicate that BCTs fail to benefit diet and activity self-regulation, we suggest that a Type 3 error occurred, whereby the meta-analytic research design implemented to analyse effects of multi-component intervention trials designed for a different purpose was mismatched to the question of how BCTs affect health outcomes. An understanding of independent and interactive effects of individual BCTs on different health outcomes and populations is needed urgently to ground a cumulative science of behaviour change.

Transparency and Reproducibility of Meta-Analyses in Psychology: A Meta-Review.

Systematic review and meta-analysis are possible as viable research techniques only through transparent reporting of primary research; thus, one might expect meta-analysts to demonstrate best practice in their reporting of results and have a high degree of transparency leading to reproducibility of their work. This assumption has yet to be fully tested in the psychological sciences. We therefore aimed to assess the transparency and reproducibility of psychological meta-analyses. We conducted a meta-review by sampling 150 studies from Psychological Bulletin to extract information about each review's transparent and reproducible reporting practices. The results revealed that authors reported on average 55% of criteria and that transparent reporting practices increased over the three decades studied (b = 1.09, SE = 0.24, t = 4.519, p < .001). Review authors consistently reported eligibility criteria, effect-size information, and synthesis techniques. Review authors, however, on average, did not report specific search results, screening and extraction procedures, and most importantly, effect-size and moderator information from each individual study. Far fewer studies provided statistical code required for complete analytical replication. We argue that the field of psychology and research synthesis in general should require review authors to report these elements in a transparent and reproducible manner.

Examining overlap of included studies in meta-reviews: Guidance for using the corrected covered area index.

Overlap in meta-reviews results from the use of multiple identical primary studies in similar reviews. It is an important area for research synthesists because overlap indicates the degree to which reviews address the same or different literatures of primary research. Current guidelines to address overlap suggest that assessing and documenting the degree of overlap in primary studies, calculated via the corrected covered area (CCA) is a promising method. Yet, the CCA is a simple percentage of overlap and current guidelines do not detail ways that reviewers can use the CCA as a diagnostic tool while also comprehensively incorporating these findings into their conclusions. Furthermore, we maintain that meta-review teams must address non-independence via overlap more thoroughly than by simply estimating and reporting the CCA. Instead, we recommend and elaborate five steps to take when examining overlap, illustrating these steps through the use of an empirical example of primary study overlap in a recently conducted meta-review. This work helps to show that overlap of primary studies included in a meta-review is not necessarily a bias but often can be a benefit. We also highlight further areas of caution in this task and potential for the development of new tools to address non-independence issues.

Effectiveness of interventions targeting self-regulation to improve adherence to chronic disease medications: a meta-review of meta-analyses.

Adherence to chronic disease medication regimens depends in part on successful self-regulation. However, the overall benefit of interventions targeting self-regulatory mechanisms is not well-understood. Accordingly, we conducted a meta-review of meta-analyses assessing the effect of interventions targeting self-regulation on medication adherence. For this meta-review, meta-analyses appearing between January 2006 and March 2019 were eligible if they included experimental trials that assessed the effect of an intervention targeting self-regulation on adherence to chronic disease medication. A systematic literature search of multiple databases for published and unpublished literature identified 16,001 abstracts. Twelve meta-analyses met eligibility criteria and had variable quality according to AMSTAR 2 item completion (M = 50%; range: 31-66%). Overall, meta-reviews showed small to medium effect sizes for interventions that targeted self-monitoring, provided personalised feedback on adherence, or involved complete self-management. Other interventions, such as goal setting, barrier identification and problem solving, and stress management showed little evidence of improving adherence. Only a limited number of self-regulation intervention components were able to be evaluated. Additional research is needed to advance the understanding of the efficacy of adherence interventions focussed on self-regulation by expanding the scope of self-regulation elements targeted (e.g., emotion regulation).

Self-regulation mechanisms in health behavior change: a systematic meta-review of meta-analyses, 2006-2017.

Self-regulation is one primary mechanism in interventions for health behavior change and has been examined in numerous recent meta-analyses. This pre-registered meta-review (PROSPERO CRD42017074018) examined Mmeta-analyses of any intervention and health behavior/outcome were eligible if they quantitatively assessed self-regulation and appeared between January 2006 and August 2017. In total, 66 meta-analyses were ultimately eligible; 27% reported a protocol, 11% used GRADE; 58% focused on RCTs. Reviews satisfied only a moderate number of items on the AMSTAR 2 (M = 45.45%, SD = 29.57%). Only 6% of meta-analyses directly examined whether changes in self-regulation predicted the behavior change (i.e., self-efficacy and physical activity, l = 2; frequency of self-monitoring and goal attainment, l = 1; cognitive bias modification and addiction, l = 1). Meta-analyses more routinely assessed self-regulation by comparing the efficacy of intervention components (97%), such as those from behavior change taxonomies. Meta-analyses that focused on intervention components identified several as successful, including personalized feedback, goal setting, and self-monitoring; however, none were consistently successful in that each worked only for some health behaviors and with particular populations. Some components had inconclusive evidence, given that they were only examined in low- quality reviews. Future reviewers should utilize advanced methods to assess mechanisms, and study authors should report hypothesized mechanisms to facilitate synthesis.

Health behaviour change in cardiovascular disease prevention and management: meta-review of behaviour change techniques to affect self-regulation.

Self-regulation processes assume a major role in health behaviour theory and are postulated as important mechanisms of action in behavioural interventions to improve health prevention and management. The need to better understand mechanisms of behaviour change interventions for cardiovascular diseases (CVD) called for conducting a meta-review of meta-analyses for interventions targeting self-regulation processes. The protocol, preregistered on Open Science Framework (OSF), found 15 eligible meta-analyses, published between 2006 and August 2019, which quantitatively assessed the role of self-regulatory mechanisms and behaviour change techniques (BCTs). Quality of the meta-analyses varied widely according to AMSTAR-2 criteria. Several BCTs, assumed to engage self-regulatory mechanisms, were unevenly represented in CVD meta-analytic reviews. Self-monitoring, the most frequently studied self-regulatory BCT, seemed to improve health behaviour change and health outcomes but these results merit cautious interpretation. Findings for other self-regulatory BCTs were less promising. No studies in the CVD domain directly tested engagement of self-regulation processes. A general challenge for this area stems from reliance on post-hoc tests of the effects of BCTs in multiple-component interventions. Recent advances in BCT taxonomies and the experimental medicine approach to engaging self-regulation mechanisms, however, provide opportunities to improve CVD prevention and management behavioural interventions.