Prevalence of current smoking and association with meeting 24-h movement guidelines: Results from a national convenience sample of autistic adults.

LAY ABSTRACT: Cigarette smoking is a leading risk behavior for cardiovascular disease; yet its prevalence and determinants are not clear in autistic adults. We examined the prevalence of current smoking and its association between meeting 24-h movement (i.e. sleep, physical activity, and sedentary behavior) guidelines in a self-selecting convenience sample of 259 autistic adults in the United States. We found that current smokers met fewer 24-h movement guidelines. Most significant, those who had insufficient sleep and those with high levels of sedentary behavior were more likely to be current smokers. Therefore, targeting these movement behaviors may be potential intervention targets for smoking cessation.

Cutoff estimation and construction of their confidence intervals for continuous biomarkers under ternary umbrella and tree stochastic ordering settings.

Tuberculosis (TB) studies often involve four different states under consideration, namely, "healthy," "latent infection," "pulmonary active disease," and "extra-pulmonary active disease." While highly accurate clinical diagnosis tests do exist, they are expensive and generally not accessible in regions where they are most needed; thus, there is an interest in assessing the accuracy of new and easily obtainable biomarkers. For some such biomarkers, the typical stochastic ordering assumption might not be justified for all disease classes under study, and usual ROC methodologies that involve ROC surfaces and hypersurfaces are inadequate. Different types of orderings may be appropriate depending on the setting, and these may involve a number of ambiguously ordered groups that stochastically exhibit larger (or lower) marker scores than the remaining groups. Recently, there has been scientific interest on ROC methods that can accommodate these so-called "tree" or "umbrella" orderings. However, there is limited work discussing the estimation of cutoffs in such settings. In this article, we discuss the estimation and inference around optimized cutoffs when accounting for such configurations. We explore different cutoff alternatives and provide parametric, flexible parametric, and non-parametric kernel-based approaches for estimation and inference. We evaluate our approaches using simulations and illustrate them through a real data set that involves TB patients.

Sleep Variability, Eating Timing Variability, and Carotid Intima-Media Thickness in Early Adulthood.

Background Day-to-day variability in sleep patterns and eating timing may disrupt circadian rhythms and has been linked with various adverse cardiometabolic outcomes. However, the extent to which variability in sleep patterns and eating timing relate to atherosclerotic development in subclinical stages remains unclear. Methods and Results Generally healthy adults (N=62, 29.3±7.3 years, 66% female) completed 14 days of sleep and dietary assessments via wrist accelerometry and photo-assisted diet records, respectively. Variability in sleep duration, sleep onset, eating onset (time of first caloric consumption), eating offset (time of last caloric consumption), and caloric midpoint (time at which 50% of total daily calories are consumed) were operationalized as the SD across 14 days for each variable. Separate regression models evaluated the cross-sectional associations between sleep and eating variability metrics with end-diastolic carotid intima-media thickness (CIMT) measured via ultrasonography. Models adjusted for age, sex, systolic blood pressure, sleep duration, and total energy intake. Each 60-minute increase in sleep duration SD and sleep onset SD were associated with a 0.049±0.016 mm (P=0.003) and 0.048±0.017 mm (P=0.007) greater CIMT, respectively. Variability in eating onset and offset were not associated with CIMT; however, each 60-minute increase in caloric midpoint SD was associated with a 0.033±0.015 mm greater CIMT (P=0.029). Exploratory post hoc analyses suggested that sleep duration SD and sleep onset SD were stronger correlates of CIMT than caloric midpoint SD. Conclusions Variability in sleep patterns and eating timing are positively associated with clinically relevant increases in CIMT, a biomarker of subclinical atherosclerosis, in early adulthood.

Psychosocial assessment practices for hematopoietic stem cell transplantation: a national survey study.

Psychosocial health predicts and contributes to medical outcomes for patients undergoing hematopoietic stem cell transplantation (HSCT). Yet, there are no standards for psychosocial assessments or support for both patients and caregivers across the care continuum. To examine the current state of psychosocial care, clinicians were sent a survey of their psychosocial assessment practices for patients and caregivers undergoing HSCT via the Listservs of professional organizations. Descriptive statistics and bivariate analyses were performed to summarize the findings. While 96% of participants reported routine pre-HSCT psychosocial assessment of patients, only 10.6% routinely used a validated transplant risk-assessment measure. Just 27% routinely performed follow-up psychosocial assessments. In contrast, only 47% of participants routinely assessed the psychosocial needs of family caregivers pre-HSCT, and 13% routinely performed follow-up assessments for caregivers. Most (90%) reported social workers were the primary providers of assessments. While patient-report measures were used for evaluation, the majority of assessments were clinical interviews. No significant differences were found between programs that treated adult and pediatric patients versus those only treating adult patients. Our findings highlight the lack of standard psychosocial practices for patients and family caregivers undergoing HSCT and we offer recommendations to fill this gap.

Rurality Impacts Mammography Screening Adherence Among Mid-life Women in the Kansas Region.

OBJECTIVE: The gold standard for breast cancer screening and prevention is regular mammography; thus, understanding what impacts adherence to this standard is essential in limiting cancer-associated costs. We assessed the impact of various understudied sociodemographic factors of interest on adherence to the receipt of regular mammograms. METHODS: A total Nc = 14,553 mammography-related claims from Nw = 6,336 female Kansas aged between 45 and 54 were utilized from insurance claim databases furnished by multiple providers. Adherence to regular mammography was quantified continuously via a compliance ratio, used to capture the number of eligible years in which at least one mammogram was received, as well as categorically. The relationship between race, ethnicity, rurality, insurance (public/private), screening facility type, and distance to nearest screening facility with both continuous and categorically defined compliance were individually assessed via Kruskal-Wallis one-way ANOVAs, chi-squared tests, multiple linear regression models, and multiple logistic regression, as appropriate. Findings from these individual models were used to inform the construction of a basic, multifaceted prediction model. RESULTS: Model results demonstrated that all factors race and ethnicity had at least some bearing on compliance with screening guidelines among mid-life female Kansans. The strongest signal was observed in the rurality variable, which demonstrated a significant relationship with compliance regardless of how it was defined. CONCLUSION: Understudied factors that are associated with regular mammography adherence, such as rurality and distance to nearest facility, may serve as important considerations when developing intervention strategies for ensuring that female patients stick to prescribed screening regimens.

Psychosocial Assessment Practices for Hematopoietic Stem Cell Transplantation: A National Survey Study.

Psychosocial health predicts and contributes to medical outcomes for patients undergoing hematopoietic stem cell transplantation (HSCT). Yet, there are no standards for psychosocial assessments or support for both patients and caregivers across the care continuum. To examine the current state of psychosocial care, clinicians were sent a survey of their psychosocial assessment practices for patients and caregivers undergoing HSCT via the Listservs of professional organizations. Descriptive statistics and bivariate analyses were performed to summarize the findings. While 96% of participants reported routine pre-HSCT psychosocial assessment of patients, only 10.6% routinely used a validated transplant risk-assessment measure. Just 27% routinely performed follow-up psychosocial assessments. In contrast, only 47% of participants routinely assessed the psychosocial needs of family caregivers pre-HSCT, and 13% routinely performed follow-up assessments for caregivers. Most (90%) reported social workers were the primary providers of assessments. While patient-report measures were used for evaluation, the majority of assessments were clinical interviews. No significant differences were found between programs that treated adult and pediatric patients versus those only treating adult patients. Our findings highlight the lack of standard psychosocial practices for patients and family caregivers undergoing HSCT and we offer recommendations to fill this gap.

NCCN Guidelines® Insights: Distress Management, Version 2.2023.

These NCCN Guidelines for Distress Management discuss the identification and treatment of psychosocial problems in patients with cancer. All patients experience some level of distress associated with a cancer diagnosis and the effects of the disease and its treatment regardless of the stage of disease. Clinically significant levels of distress occur in a subset of patients, and identification and treatment of distress are of utmost importance. The NCCN Distress Management Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights describe updates to the NCCN Distress Thermometer (DT) and Problem List, and to the treatment algorithms for patients with trauma- and stressor-related disorders.

Temporal associations between nightly sleep with daytime eating and activity levels in free-living young adults.

STUDY OBJECTIVES: This study aimed to quantify the temporal associations between nightly sleep quantity and timing with daytime eating behavior and activity levels in free-living (i.e. non-experimental) settings. METHODS: Generally healthy young adults (N = 63; 28.9 ± 7.1 years) completed concurrent sleep (wrist actigraphy), eating (photo-assisted diet records), and activity (waist actigraphy) assessments over 14 days. Multilevel models quantified the associations between nightly sleep (total sleep time, timing of sleep and wake onset) with next-day eating behavior (diet quality, caloric intake, timing of eating onset/offset, eating window duration) and activity levels (total physical activity, sedentary time). Associations in the reverse direction (i.e. eating and activity predicting sleep) were explored. Models adjusted for demographic and behavioral confounders and accounted for multiple testing. RESULTS: At within- and between-subject levels, nights with greater-than-average total sleep time predicted a shorter eating window the next day (all p ≤ 0.002). Later-than-average sleep and wake timing predicted within- and between-subject delays in next-day eating onset and offset, and between-subject reductions in diet quality and caloric intake (all p ≤ 0.008). At within- and between-subject levels, total sleep time was bidirectionally, inversely associated with sedentary time (all p < 0.001), while later-than-average sleep and wake timing predicted lower next-day physical activity (all p ≤ 0.008). CONCLUSIONS: These data underscore the complex interrelatedness between sleep, eating behavior, and activity levels in free-living settings. Findings also suggest that sleep exerts a greater influence on next-day behavior, rather than vice versa. While testing in more diverse samples is needed, these data have potential to enhance health behavior interventions and maximize health outcomes.

Identifying the most proximal multi-level factors associated with meeting each of the 24-h movement behavior recommendations in a sample of autistic adults.

BACKGROUND: Autistic adults have poorer 24-h movement behaviors, including lower levels of physical activity, more time spent being sedentary, and shorter sleep duration than neurotypical adults. Social ecological frameworks posit that 24-h movement behaviors are determined by multi-level domains; however, not known is which multi-level factors are most important to meeting each of the 24-h movement behavior guidelines among autistic adults. OBJECTIVE: This study examined the relative importance of a range of multi-level determinants on meeting guidelines for the 24-h movement behaviors of aerobic physical activity, sedentary behavior, and sleep. METHODS: We administered at cross-sectional electronic survey to a national self-selecting, convenience sample of autistic adults and caregivers of autistic adults residing in the USA. We used machine learning to examine the relative variable importance (VIMP) of 55 multi-level variables with meeting recommendations for physical activity, sedentary behavior, and sleep duration. VIMPs >0 indicate predictive variables/domains. RESULTS: A greater number of group activities attended in the last 3-months, and greater independence in completing activities of daily living were most important to meeting aerobic physical activity guidelines. Group activity participation and marital status were important to meeting sedentary behavior guidelines while having a fewer number of comorbidities was most important to achieving adequate sleep. CONCLUSIONS: These data support hypotheses about the role of family and social level interventions targeting movement behaviors in autistic adults.

More often than not, we're in sync: patient and caregiver well-being over time in stem cell transplantation.

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is an aggressive medical procedure which significantly impacts the shared emotional well-being of patients and family caregivers (FC). Prior work has highlighted the significant overlap in well-being among patients and FCs; however, how this interdependence may change over the course of HSCT has received less attention. METHODS: We conducted secondary analyses of a supportive intervention delivered to 154 FCs of HSCT patients and examined relationships at baseline, 6 weeks, 3 and 6 months post-HSCT. Actor Partner Interdependence Modeling examined patient quality of life (QOL) and FC anxiety/depression. RESULTS: The data did not fit a multigroup approach limiting our ability to test intervention effects; however, bivariate analyses indicated FC depression significantly correlated to patient QOL at baseline (r = - .32), 6 weeks (r = - .22) and 6 months post-HSCT (r = - .34; p's < .05); whereas FC anxiety was only correlated with patient QOL at the first two timepoints (p's < .05). There was an unexpected, partner effect such that worse patient QOL at 6-weeks significantly related to lower FC depression at 3-months (B = .193; p = .026) and changed direction with patient QOL at 3-months being related to more FC depression at 6-months (B = - .187; p = .001). CONCLUSIONS: These findings highlight the significant, yet nuanced, interdependence of patient QOL and FC well-being during HSCT. Specifically, greater interdependence was observed between patient QOL and FC depression compared to FC anxiety, suggesting potential treatment targets for patients and their families. Trial was registered at ClinicalTrials.gov Identifier: NCT02037568; first registered: January 16, 2014; https://clinicaltrials.gov/ct2/show/NCT02037568.

Brief Report: Perceived Barriers to Physical Activity Among a National Sample of Autistic Adults.

Improving physical activity (PA) levels in autistic adults is an important population health goal. Limiting efforts to achieve this goal is an incomplete understanding of the barriers to PA in this high-risk group. This study utilized cross-sectional data collected via an electronic survey from 253 autistic adults aged 18-50 years to examine their perceived barriers to PA, how PA barriers differed by demographic factors, and the relationship between PA barriers and meeting PA guidelines. The Barriers to Physical Activity scale assessed the independent variable. Lack of motivation to exercise, perceiving exercise as boring, and lack of transportation were the most strongly endorsed barriers to PA. Participants who reported these barriers were significantly less likely (≤ 50%) to meet PA guidelines.

Psychological and behavioral moderators of physical health among caregivers and non-caregivers.

The current study sought to evaluate whether psychological and/or behavioral health moderate the relationship between caregiving and physical health. MATERIALS AND METHODS: Using data from the Behavioral Risk Factor Surveillance System (BRFSS) survey (2017-2018), separate composite scores were created for psychological and behavioral health. Self-reported physical health was the primary outcome. The sample was 1,387 non-caregivers and 266 caregivers. RESULTS: The psychological, behavioral, and self-reported physical health did not significantly differ between caregivers and non-caregivers, but psychological and behavioral health were shown to differentially affect self-reported health outcomes among caregivers, compared to non-caregivers. Caregivers with worse psychological health had higher odds of experiencing poor physical health versus non-caregivers, while caregivers with better behavioral health had lower odds of having better general health versus non-caregivers. DISCUSSION: These data extend our understanding on how to consider the impact of psychological and behavioral health as a caregiver and opportunities to develop targeted interventions.

Actigraphy-derived rest--activity rhythms are associated with nocturnal blood pressure in young women.

INTRODUCTION: Misalignment between lifestyle behaviors and endogenous circadian rhythms is associated with elevated nocturnal blood pressure (BP) in experimental studies; however, less is known about free-living (i.e. nonlaboratory) circadian disruption and nocturnal BP. Additionally, sex-specific cardiovascular implications of circadian disruption are unclear. OBJECTIVE: To examine the associations between rest--activity rhythms (RAR), a field-based estimate of circadian disruption, and nocturnal BP characteristics in young men and women. METHODS: Fifty participants (20 ±â€Š1 years; 20 men/30 women) underwent 24-h ambulatory BP monitoring following 14 days of wrist actigraphy. RAR variables of interdaily stability (day-to-day consistency in RAR), intradaily variability (within-day fragmentation of RAR), and relative amplitude (difference between peak vs. trough activity) were derived from actigraphy. Multivariable regression models of mean nocturnal SBP, DBP, and SBP dipping were generated to test main associations with RAR variables, and sex × RAR interactions. Daytime BP, race, BMI, physical activity, sleep duration, alcohol, caffeine, and sodium intake were considered as covariates. RESULTS: In the full sample, no main associations between RAR and nocturnal BP characteristics were found. Sex interacted with RAR such that in women, higher interdaily stability (ß = -5.39, 95% CI = -10.04 to -0.73, P = 0.024) and relative amplitude (ß = -4.78, 95% CI = -9.22 to -0.34, P = 0.036) were both associated with lower nocturnal SBP. Sex-stratified multivariable models of nocturnal BP also revealed associations between interdaily stability and relative amplitude with SBP dipping in women (all P ≤ 0.01). No associations were apparent in men. CONCLUSION: Consistent and high-amplitude RAR are favorably associated with nocturnal BP characteristics in young women.

24-h movement behaviors among autistic adults: Differences by sex, age, and level of independence.

BACKGROUND: Autistic adults have low levels of physical activity [PA], high levels of sedentary behavior [SB], and insufficient sleep. Not known is the extent to which engagement in these movement behaviors vary by sex, age, and level of independence in activities of daily living (ADLs). OBJECTIVE: To characterize movement behaviors in a national sample of autistic adults by sex, age, and level of independence in ADLs. METHODS: A national sample of autistic adults and caregivers of autistic adults self-reported PA, SB and sleep behaviors as well as demographic variables using an electronic survey. Levels of engagement in movement behaviors were described, and compared by sex, age (young-adult versus middle-age), and level of independence in ADLs. RESULTS: Data were collected on 361 autistic adults (60.3% male, n = 217, mage = 30.82 years, SD = 10.24). Overall, 44% did not meet the PA guideline; PA guideline adherence was lowest among males and those who were dependent on others in ADLs. Overall, the SB guideline was not met by 43% of the sample at weekdays and 48% at weekends. SB guideline adherence was lowest among adults who were middle-aged, and those who were fully independent in ADLs. Overall, 35.2% did not meet the total sleep time (TST) guideline. Middle-aged autistic adults had the lowest adherence to the TST guideline. CONCLUSIONS: These finding should prompt researchers to consider these demographic differences, and tailor research and programmatic efforts to account for the unique movement behavior profiles of different segments of this heterogenous population.

An exploration of clinical, behavioral, and community factors associated with sleep duration and efficiency among middle-aged Black/African American smokers.

STUDY OBJECTIVES: We examined the most important correlates to sleep duration and efficiency from a comprehensive array of multilevel factors. METHODS: Baseline data from a cohort of 216 Black/African American smokers aged 40-65 years were examined. The binary outcomes of healthy sleep duration (6-8 h/night) and efficiency (≥85%) were ascertained from 14 consecutive days of actigraphy. Seventy-three independent variables from socio-demographic, individual behavioral, individual physiological, interpersonal, and community domains were assessed. Random survival forest decision trees were generated for each outcome, and variable importance metrics used to rank the predictive abilities of exposure variables. The 5 most predictive exposure variables for each outcome were entered into a regression model of the respective outcome (with age and sex). RESULTS: Study participants (N = 216) had a mean age of 54.57 years (SD = 6.17) and 57% were male. Healthy sleep duration was achieved by 56.5% and healthy sleep efficiency by 13.6% of the sample. Regression models showed every additional minute of light physical activity was associated with 1% increased odds, while every unit decrease in the inflammation marker of interleukin-8 was associated with 12% increased odds, of achieving a healthy sleep duration. Every unit increase in total social support was associated with a 34% increased odds, while every unit increase in the hazardous drinking score corresponded with 30% decreased odds, of achieving healthy sleep efficiency. CONCLUSIONS: Light physical activity, social support, and alcohol consumption may be key modifiable intervention targets to improving sleep duration and sleep efficiency in this population.

Check your sleep before you start: A secondary analysis of a stress management intervention for caregivers of stem cell transplant patients.

OBJECTIVE: Caregiving for hematopoietic stem cell transplant (HSCT) patients is associated with significant physical and psychological sequelae. While psychosocial interventions may reduce caregiver burden, knowledge regarding which caregivers may benefit the most from such interventions is limited. The purpose of this secondary analysis was to examine whether HSCT caregivers' peritransplant sleep moderated the effect of a psychosocial intervention on depression and anxiety posttransplant. METHODS: Participants included 135 caregivers (mean age = 54.23) who participated in randomized controlled trial and were assigned to receive either 8 weeks of Psychoeducation, Paced Respiration, and Relaxation (PEPRR) or treatment as usual (TAU). Sleep, depression, and anxiety were assessed using the Pittsburg Sleep Quality Index, the Center for Epidemiologic Studies Depression Scale, and the State-Trait Anxiety Inventory, respectively. Caregiver symptoms were assessed at baseline (e.g., peritransplant period) and 6-month posttransplant. RESULTS: Baseline sleep quality (∆R2  = 0.04, p = 0.002), sleep efficiency (∆R2  = 0.03, p = 0.02), and sleep onset latency (∆R2  = 0.07, p < 0.001) independently moderated the effect of group assignment on depression outcomes at the 6-month follow-up. Specifically, caregivers with poor sleep at baseline who received PEPRR reported significantly lower depression scores at follow-up compared to caregivers with poor sleep who received TAU. By contrast, only sleep quality (∆R2  = 0.02, p = 0.01) and sleep onset latency (∆R2  = 0.02, p = 0.005) moderated the effect of the group assignment on anxiety. CONCLUSIONS: Psychosocial interventions for HSCT caregivers may buffer against psychological morbidity, particularly among caregivers with poor sleep quality.

Rest-activity rhythms in emerging adults: implications for cardiometabolic health.

Emerging adulthood (18-25 years) represents a window of opportunity to modify the trajectory of cardiometabolic disease risk into older adulthood. Not known is the extent to which rest-activity rhythms (RAR) may be related to biomarkers of cardiometabolic health in this population. In this cross-sectional, observational study, 52 healthy emerging adults wore wrist accelerometers (14 consecutive days; 24 h/day) for assessment of nonparametric RAR metrics, including interdaily stability (IS; day-to-day RAR consistency), intradaily variability (IV; within-day RAR fragmentation), and relative amplitude (RA; robustness of RAR), as well as autocorrelation (correlation of rest/activity levels at 24-h lag-times). Cardiometabolic biomarkers, including body mass index (BMI), body fat percentage, blood pressure (BP), fasting lipids, glucose, and C-reactive protein (CRP) were assessed. Additional measures including physical activity, sleep duration, and habitual caffeine and alcohol consumption were also evaluated. A series of multivariable regression models of cardiometabolic biomarkers were used to quantify associations with RAR metrics. On average, participants were 20 ± 1 years of age (21 males, 31 females), non-obese, and non-hypertensive. All were nonsmokers and free of major diseases or conditions. In separate models, which adjusted for sex, BMI, moderate-vigorous physical activity, sleep duration, caffeine, and alcohol consumption, IS was inversely associated with total cholesterol (p ≤ 0.01) and non-HDL cholesterol (p < .05), IV was positively associated with CRP (p < .05), and autocorrelation was inversely associated with total cholesterol (p < .05) and CRP (p < .05). Conversely, associations between RA and cardiometabolic biomarkers were nonsignificant after adjustment for BMI, alcohol, and caffeine consumption. In conclusion, RAR metrics, namely, a higher IS, lower IV, and higher autocorrelation, emerged as novel biomarkers associated with more favorable indices of cardiometabolic health in this sample of apparently healthy emerging adults.

Caregiver Health by Context: Moderating Effects of Mental Health and Health Behaviors.

This study assessed caregivers' perceptions of their physical health by care context and explored the moderating role of mental health and health behaviors. This a cross-sectional, secondary analysis using de-identified Behavioral Risk Factor Surveillance System survey data. Deficits in mental health and engaging in healthier behaviors was associated with an increased odds of experiencing at least one week of poor physical health or being in a fair or better health category, respectively. Differences in the odds were noted according to care context (i.e., reason for care). For example, with each unit increase in mental health score (worse mental health), the odds of experiencing at least one week of poor physical health increased among cancer caregivers at about one-and-a-half times as compared to old age caregivers (p=0.006). Findings suggest that some caregiving groups derive less benefit from positive health behaviors, while some groups are more adversely impacted by poorer mental health.