Examining parents' experiences and challenges of feeding preschool children with avid eating behaviour.

Avid eating behaviours, including greater responsiveness to food cues and emotional over-eating, have been linked to child overweight and obesity. Parental feeding practices are modifiable components of a child's food environment and may be key levers for behaviour change in tailored interventions to support parents of children with avid eating behaviour. However, there is a lack of research examining parents' experiences in this context. This study aimed to explore parents' experiences of feeding children with avid eating behaviour and to understand any challenges experienced in this context. Semi-structured interviews with parents (N=15) of a preschool child (3-5 years) identified as having an avid eating behaviour profile explored how children's avid eating manifests, the parental feeding practices used to manage avid eating, and the perceived effectiveness of these strategies. Data were analysed using reflexive thematic analysis. Four core themes were generated. Theme one, 'Have they got worms? Children's insatiable hunger', captures parents' interpretation of the complex ways in which avid eating behaviour manifests. Theme two, 'Parenthood as a duty', illustrates how parents' perceived responsibilities shape their feeding practices. Theme three, 'Lifelong habits', captures parents' use of responsive feeding practices to support children's healthy relationship with food. Theme four, 'Picking battles', captures the structure- and coercive-based feeding strategies commonly used to manage children's avid eating. This novel study provides an in-depth understanding of the complex ways that children's avid eating behaviour manifests, and the strategic and creative parental feeding practices used to manage these behaviours. Such findings are valuable for informing the development of future support resources for parents/caregivers to help their children with avid eating behaviours to develop a healthy relationship with food.

Repeated exposure to models' positive facial expressions whilst eating a raw vegetable increases children's consumption of the modelled vegetable.

Exposing children to adults eating a raw vegetable with positive facial expressions ('positive modelling') increases children's consumption of the modelled vegetable. However, whether repeated versus a single exposure to positive modelling enhances this effect, and whether it generalises to a non-modelled vegetable, remains to be examined. Hence, this study examined the effect of a single exposure, versus repeated, exposure to positive modelling on children's acceptance and intake of a modelled and non-modelled vegetable. Children aged 5-6 years (N = 153; 81 males, 72 females) were randomised to one of three conditions in which they had i) a single or ii) repeated exposure to a video of adults eating raw broccoli with positive facial expressions or iii) were exposed to a no-food control video. Children's acceptance (measured as willingness to try and number of tastes), intake and liking of a modelled (raw broccoli) and non-modelled vegetable (raw mangetout) were measured. Children had greater raw broccoli consumption and liking if they had received repeated exposure to positive modelling, compared to children who had received a single exposure, but not compared to children in the control condition. Children's mangetout intake was greater in the single (versus repeated) positive condition, but this effect was not dependent on time. There was no effect on children's vegetable acceptance. Repeatedly exposing children to adults enjoying a vegetable encourages children's intake of the modelled vegetable in comparison to a single exposure. Thus, repeated exposure to others' food enjoyment may be a practical and useful strategy to encourage children's vegetable consumption.

Examining Parent Mood, Feeding Context, and Feeding Goals as Predictors of Feeding Practices Used by Parents of Preschool Children With Avid Eating Behavior: Protocol for an Ecological Momentary Assessment Study.

BACKGROUND: An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents' daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children's healthy eating behavior. OBJECTIVE: We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. METHODS: Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. RESULTS: Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. CONCLUSIONS: The findings from this study will provide an understanding of caregivers' daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children's avid eating behavior. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55193.

Sowing the Seeds of Recovery: A Qualitative Study of Women in Recovery From Addiction and Victimization.

The purpose of this study was to understand the lived experiences of women with histories of victimization and addiction who were recently admitted to a sober living home (SLH). From the 17 interviews conducted, five themes (i.e., experiences of violence, challenges leaving an abusive relationship, chaos, using substances to cope, and social support) and one constitutive pattern (i.e., sowing the seeds of recovery) emerged from the data. These results highlight the importance of social support in promoting recovery and that social support may foster positive relationships with safe and trustworthy individuals as well as empower and support others with similar experiences.

Regional Variations in Corneal Epithelial Cell Density and Morphology Assessed Using In Vivo Confocal Microscopy.

AIM: To characterize the regional variations in corneal epithelial cell density and morphology using in vivo confocal microscopy (IVCM). METHODS: Corneal imaging (IVCM) at 10 locations was performed; corneal apex (i.e., the center), immediately anterior to the corneal nerve whorl (i.e., slightly inferior to the apex), and four quadrants (superior, nasal, inferior, and temporal) both at 1.5 mm and 4.5 mm from the corneal apex (corresponding to 3 mm central and 9 mm peripheral diameter rings). The data of 21 young adults, aged 18 to 35 years, were analyzed. Cell morphometric parameters, including cell density, area, perimeter, Feret diameter, and circularity, were measured for basal and wing cells using Image J software. RESULTS: There was a significant difference in basal cell density (BCD) ( P <0.001) and wing cell density (WCD) ( P <0.001) for different corneal locations. The BCD (mean±SD: 8,839±416 cells/mm 2 ) and WCD (mean±SD: 5,932±310 cells/mm 2 ) were highest at the corneal nerve whorl compared with all other corneal locations. There were significant differences in wing cell area ( P <0.001), perimeter ( P <0.001), Feret diameter ( P <0.001), and circularity ( P <0.001) at varying corneal locations. CONCLUSION: There are significant regional variations in corneal epithelial cell density and morphology. The BCD and WCD was highest anterior to the corneal nerve whorl.

Examination of the Multilevel Sexual Stigma Model of Intimate Partner Violence Risk Among LGBQ+ College Students: A Prospective Analysis Across Eighteen Institutions of Higher Education.

Sexual stigma operates at multiple levels (institutional, group, individual), which serves to disadvantage sexual minority (LGBQ+) individuals and increases risk for deleterious outcomes. The current study evaluated a novel multilevel sexual stigma model of intimate partner violence (MLSSM-IPV) that incorporates multiple levels of sexual stigma as related to IPV risk via several pathways (e.g. hazardous drinking, affective symptoms). We evaluated this model in a longitudinal study of LGBQ+ undergraduate college students (n = 2,415) attending 18 universities who completed surveys in the Fall and Spring semesters. Group-level sexual stigma on each campus was assessed via surveys with heterosexual students (n = 8,517) and faculty, staff, and administrators (n = 2,865), and institutional-level stigma was evaluated via a campus climate assessment. At the campus level, institutional stigma was related to LGBQ+ students' self-stigma and identity concealment. Moreover, self-stigma prospectively predicted IPV victimization, and hazardous drinking mediated the relations between self-stigma and IPV perpetration and victimization. Results suggest that interventions addressing stigma and hazardous drinking may be efficacious in reducing IPV among LGBQ+ students. Further, comprehensive efforts to improve campus climate for LGBQ+ students are likely to produce a plethora of benefits for these students.

Understanding family food purchasing behaviour of low-income urban UK families: An analysis of parent capability, opportunity and motivation.

OBJECTIVE: Family food purchasing decisions have a direct influence on children's food environments and are powerful predictors of obesity and dietary quality. This study explored parents' capability, opportunities, and motivations regarding food purchasing for their families, as well as barriers and facilitators of healthy food purchasing behaviour, in an ethnically diverse, low-income area. DESIGN: Semi-structured interviews with parents of under-11-year-old children were conducted to investigate family food purchases, both when eating inside and outside the home. Interviews were analysed using framework analysis mapped against the COM-B model (Michie et al., 2011). SETTING: An ethnically diverse, low-income area in Birmingham, UK. PARTICIPANTS: Sixteen parents (13F, 3M) of under-11-year-old children. 75% Pakistani, 12.5% White British, 6.3% White and Black Caribbean, and 6.3% "Other". RESULTS: Four themes were identified: i) I know how to provide healthy meals for my family, ii) Family food purchase decisions are complex, iii) I want what they are eating and iv) Healthy eating is important but eating outside of the home is a treat. The barriers of healthy family food purchasing were predominantly at family and community levels, including time, cost, and both parents' and children's food enjoyment and preferences. Facilitators of healthy family food purchasing were primarily identified at an individual level, with high levels of capability and motivation for healthy food provision. CONCLUSIONS: Attempts to enhance parental capability to improve healthy food purchasing through nutrition education is not likely to be a useful intervention target in this group. Emphasis on enjoyment, palatability and value for money could be key to increasing parental motivation to purchase healthy family foods.

Resilience and Challenges Among Women With Histories of Addiction and Victimization Newly Admitted to a Sober Living Home: A Brief Report.

This study examined strengths (i.e., empowerment, purpose) and challenges (i.e., depressive and posttraumatic stress disorder symptomatology, financial and housing worries) experienced by women (N = 44) with histories of addiction and victimization newly admitted to a sober living home (SLH). Women had moderate to high levels of both strengths and challenges. In general, strengths and challenges were inversely related (e.g., higher purpose was related to lower depression), and challenges were positively related (e.g., higher financial worries were related to higher posttraumatic stress symptoms). The findings remind us that women entering SLHs have myriad needs and that comprehensive services drawing upon women's resilience are needed.

Social Reactions to Disclosure of Sexual Violence Experienced by Sexual and Gender Minority Young Adults: Comparisons of Sexual and Gender Minority Recipients Versus Cisgender/Heterosexual Recipients.

Sexual and gender minority (SGM) individuals are at an increased risk of experiencing sexual violence (SV). Social reactions received upon disclosure of SV impact survivors' mental health, and this may be more extreme when social reactions are provided by other SGM individuals. The purpose of the current study was to understand the SV disclosure experiences of SGM young adults, including the identity of disclosure recipients and the quality of the social reactions received by SGM and cisgender/heterosexual disclosure recipients. Additionally, the current study sought to examine how the SGM identity of the disclosure recipient and the quality of the social reactions received were associated with mental health outcomes (depression, post-traumatic stress disorder [PTSD], and alcohol use) among SGM SV survivors. SGM-identifying participants (N = 110) completed a 10-min survey on Qualtrics that was distributed through Prime Panels. Results revealed that 83% of participants (SGM survivors of SV) disclosed their SV experience to other SGM individuals. SGM disclosure recipients provided more positive social reactions and fewer negative social reactions than cisgender/heterosexual disclosure recipients. Regression models indicated that positive social reactions from cisgender/heterosexual recipients were associated with a decrease in depression scores. Negative social reactions from SGM recipients were associated with an increase in depression scores. Unexpectedly, positive social reactions from SGM recipients, while negative social reactions from cisgender/heterosexual recipients, were associated with an increase in PTSD scores. No associations were found between social reactions and alcohol use. Findings highlight the importance of social reactions and disclosure experiences on SGM survivors' mental health and mitigation opportunities to improve these disclosure experiences.

The Role of Minority Stress in Psychological Distress and Hazardous Drinking Among Sexual Minority College Student Victims of Intimate Partner Violence.

Sexual minority, individuals who are not heterosexual, college students experience high rates of intimate partner violence (IPV), which is linked to a myriad of deleterious outcomes. However, little work has evaluated whether there are differences in IPV outcomes among sexual minority college students as compared to heterosexual college students. Further, the extent to which minority stress at the institutional and individual level relates to IPV outcomes among sexual minority students is understudied. As such, the purpose of the current study was to evaluate IPV outcomes in a large sample of undergraduate students attending 18 medium- to large-sized universities across the contiguous U.S. Results supported that sexual minority victims of IPV had more anxious and depressive symptoms than heterosexual victims of IPV but were not more likely to engage in hazardous drinking. Further, analyses supported that several campus-level (but not individual-level) indicators of minority stress moderated the relation between IPV victimization and negative outcomes among sexual minority students, such that the association between IPV and negative outcomes was stronger among students embedded in campuses with higher levels of minority stressors. Results support the critical importance of interventions addressing campus-level minority stressors to reduce deleterious IPV outcomes among sexual minority college student victims.

Alcohol Use, Discrimination, and Psychological Partner Abuse Among LGBQ+ College Students: Results From a Daily Diary Study.

Alcohol use correlates with psychological partner abuse (PA) perpetration among lesbian, gay, bisexual, queer, and other nonheterosexual (LGBQ+) young adults. However, less is known about the proximal association between alcohol use and psychological PA within this population, which would provide valuable information for intervention development. Informed by minority stress and alcohol-related PA theories, we evaluated whether (a) psychological PA perpetration odds increased as the number of drinks consumed prior to psychological PA on a given day increased, (b) psychological PA perpetration odds were greater following heavy episodic drinking (HED) relative to non-HED, and (c) experiencing LGBQ+-specific discrimination (i.e., heterosexist harassment, incivility, and hostility) strengthened the association between daily alcohol use (number of drinks, HED) and subsequent psychological PA perpetration. LGBQ+ college students (N = 41; 75.6% women, 22.0% men, and 2.4% transgender/non-binary) completed a baseline survey of past-year discrimination before completing daily reports of their alcohol use and psychological PA for 60 consecutive days. Multilevel modeling revealed that drinking more than one usually does on a given day is positively associated with subsequent psychological PA odds (OR = 1.31, p < .001). Psychological PA was more likely following HED relative to non-HED (OR = 3.23, p < .001). Unexpectedly, experiencing discrimination was negatively associated with psychological PA odds across models (OR = .26 p = .01). No alcohol × discrimination interactions emerged. Results support alcohol use as a proximal risk factor for psychological PA among LGBQ+ college students and underscore the need for more nuanced examination of discrimination and other contextual variables in alcohol-related PA.

Past 6-Month Prevalence of IPV Victimization among Transgender and Gender-Diverse Undergraduate Students: A Brief Report.

Research has largely neglected the issue of intimate partner violence (IPV) among transgender and gender-diverse (TGD; e.g., nonbinary and genderqueer) individuals. However, existing research suggests that TGD individuals are disproportionately affected by IPV. The current study sought to explore if and how rates of IPV vary among subgroups of TGD undergraduate students and contextual factors of IPV among TGD individuals including the co-occurrence of multiple forms of IPV victimization, the type of relationship in which IPV occurred, and the gender identity of the IPV perpetrator. Participants were 280 TGD undergraduate students attending 20 medium- and large-sized residential public universities across the contiguous United States. Of the entire sample of TGD undergraduate students (N = 280), a total of 27.5% endorsed past 6-month IPV victimization (20.0% psychological, 6.1% physical, 8.9% sexual, 11.4% coercive control, and 5.7% LGBTQIA+-specific). Among only the participants who endorsed past 6-month IPV victimization (N = 77), 45.4% reported one form of IPV victimization, 26.0% two forms, 22.1% three forms, and 6.5% four forms. Further, 41.3% of TGD IPV victims were in a casual relationship, 56.0% were in a serious relationship, and 2.7% were in multiple relationship types. Finally, 55.8% of victims reported their perpetrator was a man, 22.1% a woman, and 22.1% a TGD individual. No significant differences in rates of IPV were found between TGD respondents. These data highlight the urgent need for programming efforts on college campuses that are specifically designed to prevent and address IPV among and against TGD students. Future research should evaluate universal- and population-specific risk and protective factors for IPV among TGD individuals to inform prevention and response efforts for this highly vulnerable population.

Programs to Prevent Violence Against Children in Sub-Saharan Africa: A Systematic Review.

Violence against children-which includes maltreatment (including physical, sexual, psychological and emotional violence, and neglect), bullying (including cyberbullying), youth violence (including physical assault with or without weapons), intimate partner violence (including exposure to domestic violence and direct involvement in teen dating violence), and sexual violence-continues to present itself as a significant public health crisis in Sub-Saharan Africa (SSA) leading to numerous short- and long-term deleterious outcomes. As such, the prevention of violence against children in SSA is a critical public health priority. In this systematic literature review, we identified 45 articles that reported on results from 22 programs that seek to reduce violence against children in SSA. Results suggested that programs that focus on (1) economic strengthening, (2) teachers schools, (3) entire families, (4) caregivers only, and (5) children only are generally effective in reducing violence against children by promoting focused action on the mechanisms of change (e.g., parenting skills, enhanced parent-child relationships, resistance skills for children). To date, no research in SSA has examined the impact of policy interventions on childhood victimization or community-level interventions to change norms and values that support violence against children. Future research is needed to examine the impacts of comprehensive efforts to prevent violence against children in SSA as well as factors that predict uptake and sustainability of such prevention efforts in SSA.

Empowerment Transformation Training Reduces Rape Among Girls and Young Women in South Sudan and the Kakuma Refugee Camp.

PURPOSE: Rape occurs at high rates in South Sudan and Kakuma refugee camps, a region characterized by armed conflict, gender inequity, and economic crisis. To date, we know little about how to prevent rape in this region of the world. As such, the purpose of this study was to examine outcomes of Empowerment Transformation Training (ETT) (an adapted empowerment self-defense program; empowerment self-defense) among female participants in South Sudan and the Kakuma refugee camp. METHODS: Schools were assigned to the treatment (ETT) condition (n = 7) or control (life skills) condition (n = 9) and used as the unit of analysis given the cluster-randomized design. Female participants anonymously completed a baseline (T1) and 12-month follow-up (T2) paper and pencil survey. RESULTS: Annual rape victimization rates decreased from 10.7% to 5.5% in the ETT schools (risk ratio [RR] = 0.51); there was no change in the control schools (10.0%-9.0%). Empowerment Transformation Training (ETT) schools had increased confidence at T2 (T1: 42.4%; T2: 75.4%; RR = 1.79) and greater rates of confidence at T2 compared to control schools (54.3%; RR = 1.39). Knowledge of effective self-defense strategies (T2) was greater for ETT schools (47.4%) compared to control schools (30.1%) (RR = 1.57). DISCUSSION: The ETT program reduced rates of rape, increased confidence, disclosures of rape (among victims), and knowledge of effective self-defense strategies. Empowerment self-defense programs are a critical component to rape prevention across global communities, including those characterized by armed conflict, gender inequity, and economic crisis.

Staff perceptions towards virtual reality-motivated treadmill exercise for care home residents: a qualitative feedback study with key stakeholders and follow-up interview with technology developer.

OBJECTIVES: Health and care resources are under increasing pressure, partly due to the ageing population. Physical activity supports healthy ageing, but motivating exercise is challenging. We aimed to explore staff perceptions towards a virtual reality (VR) omnidirectional treadmill (MOTUS), aimed at increasing physical activity for older adult care home residents. DESIGN: Interactive workshops and qualitative evaluation. SETTINGS: Eight interactive workshops were held at six care homes and two university sites across Cornwall, England, from September to November 2021. PARTICIPANTS: Forty-four staff participated, including care home, supported living, clinical care and compliance managers, carers, activity coordinators, occupational therapists and physiotherapists. INTERVENTIONS: Participants tried the VR treadmill system, followed by focus groups exploring device design, potential usefulness or barriers for care home residents. Focus groups were audio-recorded, transcribed verbatim and thematically analysed. We subsequently conducted a follow-up interview with the technology developer (September 2022) to explore the feedback impact. RESULTS: The analysis produced seven key themes: anticipated benefits, acceptability, concerns of use, concerns of negative effects, suitability/unsuitability, improvements and current design. Participants were generally positive towards VR to motivate care home residents' physical activity and noted several potential benefits (increased exercise, stimulation, social interaction and rehabilitation). Despite the reported potential, staff had safety concerns for frail older residents due to their standing position. Participants suggested design improvements to enhance safety, usability and accessibility. Feedback to the designers resulted in the development of a new seated VR treadmill to address concerns about falls while maintaining motivation to exercise. The follow-up developer interview identified significant value in academia-industry collaboration. CONCLUSION: The use of VR-motivated exercise holds the potential to increase exercise, encourage reminiscence and promote meaningful activity for care home residents. Staff concerns resulted in a redesigned seated treadmill for those too frail to use the standing version. This novel study demonstrates the importance of stakeholder feedback in product design.

Social networks and violence victimization and perpetration among youth: A longitudinal analysis.

Interpersonal violence (IV) is a serious concern for adolescents in the United States that has devastating impacts for individuals and communities. Given the increased importance placed on friendships during adolescence, the purpose of the current study was to examine the extent to which IV experiences cluster within youths' friendship networks. Participants were students (N = 1303) in grades 7th to 10th who completed surveys at the beginning and end of an academic year. Results showed that friends' average perpetration (i.e., the percentage of the friends they nominated who perpetrated IV) was strongly associated with likelihood of individual perpetration at baseline but not at the follow-up. For victimization, friends' average report of victimization (i.e., the percentage of the friends they nominated who were victimized) was associated with higher likelihood reporting of victimization (at both baseline and follow-up). Although future research is needed to understand explanatory mechanisms underlying these findings, it is possible that the effectiveness of prevention initiatives may be enhanced by incorporating peer group information.

Identifying an avid eating profile in childhood: Associations with temperament, feeding practices and food insecurity.

This study aimed to identify distinct eating behaviour profiles in young children and examine how other key predictors of children's eating behaviour, including child temperament, the experience of food insecurity, or parental feeding practices, may vary by identified profiles. An online survey was conducted with 995 parents/carers living in England and Wales (N = 995, Mage = 35.4 years, 80% female, 88% White). Participants reported on their child's eating behaviour using the Child Eating Behaviour Questionnaire and completed measures of child temperament, household food security and parental feeding practices. Latent Profile Analysis (LPA) was carried out to identify distinct eating profiles amongst the children (36-72 months, Mage = 48.8 months, 52% female). Four eating profiles emerged from the sample of children: (a) avid eating, (b) avoidant eating, (c) happy eating, and (d) typical eating. Avid eating (21.9% of children) was characterised by higher levels of food responsiveness, enjoyment of food, and emotional over-eating in combination with lower satiety responsiveness, slowness in eating and food fussiness. Children with an avid eating profile were reported to be more surgent and experienced greater food insecurity than all other eating profiles. Parents of children belonging to the avid eating profile showed significantly greater use of food for emotional regulation, varied and balanced food provision, restriction of food for health, and restriction of food for weight feeding practices than the three other eating profiles.

Corneal Epithelial Cell Density Is Reduced in Young Adults With Conjunctival Ultraviolet Autofluorescence.

PURPOSE: The aim of this study was to investigate the effects of chronic ultraviolet (UV) radiation exposure on the corneal microstructure using conjunctival UV autofluorescence (CUVAF) as a marker of exposure. METHODS: Young healthy adults aged 18 to 35 years were recruited. Participant's demographics and sun exposure behavior were recorded using questionnaires. Images of the bulbar conjunctiva from the right eye were captured and analyzed for the CUVAF area. Corneal microstructure was assessed by in vivo confocal microscopy and anterior segment optical coherence tomography. The presence of palisades of Vogt in all 4 limbal quadrants was recorded. RESULTS: CUVAF was observed in 31 of 52 eyes (60%), with a mean (±SD) nasal, temporal, and total CUVAF area of 5.39 ± 4.16 mm2, 4.29 ± 4.27 mm2, and 9.67 ± 7.01 mm2, respectively. Individuals with CUVAF were significantly more likely to report undertaking moderate-intensity to high-intensity outdoor exercise (P = 0.021). Individuals with CUVAF were less likely to have visible nasal and temporal palisades of Vogt (P = 0.011). Corneal basal cell densities anterior to the nerve whorl (P < 0.001) and nasally (P = 0.005) were lower in individuals with CUVAF. Wing cell density anterior to the nerve whorl was lower in individuals with CUVAF (P = 0.011). No significant changes in the central and limbal corneal epithelial thickness were observed. CONCLUSIONS: Significant reductions in corneal epithelial cell density were observed in individuals with CUVAF, a biomarker of chronic UV exposure. This observation suggests that chronic UV exposure is damaging to the corneal microstructure.