BACKGROUND: Weight-related self-monitoring (WRSM) apps are used by millions, but the effects of their use remain unclear. This study examined longitudinal relationships between WRSM and disordered eating among a population-based sample of emerging adults.
METHODS: Participants (n = 138) were recruited from EAT 2010-2018 (Eating and Activity over Time study) to participate in a mixed-methods (quantitative and qualitative) longitudinal study to understand the impacts of WRSM. In 2018, participants (Mage=21.7 ± 1.9 years) reported motivations for use and types of WRSM apps used. Dependent variables collected in 2022 (Mage=25.7 ± 1.9 years) included past year total number of disordered weight control behaviors, disordered muscle building behaviors, compulsive exercise, and binge eating. Linear and logistic regressions were used adjusting for sociodemographics, body mass index, and baseline disordered eating. Semi-structured interviews (n = 25) were analyzed using inductive thematic analysis.
RESULTS: Participants using WRSM apps for weight management demonstrated an increase in disordered weight control behaviors over time (β = 0.894, p = .012). Using WRSM apps for \"healthy\" eating was marginally associated with an increase in disordered weight control behaviors. (β = 0.673, p = .052). Qualitatively, participants reported varied temporality between WRSM and disordered eating, but believed that app use encouraged restriction/binge cycles and normalized disordered eating.
CONCLUSIONS: Findings suggest there may be individual variation in the relationships between WRSM and disordered eating, but that using WRSM apps with the motivation of managing eating or weight may increase disordered eating in some. Additionally, WRSM apps may normalize or encourage disordered eating. Therefore, safeguards, including screening and monitoring, are needed to ensure WRSM does not cause or escalate harm among WRSM users.
For some, weight-related self-monitoring apps, like MyFitnessPal and Fitbit, may cause or worsen disordered eating over time among emerging adults. However, it seems as though the motivation for self-monitoring (e.g., for managing eating or weight) may be more important than what they are monitoring when it comes to disordered eating risk.

BACKGROUND: Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D.
OBJECTIVE: This study aimed to understand the diabetes management experiences of older adolescents and EAs (age 16-25 years) with T1D living in a rural area and to assess their perceptions of the acceptability of 4 fully automated mobile health (mHealth) interventions to support diabetes management.
METHODS: EAs were identified by clinical staff through convenience sampling. In total, 8 EAs participated in 1 focus group and 1 EA completed an individual interview; all data were collected over Zoom. Facilitators explored EAs\' experiences living in a rural community with T1D and discussed EAs\' impressions of, feedback on, and recommendations for improving 4 mHealth interventions to meet the specific needs of EAs with T1D living in rural communities. Discussions were transcribed and analyzed using conventional content analysis.
RESULTS: In total, 9 EAs (aged 18.8, SD 2.7 years; 5, 56% men; 8, 89% White) with a duration of diabetes of 8.6 (SD 4.3) years participated. They described experiences with diabetes stigma (attributing diabetes to poor lifestyle choices) and feelings of self-consciousness (hyperawareness) in their rural communities. They attributed these experiences to the small size of their communities (\"everyone knows\") and community members\' lack of knowledge about diabetes (unable to differentiate between type 1 and type 2 diabetes). In contrast, EAs reported high levels of social support for diabetes and diabetes care from family, friends, and other community members, but low support for medical needs. The location of their diabetes care providers and the limited accessibility of diabetes-specific and general medical care services in their local community created a challenging medical care context. Overall, EAs found mHealth interventions appealing due to their digital delivery and highlighted features that increased accessibility (voiceovers and simple, jargon-free language), individualization (ability to tailor intervention content and delivery), and applicability to their own lives and other EAs with T1D (relatability of vignettes and other content). EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences (greater frequency and duration, ability to adapt content to emerging needs), increasing opportunities for peer support within the interventions (friend and significant other as identified support person, connecting with peers beyond their local community), and making the tone of intervention components more casual and engaging.
CONCLUSIONS: mHealth interventions aligned with EAs\' needs and preferences are a promising strategy to support EAs in communities where social support and resources might be limited.
BACKGROUND: N/A, not a clinical trial.

The present study sought to identify profiles of 753 emerging adults (62.5% females) with different levels of hostile attribution bias (HAB) and jealousy dimensions (i.e., cognitive, emotional, behavioral) and examined differences in their levels of romantic relational aggression (RoRAgg) across profiles. Participants were recruited from Greek universities and completed and online survey. Using a person-centered approach, Latent Profile Analysis indicated the presence of three profiles of participants: a) jealous and hostile intent attributers who had high scores on jealousy dimensions and HAB, b) low risk who scored low on jealousy and HAB, and c) emotionally jealous and moderate hostile intent attributers with moderate cognitive and behavioral jealousy as well as HAB, and high emotional jealousy. As predicted, jealous and hostile intent attributers scored higher on RoRAgg compared with emotionally jealous and moderate hostile intent attributers and low risk. The findings confirm previous research and are discussed in terms of their implications. Interventions targeting relational aggressor\'s hostile attributions, cognitive suspicions, and negative thoughts should be implemented to reduce RoRAgg.

Objective: Despite experiencing exacerbation of mental health issues, post-secondary students may not seek help due to perceived stigma, overreliance on the self, or preference for nonprofessional supports - including peer support. This study aimed to understand peer support workers\' (PSWs) perspectives regarding providing support for mental health concerns in post-secondary institutions. Methods: 41 PSWs were recruited from two post-secondary institutions. 17 semi-structured interviews and three focus groups were conducted. Themes were identified using a qualitative descriptive approach. Results: Three themes emerged: (1) diverse presentations and approaches to operationalizing peer support for mental health issues on campus exist; (2) peer support has core ingredients; (3) reasons why students access peer support extend beyond mental health crisis. Conclusions: An inclusive peer support approach to mental health is needed for post-secondary students. Considerations for implementation hinge on providing standardized, foundational training to prepare PSWs for the complex mental health issues that present across services.

Physical activity is a modifiable lifestyle behavior known for reducing symptoms of and being a risk factor for depression and mental health disorders. However, emerging adults (ages 18-25) struggle to meet recommended amounts. In this study, we explore the association between physical activity, depressive symptoms, and health factors in 137 Hispanic emerging adults. Using a cross-sectional survey design, sociodemographic information, depressive symptoms (CES-D score), physical activity (IPAQ score), body composition, and blood pressure measures were obtained. Statistical analyses included correlation and regression analyses. More than half of the participants demonstrated depressive symptomology (59.1%) and body fat percentage greater than 25% (64.2%). Body fat percentage, lean body mass, stress, and heart rate demonstrated notable associations with depressive symptoms and physical activity. When measured continuously and categorically, IPAQ was not a significant predictor of depressive symptoms. When used as a binary variable with a cutoff of 600 MET min/week, IPAQ score revealed a negative relationship with CES-D score (β = -0.169, SE = 2.748, p = 0.034). Our results indicate that a threshold of physical activity, 600 MET min/week, may confer protective effects against depressive symptoms. Future research should investigate the context and quality of physical activity to address mental health disparities in this underrepresented population.

BACKGROUND: Emerging adults aged 18-30 years face challenges during life transitions, with an added burden of navigating the health care system and additional costs associated with diabetes. This stress is compounded by overall low levels of health insurance literacy in this population, as people may not know about available financial and health care resources to minimize suboptimal diabetes outcomes. This study aimed to tailor a financial and health insurance toolkit to emerging adults with type 1 diabetes, including racially, ethnically diverse, and Medicaid-insured individuals, through community-based participatory action research.
METHODS: An academic research team and community members from a national organization held six online community advisory board (CAB) content-creation meetings to understand how to tailor a financial and health insurance Toolkit. The CAB was comprised of six racially and insurance-diverse emerging adults with type 1 diabetes and four content experts (clinical, financial, and insurance). Six 60-minute online CAB meetings were held via University Hospitals (UH)-encrypted Zoom over five months. Pre-reading materials were emailed to CAB members before the meetings. A moderator established the purpose of each meeting and briefly discussed meeting rules before each meeting commenced. During the meetings, the moderator guided the discussions and provided the CAB members opportunities to respond and build on one another\'s feedback. A deductive thematic qualitative analysis was utilized. Three researchers independently coded the cross-referenced and de-identified CAB meeting transcripts and then convened to reach a group consensus. Two CAB members performed member-checking.
RESULTS: The following key themes emerged to tailor the Toolkit: ensuring that content covers empowerment and self-advocacy, including genuine stories and multimedia visuals for aesthetics, addressing clinician bias, acknowledging racial and ethnic disparities in care, incorporating cultural representation, and demystifying Medicaid stigma.
CONCLUSIONS: By successfully partnering with the CAB and a community organization through a community-based participatory action research approach, we will develop a financial and health insurance Toolkit tailored to the needs of racially and ethnically diverse and Medicaid-insured emerging adults with type 1 diabetes.
OBJECTIVE: This study aims to tailor a financial and health insurance Toolkit to emerging adults, ages 18–30, with type 1 diabetes. Including the insight from racially and ethnically diverse and Medicaid-insured individuals in developing the Toolkit is essential.
UNASSIGNED: Emerging adults with type 1 diabetes have stressful challenges such as navigating the healthcare system, the costs of diabetes, and general diabetes self-management. This stress is worsened by low levels of health insurance literacy and leads to suboptimal diabetes outcomes. This issue affects many individuals but dramatically impacts those who are racially and ethnically diverse or Medicaid-insured.
UNASSIGNED: Six online content-creation meetings were held to understand the Toolkit content needs and preferences. We analyzed the meeting transcripts to uncover common themes. Patient and public involvement: An academic research team, a national organization (The Diabetes Link), and a Community Advisory Board (CAB) partnered together. The CAB members were racially and insurance-diverse emerging adults with type 1 diabetes and content (financial, insurance, clinical diabetes) experts. We will continue to collaborate with the CAB members to develop a research protocol to test the effects of the Toolkit.
RESULTS: The research findings will be shared with young adult type 1 diabetes stakeholders, healthcare providers, and community and professional organizations. Dissemination strategies will include publications, community and scientific conference presentations, community events, and social media resources and content. The finalized Toolkit will be publicly available on the Diabetes Link Resource Hub.

BACKGROUND: Emerging adults (aged 18-26 years) are the most at-risk yet underserved age group among people with substance use disorder, especially rural emerging adults, and polysubstance use is common. Recovery capital is lower among emerging adults than older adults, and evidence-based treatments are typically unavailable or not developmentally tailored, especially in rural areas. Both supportive parents (or parental figures) and peer recovery support services (PRSS) can be leveraged to better support these emerging adults. Previous research indicates parents can be engaged to deliver contingency management (CM), an extensively researched evidence-based intervention for substance use.
OBJECTIVE: This protocol describes a funded pilot of Launch, a novel, scalable service package that pairs web-based coaching for parents to deliver CM for emerging adults (CM-EA) at home and in-person PRSS with educational and vocational goal setting. Specifically, this protocol describes feasibility, acceptability, and appropriateness testing (implementation-related outcomes) and steps taken to prepare for a future large-scale trial of Launch.
METHODS: Upon the recruitment of 48 emerging adult and parent pairs from sites serving primarily rural clients, participants will be randomized into 1 of 3 conditions for this randomized controlled trial: virtual parent coaching to deliver CM-EA, in-person PRSS for emerging adults, or both sets of services. Emerging adult eligibility includes polysubstance use, a substance use disorder, and availability of a consenting parent. Emerging adults will be interviewed at baseline and 6 months about substance use, quality of life, recovery capital, parental relationship, and Launch implementation-related outcomes (6-month follow-up only). Parents, peer workers delivering PRSS, and parent CM-EA coaches will be interviewed about implementation-related outcomes at the end of the study period. Peer workers and CM-EA coaches will be asked to complete checklists of services delivered after each session. Finally, payers and providers will be interviewed for additional insights into Launch implementation and to identify key outcomes of Launch. Data analysis for emerging adult outcomes will be primarily descriptive, but parent CM-EA training adherence will be assessed using nested mixed-effects regression models of repeated measures.
RESULTS: Launch is currently ongoing, with funding received in August 2023, and is expected to end in September 2025, with data analysis and results in December 2026. Participants are expected to begin enrolling in June 2024.
CONCLUSIONS: While this pilot is limited by the small sample size and restriction to emerging adults with an involved parent, this is mitigated by the study\'s strengths and is appropriate for the pilot stage. Launch uses an innovative combination of existing strategies to generate better outcomes for emerging adults while remaining scalable. This pilot will provide insights into the feasibility and acceptability of Launch from the perspectives of service recipients, providers, and payers to inform a larger-scale effectiveness trial.
BACKGROUND: ClinicalTrials.gov NCT06414993; https://clinicaltrials.gov/study/NCT06414993.
UNASSIGNED: PRR1-10.2196/60671.

Anxiety disorders represent a prevalent mental health concern, with escalating rates, especially among emerging adults. University students, in particular, face a myriad of academic and life stressors that can amplify feelings of worry and anxiety. While early parental bonding seem to predict anxiety disorders later in life, the applicability to emerging adult students and its applicability to predict sub-clinical and transdiagnostic anxiety features remain unclear. This study aims to examine i) the relationship between demographic variables and key features of anxiety disorders (i.e., worry and anxiety symptoms); and ii) the predictive association between early parental bonding and anxiety-related features. A sample of 370 university students in Italy (n = 279 females; M age = 20.84 years, SD age = 1.81 years) completed the Parental Bonding Instrument, the Penn State Worry Questionnaire, and the Beck Anxiety Inventory. Females reported higher levels of worry and anxiety compared to males. Significantly higher worry and anxiety symptoms were reported by individuals who experienced affectionless control (low care and high overprotection) as compared to those exposed to optimal parenting (high care and low overprotection). Predictive models indicated that scores of parental care (i.e., the principal component between maternal and paternal care scores) and parental overprotection (i.e., the principal component between maternal and paternal overprotection scores) are robust predictors of worry and anxiety symptoms. However, this relationship showed a gender-specific pattern: lower parental care was more significant in predicting anxiety features in males, while high overprotection was more significant in females. The findings contribute to the comprehension of the risk factors influencing the susceptibility of emerging adult students to anxiety disorders.

Despite not displaying higher overall rates of substance use compared to White Americans, the social consequences of substance use disorders for Black Americans, particularly among Black American men, are more damaging. Furthermore, recent data suggest an uptick in substance use-related deaths among Black Americans, raising serious concerns about a growing health disparity that warrants the need for studies to identify factors associated with prevention. For decades, Black cultural theorists have argued that Afrocentric norms are important buffers against maladaptive behaviors in Black Americans, but the association in the context of substance use is still an emerging area. The present study investigated the associations between Afrocentric norms, Afrocentric self-regard, internalized negative stereotypes, and substance use attitudes and behaviors among Black young adults. Self-report questionnaires were administered to measure internalized negative stereotypes, Afrocentric norms, Afrocentric self-regard, substance use attitudes, and substance use from a sample of Black young adults (N = 619). Favorable attitudes toward substance use were found to be positively associated with internalized negative stereotypes but were inversely associated with Afrocentric norms and Afrocentric self-regard. Similarly, substance use reports within the past 30 days were inversely associated with Afrocentric norms, but the relationship to cannabis use was non-significant. Gender differences between Black men and women were also found. Implications for social work are discussed.

Prior studies estimating longitudinal associations between nicotine vaping and subsequent initiation of cannabis and other substances (e.g., cocaine, heroin) have been limited by short follow-up periods, convenience sampling, and possibly inadequate confounding control. We sought to address some of these gaps using the nationally representative Population Assessment of Tobacco and Health Study (PATH) to estimate longitudinal associations between nicotine vaping and the initiation of cannabis or other substances among adolescents transitioning to adulthood from2013 to 2019, adjusting for treatment-confounder feedback. Estimands like the longitudinal average treatment effect were not identified because of extensive practical positivity violations. Therefore, we estimated longitudinal incremental propensity score effects, which were identified. We found that reduced odds of nicotine vaping were associated with decreased risks of cannabis or other substance initiation; these associations strengthened over time. For example, by the final wave (2018-19), cannabis and other substance initiation risks were 6.2 (95%CI:4.6-7.7) and 1.8 (95%CI:0.4-3.2) percentage points lower when odds of nicotine vaping were reduced to be 90% lower in all preceding waves (2013-14 to 2016-18), as compared with observed risks. Strategies to lower nicotine vaping prevalence during this period may have resulted in fewer young people initiating cannabis and other substances.