Objective: To determine individual- and country-level factors associated with self-reported changes in solo and partnered sexual behaviors in an international sample of adults during COVID-19. Methods: Data were from the International Sexual Health And REproductive Health during COVID-19 study (I-SHARE)—a cross-sectional, multi-country study (N = 26 countries) assessing adult (N = 19,654) sexual/reproductive health before and during the first wave of COVID-19. We examined self-reported changes (three-point scale: decreased, no change, increased) in solo masturbation, hugging/holding hands/cuddling with a partner, sex with a primary partner, sex with a casual partner, sexting with a partner, viewing sexually explicit media and partnered cybersex. Ordinal regression assessed the impact of individual (age, gender- and sexual-identity, romantic partnership status, employment and income stability, household change and content, mental well-being, changes in alcohol use, and changes in marijuana use) and country-level (e.g., Oxford Stringency Index, Human Development Index, and the Palma Ratio) factors on behavior change. Results: The most common behavior to increase was hugging, kissing, or cuddling with a partner (21.5%), and the most common behavior to decrease was sex with a main partner (36.7%). Household factors like job/income instability and having children over the age of 12 years were significantly associated with decreased affectionate and sexual partnered sexual behaviors; more frequent substance use was linked to significantly increased solo, partnered, and virtual sexual behaviors. Conclusions: Understanding changes in sexual behaviors—as well as the factors that make changes more or less likely among adults around the world—are important to ensure adequate sexual health support development for future public health emergencies.

Sexual trauma is common. Consequences of sexual trauma can include deterioration of mental and physical health and it can also affect future romantic and sexual relationships. Previous studies have identified common healthy and destructive coping mechanisms to recover after experiencing sexual trauma, but few studies have investigated useful strategies to move into a healthy sexual relationship focused on resilience. In-depth semi-structured interviews were conducted with 41 women with a history of sexual trauma who were in a healthy sexual relationship at the time of participation. Participants provided strategies that helped them move beyond the sexually traumatic event(s) toward a healthy sexual relationship. Reflexive thematic analysis identified 5 effective and 6 ineffective strategies reported by the participants. Rich examples of resilience and empowerment were overarching in the effective strategies used for moving toward healthy sexual relationships. Women were also able to reflect on the strategies that were ineffective for them with kindness and understanding for their coping at that time, a normalizing theme for women working through sexual trauma. The results of this study will help therapists and researchers working with women who have experienced sexual trauma learn from their experiences in working beyond trauma toward a healthy sexual relationship.

Emotion dysregulation is an associated feature of compulsive sexual behavior disorder (CSBD), now recognized by the World Health Organization. Previous studies have identified associations between trait emotion dysregulation and CSBD. Given that difficulties with emotion regulation (DERS) is comprised of several facets (e.g., difficulty with impulse control and lacking awareness of one’s feelings when upset), and that these facets differentially relate to other mental health concerns, the present study aimed to examine how DERS facets relate to compulsive sexual behavior (CSB). The present study also considered interpersonal emotion regulation via attachment avoidance and attachment anxiety. Hierarchical regression was conducted, first accounting for demographic covariates, then adding attachment styles, and finally all DERS subscales. Results indicated that, among a large, diverse, online U.S. sample (N = 915; Mage = 39.21, SD = 0.81; 54.3% men), difficulty controlling impulses when upset, difficulty with clarity of emotions, and non-acceptance of emotions were significantly positively associated with CSB (small to moderate effects). Attachment anxiety and avoidance were also significantly positively associated with CSB, although their effects were minimal when adding DERS facets. Overall, this study supports the theorized impact of emotion dysregulation on CSB. Assessment of individual differences in DERS and intervening on these concerns are important for treating CSB.

Communication is an important component of many healthy sexual and romantic relationships. Positive communication strategies including expressing fondness and affection, exchanging compliments, and...

Purpose: To evaluate cross-sectional and longitudinal associations between controlling parental feeding practices in adolescence (i.e., restrictive feeding and pressure-to-eat [PE]) and intuitive eating (IE) in adolescence and emerging adulthood; and explore child gender and parental concern about child weight as moderators. Methods: The sample included participants (N = 1,383) from the population-based EAT 2010–2018 study who provided data in adolescence (14.4 ± 2.0 years) and emerging adulthood (22.0 ± 2.0 years) and had at least one caregiver complete surveys in adolescence. Generalized estimating equations evaluated cross-sectional and longitudinal associations between restrictive feeding and PE in adolescence and IE in adolescence and emerging adulthood. Interactions with gender and parental concern over child weight in adolescence were explored. Results: Restrictive feeding was cross-sectionally associated with lower IE in adolescence (b = −0.04), though evidence of moderation by parental weight concern indicated this association was only observed in the context of low parental weight concern. Greater PE was associated with lower adolescent IE among boys but higher IE among girls. Longitudinally, the association between PE in adolescence and IE in emerging adulthood differed by parental weight concern; greater PE predicted higher emerging adult IE at high parental weight concern, but lower IE at low parental weight concern. Discussion: Controlling feeding practices in adolescence displayed differential associations with child IE in adolescence and emerging adulthood based on child gender and parental concern over child weight. Notably, PE was associated with greater IE among adolescent girls but lower IE among boys. Results suggest that parental feeding is a valuable intervention target.

Background: Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the "quality" of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan. Methods/design: The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI+Virtual Home Visiting with CHW+Video Feedback; and (3) EMI+Hybrid Home Visiting with CHW+Video Feedback. The intervention will be carried out across 6 months with children ages 5-10 (n=525) with increased risk for cardiovascular disease (i.e., BMI ≥75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference. Discussion: This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary assessment, intervention, video feedback and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care. Trial Registration: This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.

Given emerging adulthood is a period of increased independence, it is unclear how much contact emerging adults have with their parents, how this communication occurs, and how frequency of communication differs across sociodemographic characteristics. The main aim of this study was to examine communication patterns and modalities between emerging adults and their parents. Data are from an 8-year longitudinal, population-based study of socio-economically and racially/ethnically diverse adolescents followed into emerging adulthood (n = 1539; mean age = 22.1; 53.1% female). Latent profile analysis results supported a 5-class model, in which classes were characterized by patterns of frequency of communication with parents across different modalities. The most common communication modality included medium levels of engagement (i.e., few times/week), with both parents, and was in-person or via the phone (i.e., calls, text messages, email). Results differed by race/ethnicity. Findings from this exploratory study may be useful for supporting positive communication patterns between emerging adults and their parents and may inform what intervention delivery format (e.g., phone, social media-based, in-person) may be more effective for certain parent/emerging adult subgroups engaging in family-based interventions.

Research addressing the impact of the COVID-19 pandemic on psychosocial well-being and health behavior is accumulating; however, implications for emerging adult populations are underexplored. This ...

Objective: To estimate associations of residential mobility with body mass index (BMI), physical activity, and diet and whether associations differ across demographics. Design: Longitudinal cohort with 4 waves of survey follow-up over 15 years. Participants and Setting: A total of 2,110 adolescents and young adults originally from the Twin Cities of Minnesota responded to at least 2 waves of follow-up, beginning at ages 15 to 23 years. Main Outcome Measure(s): Self-reported BMI, physical activity, fast food consumption, breakfast frequency, sugary drink consumption, fruit and vegetable consumption, and screen time. Analysis: Each outcome was modeled as a continuous variable using hierarchical linear regression. Residential mobility—change in residential address—was the main effect of interest. Models adjusted for demographics, marriage during follow-up, and previous level of the outcome. Inverse propensity weights accounted for loss to follow up. Results: No weight-related outcomes differed between movers and nonmovers in the whole sample. When examining effect modification by age, as participants aged, moving was increasingly associated with improvements in weight-related outcomes, particularly BMI. Conclusions and Implications: Results suggest that moving may be associated with poorer weight-related outcomes during a brief window from late teens and early-20s and less associated with weight-related outcomes in the mid-20s and 30s.

between 15e17-years old had stopped gender-affirming medications compared with 10.6% of patients who started GnRHa between 9e14-years, though this difference did not reach statistical significance. Insurance sponsor's rank (family income), birth-assigned sex, and the presence of mood disorders were not associated with cessation rates. Within 2 years of starting GnRHa, 83.2% (95%CI: 70.2 e 94.4%) of patients had started gender-affirming hormones; within 8 years of starting GnRHa, this number increased to 91.6% (95%CI 81.6 e100%). Younger patients had a greater delay in starting gender-affirming hormones. Insurance sponsor's rank, birth-assigned sex, and the presence of mood disorders were not associated with initiation of gender-affirming hormones. Conclusions: Contrary to concerns, GnRHa use did not inevitably lead to use of gender-affirming hormones. One out of twelve TGD adolescents who started GnRHa to address gender dysphoria subsequently stopped treatment. Sources of Support: None. Purpose: StRONG was a multicenter randomized clinical trial of refeeding in hospitalized adolescents and young adults with malnutrition secondary to anorexia nervosa (AN) and atypical anorexia nervosa (AAN) (ClinicalTrials.gov #NCT02488109). At end-of-treatment, higher calorie refeeding (HCR) was more efficacious and less costly than lower calorie refeeding (LCR). Here we compare efficacy of HCR in AAN vs. AN. Methods: Participants were N¼120, 12-24 yr-olds with > 60% median Body Mass Index (%mBMI) and medical instability. AAN was defined as %mBMI >85% at baseline. Meal-based HCR began 2000 calories/day (kcal/d) and advanced 200 kcal/d; LCR began 1400 kcal/d and advanced 200 kcal every other day (no tube feeding). Efficacy was defined as time to restore a 6-point Medical Stability Index (MSI): heart rate (HR) 45 bpm; systolic blood pressure (SBP) 90 mmHg, temperature 35.6 C, orthostatic increase in HR 35 bpm and decrease SBP 20 mmHg, and 75% median BMI (%mBMI). Main outcome was days to restore MSI, compared between groups with unpaired t-test. Exploratory moderator analyses examined the interaction between refeeding treatment and diagnosis on key outcomes (time to recover heart rate and weight gain). Weight gain was defined as change in %mBMI. Results: Modified intention to treat analyses included N¼111. Mean age was 16.5 (2.5) yrs, 43% had AAN. Upon admission, %mBMI was 95.2 (9) in AAN vs. 76.5 (5.9) in AN, p<.001. Upon discharge, %mBMI was 98.3 (8.9) in AAN vs. 82.2 (5.3) in AN, p<.001. MSI was restored fastest in patients with AN refed by HCR [7.1 (5.4) days], whereas medical stability required three additional days to restore in patients with AAN [10.1 (5.3) days, p<0.01]. Diagnosis (AAN or AN) and treatment (HCR or LCR) interacted to weaken the effect of refeeding on HR recovery [B¼3.76 (.572,6.95), p¼0.021] and weight gain [B¼039 (.006,072), p¼0.021], which was 0.3% mBMI per day slower (p¼0.005) and 2.6% mBMI less overall (p¼0.009) in AAN than AN. Conclusions: While HCR is more efficacious than LCR for refeeding in AN, it may contribute to underfeeding in AAN. source) and four family variables (family functioning , parental connection, parental monitoring, and parental psychological control). The outcome, UWCB (e.g. fasting, vomiting, laxative use), was self-reported by young adults eight years later. Logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) of UWCB for four weight stigma predictors and four family predictors. Models were adjusted for sociodemographic characteristics, baseline UWCB, and baseline BMI percentile, and predictors were modeled separately. Results: In analyses adjusted for sociodemographic characteristics, all weight stigma and family variables during adolescence longitudinally predicted significantly higher odds of UWCB eight years later. After additionally adjusting for baseline UWCB and baseline BMI percentile, two weight stigma variables (weight teasing from family [OR: 1.42, 95% CI: 1.08, 1.87] and hurtful weight-related comments from family [OR: 1.34, 95% CI: 1.06, 1.70]) and one family variable (poor family functioning [OR: 1.44, 95% CI: 1.14, 1.81]) remained significantly associated with subsequent UWCB. Conclusions: Findings indicate that there are long-term consequences , across major development periods, of weight teasing from family, hurtful weight-related comments from family, and low family 2022 SAHM Annual Meeting / Journal of Adolescent Health 70 (2022) S1eS32 S11

Background: Much of the research to-date on food parenting has evaluated typical use of various parent feeding practices via questionnaire. The Real-Time Parent Feeding Practices Measurement survey was developed for use within an Ecological Momentary Assessment (EMA) protocol to capture momentary use of parent feeding practices in real-time. Methods: This manuscript describes the development of the EMA-based Real-Time Parent Feeding Practices survey and highlights initial descriptive data on the real-time use of 22 individual parent feeding practices (e.g., pressure-to-eat, guided choices, etc.) as reported via EMA by parents of preschool-aged children (n = 116) over a 10-day data collection time period. A total of 3382 eating occasions were reported, with an average of 29.2 reported eating occasions per participant. Results: Results revealed that most participants used a variety of food-related parenting practices day-to-day that span four higher-order domains: structure, autonomy support, coercive control and indulgence. Supportive feeding practices, defined as those from the structure and autonomy support domains, were reported most frequently, with one or more structure behavior (e.g., specific mealtime rules/routines) was used at 88.9% of reported eating occasions and one or more autonomy support behavior (e.g., involvement of the child in meal preparation) was used at 87.3% of eating occasions. While unsupportive feeding practices, defined as practices from within the coercive control (e.g., pressure-to-eat) and indulgent (e.g., anticipatory catering) feeding domains, were reported less frequently, one or more behaviors from each of these domains were still reported at over 25% of all eating occasions. Conclusions: Results of the current study take a next step towards deepening our understanding of the use of a broad range of food-related parenting practices in real-time. Findings revealed that the vast majority of practices used by parents fall within the structure and autonomy support domains. However, most parents did not exclusively use supportive or unsupportive practices, rather they used a combination of food-related parenting practices across all domains. Future research should continue to explore a broad range of food-related parenting practices and seek to understand how parent approaches to feeding are associated with long-term child outcomes, including dietary intake, food preferences, and eating patterns.

This study aimed to identify patterns of change in muscle-building behaviors from adolescence to emerging adulthood and determine what adolescent factors predict new-onset muscle-building behavior in emerging adulthood. Prospective cohort data from a diverse sample of 1,535 participants followed from adolescence (baseline, Mage = 14.4 ± 2.0 years) to emerging adulthood (follow-up, Mage = 22.1 ± 2.0 years) from the population-based EAT 2010–2018 (Eating and Activity over Time) study were analyzed. Changes in muscle-building behavior were identified (starting, stopping, persistent use, or never use). Log-binomial regression models examined adolescent predictors of starting (i.e., new-onset) muscle-building behaviors in emerging adulthood. Prevalence of any use in adolescence (EAT 2010) and/or emerging adulthood (EAT 2018) was 55.1% (males) and 33.0% (females) for protein powder/shakes, 6.7% (males) and 5.4% (females) for steroids, and 19.4% (males) and 6.5% (females) for other muscle-building substances (e.g., creatine, amino acids). In particular, 22.6% (males) and 13.7% (females) started protein powder/shakes, 2.2% (males) and 1.0% (females) started steroid use, and 9.0% (males) and 2.0% (females) started other muscle-building substances during emerging adulthood. Adolescent protein powder/shake consumption was associated with starting steroids/other muscle-building substances use in emerging adulthood in males (adjusted risk ratio [ARR] 2.09, 95% confidence interval [CI] 1.29–3.39) and females (ARR 4.81, 95% CI 2.01–11.48). Adolescent use of protein powders/shakes may lead to a two- to five-fold higher risk of new use of steroids and other muscle-building products in emerging adulthood. Clinicians, parents, and coaches should assess for use of muscle-building behaviors in adolescents and emerging adults and discourage use of harmful products.

Healthcare professionals may motivate their patients to exercise to lose weight, but it is unknown how weight-focused motivations influence young peoples’ PA trajectories. Purpose To examine if weight-motivated exercise predicts moderate-to-vigorous physical activity (MVPA) from adolescence to adulthood in a population-based sample and if this relationship differs by age and body mass index (BMI). Methods Participants (N = 1,428; 13–18 years at baseline; 48.6% female; 49.0% white) responded to surveys in the 15-year longitudinal study, Project EAT (Eating and Activity in Teens and Young Adults). Weight-motivated exercise was examined as a predictor of MVPA across the life course at five-year intervals using linear regression generalized estimating equations and adjusting for demographics (age modeled continuously), BMI (modeled continuously), weight-related intentions, and prior MVPA. Results Weight-motivated exercise predicted higher subsequent MVPA at five-year intervals among females (B = .57, 95% CI:0.13, 1.00) but not males (B = .31, 95% CI:-.09, .72). The association differed by BMI in females (p = .02); weight-motivated exercise was associated with higher subsequent MVPA at lower BMI but lower subsequent MVPA at higher BMI. The association also differed by age in males (p = .008), such that older males who reported weight-motivated exercise had higher subsequent MVPA, whereas this association was not present in younger males. Conclusion Weight-motivated exercise may have a deleterious influence on MVPA for females with higher BMI and may have an advantageous influence on older males. Understanding how motivations for exercise may influence PA trajectories can inform PA promotion over the life course by providing more nuanced guidance by age, BMI, and sex.

Adverse experiences, such as childhood abuse and other violence victimization, are associated with problematic eating. However, whether different types of adversity relate to both maladaptive and adaptive eating behaviors is unclear. This study examined the associations of different adverse experiences with maladaptive (i.e., overeating and binge eating) and adaptive (i.e., intuitive eating and mindful eating) eating by gender. Data were derived from the EAT-2018 (Eating and Activity over Time) study (N = 1411, aged 18–30 years in 2017–2018). Modified Poisson regressions were used to examine the associations between adverse experiences and the prevalence of maladaptive eating. Linear regressions were used to examine the associations between adverse experiences and adaptive eating scores. Each adverse experience was associated with greater prevalence of maladaptive eating and lower adaptive eating scores. Among women, intimate partner sexual violence was strongly associated with more overeating (PR = 2.1 [95% CI = 1.4–3.1]) and binge eating (PR = 2.4 [95% CI = 1.5–3.9]), and less mindful eating (β = −0.6, [95% CI = −0.8, −0.3]); being attacked, beaten, or mugged was most associated with less intuitive eating (β = −0.5, [95% CI = −0.8, −0.2]). Among men, being attacked, beaten, or mugged was strongly associated with more overeating (PR = 2.1 [95% CI = 1.2–3.5]) and binge eating (PR = 3.2 [95% CI = 1.6–6.5]); intimate partner physical violence was strongly associated with less intuitive eating (β = −0.6, [95% CI = −0.9, −0.2]); childhood emotional abuse was strongly associated with less mindful eating (β = −0.8, [95% CI = −1.0, −0.5]). To improve eating behaviors, adverse life experiences and the potential impact on maladaptive and adaptive eating should be considered.