A B S T R A C T PurposeSurvivors of Hodgkin lymphoma (HL) are at increased risk of treatment-related cardiovascular (CV) events; whether exercise modifies this risk is unknown. MethodsSurvivors of HL (n ϭ 1,187; median age, 31.2 years) completed a questionnaire evaluating vigorous-intensity exercise behavior. CV events were collected in follow-up questionnaires and graded according to Common Terminology Criteria for Adverse Events (version 4.03). The primary end point was incidence of any major (grade 3 to 5) CV event. Poisson regression analyses were used to estimate the association between exercise exposure (metabolic equivalent [MET] hours/week Ϫ1 ) and risk of major CV events after adjustment for clinical covariates and cancer treatment. ResultsMedian follow-up was 11.9 years (range, 1.7 to 14.3 years). Cumulative incidence of any CV event was 12.2% at 10 years for survivors reporting 0 MET hours/week Ϫ1 compared with 5.2% for those reporting Ն 9 MET hours/week Ϫ1 . In multivariable analyses, the incidence of any CV event decreased across increasing MET categories (P trend ϭ .002). Compared with survivors reporting 0 MET hours/week Ϫ1 , the adjusted rate ratio for any CV event was 0.87 (95% CI, 0.56 to 1.34) for 3 to 6 MET hours/week Ϫ1 , 0.45 (95% CI, 0.26 to 0.80) for 9 to 12 MET hours/week Ϫ1 , and 0.47 (95% CI, 0.23 to 0.95) for 15 to 21 MET hours/week Ϫ1 . Adherence to national vigorous intensity exercise guidelines (ie, Ն 9 MET hours/week Ϫ1 ) was associated with a 51% reduction in the risk of any CV event in comparison with not meeting the guidelines (P ϭ .002). ConclusionVigorous exercise was associated with a lower risk of CV events in a dose-dependent manner independent of CV risk profile and treatment in survivors of HL.

Weight management after breast cancer (BC) treatment in African American (AA) women is crucial to reduce comorbid conditions and health disparities. We examined feasibility and potential efficacy of commercial eHealth/mHealth tools for weight management in AA BC survivors in New Jersey. Participants (N = 35) were randomized to an intervention (SparkPeople) plus activity tracker, Fitbit Charge (n = 18), or wait-list active control group (Fitbit only, n = 17). Anthropometric, behavioral, and quality of life (QOL) outcomes were collected at baseline, 3, 6, and 12 months. Differences in outcomes were assessed using intent-to-treat analysis. Retention was 97.1%. Both groups lost weight, with no significant differences between groups. At month 6, mean weight change was: intervention: −1.71 kg (SD 2.33; p = .006), 33.3% lost ≥3% of baseline weight; control: −2.54 kg (SD 4.00, p = .002), 23.5% lost ≥3% weight. Intervention participants achieved significant improvements in waist circumference (−3.56 cm, SD 4.70, p = .005), QOL (p = .030), and use of strategies for healthy eating (p = .025) and decreasing calories (p < .001). Number of days logged food per week was associated with decreases in waist circumference at 6 months (β −0.79, 95% CI, −1.49, −0.09, p = .030) and 12 months (β −2.16, 95% CI, −4.17, −0.15, p = .038). Weight loss was maintained at 12 months. This is the first study to demonstrate potential efficacy of commercial eHealth/mHealth tools for weight loss in AA BC survivors, without additional counseling from the research team. If effective, they may be convenient weight loss tools that can be easily and widely disseminated. Clinical Trials registration: ClinicalTrials.gov NCT02699983

A developmentally-oriented bio-neuropsychosocial model is introduced to explain variation in family functioning and psychosocial adjustment in youth and young adults with spina bifida (SB). Research on the family functioning and psychosocial adjustment of individuals with SB is reviewed. The findings of past research on families of youth with SB support a resiliencedisruption view of family functioning. That is, the presence of a child with SB disrupts normative family functioning, but many families adapt to such disruption and exhibit considerable resilience in the face of adversity. Parents of youth with SB, and particularly those from lower SES homes, are at-risk for psychosocial difficulties. Individuals with SB are at-risk for developing internalizing symptoms, attention problems, educational difficulties, social maladjustment, and delays in the development of independent functioning. Emerging adults are often delayed in achieving milestones related to this stage of development (e.g., vocational and educational achievements). Methodologically-sound, longitudinal, and theory-driven studies of family and psychosocial functioning are needed, as are randomized family-based intervention trials, to promote adaptive functioning and better psychosocial outcomes in families of individuals with SB. Keywords spina bifida; psychosocial adjustment; family; children; adolescents; emerging adults Psychosocial and Family Functioning in Spina BifidaSpina bifida (SB) is a relatively common congenital birth defect that has a pervasive multisystemic impact on the physical, neurocognitive, psychological, and social functioning of affected individuals. Historically, most of the research on SB has focused on the physical and neurocognitive domains, with less attention paid to the psychological and social domains of functioning. However, it is well known that the clinical symptoms of SB place considerable physical, psychological, and social demands on the individuals and families involved Holmbeck et al., 2003;Kelly et al., 2008;Singh 2003]. Specifically, all of the following SB-related stressors likely have a significant and cumulative impact on individual and family functioning: (1) the cognitive and neurological features of SB, particularly the most common type of spinal lesion, myelomeningocele (e.g., executive functioning deficits, attention problems, learning difficulties; see Dennis and Barnes, in press), (2) the effects of SB on physical development [e.g., precocious puberty, short stature, and obesity are all more common in this population than in the general population; Dosa et al., 2009], (3) the multiple surgical procedures experienced by most individuals in this population (e.g., shunt revisions, orthopedic surgeries), (4) the difficulties with bowel and bladder management as well as ambulation challenges, (5) the characteristic

This narrative review describes the evidence regarding digital health interventions targeting adolescent and young adult (AYA) cancer survivors. We reviewed the published literature for studies involving Internet, mHealth, social media, telehealth, and other digital interventions for AYA survivors. We highlight selected studies to illustrate the state of the research in this unique patient population. Interventions have used various digital modalities to improve health behaviors (eg, physical activity, nutrition, tobacco cessation), enhance emotional well-being, track and intervene on cancer-related symptoms, and improve survivorship care delivery. The majority of studies have demonstrated feasibility and acceptability of digital health interventions for AYA survivors, but few efficacy studies have been conducted. Digital health interventions are promising to address unmet psychosocial and health information needs of AYA survivors. Researchers should use rigorous development and evaluation methods to demonstrate the efficacy of these approaches to improve health outcomes for AYA survivors.

Recommendations for future research are provided, including suggestions for the construction and use of measures to inform treatment research.

Barriers to adherence are essential to address in an effort to ameliorate adherence difficulties and potentially reduce the incidence of medical complications.

A recent special issue of the Journal of Pediatric Psychology included papers focused on evidence-based assessment across several broad domains of assessment in pediatric psychology (e.g., adherence, pediatric pain, and quality of life). In one of these papers, Holmbeck et al. ( 2008) reviewed strengths and limitations of existing measures of psychosocial adjustment and psychopathology, concluding that many measures lacked supporting psychometric data (e.g., basic indices of reliability and validity) that would permit a complete evaluation of these measures. Given that measure development and validation papers are frequently published in JPP (Brown, 2007), it is important that we attend to guiding psychometric principles when developing and disseminating data on new measures to be employed with pediatric populations (Nunnally & Bernstein, 1994). Thus, the purpose of this paper is to present and describe a checklist for authors to use when submitting measure development papers to JPP. This checklist is included in the Appendix and is also included at the following link on the JPP website:

Interventions targeting executive function, intrinsic motivation, and parenting behavior may facilitate achievement of emerging adulthood milestones.