New information was identified that can be used to address access barriers and to offer AYA psychosocial programs in formats that might improve interest and accessibility. Ongoing evaluation of AYA psychosocial programs is recommended to determine acceptability, feasibility, and effectiveness to meet the evolving needs of AYA patients with cancer.

Objective: To examine effects of stress on caregiver psychological adjustment during the first year of pediatric cancer. Method: Caregivers (N = 159) of children with cancer completed monthly questionnaires assessing domains of caregiver psychological adjustment (depression, anxiety, and posttraumatic stress symptoms) and stress (general life stress, treatment-related stress, caregiver perceptions of treatment intensity and life threat). Effects of stress were assessed at two levels to examine whether withinperson changes in stress predicted concurrent changes in caregiver adjustment and whether average stress was associated with between-person differences in caregiver adjustment trajectories. Results: Overall, higher levels of stress factors were associated with poorer caregiver adjustment at both the between-and within-person levels, with high average levels of treatment-related stress and general life stress emerging as leading predictors of worse adjustment. Conclusions: Both types of stressors, those directly related as well as unrelated to a child's cancer, contribute uniquely to caregiver distress. Caregiver distress is impacted by both overall levels of stress over time as well as month-to-month changes in stress. Implications for informing care for at-risk caregivers are discussed.

Emotion regulation (ER) is an important factor in resilience and overall well-being throughout development, and youth report increased variation in emotion and capacity for regulation across adolescence and early adulthood. Specific emotions may be associated with the use of different ER strategies, but much evidence exclusively collapses across negative and positive affect or may not reflect the daily experience of emotion and emotion regulation. The present study examined associations between the experience of unique positive and negative emotions and the use of common ER strategies in adolescence and early adulthood during daily life using ecological momentary assessment (EMA). The sample included 184 high school and college students (55% female, M age = 17.88, SD = 1.25) who completed EMA surveys three times daily for 10 days (89% compliance). Participants reported on their recent emotional states and which of eight ER strategies they had used. Multilevel logistic regressions tested emotions as predictors of ER strategies, separately for each emotion-ER strategy combination across 96 total models, using the Benjamini-Hochberg procedure to control the false discovery rate. Individuals had higher odds of engaging in maladaptive ER strategies, particularly suppression or rumination, when reporting most types of negative emotions-with the largest associations among unhappiness and anger. Conversely, positive emotions were generally linked to reported use of no ER strategies, though happiness and engagement were related to higher odds of problem-solving, while calm was related to less use of nearly all strategies. Specific emotion-strategy combinations may have implications for clinical targets.

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Objective: Previous work has examined family income and material hardship in pediatric cancer. However, few studies have focused on perceived financial strain (PFS), or the extent to which caregivers perceive financial stress and worry related to their child's cancer. The current study addresses this gap by a) describing the trajectory of perceived financial strain over the first year of pediatric cancer treatment; b) examining sociodemographic predictors of that trajectory; and c) examining associations between PFS and caregiver and child psychological adjustment. Method: Primary caregivers of children (M age = 6.31) recently diagnosed with cancer provided 12 monthly reports of their own perceived financial strain and depression, anxiety, and posttraumatic stress symptoms, as well as their child's internalizing and externalizing symptoms. Data were analyzed using multilevel models. Results: Caregiver PFS decreased over the first year of treatment. Nonmarried caregivers and those with lower income reported higher levels of PFS over time. Caregivers with higher PFS relative to other caregivers and relative to their own average PFS in a given month experienced psychological maladjustment. PFS was not associated with child adjustment. Conclusions: On average caregivers perceive less financial strain over the first year of treatment; however, nonmarried caregivers and those with lower income are at risk for higher PFS over time, and PFS may contribute to psychological maladjustment in caregivers. Caregivers may benefit from psychosocial support focused on managing financial strain.