Psychosocial well-being relates to lower cardiovascular risk, and a healthy lifestyle may contribute to this association. Prior research has focused on aging adults, although health behaviors are usually consolidated in early adulthood. This longitudinal study assessed the association between two psychosocial well-being indicators and subsequent healthy lifestyles in young adults. Participants (n = 799; agemean = 30.6 years) in the Nicotine Dependence in Teens Study completed items to derive the emotional vitality score, a flourishing scale, and covariates in 2017–2020. Data on selected outcomes (i.e., smoking, sleep, physical activity, alcohol intake, diet quality), collected in 2017–2020 and 2020–2021, were combined into a lifestyle score used categorically (≥ 4 healthy behaviors) and continuously (0–5 scores). Associations between psychosocial well-being indicators and lifestyle up to 4 years later were modeled using logistic and linear regressions. In model 3 adjusting for sociodemographic, health-related, and depression covariates, higher likelihood of a healthy lifestyle (≥ 4 healthy behaviors) was observed with flourishing (OR = 1.56, 95

OBJECTIVE:Fifteen percent of Canadian children are exposed to household second-hand smoke. The Clinical Effort Against Secondhand Smoke (CEASE) intervention systematically screens parents for tobacco use in pediatric care settings and facilitates access to evidence-based cessation services. This single-blind pilot randomized controlled trial (RCT) compared CanCEASE (an adaptation of CEASE for adolescents and e-cigarette users) to usual care. METHODS:Parents of children ages 0 to 17 years and adolescents ages 14 to 17 years were eligible if they reported smoking or using e-cigarettes in the past 7 days. Use behaviors were evaluated at baseline and at 1, 3, and 6 months post baseline. While feasibility outcomes are reported elsewhere, we describe exploratory effectiveness outcomes, including self-reported 7-day point prevalence abstinence, quit attempts, and intensity of cigarette and e-cigarette use. RESULTS:Sixty-seven parents and 45 adolescents were included. At the end of the 6-month follow-up period, parents in the intervention group were more likely to have quit vaping or smoking over the study period (RD (risk difference) = 23% [95%CI 3.2-43]) or reduce cigarette or e-cigarette use (RD = 35% [95%CI 3.8-66]) compared to controls. Smoking or vaping quit rates among adolescents were similar in the intervention and control groups. CONCLUSIONS:In this pilot study, CanCEASE showed promising effects on parent smoking and vaping behavior. Larger trials are needed to evaluate effectiveness in broader clinical settings and among adolescents.

Tobacco use is a strong risk factor for premature mortality and morbidity. We assessed the feasibility of screening and recruiting participants for a randomized controlled trial (RCT) of a facilitated referral intervention to promote smoking and vaping cessation among parents and children (CanCEASE). We conducted a pilot RCT of CanCEASE in five outpatient pediatric clinics in Montreal, Canada. We recruited parents (≥ 18 years) and adolescents (14–17 years) who reported smoking or vaping in the 7 days prior to recruitment. Our primary outcome was the number of participants recruited and randomized per day of recruitment (> 0.6/day). Secondary outcomes included interest in cessation resources (binary, at least one resource requested by the end of participation at 6 months) and participant retention (≥ 60

BACKGROUND:While individual movement behaviours (i.e., physical activity (PA), sedentary behaviour (SB), and sleep) are linked to anxiety, the effect of adhering to integrated 24-h movement recommendations remains unclear. This study estimated the causal effect of meeting the Canadian 24-Hour Movement Guidelines on generalized anxiety symptoms among young adults. METHODS:Data were drawn from 692 participants (mean age 34; 58% female) from a Canadian longitudinal observational study. Participants self-reported PA, SB, sleep, and completed the Generalized Anxiety Disorder-7 (GAD-7) scale (score range: 0-21). Guidelines were defined as: ≥150 min/week of moderate-to-vigorous PA; ≤7 h/day of self-reported sitting time including ≤3 h/day of leisure screen time; and 7-9 h of sleep/night. The target trial framework was used to emulate four hypothetical trials, and targeted maximum likelihood estimation was used to evaluate the effect of meeting PA, SB, sleep, and all three recommendations, on GAD-7 scores after 1.5 years of follow-up. RESULTS:Meeting the SB recommendation reduced GAD-7 scores by 0.73 points (95% confidence interval: -1.41, -0.05). In contrast, meeting the PA recommendation resulted in a change in GAD-7 scores very close to zero with wide 95% confidence intervals, while meeting the sleep recommendation and all three recommendations did not demonstrate a statistically significant change. CONCLUSION:The observed small decrease in GAD-7 scores associated with meeting the SB recommendation is meaningful at a population level. These findings may help refocus Canada's 24-Hour Movement Guidelines to inform population-level strategies to address anxiety in young adults.

Young adulthood is a key period for establishing long-term health behaviours, yet it is often marked by poor diet, which may lead to weight gain. In 304 participants from the Nicotine Dependence in Teens cohort study, followed from a mean age of 24.0 (2010-2012) to 30.6 (2017-2018), higher baseline diet quality was associated with minimal weight change over follow-up in females and males. Among females only with overweight or obesity, modest weight reductions were suggested-estimates were uncertain, as reflected by wide confidence intervals. These findings suggest that higher diet quality may be associated with more favourable weight trajectories and highlight the need for larger, sex-specific studies.

Introduction:Adolescence is a period of heightened emotional reactivity and vulnerability to mental health problems, during which well-being plays a central role in psychological adjustment. Beyond reflecting immediate experiences, momentary well-being has been linked to long-term outcomes such as depression and substance use. While social and geographic contexts are recognized determinants of adolescents' mental health, their influence on momentary well-being remains unclear. We aimed to investigate these associations in a sample of French adolescents using real-time assessments. Methods:Participants were adolescents from the EXIST cohort, who agreed to participate in the Geographically-explicit Ecological Momentary Assessment (GEMA) sub-study. Over 10 days, participants received two SMS prompts daily linked to a short questionnaire. Geolocation was recorded at each questionnaire completion. We used mixed-effects linear regression models to assess the associations between momentary contextual factors and well-being. Results:A total of 122 adolescents provided 1236 observations. The median age was 13.4 years (IQR: 13.3-13.6). Being with friends or family was associated with higher momentary well-being compared to being alone (adjusted Beta (95%CI) = 3.5 (1.1-5.9), and 3.0 (1.6-4.5), respectively). There was a trend suggestive of an association between momentary well-being and exposure to green space, as measured by the average NDVI (Normalized Difference Vegetation Index) within a 100m radius. Girls and gender-diverse adolescents reported significantly lower levels of momentary well-being than boys. Conclusion:Immediate social context emerged as one of the strongest correlates of adolescents' momentary well-being. Our findings suggest that supportive social relationships are closely associated with higher momentary well-being among adolescents. They also highlight the potential of GEMA for investigating contextual correlates of well-being and for informing future research on context-sensitive approaches to mental health promotion.

Causal variable selection in time-varying treatment settings is challenging due to evolving confounding effects. Existing methods mainly focus on time-fixed exposures and are not directly applicable to time-varying scenarios. We propose a novel two-step procedure for variable selection when modeling the treatment probability at each time point. We first introduce a novel approach to longitudinal confounder selection using a Longitudinal Outcome Adaptive LASSO (LOAL) that will data-adaptively select covariates with theoretical justification of variance reduction of the estimator of the causal effect. We then propose an Adaptive Fused LASSO that can collapse treatment model parameters over time points with the goal of simplifying the models in order to improve the efficiency of the estimator while minimizing model misspecification bias compared with naive pooled logistic regression models. Our simulation studies highlight the need for and usefulness of the proposed approach in practice. We implemented our method on data from the Nicotine Dependence in Teens study to estimate the effect of the timing of alcohol initiation during adolescence on depressive symptoms in early adulthood.

PURPOSE:This study identified profiles of health-related behaviors in adolescents (age 12-17 years), described transitions in profiles over time, and identified sociodemographic factors associated with profiles and transitions in profiles. METHODS:Data for 775 adolescents (50.6% female) were drawn from the ongoing NDIT (Nicotine Dependence In Teens) study. Self-report data on physical activity, team sport participation, sedentary behavior, cigarette smoking, and alcohol consumption collected in grades 7 (ages 12-13 years), 9 (ages 14-15 years), and 11 (ages 16-17 years) were clustered into profiles using latent transition analysis. Multinomial logistic regression models were used to identify sociodemographic factors associated with profiles and transitions in profiles over time. RESULTS:Five profiles (labeled herein according to the predominant behavior) were identified in grade 7: 1) "cigarette smoking" (n = 33, 4.3%); 2) "physically active" (n = 480, 61.9% of 775 participants); 3) "relatively inactive and sedentary" (n = 125, 16.1%); 4) "alcohol consumption" (n = 25, 3.2%); and 5) "inactive but not sedentary" (n = 112, 14.5%). From grades 7 to 11, the proportion of participants decreased in the "physically active" profile from 61.9% to 23.1%, and increased from 4.3% to 14.7% in the cigarette smoking profile, and from 3.2% to 23.2% in the alcohol consumption profile. Sex, age, parental education, and school location were associated with profiles and transitions in profiles. DISCUSSION:Adolescents' health behavior profiles changed significantly from 12 to 17, with a shift from physical activity to smoking and alcohol use. Sociodemographic factors influenced both profiles and their transitions, highlighting the need for early, targeted interventions to support sustained healthy behaviors during adolescence.

Introduction: The Generalized Anxiety Disorder-7 Scale (GAD-7) is widely used to measure anxiety symptom severity. One-factor, two-factor, and bifactor latent structures are supported by previous research. Yet, measurement invariance of the GAD-7 across sex and language (i.e., between groups) and longitudinally (i.e., within group over time) is infrequently studied in population-based samples. The objective was to examine the factor structure of the GAD-7 and its measurement invariance across sex, language, and time in young adults. Methods: Data were drawn from an ongoing longitudinal investigation in Canada that began in 1999-2000 at age 12. One-factor, two-factor, and bifactor (S-1) models were compared in a sample of 799 participants at age 30. Measurement invariance was tested using multigroup confirmatory factor analyses iteratively in four steps (i.e., configural, thresholds, thresholds and loadings/strong) across sex (male; female) and language of questionnaire completion (English; French). Invariance across time was tested among 633 participants with data at ages 30, 34 and 35. Results: A one-factor model showed the best fit. Partial strong invariance across sex and full strong invariance across language of the one-factor model was demonstrated. Strong invariance across time was also demonstrated, indicating stability in parameters over time for the same participants ages 30 to 35. Limitations: The results are restricted to young adults and may not generalize to wider age ranges. Participants are predominantly born in Canada and report high levels of education and employment. Conclusion: The one-factor structure of the GAD-7 demonstrated measurement invariance across sex, language, and time in young adults.

Objective: Growing evidence suggests that higher levels of psychological well-being indicators (e.g., emotional vitality, positive mental health) are related to lower cardiometabolic risk. Healthy lifestyle habits (e.g., physical activity) may underpin this association. However, most studies evaluating the association between psychological well-being indicators and lifestyle habits are cross-sectional, precluding temporal sequence of events. Moreover, although such habits are typically established in early adulthood, prior research has been undertaken mainly in midlife or older adults. Finally, past studies usually consider habits separately despite their tendency to cluster and have interactive effects on long-term health. The current study assessed the longitudinal association of emotional vitality and positive mental health with the likelihood of adopting an overall healthy lifestyle among young adults in Canada. Methods: Participants (N=799) from the Nicotine Dependence in Teens Study completed items to derive the emotional vitality score in 2011-12 (mean age: 24.1 years) and a validated positive mental health scale in 2017-20 (mean age: 30.6 years). Data on smoking, sleep, physical activity, alcohol intake, and diet quality were collected in 2011-12, 2017-20, and 2020-21 (mean age: 33.6 years) and used to create a composite lifestyle score. The associations of interest were modeled using logistic regressions adjusting first for baseline sociodemographic factors, health status (e.g., BMI), and depression (Model 1), and then including baseline lifestyle (Model 2). Effect modification by sex was examined. Results: In Model 1, a 1-standard deviation increase in emotional vitality (OR=1.28, 95%CI=1.06-1.54) and positive mental health (OR=1.31, 95%CI: 1.02-1.68) was related to a greater likelihood of a healthy lifestyle 4-10 years later. In Model 2, the findings were robust for positive mental health but the confidence intervals for emotional vitality included the null. Sex did not modify these associations. When considering habits separately, emotional vitality and positive mental health were both related to healthy diets and sleep, but not with the other habits. Conclusions: Both emotional vitality and positive mental health may have beneficial effects on lifestyle. They should be considered when developing primordial prevention strategies that aim to promote healthy lifestyles in young adults, to contribute to cardiometabolic health over the life course.

Stress-related coping is an important mechanism of mental health functioning. However, the distribution of coping processes across various factors (e.g., individual like sex, contextual like perceived social status) remain under-explored. This study identified individual, intergenerational, and contextual factors associated with coping strategies, variability in their use (as a proxy for using strategies flexibly across contexts), and perceived coping efficacy to handle stressors among young adults. Participants from the Nicotine Dependence in Teens study (NDIT; N = 827) completed the validated Coping Inventory for Stressful Situations scale in 2011–12 (age 24). Data on many factors, including race/ethnicity, intergenerational education patterns, and perceived social status, were collected from 1999–2000 (at NDIT inception; age 12–13) to 2011–12. Linear and multinominal regressions modeled the associations between individual, intergenerational, and contextual factors and coping strategies, variability, and efficacy, separately. Women versus men reported more frequent use of emotion-, distraction-, and social diversion-oriented strategies and higher variability levels (e.g., Bemotion=0.40, 95

Harm reduction strategies encourage people who use cannabis to adopt lower-risk behaviors, such as refraining from daily or intensive use or limiting simultaneous use with other psychoactive substances. However, little is known about the characteristics of people who use cannabis but are at lower risk of cannabis use disorder (CUD). This study identified sociodemographic, lifestyle, and mental health factors associated with lower-risk cannabis use among adults in their mid-thirties. Cross-sectional data from 731 adults in the Nicotine Dependence in Teens study were analyzed from the 2022–2023 data collection. Risk of CUD was assessed with the Cannabis Abuse Screening Test (CAST). Sociodemographic, mental health, lifestyle factors, and patterns of cannabis use were compared across participants who did not use cannabis, those with lower-risk cannabis use, and those at higher risk of CUD using cross-tabulations. Among participants who used cannabis, log-binomial regression models adjusted for age, sex, and education were fitted to identify factors associated with lower-risk cannabis use. Of 731 participants (mean [SD] age = 35.3 [0.6] years; 58

This systematic review was conducted to identify effect modification and interaction factors that moderate the association between socioeconomic status (SES) and smoking behavior among adolescents. We searched the PubMed, Embase, PsycINFO, and Web of Science databases using keywords including "adolescents," "smoking," "inequality," "effect modification," and "interaction." Peer-reviewed articles published in English or French between January 1, 2011, and December 31, 2021, were included, as were relevant studies identified from reference lists. Of 3485 articles, 23 met the eligibility criteria. All reported quantitative observational study designs to identify factors that modify the SES-smoking behavior association. Two independent reviewers extracted data from each article, using a standardized form. Reporting quality was assessed using the Strengthening the Reporting of Observational Articles in Epidemiology guidelines. Of 23 studies, 13 reported statistically significant moderation associations. The most frequently studied moderators were race/ethnicity (n = 5; significant in 4) and sex (n = 5; no significant associations). Contextual factors, including school-level SES (n = 2; significant in 1), neighborhood SES (n = 2; significant in both), and peer influence (n = 2; significant in both), were also examined. Time trends (n = 2), country-level factors (n = 2), and social capital (n = 1) were significant moderators in the few studies that investigated them. Methodologically, adherence to best practices was limited. This review highlights the need for use of a wider range of SES measures, exploration of understudied potential moderators, and consistent adherence to standardized methodologies to better inform public health interventions addressing adolescent smoking inequalities.

OBJECTIVE:To identify sociodemographic, lifestyle, and psychological correlates of flourishing mental health (i.e., feeling good and functioning well) in a population-based sample of young adults. METHOD:Data for this cross-sectional study were drawn from the ongoing Nicotine Dependance in Teens study, Québec, Canada. Of 799 participants in cycle 23, 792 (mean (SD) age = 30.6 (1.0) years) provided data on positive mental health using the Mental Health Continuum - Short Form (MHC-SF) and were retained for analysis. Each potential correlate was studied in an unadjusted model, a model adjusted for age and sex, and a model adjusted for age, sex and other covariates related to the specific correlate of interest. RESULTS:Of 792 participants retained for analysis, 39.4% (39.9% of females; 38.8% of males) reported flourishing mental health. Variables associated with higher odds of flourishing included attended university (OR: 1.44 [1.05, 1.99]), being in a relationship (OR: 1.64 [1.22, 2.21], being employed (OR: 1.97 [1.27, 3.11]), high sleep quality (OR: 3.45 [2.53, 4.73]), meeting leisure screen time guidelines (OR: 2.12 [1.59, 2.85]), and relatively high levels of coping ability (OR: 3.11 [2.58, 3.80]). Variables associated with lower odds of flourishing included living alone (OR: 0.58 [0.38, 0.86]), relatively low household income (OR: 0.37 [0.20, 0.64]), and high depressive (OR: 0.05 [0.01, 0.15]) and anxiety (0.17 [0.09, 0.29]) symptoms. CONCLUSIONS:Sociodemographic (education, relationship status, employment status, and income), lifestyle (sleep, screen time), and psychological (coping ability, depressive and anxiety symptoms) factors are correlates of flourishing mental health in this population-based sample of young adults. Results provide a foundation for future research to inform the development of effective programs targeting specific subgroups to promote positive mental health in young adults.

To describe mental health indicators according to regular (i.e., weekly or daily) alcohol, cannabis, and/or nicotine use in a population-based sample of young adults. Data for 733 participants (mean age = 30.6 years) were drawn from cycle 23 of the ongoing Nicotine Dependence In Teens study, Montreal, Canada. The associations between (i) number of substances used and (ii) pattern of polysubstance use and each of depressive symptoms, anxiety symptoms, and positive mental health (PMH) were modeled using multivariable linear regression adjusting for age, sex, and education. Median (IQR) scores for depressive symptoms (range 0–50), anxiety symptoms (range 0–21), and PMH (range 0–70) were 8.0 (7.0), 4.0 (6.0), and 43.0 (18.0), respectively. One third (37 β [95

Genome-wide association studies (GWAS) in adults have identified single nucleotide polymorphisms (SNPs) associated with systolic blood pressure (SBP), but it is unclear whether the findings apply in youth. Further, the role of body mass index (BMI) in these associations is understudied. Our objective was to determine whether BMI modifies genetic susceptibility to high SBP in young people. The sample comprised 714 participants of European ancestry recruited in 1999–2000 from 10 Montreal-area high schools for a longitudinal study. SBP was measured at ages 12, 15, 17, 24, and 30. Blood and saliva samples were collected at ages 14, 20, and 25. Two evidence-based genetic risk scores (GRS) were constructed based on GWAS results in adults: GRS22 used 22 SNPs and GRS182 added 160 additional SNPs to GRS22. Sex-specific associations between each GRS and repeated measures of SBP were estimated using linear mixed models including BMI and a GRS*BMI product term. GRS182 explained a greater proportion of SBP variance than GRS22, and a greater proportion in females than males. The associations increased monotonically with BMI values between 22 kg/m2 and 35 kg/m2. Results indicate that BMI modifies the association between a GRS and SBP levels from adolescence to adulthood.

PURPOSE: There is growing interest in ecological momentary interventions to promote and improve mental health in youth. However, the lack of validated measurement tools for ecological momentary assessment may hinder implementation and evaluation of such interventions. This study aimed to provide an initial validation of the English version of the Ecological Momentary Well-being Instrument (EMoWI), which was designed for momentary measurement of adolescent well-being. METHODS: Both Classical Test Theory and Item Response Theory were used to assess dimensionality, reliability, and validity of the scale, as part of a cross-sectional approach, in a sample of 2,504 Canadian English-speaking adolescents from the COMPASS study. Examination of differential item functioning (DIF) was conducted on both gender and nationality, by combining the current sample with the sample of French adolescents used in the French version validation study. RESULTS: Confirmatory factor analysis supported a single factor hypothesis. Internal consistency was high and item fit statistics were satisfactory. Correlations with existing scales were consistent with pre-set hypotheses. We observed a significant overlap between respondents’ abilities and item difficulties, suggesting the EMoWI items adequately measure people’s level of well-being. DIF was statistically significant, yet negligible in effect size, for several items, thus allowing the use of score comparisons across genders and countries. CONCLUSION: The EMoWI seems to be a promising candidate to measure momentary well-being in English-speaking adolescents. Subject to further psychometric validation in a momentary context, its use could inform the design and evaluation of ecological momentary interventions in the field of youth mental health in international studies.

Objectives With the growing interest in Ecological Momentary Assessment (EMA) in mental health research, the need for precise and reliable measurement tools has become a pressing issue. However, few candidate instruments have been validated in intensive longitudinal data collection contexts. The present study provides an example of the psychometric validation of measurement instruments designed for EMA, by assessing the psychometric properties of Ecological Momentary Well-being Instrument (EMoWI), the first scale specifically designed to measure momentary well-being. Study Design and Setting Participants from the COvid-19 HEalth and Social InteractiOn in Neighborhoods (COHESION) cohort, a general population sample of Canadian adults, who participated in the September 2022 EMA wave, were included. Prompts including the 8 EMoWI items were sent to participants three times a day, over 10 consecutive days. Based on recent recommendations, we combined Classical Test and Item Response theories to assess content, structural, and construct validity, as well as reliability of EMoWI in an intensive longitudinal data collection context. Results Two Hundred Ninety adults aged between 19 and 80 were included, representing a total of 7974 prompts over 10 days. Variance decomposition analysis confirmed significant variability in momentary well-being at both the participant and day levels. Multilevel confirmatory factor analysis supported a single factor hypothesis (root mean square error of approximation = 0.074). Internal consistency was high, both at the within- and between-variance level (MacDonald's ω = 0.814 and 0.938, respectively) and we demonstrated longitudinal measurement invariance over time. Variations in mean momentary well-being across subgroups were consistent with our predefined hypotheses, supporting construct validity of EMoWI. Conclusion We demonstrated the validity and reliability of EMoWI to measure momentary well-being in intensive longitudinal studies. These results will enhance the accuracy of findings related to well-being in EMA studies and inform the development of evidence-based mental health ecological momentary interventions.

BACKGROUND:While excess body fatness in older adulthood has been linked to ovarian cancer, the influence of changes in body fatness over time is unclear. This study examined the association between adulthood trajectories of body mass index (BMI), a proxy for body fatness, and ovarian cancer. METHODS:In a population-based case-control study (440 cases, 820 controls), we used a group-based trajectory approach to identify BMI trajectories from age 20-70. Using unconditional logistic regression, we estimated adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) for the associations between the estimated trajectories and ovarian cancer. RESULTS:We identified three distinct BMI trajectories: a normal-stable trajectory, a normal-to-overweight trajectory and an overweight-to-obese trajectory, which included 63.2 %, 31.0 % and 6.8 % of the population, respectively. Multivariable aORs suggested that participants with normal weight at the onset of adulthood who became overweight over their adulthood time did not differ in their risk of ovarian cancer compared to those who maintained a normal weight throughout adulthood (aOR (95 %CI): 0.89 (0.69-1.16)). Among those in the overweight-to-obese trajectory, the aOR (95 %CI) was 1.45 (0.87-2.43), and thus in the direction of an increased ovarian cancer risk compared to those who maintained a normal weight. CONCLUSION:Our findings underscore the need for further research to clarify the role of body fatness across the lifetime in the etiology of ovarian cancer.

Objective: To describe the natural course of exergaming among young adults and identify predictors of sustained exergaming.Methods: To describe the natural course, we retained 592 participants from an ongoing longitudinal study with complete data on exergaming at four time points over 12-13 years between 2010-12 and 2023 (i.e., T1-T4 at mean ages 24.0, 30.6, 33.6, and 35.2, respectively). To identify predictors of sustained exergaming, we retained 228 participants with data on 27 potential predictors at T2 and data on exergaming at T2 and T3. The association between each potential predictor and sustained exergaming was examined as an independent study using multivariable logistic regression controlling for age, sex, and educational attainment.Results: Of 592 participants, 41.3%, 34.1%, and 38.5% sustained exergaming from T1 to T2, from T2 to T3, and from T3 to T4, respectively. Only 3% of participants sustained exergaming from T1 to T4. Most participants reported light- or moderate-intensity exergaming at all time points. Higher levels of external pressure to engage in physical activity, encouragement from close friends to exercise, and taking breaks from sitting during a typical workday were each associated with lower odds of sustained exergaming.Conclusion: Although exergaming is a popular activity among young adults, long-term sustained exergaming was rare. This may link to time constraints related to life transitions, evolving interests, changes in social circles, and shifting fitness goals among young adults. Research is needed to inform strategies that promote sustained exergaming and maximize its potential for positive impact among young adults.