Numerate people tend to make more informed judgments and decisions because they are more risk literate (i.e., better able to evaluate and understand risk). Do numeracy skills also help people understand regular science reporting from mainstream news sources? To address this question, we investigated responses to regular science reports (e.g., excerpts from CNN Health), testing a cognitive model linking numeracy, scientific reasoning, judgment biases, and causal theory errors (i.e., interpreting correlational information as causal). In Study 1 (n = 200), structural equation modeling indicated that more numerate people were less likely to exhibit judgment biases because they were better at scientific reasoning, which helped them avoid causal misinterpretations. Study 2 (n = 342) cross-validated findings from Study 1, indicating that the link between numeracy and scientific reasoning was also associated with improved cognitive self-assessment (e.g., reduced overconfidence on comprehension judgments). Results indicate that more numerate people may generally be less likely to confuse correlation and causation in regular science reporting. Results also suggest that numerate people are more likely to have acquired scientific reasoning skills that more generally support risk literacy and knowledge acquisition, consistent with Skilled Decision Theory. Discussion focuses on implications for risk literacy research, and includes a Risk Literacy Difficulty Analysis indicating that more than half of the USA adult population may be likely to misunderstand common types of regular science reports.

Improving family quality of life (FQoL) of families of children with autism spectrum disorder (ASD) is a key priority in clinical research and practice. Previous studies have suggested that certain health-related behaviors in children with ASD, such as sleep or physical activity, may affect FQoL. However, the relative and independent effects of different health-related behaviors on FQoL remain poorly understood. This study investigated the relationship between sleep, mealtime difficulties, screen time, physical activity, and FQoL in ASD. Parents of 65 children with ASD aged four to thirteen years completed a detailed assessment of their children’s health-related behaviors and FQoL. A multiple regression framework was used to estimate the independent contribution of each health-related behavior to FQoL. Only sleep and mealtime problems were independently associated with lower FQoL, even after controlling for physical activity, screen time, gender, age, traits of ASD, and intelligence, accounting for a 60, and 3% of the variance, respectively. All categories of sleep and mealtime problems were associated with FQoL, with particularly strong correlations for sleep anxiety ( r =.71), daytime sleepiness ( r =.70), and food refusal ( r =.72). In addition to core autistic features, sleep and mealtime behaviors are associated with FQoL in children with ASD. Interventions aimed at improving sleep habits and reducing mealtime difficulties many enhance FQoL in children with ASD.

Background: In acute coronary syndrome the time elapsed between the start of symptoms and the moment the patient receives treatment is an important determinant of survival and subsequent recovery. However, many patients do not receive treatment as quickly as recommended, mostly due to substantial prehospital delays such as waiting to seek medical attention after symptoms have started. Objective: To conduct a systematic review with meta-analysis of the relationship between nine frequently investigated psychological and cognitive factors and prehospital delay. Design: A protocol was preregistered in PROSPERO [CRD42018094198] and a systematic review was conducted following PRISMA guidelines. Data sources: The following databases were searched for quantitative articles published between 1997 and 2019: Medline (PubMed), Web of Science, Scopus, Psych Info, PAIS, and Open grey. Review methods: Study risk of bias was assessed with the NIH Quality Assessment Tool for Observational, Cohort, and Cross-Sectional Studies. A best evidence synthesis was performed to summarize the findings of the included studies. Results: Forty-eight articles, reporting on 57 studies from 23 countries met the inclusion criteria. Studies used very diverse definitions of prehospital delay and analytical practices, which precluded meta-analysis. The best evidence synthesis indicated that there was evidence that patients who attributed their symptoms to a cardiac event (n = 37), perceived symptoms as serious (n = 24), or felt anxiety in response to symptoms (n = 15) reported shorter prehospital delay, with effect sizes indicating important clinical differences (e.g., 1.5-2 h shorter prehospital delay). In contrast, there was limited evidence for a relationship between prehospital delay and knowledge of symptoms (n = 18), concern for troubling others (n = 18), fear (n = 17), or embarrassment in asking for help (n = 14). Conclusions: The current review shows that symptom attribution to cardiac events and some degree of perceived threat are fundamental to speed up help-seeking. In contrast, social concerns and barriers in seeking medical attention (embarrassment or concern for troubling others) may not be as important as initially thought. The current review also shows that the use of very diverse methodological practices strongly limits the integration of evidence into meaningful recommendations. We conclude that there is urgent need for common guidelines for prehospital delay study design and reporting. (C) 2020 The Author(s). Published by Elsevier Ltd.

The human papillomavirus (HPV) vaccine has been shown to be an effective cancer-prevention vaccine against oncogenic types of the HPV virus implicated in cervical, anogenital, and oropharyngeal cancers. Since Covid-19, there are global suboptimal uptake rates for the HPV vaccine. In high-income countries, there are persistently lower uptake rates among boys/men and vulnerable groups despite many countries now offering the HPV vaccine to both girls and boys in gender-neutral vaccine campaigns. It is important to understand the nuances with vaccine hesitancy and qualitative research approaches can be valuable to understand rich, contextual understandings in public health communication among hard-to-reach groups. This commentary draws insights from previous literature and our own research including two studies submitted to this Special Edition on Vaccine Communication. We consider the cultural context, gender and specific hard-to-reach groups in Scotland including those with an intellectual disability, sexual minorities, and ethnically diverse groups to draw some insights. Such groups may experience taboos and stigma in various guises. It is important that public health communication in given contexts is gender-inclusive and can incorporate messages that reach vulnerable groups. Cancer prevention communication delivered by trusted healthcare providers and community leaders are important strategies to deliver trusted messages.

Numerical skills are essential to make informed decisions in our daily life. Unfortunately, many people lack basic numeracy, which limits their ability to accurately interpret risks (i.e., risk literacy). In this paper, we provide an overview of research investigating the role of numeracy in two prominent domains, where most research was concentrated, health and finance. We summarize what has been learned so far in these domains and suggest promising venues for future research. We conclude that it is important to conduct interventions to improve numeracy in less numerate individuals and to help them make informed decisions and achieve better life outcomes.

Globally, human papillomavirus (HPV) vaccine uptake rates have declined within a wider context of vaccine hesitancy. Gender-neutral vaccine programmes are increasing and recommended for the prevention of cervical, anogenital, and oropharyngeal cancers affecting both women and men. To address the problem of suboptimal HPV uptake rates for boys and men, we aimed to understand young men’s communication needs for HPV messages in a cross-cultural analysis. Qualitative methods consisting of 14 focus group discussions were conducted with young men (18–26 years) about the HPV vaccine in three countries with varying HPV vaccine implementation policies at the time. A total of 55 participants were included from Scotland (n=14), Spain (n=25), single-gendered programmes, and the USA (n=16), gender-neutral programme. Analysis was informed by reflexive thematic analysis. Four themes were identified: (1) the ‘Girl vaccine’: primarily seen as a vaccine for girls, despite varying vaccine knowledge and awareness across contexts; (2) vaccine ambivalence: perceptions of men’s HPV risks were low and some vaccine worries were evident from US contexts; (3) altruism: a pervasive theme related to young men’s roles and responsibilities for HPV transmission within relationships; (4) trusted sources: messages from health care providers/authorities were persistently valued but direct opportunities were often absent. Public health messaging to increase HPV vaccination for young men should focus on direct appeal to young men’s health through specific and targeted HPV messages for cancer and sexual health benefits to increase the personal relevance of the vaccine. It should also focus on indirect appeal through incorporating messages about safe sex in relationships and for herd immunity. Healthcare providers and authorities are trusted sources of information and can influence men’s confidence for the HPV vaccine; opportunities for interactions should be optimised.

We investigated what factors may foster or hinder physicians’ cancer screening risk literacy–specifically the ability to understand evidence regarding screening effectiveness and make evidence-based recommendations to patients. In an experiment, physicians in training (interns and residents) read statistical information about outcomes from screening for cancer, and had to decide whether to recommend it to a patient. We manipulated the effectiveness of the screening (effective vs. ineffective at reducing mortality) and the demand of the patient to get screened (demand vs. no demand). We assessed participants’ comprehension of the presented evidence and recommendation to the patient, as well as a-priori screening beliefs (e.g., that screening is always a good choice), numeracy, science literacy, knowledge of screening statistics, statistical education, and demographics. Stronger positive a-priori screening beliefs, lower knowledge of screening statistics, and lower numeracy were related to worse comprehension of the evidence. Physicians recommended against the ineffective screening but only if they showed good comprehension of the evidence. Physicians’ recommendations were further based on the perceived benefits from screening but not on perceived harms, nor the patient’s demands. The current study demonstrates that comprehension of cancer screening statistics and the ability to infer the potential benefits for patients are essential for evidence-based recommendations. However, strong beliefs in favor of screening fostered by promotion campaigns may influence how physicians evaluate evidence about specific screenings. Fostering physician numeracy skills could help counteract such biases and provide evidence-based recommendations to patients.

Autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) are the most prevalent neurodevelopmental disorders. There is a growing body of literature investigating factors affecting quality of life in families (FQoL) with a child with these disorders. However, there are no studies that trace their knowledge anatomy. Thus, we conducted a scientometric analysis to describe this literature, detect certain variables that could be related to FQoL, and identify tendencies and open questions for future research. A literature search in the Web of Science, PubMed, and Scopus was run and identified 3281 publications published between 1975 and 2022. The results suggest an increase in the quantity of publications on FQoL in ASD and ADHD over the last few years (14% and 12%, respectively). For both research fields, the USA published the highest number of documents, showing that the production related to ADHD and FQoL is concentrated in just a few countries. Thematic analysis revealed several clusters, considering quality of life and children as core themes that are still setting trend lines. Moreover, it would be worthwhile to describe and analyze FQoL not only during the childhood of children with ASD and ADHD but also during their adolescence.

BACKGROUND:Individuals with cancer often experience stress throughout the cancer trajectory and have a high risk of experiencing depression.OBJECTIVE:The aim of this study was to examine the relationship between allostatic load (AL), a measure of cumulative stress-related physiologic dysregulation of different body systems, and symptoms of depression in cancer survivors.METHODS:Participants were 294 adult cancer survivors from the US National Health and Nutrition Examination Survey (NHANES 2007-2018). Allostatic load was measured using 14 indicators representing cardiometabolic risk, glucose metabolism, cardiopulmonary functioning, parasympathetic functioning, and inflammation. Depressive symptoms were measured with the Patient Health Questionnaire-9. The relationship between AL and depressive symptoms was investigated using multiple regression adjusted for diverse sociodemographic and diagnosis variables.RESULTS:Higher AL was associated with higher depressive symptom scores. The higher risk of depression was concentrated among those survivors in the highest AL quartile, with 21% (95% confidence interval, 11%-32%) of survivors presenting a high risk of depression compared with 8% to 11% of survivors in the lower quartiles. In exploratory analyses, the relationship between AL and depressive symptoms was only significant among survivors with a lower income. In contrast, in survivors in the highest income group, depressive symptoms were lower and unrelated to AL.CONCLUSION:High AL is associated with more depressive symptoms among cancer survivors.IMPLICATIONS FOR PRACTICE:Nurses have an important role in identifying psychological distress in cancer patients and survivors. Further research is needed to investigate the usefulness of AL as a marker in the context of cancer follow-up care and screening for psychological distress.

Deliberate ignorance is the willful choice not to know the answer to a question of personal relevance. The question of whether a man is the biological father of his child is a sensitive issue in many cultures and can lead to litigation, divorce, and disinheritance. Thanks to DNA tests, men are easily able to resolve the uncertainty. Psychological theories that picture humans as informavores who are averse to ambiguity suggest men would do a DNA test, as does evolutionary theory, which considers investing in raising a rival’s offspring a mistake. We conducted two representative studies using computer-based face-to-face interviews in Germany (n = 969) and Spain (n = 1,002) to investigate whether men actually want to know and how women would react to this desire. As a base line, Germans (Spanish) estimated that 10% (20%) of fathers mistakenly believe that they are the biological father of their child. Nevertheless, in both countries, only 4% of fathers reported that they had performed a DNA paternity test, while 96% said they had not. In contrast, among men without children, 38% (33%) of Germans (Spanish) stated they would do a DNA test if they had children, mostly without telling their partners. Spanish women with children would more often disapprove of a paternity test or threaten their husbands with divorce (25%) than would German women (13%). We find that a simple test of risk aversion, measured also by the purchase of non-mandatory insurances, is correlated with not wanting to know.

Autism Spectrum Disorder (ASD) and Developmental Language Disorder (DLD) have traditionally been considered separate disorders, although some similarities and overlaps in certain aspects of language have been detected. In this paper, we compare the deficits in receptive grammar in these two disorders. We analyse the proportion of grammatical errors in relation to semantic complexity in 84 children divided into four groups: children with autism language impairment (ALI), with autism language normal (ALN), with DLD, and with typical development (TD), all groups with the same age of receptive vocabulary. The results show significant differences in the comprehension of grammatical structures, both simple (canonical and non-reversible) and complex (non-canonical and reversible). Children with ASD and DLD show different language profiles depending on the syntactic complexity. In the simplest structures, no differences are found between the groups, starting at an equivalent vocabulary age of 7:8 years. However, there are differences between the ALI and DLD groups with respect to the TD group in the more complex structures, starting at an equivalent vocabulary age of 3 years. Therefore, both groups ALI and DLD present the greatest difficulties compared to ALN and TD. The paper discusses the importance of attending to these differences, since the repercussion of comprehension difficulties increases as children grow.

OBJECTIVE:People's beliefs about cancer can affect the actions they take to prevent and detect the disease. We investigated socio-economic inequalities in beliefs about cancer and its causes in the general population. METHODS:We analyzed data from the representative probabilistic Spanish Oncobarometer survey (N = 4769, 2020) and the non-probabilistic weight-corrected Spanish Cancer Awareness Survey (N = 1029, 2022). Beliefs about cancer, recognition of cancer symptoms, and recognition of risk factors were measured with the Awareness and Beliefs about Cancer questionnaire. Endorsement of mythical causes was measured with the CAM-Mythical Causes questionnaire. The effects of socio-economic status (SES) were investigated in multiple regression analyses adjusted for age, sex, and personal and family cancer history. RESULTS:Individuals with lower SES were more likely to endorse pessimistic beliefs (e.g., "cancer is a death sentence"), and less likely to endorse optimistic beliefs about cancer (e.g., "people with cancer continue with normal activities"). Individuals with lower SES also recognized fewer cancer symptoms and risk factors and endorsed more mythical causes of cancer. The gap in knowledge regarding cancer causes was wider among people with low SES, who were more likely to endorse several mythical causes than some established risk factors included in cancer prevention recommendations. CONCLUSIONS:Socio-economic inequalities in beliefs about cancer are robust and multidimensional and indicate worse preparedness to act against the disease among lower socio-economic groups. Differences in beliefs about disease outcomes and causes are likely one of the multiple contributors to cancer disparities and should be targeted and monitored in prevention efforts.

Statistical numeracy skills have been found to be among the most robust general predictors of risk understanding and decision-making quality. However, some research suggests that when numerate people hold extreme worldviews they could use their skills to engage in motivated (biased) reasoning about controversial topics like climate change, further polarizing their judgments and beliefs. While suggestive, previous numeracy studies on this topic have neglected the highly influential role of knowledge in skilled judgment and decision making (see Skilled Decision Theory; Cokely et al., 2018). To address this limit, we conducted two studies with diverse (n = 537) and probabilistically representative samples (n = 305) of U.S. residents, testing the first integrated cognitive model of the relations between numeracy, worldviews, knowledge, beliefs, and risk perceptions. Structural modeling revealed that regardless of people's worldviews, numeracy was not associated with polarization or enhanced bias. However, numeracy was consistently related to more accurate climate change knowledge, which was by far the strongest predictor of accurate beliefs (e.g., 6-10 times stronger than people's worldviews), largely mediating the associations between worldviews and risk perceptions (e.g., individualists were less informed and less concerned about climate change). Consistent with the risk literacy Knowledge is Power account, results suggest that when accurate risk knowledge is available numeracy skills may generally promote more informed and therefore less biased judgment and decision making, even when people are confronted with controversies and conflicts of interest.

BACKGROUND AND OBJECTIVE:Reducing patient decision delay - the time elapsed between symptom onset and the moment the patient decides to seek medical attention - can help improve acute coronary syndrome survival. Patient decision delay is typically investigated in retrospective studies of acute coronary syndrome survivors that are prone to several biases. To offer an alternative approach, the goal of this research was to investigate anticipated patient decision delay in the general population in response to different symptom clusters. METHODS:We developed scenarios representing four commonly experienced symptom clusters: classic (chest symptoms only), heavy (a large number of very intense symptoms including chest pain), diffuse (mild symptoms including chest pain), and weary (mild symptoms without clear chest involvement). The scenarios were administered in random order in a representative survey of 1002 adults ≥55 years old from the non-institutionalized general population in Spain. We measured help-seeking intentions, anticipated patient decision delay (waiting >30 min to seek help), and symptom attribution. RESULTS:Patient decision delay was most common in the diffuse scenario (55%), followed by the weary (34%), classic (22%), and heavy (11%) scenarios. Attributing the symptoms to a cardiovascular cause and intentions to call emergency services were least frequent in the weary and diffuse scenarios. Women were less likely to intend to seek help than men in the classic (OR = 0.48, [0.27, 0.85], diffuse (OR = 0.67, [0.48, 0.92]), and weary (OR = 0.66, [0.44, 0.98]) scenarios, despite being more likely to attribute symptoms to cardiovascular causes. Participants with traditional cardiovascular risk factors (e.g., diabetes, hypercholesterolemia, hypertension) reported faster help-seeking, whereas participants with obesity and history of depression were more likely to delay. DISCUSSION:The diverse manifestations of acute coronary syndrome generate fundamentally different appraisals. Anticipated patient decision delay varies as a function of socio-demographic characteristics and medical history, supporting findings from studies with patients who experienced ACS. Measuring anticipated patient decision delay in the general population can help reveal potential barriers to help-seeking and capture effects of population interventions.

The tourism sector is known to suffer significant volatility associated with safety issues. Among the factors that influence tourists' decisions in this regard are health-related concerns about the destination country. However, when it comes to taking responsibility for their own health, there is a gap in the literature regarding effective communication strategies for motivating tourists who are reluctant to perform desirable health-related behaviours, such as getting vaccinated. This study aims to examine the effectiveness of music in communicating implicit messages about such responsible behaviours to reluctant tourists. To this end, two factors are experimentally manipulated: the type of communication stimulus (verbal/musical) and the cultural context of the tourist (high/low). The main findings are that: music exerts a greater effect on reluctant tourists than 'average' tourists; music is capable of conveying referential as well as emotional messages; and music's effectiveness in this kind of communication is greater in high-context cultures.

Background: About half of all cancers are diagnosed in adults older than 65, making them the age group at highest risk of developing this disease. Nurses from different specialties can support individuals and communities in the prevention and early detection of cancer and should be aware of the common knowledge gaps and perceived bar-riers among older adults.Objectives: The goal of the current research was to investigate personal characteristics, perceived barriers, and be-liefs related to cancer awareness in older adults, with a special focus on perceptions about the influence of cancer risk factors, knowledge of cancer symptoms, and anticipated help-seeking. Design: Descriptive cross-sectional study. Participants: Participants were 1213 older adults (>= 65 years old) from the representative national Onco-barometer survey conducted in 2020 in Spain.Methods: Questions on the perceived influence of cancer risk factors, knowledge of cancer symptoms, and the Span-ish version of the Awareness and Beliefs about Cancer (ABC) questionnaire were administered in computer-assisted telephone interviews.Results: Knowledge of cancer risk factors and symptoms was strongly related to personal characteristics and was lim-ited among males and older individuals. Respondents from lower socio-economic background recognized fewer can-cer symptoms. Having personal or family history of cancer had opposite effects on cancer awareness: It was related to more accurate symptom knowledge but also to lower perceptions about the influence of risk factors and more delayed help-seeking. Anticipated help-seeking times were strongly influenced by perceived barriers to help-seeking and be-liefs about cancer. Worry about wasting the doctor's time (48% increase, 95% CI [25%-75%]), about what the doctor might find (21% increase [3%-43%]) and not having enough time to go to the doctor (30% increase [5%-60%]) were related to more delayed help-seeking intentions. In contrast, beliefs that reflected higher perceived seriousness of a potential cancer diagnosis were related to shorter anticipated help-seeking times (19% decrease [5%-33%]).Conclusions: These results suggest that older adults could benefit from interventions informing them about how to re-duce their cancer risk and addressing emotional barriers and beliefs associated with help-seeking delays. Nurses can contribute to educating this vulnerable group and are in a unique position to address some barriers to help-seeking. Study registration: Not registered. (c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background Individuals with cancer often experience stress throughout the cancer trajectory and have a high risk of experiencing depression. Objective The aim of this study was to examine the relationship between allostatic load (AL), a measure of cumulative stress-related physiologic dysregulation of different body systems, and symptoms of depression in cancer survivors. Methods Participants were 294 adult cancer survivors from the US National Health and Nutrition Examination Survey (NHANES 2007-2018). Allostatic load was measured using 14 indicators representing cardiometabolic risk, glucose metabolism, cardiopulmonary functioning, parasympathetic functioning, and inflammation. Depressive symptoms were measured with the Patient Health Questionnaire-9. The relationship between AL and depressive symptoms was investigated using multiple regression adjusted for diverse sociodemographic and diagnosis variables. Results Higher AL was associated with higher depressive symptom scores. The higher risk of depression was concentrated among those survivors in the highest AL quartile, with 21% (95% confidence interval, 11%-32%) of survivors presenting a high risk of depression compared with 8% to 11% of survivors in the lower quartiles. In exploratory analyses, the relationship between AL and depressive symptoms was only significant among survivors with a lower income. In contrast, in survivors in the highest income group, depressive symptoms were lower and unrelated to AL. Conclusion High AL is associated with more depressive symptoms among cancer survivors. Implications for Practice Nurses have an important role in identifying psychological distress in cancer patients and survivors. Further research is needed to investigate the usefulness of AL as a marker in the context of cancer follow-up care and screening for psychological distress.

OBJECTIVE:People differ in whether they understand graphical or numerical representations of statistical information better. However, assessing these skills is often not feasible when deciding which representation to select or use. This study investigates whether people choose the representation they understand better, whether this choice can improve risk comprehension, and whether results are influenced by participants' skills (graph literacy and numeracy).METHODS:In an experiment, 160 participants received information about the benefits and side effects of painkillers using either a numerical or a graphical representation. In the "no choice" condition, the representation was randomly assigned to each participant. In the "choice" condition, participants could select the representation they would like to receive. The study assessed gist and verbatim knowledge (immediate comprehension and recall), accessibility of the information, attractiveness of the representation, as well as graph literacy and numeracy.RESULTS:In the "choice" condition, most (62.5%) chose the graphical format, yet there was no difference in graph literacy or numeracy (nor age or gender) between people who chose the graphical or the numerical format. Whereas choice slightly increased verbatim knowledge, it did not improve gist or overall knowledge compared with random assignment. However, participants who chose a representation rated the representation as more attractive, and those who chose graphs rated them as more accessible than those without a choice.LIMITATIONS:The sample consisted of highly educated undergraduate students with higher graph literacy than the general population. The task was inconsequential for participants in terms of their health.CONCLUSIONS:When people can choose between representations, they fail to identify what they comprehend better but largely base that choice on how attractive the representation is for them.HIGHLIGHTS:People differ systematically in whether they understand graphical or numerical representations of statistical information better. However, assessing these underlying skills to get the right representation to the right people is not feasible in practice. A simple and efficient method to achieve this could be to let people choose among representations themselves.However, our study showed that allowing participants to choose a representation (numerical v. graphical) did not improve overall or gist knowledge compared with determining the representation randomly, even though it did slightly improve verbatim knowledge.Rather, participants largely chose the representation they found more attractive. Most preferred the graphical representation, including those with low graph literacy.It would therefore be important to develop graphical representations that are not only attractive but also comprehensible even for people with low graph literacy.

BACKGROUND Most risk factors for cardiovascular disease (CVD) are modifiable, suggesting that the burden of CVD could be substantially reduced through cardiovascular screening and healthier lifestyle. People who have social support are more likely to adhere to cardiovascular prevention recommendations, but it is not clear whether the benefit of social support is equal for men and women. PURPOSE We investigated whether sex moderates the relationship between social support and adherence to cardiovascular prevention recommendations in a nationally representative sample. METHODS Participants were 17,287 adults (n = 10,264 middle-aged adults 40-64 years old and n = 7,023 older adults ≥ 65 years old) who participated in the National Health Survey of Spain in 2017. Social support was measured with the Functional Social Support Questionnaire of Duke-UNC. Adherence to cardiovascular screening recommendations was assessed based on self-reported testing of cholesterol, blood pressure, and blood sugar by a health professional in the past 12 months. Adherence to recommended health-related behaviors was assessed based on the guidelines of the European Society of Cardiology regarding diet, alcohol consumption, smoking, and physical activity. RESULTS Multiple regression models adjusted for socio-demographic and cardiovascular history and risk variables showed that social support was more strongly associated with adherence to cardiovascular prevention recommendations in men than in women. In particular, low social support levels were especially detrimental for both middle-aged men (screening: B = 0.13, 95% CI [0.06-0.20], p < .001; behaviors: B = 0.33 [0.26-0.41], p < .001) and older men (screening: B = 0.10 [0.04-0.17], p = .001; behaviors: B = 0.16 [0.08-0.25], p < .001), whereas older women had comparatively high adherence, which was unrelated to social support (screening: B = 0.02 [-0.03 to 0.08], p = .433; behaviors: B = 0.03 [-0.03 to 0.10], p = .342). CONCLUSIONS Social support is more strongly associated with cardiovascular prevention in men than in women, such that men who lack social support have the lowest adherence to cardiovascular screening and lifestyle recommendations.