Robin M. Turner

Background: Adverse childhood experiences (ACEs) are associated with increased long-term mental and physical health risk, yet inter-individual variation indicates that resilience is possible. Distinct trajectories of sustained mental well-being have been observed among individuals exposed to ACEs, predicting favorable long-term outcomes. However, the biopsychosocial markers underpinning sustained trajectories of resilience remain poorly understood. This study aimed to identify factors that predict higher well-being (‘resilient’) trajectories over time in individuals with and without ACE exposure. Methods: Previously identified 12-year well-being trajectory classes (higher vs. lower well-being) were examined in participants with no ACE history ( n = 779) and those exposed to ACEs ( n = 889). Logistic regression models were used to identify factors differentiating higher versus lower well-being trajectories in the non-ACE sample, and resilience versus risk trajectories in the ACE sample. Predictors included childhood adversity characteristics, genetic predisposition, demographic and environmental factors, social and occupational factors, health and lifestyle factors, and psychological functioning. Results: Across both samples, higher well-being was predicted by higher education, better subjective physical health, greater social engagement, stronger work performance, and adaptive personality traits (lower neuroticism and higher extraversion). In the non-ACE sample, polygenic well-being scores and family history of mental illness further differentiated trajectories. In contrast, resilience following ACEs was additionally characterized by modifiable factors, including parenting style, relationship status, BMI, and conscientiousness. Conclusions: Resilience in the context of childhood adversity is defined by identifiable, largely modifiable social, health, and personality factors, highlighting potential targets for interventions to enhance long-term well-being.

Background: TRUS Biopsy (TRUS Bx) can be poorly tolerated under local anaesthetic. Virtual Reality (VR) has been shown to reduce pain and anxiety levels as an adjunct to standard analgesia in a range of settings. This includes paediatric procedures, burn wound debridement and gynaecological procedures. However, its effect in TRUS Bx remains unclear. The aim of this study was to determine if intra‐procedure VR improved patient pain and satisfaction during TRUS Bx. Method: A single‐centre, parallel‐group randomised controlled trial was conducted at Dunedin Hospital. Two hundred and fifty patients presenting for first TRUS Bx were randomised to either conventional TRUS or VR‐assisted TRUS over 36 months. The intervention group wore a VR headset with distraction video software, with the control group having standard care. The primary outcome measured patients' pain scores using a visual analogue scale. Results: Patients reported similar pain when distracted with VR (mean difference [MD] –2.6, 95% CI –8.5 to 3.2). Similarly, there was no evidence of a difference in ‘time thinking about pain’ (MD 0.9, 95% CI –7.2 to 9.0) or ‘worst pain’ (pain intensity) (MD –2.4, 95% CI –8.6 to 3.8). Both groups were equally satisfied with the procedure and would happily accept having the procedure again if needed. VR was not associated with any side effects. Conclusion: VR technology did not improve patients' pain and overall satisfaction with TRUS Bx. The inherent vulnerability and invasive nature of the procedure may impact the effectiveness of this distraction technique and prevent its analgesic effects proven in non‐urological studies.

Background: Limited data exist on the motivations and expectations of participants when enrolling in dermatology clinical trials, including melanoma early detection trials. Understanding participant motivators for research engagement has been identified as a prioritized area for trial methodology research. Objective: The study aimed to determine motivators of participation and expectations from trial involvement among patients enrolled in the MEL-SELF randomized clinical trial of patient-led surveillance for new or recurrent melanoma. Methods: The MEL-SELF trial is recruiting patients previously treated for localized melanoma, who own a smartphone, have a partner to assist with skin self-examination (SSE), and attend routinely scheduled follow-up at specialist and primary care skin clinics in Australia. We evaluated responses from the first 100 randomized participants to 2 open-ended questions about their motivations and expectations for participating in the trial, administered through the internet-based baseline questionnaire. A total of 3 coders independently coded the free-text responses and resolved discrepancies through consensus. Qualitative content analysis by an iterative process was used to group responses into themes. Responses from potential participants who were not randomized and the 404 participants randomized subsequently into the trial, were also checked for new themes. Coding and analysis were conducted in Microsoft Excel. Results: Out of the 100 survey participants, 98 (98%) answered at least 1 of the 2 questions. Overall, responses across the motivation and expectation items indicated 3 broad themes: community benefit, perceived personal benefit, and trusting relationship with their health care provider. The most common motivators for participation were related to community benefit. These included progressing medical research, benefitting future melanoma patients who may have similar experiences, and broader altruistic sentiments such as “helping others” or “giving back.” The most common expectations from the trial related to personal benefit. These included perceived improved outcomes such as earlier diagnosis and treatment, access to additional care, and increased self-empowerment to take actions themselves that benefit their health. Patients expressed a desire to gain health-related knowledge and skills and were interested in the potential advantages of teledermatology. There were no new themes in responses from those who were not randomized or were randomized subsequent to the first 100. Conclusions: We report a tailorable, patient-focused approach to identify drivers of research engagement in clinical research. Clinical trials offer an opportunity to collate a substantial evidence base on determinants of research participation and to identify context-specific factors. Results from the MEL-SELF trial emphasized notable altruism, self-empowerment, and perceived advantages of teledermatology as specific motivators. These findings informed consent processes, recruitment, retention, response to trial tasks, and intervention adherence for the MEL-SELF host trial. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000176864. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379527&

BACKGROUND Limited data exist on the motivations and expectations of participants when enrolling in dermatology clinical trials, including melanoma early detection trials. Understanding participant motivators for research engagement has been identified as a prioritized area for trial methodology research. OBJECTIVE The study aimed to determine motivators of participation and expectations from trial involvement among patients enrolled in the MEL-SELF randomized clinical trial of patient-led surveillance for new or recurrent melanoma. METHODS The MEL-SELF trial is recruiting patients previously treated for localized melanoma, who own a smartphone, have a partner to assist with skin self-examination (SSE), and attend routinely scheduled follow-up at specialist and primary care skin clinics in Australia. We evaluated responses from the first 100 randomized participants to 2 open-ended questions about their motivations and expectations for participating in the trial, administered through the internet-based baseline questionnaire. A total of 3 coders independently coded the free-text responses and resolved discrepancies through consensus. Qualitative content analysis by an iterative process was used to group responses into themes. Responses from potential participants who were not randomized and the 404 participants randomized subsequently into the trial, were also checked for new themes. Coding and analysis were conducted in Microsoft Excel. RESULTS Out of the 100 survey participants, 98 (98%) answered at least 1 of the 2 questions. Overall, responses across the motivation and expectation items indicated 3 broad themes: community benefit, perceived personal benefit, and trusting relationship with their health care provider. The most common motivators for participation were related to community benefit. These included progressing medical research, benefitting future melanoma patients who may have similar experiences, and broader altruistic sentiments such as “helping others” or “giving back.” The most common expectations from the trial related to personal benefit. These included perceived improved outcomes such as earlier diagnosis and treatment, access to additional care, and increased self-empowerment to take actions themselves that benefit their health. Patients expressed a desire to gain health-related knowledge and skills and were interested in the potential advantages of teledermatology. There were no new themes in responses from those who were not randomized or were randomized subsequent to the first 100. CONCLUSIONS We report a tailorable, patient-focused approach to identify drivers of research engagement in clinical research. Clinical trials offer an opportunity to collate a substantial evidence base on determinants of research participation and to identify context-specific factors. Results from the MEL-SELF trial emphasized notable altruism, self-empowerment, and perceived advantages of teledermatology as specific motivators. These findings informed consent processes, recruitment, retention, response to trial tasks, and intervention adherence for the MEL-SELF host trial. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000176864. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379527&

Introduction: Demographic and health factors are known to predict vaping. Less is known about psychological predictors of vaping uptake, particularly among non‐smoking adults using longitudinal designs. We aimed to model how psychological factors related to personality and mental health predicted the likelihood of vaping uptake over time in non‐smoking adults ages 18+ using longitudinal data.Methods: Longitudinal regression models utilised data from the 2018–2020 waves of the New Zealand Attitudes and Values Study to assess how the Big Five personality traits, mental distress and self‐control predicted who began vaping over time among non‐users (non‐vapers and non‐smokers), controlling for gender, age, ethnicity and economic deprivation.Results: Analyses included 36,309 adults overall (ages 18 to 99; M = 51.0). The number of non‐users who transitioned into current vaping was small (transitioned from 2018 to 2019, n = 147; 0.48%; 2019 to 2020, n = 189, 0.63%). Fully adjusted models showed that adults with higher mental distress (adjusted odds ratio [aOR] 1.43; 95% confidence interval [CI] 1.09–1.88), lower self‐control (aOR 0.79; 95% CI 0.69–0.89) and higher extraversion (aOR 1.09; 95% CI 1.06–1.13) were more likely to begin vaping at the next time point compared to adults who remained non‐users. Higher neuroticism and lower conscientiousness also predicted vaping uptake in initial models, but inclusion of mental distress and self‐control superseded these traits.Discussion and Conclusions: Psychological factors related to mental distress, impulse control and sociability predicted who was more likely to begin vaping as non‐smoking adults. Harm prevention interventions could target these factors to reduce vaping uptake in non‐smokers.