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School closures, altered access to health services, and economic stress during the COVID-19 pandemic have likely had an impact on the mental and physical well-being of youth worldwide, particularly among those with chronic health conditions (CHCs). A number of challenges and opportunities have emerged during the COVID-19 pandemic for youth with CHCs. Challenges include heightened anxiety, disrupted routines, academic and social stresses associated with school closure, increased risk of domestic violence and abuse, and reduced access to physical and psychosocial support. On the other hand, opportunities include reduced academic and social stress, increased time with families, reduced access to substances, easier access to health care using technology, and opportunities to build resilience. This viewpoint paper highlights both challenges and opportunities for youth with CHCs during the pandemic and offers recommendations for further research and clinical care.

T he American Heart Association (AHA) has defined a new metric of ideal cardiovascular health to accommodate both an expanded emphasis on prevention and greater understanding of the origins of cardiovascular disease as part of its 2020 Impact Goals. The explicit goal of the AHA statement is to improve cardiovascular health of all Americans by 20% by the year 2020 while reducing deaths resulting from cardiovascular diseases and stroke by 20%.1 To monitor progress toward these goals, the AHA has launched a concept of ideal cardiovascular health. This concept is defined by the presence of 7 ideal health factors that describe whether a person has ideal cardiovascular health and indicate where improvement is needed to attain better health.1 Substantial evidence demonstrates that the ideal cardiovascular health index is associated with better vascular health 2 and with reductions in cardiovascular morbidity and mortality. 3,4 Childhood and youth are important stages of life because cardiovascular diseases are rooted in early life 5,6 and socialBackground-The American Heart Association has defined a new metric of ideal cardiovascular health as part of its 2020 Impact Goals. We examined whether psychosocial factors in youth predict ideal cardiovascular health in adulthood. Methods and Results-Participants were 477 men and 612 women from the nationwide Cardiovascular Risk in Young Finns Study. Psychosocial factors were measured from cohorts 3 to 18 years of age at the baseline of the study, and ideal cardiovascular health was examined 27 years later in adulthood. The summary measure of psychosocial factors in youth comprised socioeconomic factors, emotional factors, parental health behaviors, stressful events, self-regulation of the child, and social adjustment of the child. There was a positive association between a higher number of favorable psychosocial factors in youth and greater ideal cardiovascular health index in adulthood (β=0.16; P<0.001) that persisted after adjustment for age, sex, medication use, and cardiovascular risk factors in childhood (β=0.15; P<0.001). The association was monotonic, suggesting that each increment in favorable psychosocial factors was associated with improvement in cardiovascular health. Of the specific psychosocial factors, a favorable socioeconomic environment (β=0.12; P<0.001) and participants' selfregulatory behavior (β=0.07; P=0.004) were the strongest predictors of ideal cardiovascular health in adulthood. Conclusions-The findings suggest a dose-response association between favorable psychosocial factors in youth and cardiovascular health in adulthood, as defined by the American Heart Association metrics. The effect seems to persist throughout the range of cardiovascular health, potentially shifting the population distribution of cardiovascular health rather than simply having effects in a high-risk population. 7 Although the importance of psychosocial factors has been acknowledged, 1,[8][9][10] there remains a lack of knowledge on whether psychosocial factors, emerging already ...