Both alcohol misuse and the externally oriented thinking (EOT) facet of alexithymia are associated with deficits in facial emotion recognition and emotional empathy. The aim of the present study was to investigate whether EOT mediates the association of drinking with these deficits, and to test the hypothesis that impaired facial emotion recognition mediates the relationship between EOT and low emotional empathy, in a non-clinical sample. The sample was comprised of 161 men and women who completed an online survey which included the Alcohol Use Disorders Identification Test (AUDIT), Depression Anxiety Stress Scales, Interpersonal Reactivity Index (IRI), Reading the Mind in the Eyes Test (RMET), and Toronto Alexithymia Scale (TAS-20). In addition to replicating associations between TAS-20 and other measures, EOT was found to mediate relationships between potential alcohol misuse (as indexed by AUDIT) and facial emotion recognition (as indexed by RMET) as well as emotional empathy (as indexed by the corresponding subscale of the IRI) after controlling for mood and demographic variables. The negative relationship between EOT and emotional empathy was mediated by impaired facial emotion recognition. Present findings point to a likely role of the EOT trait in the reported associations of alcohol misuse with both poor emotion recognition and low emotional empathy, and a mediating role of poor emotion recognition in the relationship of EOT to the latter. Alexithymia and emotion recognition 3 Alexithymia, a personality trait involving difficulties in identifying and describing one's own emotional feelings and an externally oriented or concrete thinking style (Taylor,

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Background Parents play an influential role in the health behaviors of their children, such as physical activity, dietary intake, sleep, screen time, and substance use. However, further research is needed to inform the development of more effective and engaging parent-based interventions targeting adolescent risk behaviors. Objective This study aimed to assess parents’ knowledge about adolescent risk behaviors, barriers and facilitators to engaging in healthy behaviors, and preferences for a parent-based prevention intervention. Methods An anonymous web-based survey was conducted from June 2022 to August 2022. Eligible participants were parents of children aged 11 to 18 years and were residing in Australia at the time of this study. The survey assessed the parents’ perceived and actual knowledge about Australian health guidelines for youth, parent and adolescent engagement in health behaviors, parenting style and attitudes, barriers and facilitators to engaging in healthy behaviors, and delivery and component preferences for a parent-based preventive intervention. Descriptive statistics and logistic regressions were conducted to analyze the data. Results A total of 179 eligible participants completed the survey. The mean age of the parents was 42.22 (SD 7.03) years, and 63.1% (101/160) were female. Parent-reported sleep duration was high for both parents (mean 8.31, SD 1.00 hours) and adolescents (mean 9.18, SD 0.94 hours). However, the proportion of parents who reported that their child met the national recommendations for physical activity (5/149, 3.4%), vegetable intake (7/126, 5.6%), and weekend recreational screen time (7/130, 5.4%) was very low. Overall, parents’ perceived knowledge of health guidelines was moderate, ranging from 50.6% (80/158) for screen time to 72.8% (115/158) for sleep guidelines (for children aged 5-13 years). Actual knowledge was lowest for vegetable intake and physical activity, with only 44.2% (46/104) and 42% (31/74) of parents reporting correct guidelines for these behaviors, respectively. The key issues of concern reported by parents were excessive use of technology, mental health, e-cigarette use, and negative peer relationships. The top-rated delivery method for a parent-based intervention was via a website (53/129, 41.1%). The highest rated intervention component was opportunities for goal-setting (89/126, 70.7% rated very or extremely important), and other important program features were ease of use (89/122, 72.9%), paced learning (79/126, 62.7%), and appropriate program length (74/126, 58.8%). Conclusions The findings suggest that such interventions should be brief and web based and should aim to increase parental knowledge of health guidelines; provide opportunities for skill-building, such as goal-setting; and include effective behavior change techniques, such as motivational interviewing and social support. This study will inform the development of future parent-based preventive interventions to prevent multiple lifestyle risk behaviors among adolescents.

BACKGROUND Chronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving physical and mental health outcomes and reducing chronic disease risk. Schools are ideal intervention settings and eHealth interventions afford several advantages, including increased student engagement, scalability and sustainability. Although lifestyle risk behaviours tend to co-occur, few school-based eHealth interventions have targeted multiple behaviours concurrently. OBJECTIVE This paper summarises the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent six key lifestyle risk factors for chronic disease among secondary school students: alcohol use, smoking, poor diet, physical inactivity, sedentary recreational screen time and poor sleep (the “Big 6”). METHODS Development of the Health4Life program was conducted over an 18-month period in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved: i) scoping of evidence and systematic literature review, ii) consultation with adolescents (n=815) via a cross-sectional online survey to identify knowledge gaps, attitudes, barriers and facilitators in relation to the Big 6; iii) content and web development; and iv) user-testing of the web-based program with students (n=41) and teachers (n=8) to evaluate its acceptability, relevance and appeal to the target audience. RESULTS The co-design process resulted in a six-module, evidence-informed program that uses interactive cartoon storylines and web-based delivery to engage students. Student and teacher feedback collected during user-testing was positive in terms of acceptability and relevance. Commonly identified areas for improvement concerned the length of modules, age-appropriateness of language and alcohol storyline, the need for character backstories and links to syllabus information, and feasibility of implementation. Modifications were made to address these issues. CONCLUSIONS The Health4Life school-based program is the first universal, web-based program to concurrently address six important chronic disease risk factors among secondary school students. By adopting a multiple health behaviour change approach, it has the potential to efficiently modify the Big 6 risk factors within one program, and to equip young people with the skills and knowledge needed to achieve and maintain good physical and mental health throughout adolescence and into adulthood. CLINICALTRIAL