Psychiatric sequelae of childhood sexual abuse: a case series of six hospitalized minors in Moldova.

Childhood survivors of cancer now have a 5-year survival rate that exceeds 85%, with over half a million survivors estimated to be living in the United States [,]. Early-onset cardiovascular disease (CVD) is now the leading noncancer cause of late mortality among childhood survivors of cancer, with those exposed to cardiotoxic cancer treatments having markedly greater risk []. For example, data from the Childhood Cancer Survivor Study (CCSS) cohort found that after a median follow-up of 29 years, CVD accounted for 9% of deaths, trailing only the original cancer (34% of deaths) and new cancers (25% of deaths) []. Among CCSS participants, the risk of early ischemic heart disease or cardiomyopathy exceeds 10% by the age of 50 years among those exposed to cardiotoxic cancer treatments []. While efforts to minimize cardiotoxic exposures in cancer care have occurred, there remains a critical need to address modifiable risk factors that exist beyond initial treatment and throughout survivorship. In the general population, low levels of physical activity (PA) and poor diet quality are 2 of the major categories of potentially modifiable lifestyle factors that are also independently associated with increased CVD risk []. Specifically, individuals with high levels of sedentary time (more than 9‐10 hours per day) are at the greatest risk []. However, even modest reductions in sedentary time could have substantial health benefits [,]. Similarly, poor diet quality also contributes independently to increased CVD, with data from large general population cohort studies showing that diet quality is associated with an increased risk of CVD and mortality [,,]. Evidence from the literature, mainly from observational studies, supports the role of lifestyle behaviors, specifically PA and diet, in potentially modifying long-term CVD outcomes among survivors of childhood cancer [,,]. In particular, childhood and adolescent or young adult survivors of cancer often report lower PA levels and poorer diet quality compared with the general population, with barriers including limited knowledge, insufficient provider support, and lack of resources [-]. However, survivors have expressed strong interest in interventions aimed at improving lifestyle behaviors, underscoring the need for targeted and accessible strategies [,]. To address these gaps, Study of Active LifeStyle Activation (SALSA) was designed to enroll 375 adult survivors of childhood cancer with low PA, poor diet quality, or high BMI, and test different intervention strategies using a sequential multiple assignment randomized trial (SMART) design, with the overall goal of determining overall intervention efficacy and whether specific sequences of interventions can reduce sedentary behavior and improve diet quality in this high-risk population.