{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T05:12:16Z","timestamp":1778562736165,"version":"3.51.4"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This study aimed to examine longitudinal associations of alignment to the American Cancer Society (ACS) Guidelines for Cancer Prevention in 2015 and self-reported anxiety and depression in 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Participants included 88,643 women (79%) and 23,373 men (21%) with a mean (SD) age of 53 (10) in the Cancer Prevention Study-3. The ACS Guideline Score captures alignment to guidelines for co-occurring health behaviors including body mass index, physical activity, diet quality, and alcohol consumption, on a range from 0-to-8; with higher scores indicating greater alignment. Self-reported anxiety and depression symptoms were measured via the Patient Health Questionnaire-4 (PHQ-4). Multivariable logistic regression models were used to calculate odds ratios and 95% confidence intervals. Further sensitivity analyses included: (1) excluding participants with prevalent depression and\/or anxiety and those taking medications for depression and\/or anxiety at baseline (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f66,594); and (2) stratifying by level of change in PHQ-4 during the COVID-19 pandemic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 112,016 participants, 32% reported both depression and anxiety symptoms, 10% reported anxiety symptoms, and 7% had symptoms of depression at follow-up. Participants with higher ACS Guideline Scores in 2015 were less likely to experience symptoms of depression and\/or anxiety in 2021 compared to individuals with lower scores (OR\u202f=\u202f0.60; 95% CI: 0.57\u20130.63). Analyses restricted to those without anxiety or depression in 2015 resulted in attenuated, though still statistically significant findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings suggest lifestyles aligned with the ACS Guidelines for Cancer Prevention are associated with a lower likelihood of future symptoms of depression and anxiety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1817690","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T04:30:25Z","timestamp":1778560225000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Co-occurring health behaviors and mental health outcomes among a large, aging US population"],"prefix":"10.3389","volume":"14","author":[{"given":"Kathryn E.","family":"Chiang","sequence":"first","affiliation":[{"name":"Department of Population Science, American Cancer Society","place":["Atlanta, GA, United States"]},{"name":"Department of Health Promotion and Behavior, College of Public Health, University of Georgia","place":["Athens, GA, United States"]},{"name":"Winship Cancer Institute, Emory University","place":["Atlanta, GA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika","family":"Rees-Punia","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society","place":["Atlanta, GA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sicha","family":"Chantaprasopsuk","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society","place":["Atlanta, GA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alpa V.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society","place":["Atlanta, GA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren C.","family":"Bates-Fraser","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society","place":["Atlanta, GA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marissa M.","family":"Shams-White","sequence":"additional","affiliation":[{"name":"Department of Population Science, American Cancer Society","place":["Atlanta, GA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamora A.","family":"Callands","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Behavior, College of Public Health, University of Georgia","place":["Athens, GA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica L.","family":"Muilenburg","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Behavior, College of Public Health, University of Georgia","place":["Athens, GA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather M.","family":"Padilla","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Behavior, College of Public Health, University of Georgia","place":["Athens, GA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"ref1","volume-title":"Chronic Illness and Mental Health: Recognizing and Treating Depression","year":"2021"},{"key":"ref2","volume-title":"Projections of National Expenditures for Treatment of Mental and Substance Use Disorders, 2010\u20132020","year":"2020"},{"key":"ref3","volume-title":"Anxiety 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