Methods: In a nationwide cohort of 3343 Danish women (age 26-70) (response rate: 68%), use of CAM since diagnosis, depressive symptoms (Beck's Depression Inventory), and health-related variables were assessed at baseline 3 months post-surgery. Depressive symptoms were re-assessed at follow-up 15 months post-surgery (response rate for disease free women: 94%). Sociodemographic-, and clinical variables and data on comorbidity were obtained from the surgical departments and national longitudinal registries. Results: Overall CAM use was associated with more depressive symptoms at follow-up. This was due to users of dietary or vitamin supplements (N =895) at baseline exhibiting more depressive symptoms at follow-up, compared to non-users in a negative binomial regression analysis fully adjusted for baseline depression and potential confounders (ratio of mean (RM) = 1.11; 95% CI=1.04 -1.19; p=.003). Conclusion: In this prospective study use of dietary or vitamin supplements showed to be a risk factor of depressive symptoms. It remains to be explored if this finding may be explained by a hidden vulnerability for depressive symptoms among women using dietary or vitamin supplements, by interaction effects with conventional treatment, or by a direct negative influence of dietary or vitamin supplements. Learning objective 1: To gain knowledge of the association between use of CAM and changes in QoL in breast cancer patients. Learning objective 2: To gain knowledge of the association between specific types of CAM use and changes in QoL in breast cancer patients. Increasingly, breast cancer(BC) is managed as a chronic disease with persistent physical and psychosocial demands. Yet,little research has focused on the long-term psychosocial needs of women across the care continuum. The Cancer Support Community(CSC) fielded a national survey to better understand the current psychosocial needs of BC survivors. Methods: CSC conducted an online survey of 1,004 breast cancer survivors,0 to 5 years post-diagnosis. Questions were developed with input from a National Advisory Council of interdisciplinary experts representing advocacy, oncology,psychology,policy,industry and managed care. Results: 87% participants were white,with a mean age of 54. 45% graduated from college and 14% had a graduate degree. 75% had stage II cancer or less and 13% had a BC recurrence. 81% survivors reported some form of physical, emotional or spiritual distress with 67% reporting emotional distress. 64% women indicated fear of recurrence,58% physical changes,55% anxiety,47% depression,46% financial worries as the leading contributors to distress. Regarding their immediate needs, women wanted support around fears of recurrence (62%);making healthy lifestyle choices (60%);financial matters (42%);and reducing anxiety (41%). 86% believe emotional support is important to overall health,while only 52% had someone from their medical team address their emotional needs. 37% respondents did not receive a referral for support services. Of those that did receive a referral,30% did not follow up on any referrals. To reduce the cost of breast cancer,38% of respondents delayed seeking counseling or support. 64% would be likely to seek psychosocial support if it were free of charge. Discussion: Women with breast cancer recognize the importance of emotional support as part of survivorship care,yet few survivors access the care they need. As part of the M.A.P. Project,these data will inform the development of a Cancer Survivor Registry to identify behavioral trends and gaps in psychosocial care across the survivorship continuum. Background: Several studies have reported beneficial effects of expressive writing intervention (EWI) on emotional distress in patient populations. However, moderating variables are often involved and possible deleterious effects have received little attention Objectives: To explore whether the cognitive strategy of temporal comparison (i.e. comparing present life with past life) moderates the effect of EWI on negative affect (NA). Methods: A population based sample of women completing adjuvant treatment for breast cancer were randomized to a EWI group (n=253) writing about the most traumatic experience or to a control group (n=254) writing about daily activities. Both groups completed three home-based writing sessions one week apart. Temporal comparison was an evaluation of "Compared to previously, my life now is…" on a 5-point Likert scale ranging from "much worse" to "much better". NA was measured by the POMS. Both variables were assessed before randomization, 3 months, and 9 months after the first writing session. Results: The EWI and control group did not differ in use of comparisons or in NA at baseline. Repeated-measures ANOVAs showed no main effects of EWI on NA (F=0.48, ns). When temporal comparison was included in the model, a significant effect of EWI on NA was found (F=3.53, p<0.001), together with an interaction between EWI and temporal comparison (F=2.13, p<0.05). Conclusion: The results showed that EWI-women who at baseline evaluated their present life as better than previous periods increased in negative affect, whereas in the control condition, these women showed stable or reduced negative affect. This suggests that EWI could have an adverse effect in individuals who are not settled with their past. Hence, future studies may consider prescreening to optimize outcomes of EWI in patient populations. Introduction: Socioeconomic differences in weight status are well documented. These inequalities may be partly due to differences in takeaway food consumption patterns as frequent fast-food consumption is associated with increased risk of weight gain. However, the findings of studies examining socioeconomic position (SEP) and fast-food consumption are inconsistent. The current study examines SEP and takeaway food consumption behaviours. Method: A cross-sectional postal survey was conducted among 1500 adults aged 25 and 64 years (response rate=63.6%). SEP was ascertained from participants' highest achieved education level, and takeaway consumption was measured using a detailed food frequency questionnaire of 22 takeaway food and beverage items. Socioeconomic differences in the frequency (whether ate≥2 times per week) and types of takeaway food consumed were determined by logistic regression. Results: About 42% of men and 33% women consumed takeaway food at least weekly. There were no education differences in the frequency of takeaway food consumption between the highest and lowest education groups (men OR 1.48; 95% CI 0.68, 3.18; women OR 1.39; 95% CI 0.69, 2.80) . However, lower educated men and women were more likely to make unhealthy takeaway choices though this difference only reached statistical significance among women (OR 2.87; 95% CI 1.51, 5.45) . Conclusion: Takeaway food consumption may be an important contributor to dietary intakes among adults and may contribute to socioeconomic inequalities in dietary intakes and subsequently inequalities in overweight/obesity and chronic diseases. Poor mental health is more prevalent among diabetic patients and may be a risk factor for worse prognosis. Worsening glucose metabolism appears to contribute to patient's level of distress and may be an important factor in explaining future prognosis. We examined associations between psychological distress, glucose metabolism and death in adults with and without diabetes. In a representative, prospective study of 18,525 adults (4.1% with physician-diagnosed diabetes) we measured levels of psychological distress using the 12-item General Health Questionnaire (GHQ-12) and blood was collected for the assessment of glycated haemoglobin, a marker of glucose metabolism. The main outcome was all cause death. Psychological distress, that was defined as GHQ-12 score of ≥4, was apparent in 19.5% and 13.9% of participants with and without diabetes, respectively. Distress was associated with greater cardiovascular morbidity although not with impaired glucose metabolism in diabetics. Among diabetics there were 187 deaths over an average of 6.0 years of follow up. Distress was associated with higher risk of death (multivariate adjusted hazard ratio=1.95, 95% CI, 1.34 -2.84) after adjustment for glucose control, health behaviours, and cardiovascular comorbidity. The synergistic coexistence of diabetes and distress was associated with an elevated risk of all cause death, beyond that due to having either diabetes or distress alone. In summary, psychological distress is an independent risk factor for death in diabetic patients, but this association was not explained through impaired glucose metabolism. Early screening for distress may have important implications for prevention and treatment in diabetics. Background: Research suggests that men may underestimate both their weight and the health risks associated with their weight. However, there is only limited understanding of the health beliefs and health behaviours of obese men. This qualitative study of Australian men with obesity (BMI over 30) aimed to explore their beliefs about their weight, health and wellbeing; their attitudes towards weight loss; and the strategies that they employed to lose weight or improve their health. Method: In-depth semi-structured telephone interviews were conducted with a community sample of men with a body mass index of 30 or more. A range of community engagement strategies were used to encourage men to take part in the study from different socioeconomic and geographical backgrounds. Data were analysed using a descriptive thematic approach. Results: Thirty-six men participated. Most men stated that they were not aware of their weight gain and that their weight had increased slowly and steadily over a number of years. Often a significant life event, for example a health scare, motivated men to recognise that their weight was a problem and that they needed to lose weight. Men often blamed themselves for their obesity. They believed that their obesity was primarily caused by a lack of activity rather than their eating behaviours. Most strongly believed that it was their personal responsibility to lose weight and felt confident that they could achieve weight loss without the support of family members or health professionals. However, they wanted to be engaged in strategies that focused on improving their health and fitness, rather than weight loss. They felt that this was a more empowering approach and the most effective way to lose weight and keep it off. Perceived barriers to successful weight loss included commitment to work and family; social pressures to maintain unhealthy behaviours; and the costs of interventions such as gym memberships, personal trainers and commercial diets. Conclusion: The information provided in this study informs how we can tailor medical and public health strategies for obese men that resonate with their lived experiences. It also highlights the importance of social and contextual factors in understanding the experiences of obese adults. Background: Previous studies of public perceptions of obesity interventions have been quantitative and based on general population surveys. This study aims to explore the opinions and attitudes of obese individuals towards obesity interventions aimed at the population and individual level in Australia. Methods: Qualitative methods using in-depth semi-structured telephone interviews with a community sample of obese adults (Body Mass Index≥30). Theoretical, purposive and strategic sampling techniques were used to ensure a broad representation of individuals from different demographic and geographical backgrounds. Participants were asked about their attitudes towards three population based interventions (regulation, public health campaigns, and social marketing) and three individual interventions (tailored fitness programs; commercial dieting; and bariatric surgery), and the effectiveness of these interventions. Results: One hundred and forty two individuals (19-75 years) were interviewed. Participants strongly supported non-commercial interventions that were focused on encouraging individuals to make healthy lifestyle changes (regulation, physical activity programs, and public health campaigns). There was less support for interventions perceived to be invasive or high risk (gastric band surgery), stigmatising (social marketing) or commercially motivated (commercial diets and gastric band surgery). Personal experiences with weight and weight loss attempts strongly influenced attitudes. Conclusion: Obese adults support non-commercial, nonstigmatising interventions which are designed to improve lifestyles, rather than promote weight loss. While it is well established that depression is frequently comorbid with diabetes, it is still unclear whether screening for depression has utility. In this study the aims was to assess the impact of screening for depression in a hospital outpatient diabetes clinic by comparing the outcomes in patients with diabetes and depression following random allocation to three different management options. 1070 outpatients with type 1 and 2 diabetes were screening using the CES-D. Those that screened positive had a diagnosis of a major depressive episode (MDE) confirmed using the CIDI. Thus 178 patients with MDE were randomly allocated to direct referral to the hospital psychology service, information and a letter for patients to give to their primary care practitioner or usual care. Patients were assessed and then followed up six-months later to assess depression and diabetes outcomes. Patients in both the direct referral and the primary care conditions improved significantly on measures of depression compared to those in the usual care condition. However, only those patients in the primary care condition also improved significantly on a measure of diabetes control, HbA1. These findings suggest that screening for depression following by primary care is valuable in the management of diabetes. The lack of a well characterized state of the art in peer support interventions impedes their routine inclusion as standard and funded components of health care. A major challenge to efforts to characterize peer support is, in turn, the extent to which it is culturally contingent, that is, how characteristics of support are dependent on differing cultural, social, and organizational standards, norms or values. What is a sensitive offer of help in one culture may be intrusive in another or too reserved and thereby indicative of disinterest in a third. Additionally, varying attitudes toward health, fate, life and death as well as cultural contingencies surrounding key health behaviors such as diet add complexity to efforts to promote peer support across different countries. To address these challenges, Peers for Progress, a global program to promote peer support in health care, has followed a strategy of "standardization by function, not content." This identifies key functions of peer support across cultures and settings which, at the same time, allow for considerable flexibility in content of local implementation. Peers for Progress and its grantees have identified as key functions of peer support 1) assistance in daily management, 2) social and emotional support, 3) linkage to clinical care, and 4) ongoing availability of support. This symposium will explore how this approach has been realized in peer support programs in Australia, China, Thailand and Uganda. From Australia, Dr. Oldenburg will describe extension of support groups that Diabetes Australia-Victoria has established for over a decade to improve daily management, social and emotional support, and linkage to clinical care. From Hong Kong, Dr. Chan will describe "Pearl," a program that integrates peer support within "Jade," a program to promote algorithm based, systematic clinical care for diabetes in primary care. From Uganda, Dr. Baumann will describe challenges faced and successes of a peer support program in small, severely under-resourced villages. Finally, Dr. Boothroyd will describe how these and the other eleven project of Peers for Progress have increased understanding of important features of the four key functions of peer support, identified important aspects of implementation, and addressed programmatic, cultural and organizational challenges. Across all of these, identification of common functions guides program development that reflects generalized knowledge while allowing for tailoring to the strengths and characteristics of populations, cultures, and settings. Diabetes is a killing and costly disease although many of its complications are preventable and highly treatable. The Joint Asia Diabetes Evaluation (JADE) Program is the first web-based program incorporating a comprehensive risk engine, care protocols, clinical decision and self management support to improve ambulatory diabetes care. It uses state-of-the-art information technology to facilitate healthcare professionals to create a diabetes registry. The JADE e-portal also incorporates an interactive risk engine which stratifies patients into different risk levels based on clinical and biochemical data measured annually. With this risk stratification, the JADE e-portal recommends a care protocol tailored to these risk levels with decision support triggered by various risk factors. On top of 'High-Tech' accessories, quality diabetes care requires informed-decisions of motivated care providers and diabetes patients. We started the Peer Support, Empowerment And Remote Communication Linked By Information Technology (PEARL) Study in early 2009 in Hong Kong to use peer support and information technology to facilitate care providers to implement structured care and empower diabetes patients acquire selfmanagement skills. PEARL is a multi-component program making use of peer support, JADE Program and the Australasian Telephone Linked Care (TLC) system. TLC system utilizes an automatic, interactive, computer-controlled telephone system to enhance knowledge on diabetes self-management The PEARL Program involves trained mentors who are themselves diabetes patients with good self care and are motivated to support their peers. Diabetes patients receiving structured care in Hong Kong through the JADE Program will be recruited as mentees. They will receive peer support by the mentors (1 mentor to 10 diabetes patients or mentees) through regular phone calls and sharing session. They will also be reminded to use the TLC for knowledge enhancement and motivational support. Effects of various components of peer support on the patients' disease control as well as user acceptability and cost-effectiveness of these programs will be examined. We believe the combined use of a registry, structured care protocol and peer support will make quality diabetes care more accessible, sustainable and affordable, especially in resource-scare areas. Diabetes Australia-Victoria (DA-Vic) is a very well established NGO that has sustained a community network (ComNet) of support groups for people with diabetes for more than a decade. They aim to convey expert information about diabetes and to provide social support to members. Building on this experience S266 Int.J. Behav. Med. (2010) 17(Suppl 1):S1-S329 over many years, the Australasian Peers for Progress Diabetes Program (PfP-DP) aims to implement and evaluate a peer-led group program to improve daily management, social and emotional support, and linkage to clinical care for people with type 2 diabetes (T2DM). Participants will be recruited from the membership of (1) the National Diabetes Services Scheme, an Australian government initiative for people with diabetes to obtain subsidized consumables, and (2) DA-Vic membership of people with T2DM. The intervention trial involves 12 groups of 8-12 people led by lay peer leader(s), who are receiving training in group facilitation, communication, goal setting and motivational skills. Groups will meet monthly for 12 months, during which time group participants will review difficulties with their diabetes care, successes and achievements. The control (waitlist) arm comprises 12 "virtual" groups of similar composition who do not meet and receive their usual care until after the first 12 months. All study participants, and peer leaders, receive 1-day of basic diabetes self-management education prior to intervention groups commencing. Primary outcome is based on cardiovascular risk score (using the UKPDS equations) at baseline, 12 and 18 month follow up. Secondary outcomes include self-care behaviors, psychosocial functioning and quality of life. The program will also undergo an economic evaluation. The program partnership with an NGO and program delivery by volunteer, lay peer leaders trained to support behavior change in people with T2DM could enhance program transfer to other countries within the Asia Pacific region, where lay workers and community health workers are already integral to delivery of health services. The purpose of this 3-month pilot intervention was to test the feasibility of a peer support program for persons with type 2 diabetes in a resource-poor setting. Using a pre-post-intervention design, data were collected on A1C, perceptions of social support, coping, and diabetes self-care behaviors. Outcomes were improved daily self-care behaviors, social and emotional support, A1C values, and linkages with healthcare providers. Peer Champions (n=19) were patients who attended the Mityana diabetes clinic, could speak and read English, and agreed to contact another patient with diabetes (Partner) at least weekly. Champions received education in diabetes self-care and in providing supportive communication to peer Partners. Peer Partners (n=27) were patients with diabetes who attended the Mityana Clinic. Champions and Partners met at a community meeting where diabetes self-care education was again provided, and participants were assigned to pairs or triads. Telephones provided were linked to a pre-paid network so that calls were free if they were to another peer or champion, or to a healthcare provider. Participants who completed the intervention (28 females, 13 males) had a mean age of 55 years (range=32 to 74) and a mean duration of diabetes of 6.5 years. A post-intervention meeting was held with 16 Champions and 25 Partners to complete measurements and share experiences. Sixty-six percent of participants reported peer contact at least weekly. There was no change in scores on a 5-item diabetes coping scale, a 14-item barriers scale, physical activity or missing medications. Perceptions of social support from family and friends and a single item rating on "confidence in managing diabetes" significantly decreased (p=.03, and p=.02 respectively). There was improvement in eating behaviors (p<.001) and 77.8% reported that they contacted the clinic and healthcare providers more often than prior to the intervention. The most striking finding was a reduction (p<.05) in mean A1C from 9.8% to 6.8% (by IFCC standards). Eighty percent of participants indicated that the most helpful aspects of peer support were 'advice about taking care of diabetes' and 'encouragement to contact the clinic'. Participants especially liked using pre-paid telephones to contact healthcare providers and peers and receiving written material about diabetes self-care; however, most would have preferred materials in the local language and 92% reported difficulty reading because of poor eyesight. In conclusion, both providers and peers were actively engaged in a program that resulted in improved glycemic control and linkages with healthcare providers; other results may be explained by the resource-poor setting and unique cultural factors. In addition to the programs from Australia, China and Uganda described in this symposium, Peers for Progress has funded 11 other projects representing Argentina, Cameroon, England, South Africa, Thailand, and the United States. Observations from these provide opportunity for identifying ways in which generalizable key functions of peer support (assistance in daily management, social and emotional support, linkage to clinical care, and ongoing support) are represented in programs as well as ways in which programs are tailored to local characteristics or strengths. In particular, the experiences of individual projects have led not to major changes in the four key functions but to a) enhanced understanding of several of them, b) recognition of important implementation considerations, and c) attention to challenges in implementation. Enhanced understanding of the important of the functions has included recognition of the importance of attention to medications and adherence in a disease like diabetes, emotional and social support, and assisting individuals in navigating the health care system. Implementation considerations include recognizing varied modes of delivery (face-to-face, individual, group, telephone, etc.), the needs not just of individuals but of their family and caregivers, and the need of support providers for their own ongoing encouragement and support. In implementation, recognition has also grown regarding the importance of integration of understanding of the role of peer support across members of the health care team so that everyone delivers a solid and common message though they may be using different "languages." Challenges have included the widespreaqd and substantial barriers individuals face in transportation, infrastructure (e.g., electricity), and employment, difficulties in negotiating and establishing organizational partnerships, encouraging among peer supporters a stance of "peerage" rather than teaching, and cultural challenges such as those related to roles of women, roles of patients vis a vis professionals, etc. The four functions of peer support that Peer for Progress has emphasized provide important structure to thinking about peer support across national lines, but, nevertheless, leave much room for attention to the kinds of needs and challenges which successful implementation in individual settings must address. Insomnia is one of the most common complaints in the general population, and is associated with a range of adverse consequences and conditions. In the four presentations in this symposium, we focus on various aspects of insomnia at different stages throughout the life-span. Beginning with a longitudinal study on children with chronic illness, Dr Mari Hysing will present data on the chronicity of insomnia, as well as on behavioral and emotional correlates in this population. Dr Paula Salo will then present data from a Finish cohort examining the effect of insomnia on a range of depression-related outcomes. Dr Arnstein Mykletun will then present data on the association between individual and combined anxiety/depressive symptoms and insomnia, and cause specific mortality over a 3-6 year period. Finally, Dr. Børge Sivertsen will explore the consequences of chronic use of sleep medication among the elderly. Background: Children with a chronic illness have an increased rate of sleep problems and this has previously been related to emotional problems. Less is known about what specific aspects of emotional problems that contribute to sleep problems, and if sleep can predict the development of emotional problems in children with a chronic illness. Aim: The aim of this study was to assess the relation between sleep problems and emotional problems in general and more specifically; anxiety, perfectionism and obsessive compulsive symptoms in children with a chronic illness. Further, we want to examine sleep problems as a predictor of emotional problems from the age of 7-9 to 11-13. Methods: Using data from a longitudinal total population study in Norway, The Bergen Child Study, data on sleep problems, chronic illness, emotional and behavioral problems (SDQ; Strength and Difficulties Questionnaire) and anxiety (SCARED) were assessed at ages 7-9 and 11-13. Results: 496 children with a chronic illness in the age group 11-13 participated in the Bergen Child study, including a 295 of 4025 (7.3%) in the longitudinal sample. Children with a chronic illness had a higher rate of sleep problems and anxiety symptoms than their peers (p<0.001). In children with a chronic illness sleep problems were related to anxiety symptoms both based on parent and child report. Sleep problems were independent risk factors of later emotional problems (odd ratio=3.5), also when adjusting for emotional problems at time 1 (odd ratio=3.0). Conclusions: Emotional problems in general and anxiety more specifically, were related to sleep problems in children with chronic illness. Sleep problems predicted the development of emotional problems over time. Based on the results screening for anxiety is recommended as a part of sleep assessment in children with a chronic illness. Background: Depression is reported to be associated with increased mortality, although underlying mechanisms are uncertain. Increased cardiovascular (CVD) mortality and suicide is reported in depression, but the effect of depression on other causes of death is uncertain. The few studies of anxiety or insomnia in relation to mortality have produced inconclusive Results: Aims To investigate associations between individual and combined anxiety/ depression symptom loads (HADS) and insomnia, and cause specific mortality over a 3-6 year period. Method: We utilized a unique link between a large population survey (HUNT-2, n=61,349) and a comprehensive mortality database.