Abstract Body: Background
Psychosocial factors in childhood, such as emotional and behavioral difficulties, contribute to long-term cardiovascular health (CVH). However, limited research has explored the relationship between these difficulties and childhood CVH.

Methods
This cross-sectional analysis includes participants aged 2-18 (N = 6,892) from the Young Hearts cohort with complete behavioral CVH (bCVH) and Strengths and Difficulties Questionnaire (SDQ) data. SDQ scores included the Total Difficulties Score (TDS), measuring emotional and behavioral difficulties, and the Prosocial Behavior Score (PBS), reflecting empathy and cooperation. We calculated bCVH scores using the Life’s Essential 8 metrics (diet, exercise, nicotine exposure, sleep, and BMI). Linear regression was used to assess associations between TDS, PBS, and bCVH, adjusting for age, sex, race/ethnicity, parental education, financial stability, food security, and health insurance status.

Results
The sample had a mean age of 8.7, 48% female, 46% non-Hispanic White, 28% Hispanic, and 15% non-Hispanic Black. Higher TDS was associated with lower bCVH (-1.91; 95% CI -2.27, -1.56), while higher PBS was linked to better bCVH (1.75; 95% CI 1.41, 2.1), and physical activity largely contributed to these differences (Figure 1).

Conclusion
Psychosocial difficulties and prosocial behaviors have a strong association with physical activity, making it a potential intervention target for improving childhood CV outcomes. Enhancing prosocial behaviors through interventions like social-skills training may further support both psychosocial well-being and cardiovascular health in children.