Effects of Country of Origin on Consumer Product Evaluations: Finnish clothing products in the minds of Russian tourists

Companies operating in today’s highly internationalized markets consider product differentiation the key priority in pursue to attain a constant competitive advantage in challenging global environment (Baker and Ballington 2002, 158). The main driver affecting companies’ differentiation actions was described as early as 1912 by one of the marketing pioneers A. W. Shaw (1912, 710) as meeting human wants more accurate than the competition, and thus increasing customers’ perceived value and satisfaction. Dickson and Ginter (1987, 2) point out in their study based on earlier research by Chamberlin (1965) and Porter (1976) that differentiation can be based on either tangible characteristics of a product such as design or intangible characteristics such as a brand name and country of origin (hereafter referred to as COO). The concept of COO and its impact on consumers’ evaluation of a product as an extrinsic product cue has been one of the most noteworthy topics in international marketing, having been voluminously examined by over 780 authors in more than 750 academic publications in the past 40 years (Papadopoulos and Heslop 2002, 294). Many of these studies accentuate the significant effect the COO has on consumers’ product attribute evaluations. People routinely associate country images with products and services in order to judge and categorize them based on perceived quality and risk levels; thereby COO can influence the likelihood of a purchase (Peterson and Jolibert 1995, 883-884; Verlegh and Steenkamp 1999, 523). Based on the vast research related to COO in the field of international business, it is widely recognized that the country associated with a product can act in a similar way as the name of a brand and even become a part of product’s total image. Thereby depending on customer’s values and perceptions, the product-country image can either increase or decrease perceived value.

Riskienhallinnan huomioiminen tilintarkastusasiakkaan hyväksymisprosessissa - kokemuksia suurista tilintarkastusyhteisöistä

Tämän tutkimuksen tarkoituksena on selvittää, miten riskienhallinnan näkökulma on huomioitu Suomessa toimivien suurten tilintarkastusyhteisöjen asiakashyväksyntäprosesseissa. Asiakashyväksyntä on tilintarkastusprosessin ensimmäinen vaihe. Tutkimuksen tiedonhankinnan strategiana käytettiin teemahaastattelua ja tutkimuksessa haastateltiin kolmea asiakashyväksynnän näkökulmasta eri rooleissa toimivaa tilintarkastajaa. Kirjallisuuskatsauksessa perehdytään sekä tilintarkastusprosessiin että riskienhallintaan liittyvään kirjallisuuteen. Tutkimuksen tuloksena todettiin, että tutkitut tilintarkastusyhteisöt ovat kehittäneet ja formalisoineet asiakashyväksyntäprosessejaan jatkuvasti riskienhallintanäkökulman huomioiden. Automatisoidut tietojärjestelmät ovat nousseet yhä merkittävämpään rooliin ja myös asiakashyväksyntään liittyvää päätöksentekopolkua on mietitty ja uudistettu. Tutkimuksen tuloksena vahvistui näkemys siitä, että aiemmissa tutkimuksissa esitetty toimeksiantoriskin käsite kuvaa myös suomalaisten tilintarkastajien asiakashyväksyntävaiheessa tekemiä riskiarvioita. Merkittävimpinä pidettiin erilaisia tilintarkastusyhteisön maineeseen vaikuttavia riskitekijöitä sekä asiakkaan henkilökysymyksiin liittyviä seikkoja. Tilintarkastajien todettiin tarkastelevan sekä riskin negatiivisia puolia että myös siihen liittyviä positiivisia mahdollisuuksia. Varsinaisia aktiivisia riskienhallinnan toimenpiteitä tärkeämmäksi koettiin se, että asiakkaaseen liittyvät riskit kartoitetaan ja arvioidaan asianmukaisesti. Asiakashyväksynnän merkityksestä riskienhallinnassa voidaan todeta, että sitä pidettiin niin sanottuna ensimmäisenä suojamuurina, jonka avulla voidaan pyrkiä suojautumaan erityisesti sellaisia riskejä vastaan, joihin ei enää myöhemmässä vaiheessa voida tilintarkastustoimenpiteillä vaikuttaa. Tällöin liian korkeariskiset asiakkaat jätetään hyväksymättä - ei niinkään pyritä suunnittelemaan riskiä alentavia toimenpiteitä, joiden avulla asiakas voitaisiin hyväksyä.

Sijoittajien käyttäytyminen matalassa korkomarkkinassa

Tämän Pro gradu –tutkielman aiheena on tutkia sijoittajien käyttäytymistä matalassa korkomarkkinassa. Työssä tutkitaan, ovatko Kymenlaakson Osuuspankin Private –asiakkaat käyttäytyneet rahoituksen klassisen teorian mukaan rationaalisesti. Lisäksi tutkielmassa tutkitaan, ovat asiakkaat nostaneet sijoituksiensa riskitasojaan saadakseen korkeampia tuottoja riskittömän koron ollessa matalalla. Tutkielmassa tutkitaan myös, onko sijoittajien ankkurina riskitaso vai tuottotaso sekä onko naisten ja miesten välillä eroja. Tutkielman teoriapohjana käytetään perinteisiä rahoituksen teorioita, kuten CAPM-mallia, SML-käyrää, riskitöntä korkokantaa, markkinatehokkuutta sekä behavioristista taloustiedettä. Tutkimus on kvalitatiivinen ja sen empiirinen on kerätty haastattelulomakkeella Kymenlaakson Osuuspankin Private –asiakkailta. Johtopäätöksenä voidaan sanoa, etteivät tutkimukseen osallistuneet henkilöt olleet käyttäytyneet rationaalisesti. Sijoituksien riskitasoa oli nostettu ja miehet olivat nostaneet sijoituksien riskitasoa enemmän. Päätöksenteossa naisille oli hieman merkittävämpää sijoituksien riskitaso, kun taas miehille tärkeämpää oli tuottotaso. Kaikista vastaajista 51,8%:lle tuottotaso oli merkittävämpi tekijä.

Aineettomien riskien hallinta – case Itä-Suomen Biopankki

Aineeton pääoma nähdään organisaation keskeisenä kilpailutekijänä ja voimavarana. Se voi kuitenkin joissain tilanteissa olla organisaatiolle myös rasite tai jopa menestymistä heikentävä tekijä. Tutkimuksen tavoitteena oli laatia biopankin riskienhallinnalle malli, joka huomioi toimintaan vaikuttavat aineettomat riskitekijät ja toimii strategisena johtamisen ja toiminnan kehittämisen työvälineenä. Tutkimus toteutettiin tapaustutkimuksena, jossa käytettiin konstruktiivista tutkimusotetta. Biopankille luotiin konstruktio, riskienhallintamalli, jolla pyrittiin ratkaisemaan reaalimaailman ongelma ja samalla luomaan kontribuutiota tieteenalalle. Biopankki on uudentyyppinen organisaatio, joka kerää, hallinnoi ja säilyttää biologisia ihmisperäisiä näytteitä ja niihin liittyviä tietoja tulevaa tutkimusta varten. Toiminnan riskien taustasyyt ovat usein aineettomia, kuten toimintakulttuuri, asenne, osaaminen tai motivaatio. Tutkimuksessa löydettiin uusia biopankin toimintaan kytkeytyviä aineettomia riskejä koko aineettoman pääoman alueelta ja määriteltiin riskitasoihin perustuva lähestymistapa riskien hallintaan. Konstruktio aineettomien riskien hallintamalliksi sai selkeää vahvistusta tutkimuksen aineistosta, ja se voi toimia organisaation kehittämisen pohjana. Riskikartan luominen ja riskien arviointi ovat tekohetken poikkileikkauksia tilanteesta. Organisaation toiminta ja siihen kohdistuvat riskit ja mahdollisuudet muuttuvat ja kehittyvät. Riskien tunnistaminen lisää tietoa organisaatiosta ja sen toimintaympäristöstä, mikä luo puitteet myös uusien mahdollisuuksien tunnistamiselle. Sopivan riskienhallintamallin avulla voidaan löytää kilpailuetua suhteessa muihin organisaatioihin. Kilpailuetuna voi toimia myös muita parempi riskinkantokyky esimerkiksi toiminnan joustavuuden kautta.

Lappeenrannan teknillisen yliopiston jauhatuslaboratorion työturvallisuusanalyysi

Suomen työturvallisuuslaki vaatii työnantajia selvittämään työpaikan turvallisuuden ja poistamaan tai pienentämään siellä olevia vaaran riskejä. Tämä laki rinnastaa opiskelijan työntekijäksi ja yliopiston työnantajaksi. Turvallisuuden kartoitukseen on olemassa erilaisia riskianalyysimenetelmiä. Kaikissa menetelmissä analysoitavan kohteen vaaratekijät käydään läpi ja niiden aiheuttamien seurausten vakavuutta ja vaaran todennäköisyyttä arvioidaan. Näiden perusteella voidaan valita tarvittavat toimenpiteet. Yritys voi valita tarkoitukseensa sopivimman analyysimenetelmän tai yhdistellä eri menetelmiä. Tässä kandidaatin työssä Lappeenrannan teknillisen yliopiston jauhatuslaboratoriolle tehtiin riskikartoitus BS 8800-standardin mukaisesti. Riskikartoituksessa tuli ilmi vakaviakin puutteita jauhatuslaboratorion turvallisuudessa. Turvallisuuden parantamiseksi ilmi tulleille puutteille annettiin toimenpide-ehdotuksia. Toteutettujen toimenpiteiden jälkeen on laboratorion turvallisuutta seurattava ja aika ajoin riskianalyysi on tehtävä uudelleen, jotta laboratorion puutteet löydetään ja niihin voidaan puuttua. Näin laboratorio pysyy turvallisena esimerkiksi laitemuutosten jälkeen.

Biotransformation and endocrine disruptive effects of contaminants in ringed seals - implications for monitoring and risk assessment

Marine mammals are exposed to persistent organic pollutants (POPs), which may be biotransformed to metabolites some of which are highly toxic. Both POPs and their metabolites may lead to adverse health effects, which have been studied using various biomarkers. Changes in endocrine homeostasis have been suggested to be sensitive biomarkers for contaminant-related effects. The overall objective of this doctoral thesis was to investigate biotransformation capacity of POPs and their potential endocrine disruptive effects in two contrasting ringed seal populations from the low contaminated Svalbard area and from the highly contaminated Baltic Sea. Biotransformation capacity was studied by determining the relationships between congener-specific patterns and concentrations of polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), polybrominated diphenyl ethers (PBDEs) and their hydroxyl (OH)- and/or methylsulfonyl (MeSO₂)-metabolites, and catalytic activities of hepatic xenobiotic-metabolizing phase I and II enzymes. The results suggest that the biotransformation of PCBs, PBDEs and toxaphenes in ringed seals depends on the congener-specific halogen-substitution pattern. Biotransformation products detected in the seals included OH-PCBs, MeSO₂-PCBs and –DDE, pentachlorophenol, 4-OHheptachlorostyrene, and to a minor extent OH-PBDEs. The effects of life history state (moulting and fasting) on contaminant status and potential biomarkers for endocrine disruption, including hormone and vitamin homeostasis, were investigated in the low contaminated ringed seal population from Svalbard. Moulting/fasting status strongly affected thyroid, vitamin A and calcitriol homeostasis, body condition and concentrations of POPs and their OH-metabolites. In contrast, moulting/fasting status was not associated with variations in vitamin E levels. Endocrine disruptive effects on multiple endpoints were investigated in the two contrasting ringed seal populations. The results suggest that thyroid, vitamin A and calcitriol homeostasis may be affected by the exposure of contaminants and/or their metabolites in the Baltic ringed seals. Complex and non-linear relationships were observed between the contaminant levels and the endocrine variables. Positive relationships between circulating free and total thyroid hormone concentration ratios and OH-PCBs suggest that OH-PCBs may mediate the disruption of thyroid hormone transport in plasma. Species differences in thyroid and bone-related effects of contaminants were studied in ringed and grey seals from low contaminated references areas and from the highly contaminated Baltic Sea. The results indicate that these two species living at the same environment approximately at the same trophic level respond in a very different way to contaminant exposure. The results of this thesis suggest that the health status of the Baltic ringed seals has still improved during the last decade. PCB and DDE levels have decreased in these seals and the contaminant-related effects are different today than a decade ago. The health of the Baltic ringed seals is still suggested to be affected by the contaminant exposure. At the present level of the contaminant exposure the Baltic ringed seals seem to be at a zone where their body is able to compensate for the contaminant-mediated endocrine disruption. Based on the results of this thesis, several recommendations that could be applied on monitoring and assessing risk for contaminant effects are provided. Circulating OH-metabolites should be included in monitoring and risk assessment programs due to their high toxic potential. It should be noted that endogenous variables may have complex and highly variable responses to contaminant exposure including non-linear responses. These relationships may be further confounded by life history status. Therefore, it is highly recommended that when using variables related to endocrine homeostasis to investigate/monitor or assess the risk of contaminant effects in seals, the life history status of the animal should be carefully taken into consideration. This applies especially when using thyroid, vitamin A or calcitriolrelated parameters during moulting/fasting period. Extrapolations between species for assessing risk for contaminant effects in phocid seals should be avoided.

Conventional and novel cardiovascular risk factors in young Finns and their associations with structural and functional vascular changes of subclinical atherosclerosis. The Cardiovascular Risk in Young Finns Study

Background: Atherosclerosis begins in early life progressing from asymptomatic to symptomatic as we age. Although substantial progress has been made in identifying the determinants of atherosclerosis in middle to older age adults at increased cardiovascular risk, there is lack of data examining determinants and prediction of atherosclerosis in young adults. Aims: The current study was designed to investigate levels of cardiovascular risk factors in young adults, subclinical measures of atherosclerosis, and prediction of subclinical arterial changes with conventional risk factor measures and novel metabolic profiling of serum samples. Subjects and Methods: This thesis utilised data from the follow-ups performed in 2001 and 2007 in the Cardiovascular Risk in Young Finns study, a Finnish population-based prospective cohort study that examined 2,204 subjects who were aged 30-45 years in 2007. Subclinical atherosclerosis was studied using noninvasive ultrasound measurements of carotid intima-media thickness (IMT), carotid arterial distensibility (CDist) and brachial flow-mediated dilation (FMD). Measurements included conventional risk factors and metabolic profiling using highthroughput nuclear magnetic resonance (NMR) methods that provided data on 42 lipid markers and 16 circulating metabolites. Results: Trends in lipids were favourable between 2001 and 2007, whereas waist circumference, fasting glucose, and blood pressure levels increased. To study the stability of noninvasive ultrasound markers, 6-year tracking (the likelihood to maintain the original fractile over time) in 6 years was examined. IMT tracked more strongly than CDist and FMD. Cardiovascular risk scores (Framingham, SCORE, Finrisk, Reynolds and PROCAM) predicted subclinical atherosclerosis equally. Lipoprotein subclass testing did not improve the prediction of subclinical atherosclerosis over and above conventional risk factors. However, circulating metabolites improved risk stratification. Tyrosine and docosahexaenoic acid were found to be novel biomarkers of high IMT. Conclusions: Prediction of cardiovascular risk in young Finnish adults can be performed with any of the existing risk scores. The addition of metabonomics to risk stratification improves prediction of subclinical changes and enables more accurate targeting of prevention at an early stage.

Approaches to Supply Chain Risk Management: Identification, Analysis and Control

Supply chain risk management has emerged as an increasingly important issue in logistics as disruptions in the supply chain have become critical issues for many companies. The scientific literature on the subject is developing and in many respects the understanding of it is still in its infancy. Thus, there is a need for more information in order for scholars and practitioners to understand the causalities and interrelations that characterise the phenomenon. The aim of this dissertation is to narrow this gap by exploring key aspects of supply chain risk management through two maritime supply chains in the immediate region of the Gulf of Finland. The study contributes to the field in three different ways. Firstly, it facilitates the identification of risks on different levels of the supply chain through a systematic analysis of the processes and actors, and of the cognitive barriers that limit the actors’ visibility and their understanding of the operations and the risks involved. There is a clear need to increase collaboration and information exchange in order to improve visibility in the chain. Risk management should be a collaborative effort among the individual actors, aimed at obtaining a holistic picture. Secondly, the study contributes to the literature on risk analysis through the use of systemic frameworks that illustrate the causalities and linkages in the system, thereby making it easier to perceive the vulnerabilities. Thirdly, the study enhances current knowledge of risk control in identifying actor roles, risk visibility and risk controllability as being among the key factors determining risk-management effectiveness against supply-chain vulnerability. This dissertation is divided into two parts. The first part gives a general overview of the relevant literature, the research design and the conclusions of the study, and the second part comprises six research publications. Case-study methodology with systematic combining approach is used, where in-depth interviews, questionnaires and expert panel sessions are the main data collection methods. The study illustrates the current state of risk management in multimodal maritime supply chains, and develops frameworks for further analysis. The results imply that there are major differences between organizations in their ability to execute supply chain risk management. Further collaboration should be considered in order to facilitate the development of systematic and effective management processes.

Bone Health, Osteoporosis and Fracture Risk in Neurofibromatosis 1 - An Emphasis on Osteoclasts

Neurofibromatosis 1 (NF1) is an autosomal dominant hereditary syndrome, affecting skin, neural tissues and skeleton. Hallmarks of NF1 include benign cutaneous neurofibroma tumors, pigmentation lesions on the skin and in the iris, learning disabilities and predisposition to selected malignancies. Low bone mineral density (BMD) and osteopenia/osteoporosis are common in NF1. Osteoporosis is a systemic disorder characterized by low bone mineral density and increased fracture risk. Treatment of osteoporosis aims to prevent falls and decrease fracture risk. Osteoporosis is diagnosed in adults by measuring BMD and evaluating clinical risk factors of the patient. Bone turnover is a process of old bone resorbed by osteoclasts and new bone formed by osteoblasts. Multinuclear osteoclasts are derived from osteoclast progenitors, which can be isolated from peripheral blood. Osteoclast progenitors were isolated from 17 NF1 patients and healthy controls, and cultured in vitro to osteoclasts. NF1 osteoclasts are hyperactive, displaying increased differentiation and resorption capacity, abnormal morphology and tolerance to serum deprivation compared to control osteoclasts. These findings expanded the study to evaluate the effects of bisphosphonates, drugs designed to treat osteoporosis, in osteoclasts derived from blood samples of 20 NF1 and control persons. The number of control osteoclasts was expectedly reduced after bisphosphonate treatment. However, NF1 osteoclasts tolerated the apoptotic effect of alendronate, zoledronic acid and clodronate in vitro compared to controls. NF1-related osteoporosis was found in ~20 % of the patients, and selected laboratory parameters were measured. Patients with NF1 have increased levels of serum CTX and PINP, reflecting increased bone turnover in vivo. BMD decreases progressively in NF1 as evaluated in 19 NF1 patients 12 years after their initial BMD measurement. Patients with NF1-related osteopenia often progress to osteoporosis. This was found in patients aged 37-76.

Balancing creativity and risk intelligence in professional knowledge-intensive business services

The main strengths of professional knowledge-intensive business services (P-KIBS) are knowledge and creativity which needs to be fostered, maintained and supported. The process of managing P-KIBS companies deals with financial, operational and strategic risks. That is why it is reasonable to apply risk management techniques and frameworks in this context. A significant challenge hides in choosing reasonable ways of implementing risk management, which will not limit creative ability in organization, and furthermore will contribute to the process. This choice is related to a risk intelligent approach which becomes a justified way of finding the required balance. On a theoretical level the field of managing both creativity and risk intelligence as a balanced process remains understudied in particular within KIBS industry. For instance, there appears to be a wide range of separate models for innovation and risk management, but very little discussion in terms of trying to find the right balance between them. This study aims to shed light on the importance of well-managed combination of these concepts. The research purpose of the present study is to find out how the balance between creativity and risk intelligence can be managed in P-KIBS. The methodological approach utilized in the study is strictly conceptual without empirical aspects. The research purpose can be achieved through answering the following research supporting questions: 1. What are the characteristics and role of creativity as a component of innovation process in a P-KIBS company? 2. What are the characteristics and role of risk intelligence as an approach towards risk management process implementation in a P-KIBS company? 3. How can risk intelligence and creativity be balanced in P-KIBS? The main theoretical contribution of the study conceals in a proposed creativity and risk intelligence stage process framework. It is designed as an algorithm that can be applied on organizational canvas. It consists of several distinct stages specified by actors involved, their roles and implications. Additional stage-wise description provides detailed tasks for each of the enterprise levels, while combining strategies into one. The insights driven from the framework can be utilized by a vast range of specialists from strategists to risk managers, and from innovation managers to entrepreneurs. Any business that is designing and delivering knowledge service can potentially gain valuable thoughts and expand conceptual understanding from the present report. Risk intelligence in the current study is a unique way of emphasizing the role of creativity in professional knowledge-intensive industry and a worthy technique for making profound decisions towards risks.

Oxidized LDL lipids as a risk factor for atherosclerosis

University of Turku, Faculty of Medicine, Department of Clinical Medicine, Department of Physical Activity and Health, Paavo Nurmi Centre, Doctoral Programme of Clinical Investigation, University of Turku, Turku, Finland. Annales Universitatis Turkuensis. Medica – Odontologica, Turku, Finland, 2014. Background: Atherosclerosis progression spans an entire lifetime and has a wide pool of risk factors. Oxidized LDL (oxLDL) is a crucial element in the progression of atherosclerosis. As a rather new member in the atherosclerosis risk factor family, its interaction with the traditional pro-atherogenic contributors that occur at different ages is poorly known. Aims: The aim of this study was to investigate oxLDL and its relation to major contributing risk factors in estimating atherosclerosis risk in data consisting mostly of adult men. The study subjects of this study consisted of four different sets of data, one of which contained also women. The age range of participants was 18-100 years and totaled 2337 participants (of whom 69% were men). Data on anthropometric and hormonal parameters, laboratory measures and medical records were assessed during 1998-2009. Results: Obesity was paralleled with high concentrations of oxLDL, which consequentially was reduced by weight reduction. Importantly, successful weight maintenance preserveed this benefit. A shift from insulin sensitivity to insulin resistance increased oxLDL. Smokers had more oxLDL than non-smokers. A combination of obesity and smoking, or smoking and low serum total testosterone,resulted in even higher levels of oxLDL than any of the three conditions alone. Proportioning oxLDL to HDL-c or apoA1 stood out as a risk factor of all-cause mortality in the elderly. Conclusions: OxLDL was associated with aging, androgens, smoking, obesity, insulin metabolism, weight balance and other circulating lipid classes. Through this variety of metabolic environments containing both constant conditions (aging and gender) as well as lifestyle issues, these findings supported an essential and multidimensional role that oxLDL plays in atherosclerosis pathogenesis.

Linking supplier delivery risk to outbound delivery service performance improvement

Customer satisfaction should be the main focus for all of the parts of the business. Usually supply chain behind the business is in a key role when this focus is pursued especially in repair service business. When focusing on the materials that are needed to make repairs to equipment under service contracts, the time aspect of quality is critical. Do late deliveries from supplier have an effect on the service performance of repairs when distribution center of a centralized purchasing unit is acting as a buffer between suppliers and repair service business? And if so, how should the improvement efforts be prioritized? These are the two main questions that this thesis focuses on. Correlation and linear regression was tested between service levels of supplier and distribution center. Percentage of on-time deliveries were compared to outbound delivery service level. It was found that there is statistically significant correlation between inbound and outbound operations success. The other main question of the thesis, improvement prioritization, was answered by creating material availability based supplier classification and additional to that, by developing the decision process for the analysis of most critical suppliers. This was built on a basis of previous supplier and material classification methods.

Cardiovascular health from childhood to adulthood – with special reference to early vascular changes. The Cardiovascular Risk in Young Finns Study

Background: Recent recommendations aim to improve cardiovascular health (CVH) by encouraging the general population to meet positive and modifiable ideal CVH metrics: not smoking, being physically active, and maintaining normal weight, blood pressure, blood glucose and total cholesterol levels and a healthy diet. Aims: The aim of the present study was to report the prevalence of ideal CVH in children and young adults and study the associations of CVH metrics with markers of subclinical atherosclerosis. Participants and methods: The present thesis is part of the Cardiovascular Risk in Young Finns Study (Young Finns Study). Data on associations of CVH metrics and subclinical atherosclerosis were available from 1,898 Young Finns Study participants. In addition, joint analyses were performed combining data from the International Childhood Cardiovascular Cohort (i3C) Consortium member studies from Australia and the USA. Results: None of the participants met all 7 CVH metrics and thus had ideal CVH in childhood and only 1% had ideal CVH as young adults. The number of CVH metrics present in childhood and adulthood predicted lower carotid artery intima-media thickness, improved carotid artery distensibility and lower risk of coronary artery calcification. Those who improved their CVH status from childhood to adulthood had a comparable risk of subclinical atherosclerosis to participants who had always had a high CVH status. Conclusions: Ideal CVH proved to be rare among children and young adults. A higher number of ideal CVH metrics and improvement of CVH status between childhood and adulthood predicted a lower risk of subclinical atherosclerosis.