Social-Cognitive Factors in Changing Health-Related Behaviors

Self-Perception Profile, Body Image Perception and Satisfaction in Relation to Body Mass Index: An Investigation in a Sample of Adolescents from the Campania Region, Italy

(1) Background: Body image dissatisfaction has been commonly reported in adolescents with overweight/obesity and has been related to a lack of motivation to change lifestyle behaviors. Plus, a better perception of physical fitness has been related to a higher self-perception in physical aspect and social items in youths. (2) Methods: A total of 120 (59.2% males, mean age of 12.3 ± 0.9 years) middle-school adolescents participated in the present study. Anthropometric measurements were assessed following the standard procedures. Body weight perception and body image satisfaction were assessed using the Silhouette Figure Body Images Test. Self-perception profile, perceived physical fitness, and perceived difficulties in conducting physical tasks were assessed by using structured questionnaires. (3) Results: Overweight was present in 27.5% adolescents and obesity in 32.5%. A total of 89.7% of adolescents with obesity did not have a real perception of his/her weight status and 84.6% of adolescents with obesity were not satisfied with his/her body image. The self-perception of physical appearance, perceived difficulties in running, perceived overall fitness, and perceived speed/agility were lower in adolescents who were unsatisfied with their body image. Body image satisfaction was positively associated with the self-perception of physical appearance and overall fitness and negatively associated with perceived difficulties in running, independently of sex, age, and BMI. (4) Conclusions: Adolescents with obesity did not have a real perception of their weight status and were unsatisfied with their body image. The positive association between body satisfaction, a better perception of overall fitness, and less difficulties in conducting physical tasks suggests the protective role of the components of physical activity and health-related fitness on body acceptance in a critical period of life.

Ability-Related Emotional Intelligence: An Introduction

Emotionally intelligent people are thought to be more skilled in recognizing, thinking about, using, and regulating emotions. This construct has garnered considerable interest, but initial enthusiasm has faded and it is time to take stock. There is consensus that ability-related measures of emotional intelligence (EI) can be favored to self-report tests, in part because the resulting scores cannot be equated with personality traits. However, there are questions surrounding measurement as well as predictive value. Experts in the field were encouraged to chart new directions, with the idea that these new directions could reinvigorate EI scholarship. Special Issue papers speak to theory, mechanism, measurement, and training. In addition, these papers seek to forge links with research traditions focused on interpersonal perception, emotional awareness, and emotion regulation. As a result of these efforts, new insights into what EI is and how it works can be anticipated in upcoming years.

"If this is what it means to be old…": a mixed methods study on the effects of age simulation on views on aging and perceptions of age-related impairments

Age simulation suits are a promising tool to increase empathy and to promote positive attitudes toward older adults. However, studies have largely focused on (young) healthcare professionals, are probably biased by social desirability, and have not addressed participants' views of the aging process triggered by the simulation. The current work combines two studies addressing effects of aging suits on both general and personal views on aging among heterogeneous samples, and exploring spontaneous associations during the simulation. In study 1, N = 165 adults (M = 37.1 years, SD = 15.4, range 18-74 years) answered questionnaires containing general views regarding older adults ("old people are…") as well as personal perceptions ("aging means to me…") before and after wearing an aging suit. In study 2, young adults (N = 22; M = 24.8 years, SD = 4.3, range 20-38 years) and middle-aged adults (N = 41; M = 60.8 years, SD = 6.9, range 40-75 years) carried out established geriatric assessments with and without aging suit, and spontaneous impressions on the instant aging experience were recorded. Findings indicated negative shifts in both general and personal views on aging measures in both age groups (d = .30 to d = .44). Analyses of qualitative data resulted in seven main themes, e.g., "strain/coordination", "future me", "empathy/insight". Group comparisons revealed higher frequencies of future-self related thoughts among middle-aged adults, whereas younger adults mentioned predominantly physical effects of the suit. In conclusion, applying age simulation suits might evoke unintended negative views on aging. In comparison with young adults, middle-aged adults showed broader reflections including thoughts related to emotions, future-self, and potential struggles of older people.

A psycho-social-environmental lens on radon air pollutant: authorities', mitigation contractors', and residents' perceptions of barriers and facilitators to domestic radon mitigation

Introduction

Radon is a major indoor air pollutant that poses a significant risk of lung cancer to those exposed in their homes. While mitigation of high radon levels in homes has been shown to be effective, home mitigation rates remain low. This study examines the barriers and facilitators to radon mitigation in homes from the perspectives of authorities responsible for radon risk management, the mitigation industry (contractors), and residents in four European countries (Belgium, Ireland, Slovenia, and the UK) with high radon risks and low mitigation rates.

Methods

A multi-method approach was used to gather data from various stakeholders, including online surveys, content analysis of legal documents, group interviews, workshops, and focus groups.

Results

Authorities, contractors, and residents identified various facilitators to radon mitigation, including legal requirements for mitigation, awareness campaigns, low mitigation costs, availability of financial support, accreditation of mitigation contractors, and a perception of radon as a health threat. However, barriers to mitigation were also identified, such as a lack of awareness, fragmented mitigation processes, and inadequate communication between stakeholders.

Discussion

The study highlights the complexity of the radon mitigation process and suggests that interventions aimed at increasing mitigation rates should target stakeholders beyond just residents, such as constructors, health professionals, and policy makers. An integrated approach to radon mitigation, from policy to provision, is necessary to effectively lower levels of this indoor air pollutant.

Non-consciously processed physical activity for survival versus consciously deliberated exercise for health

Humans evolved to become dependent on physical activity for their survival, but they have not evolved to exercise today. Because survival in modern society is heavily reliant on conscious thinking, most people (54%) have evolved away from physical activity and become occasional exercisers. This transition from non-conscious to conscious processing prevents people from capitalizing on evolution's wisdom for survival and wellbeing as they consciously deliberate on the utility of health practices to achieve certain outcomes (e.g., weight loss). Unlike in early times, people today have a choice of not engaging in physical activity and yet surviving. As a result, they struggle with the question whether the gains from exercising are greater than losses from not doing it, weighing positive gains and losses against negative gains and losses. Such conscious deliberations, however, can easily be overridden by solving cognitive dissonance (e.g., "exercise is good for my health" vs. "I don't exercise") through conscious rationalizations and non-conscious dismissal. Today's exercise problem can only be solved by individually acquiring the mindset of early times of evolution when the initiation of physical activity was largely a matter of non-conscious thoughts and feelings.

The Association of Gender Role Attitudes and Risky Drinking: Changes in the Relationship between Masculinity and Drinking in Korean Young Men

Recently, younger men in Korean society tend not to view drinking as a proud feature of men who work. The relationship between gender role attitudes and high-risk drinking is expected to change accordingly. An online survey was conducted in January-February 2022, and the frequency of drinking, the amount of drinking, and traditional gender role attitudes, such as "men should be independent and women should take care of the children", were measured. Participants were 786 men aged between 19 and 69 years. When comparing men in their 20s and 30s with those in their 40s to 60s, the younger men reported drinking relatively high amounts of alcohol in one place, and older men had a relatively high frequency of drinking. High-risk drinking was significantly higher in the older group. Gender role attitudes were more traditional in the older group and were a predictor of high-risk drinking in older men, but there was no significant relationship between the two variables in the younger age group. The results indicate that different generations have different perceptions of how men should drink. In addition to more detailed qualitative research on drinking motivation by generation, research on whether similar changes are occurring in other countries is needed.

Intelligent physical activity versus modified behavioral activation in adolescent and young adult cancer patients with psychological distress: A randomized, controlled pilot trial

BACKGROUND

More than 80% of adolescent and young adult cancer patients (AYACPs) experienced psychological distress. Physical activity and behavioral activation are effective to relieve the psychological distress in AYACPs.

METHODS

Participants aged 15-39 years diagnosed with malignant tumors were included. A total of 143 eligible AYACPs were randomly assigned to three groups. The treatment-as-usual group (N = 48) received routine care, the physical activity group (N = 47) received 8 weeks of physical activity program based on intelligent wearable devices, and the behavioral activation group (N = 48) received an internet-based modified behavioral activation program for 8 weeks. Objective outcome measures included salivary cortisol and testosterone.

RESULTS

Linear mixed-model analyses showed significant differences between treatment-as-usual, physical activity and behavioral activation in salivary cortisol, as well as total scores on depression and anxiety, physical activity, self-efficacy, and social support. Significantly stronger effect sizes for physical activity group compared with behavioral activation group were found on physical activity (d = 0.53) (1 week after intervention), moderate activity (d = 0.61), and walking activity (d = 0.57) (3-month follow-up).

CONCLUSIONS

Intelligent, wearable, device-based physical activity program is more effective in alleviating anxiety and depression, reducing saliva cortisol, and improving physical activity in AYACPs than internet-based modified behavioral activation program. Intelligent, wearable, device-based physical activity program can reduce the time cost of AYACPs to ensure that the intervention is carried out.

Community-based exercise enhanced by a self-management programme to promote independent living in older adults: a pragmatic randomised controlled trial

BACKGROUND

older adults face several modifiable barriers for engaging in physical activity (PA) programmes such as incontinence, loneliness and fear of falling. Enhancing PA programmes with behavioural components to support self-management of such barriers may increase the effectiveness to preserve functional capacity and independent living.

OBJECTIVE

this study aimed at assessing the effects of a complex active lifestyle intervention (CALSTI) on objective and self-report measures of functional capacity and disability in community-dwelling older adults.

SUBJECTS AND METHODS

about 215 older adults (79.9 ± 0.4 years) at increased risk of functional decline were randomly allocated to (i) CALSTI consisting of 12-weeks progressive explosive resistance training (24 sessions) enhanced by a 24-week multi-factorial self-management programme (8 sessions), or (ii) an extended version of the self-management intervention (SEMAI; 12 sessions) to reflect a reinforcement of usual care. The interventions were embedded in a nationally regulated preventive care pathway. Blinded assessors collected primary (the Short Physical Performance Battery; SPPB) and secondary outcome data (self-reported difficulty in activities of daily living, the short version of the Late-Life Function and Disability Index, and the EQ-health VAS scale) at baseline and after 12 and 24 weeks.

RESULTS

after 24 weeks, CALSTI led to a clinically superior increase in SPPB compared with SEMAI (+0.77 points, P < 0.01), and the CALSTI group also demonstrated improvements in selected self-reported outcomes.

CONCLUSIONS

a novel complex exercise and multi-factorial self-management intervention embedded in preventive care practice had large and clinically meaningful effects on a key measure of functional capacity and predictor of disability.

Psychological predictors of protective behaviours during the Covid-19 pandemic: Theory of planned behaviour and risk perception

The Covid-19 outbreak was declared a public health emergency by the World Health Organization in January 2020. As a consequence, several protective measures were urged by national governments in order to limit the spread of the pandemic. Drawing on the literature on health behaviours, in the present study, we investigated the psychological factors (i.e., attitudes, social norms, perceived behavioural control, intentions, and risk perception) that were associated with two highly recommended behaviours: frequent hand washing and social distancing (i.e., staying at home except for essential reasons). The study employed a correlational design with a follow-up. A questionnaire including measures of psychological predictors was administered via social media to a sample of 403 adults residing in Italy during the lockdown. Self-reported behaviours were assessed one week later. Findings showed that attitudes, social norms, perceived behavioural control were significantly related to hand washing and social distancing through intentions. Risk perception was a significant predictor of social distancing but not of hand washing. These findings suggest that intervention and communication strategies aimed at encouraging preventive measures during the Covid-19 pandemic should be organized taking into account multiple factors which partially differ depending on the type of behaviour considered. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

“Aging Means to Me… That I Feel Lonely More Often”? An Experimental Study on the Effects of Age Simulation Regarding Views on Aging

Over the last decades, educational programs involving age simulation suits (ASS) emerged with the ambition to further the understanding of age-related loss experiences, enhance empathy and reduce negative attitudes toward older adults in healthcare settings and in younger age groups at large. However, the impact of such “instant aging” interventions on individuals’ personal views on aging have not been studied yet. The aim of the current study is to address possible effects of ASS interventions on multiple outcomes related to views on aging, i.e., aging-related cognitions (i.e., expectations regarding social losses), awareness of age-related change (AARC) and age stereotypes. Moreover, we explore effects on broader constructs with relevance to aging, i.e., perceived obsolescence, risk perceptions, as well as desired support through technology. In a within-subjects design, N = 40 participants (M = 61.4 years, SD = 6.16) went through a series of established geriatric assessments (i.e., Timed up and Go) with and without an ASS. Views on aging constructs were assessed in standardized questionnaires before and after the ASS intervention. Changes in aging-related cognitions were observed, with more negative expectations regarding social integration and continuous development after wearing the ASS. AARC and age stereotypes did not change from pre- to post-assessment, but participants reported an increased susceptibility to age-associated impairments and stronger feelings of obsolescence. Those participants who exhibited higher difficulties in geriatric assessments while wearing the suit reported higher openness to be supported by intelligent assistive devices or robots afterwards. We conclude that ASS interventions should only be combined with education on losses and gains during the aging process to prevent negative effects on individual views on aging. On the other hand, potentials regarding technology acceptance and formation of intentions to engage in prevention and health behaviors among middle-aged to young-old adults are discussed.

Culinary Nutrition Education Improves Home Food Availability and Psychosocial Factors Related to Healthy Meal Preparation Among Children

OBJECTIVE

To evaluate the effectiveness of a culinary nutrition education intervention on children's home food availability and psychosocial factors related to healthy meal preparation.

DESIGN

Randomized-controlled trial.

SETTING

Schools in Kuala Lumpur, Malaysia.

PARTICIPANTS

Eighty-three school children aged 10-11 years and their parents.

INTERVENTION

Twelve weeks of culinary nutrition education with 5 hands-on healthy meal preparation modules and a module with parents on home food availability (conducted every 2 weeks).

MAIN OUTCOME MEASURES

Psychosocial factors (knowledge, attitude, practice, and self-efficacy) related to healthy meal preparation and home food availability (fruits, vegetables, healthful foods, and less healthful foods) assessed via children and parents, respectively, using validated questionnaires at baseline, postintervention, and 3-month follow-up.

ANALYSIS

Repeated measures ANOVA.

RESULTS

Intervention group had a higher (P < 0.001) mean knowledge score (mean difference, 1.2), attitude (mean difference, 2.6), practice (mean difference, 4.4) and self-efficacy (mean difference, 3.9) of healthy meal preparation as compared with control group across 3-time points. Improvements were seen in the availability of fruits (mean difference, 3.0; P < 0.001), vegetables (mean difference, 2.4; P < 0.001), healthful foods (mean difference, 1.5; P < 0.001) and less healthful foods (mean difference, -0.9; P = 0.001), favoring the intervention group.

CONCLUSION AND IMPLICATIONS

Culinary nutrition education had positive impact on children's psychosocial factors and home food availability, demonstrating the potential to improve children's nutrition.

Integrating self-efficacy in the cyclical process of paediatric asthma management: a new perspective

Asthma management consists of a cyclical process based on clinical assessment of the patient, the implementation of therapeutic adjustments, and evaluation of the patient's response. Self-efficacy is the person's confidence in his or her ability to successfully perform a behaviour and guides the patient's decisions for producing healthy behaviours.Studies have shown that asthma management is related to self-efficacy, which in turn can be influenced by various psychosocial factors. A literature search on the relationship between asthma and self-efficacy in paediatric age, has allowed us to hypothesize that adequate levels of self-efficacy might be achieved through a cyclical process, 'the self-efficacy cycle', taking into account assessment, identification of modifiable risk factors and patient's response. This would make it easier to identify the personal and social aspects on which to intervene to promote a proper management of the disease.

Using Trauma Informed Principles in Health Communication: Improving Faith/Science/Clinical Collaboration to Address Addiction

Problematic substance use is a pressing global health problem, and dissemination and implementation of accurate health information regarding prevention, treatment, and recovery are vital. In many nations, especially the US, many people are involved in religious groups or faith communities, and this offers a potential route to positively affect health through health information dissemination in communities that may have limited health resources. Health information related to addiction will be used as the backdrop issue for this discussion, but many health arenas could be substituted. This article evaluates the utility of commonly used health communication theories for communicating health information about addiction in religious settings and identifies their shortcomings. A lack of trusting, equally contributing, bidirectional collaboration among representatives of the clinical/scientific community and religious/faith communities in the development and dissemination of health information is identified as a potential impediment to effectiveness. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) tenets of trauma-informed practice, although developed for one-on-one use with those who have experienced trauma or adversity, are presented as a much more broadly applicable framework to improve communication between groups such as organizations or communities. As an example, we focus on health communication within, with, and through religious groups and particularly within churches.

Adherence to Recommended Preventive Behaviors During the COVID-19 Pandemic: The Role of Empathy and Perceived Health Threat

Background

Coping via empathic responding may play a role in preventive behavior engagement during the COVID-19 pandemic, and unlike trait empathy, is a potentially alterable target for changing health behavior.

Purpose

Our goal was to examine the role of empathic responding in preventive behavior engagement during the COVID-19 pandemic, independent of trait empathy and perceived threat of COVID-19.

Methods

Participants (N = 2,841) completed a baseline survey early in the pandemic, and a follow-up survey approximately 2 weeks later (M = 13.50 days, SD = 5.61). Preventive health behaviors, including physical distancing and hygiene practices, were assessed at both timepoints. Hierarchical linear regression examined the contributions of trait empathy, perceived threat of COVID-19, and empathic responding at baseline to preventive behaviors at follow-up.

Results

Controlling for baseline levels of preventive behaviors and demographic covariates, trait empathy and threat of COVID-19 at baseline were each independently associated with preventive behaviors at follow-up. An interaction between perceived threat and empathic responding indicated that those perceiving high threat of COVID-19 at baseline tended to report engaging in preventive behaviors at follow-up regardless of their levels of empathic responding, whereas for those reporting low levels of perceived threat, higher levels of empathic responding were associated with higher engagement in preventive behavior.

Conclusions

When perceived threat of COVID-19 was low, higher empathic responding was associated with increased engagement in preventive behaviors regardless of trait empathy, suggesting that empathic responding can serve as an actionable target for intervention to promote preventive behavior during the pandemic.

From ability to behavior: A scenario-based assessment of health competence predicts daily health behaviors

Recent findings have suggested that we can gain new insights into health decision-making and behavior through the use of a scenario-based approach to health competence (HC). The present research sought to investigate whether and how such individual differences would matter in the conduct of daily life, within two daily diary studies (N = 260). In Study 1, participants receiving higher HC scores were more active in dealing with daily stressors or problems; by contrast, low-HC individuals were more prone to impulsive and antisocial behaviors. Based on these promising results, the Study 2 protocol was a more extensive one. Participants who received higher HC scores thought about their health more often and engaged in diverse healthy behaviors more frequently. Conversely, low-HC individuals were prone to risky and unhealthy daily behaviors. In total, the findings provide key evidence in favor of a new approach to HC and its behavioral manifestations.

Physical Activity and Its Determinants among Senior Residents of Podlasie, a Green Region of Poland, Based on the National PolSenior Study

Physical activity is essential at all stages of life, and particularly so in the later years. The main objectives of the present work was to evaluate the physical activity of seniors, aged 65 years and older, living in the area of the Podlaskie voivodeship (Podlasie), Poland, based on the results of the nationwide PolSenior project, and to formulate recommendations for health policies implemented by both national and local government units. The study was performed as part of the national PolSenior project, whose aim was to evaluate various aspects of aging in Poland. The physical activity of a group of 186 randomly-selected people aged 65 years and above, 94 men and 92 women, was evaluated by questionnaire. The analysis included participants who took part in physical activity at least several times a week. Although all participants reported a decline in physical activity with age, the men remained physically active for longer. Among the respondents, 68.3% of women and 62.7% of men took short walks around the house as the main form of exercise, with working on the allotment or garden being another frequent activity; however, this was more common among men (53.9%) than women (34.7%). In addition, men were nearly twice as likely to take part in cycling (31.5%) than women (13.1%). The greatest motivation for physical activity given by the respondents was health, as noted by 73.8% of the men and 77.7% of the women. The physical activity of seniors in Podlasie is unsatisfactory and does not fulfil the WHO recommendations regarding the prophylaxis and prevention of chronic illness. This level does not, however, significantly differ from that reported in the nationwide PolSenior study or in other European countries in the Eurobarometer study. The decline in physical activity with age highlights the need for its greater promotion among seniors by local authorities. Such initiatives will help maintain the physical fitness and independence of this age group and contribute to a greater quality of life.

Mental imagery-based self-regulation: Effects on physical activity behaviour and its cognitive and affective precursors over time

OBJECTIVES

(1) Test whether a mental imagery-based self-regulation intervention increases physical activity behaviour over 90 days; (2) Examine cognitive and affective precursors of change in physical activity behaviour.

DESIGN

A randomized control trial with participants (N = 500) randomized to one of six intervention conditions in a 3 (risk communication format: bulleted list, table, risk ladder) x 2 (mental imagery behaviour: physical activity, active control [sleep hygiene]) factorial design.

METHODS

After receiving personalized risk estimates via a website on a smartphone, participants listened to an audiorecording that guided them through a mental imagery activity related to improving physical activity (intervention group) or sleep hygiene behaviour (active control). Participants received text message reminders to complete the imagery for 3 weeks post-intervention, 4 weekly text surveys to assess behaviour and its cognitive and affective precursors, and a mailed survey 90 days post-baseline.

RESULTS

Physical activity increased over 90 days by 19.5 more minutes per week (95%CI: 2.0, 37.1) in the physical activity than the active control condition. This effect was driven by participants in the risk ladder condition, who exercised 54.8 more minutes (95%CI 15.6, 94.0) in the physical activity condition than participants in the active control sleep hygiene group. Goal planning positively predicted physical activity behaviour (b = 12.2 minutes per week, p = 0.002), but self-efficacy, image clarity, and affective attitudes towards behaviours did not (p > 0.05).

CONCLUSIONS

Mental imagery-based self-regulation interventions can increase physical activity behaviour, particularly when supported by personalized disease risk information presented in an easy-to-understand format.

The Intensity Side of Volition

Abstract. Attaining sports or health goals requires not only high motivation but also the willpower to translate sport-behavior intentions into successful action. This volitional regulation calls for the mobilization of effort to overcome obstacles in the pursuit of goals. The present article provides a theoretical and empirical overview of motivation intensity theory ( Brehm & Self, 1989 ) – a conceptual framework that makes clear and testable predictions about effort mobilization in various contexts. First, we present the guiding principles of this theory and its operationalizations by measures of effort-related cardiovascular reactivity and physical handgrip force. Second, we review a selection of empirical tests of the basic assumptions of this theory and the impact of psychological moderator variables such as affect, fatigue, pain, and personality on effort mobilization. Finally, we discuss important implications of these findings for the sports and health domains and make suggestions for future research.

Evaluating the Feasibility of Continuing Medical Education for Disseminating Emerging Science on the Breast Cancer and Environment Connection

Developing continuing medical education (CME) training programs is a strategy for communicating emerging science to health practitioners. This research tests the feasibility of using CME modules for translating and disseminating research findings from the Breast Cancer and Environment Research Program. Recent findings have identified certain windows of susceptibility, like during puberty, in which exposure to endocrine-disrupting chemicals can increase breast cancer risk later in life. In order to reach pediatric patients and their caregivers, using a Diffusion of Innovations framework, pediatric health-care providers were identified as opinion leaders. Two CME modules informed by theory and formative research were tested with a sample of pediatricians and pediatric nurse practitioners. Participants completed knowledge, attitude, intention, and behavior items immediately before and after exposure to a randomly assigned module, and then again 3 weeks later. Quantitative and qualitative results indicate knowledge gain and strong links between practitioners' intentions to enact and implemented behavior learned from training recommendations with parents and caregivers in their practices. Results indicate that CMEs can be an effective strategy for translational activities targeted to health providers in order to change behavior within practice.

What influences new graduate nurses' core competencies transformation to clinical in China? A cross-sectional study

BACKGROUND

The core competencies of new graduate nurses (NGNs) have significant health outcomes in the clinical environment. However, these nurses experience a theory-practice gap, which creates a barrier in the transition process when they first enter the clinical workplace.

OBJECTIVE

To understand the general overview of the transition of the core competencies of NGNs to clinical practice in China and the influencing factors.

DESIGN AND SETTING

A cross-sectional study design consisting of a multi-stratified grounded random sample from 31 hospitals in seven regions nationwide.

PARTICIPANTS

2400 NGNs were recruited by email.

METHODS

The Competencies Inventory for Registered Nurse (CIRN) was applied to evaluate NGNs' core competencies.

RESULTS

NGNs performed best on leadership and worst on critical thinking or research aptitude. Core competencies were predicted by depressive symptoms, worked for two-three years, having a nurse-in-charge title, professional values, department, happiness, etc. Besides, the preceptor program also has significant to core competencies.

CONCLUSION

The average level of Chinese NGNs' core competencies was at a moderate level, which wasn't well optimized. It is recommended to adopt appropriate interventions to support NGNs. With an increase in work years and the accumulation of more work experience, the corresponding core competencies of NGNs will also improve. Preceptor institutions, limiting first-degree recruitment, and early ICU or operating room department rotations can be carried out by nursing educators to improve core competencies.

Effect of Two Interventions on Sleep Quality for Adolescent and Young Adult Cancer Survivors: A Pilot Randomized Controlled Trial

BACKGROUND

Sleep disturbance is common among adolescent and young adult (AYA) cancer survivors. Physical activity (PA) and behavioral activation (BA) therapy have been reported as enhancing sleep quality, but few studies exist on the effects of such interventions combined with technology to promote sleep quality in AYA cancer patients.

OBJECTIVE

The aim of this study was to investigate the feasibility and effects of intelligent wearable device-based PA therapy and internet-based modified BA therapy to improve sleep quality among AYA cancer patients.

METHODS

A randomized controlled trial with 143 AYA cancer patients was conducted. Participants were randomly assigned to a control group (n = 48), which performed routine care, a PA group (n = 47), which received 8-week PA therapy based on intelligent wearable devices, and a BA group (n = 48), which participated in internet-based modified BA therapy for 8 weeks.

RESULTS

At 1 week and 3 months after the intervention for sleep quality, there were statistically significant differences between the PA group and the control group (P = .020), but no statistically significant difference between the BA group and the control group.

CONCLUSIONS

The intelligent wearable device-based PA therapy has more advantages than internet-based modified BA therapy in improving the overall state of AYA cancer patients, and the intervention effect was sustained for at least 3 months.

IMPLICATIONS FOR PRACTICE

Developing and implementing PA plans for AYA cancer survivors can improve their sleep quality. Social media, intelligent wearable devices, and mobile health applications have unique advantages in promoting sleep quality for AYA cancer survivors.

More than just a mental stressor: psychological value of social distancing in COVID-19 mitigation through increased risk perception-a preliminary study in China

Social distancing is an effective measure to prevent epidemic infections during a pandemic outbreak, but its psychological value in COVID-19 pandemic mitigation remained less detected. Our study fills this gap by conducting a nationwide survey in China between 12 and 25 February (2020), and a follow-up survey targeting the same participants between 25 and 28 March (2020). We have discovered that perceived increased time staying at home, a subjective agency for social distancing, positively predicts not only risk perception of COVID-19 epidemic at the outbreak and eased stage, but also predicts subjective controllability of COVID-19 epidemic at the eased stage. Given that risk perception indicates potential active engagement of preventative behavior and that subjective controllability associating with self-efficacy could promote individual health behavior, this study preliminarily justifies the value of social distancing from the angle of perceptual factors, adding to existing mounting evidence of its effect on physically controlling pandemic spread.

Ego effectiveness: A novel individual difference approach to health behavior and coping

Taking care of one's health can require trading current feelings for longer-term considerations of health and well-being. The present research (total N = 366) sought to assess ego operations of this type in terms of the extent to which the self would be capable of responding to health-challenging situations in ways deemed to be effective. Ego effective individuals engaged in a greater frequency of health-protective behaviors as well as a lesser frequency of risky behaviors, both with respect to a peer protocol (Study 1) and a daily life protocol (Study 2). Findings are informative concerning multiple self-regulation perspectives on health.

Protein Intake and Physical Activity in Newly Diagnosed Patients with Acute Coronary Syndrome: A 5-Year Longitudinal Study

Cardiovascular disease is one of the most common causes of hospitalization and is associated with high morbidity and mortality rates. Among the most important modifiable and well-known risk factors are an unhealthy diet and sedentary lifestyle. Nevertheless, adherence to healthy lifestyle regimes is poor. The present study examined longitudinal trajectories (pre-event, 6-, 12-, 24-, 36-, and 60-month follow-ups) of protein intake (fish, legumes, red/processed meat) and physical activity in 275 newly-diagnosed patients with acute coronary syndrome. Hierarchical Generalized Linear Models were performed, controlling for demographic and clinical variables, the season in which each assessment was made, and the presence of anxiety and depressive symptoms. Significant changes in protein intake and physical activity were found from pre-event to the six-month follow-up, suggesting the adoption of healthier behaviors. However, soon after the six-month follow-up, patients experienced significant declines in their healthy behaviors. Both physical activity and red/processed meat intake were modulated by the season in which the assessments took place and by anxiety symptoms over time. The negative long-term trajectory of healthy behaviors suggests that tailored interventions are needed that sustain patients’ capabilities to self-regulate their behaviors over time and consider patient preference in function of season.

Risk Ladder, Table, or Bulleted List? Identifying Formats That Effectively Communicate Personalized Risk and Risk Reduction Information for Multiple Diseases

BACKGROUND

Personalized medicine may increase the amount of probabilistic information patients encounter. Little guidance exists about communicating risk for multiple diseases simultaneously or about communicating how changes in risk factors affect risk (hereafter "risk reduction").

PURPOSE

To determine how to communicate personalized risk and risk reduction information for up to 5 diseases associated with insufficient physical activity in a way laypeople can understand and that increases intentions.

METHODS

We recruited 500 participants with <150 min weekly of physical activity from community settings. Participants completed risk assessments for diabetes, heart disease, stroke, colon cancer, and breast cancer (women only) on a smartphone. Then, they were randomly assigned to view personalized risk and risk reduction information organized as a bulleted list, a simplified table, or a specialized vertical bar graph ("risk ladder"). Last, they completed a questionnaire assessing outcomes. Personalized risk and risk reduction information was presented as categories (e.g., "very low"). Our analytic sample (N = 372) included 41.3% individuals from underrepresented racial/ethnic backgrounds, 15.9% with vocational-technical training or less, 84.7% women, 43.8% aged 50 to 64 y, and 71.8% who were overweight/obese.

RESULTS

Analyses of covariance with post hoc comparisons showed that the risk ladder elicited higher gist comprehension than the bulleted list (P = 0.01). There were no significant main effects on verbatim comprehension or physical activity intentions and no moderation by sex, race/ethnicity, education, numeracy, or graph literacy (P > 0.05). Sequential mediation analyses revealed a small beneficial indirect effect of risk ladder versus list on intentions through gist comprehension and then through perceived risk (b_{IndirectEffect} = 0.02, 95% confidence interval: 0.00, 0.04).

CONCLUSION

Risk ladders can communicate the gist meaning of multiple pieces of risk information to individuals from many sociodemographic backgrounds and with varying levels of facility with numbers and graphs.

The Impact of Socio-environmental Barriers on the Process of Engagement in Cardiac Rehabilitation Programs

Cardiac rehabilitation (CR) is a multi-disciplinary intervention designed to stabilise, slow, or reverse CVD, restore health following a cardiac event and facilitate the prevention of further events. The Model of Therapeutic Engagement (MTE) is a comprehensive conceptual model for explaining the process of engagement in rehabilitation. Of concern is that the role of socio-environmental factors is absent from explaining individual engagement in the MTE. There is also a lack of prospective studies investigating the impact of socio-environmental barriers on engagement in CR programs over time. This study aimed to expand the MTE, by illuminating the role of socio-environmental barriers in a three-stage process of engagement in CR programs. A prospective study was conducted, with 217 individuals recruited from the Cardiology Ward in the Gold Coast University Hospital (GCUH) and the Robina Cardiac Rehabilitation Centre. The collected data were examined using a structural equation model that added socio-environmental factors into the MTE, using multi-group analyses. In this study, we found that socio-environmental factors were not associated with intention to engage in the CR program, but were related to actual attendance and maintenance of participation in CR programs. Knowing how these socio-environmental barriers affect the process of engagement at different stages may help to tailor more accessible CR programs for the population.

Sociocognitive factors associated with lifestyle intervention attrition after successful weight loss among participants with prediabetes-The PREVIEW study

INTRODUCTION

Major risk factors for type 2 diabetes are lifestyle choices such as lack of physical activity (PA) and poor diet. Many individuals either do not take part or struggle to complete interventions supporting lifestyle changes. Demographic and theory-based sociocognitive factors associated with PREVIEW intervention attrition after successful weight loss were examined.

METHODS

Participants (1,856) who started the weight maintenance phase after completion of low-energy diet were retrospectively divided into three clusters depending on the point they left the trial. Discriminant analysis examined which demographic and theory-based sociocognitive variables were associated with cluster membership.

RESULTS

Most of the participants were women and well-educated. Two discriminant functions were calculated (χ² (24) = 247.0, p ≥ .05, d = 0.78). The demographic variables, such as age and ethnicity, and the social cognitive variable outcome expectancies on the other side were associated with cluster membership. Older age, Caucasian ethnicity, and fewer expected disadvantages of PA were associated with high success.

DISCUSSION

The discriminant model gave insight into some factors associated with early attrition. For practitioners planning interventions it underlines the necessity to take extra attention to younger participants and to those being afraid that being physically active causes unpleasant ramifications.

Determining predictors of change in sugar sweetened beverage consumption behaviour among university students in India

Background Consumption of sugar sweetened beverages (SSBs) is a significant risk behaviour that leads to the development of several chronic diseases. The present study aimed to predict the SSB consumption behaviour among Indian university students by utilising a multi theory model (MTM) of health behaviour change. Methods In a cross-sectional design, a validated 37-item self-report questionnaire was administered to 267 participants from a mid-size university in the National Capital Region (NCR) of India. Stepwise multiple regressions were used to determine predictors of change in initiation and sustenance of SSB consumption behaviour. For stepwise multiple regression, the a priori criteria of probability of F to enter the predictor in the model was set as less than or equal to 0.05 and for removing the predictor as greater than or equal to 0.10. Results The model was able to predict 16.7% variance in behavioural initiation through the constructs of participatory dialogue and behavioural confidence, and 30.2% variance in sustenance through emotional transformation and change in social environment. Participatory dialogue and behavioural confidence were predictors of behaviour initiation; and emotional transformation, and change in social environment were predictors of behaviour sustenance for SSB consumption behaviour change. Conclusion The study provided a pathway for design of interventions for SSB intake reduction in Indian university students. Interventions should be designed using participatory dialogue and behavioural confidence initiation, and emotional transformation and change in social environment for sustenance of change in SSB consumption in this population.

Hepatitis B virus perceptions and health seeking behaviors among pregnant women in Uganda: implications for prevention and policy

BACKGROUND

With most countries in sub-Saharan Africa (SSA) lagging behind schedule to implement a comprehensive viral hepatitis elimination strategy, several barriers to accurate information and hepatitis B virus (HBV) services still exist, that are unique to different regions. In an obstetric population of a high HBV burden SSA setting without antenatal HBV services, we systematically evaluated perceptions and prevention behavioral intentions in relation to HBV and liver cancer.

METHODS

Eligible consenting pregnant women were recruited from public health care facilities in the central and northern regions of Uganda, between October 2016 and December 2017. Standardized procedures and instruments based on the health belief model and theory of planned behavior were used to collect data on socio-demographic characteristics, HBV perceptions and behavioral intentions. Descriptive analysis using Chi-square tests was done to obtain distribution of respondents by levels of perceived risk of HBV and liver cancer for themselves, their child under 5 years and their spouse. Modified Poisson regression analyses were used to evaluate relationships between perception variables and different behavioral outcomes (intention to screen, vaccinate and treat HBV).

RESULTS

Perceived risk (PRR = 0.95(0.90-1.00), p = 0.055) was inversely associated with intention to screen for HBV. Conversely, perceived self-efficacy showed a consistent association with intention to screen for HBV (PRR = 1.18(1.10-1.23) p = 0.005), to vaccinate (PRR = 1.20(1.05-1.36) p = 0.006) and to seek treatment for HBV (PRR = 1.40(1.18-1.67) p < 0.001). Women from the north, compared to the central region (PRR = 1.76 (1.13-2.72) p = 0.012), and those who self-identified as Catholic (PRR = 1.85 (0.99-3.56) p = 0.056), and as Protestant, (PRR = 2.22 (1.22-4.04) p = 0.002), were more likely to have higher perceived self-efficacy, compared to Muslims. Age and education were not related to perceived self-efficacy.

CONCLUSION

Women in both regions hold incorrect perceptions of HBV and liver cancer risk, with women from the central reporting higher perceived risk than those from the north. High perceived self-efficacy influenced intention to participate in HBV prevention. Programs and policies geared towards enhancing HBV prevention in this sub-population may consider socio-cultural factors observed to influence prevention behaviors. These findings may guide HBV interventions aimed at improving capacity to seek HBV prevention services, thereby promoting HBV micro-elimination in this sub-population.

A Daily Diary Study of Rumination and Health Behaviors: Modeling Moderators and Mediators

OBJECTIVE

Rumination, thinking about a negative mood repetitively, is a common cognitive process that may affect health behavior engagement or avoidance. Little research has examined relations between rumination and health behaviors.

PURPOSE

We aimed to test links between rumination and health behaviors as well as possible moderators and mediators of those links.

METHODS

We used an 11-day online daily diary design. Health behavior outcomes included fruit intake, vegetable intake, exercise, alcohol intake, sexual risk taking behavior, and cigarette smoking.

RESULTS

Rumination was related to alcohol intake at the within-person level. Using multivariate modeling, we found that significant within-person mediators for rumination to health behaviors included impulsivity, amotivation, self control, and using health behaviors as coping, with each of these mediating relationships for one to four out of the five health behavior outcomes. A significant between-person moderator includes perceived behavioral control for alcohol intake only, and intention was not a significant moderator of the rumination to health behavior relationships.

CONCLUSIONS

Rumination affects various maladaptive health behaviors differentially, through a number of mechanisms and under a moderating condition whereby those who feel more control are better able to buffer rumination's deleterious effects. Future interventions can apply the results to individual and multiple behavior change interventions for chronic disease prevention, especially for those who are particularly suffering from ruminative thoughts.

The PREVIEW Study

Abstract. Individuals at risk of Type 2 Diabetes are advised to change health habits. This study investigated how the PREMIT behavior modification intervention and its association with socio-economic variables influenced weight maintenance and habit strength in the PREVIEW study. Overweight adults with pre-diabetes were enrolled ( n = 2,224) in a multi-center RCT including a 2-month weight-loss phase and a 34-month weight-maintenance phase for those who lost ≥ 8% body weight. Initial stages of the PREMIT covered the end of weight-loss and the beginning of weight-maintenance phase (18 weeks). Cross-sectional and longitudinal data were explored. Frequent PREMIT sessions attendance, being female, and lower habit strength for poor diet were associated with lower weight re-gain. Being older and not in employment were associated with lower habit strength for physical inactivity. The PREMIT appeared to support weight loss maintenance. Younger participants, males, and those in employment appeared to struggle more with inactivity habit change and weight maintenance.

Measuring Test Anxiety With an Invariant Measure Across Genders: The Case of the German Test Anxiety Inventory

Since test performance is increasingly relevant in educational and occupational circles, the assessment of test anxiety—the phenomenological, physiological, and behavioral responses to the negative consequences that often emerge in evaluative situations—has become increasingly important to scholars and practitioners. One of the most widely employed scales to measure test anxiety in adolescents is the German Test Anxiety Inventory (in German: Prufungsangstfragebogen, PAF). The current study investigated the psychometric properties of the PAF when administered to Italian students. Our research found evidence of validity, supported the five-factor structure, and demonstrated the test’s good internal consistency. Moreover, the invariance of the dimensional structure across genders was examined. Overall, this study provides evidence for the reliability and validity of the PAF among Italian students.

Using the Short Graph Literacy Scale to Predict Precursors of Health Behavior Change

BACKGROUND

Visual displays can facilitate risk communication and promote better health choices. Their effectiveness in improving risk comprehension is influenced by graph literacy. However, the construct of graph literacy is still insufficiently understood, partially because existing objective measures of graph literacy are either too difficult or too long.

OBJECTIVES

We constructed a new 4-item Short Graph Literacy (SGL) scale and examined how SGL scores relate to key cognitive, affective, and conative precursors of health behavior change described in common health behavior theories.

METHODS

We performed secondary analyses to adapt the SGL scale from an existing 13-item scale. The initial construction was based on data collected in a laboratory setting in Germany ( n = 51). The scale was then validated using data from nationally representative samples in Germany ( n = 495) and the United States ( n = 492). To examine how SGL scores relate to precursors of health behavior change, we performed secondary analyses of a third study involving a nationwide US sample with 47% participants belonging to racial/ethnic minorities and 46% with limited formal education ( n = 835).

RESULTS

Graph literacy was significantly associated with cognitive precursors in theoretically expected ways (e.g., positive associations with risk comprehension and response efficacy and a negative association with cognitive risk perception). Patterns for affective precursors generally mirrored those for cognitive precursors, although numeracy was a stronger predictor than graph literacy for some affective factors (e.g., feelings of risk). Graph literacy had predictive value for most cognitive and affective precursors beyond numeracy. In addition, graph literacy (but not numeracy) predicted key conative precursors such as defensive processing.

CONCLUSIONS

Our data suggest that the SGL scale is a fast and psychometrically valid method for measuring objective graph literacy. Our findings also highlight the theoretical and practical relevance of graph literacy.

A Study Using Visual Art Methods to Explore the Perceptions and Barriers of Self-Management in Children and Adolescents with Lymphedema

Background: The aims of this study were to explore, using visual art methodology, how children and adolescents perceive their lymphedema and conceptualize the barriers and enablers in self-management and to explore the role of an educational camp in promoting self-efficacy. Methods: Participants (speaking English, French, and Italian) were recruited during an educational camp for children with lymphedema. Children and adolescents used different methodologies to depict living and self-managing their condition. Younger children (aged 5-12 years) drew pictures, and all children and adolescents (aged 5-18 years) were given cameras and asked to take photographs that depicted their experience of learning self-management of their condition during the camp. Rose's critical visual methodology framework was used for analysis. Results: Analysis of the data produced five categories: Normal versus altered childhood, living with lymphedema; perceptions of lymphedema and self-care in younger children; adolescents' perception of living and managing lymphedema; learning self-efficacy; and insights into cultural differences in self-care. Conclusions: The study has shown that self-management is complex. Children and adolescents face many daily challenges and frustrations in managing their condition in addition to the normal challenges of development and growth that impact on: home life, time with friends, school activities, and relationships. Children expressed a deep longing for cure and a recognition that their lives were altered by having the condition that led to limitations in sport and wearing fashionable clothes and shoes. The importance of relationships with professionals was critical as was the experience of meeting and learning with other children through the camp experience. Attempts to simplify self-management techniques would appear to be a key priority as would a greater understanding of the self-beliefs young people have of their ability to influence and control their condition and its impact on their life.

A Study to Explore the Parental Impact and Challenges of Self-Management in Children and Adolescents Suffering with Lymphedema

Background: Limited research has shown the impact lymphedema has on children and families. The aim of this study was to explore the parental experience of caring for a child or adolescent with lymphedema and the daily challenges of self-management and self-efficacy. Methods and Results: Participants were recruited during an educational camp for children with lymphedema (N = 26). Three individual semistructured focus groups were undertaken in English, French, and Italian with simultaneous translation. Data were analyzed using interpretative phenomenological analysis. Analysis identified four superordinate themes; the journey, treatment management, independence, and psychosocial impact. Ten subthemes were identified: bandaging/compression, professional support, holistic care, fear, self-efficacy, acceptance, friendship, guilt, distress, and hope. Conclusions: Parental self-management of children with lymphedema is complex and invades many aspects of life. Lack of professional agreement over what constitutes self-management leads to parental confusion and anxiety. Self-management is demanding, and parents are ambivalent to its effectiveness, but choose to persevere through fear of their child's condition deteriorating. Self-efficacy is evident in complex problem solving, despite parents believing that they are not adequately prepared for this.

Kindheitsbelastungen und gestörtes Essverhalten – Die Rolle von Selbstregulation

Zusammenfassung. Die verschiedenen Formen der Kindesmisshandlung (körperlicher, sexueller oder emotionaler Missbrauch sowie emotionale und körperliche Vernachlässigung) gelten sowohl für die Entwicklung von Essstörungen als auch für einzelne Symptome pathologischen Essverhaltens (Essanfälle, Adipositas) als Risikofaktoren. Darüber hinaus ist bekannt, dass sich selbstregulatorische Fähigkeiten durch die Erfahrung von Kindesmisshandlung defizitär entwickeln können. Aus diesem Grund soll die Rolle von Selbstregulation für den Zusammenhang von erinnerter Kindheitsbelastung und Essverhalten eruiert werden, um Ansatzpunkte für Prävention und Behandlung von gestörtem Essverhalten zu erhalten. Eine hinsichtlich Geschlecht, Alter und Bildung bevölkerungsrepräsentative Stichprobe von 2508 Personen (1174 Männer und 1334 Frauen) im Alter von 14–92 Jahren ( M = 49.67, SD = 18.32) wurde im Rahmen eines umfassenden Gesundheits-Surveys zu Essverhalten, erinnerter Kindheitsbelastung und selbstregulatorischen Fähigkeiten befragt. Neben umfangreichen deskriptiven Analysen zu Essverhalten und Kindheitsbelastung wurde die Interaktion von Selbstregulation und Kindheitsbelastung unter Berücksichtigung von Geschlechtsunterschieden auf die Ausprägungen des Essverhaltens mittels einer moderierten Regressionsanalyse überprüft. Die Prävalenzraten für auffälliges Essverhalten liegen für Frauen höher als für Männer (14.7% vs. 6.5%). Frauen berichteten ebenfalls häufiger, dass sie eine Form der Kindesmisshandlung erlebt haben. Bei Betrachtung der einzelnen Formen von Kindesmisshandlung unterscheiden sich Männer und Frauen nur in der Häufigkeit von sexuellem Missbrauch, den Frauen häufiger berichteten. Die Interaktion aus höherer Kindheitsbelastung und Selbstregulationsdefiziten stellte sich lediglich für Männer als Risikofaktor für gestörtes Essverhalten heraus, nicht bei Frauen. Männer und Frauen zeigen unterschiedliche Risikoprofile, die weiter untersucht werden sollten. Bessere Kenntnisse geschlechtsspezifischer Unterschiede dienen der Prävention und Behandlung von Essstörungen sowie Adipositas.

The Response of More Health Focused and Less Health Focused People to a Physical Activity Calorie Equivalent Label on Discretionary Snack Foods

A Physical Activity Calorie Equivalent (PACE) label shows the minutes of physical activity required to burn off the caloric content of a particular food. This study investigated the influence of PACE labelling on liking and consumption of discretionary snack foods in a group of more health focused and less health focused consumers. Participants (n = 97) tasted and rated (i.e., liking, prospective consumption) a range of snack foods with or without a PACE label. Total sampling consumption was also measured. Participants completed a shortened version of the International Physical Activity Questionnaire and the General Health Interest Scale questionnaire. Paired samples t-test, independent samples t-tests, a General Linear Model and Chi-Square tests were used to check for statistical significance. For more health focused participants (n = 57), the PACE label decreased only liking (p = 0.02). The PACE label was not effective in reducing liking (p = 0.49), prospective consumption (defined as the amount of the sample participants thought that they could consume) (p = 0.10) or consumption (p = 0.41) of energy-dense discretionary snack foods for less health focused individuals (n = 40). The level of participants’ physical activity did not facilitate the influence of PACE labelling on liking, consumption or prospective consumption. The PACE label was found to not be effective among less health focused individuals or the overall sample population. Therefore, the PACE label may not be an effective labelling strategy to reduce the liking or consumption of discretionary snack foods.

Overloaded and overlooked: Improving resident advisors' self-care

The purpose of this viewpoint is to discuss the lack of research on resident advisor (RA) self-care and how behavioral interventions can be used in housing programs to educate and improve RA self-care. It is essential for live-in housing staff (both professional and paraprofessional) to learn how to develop appropriate strategies that target problem behaviors to improve self-care. An overview of the RA position, the effects of increased demands (i.e., burnout), and the research on self-care behavioral interventions are discussed. Lastly, the call to use behavioral interventions within housing programs to educate RAs on self-care awareness and improve and monitor their health behaviors to prevent burnout and psychological distress is provided.

A cluster randomized controlled trial comparing the effectiveness of an individual planning intervention with collaborative planning in adolescent friendship dyads to enhance physical activity (TWOgether)

BACKGROUND

Most adolescents do not meet the recommendations for physical activity (PA) of at least 1 h per day. Individual planning (IP) interventions, including forming plans for when, where and how (action planning) to engage in a behavior, as well as the planning for how to deal with arising barriers (coping planning), are effective to enhance PA in adults. Collaborative planning (CP) is conjoint planning of two individuals regarding a behavior which is performed together. It is assumed that CP stimulates social exchange processes between the planning partners. However, it remains unclear whether planning interventions of PA in adolescents are successful and which planning intervention is more effective. Thus, this cluster randomized controlled trial (RCT) examines changes in daily moderate-to-vigorous PA in adolescents' friendship dyads resulting from planning. Individual self-regulating mechanism and social exchange processes are proposed as mediating mechanisms of the effects of planning for health behavior change.

METHODS

A single-blind four-arm parallel-group cluster-RCT is used. The sample consists of 400 friendship dyads between 14 and 18 years of age. As the recruitment takes place in schools, a cluster randomization of the schools is used to enroll dyads to (a) an IP intervention, (b) a CP intervention or (c) one of the two no-planning control conditions. Devise-measured and self-reported PA as the primary outcomes, self-regulatory strategies, and social exchange processes as secondary outcomes are assessed at three or four time points. After baseline measurement, the baseline ecological momentary assessment of the main variables takes place for 8 days followed by the intervention and a 7-days diary phase. Follow-ups are 1 month and 6 months later. Subsequent to the six-month follow-up, another 7-days diary phase takes place.

DISCUSSION

This is the first study examining IP in comparison to CP in adolescents applying a single-blind cluster RCT. Consequently, the study allows for understanding the efficacy of individual and collaborative planning and the underlying mechanisms in adolescent dyads.

TRIAL REGISTRATION

This RCT was funded by the Swiss National Science Foundation (100019_169781/1) and was registered on 18/06/2018 at ClinicalTrials.gov : NCT03575559 .

Combining risk communication strategies to simultaneously convey the risks of four diseases associated with physical inactivity to socio-demographically diverse populations

A single risk factor can increase the risk of developing multiple diseases, but most risk communication research has been conducted in the context of a single disease. We explored which combination of three recommended risk communication strategies is most effective in simultaneously conveying risk estimates of four diseases associated with physical inactivity: colon cancer, stroke, diabetes, and heart disease. Participants (N = 1161, 50% no college experience, 50% racial/ethnic minority) were shown hypothetical risk estimates for each of the four diseases. All four diseases were placed at varying heights on 1 of 12 vertical bar charts (i.e., "risk ladders") to indicate their respective probabilities. The risk ladders varied in a 2 (risk reduction information: present/absent) × 2 (numerical format: words/words and numbers) × 3 (social comparison information: none/somewhat higher than average/much higher than average) full factorial design. Participants were randomly assigned to view one of the risk ladders and then completed a questionnaire assessing message comprehension, message acceptance, physical activity-related risk and efficacy beliefs, and physical activity intentions. Higher message acceptance was found among (1) people who received risk reduction information versus those who did not (p = .01), and (2) people who did not receive social comparison information versus those told that they were at higher than average risk (p = .03). Further, absolute cognitive perceived risk of developing "any of the diseases shown in the picture" was higher among people who did not receive social comparison information (p = .03). No other main effects and only very few interactions with demographic variables were found. Combining recommended risk communication strategies did not improve or impair key cognitive or affective precursors of health behavior change. It might not be necessary to provide people with extensive information when communicating risk estimates of multiple diseases.

STI-protective self-efficacy and binge drinking in a sample of university students in the United Kingdom

OBJECTIVE

Alcohol use has consistently been shown to be related to sexual risk-taking behaviours. To assess what factors may contribute to the sexual risk decision-making process, this study examined the relationships among alcohol use (frequency, quantity, and binge drinking), cognitive appraisals of sexual risk taking, sex-related alcohol expectancies, and STI-protective self-efficacy.

METHOD

138 sexually-active university students who drink alcohol completed scales measuring alcohol consumption, appraisals of consequences, sex-related alcohol expectancies, and items regarding STI-protective self-efficacy.

RESULTS

Increasing levels of binge drinking were negatively associated with STI-protective self-efficacy. A moderated mediation analysis revealed that for binge drinkers, stronger appraisals of the positive consequences for having sexual intercourse while intoxicated predicted lower STI-protective self-efficacy indirectly through increasing rates of sex-related alcohol risk expectancies.

CONCLUSION

Findings provide evidence of a need to target binge drinkers and increase their STI-protective self-efficacy by shifting their focus from positive consequences to negative risk consequences of engaging in sexual intercourse while intoxicated.

Understanding the Cognitive and Affective Mechanisms that Underlie Proxy Risk Perceptions among Caregivers of Asthmatic Children

OBJECTIVE

Medical decisions made on behalf of another person-particularly those made by adult caregivers for their minor children-are often informed by the decision maker's beliefs about the treatment's risks and benefits. However, we know little about the cognitive and affective mechanisms influencing such "proxy" risk perceptions and about how proxy risk perceptions are related to prominent judgment phenomena.

METHODS

Adult caregivers of minor children with asthma ( N = 132) completed an online, cross-sectional survey assessing 1) cognitions and affects that form the basis of the availability, representativeness, and affect heuristics; 2) endorsement of the absent-exempt and the better-than-average effect; and 3) proxy perceived risk and unrealistic comparative optimism of an asthma exacerbation. We used the Pediatric Asthma Control and Communication Instrument (PACCI) to assess asthma severity.

RESULTS

Respondents with higher scores on availability, representativeness, and negative affect indicated higher proxy risk perceptions and (for representativeness only) lower unrealistic optimism, irrespective of asthma severity. Conversely, respondents who showed a stronger display of the better-than-average effect indicated lower proxy risk perceptions but did not differ in unrealistic optimism. The absent-exempt effect was unrelated to proxy risk perceptions and unrealistic optimism.

CONCLUSION

Heuristic judgment processes appear to contribute to caregivers' proxy risk perceptions of their child's asthma exacerbation risk. Moreover, the display of other, possibly erroneous, judgment phenomena is associated with lower caregiver risk perceptions. Designing interventions that target these mechanisms may help caregivers work with their children to reduce exacerbation risk.

Why Information Matters: Examining the Consequences of Suggesting That Pedophilia Is Immutable

In this study, the impact of suggesting that pedophilia is immutable on a man's specific self-efficacy for modifying his sexual interest in children was examined in 94 men with a sexual interest in children. The participants were selected from differing contexts and included non-forensic patients, forensic patients, and participants from the Internet. Randomly distributed to two conditions, the mutable condition group received the information that experts consider pedophilia to be modifiable, whereas the immutable condition group received the information that experts consider pedophilia to be stable. Afterward, the participants' levels of specific self-efficacy for modifying their sexual interest in children were assessed. Non-forensic participants in the mutable condition reported higher levels of specific self-efficacy than those in the immutable condition. No differences in specific self-efficacy were revealed for the forensic and Internet participants when comparing the mutable and immutable conditions. It would appear appropriate to avoid generalized and absolute statements about the (im)mutability of sexual interest in children, as scientific research on this topic remains insufficient. Furthermore, given the present results, such statements might have serious consequences for an individual's belief in being able to change his sexual interest in children.

Linguistic Evidence for the Failure Mindset as a Predictor of Life Span Longevity

BACKGROUND

When people think that their efforts will fail to achieve positive outcomes, they sometimes give up their efforts after control, which can have negative health consequences.

PURPOSE

Problematic orientations of this type, such as pessimism, helplessness, or fatalism, seem likely to be associated with a cognitive mindset marked by higher levels of accessibility for failure words or concepts. Thus, the purpose of the present research was to determine whether there are individual differences in the frequency with which people think about failure, which in turn are likely to impact health across large spans of time.

METHODS

Following self-regulatory theories of health and the learned helplessness tradition, two archival studies (total n = 197) scored texts (books or speeches) for their use of failure words, a category within the Harvard IV dictionary of the General Inquirer.

RESULTS

People who used failure words more frequently exhibited shorter subsequent life spans, and this relationship remained significant when controlling for birth year. Furthermore, study 2 implicated behavioral factors. For example, the failure/longevity relationship was numerically stronger among people whose causes of death appeared to be preventable rather than non-preventable.

CONCLUSIONS

These results significantly extend our knowledge of the personality/longevity relationship while highlighting the value of individual differences in word usage as predictors of health and mortality.

The impact of media type on shared decision processes in third-age populations

PURPOSE

To examine the relationship between the media, through which medical information was made available (e.g. digital versus printed), and the patients' desire to play an active part in a medical decision in an SDM or an ISDM-based process. The goal of this research was to expand knowledge concerning social and personal factors that affect and explain patients' willingness to participate in the process.

METHODS

A questionnaire was distributed in this empirical study of 103 third-age participants. A theoretical model formed the basis for the study and utilized a variety of factors from technology acceptance, as well as personal and environmental influences to investigate the likelihood of subjects preferring a certain decision-making approach. The research population included men and women aged 65 or older who resided in five assisted living facilities in Israel. The sample was split randomly into 2 groups. One group used digital information and the other print. A path analysis was conducted, using Structural Equation Modelling (SEM) in AMOS SPSS, to determine the influence of the information mode of presentation on the patient's choice of the SDM or ISDM model.

RESULTS

When digital media was accessible, the information's perceived usefulness (PU) led participants to choose an ISDM-based process; this was not true with printed information. When information was available online, higher self-efficacy (SE) led participants to prefer an SDM-based process. When the information was available in print, a direct positive influence was found on the participant's choice of SDM, while a direct negative influence was found on their choice of an ISDM-based process. PU was found to be affected by external peer influences, particularly when resources were made available in print. This meant that digital resources tended to be accepted at face value more readily. Cognitive absorption had a positive effect on the research variables only when the information was available digitally. The findings suggest the use of digital information may be related to cognitive functions of older adults, since the use of digital technology and information requires more cognitive effort.

CONCLUSIONS

The study illustrates factors that make patients choose SDM or ISDM-based processes in third-age populations. In general, the results suggest that, even though a physician may attempt to place the patient in the center of the decision process, printed information does not empower the patient in the same way that digital resources do. This may have wider ramifications if the patient does not buy into the treatment plan is and becomes less motivated to be compliant with the treatment. Another key contribution of this research is to identify processes that reflect information assessment and adoptions, and the behaviors related to medical decision making, both as a model and as a process. This study suggests what health care professionals should expect to see as the transition to more digital information sources becomes the norm among the elderly population. Future research is needed to examine this model under different conditions, and to check for other variables and mechanisms perceived as mediators in the choice of SDM or ISDM processes.