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De-Loyde K, Ferrar J, Pilling MA, Hollands GJ, Clarke N, Matthews JA, Maynard OM, Wood T, Heath C, Munafò MR, Attwood AS. The impact of introducing alcohol-free beer options in bars and public houses on alcohol sales and revenue: A randomised crossover field trial. Addiction 2024; 119:1071-1079. [PMID: 38508212 DOI: 10.1111/add.16449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/21/2024] [Indexed: 03/22/2024]
Abstract
AIMS The study aimed to estimate the impact of introducing a draught alcohol-free beer, thereby increasing the relative availability of these products, on alcohol sales and monetary takings in bars and pubs in England. DESIGN Randomised crossover field trial. SETTING England. PARTICIPANTS Fourteen venues that did not previously sell draught alcohol-free beer. INTERVENTION AND COMPARATOR Venues completed two intervention periods and two control periods in a randomised order over 8 weeks. Intervention periods involved replacing one draught alcoholic beer with an alcohol-free beer. Control periods operated business as usual. MEASUREMENTS The primary outcome was mean weekly volume (in litres) of draught alcoholic beer sold. The secondary outcome was mean weekly revenue [in GBP (£)] from all drinks. Analyses adjusted for randomised order, special events, season and busyness. FINDINGS The adjusted mean difference in weekly sales of draught alcoholic beer was -20 L [95% confidence interval (CI) = -41 to +0.4], equivalent to a 4% reduction (95% CI = 8% reduction to 0.1% increase) in the volume of alcoholic draught beer sold when draught alcohol-free beer was available. Excluding venues that failed at least one fidelity check resulted in an adjusted mean difference of -29 L per week (95% CI = -53 to -5), equivalent to a 5% reduction (95% CI = 8% reduction to 0.8% reduction). The adjusted mean difference in weekly revenue was +61 GBP per week (95% CI = -328 to +450), equivalent to a 1% increase (95% CI = 5% decrease to 7% increase) when draught alcohol-free beer was available. CONCLUSIONS Introducing a draught alcohol-free beer in bars and pubs in England reduced the volume of draught alcoholic beer sold by 4% to 5%, with no evidence of the intervention impacting net revenue.
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Affiliation(s)
- Katie De-Loyde
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Jennifer Ferrar
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Mark A Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Gareth J Hollands
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | | | - Joe A Matthews
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Olivia M Maynard
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Tiffany Wood
- Communities and Public Health People Directorate, Bristol City Council, Bristol, UK
| | - Carly Heath
- Communities and Public Health People Directorate, Bristol City Council, Bristol, UK
| | - Marcus R Munafò
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Angela S Attwood
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
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Hollands GJ, South E, Shemilt I, Oliver S, Thomas J, Sowden AJ. Methods used to conceptualize dimensions of health equity impacts of public health interventions in systematic reviews. J Clin Epidemiol 2024; 169:111312. [PMID: 38432524 DOI: 10.1016/j.jclinepi.2024.111312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Our aims were to, first, identify and summarize the use of methods, frameworks, and tools as a conceptual basis for investigating dimensions of equity impacts of public health interventions in systematic reviews including an equity focus. These include PROGRESS-Plus, which identifies key sociodemographic characteristics that determine health outcomes. Second, we aimed to document challenges and opportunities encountered in the application of such methods, as reported in systematic reviews. STUDY DESIGN AND SETTING We conducted a methodological study, comprising an overview of systematic reviews with a focus on, or that aimed to assess, the equity impacts of public health interventions. We used electronic searches of the Cochrane Database of Systematic Reviews, the Database of Promoting Health Effectiveness Reviews (DoPHER), and the Finding Accessible Inequalities Research in Public Health Database, supplemented with automated searches of the OpenAlex dataset. An active learning algorithm was used to prioritize title-abstract records for manual screening against eligibility criteria. We extracted and analyzed a core dataset from a purposively selected sample of reviews, to summarize key characteristics and approaches to conceptualizing investigations of equity. RESULTS We assessed 322 full-text reports for eligibility, from which we included 120 reports of systematic reviews. PROGRESS-Plus was the only formalized framework used to conceptualize dimensions of equity impacts. Most reviews were able to apply their intended methods to at least some degree. Where intended methods were unable to be applied fully, this was usually because primary research studies did not report the necessary information. A general rationale for focusing on equity impacts was often included, but few reviews explicitly justified their focus on (or exclusion of) specific dimensions. In addition to practical challenges such as data not being available, authors highlighted significant measurement and conceptual issues with applying these methods which may impair the ability to investigate and interpret differential impacts within and between studies. These issues included investigating constructs that lack standardized operationalization and measurement, and the complex nature of differential impacts, with dimensions that may interact with one another, as well as with particular temporal, personal, social or geographic contexts. CONCLUSION PROGRESS-Plus is the predominant framework used in systematic reviews to conceptualize differential impacts of public health interventions by dimensions of equity. It appears sufficiently broad to encompass dimensions of equity examined in most investigations of this kind. However, PROGRESS-Plus does not necessarily ensure or guide critical thinking about more complex pathways, including interactions between dimensions of equity, and with wider contextual factors, and important practical, measurement and conceptual challenges remain. The findings from investigations of equity impacts in systematic reviews could be made more useful through more explicitly rationalized and considered approaches to the design, conduct and reporting of both primary research and the reviews themselves.
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Affiliation(s)
- Gareth J Hollands
- EPPI Centre, UCL Social Research Institute, University College London, London, UK.
| | - Emily South
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ian Shemilt
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Sandy Oliver
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - James Thomas
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Amanda J Sowden
- Centre for Reviews and Dissemination, University of York, York, UK
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Mantzari E, Ventsel M, Pechey E, Lee I, Pilling MA, Hollands GJ, Marteau TM. Impact on wine sales of removing the largest serving size by the glass: An A-B-A reversal trial in 21 pubs, bars, and restaurants in England. PLoS Med 2024; 21:e1004313. [PMID: 38236840 PMCID: PMC10796003 DOI: 10.1371/journal.pmed.1004313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 10/25/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Interventions that alter aspects of the physical environments in which unhealthy behaviours occur have the potential to change behaviour at scale, i.e., across populations, and thereby decrease the risk of several diseases. One set of such interventions involves reducing serving sizes, which could reduce alcohol consumption. The effect of modifying the available range of serving sizes of wine in a real-world setting is unknown. We aimed to assess the impact on the volume of wine sold of removing the largest serving size by the glass from the options available in licensed premises. METHODS AND FINDINGS The study was conducted between September 2021 and May 2022 in 21 licensed premises in England that sold wine by the glass in serving sizes greater than 125 ml (i.e., 175 ml or 250 ml) and used an electronic point of sale till system. It used an A-B-A reversal design, set over 3 four-weekly periods. "A" represented the nonintervention periods during which standard serving sizes were served and "B" the intervention period when the largest serving size for a glass of wine was removed from the existing range in each establishment: 250 ml (18 premises) or 175 ml (3 premises). The primary outcome was the daily volume of wine sold, extracted from sales data. Twenty-one premises completed the study, 20 of which did so per protocol and were included in the primary analysis. After adjusting for prespecified covariates, the intervention resulted in -420·8 millilitres (ml) (95% confidence intervals (CIs) -681·4 to -160·2 p = 0·002) or -7·6% (95% CI -12·3%, -2·9%) less wine being sold per day. There was no evidence that sales of beer and cider or total daily revenues changed but the study was not powered to detect differences in these outcomes. The main study limitation is that we were unable to assess the sales of other alcoholic drinks apart from wine, beer, and cider, estimated to comprise approximately 30% of alcoholic drinks sold in participating premises. CONCLUSIONS Removing the largest serving size of wine by the glass from those available reduced the volume of wine sold. This promising intervention for decreasing alcohol consumption across populations merits consideration as part of alcohol licensing regulations. TRIAL REGISTRATION ISRCTN https://doi.org/10.1186/ISRCTN33169631; OSF https://osf.io/xkgdb.
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Affiliation(s)
- Eleni Mantzari
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Minna Ventsel
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Emily Pechey
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ilse Lee
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mark A. Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- EPPI Centre, UCL Social Research Institute, University College London, London, United Kingdom
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
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Clarke N, Ferrar J, Pechey E, Ventsel M, Pilling MA, Munafò MR, Marteau TM, Hollands GJ. Impact of health warning labels and calorie labels on selection and purchasing of alcoholic and non-alcoholic drinks: A randomized controlled trial. Addiction 2023; 118:2327-2341. [PMID: 37528529 PMCID: PMC10952514 DOI: 10.1111/add.16288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/29/2023] [Indexed: 08/03/2023]
Abstract
AIMS To estimate the impact on selection and actual purchasing of (a) health warning labels (text-only and image-and-text) on alcoholic drinks and (b) calorie labels on alcoholic and non-alcoholic drinks. DESIGN Parallel-groups randomised controlled trial. SETTING Drinks were selected in a simulated online supermarket, before being purchased in an actual online supermarket. PARTICIPANTS Adults in England and Wales who regularly consumed and purchased beer or wine online (n = 651). Six hundred and eight participants completed the study and were included in the primary analysis. INTERVENTIONS Participants were randomized to one of six groups in a between-subjects three [health warning labels (HWLs) (i): image-and-text HWL; (ii) text-only HWL; (iii) no HWL] × 2 (calorie labels: present versus absent) factorial design (n per group 103-113). MEASUREMENTS The primary outcome measure was the number of alcohol units selected (with intention to purchase); secondary outcomes included alcohol units purchased and calories selected and purchased. There was no time limit for selection. For purchasing, participants were directed to purchase their drinks immediately (although they were allowed up to 2 weeks to do so). FINDINGS There was no evidence of main effects for either (a) HWLs or (b) calorie labels on the number of alcohol units selected (HWLs: F(2,599) = 0.406, P = 0.666; calorie labels: F(1,599) = 0.002, P = 0.961). There was also no evidence of an interaction between HWLs and calorie labels, and no evidence of an overall difference on any secondary outcomes. In pre-specified subgroup analyses comparing the 'calorie label only' group (n = 101) with the 'no label' group (n = 104) there was no evidence that calorie labels reduced the number of calories selected (unadjusted means: 1913 calories versus 2203, P = 0.643). Among the 75% of participants who went on to purchase drinks, those in the 'calorie label only' group (n = 74) purchased fewer calories than those in the 'no label' group (n = 79) (unadjusted means: 1532 versus 2090, P = 0.028). CONCLUSIONS There was no evidence that health warning labels reduced the number of alcohol units selected or purchased in an online retail context. There was some evidence suggesting that calorie labels on alcoholic and non-alcoholic drinks may reduce calories purchased from both types of drinks.
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Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- School of SciencesBath Spa UniversityBathUK
| | - Jennifer Ferrar
- School of Psychological Science, Tobacco and Alcohol Research GroupUniversity of BristolBristolUK
| | - Emily Pechey
- Behaviour and Health Research Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Minna Ventsel
- Behaviour and Health Research Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Mark A. Pilling
- Behaviour and Health Research Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Marcus R. Munafò
- School of Psychological Science, Tobacco and Alcohol Research GroupUniversity of BristolBristolUK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- EPPI Centre, UCL Social Research InstituteUniversity College LondonLondonUK
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Larsen JK, Hollands GJ, Garland EL, Evers AWM, Wiers RW. Be more mindful: Targeting addictive responses by integrating mindfulness with cognitive bias modification or cue exposure interventions. Neurosci Biobehav Rev 2023; 153:105408. [PMID: 37758008 DOI: 10.1016/j.neubiorev.2023.105408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/01/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023]
Abstract
This review provides an overview of the most prominent neurocognitive effects of cognitive bias modification (CBM), cue-exposure therapy and mindfulness interventions for targeting addictive responses. It highlights the key insights that have stemmed from cognitive neuroscience and brain imaging research and combines these with insights from behavioural science in building a conceptual model integrating mindfulness with response-focused CBM or cue-exposure interventions. This furthers our understanding of whether and how mindfulness strategies may i) facilitate or add to the induced response-focused effects decreasing cue-induced craving, and ii) further weaken the link between craving and addictive responses. Specifically, awareness/monitoring may facilitate, and decentering may add to, response-focused effects. Combined awareness acceptance strategies may also diminish the craving-addiction link. The conceptual model presented in this review provides a specific theoretical framework to deepen our understanding of how mindfulness strategies and CBM or cue-exposure interventions can be combined to greatest effect. This is important in both suggesting a roadmap for future research, and for the further development of clinical interventions.
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Affiliation(s)
- Junilla K Larsen
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, the Netherlands.
| | - Gareth J Hollands
- EPPI Centre, UCL Social Research Institute, University College London, UK
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, USA
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, NL, and Medical Delta, Leiden University, TU Delft and Erasmus University, UK
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT)-lab, Department of Psychology, University of Amsterdam and Centre for Urban Mental Health, University of Amsterdam, the Netherlands
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Mantzari E, Ventsel M, Pechey E, Lee I, Pilling M, Hollands GJ, Marteau TM. Impact on sales of adding a smaller serving size of beer and cider in licensed premises: an A-B-A reversal design. BMC Public Health 2023; 23:1239. [PMID: 37365548 PMCID: PMC10294394 DOI: 10.1186/s12889-023-16163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Smaller serving sizes of alcoholic drinks could reduce alcohol consumption across populations thereby lowering the risk of many diseases. The effect of modifying the available range of serving sizes of beer and cider in a real-world setting has yet to be studied. The current study assessed the impact on beer and cider sales of adding a serving size of draught beer and cider (2/3 pint) that was between the current smallest (1/2 pint) and largest (1 pint) standard serving sizes. METHODS Twenty-two licensed premises in England consented to taking part in the study. The study used an ABA reversal design, set over three 4-weekly periods, with A representing the non-intervention periods, during which standard serving sizes were served and B the intervention period when a 2/3 pint serving size of draught beer and cider was added to the existing range, along with smaller 1/2 pint and larger 1 pint serving sizes. The primary outcome was the daily volume of beer and cider sold, extracted from sales data. RESULTS Fourteen premises started the study, of which thirteen completed it. Twelve of those did so per protocol and were included in the primary analysis. After adjusting for pre-specified covariates, the intervention did not have a significant effect on the volume of beer and cider sold per day (3.14 ml; 95%CIs -2.29 to 8.58; p = 0.257). CONCLUSIONS In licensed premises, there was no evidence that adding a smaller serving size for draught beer and cider (2/3 pint) when the smallest (1/2 pint) and largest (1 pint) sizes were still available, affected the volume of beer and cider sold. Studies are warranted to assess the impact of removing the largest serving size. TRIAL REGISTRATION ISRCTN: https://doi.org/10.1186/ISRCTN33169631 (08/09/2021), OSF: https://osf.io/xkgdb/ (08/09/2021).
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Affiliation(s)
- Eleni Mantzari
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Minna Ventsel
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Emily Pechey
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Ilse Lee
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Mark Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
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Robb KA, Kotzur M, Young B, McCowan C, Hollands GJ, Irvine A, Macdonald S, McConnachie A, O'Carroll RE, O'Connor RC, Steele RJC. Increasing uptake of FIT colorectal screening: protocol for the TEMPO randomised controlled trial testing a suggested deadline and a planning tool. BMJ Open 2023; 13:e066136. [PMID: 37202130 PMCID: PMC10201271 DOI: 10.1136/bmjopen-2022-066136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Screening can reduce deaths from colorectal cancer (CRC). Despite high levels of public enthusiasm, participation rates in population CRC screening programmes internationally remain persistently below target levels. Simple behavioural interventions such as completion goals and planning tools may support participation among those inclined to be screened but who fail to act on their intentions. This study aims to evaluate the impact of: (a) a suggested deadline for return of the test; (b) a planning tool and (c) the combination of a deadline and planning tool on return of faecal immunochemical tests (FITs) for CRC screening. METHODS AND ANALYSIS A randomised controlled trial of 40 000 adults invited to participate in the Scottish Bowel Screening Programme will assess the individual and combined impact of the interventions. Trial delivery will be integrated into the existing CRC screening process. The Scottish Bowel Screening Programme mails FITs to people aged 50-74 with brief instructions for completion and return. Participants will be randomised to one of eight groups: (1) no intervention; (2) suggested deadline (1 week); (3) suggested deadline (2 weeks); (4) suggested deadline (4 weeks); (5) planning tool; (6) planning tool plus suggested deadline (1 week); (7) planning tool plus suggested deadline (2 weeks); (8) planning tool plus suggested deadline (4 weeks). The primary outcome is return of the correctly completed FIT at 3 months. To understand the cognitive and behavioural mechanisms and to explore the acceptability of both interventions, we will survey (n=2000) and interview (n=40) a subgroup of trial participants. ETHICS AND DISSEMINATION The study has been approved by the National Health Service South Central-Hampshire B Research Ethics Committee (ref. 19/SC/0369). The findings will be disseminated through conference presentations and publication in peer-reviewed journals. Participants can request a summary of the results. TRIAL REGISTRATION NUMBER clinicaltrials.govNCT05408169.
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Affiliation(s)
- Kathyrn A Robb
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marie Kotzur
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ben Young
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of St. Andrews, St Andrews, UK
| | - Gareth J Hollands
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Audrey Irvine
- Scottish Bowel Screening Centre, NHS Tayside, Dundee, Dundee, UK
| | - Sara Macdonald
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Rory C O'Connor
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Clarke N, Blackwell AKM, Ferrar J, De-Loyde K, Pilling MA, Munafò MR, Marteau TM, Hollands GJ. Impact on alcohol selection and online purchasing of changing the proportion of available non-alcoholic versus alcoholic drinks: A randomised controlled trial. PLoS Med 2023; 20:e1004193. [PMID: 36996190 PMCID: PMC10062674 DOI: 10.1371/journal.pmed.1004193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 02/08/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Increasing the availability of non-alcoholic options is a promising population-level intervention to reduce alcohol consumption, currently unassessed in naturalistic settings. This study in an online retail context aimed to estimate the impact of increasing the proportion of non-alcoholic (relative to alcoholic) drinks, on selection and purchasing of alcohol. METHODS AND RESULTS Adults (n = 737) residing in England and Wales who regularly purchased alcohol online were recruited between March and July 2021. Participants were randomly assigned to one of 3 groups: "25% non-alcoholic/75% alcoholic"; "50% non-alcoholic/50% alcoholic"; and "75% non-alcoholic/25% alcoholic," then selected drinks in a simulated online supermarket, before purchasing them in an actual online supermarket. The primary outcome was the number of alcohol units selected (with intention to purchase); secondary outcomes included actual purchasing. A total of 607 participants (60% female, mean age = 38 years [range: 18 to 76]) completed the study and were included in the primary analysis. In the first part of a hurdle model, a greater proportion of participants in the "75% non-alcoholic" group did not select any alcohol (13.1%) compared to the "25% non-alcoholic" group (3.4%; 95% confidence interval [CI] -2.09, -0.63; p < 0.001). There was no evidence of a difference between the "75% non-alcoholic" and the "50% non-alcoholic" (7.2%) groups (95% CI 0.10, 1.34; p = 0.022) or between the "50% non-alcoholic" and the "25% non-alcoholic" groups (95% CI -1.44, 0.17; p = 0.121). In the second part of a hurdle model in participants (559/607) selecting any drinks containing alcohol, the "75% non-alcoholic" group selected fewer alcohol units compared to the "50% non-alcoholic" (95% CI -0.44, -0.14; p < 0.001) and "25% non-alcoholic" (95% CI -0.54, -0.24; p < 0.001) groups, with no evidence of a difference between the "50% non-alcoholic" and "25% non-alcoholic" groups (95% CI -0.24, 0.05; p = 0.178). Overall, across all participants, 17.46 units (95% CI 15.24, 19.68) were selected in the "75% non-alcoholic" group; 25.51 units (95% CI 22.60, 28.43) in the "50% non-alcoholic" group; and 29.40 units (95% CI 26.39, 32.42) in the "25% non-alcoholic" group. This corresponds to 8.1 fewer units (a 32% reduction) in the "75% non-alcoholic" compared to the "50% non-alcoholic" group, and 11.9 fewer alcohol units (41% reduction) compared to the "25% non-alcoholic" group; 3.9 fewer units (13% reduction) were selected in the "50% non-alcoholic" group than in the "25% non-alcoholic" group. For all other outcomes, alcohol selection and purchasing were consistently lowest in the "75% non-alcoholic" group. Study limitations include the setting not being entirely naturalistic due to using a simulated online supermarket as well as an actual online supermarket, and that there was substantial dropout between selection and purchasing. CONCLUSIONS This study provides evidence that substantially increasing the proportion of non-alcoholic drinks-from 25% to 50% or 75%-meaningfully reduces alcohol selection and purchasing. Further studies are warranted to assess whether these effects are realised in a range of real-world settings. TRIAL REGISTRATION ISRCTN: 11004483; OSF: https://osf.io/qfupw.
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Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- School of Sciences, Bath Spa University, Bath, United Kingdom
| | - Anna K. M. Blackwell
- School of Psychological Science, Tobacco and Alcohol Research Group, University of Bristol, Bristol, United Kingdom
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Jennifer Ferrar
- School of Psychological Science, Tobacco and Alcohol Research Group, University of Bristol, Bristol, United Kingdom
| | - Katie De-Loyde
- School of Psychological Science, Tobacco and Alcohol Research Group, University of Bristol, Bristol, United Kingdom
| | - Mark A. Pilling
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Marcus R. Munafò
- School of Psychological Science, Tobacco and Alcohol Research Group, University of Bristol, Bristol, United Kingdom
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- EPPI Centre, UCL Social Research Institute, University College London, London, United Kingdom
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Lee I, Blackwell AKM, Hobson A, Wiggers D, Hammond D, De‐loyde K, Pilling MA, Hollands GJ, Munafò MR, Marteau TM. Cigarette pack size and consumption: a randomized cross-over trial. Addiction 2023; 118:489-499. [PMID: 36326156 PMCID: PMC10100265 DOI: 10.1111/add.16062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND AIMS Smoking fewer cigarettes per day may increase the chances of stopping smoking. Capping the number of cigarettes per pack is a promising policy option, but the causal impact of such a change is unknown. This study aimed to test the hypothesis that lowering cigarette pack sizes from 25 to 20 reduces the number of cigarettes smoked. DESIGN This randomized controlled cross-over trial had two 14-day intervention periods with an intervening 7-day period of usual behaviour. Participants purchased their own cigarettes. They were instructed to smoke their usual brand from either one of two sizes of pack in each of two 14-day intervention periods: (a) 25 cigarettes and (b) 20 cigarettes. Participants were randomized to the order in which they smoked from the two pack sizes (a-b; b-a). SETTING Canada. PARTICIPANTS Participants were adult smokers who smoked from pack sizes of 25, recruited between July 2020 and June 2021. Of 252 randomized, 240 (95%) completed the study and 236 (94%) provided sufficient data for the primary analysis. MEASUREMENTS Cigarettes smoked per participant per day. FINDINGS Participants smoked fewer cigarettes per day from packs of 20 cigarettes [n = 234, mean = 15.7 standard deviation (SD) = 7.1] than from packs of 25 (n = 235, mean = 16.9, SD = 7.1). After adjusting for pre-specified covariates (baseline consumption and heaviness of smoking), modelling estimated that participants smoked 1.3 fewer cigarettes per day [95% confidence interval (CI) = -1.7 to -0.9], equivalent to 7.6% fewer (95% CI = -10.1 to -5.2%) from packs of 20 cigarettes. CONCLUSIONS Smoking from packs of 20 compared with 25 cigarettes reduced the number of cigarettes smoked per day.
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Affiliation(s)
- Ilse Lee
- Behaviour and Health Research UnitUniversity of CambridgeCambridgeUK
| | | | - Alice Hobson
- Behaviour and Health Research UnitUniversity of CambridgeCambridgeUK
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Danielle Wiggers
- School of Public Health Sciences, Faculty of HealthUniversity of WaterlooWaterlooOntarioCanada
| | - David Hammond
- School of Public Health Sciences, Faculty of HealthUniversity of WaterlooWaterlooOntarioCanada
| | - Katie De‐loyde
- School of Psychological ScienceUniversity of Bristol, 12a Priory RoadBristolUK
| | - Mark A. Pilling
- Behaviour and Health Research UnitUniversity of CambridgeCambridgeUK
| | - Gareth J. Hollands
- Behaviour and Health Research UnitUniversity of CambridgeCambridgeUK
- EPPI Centre, UCL Social Research InstituteUniversity College LondonLondonUK
| | - Marcus R. Munafò
- School of Psychological ScienceUniversity of Bristol, 12a Priory RoadBristolUK
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Mantzari E, Ventsel M, Ferrar J, Pilling MA, Hollands GJ, Marteau TM. Impact of wine bottle and glass sizes on wine consumption at home: a within- and between- households randomized controlled trial. Addiction 2022; 117:3037-3048. [PMID: 35852024 PMCID: PMC9804259 DOI: 10.1111/add.16005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/27/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Reducing alcohol consumption across populations would decrease the risk of a range of diseases, including many cancers, cardiovascular disease and Type 2 diabetes. The aim of the current study was to estimate the impact of using smaller bottles (37.5- versus 75-cl) and glasses (290 versus 370 ml) on consuming wine at home. DESIGN Randomized controlled trial of households with cross-over randomization to bottle size and parallel randomization to glass size. SETTING UK households. PARTICIPANTS A total of 260 households consuming at least two 75-cl bottles of wine each week, recruited from the general population through a research agency. The majority consisted of adults who were white and of higher socio-economic position. INTERVENTION Households were randomized to the order in which they purchased wine in 37.5- or 75-cl bottles, to consume during two 14-day intervention periods, and further randomized to receive smaller (290 ml) or larger (350 ml) glasses to use during both intervention periods. MEASUREMENTS Volume (ml) of study wine consumed at the end of each 14-day intervention period, measured using photographs of purchased bottles, weighed on study scales. FINDINGS Of the randomized households, 217 of 260 (83%) completed the study as per protocol and were included in the primary analysis. There was weak evidence that smaller bottles reduced consumption: after accounting for pre-specified covariates, households consumed on average 145.7 ml (3.6%) less wine when drinking from smaller bottles than from larger bottles [95% confidence intervals (CI) = -335.5 to 43. ml; -8.3 to 1.1%; P = 0.137; Bayes factor (BF) = 2.00]. The evidence for the effect of smaller glasses was stronger: households consumed on average 253.3 ml (6.5%) less wine when drinking from smaller glasses than from larger glasses (95% CI = -517 to 10 ml; -13.2 to 0.3%; P = 0.065; BF = 2.96). CONCLUSIONS Using smaller glasses to drink wine at home may reduce consumption. Greater uncertainty remains around the possible effect of drinking from smaller bottles.
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Affiliation(s)
- Eleni Mantzari
- Behaviour and Health Research UnitUniversity of CambridgeCamvbridgeUK
| | - Minna Ventsel
- Behaviour and Health Research UnitUniversity of CambridgeCamvbridgeUK
| | - Jennifer Ferrar
- School of Psychological Science, Tobacco and Alcohol Research GroupUniversity of BristolBristolUK
| | - Mark A. Pilling
- Behaviour and Health Research UnitUniversity of CambridgeCamvbridgeUK
| | - Gareth J. Hollands
- Behaviour and Health Research UnitUniversity of CambridgeCamvbridgeUK,EPPI‐Centre, UCL Social Research InstituteUniversity College LondonLondonUK
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11
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Reynolds JP, Ventsel M, Hobson A, Pilling MA, Pechey R, Jebb SA, Hollands GJ, Marteau TM. Evaluation of physical activity calorie equivalent (PACE) labels' impact on energy purchased in cafeterias: A stepped-wedge randomised controlled trial. PLoS Med 2022; 19:e1004116. [PMID: 36346795 PMCID: PMC9642872 DOI: 10.1371/journal.pmed.1004116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recent meta-analysis suggested that using physical activity calorie equivalent (PACE) labels results in people selecting and consuming less energy. However, the meta-analysis included only 1 study in a naturalistic setting, conducted in 4 convenience stores. We therefore aimed to estimate the effect of PACE labels on energy purchased in worksite cafeterias in the context of a randomised study design. METHODS AND FINDINGS A stepped-wedge randomised controlled trial (RCT) was conducted to investigate the effect of PACE labels (which include kcal content and minutes of walking required to expend the energy content of the labelled food) on energy purchased. The setting was 10 worksite cafeterias in England, which were randomised to the order in which they introduced PACE labels on selected food and drinks following a baseline period. There were approximately 19,000 workers employed at the sites, 72% male, with an average age of 40. The study ran for 12 weeks (06 April 2021 to 28 June 2021) with over 250,000 transactions recorded on electronic tills. The primary outcome was total energy (kcal) purchased from intervention items per day. The secondary outcomes were: energy purchased from non-intervention items per day, total energy purchased per day, and revenue. Regression models showed no evidence of an overall effect on energy purchased from intervention items, -1,934 kcals per site per day (95% CI -5,131 to 1,262), p = 0.236, during the intervention relative to baseline, equivalent to -5 kcals per transaction (95% CI -14 to 4). There was also no evidence for an effect on energy purchased from non-intervention items, -5 kcals per site per day (95% CI -513 to 504), p = 0.986, equivalent to 0 kcals per transaction (95% CI -1 to 1), and no clear evidence for total energy purchased -2,899 kcals per site (95% CI -5,810 to 11), p = 0.051, equivalent to -8 kcals per transaction (95% CI -16 to 0). Study limitations include using energy purchased and not energy consumed as the primary outcome and access only to transaction-level sales, rather than individual-level data. CONCLUSION Overall, the evidence was consistent with PACE labels not changing energy purchased in worksite cafeterias. There was considerable variation in effects between cafeterias, suggesting important unmeasured moderators. TRIAL REGISTRATION The study was prospectively registered on ISRCTN (date: 30.03.21; ISRCTN31315776).
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Affiliation(s)
- James P. Reynolds
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- School of Psychology, Aston University, Birmingham, United Kingdom
- * E-mail: (JPR); (TMM)
| | - Minna Ventsel
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Alice Hobson
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mark A. Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Pechey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- EPPI-Centre, UCL Social Research Institute, University College London, London, United Kingdom
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- * E-mail: (JPR); (TMM)
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12
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Ventsel M, Pechey E, De-Loyde K, Pilling MA, Morris RW, Maistrello G, Ziauddeen H, Marteau TM, Hollands GJ, Fletcher PC. Effect of health warning labels on motivation towards energy-dense snack foods: Two experimental studies. Appetite 2022; 175:106084. [PMID: 35580820 PMCID: PMC9194909 DOI: 10.1016/j.appet.2022.106084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/10/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022]
Abstract
Health warning labels (HWLs) show promise in reducing motivation towards energy-dense snack foods. Understanding the underlying mechanisms could optimise their effectiveness. In two experimental studies in general population samples (Study 1 n = 90; Study 2 n = 1382), we compared the effects of HWLs and irrelevant aversive labels (IALs) on implicit (approach) motivation towards unhealthy snacks, using an approach-avoidance task (Study 1), and a manikin task (Study 2). We also assessed explicit motivation towards unhealthy snacks using food selection tasks. We examined whether labelling effects on motivation arose from the creation of outcome-dependent associations between the food and its health consequences or from simple, non-specific aversive associations. Both label types reduced motivation towards snack foods but only when the label was physically present. HWLs and IALs showed similar effects on implicit motivation, although HWLs reduced explicit motivation more than IALs. Thus, aversive HWLs appear to act both through low level associative mechanisms affecting implicit motivation, and by additionally emphasizing explicit causal links to health outcomes thereby affecting explicitly motivated choice behaviours.
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Affiliation(s)
- Minna Ventsel
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
| | - Emily Pechey
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK
| | - Katie De-Loyde
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, 12a Priory Road, BS8 1TU, Bristol, UK
| | - Mark A Pilling
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK
| | - Richard W Morris
- Bristol Medical School, University of Bristol, 5 Tyndall Avenue, BS8 1UD, Bristol, UK
| | - Giulia Maistrello
- Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Rd, CB2 8AH, Cambridge, UK
| | - Hisham Ziauddeen
- Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Rd, CB2 8AH, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, CB21 5EF, Cambridge, UK; Wellcome Trust-MRC Institute of Metabolic Science - Metabolic Research Laboratories, Addenbrooke's Hospital, CB2 0QQ, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK; EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Rd, CB2 8AH, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, CB21 5EF, Cambridge, UK; Wellcome Trust-MRC Institute of Metabolic Science - Metabolic Research Laboratories, Addenbrooke's Hospital, CB2 0QQ, Cambridge, UK.
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13
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Pechey R, Hollands GJ, Marteau TM. Explaining the effect on food selection of altering availability: two experimental studies on the role of relative preferences. BMC Public Health 2022; 22:868. [PMID: 35501746 PMCID: PMC9063226 DOI: 10.1186/s12889-022-13067-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/23/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Increasing the availability of healthier or plant-based foods increases their selection. The current studies aimed to examine the extent to which relative preferences account for food selections following availability interventions. In particular, (a) whether increasing the availability of lower-energy options increases the likelihood that individuals' highest-ranked option is lower-energy, and (b) the extent to which selections reflect individuals' highest-ranked option from the available range. METHODS UK adults (Study 1: n = 1976; Study 2: n = 1078) took part in within-subjects online studies. In both studies, the order of preference between food options was established by participants choosing the option that they would prefer "to eat right now" from every possible pairing within a pool of eight options. Then, participants were shown either predominantly higher-energy options (three higher- and one lower-energy) or predominantly lower-energy options (vice versa), presented in a random order. RESULTS When predominantly lower-energy options were presented, the odds of the highest-ranked option being a lower-energy option increased ten-fold (Study 1: odds ratio: 10.1; 95%CI: 8.9,11.4; Study 2: odds ratio: 10.4; 95%CI: 7.4,14.7), compared to when predominantly higher-energy options were available. In both studies, around 90% of selections reflected the highest-ranked option in the range offered in the studied availability conditions (range 88-92%). CONCLUSIONS These studies suggest that increased availability of lower-energy options increases the likelihood of an individual's highest-ranked option being lower-energy, and that the highest-ranked option has the greatest likelihood of selection. As such, preferences may be a key contributor to the effects of altering availability on food selections. TRIAL REGISTRATION ISRCTN ( http://www.isrctn.com/ISRCTN27598623 ; 3/12/19 [Study 1]; http://www.isrctn.com/ISRCTN61010183 ; 20/4/20 [Study 2]).
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Affiliation(s)
- Rachel Pechey
- Institute of Public Health, University of Cambridge, Cambridge, UK.
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.
| | - Gareth J Hollands
- Institute of Public Health, University of Cambridge, Cambridge, UK
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
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Affiliation(s)
- Theresa M Marteau
- University of Cambridge, Department of Public Health and Primary Care, Cambridge CB2 0SR, UK
| | - Gareth J Hollands
- University of Cambridge, Department of Public Health and Primary Care, Cambridge CB2 0SR, UK
- University College London, EPPI-Centre, UCL Social Research Institute, London WC1H 0NR, UK
| | - Rachel Pechey
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Woodstock Road, Oxford OX2 6GG, UK
| | | | - Susan A Jebb
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Woodstock Road, Oxford OX2 6GG, UK
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15
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Hollands GJ, Usher-Smith JA, Hasan R, Alexander F, Clarke N, Griffin SJ. Visualising health risks with medical imaging for changing recipients' health behaviours and risk factors: Systematic review with meta-analysis. PLoS Med 2022; 19:e1003920. [PMID: 35239659 PMCID: PMC8893626 DOI: 10.1371/journal.pmed.1003920] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 01/19/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is ongoing clinical and research interest in determining whether providing personalised risk information could motivate risk-reducing health behaviours. We aimed to assess the impact on behaviours and risk factors of feeding back to individuals' images of their bodies generated via medical imaging technologies in assessing their current disease status or risk. METHODS AND FINDINGS A systematic review with meta-analysis was conducted using Cochrane methods. MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to July 28, 2021, with backward and forward citation searches up to July 29, 2021. Eligible studies were randomised controlled trials including adults who underwent medical imaging procedures assessing current health status or risk of disease, for which personal risk may be reduced by modifying behaviour. Trials included an intervention group that received the imaging procedure plus feedback of visualised results and assessed subsequent risk-reducing health behaviour. We examined 12,620 abstracts and included 21 studies, involving 9,248 randomised participants. Studies reported on 10 risk-reducing behaviours, with most data for smoking (8 studies; n = 4,308), medication use (6 studies; n = 4,539), and physical activity (4 studies; n = 1,877). Meta-analysis revealed beneficial effects of feedback of visualised medical imaging results on reduced smoking (risk ratio 1.11, 95% confidence interval [CI] 1.01 to 1.23, p = 0.04), healthier diet (standardised mean difference [SMD] 0.30, 95% CI 0.11 to 0.50, p = 0.003), increased physical activity (SMD 0.11, 95% CI 0.003 to 0.21, p = 0.04), and increased oral hygiene behaviours (SMD 0.35, 95% CI 0.13 to 0.57, p = 0.002). In addition, single studies reported increased skin self-examination and increased foot care. For other behavioural outcomes (medication use, sun protection, tanning booth use, and blood glucose testing) estimates favoured the intervention but were not statistically significant. Regarding secondary risk factor outcomes, there was clear evidence for reduced systolic blood pressure, waist circumference, and improved oral health, and some indication of reduced Framingham risk score. There was no evidence of any adverse effects, including anxiety, depression, or stress, although these were rarely assessed. A key limitation is that there were some concerns about risk of bias for all studies, with evidence for most outcomes being of low certainty. In particular, valid and precise measures of behaviour were rarely used, and there were few instances of preregistered protocols and analysis plans, increasing the likelihood of selective outcome reporting. CONCLUSIONS In this study, we observed that feedback of medical images to individuals has the potential to motivate risk-reducing behaviours and reduce risk factors. Should this promise be corroborated through further adequately powered trials that better mitigate against risk of bias, such interventions could usefully capitalise upon the widespread and growing use of medical imaging technologies in healthcare.
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Affiliation(s)
- Gareth J. Hollands
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- EPPI-Centre, UCL Social Research Institute, University College London, London, United Kingdom
- * E-mail:
| | - Juliet A. Usher-Smith
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Rana Hasan
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Florence Alexander
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Natasha Clarke
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Simon J. Griffin
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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16
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MacFarlane D, Hurlstone MJ, Ecker UKH, Ferraro PJ, Linden S, Wan AKY, Veríssimo D, Burgess G, Chen F, Hall W, Hollands GJ, Sutherland WJ. Reducing demand for overexploited wildlife products: Lessons from systematic reviews from outside conservation science. Conservat Sci and Prac 2022. [DOI: 10.1111/csp2.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Douglas MacFarlane
- Conservation Science Group, Department of Zoology University of Cambridge Cambridge UK
- School of Psychological Science University of Western Australia Crawley Western Australia Australia
| | - Mark J. Hurlstone
- School of Psychological Science University of Western Australia Crawley Western Australia Australia
- Department of Psychology Lancaster University Lancaster UK
| | - Ullrich K. H. Ecker
- School of Psychological Science University of Western Australia Crawley Western Australia Australia
| | - Paul J. Ferraro
- Carey Business School and the Department of Environmental Health and Engineering, A Joint Department of the Bloomberg School of Public Health and the Whiting School of Engineering Johns Hopkins University Baltimore Maryland USA
| | - Sander Linden
- Department of Psychology, Social Decision‐Making Laboratory University of Cambridge Cambridge UK
| | - Anita K. Y. Wan
- Socio‐Ecological and Conservation Science Laboratory, School of Life Sciences, Sun Yat‐Sen University Guangzhou Guangdong China
| | - Diogo Veríssimo
- Oxford Martin Program on the Illegal Wildlife Trade, Oxford University Oxford UK
- Department of Zoology University of Oxford Oxford UK
| | - Gayle Burgess
- TRAFFIC, The Wildlife Trade Monitoring Network Cambridge UK
| | - Frederick Chen
- Department of Economics Wake Forest University Winston‐Salem North Carolina USA
| | - Wayne Hall
- National Centre for Youth Substance Use Research, University of Queensland Brisbane Queensland Australia
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, University of Cambridge Cambridge UK
| | - William J. Sutherland
- Conservation Science Group, Department of Zoology University of Cambridge Cambridge UK
- BioRISC, St. Catharine's College Cambridge UK
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Mantzari E, Reynolds JP, Jebb SA, Hollands GJ, Pilling MA, Marteau TM. Public support for policies to improve population and planetary health: A population-based online experiment assessing impact of communicating evidence of multiple versus single benefits. Soc Sci Med 2022; 296:114726. [PMID: 35093794 PMCID: PMC8907862 DOI: 10.1016/j.socscimed.2022.114726] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/20/2022]
Abstract
Background Effective interventions for reducing the consumption of products that harm population and planetary health often lack public support, impeding implementation. Communicating evidence of policies’ effectiveness can increase public support but there is uncertainty about the most effective ways of communicating this evidence. Some policies have multiple benefits such as both improving health and the environment. This study assesses whether communicating evidence of multiple versus single benefits of a policy increases its support. Method Participants (n = 4616) nationally representative of the British population were randomised to one of 24 groups in an online experiment with a 4 × 3 × 2 between-subjects factorial design. The messages that participants viewed differed according to the evidence they communicated (no message, effectiveness for changing behaviour, effectiveness for changing behaviour + one policy benefit, effectiveness for changing behaviour + three policy benefits), type of policy (taxation, availability) and the target behaviour (consumption of energy-dense food, alcohol, or meat). The primary outcome was policy support. Results In a full factorial ANOVA, there was a significant main effect of communicating evidence of effectiveness on policy support, which was similar across policies and behaviours. Communicating three benefits increased support relative to communicating one benefit (d = 0.15; p = 0.01). Communicating one benefit increased support compared to providing evidence for changing behaviour alone (d = 0.13; p = 0.004) or no message (d = 0.11 p = 0.022). Conclusion Communicating evidence of a policy's benefits increases support for policy action across different behaviours and policies. Presenting multiple benefits of policies enhances public support. Providing evidence of policies effectiveness at achieving policy goals increases public support. Uncertainty exists about the most effective ways of communicating this evidence. Evidence about multiple policy benefits increases support more than evidence for a single benefit. Effects are evident across behaviours and policies.
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Affiliation(s)
- Eleni Mantzari
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - James P Reynolds
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mark A Pilling
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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18
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Clarke N, Blackwell AKM, De-Loyde K, Pechey E, Hobson A, Pilling M, Morris RW, Marteau TM, Hollands GJ. Health warning labels and alcohol selection: a randomised controlled experiment in a naturalistic shopping laboratory. Addiction 2021; 116:3333-3345. [PMID: 33861881 DOI: 10.1111/add.15519] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/15/2020] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Health warning labels (HWLs) on tobacco products reduce smoking. There is an absence of evidence concerning the impact of alcohol HWLs on selection or purchasing in naturalistic settings. Using a commercial-standard naturalistic shopping laboratory, this study aimed to estimate the impact on selection of alcoholic drinks of HWLs describing adverse health consequences of excessive alcohol consumption. DESIGN A between-subjects randomised experiment with three groups was conducted: group 1: image-and-text HWL; group 2: text-only HWL; group 3: no HWL. SETTING A commercial-standard naturalistic shopping laboratory in the United Kingdom. PARTICIPANTS Adults (n = 399, 55% female) over the age of 18 years, who purchased beer or wine weekly to drink at home. INTERVENTIONS Participants were randomised to one of three groups varying in the HWL displayed on the packaging of the alcoholic drinks: (i) image-and-text HWL (n = 135); (ii) text-only HWL (n = 129); (iii) no HWL (n = 135). Participants completed a shopping task, selecting items from a range of alcoholic and non-alcoholic drinks, and snacks. MEASUREMENT The primary outcome was the proportion of alcoholic drinks selected. Secondary outcomes included HWL ratings on negative emotional arousal and label acceptability. FINDINGS There was no clear evidence of a difference in the HWL groups for the percentage of drinks selected that were alcoholic compared to no HWL (44%): image-and-text HWL: 46% (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.82, 1.42); text-only HWL: 41% (OR = 0.87, 95% CI = 0.67, 1.14). Concordant with there being no difference between groups, there was extreme evidence in favour of the null hypothesis (Bayes factor [BF] < 0.01). Negative emotional arousal was higher (P < 0.001) and acceptability lower (P < 0.001) in the image-and-text HWL group, compared to the text-only HWL group. CONCLUSIONS In a naturalistic shopping laboratory, there was no evidence that health warning labels describing the adverse health consequences of excessive alcohol consumption changed selection behaviour.
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Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Anna K M Blackwell
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Katie De-Loyde
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Emily Pechey
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alice Hobson
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mark Pilling
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Theresa M Marteau
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Clarke N, Pechey E, Pechey R, Ventsel M, Mantzari E, De-Loyde K, Pilling MA, Morris RW, Marteau TM, Hollands GJ. Size and shape of plates and size of wine glasses and bottles: impact on self-serving of food and alcohol. BMC Psychol 2021; 9:163. [PMID: 34670610 PMCID: PMC8527815 DOI: 10.1186/s40359-021-00645-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background The physical properties of tableware could influence selection and consumption of food and alcohol. There is considerable uncertainty, however, around the potential effects of different sizes and shapes of tableware on how much food and alcohol people self-serve. These studies aimed to estimate the impact of: 1. Plate size and shape on amount of food self-served; 2.Wine glass and bottle size on amount of wine self-poured. Methods 140 adults participated in two laboratory studies—each using randomised within-subjects factorial designs—where they self-served food (Study 1) and wine (Study 2): Study 1: 3 plate sizes (small; medium; large) × 2 plate shapes (circular; square). Study 2: 3 wine glass sizes (small; medium; large) × 2 wine bottle sizes (75 cl; 50 cl). Results Study 1: There was a main effect of plate size: less was self-served on small (76 g less, p < 0.001) and medium (41 g less, p < 0.001) plates, compared to large plates. There was no evidence for a main effect of plate shape (p = 0.46) or a size and shape interaction (p = 0.47). Study 2: There was a main effect of glass size: less was self-served in small (34 ml less, p < 0.001) and medium (17 ml less, p < 0.001) glasses, compared to large glasses. There was no evidence of a main effect of bottle size (p = 0.20) or a glass and bottle size interaction (p = 0.18). Conclusions Smaller tableware (i.e. plates and wine glasses) decreases the amount of food and wine self-served in an initial serving. Future studies are required to generate estimates on selection and consumption in real world settings when numerous servings are possible. Protocol registration information: OSF (https://osf.io/dj3c6/) and ISRCTN (10.1186/ISRCTN66774780). Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00645-z.
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Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Emily Pechey
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rachel Pechey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Minna Ventsel
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Eleni Mantzari
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Katie De-Loyde
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Mark A Pilling
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Theresa M Marteau
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Pechey R, Clarke N, Pechey E, Ventsel M, Hollands GJ, Marteau TM. Impact of altering the available food options on selection: Potential mediation by social norms. Appetite 2021; 164:105245. [PMID: 33836216 PMCID: PMC8214103 DOI: 10.1016/j.appet.2021.105245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/10/2021] [Accepted: 03/28/2021] [Indexed: 01/10/2023]
Abstract
Increasing the availability of lower-energy foods increases their selection. The current studies examine the extent to which this effect could be mediated by social norms - assessed by perceived popularity of foods - which may be implied by their relative availability. Study 1 (Online): 2340 UK adults estimated the perceived popularity of products. Participants were randomised to see photos of cafeteria shelves varying in the availability of lower-energy options (1/4 lower-energy; 1/2 lower-energy; 3/4 lower-energy) and fullness of shelves (fuller; emptier). Study 2 (Laboratory): 139 English adults were asked to select a snack. Participants were randomised to select from trays varying in the availability of the lower-energy option (1/3 lower-energy; 2/3 lower-energy) and fullness of tray (fuller; emptier). In Study 1, evidence for an interaction was found, such that when shelves were fuller, a higher proportion of lower-energy options led to greater perceived popularity of lower-energy products (1/4 lower-energy: 40.9% (95%CIs: 40.1,41.8); 3/4 lower-energy: 47.2% (46.3,48.0)), whereas when shelves were emptier, a higher proportion of lower-energy options led to lower perceived popularity (1/4 lower-energy: 48.4% (47.5,49.2); 3/4 lower-energy: 39.2% (38.3,40.0)). In Study 2, when the tray was fuller, participants were more likely - albeit non-significantly - to select a lower-energy snack when 2/3 of the available snacks were lower-energy (35.7% (18.5,52.9)) than when 1/3 were lower-energy (15.4% (4.2,26.5)). For emptier trays, lower-energy selections decreased as the relative availability of lower-energy snacks increased (1/3 lower-energy snacks: 36.0% (17.9,54.1); 2/3 lower-energy snacks: 27.8% (13.9,41.7)). These studies provide novel evidence that social norms may mediate the impact of availability on food selection. In addition, they suggest that the effect of availability may be moderated by display layout through its impact on perceived product popularity.
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Affiliation(s)
- Rachel Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK.
| | - Natasha Clarke
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Emily Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Minna Ventsel
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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Reynolds JP, Ventsel M, Kosīte D, Rigby Dames B, Brocklebank L, Masterton S, Pechey E, Pilling M, Pechey R, Hollands GJ, Marteau TM. Impact of decreasing the proportion of higher energy foods and reducing portion sizes on food purchased in worksite cafeterias: A stepped-wedge randomised controlled trial. PLoS Med 2021; 18:e1003743. [PMID: 34520468 PMCID: PMC8439477 DOI: 10.1371/journal.pmed.1003743] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/27/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Overconsumption of energy from food is a major contributor to the high rates of overweight and obesity in many populations. There is growing evidence that interventions that target the food environment may be effective at reducing energy intake. The current study aimed to estimate the effect of decreasing the proportion of higher energy (kcal) foods, with and without reducing portion size, on energy purchased in worksite cafeterias. METHODS AND FINDINGS This stepped-wedge randomised controlled trial (RCT) evaluated 2 interventions: (i) availability: replacing higher energy products with lower energy products; and (ii) size: reducing the portion size of higher energy products. A total of 19 cafeterias were randomised to the order in which they introduced the 2 interventions. Availability was implemented first and maintained. Size was added to the availability intervention. Intervention categories included main meals, sides, cold drinks, snacks, and desserts. The study setting was worksite cafeterias located in distribution centres for a major United Kingdom supermarket and lasted for 25 weeks (May to November 2019). These cafeterias were used by 20,327 employees, mainly (96%) in manual occupations. The primary outcome was total energy (kcal) purchased from intervention categories per day. The secondary outcomes were energy (kcal) purchased from nonintervention categories per day, total energy purchased per day, and revenue. Regression models showed an overall reduction in energy purchased from intervention categories of -4.8% (95% CI -7.0% to -2.7%), p < 0.001 during the availability intervention period and a reduction of -11.5% (95% CI -13.7% to -9.3%), p < 0.001 during the availability plus size intervention period, relative to the baseline. There was a reduction in energy purchased of -6.6% (95% CI -7.9% to -5.4%), p < 0.001 during the availability plus size period, relative to availability alone. Study limitations include using energy purchased as the primary outcome (and not energy consumed) and the availability only of transaction-level sales data per site (and not individual-level data). CONCLUSIONS Decreasing the proportion of higher energy foods in cafeterias reduced the energy purchased. Decreasing portion sizes reduced this further. These interventions, particularly in combination, may be effective as part of broader strategies to reduce overconsumption of energy from food in out-of-home settings. TRIAL REGISTRATION ISRCTN registry ISRCTN87225572.
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Affiliation(s)
- James P. Reynolds
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- School of Psychology, Aston University, Birmingham, United Kingdom
| | - Minna Ventsel
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Daina Kosīte
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Brier Rigby Dames
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Laura Brocklebank
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Sarah Masterton
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Emily Pechey
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mark Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Pechey
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- Nuffield Department of Primary Care and Health Science, University of Oxford, Oxford, United Kingdom
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
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Clarke N, Pechey E, Kosīte D, König LM, Mantzari E, Blackwell AK, Marteau TM, Hollands GJ. Impact of health warning labels on selection and consumption of food and alcohol products: systematic review with meta-analysis. Health Psychol Rev 2021; 15:430-453. [PMID: 32515697 PMCID: PMC8635708 DOI: 10.1080/17437199.2020.1780147] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 06/03/2020] [Indexed: 01/31/2023]
Abstract
Health warning labels (HWLs) could reduce harmful consumption of food (including non-alcoholic drinks) and alcoholic drinks. A systematic review with meta-analysis using Cochrane methods was conducted to assess the impact on selection (including hypothetical selection) or consumption of food or alcoholic drink products displaying image-and-text (sometimes termed 'pictorial') and text-only HWLs. Fourteen randomised controlled trials were included, three for alcohol, eleven for food. For the primary outcomes, eleven studies measured selection and one measured consumption (two measured only other secondary outcomes). Meta-analysis of twelve comparisons from nine studies (n=12,635) found HWLs reduced selection of the targeted product compared with no HWL (RR=0.74 (95%CI 0.68-0.80)), with participants 26% less likely to choose a product displaying a HWL. A planned subgroup analysis suggested a larger (although not statistically significant) effect on selection of image-and-text HWLs (RR=0.65 (95%CI 0.54-0.80)) than text-only HWLs (RR=0.79 (95%CI 0.74-0.85)). These findings suggest significant potential for HWLs to reduce selection of food and alcoholic drinks, but all experimental studies to date were conducted in laboratory or online settings with outcomes assessed immediately after a single exposure. Studies in field and naturalistic laboratory settings are needed to estimate the potential effects of food and alcohol HWLs.Study registration: PROSPERO 2018 (registration number: CRD42018106522).
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Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Emily Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Daina Kosīte
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Laura M. König
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Eleni Mantzari
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Anna K.M. Blackwell
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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23
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Marteau TM, Fletcher PC, Munafò MR, Hollands GJ. Beyond choice architecture: advancing the science of changing behaviour at scale. BMC Public Health 2021; 21:1531. [PMID: 34376159 PMCID: PMC8356415 DOI: 10.1186/s12889-021-11382-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 06/25/2021] [Indexed: 11/10/2022] Open
Abstract
Addressing the global threats to population and planetary health requires changing many behaviours at scale. This demands consideration not only of the effect size of an intervention but also its reach - the proportion of the population exposed to the intervention.We propose that a relatively under-researched and generally poorly specified set of interventions involving changes to physical micro-environments - often referred to as Choice Architecture - has the potential to make a significant contribution to meeting this urgent challenge.Realising the potential of Choice Architecture interventions requires integration of basic - i.e. laboratory-based - and applied - i.e. field-based - research, generating interventions that can be delivered at scale alongside advancing theory. We illustrate this with examples to highlight the complementarity of laboratory and field studies informed by and in turn updating the results of evidence synthesis. The examples comprise two sets of interventions - changing the relative availability of products and changing their size - to reduce consumption of meat, energy from food and alcohol across populations.
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Affiliation(s)
- Theresa M Marteau
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marcus R Munafò
- University of Bristol, School of Psychological Science, Bristol, UK
| | - Gareth J Hollands
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Hollands GJ, Sutton S, Aveyard P. The effect of nicotine dependence and withdrawal symptoms on use of nicotine replacement therapy: Secondary analysis of a randomized controlled trial in primary care. J Subst Abuse Treat 2021; 132:108591. [PMID: 34391588 DOI: 10.1016/j.jsat.2021.108591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/13/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Nicotine replacement therapy (NRT) is effective for smoking cessation, but the optimal method of using NRT to maximize benefit is unclear. We examined whether nicotine dependence was associated with consumption of NRT, whether this was mediated by withdrawal symptoms, and the impact of these factors on cessation, in a population advised to use as much NRT as needed. METHODS Secondary analysis of data from an open label, parallel group randomized controlled trial. Participants (n = 539) attended a smoking cessation clinic in primary care and remained engaged with treatment for at least one week following a quit attempt. Baseline dependence was measured by the Fagerström Test for Cigarette Dependence (FTCD), with tobacco exposure assessed via an exhaled carbon monoxide test. At one week after quit day, mean daily consumption of NRT was measured for all participants; withdrawal (Mood and Physical Symptoms Scale (MPSS)) was also assessed in the subsample who reported being completely abstinent to that point (n = 279). Abstinence was biochemically assessed at four weeks for all participants as the principal smoking cessation outcome. RESULTS Each point higher on the FTCD was associated with 0.83 mg/day more NRT consumption, controlling for tobacco exposure. This relationship was diminished when withdrawal was controlled for, and withdrawal was associated with NRT consumption, with each point higher on the MPSS associated with a 0.12 mg/day increase. Increased consumption of NRT directly predicted subsequent smoking cessation. CONCLUSIONS Higher dependence appears to lead to greater withdrawal, which appears to drive greater use of NRT. This effect may partly offset lower abstinence rates in people with higher dependence. Advice to use sufficient NRT to suppress withdrawal may increase abstinence rates.
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Affiliation(s)
- Gareth J Hollands
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, UK.
| | - Stephen Sutton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Asbridge SCM, Pechey E, Marteau TM, Hollands GJ. Effects of pairing health warning labels with energy-dense snack foods on food choice and attitudes: Online experimental study. Appetite 2021; 160:105090. [PMID: 33373631 PMCID: PMC7895764 DOI: 10.1016/j.appet.2020.105090] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/29/2020] [Accepted: 12/22/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is limited evidence concerning the potential effectiveness of health warning labels (HWLs) using images and text to depict possible negative health consequences of consumption, for reducing selection of energy-dense snack foods. Furthermore, the underlying mechanisms have received little attention; particularly effects on implicit attitudes, which previous work has shown may mediate the effect of aversive images on food choice. AIM To assess the impact of pairing image- and text-based HWLs with energy-dense snack foods on a) the selection of, and b) implicit and explicit attitudes towards, those foods. METHODS Online experimental study with a representative UK sample (n = 1185), using a 2(Image/No Image) x 2(Text/No Text) factorial between-subjects design. Participants were randomised to one of four study arms, viewing snack food images paired with either: image-only HWLs, text-only HWLs, image-and-text HWLs, or no HWLs (control). HWLs concerned various negative health consequences of excess energy intake, such as heart disease and type 2 diabetes. The primary outcome was hypothetical food choice (energy-dense snack foods versus fruit), assessed post-intervention. Secondary outcomes were implicit and explicit attitudes. RESULTS Neither food choice nor explicit attitudes were changed significantly by any type of HWL. Implicit attitudes towards energy-dense snack foods were more negative after exposure to text-only or image-and-text HWLs. Both implicit and explicit attitudes predicted unique variance in food choice. CONCLUSIONS This study suggests that short-term repeated exposure to HWLs paired with energy-dense snack foods may not consistently alter food choices, but can change implicit attitudes associated with food choices. Further laboratory and field studies are needed to more definitively assess the impact of HWLs on food selection and consumption in applied contexts and over time, as well as delineate underlying mechanisms.
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Affiliation(s)
- Stephanie C M Asbridge
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Emily Pechey
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK.
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Brocklebank LA, Blackwell AKM, Marteau TM, Hollands GJ, Fletcher PC, De-Loyde K, Morris RW, Pilling MA, Pechey R, Maynard OM, Attwood AS, Munafò MR. Straight-sided beer and cider glasses to reduce alcohol sales for on-site consumption: A randomised crossover trial in bars. Soc Sci Med 2021; 278:113911. [PMID: 33962320 PMCID: PMC8146727 DOI: 10.1016/j.socscimed.2021.113911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Straight-sided glasses can slow the rate of lager consumption in a laboratory setting compared with curved glasses. Slower drinking rates may lower overall alcohol consumption. Glass shape is therefore a potential target for intervention. The aim of this randomised crossover trial was to estimate the impact of serving draught beer and cider in straight-sided glasses, compared with usual, predominantly curved glasses, on alcohol sales for on-site consumption in bars. METHODS Twenty-four bars in England completed two intervention periods (A) and two control periods (B) in a randomised order: 1) BABA; 2) BAAB; 3) ABBA; or 4) ABAB. Each period lasted two weeks and involved serving draught beer and cider in either straight-sided glasses (A) or the venue's usual glasses (≥75% curved; B). The primary outcome was the mean volume (in litres) of draught beer and cider sold weekly, compared between A and B periods using a paired-samples t-test on aggregate data. A regression model adjusted for season, order, special events, and busyness. FINDINGS Mean weekly volume sales of draught beer and cider was 690·9 L (SD 491·3 L) across A periods and 732·5 L (SD 501·0 L) across B periods. The adjusted mean difference (A minus B) was 8·9 L per week (95% CI -45·5 to 63·3; p = 0·737). INTERPRETATION This study provides no clear evidence that using straight-sided glasses, compared with usual, predominantly curved glasses, reduces the volume of draught beer and cider sold for on-site consumption in bars.
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Affiliation(s)
- Laura A Brocklebank
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK; Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Anna K M Blackwell
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Clifford Allbut Building, Addenbrooke's Hospital, Cambridge, CB2 0SP, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK; Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Katie De-Loyde
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Richard W Morris
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mark A Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Rachel Pechey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Olivia M Maynard
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Angela S Attwood
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Marcus R Munafò
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK; National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
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Pechey R, Hollands GJ, Marteau TM. Are meat options preferred to comparable vegetarian options? An experimental study. BMC Res Notes 2021; 14:37. [PMID: 33499902 PMCID: PMC7836153 DOI: 10.1186/s13104-021-05451-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Reducing meat consumption would have substantial benefits both in terms of health and environmental impact, but meat options may be more attractive to customers than meat-free options. This study tested this by presenting UK adults (n = 540) with a series of pictures showing two meal options and asking them to select which they would prefer to eat right now. They completed this task for every possible pair from a pool of six comparator meat-based options and six target options (66 pairs). Participants all saw identical comparator options, and were randomised to see the same pictures of target options but with descriptions that suggested they were either meat-based or vegetarian. RESULTS Selections were used to rank the options for each individual from 1 (most-selected) to 12 (least-selected). Vegetarian target options were ranked worse [by 1.23 places (95% CI: 1.02, 1.44)] than meat target options. Higher self-reported consumption of meat predicted worse mean rankings of target options when these were vegetarian, but not when target options were meat-based. This suggests meat options are preferred to equivalent vegetarian options and may be more likely to be selected. This has implications for interventions aiming to reduce meat consumption to make diets healthier and more sustainable.
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Affiliation(s)
- Rachel Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG UK
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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Abstract
While previous frameworks to address health behaviours through targeting underlying automatic processes have stimulated an improved understanding of related interventions, deciding between intervention strategies often remains essentially arbitrary and atheoretical. Making considered decisions has likely been hampered by the lack of a framework that guides the selection of different intervention strategies targeting automatic processes to reduce unhealthy behaviours. We propose a process framework to fulfil this need, building upon the process model of emotion regulation. This framework differentiates types of intervention strategies along the timeline of the unfolding automatic response, distinguishing between three broad classes of intervention strategies - direct antecedent, indirect antecedent, and response-focused. Antecedent-focused strategies aim to prevent the exposure to or activation of automatic responses directly through the avoidance of unwanted stimulus-response associations (i.e., situation modification or situation-specific response selection), or indirectly through automatising self-control (i.e., attentional deployment or cognitive change). Response-focused strategies aim to directly downregulate automatic unwanted responses (i.e., response modulation). Three main working hypotheses derived from this process framework provide practical guidance for selecting interventions, but await direct testing in future studies.
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Affiliation(s)
- Junilla K Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
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Clarke N, Pechey E, Mantzari E, Blackwell AKM, De-Loyde K, Morris RW, Munafò MR, Marteau TM, Hollands GJ. Impact of health warning labels communicating the risk of cancer on alcohol selection: an online experimental study. Addiction 2021; 116:41-52. [PMID: 32267588 DOI: 10.1111/add.15072] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/25/2019] [Accepted: 04/01/2020] [Indexed: 01/08/2023]
Abstract
AIMS Evidence from tobacco research suggests that health warning labels (HWLs) depicting the adverse consequences of consumption change smoking behaviours, with image-and-text (also known as 'pictorial' or 'graphic') HWLs most effective. There is an absence of evidence concerning the potential impact of HWLs placed on alcohol products on selection of those products. This study aimed to obtain a preliminary assessment of the possible impact of (i) image-and-text, (ii) text-only, and (iii) image-only HWLs on selection of alcoholic versus non-alcoholic drinks. DESIGN A between-subjects randomised experiment with a 2 (image: present versus absent) × 2 (text: present versus absent) factorial design. SETTING The study was conducted on the online survey platform Qualtrics. PARTICIPANTS Participants (n = 6024) were adults over the age of 18 who consumed beer or wine regularly (i.e. at least once a week), recruited through a market research agency. INTERVENTIONS Participants were randomised to one of four groups varying in the HWL displayed on the packaging of alcoholic drinks: (i) image-and-text HWL; (ii) text-only HWL; (iii) image-only HWL; and (iv) no HWL. HWLs depicted bowel cancer, breast cancer and liver cancer, which were each displayed twice across six alcoholic drinks. Each group viewed six alcoholic and six non-alcoholic drinks and selected one drink that they would like to consume. MEASUREMENTS The primary outcome was the proportion of participants selecting an alcoholic versus a non-alcoholic drink. FINDINGS Alcoholic drink selection was lower for all HWL types compared with no HWL (image-and-text: 56%; image-only: 49%; text-only: 61%; no HWL: 77%), with selection lowest for HWLs that included an image. Image-and-text HWLs reduced the odds of selecting an alcoholic drink compared with text-only HWLs (OR = 0.80, 95% CI = 0.69, 0.92), but increased the odds of selecting an alcoholic drink compared with image-only HWLs (OR = 1.34, 95% CI = 1.16, 1.55). CONCLUSIONS Health warning labels communicating the increased risk of cancers associated with alcohol consumption reduced selection of alcoholic versus non-alcoholic drinks in a hypothetical choice task in an online setting; labels displaying images had the largest effect. Their impact in laboratory and real-world field settings using physical products awaits investigation.
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Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Emily Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Eleni Mantzari
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Anna K M Blackwell
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Katie De-Loyde
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | | | - Marcus R Munafò
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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Codling S, Mantzari E, Sexton O, Fuller G, Pechey R, Hollands GJ, Pilling M, Marteau TM. Impact of bottle size on in-home consumption of wine: a randomized controlled cross-over trial. Addiction 2020; 115:2280-2292. [PMID: 32270544 PMCID: PMC8190654 DOI: 10.1111/add.15042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/17/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023]
Abstract
AIM To assess the impact of purchasing wine in 50 cl bottles compared with 75 cl bottles on the amount of wine consumed at home. DESIGN Cross-over randomized controlled trial with a 'usual behaviour' period of a maximum of 3 weeks between conditions. SETTING Households in the United Kingdom. PARTICIPANTS One hundred and eighty-six households that consumed between two and eight 75 cl bottles of wine each week. INTERVENTION Households were randomized to the order in which they purchased wine in two bottle sizes. During two 14-day intervention periods, households purchased a pre-set volume of wine-based on their baseline self-reported weekly consumption-in either 75 cl bottles or 50 cl bottles. On days 7 and 14 of each study period, participating households sent photographs of each purchased wine bottle. MEASUREMENTS The primary outcome was the volume of study wine in millilitres (ml) consumed during each study period estimated through returned photographs. The secondary outcome was the rate of consumption measured by the mean number of days taken to drink 1.5 litres from each bottle size. FINDINGS One hundred and sixty-six of 186 enrolled households satisfactorily completed the study. After accounting for pre-specified covariates, 191.1 ml [95% confidence interval (CI) = 42.03-339.2] or 4.5% (95% CI = 1.0-7.9%) more wine was consumed per 14-day period from 75-cl bottles than from 50-cl bottles. Consumption was 5.8% faster (95% CI = -10.9 to -0.4%) from 75 cl bottles than from 50 cl bottles. CONCLUSIONS Consuming wine at home from 50 cl bottles, compared with 75 cl bottles, may reduce both amount consumed and rate of consumption.
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Affiliation(s)
- Saphsa Codling
- Behaviour and Health Research UnitUniversity of CambridgeUK
| | - Eleni Mantzari
- Behaviour and Health Research UnitUniversity of CambridgeUK
| | - Olivia Sexton
- Behaviour and Health Research UnitUniversity of CambridgeUK
| | - Georgia Fuller
- Behaviour and Health Research UnitUniversity of CambridgeUK
| | - Rachel Pechey
- Behaviour and Health Research UnitUniversity of CambridgeUK
| | | | - Mark Pilling
- Behaviour and Health Research UnitUniversity of CambridgeUK
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Clarke N, Pechey E, Mantzari E, Blackwell AKM, De-Loyde K, Morris RW, Munafò MR, Marteau TM, Hollands GJ. Impact of health warning labels on snack selection: An online experimental study. Appetite 2020; 154:104744. [PMID: 32562806 PMCID: PMC7450271 DOI: 10.1016/j.appet.2020.104744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Abstract
Excessive consumption of energy-dense food increases the risk of obesity, which in turn increases the risk of non-communicable diseases, including heart disease, type 2 diabetes and most non-smoking-related cancers. Health warning labels (HWLs) that communicate the adverse health consequences of excess energy consumption could reduce intake of energy-dense foods. The aim of the current study was to estimate the impact on selection of energy-dense snacks of (a) image-and-text HWLs (b) text-only HWLs and (c) calorie information. In a between-subjects, 3 (HWL: image-and-text, text-only, no label) x 2 (calorie information: present, absent), factorial experimental design, participants (N = 4134) were randomised to view a selection of energy-dense and non-energy-dense snacks with one of five label types or no label. The primary outcome was the proportion of participants selecting an energy-dense snack in a hypothetical vending machine task. The proportion of participants selecting an energy-dense snack was reduced in all label groups, relative to the no label group (no label: 59%; calories only: 54%; text-only HWL: 48%; text-only HWL with calories: 44%; image-and-text HWL: 37%; image-and-text HWL with calories: 38%). Compared to the no label group, participants were least likely to select an energy-dense snack in the image-and-text HWL group (OR = 0.46, 95%CI = 0.40, 0.54, p < 0.001). Health warning labels - particularly those including an image and text - have the potential to reduce selection of energy-dense snacks in an online setting. Their impact on selection and consumption in real-world settings awaits testing.
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Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Emily Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Eleni Mantzari
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Anna K M Blackwell
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Katie De-Loyde
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | | | - Marcus R Munafò
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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Pilling M, Clarke N, Pechey R, Hollands GJ, Marteau TM. The effect of wine glass size on volume of wine sold: a mega-analysis of studies in bars and restaurants. Addiction 2020; 115:1660-1667. [PMID: 32003493 PMCID: PMC7496108 DOI: 10.1111/add.14998] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/30/2019] [Accepted: 01/28/2020] [Indexed: 11/29/2022]
Abstract
AIM To estimate the effects of wine glass size on volume of wine sold in bars and restaurants. DESIGN A mega-analysis combining raw (as opposed to aggregate-level) data from eight studies conducted in five establishments. A multiple treatment reversal design was used for each data set, with wine glass size changed fortnightly while serving sizes were unaffected, in studies lasting between 14 and 26 weeks. SETTING AND PARTICIPANTS Five bars and restaurants in England participated in studies between 2015 and 2018, using wine glasses of five sizes: 250, 300, 370, 450 and 510 ml, with the largest size only used in bars. MEASUREMENTS Daily volume of wine sold by the glass, bottle or carafe for non-sparkling wine were recorded at bars (594 days) and restaurants (427 days), averaging 4 months per study. FINDINGS Mega-analysis combining data from bars did not find a significant effect of glass size on volume of wine sold compared with 300-ml glasses: the volume of wine sold using 370-ml glasses was 0.5% lower [95% confidence interval (CI) = -8.1% to 6.1%], using 450-ml glasses was 1.0% higher (95% CI = -9.1 to 12.2) and using 510-ml glasses was 0.4% lower (95% CI = -9.4 to 9.4). For restaurants, compared with 300-ml glasses, the volume of wine sold using 250-ml glasses did not show a significant difference: 9.6% lower (95% CI = -19.0 to 0.7). Using 370-ml glasses the volume of wine sold was 7.3% higher (95% CI = 1.5% to 13.5%); no significant effect was found using 450-ml glasses: 0.9% higher (95% CI = -5.5 to 7.7). CONCLUSIONS The volume of wine sold in restaurants in England may be greater when 370-ml glasses are used compared with 300-ml wine glasses, but may not be in bars. This might be related to restaurants compared with bars selling more wine in bottles and carafes, which require free-pouring.
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Affiliation(s)
- Mark Pilling
- Behaviour and Health Research UnitUniversity of CambridgeCambridgeUK
| | - Natasha Clarke
- Behaviour and Health Research UnitUniversity of CambridgeCambridgeUK
| | - Rachel Pechey
- Behaviour and Health Research UnitUniversity of CambridgeCambridgeUK
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Pechey R, Hollands GJ, Carter P, Marteau TM. Altering the availability of products within physical micro-environments: a conceptual framework. BMC Public Health 2020; 20:986. [PMID: 32594907 PMCID: PMC7322874 DOI: 10.1186/s12889-020-09052-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/04/2020] [Indexed: 01/10/2023] Open
Abstract
Altering the availability of products (e.g. food, alcohol or tobacco products) is one potential intervention to change behaviours to help reduce preventable premature deaths worldwide. However, research on these interventions lacks consistent conceptualisation, hindering clear reporting and cumulative synthesis. This paper proposes a conceptual framework – categorising intervention types and summarising constituent components – with which interventions can be reliably described and evidence synthesised. Three principal distinctions are proposed: interventions altering: (i) Absolute Availability (changing the overall number of options, while keeping the proportions comprised by any subsets of options constant); (ii) Relative Availability (changing the proportion comprised by a subset of options, yet keeping the overall number of options constant); (iii) Absolute and Relative Availability (changing both the overall number of options and the proportions comprised by subsets of options). These are subdivided into those targeting (a) a product or (b) a category of products. Mechanisms that might underlie each of these intervention types are discussed, and implications for future research highlighted. The proposed framework aims to facilitate study of a set of interventions that could contribute significantly to healthier behaviour across populations.
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Affiliation(s)
- Rachel Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, CB2 0SR, Cambridge, UK.
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, CB2 0SR, Cambridge, UK
| | - Patrice Carter
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, WC1E 7HB, London, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, CB2 0SR, Cambridge, UK
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Blackwell AKM, De-Loyde K, Hollands GJ, Morris RW, Brocklebank LA, Maynard OM, Fletcher PC, Marteau TM, Munafò MR. The impact on selection of non-alcoholic vs alcoholic drink availability: an online experiment. BMC Public Health 2020; 20:526. [PMID: 32370760 PMCID: PMC7201696 DOI: 10.1186/s12889-020-08633-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/01/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Increasing the availability of healthier food increases its selection and consumption. However, there is an absence of evidence related to alcohol. This study aimed to estimate the impact of increasing the absolute and relative availability of non-alcoholic compared to alcoholic drinks on selection. We also assessed whether effects were modified by cognitive resource. METHODS UK adult weekly alcohol consumers (n = 808) were recruited to an online experiment with a hypothetical drink selection task. Participants were randomly assigned to one of eight conditions, in a 4 (availability) × 2 (cognitive resource) factorial design. The four availability conditions were: i. Reference 1 (two non-alcoholic, two alcoholic drinks); ii. Reference 2 (four non-alcoholic, four alcoholic drinks); iii. Increased non-alcoholic drinks (six non-alcoholic, two alcoholic drinks); iv. Increased alcoholic drinks (two non-alcoholic, six alcoholic drinks). The two cognitive resource conditions were: a. Low (high time pressure); b. High (low time pressure). Logistic regression was used to assess selection of a non-alcoholic drink. RESULTS 49% of participants selected a non-alcoholic drink in the Increased non-alcoholic drinks condition, compared to 36% in Reference 1, 39% in Reference 2, and 26% in the Increased alcoholic drinks condition. Non-alcoholic drink selection was similar between Reference 1 and 2 when the total number of drinks increased (absolute availability) but the proportion of non-alcoholic compared to alcoholic drinks (relative availability) was unchanged (OR = 1.15, 95% CI 0.77, 1.73). In contrast, the odds of selecting a non-alcoholic drink were 71% higher when both absolute and relative availability of non-alcoholic compared to alcoholic drinks was increased from Reference 1 to the Increased non-alcoholic drinks condition (OR: 1.71, 95% CI 1.15, 2.54), and 48% higher when increased from Reference 2 to the Increased non-alcoholic drinks condition (OR: 1.48, 95% CI 0.99, 2.19). There was no evidence of an effect of cognitive resource. CONCLUSIONS Greater availability of non-alcoholic drinks, compared to alcoholic drinks, increased their online selection, an effect that may be larger when changing their relative availability, i.e., increasing the proportion of non-alcoholic drinks. Naturalistic studies are needed to determine the impact of availability interventions on reducing alcohol purchasing and consumption.
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Affiliation(s)
- Anna K M Blackwell
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK.
| | - Katie De-Loyde
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Richard W Morris
- Bristol Medical School: Population Health Sciences, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Laura A Brocklebank
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Olivia M Maynard
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
- The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories (IMS-MRL), University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Marcus R Munafò
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- National Institute for Health Research Bristol Biomedical Research Centre (NIHR Bristol BRC), Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
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Pechey E, Clarke N, Mantzari E, Blackwell AKM, De-Loyde K, Morris RW, Marteau TM, Hollands GJ. Image-and-text health warning labels on alcohol and food: potential effectiveness and acceptability. BMC Public Health 2020; 20:376. [PMID: 32238154 PMCID: PMC7114781 DOI: 10.1186/s12889-020-8403-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/24/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Health warning labels (HWLs) using images and text to depict the negative health consequences of tobacco consumption are effective and acceptable for changing smoking-related outcomes. There is currently limited evidence concerning their potential use for reducing consumption of alcoholic drinks and energy-dense foods. The aim of this research was to describe the potential effectiveness and acceptability of image-and-text (also known as pictorial or graphic) HWLs applied to: i. alcoholic drinks and ii. energy-dense snack foods. METHODS Two online studies were conducted using between-subjects designs with general population samples. Participants rated one of 21 image-and-text HWLs on alcoholic drinks (n = 5528), or one of 18 image-and-text HWLs on energy-dense snacks (n = 4618). HWLs comprised a graphic image with explanatory text, depicting, respectively, seven diseases linked to excess alcohol consumption, and six diseases linked to excess energy intake. Diseases included heart disease and various cancers. Outcomes were negative emotional arousal, desire to consume the labelled product, and acceptability of the label. Free-text comments relating to HWLs were content analysed. RESULTS For both alcoholic drinks and energy-dense snacks, HWLs depicting bowel cancer generated the highest levels of negative emotional arousal and lowest desire to consume the product, but were the least acceptable. Acceptability was generally low for HWLs applied to alcohol, with 3 of 21 rated as acceptable, and was generally high for snacks, with 13 of 18 rated as acceptable. The majority of free-text comments expressed negative reactions to HWLs on alcohol or energy-dense snacks. CONCLUSIONS Image-and-text health warning labels depicting bowel cancer showed greatest potential for reducing selection and consumption of alcoholic drinks and energy-dense snacks, although they were the least acceptable. Laboratory and field studies are needed to assess their impact on selection and consumption.
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Affiliation(s)
- Emily Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Natasha Clarke
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Eleni Mantzari
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Anna K M Blackwell
- Tobacco and Alcohol Research Group, University of Bristol, School of Psychological Science, Bristol, BS8 1TU, UK
| | - Katie De-Loyde
- Tobacco and Alcohol Research Group, University of Bristol, School of Psychological Science, Bristol, BS8 1TU, UK
| | - Richard W Morris
- Bristol Medical School: Population Health Sciences, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK.
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Blackwell AKM, De-Loyde K, Brocklebank LA, Maynard OM, Marteau TM, Hollands GJ, Fletcher PC, Attwood AS, Morris RW, Munafò MR. Tobacco and electronic cigarette cues for smoking and vaping: an online experimental study. BMC Res Notes 2020; 13:32. [PMID: 31941548 PMCID: PMC6964108 DOI: 10.1186/s13104-020-4899-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/08/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study examined whether exposure to smoking and vaping cues the urge to smoke or vape. It extends previous studies on first-generation cigalikes (visually similar to cigarettes) and second-generation devices (visually similar to pens) by including third-generation tank system devices (larger bulky units). In an online experiment, participants were randomly assigned to view one of four videos, which included smoking, vaping (cigalike or tank system), or neutral cues. The primary outcome was urge to smoke. Secondary outcomes were urge to vape, desire to smoke and vape, and intention to quit or remain abstinent from smoking. RESULTS UK adults varying in smoking (current or former) and vaping (user or non-user) status (n = 1120) completed the study: 184 (16%) failed study attention checks meaning 936 were included in the final analysis. Urges to smoke were similar across cue groups. Urges to vape were higher following exposure to vaping compared to neutral cues. There was no clear evidence of an interaction between cue group and smoking or vaping status. The lack of cueing effects on smoking urges is inconsistent with previous research, raising questions about the ability to assess craving in online settings.
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Affiliation(s)
- Anna K M Blackwell
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK.
| | - Katie De-Loyde
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Laura A Brocklebank
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Olivia M Maynard
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Paul C Fletcher
- Department of Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, University of Cambridge, Douglas House, Cambridge, CB2 8AH, UK.,The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories (IMS-MRL), University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Angela S Attwood
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Richard W Morris
- Bristol Medical School: Population Health Sciences, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Marcus R Munafò
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK.,MRC Integrative Epidemiology Unit (IEU), University of Bristol, Oakfield House Oakfield Grove, Bristol, BS8 2BN, UK
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Reynolds JP, Kosīte D, Rigby Dames B, Brocklebank LA, Pilling M, Pechey R, Hollands GJ, Marteau TM. Increasing the proportion of healthier foods available with and without reducing portion sizes and energy purchased in worksite cafeterias: protocol for a stepped-wedge randomised controlled trial. BMC Public Health 2019; 19:1611. [PMID: 31791299 PMCID: PMC6889705 DOI: 10.1186/s12889-019-7927-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/08/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Overconsumption of energy from food contributes to high rates of overweight and obesity in many populations. A promising set of interventions tested in pilot studies in worksite cafeterias, suggests energy intake may be reduced by increasing the proportion of healthier - i.e. lower energy - food options available, and decreasing portion sizes. The current study aims to assess the impact on energy purchased of i. increasing the proportion of lower energy options available; ii. combining this with reducing portion sizes, in a full trial. METHODS A stepped-wedge randomised controlled trial in 19 worksite cafeterias, where the proportion of lower energy options available in targeted food categories (including main meals, snacks, and cold drinks) will be increased; and combined with reduced portion sizes. The primary outcome is total energy (kcal) purchased from targeted food categories using a pooled estimate across all sites. Follow-up analyses will test whether the impact on energy purchased varies according to the extent of intervention implementation. DISCUSSION This study will provide the most reliable estimate to date of the effect sizes of two promising interventions for reducing energy purchased in worksite cafeterias. TRIAL REGISTRATION The study was prospectively registered on ISRCTN (date: 24.05.19; TRN: ISRCTN87225572; doi: https://doi.org/10.1186/ISRCTN87225572).
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Affiliation(s)
- James P Reynolds
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Daina Kosīte
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Brier Rigby Dames
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | | | - Mark Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Rachel Pechey
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK.
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Mantzari E, Pechey R, Codling S, Sexton O, Hollands GJ, Marteau TM. The impact of 'on-pack' pictorial health warning labels and calorie information labels on drink choice: A laboratory experiment. Appetite 2019; 145:104484. [PMID: 31626833 PMCID: PMC8161725 DOI: 10.1016/j.appet.2019.104484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/20/2019] [Accepted: 10/06/2019] [Indexed: 02/04/2023]
Abstract
Sugar-sweetened beverages (SSBs) are one of the largest added sugar sources to diets in the UK and USA. Health warning labels reduce hypothetical selection of SSBs in online studies but uncertainty surrounds their impact on selection of drinks for consumption. Calorie information labels are also promising but their impact on SSB selection is unclear. This laboratory study assessed the impact on SSB selection of ‘on-pack’ labels placed directly on physical products: i.a pictorial health warning label depicting an adverse health consequence of excess sugar consumption; and ii.calorie information labels. Potential moderation of any effects by socio-economic position (SEP) was also examined. Participants - 401 adults, resident in England, approximately half of whom were of lower SEP and half of higher SEP, were asked to select a drink from a range of two non-SSBs and four SSBs (subsequent to completing a separate study assessing the effects of food availability on snack selection). The drinks included ‘on-pack’ labels according to randomisation: Group 1: pictorial health warning label on SSBs; Group 2: calorie information label on all drinks; Group 3: no additional label. The primary outcome was the proportion of participants selecting an SSB. Compared to not having additional labels (39%), neither the pictorial health warning label (40%) nor calorie information labels (43%) affected the proportion of participants selecting an SSB. Lower SEP participants (45%) were more likely to select an SSB compared to those of higher SEP (35%), but SEP did not moderate the impact of labels on drink selection. In conclusion, pictorial health warning labels may be less effective in reducing SSB selection in lab-based compared with online settings, or depending on label design and placement. Findings suggest that effects might be absent when choosing from real products with actual ‘on-pack’ labels, positioned in a ‘realistic’ manner. Field studies are needed to further assess the impact of ‘on-pack’ SSB warning labels in real-world settings to rule out the possible contribution of study design factors.
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Affiliation(s)
- Eleni Mantzari
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
| | - Rachel Pechey
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
| | - Saphsa Codling
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
| | - Olivia Sexton
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
| | - Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
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Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 9:CD012573. [PMID: 31482606 PMCID: PMC6953356 DOI: 10.1002/14651858.cd012573.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
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Almiron-Roig E, Forde CG, Hollands GJ, Vargas MÁ, Brunstrom JM. A review of evidence supporting current strategies, challenges, and opportunities to reduce portion sizes. Nutr Rev 2019; 78:91-114. [DOI: 10.1093/nutrit/nuz047] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Although there is considerable evidence for the portion-size effect and its potential impact on health, much of this has not been successfully applied to help consumers reduce portion sizes. The objective of this review is to provide an update on the strength of evidence supporting strategies with potential to reduce portion sizes across individuals and eating contexts. Three levels of action are considered: food-level strategies (targeting commercial snack and meal portion sizes, packaging, food labels, tableware, and food sensory properties), individual-level strategies (targeting eating rate and bite size, portion norms, plate-cleaning tendencies, and cognitive processes), and population approaches (targeting the physical, social, and economic environment and health policy). Food- and individual-level strategies are associated with small to moderate effects; however, in isolation, none seem to have sufficient impact on food intake to reverse the portion-size effect and its consequences. Wider changes to the portion-size environment will be necessary to support individual- and food-level strategies leading to portion control.
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Affiliation(s)
- Eva Almiron-Roig
- E. Almiron-Roig and M. Ángeles Vargas are with the Centre for Nutrition Research, University of Navarra, Pamplona, Spain
- E. Almiron-Roig is with the Navarra Institute for Health Research (IdiSNa), Pamplona, Spain
| | - Ciaran G Forde
- C.G. Forde is with the Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Singapore
| | - Gareth J Hollands
- G.J. Hollands is with the Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - M Ángeles Vargas
- E. Almiron-Roig and M. Ángeles Vargas are with the Centre for Nutrition Research, University of Navarra, Pamplona, Spain
| | - Jeffrey M Brunstrom
- J.M. Brunstrom is with the Nutrition and Behaviour Unit, School of Psychological Science, and the National Institute for Health Research, Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
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Reynolds JP, Archer S, Pilling M, Kenny M, Hollands GJ, Marteau TM. Public acceptability of nudging and taxing to reduce consumption of alcohol, tobacco, and food: A population-based survey experiment. Soc Sci Med 2019; 236:112395. [PMID: 31326778 PMCID: PMC6695289 DOI: 10.1016/j.socscimed.2019.112395] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/14/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
Abstract
There is growing evidence for the effectiveness of choice architecture or 'nudge' interventions to change a range of behaviours including the consumption of alcohol, tobacco and food. Public acceptability is key to implementing these and other interventions. However, few studies have assessed public acceptability of these interventions, including the extent to which acceptability varies with the type of intervention, the target behaviour and with evidence of intervention effectiveness. These were assessed in an online study using a between-participants full factorial design with three factors: Policy (availability vs size vs labelling vs tax) x Behaviour (alcohol consumption vs tobacco use vs high-calorie snack food consumption) x Evidence communication (no message vs assertion of policy effectiveness vs assertion and quantification of policy effectiveness [e.g., a 10% change in behaviour]). Participants (N = 7058) were randomly allocated to one of the 36 groups. The primary outcome was acceptability of the policy. Acceptability differed across policy, behaviour and evidence communication (all ps < .001). Labelling was the most acceptable policy (supported by 78%) and Availability the least (47%). Tobacco use was the most acceptable behaviour to be targeted by policies (73%) compared with policies targeting Alcohol (55%) and Food (54%). Relative to the control group (60%), asserting evidence of effectiveness increased acceptability (63%); adding a quantification to this assertion did not significantly increase this further (65%). Public acceptability for nudges and taxes to improve population health varies with the behaviour targeted and the type of intervention but is generally favourable. Communicating that these policies are effective can increase support by a small but significant amount, suggesting that highlighting effectiveness could contribute to mobilising public demand for policies. While uncertainty remains about the strength of public support needed, this may help overcome political inertia and enable action on behaviours that damage population and planetary health.
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Kosīte D, König LM, De-loyde K, Lee I, Pechey E, Clarke N, Maynard O, Morris RW, Munafò MR, Marteau TM, Fletcher PC, Hollands GJ. Plate size and food consumption: a pre-registered experimental study in a general population sample. Int J Behav Nutr Phys Act 2019; 16:75. [PMID: 31462252 PMCID: PMC6714429 DOI: 10.1186/s12966-019-0826-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is considerable uncertainty regarding the impact of tableware size on food consumption. Most existing studies have used small and unrepresentative samples and have not followed recommended procedures for randomised controlled trials, leading to increased risk of bias. In the first pre-registered study to date, we examined the impact on consumption of using larger versus smaller plates for self-served food. We also assessed impact on the underlying meal micro-structure, such as number of servings and eating rate, which has not previously been studied. METHODS The setting was a purpose-built naturalistic eating behaviour laboratory. A general population sample of 134 adult participants (aged 18-61 years) was randomly allocated to one of two groups varying in the size of plate used for self-serving lunch: large or small. The primary outcome was amount of food energy (kcal) consumed during a meal. Additionally, we assessed impact on meal micro-structure, and examined potential modifying effects of executive function, socio-economic position, and sensitivity to perceptual cues. RESULTS There was no clear evidence of a difference in consumption between the two groups: Cohen's d = 0.07 (95% CI [- 0.27, 0.41]), with participants in the large plate group consuming on average 19.2 (95% CI [- 76.5, 115.0]) more calories (3%) compared to the small plate group (large: mean (SD) = 644.1 (265.0) kcal, versus small: 624.9 (292.3) kcal). The difference between the groups was not modified by individual characteristics. There was no evidence of impact on meal micro-structure, with the exception of more food being left on the plate when larger plates were used. CONCLUSIONS This study suggests that previous meta-analyses of a low-quality body of evidence may have considerably overestimated the effects of plate size on consumption. However, the possibility of a clinically significant effect - in either direction - cannot be excluded. Well-conducted trials of tableware size in real-world field settings are now needed to determine whether changing the size of tableware has potential to contribute to efforts to reduce consumption at population-level. TRIAL REGISTRATION The study protocol ( https://osf.io/e3dfh/ ) and data analysis plan ( https://osf.io/sh5u7/ ) were pre-registered on the Open Science Framework.
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Affiliation(s)
- Daina Kosīte
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Laura M. König
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Konstanz, Constance, Germany
| | - Katie De-loyde
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
| | - Ilse Lee
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Emily Pechey
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Natasha Clarke
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Olivia Maynard
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
| | - Richard W. Morris
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus R. Munafò
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU), UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Paul C. Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
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Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 8:CD012573. [PMID: 31452193 PMCID: PMC6710643 DOI: 10.1002/14651858.cd012573.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
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Abstract
BACKGROUND Pharmacological treatments for tobacco dependence, such as nicotine replacement therapy (NRT), have been shown to be safe and effective interventions for smoking cessation. Higher levels of adherence to these medications increase the likelihood of sustained smoking cessation, but many smokers use them at a lower dose and for less time than is optimal. It is important to determine the effectiveness of interventions designed specifically to increase medication adherence. Such interventions may address motivation to use medication, such as influencing beliefs about the value of taking medications, or provide support to overcome problems with maintaining adherence. OBJECTIVES To assess the effectiveness of interventions aiming to increase adherence to medications for smoking cessation on medication adherence and smoking abstinence compared with a control group typically receiving standard care. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register, and clinical trial registries (ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform) to the 3 September 2018. We also conducted forward and backward citation searches. SELECTION CRITERIA Randomised, cluster-randomised or quasi-randomised studies in which adults using active pharmacological treatment for smoking cessation were allocated to an intervention arm where there was a principal focus on increasing adherence to medications for tobacco dependence, or a control arm providing standard care. Dependent on setting, standard care may have comprised minimal support or varying degrees of behavioural support. Included studies used a measure that allowed assessment of the degree of medication adherence. DATA COLLECTION AND ANALYSIS Two authors independently screened studies for eligibility, extracted data for included studies and assessed risk of bias. For continuous outcome measures, we calculated effect sizes as standardised mean differences (SMDs). For dichotomous outcome measures, we calculated effect sizes as risk ratios (RRs). In meta-analyses for adherence outcomes, we combined dichotomous and continuous data using the generic inverse variance method and reported pooled effect sizes as SMDs; for abstinence outcomes, we reported and pooled dichotomous outcomes. We obtained pooled effect sizes with 95% confidence intervals (CIs) using random-effects models. We conducted subgroup analyses to assess whether the primary focus of the adherence treatment ('practicalities' versus 'perceptions' versus both), the delivery approach (participant versus clinician-centred) or the medication type were associated with effectiveness. MAIN RESULTS We identified two new studies, giving a total of 10 studies, involving 3655 participants. The medication adherence interventions studied were all provided in addition to standard behavioural support.They typically provided further information on the rationale for, and emphasised the importance of, adherence to medication or supported the development of strategies to overcome problems with maintaining adherence (or both). Seven studies targeted adherence to NRT, two to bupropion and one to varenicline. Most studies were judged to be at high or unclear risk of bias, with four of these studies judged at high risk of attrition or detection bias. Only one study was judged to be at low risk of bias.Meta-analysis of all 10 included studies (12 comparisons) provided moderate-certainty evidence that adherence interventions led to small improvements in adherence (i.e. the mean amount of medication consumed; SMD 0.10, 95% CI 0.03 to 0.18; I² = 6%; n = 3655), limited by risk of bias. Subgroup analyses for the primary outcome identified no significant subgroup effects, with effect sizes for subgroups imprecisely estimated. However, there was a very weak indication that interventions focused on the 'practicalities' of adhering to treatment (i.e. capabilities, resources, levels of support or skills) may be effective (SMD 0.21, 95% CI 0.03 to 0.38; I² = 39%; n = 1752), whereas interventions focused on treatment 'perceptions' (i.e. beliefs, cognitions, concerns and preferences; SMD 0.10, 95% CI -0.03 to 0.24; I² = 0%; n = 839) or on both (SMD 0.04, 95% CI -0.08 to 0.16; I² = 0%; n = 1064), may not be effective. Participant-centred interventions may be effective (SMD 0.12, 95% CI 0.02 to 0.23; I² = 20%; n = 2791), whereas those that are clinician-centred may not (SMD 0.09, 95% CI -0.05 to 0.23; I² = 0%; n = 864).Five studies assessed short-term smoking abstinence (five comparisons), while an overlapping set of five studies (seven comparisons) assessed long-term smoking abstinence of six months or more. Meta-analyses resulted in low-certainty evidence that adherence interventions may slightly increase short-term smoking cessation rates (RR 1.08, 95% CI 0.96 to 1.21; I² = 0%; n = 1795) and long-term smoking cessation rates (RR 1.16, 95% CI 0.96 to 1.40; I² = 48%; n = 3593). In both cases, the evidence was limited by risk of bias and imprecision, with CIs encompassing minimal harm as well as moderate benefit, and a high likelihood that further evidence will change the estimate of the effect. There was no evidence that interventions to increase adherence to medication led to any adverse events. Studies did not report on factors plausibly associated with increases in adherence, such as self-efficacy, understanding of and attitudes toward treatment, and motivation and intentions to quit. AUTHORS' CONCLUSIONS In people who are stopping smoking and receiving behavioural support, there is moderate-certainty evidence that enhanced behavioural support focusing on adherence to smoking cessation medications can modestly improve adherence. There is only low-certainty evidence that this may slightly improve the likelihood of cessation in the shorter or longer-term. Interventions to increase adherence can aim to address the practicalities of taking medication, change perceptions about medication, such as reasons to take it or concerns about doing so, or both. However, there is currently insufficient evidence to confirm which approach is more effective. There is no evidence on whether such interventions are effective for people who are stopping smoking without standard behavioural support.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Felix Naughton
- University of East AngliaSchool of Health SciencesNorwichUK
| | - Amanda Farley
- University of BirminghamPublic Health, Epidemiology and BiostatisticsEdgbastonBirminghamWest MidlandsUKB15 2TT
| | - Nicola Lindson
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Paul Aveyard
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
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Hollands GJ, Cameron LD, Crockett RA, Marteau TM. Presentation of aversive visual images in health communication for changing health behaviour. Hippokratia 2019. [DOI: 10.1002/14651858.cd009086.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Gareth J Hollands
- University of Cambridge; Behaviour and Health Research Unit; Forvie Site Robinson Way Cambridge UK CB2 0SR
| | - Linda D Cameron
- University of California, Merced; School of Social Sciences, Humanities and Arts; 5200 North Lake Road Merced CA USA 95343
| | | | - Theresa M Marteau
- University of Cambridge; Behaviour and Health Research Unit; Forvie Site Robinson Way Cambridge UK CB2 0SR
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Clarke N, Pechey R, Pilling M, Hollands GJ, Mantzari E, Marteau TM. Wine glass size and wine sales: four replication studies in one restaurant and two bars. BMC Res Notes 2019; 12:426. [PMID: 31315655 PMCID: PMC6637618 DOI: 10.1186/s13104-019-4477-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/12/2019] [Indexed: 11/11/2022] Open
Abstract
Objective Previous research suggests that wine glass size affects sales of wine in bars, with more wine purchased when served in larger glasses. The current four studies, conducted in one restaurant (Studies 1 and 2) and two bars (Studies 3 and 4) in Cambridge, England, aim to establish the reproducibility of this effect of glass size on sales. A multiple treatment reversal design was used, involving wine being served in sequential fortnightly periods in different sized glasses of the same design (290 ml, 350 ml, and 450 ml). The primary outcome was daily wine volume (ml) sold. Results Restaurant: Daily wine volume sold was 13% (95% CI 2%, 24%) higher when served with 350 ml vs. 290 ml glasses in Study 1. A similar direction of effect was seen in Study 2 (6%; 95% CI − 1%, 15%). Bars: Daily wine volume sold was 21% (95% CI 9%, 35%) higher when served with 450 ml vs. 350 ml glasses in Study 3. This effect was not observed in Study 4 (− 7%, 95% CI − 16%, 3%). Meaningful differences were not demonstrated with any other glass comparison. These results partially replicate previous studies showing that larger glasses increase wine sales. Considerable uncertainty remains about the magnitude of any effect and the contexts in which it might occur. Trial registration Study 1: ISRCTN17958895 (21/07/2017), Study 2: ISRCTN17097810 (29/03/2018), Study 3 and 4: ISRCTN39401124 (10/05/2018) Electronic supplementary material The online version of this article (10.1186/s13104-019-4477-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK.
| | - Rachel Pechey
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Mark Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Eleni Mantzari
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
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Vasiljevic M, Fuller G, Pilling M, Hollands GJ, Pechey R, Jebb SA, Marteau TM. What is the impact of increasing the prominence of calorie labelling? A stepped wedge randomised controlled pilot trial in worksite cafeterias. Appetite 2019; 141:104304. [PMID: 31152762 PMCID: PMC8161726 DOI: 10.1016/j.appet.2019.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/29/2019] [Accepted: 05/28/2019] [Indexed: 11/18/2022]
Abstract
Background Calorie labelling may help to reduce energy consumption, but few well-controlled experimental studies have been conducted in real world settings. In a previous randomised controlled pilot trial we did not observe an effect of calorie labelling on energy purchased in worksite cafeterias. In the present study we sought to enhance the effect by making the labels more prominent, and to address the operational challenges reported previously by worksites. Methods Three worksite cafeterias were randomised in a stepped wedge design to start the intervention at one of three fortnightly periods between March and July 2018. The intervention comprised introducing prominent calorie labelling for all cafeteria products for which calorie information was available (on average 87% of products offered across the three sites were labelled). Calorie content was displayed in bold capitalised Verdana typeface with a minimum font size of 14 e.g.120 CALORIES. Feasibility and acceptability were assessed using post-intervention surveys with cafeteria patrons and semi-structured interviews with managers. Effectiveness was assessed using total daily energy (kcal) purchased from intervention items across the three sites, analysed using semi-parametric GAMLSS models. Results Recruitment and retention of worksite cafeterias proved feasible: all three randomised sites successfully completed the study. Post-intervention feedback suggested high levels of intervention acceptability: 87% of responding patrons wanted calorie labelling to remain in place. No effect of the intervention on daily energy purchased was observed: −0.6% (95%CI -2.5 to 1.2, p = .487). By-site analyses showed similar null effects at each of the three sites, all ps > .110. Conclusions There was no evidence that prominent calorie labelling changed daily energy purchased across three English-based worksite cafeterias. The intervention was feasible to implement and acceptable to patrons and managers.
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Affiliation(s)
- Milica Vasiljevic
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK; Department of Psychology, Durham University, Durham, UK.
| | - Georgia Fuller
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Mark Pilling
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Rachel Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Susan A Jebb
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
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Pechey R, Cartwright E, Pilling M, Hollands GJ, Vasiljevic M, Jebb SA, Marteau TM. Impact of increasing the proportion of healthier foods available on energy purchased in worksite cafeterias: A stepped wedge randomized controlled pilot trial. Appetite 2019; 133:286-296. [PMID: 30468803 PMCID: PMC6335439 DOI: 10.1016/j.appet.2018.11.013] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/26/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022]
Abstract
Increasing the proportion of healthier foods available could encourage healthier consumption, but evidence to date is limited in scope and quality. The current study aimed to: (a) examine the feasibility and acceptability of intervening to change product availability in worksite cafeterias; and (b) estimate the impact on energy purchased of increasing the proportion of healthier (i.e. lower energy) cooked meals, snacks, cold drinks and sandwiches. Six English worksite cafeterias increased the proportion of healthier foods available, aiming to keep the total number of options constant, in a stepped wedge randomized controlled pilot trial conducted between January and May 2017. The intervention was generally successfully implemented and acceptable to clientele. Generalized linear mixed models showed a reduction of 6.9% (95%CI: -11.7%, -1.7%, p = 0.044) in energy (kcal) purchased from targeted food categories across all sites. However, impact varied across sites, with energy purchased from targeted categories significantly reduced in two sites (-10.7% (95%CI: -18.1% to -2.6%, p = 0.046); -18.4% (95%CI: -26.9% to -8.8%, p = 0.013)), while no significant differences were seen in the other four sites. Overall, increasing the proportion of healthier options available in worksite cafeterias seems a promising intervention to reduce energy purchased but contextual effects merit further study.
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Affiliation(s)
- Rachel Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Emma Cartwright
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Mark Pilling
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Milica Vasiljevic
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Susan A Jebb
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
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Hunter JA, Hollands GJ, Pilling M, Marteau TM. Impact of proximity of healthier versus less healthy foods on intake: A lab-based experiment. Appetite 2019; 133:147-155. [PMID: 30367891 PMCID: PMC6335384 DOI: 10.1016/j.appet.2018.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/20/2018] [Accepted: 10/18/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Placing food further away from people decreases likelihood of consumption ("Proximity Effect"). However, it is unclear how proximity affects consumption when both healthier and less healthy foods are available and cognitive resource for self-control is limited. AIMS To test the hypothesis that when both healthier (raisins) and less healthy (chocolate M&Ms) foods are available, placing less healthy food far, rather than near, increases the likelihood that healthier food is consumed. METHODS General population participants (N = 248) were all put under cognitive load and randomised to one of four groups: 1. Raisins near (20 cm), M&Ms far (70 cm); 2. Both foods near; 3. M&Ms near, raisins far; 4. Both far. PRIMARY OUTCOME proportions of participants consuming raisins and M&Ms, respectively. RESULTS The results did not support the primary hypothesis: when healthier and less healthy foods were both available, placing M&Ms far, rather than near, did not increase likelihood of consuming raisins (OR = 1.54, p = .432). Regardless of the M&Ms proximity, likelihood of consuming raisins was unaffected by the raisins' proximity (62.9%(near) vs. 56.5%(far) OR = 0.61, p = .211). Likelihood of consuming M&Ms non-significantly decreased when they were far and raisins were near, and when both foods were far (OR = 2.83, p = .057). Likelihood of consuming M&Ms was affected by M&Ms proximity, being higher when near (68.3%) than far (55.6%), OR = 0.39, p = .015. Indices of cognitive load impact (higher vs lower) were unrelated to consumption of either food. CONCLUSIONS Likelihood of consuming a healthier food was unaffected by its proximity and that of a less healthy food. By contrast, likelihood of consuming a less healthy food was influenced by its proximity and possibly by that of a healthier food. These effects need replication in studies designed to detect smaller effect sizes. TRIAL REGISTRATION This study was registered online with ISRCTN (ISRCTN11740813).
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Affiliation(s)
- J A Hunter
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom
| | - G J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom
| | - M Pilling
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom
| | - T M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom.
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Affiliation(s)
| | - Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
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