Potential Mediators of a School-Based Digital Intervention Targeting Six Lifestyle Risk Behaviours in a Cluster Randomised Controlled Trial of Australian Adolescents

Lifestyle risk behaviours-physical inactivity, poor diet, poor sleep, recreational screen time, and alcohol and tobacco use-collectively known as the "Big 6" emerge during adolescence and significantly contribute to chronic disease development into adulthood. To address this issue, the Health4Life program targeted the Big 6 risk behaviours simultaneously via a co-designed eHealth school-based multiple health behaviour change (MHBC) intervention. This study used multiple causal mediation analysis to investigate some potential mediators of Health4Life's effects on the Big 6 primary outcomes from a cluster randomised controlled trial of Health4Life among Australian school children. Mediators of knowledge, behavioural intentions, self-efficacy, and self-control were assessed. The results revealed a complex pattern of mediation effects across different outcomes. Whilst there was a direct effect of the intervention on reducing moderate-to-vigorous physical activity risk, the impact on sleep duration appeared to occur indirectly through the hypothesised mediators. Conversely, for alcohol and tobacco use, both direct and indirect effects were observed in opposite directions cancelling out the total effect (competitive partial mediation). The intervention's effects on alcohol and tobacco use highlighted complexities, suggesting the involvement of additional undetected mediators. However, little evidence supported mediation for screen time and sugar-sweetened beverage intake risk. These findings emphasise the need for tailored approaches when addressing different risk behaviours and designing effective interventions to target multiple health risk behaviours. The trial was pre-registered with the Australian and New Zealand Clinical Trials Registry: ACTRN12619000431123.

Definition matters: assessment of tolerance to the effects of alcohol in a prospective cohort study of emerging adults

BACKGROUND AND AIMS

Tolerance to the effects of alcohol is an important element in the diagnosis of alcohol use disorders (AUD); however, there is ongoing debate about its utility in the diagnosis AUD in adolescents and young adults. This study aimed to refine the assessment of tolerance in young adults by testing different definitions of tolerance and their associations with longitudinal AUD outcomes.

DESIGN

Prospective cohort study.

SETTINGS

Australia.

PARTICIPANTS

A contemporary cohort of emerging adults across Australia (n = 565, mean age = 18.9, range = 18-21 at baseline).

MEASUREMENTS

Clinician-administered Structured Clinical Interview for DSM-IV Research Version (SCID-IV-RV) assessed for AUD criteria across five interviews, at 6-month intervals over 2.5 years. Tolerance definitions were operationalized using survey-type response (yes/no), clinician judgement (SCID-IV-RV), different initial drinking quantity and percentage increase thresholds and average heavy consumption metrics. AUD persistence was operationalized by the number of times AUD was present across the 2.5-year study period (n = 491), and new-onset AUD was operationalized as any new incidence of AUD during the follow-up period (n = 461).

FINDINGS

The (i) SCID-IV-RV clinician judgement [odds ratio (OR) = 2.50, P = 0.005], (ii) an initial drinking quantity threshold of four to five drinks and 50% minimum increase (OR = 2.48, P = 0.007) and (iii) 50% increase only (OR = 2.40, P = 0.005) were the tolerance definitions more strongly associated with any new onset of AUD throughout the four follow-up time-points than other definitions. However, these definitions were not associated with persistent AUD (Ps > 0.05). Average heavy consumption definitions of tolerance were most strongly associated with persistent AUD (OR = 6.66, P = 0.001; OR = 4.65, P = 0.004) but not associated with new-onset AUD (Ps > 0.05).

CONCLUSIONS

Initial drink and percentage change thresholds appear to improve the efficacy of change-based tolerance as an indicator for new-onset alcohol use disorder diagnosis in self-report surveys of young adults. When predicting persistent alcohol use disorder, average heavy consumption-based indicators appear to be a better way to measure tolerance than self-reported change-based definitions.

What Does It Mean to Be Responsive to a Partner's Sexual Needs? Toward a Definition of Sexual Need Responsiveness

Being responsive to a partner's sexual needs in relationships (i.e., sexual need responsiveness) is associated with higher sexual and relationship satisfaction. Previous research has focused on researcher-led definitions of sexual need responsiveness. The purpose of the present study was to develop a participant-informed definition of sexual need responsiveness. A total of 305 individuals responded to five open-ended questions concerning the definition and behaviors pertaining to sexual need responsiveness. The content analysis results showed that the most common elements in participants' definition included listening to and accommodating each other's sexual needs and wishes whenever possible, while respecting both partners' safety and boundaries. Both verbal and non-verbal communication in various forms was used to express and share needs with partners and participants often evaluated responsiveness in terms of their sexual satisfaction. The results provide a participant-informed definition of sexual need responsiveness and can be used to inform research and clinical practice.

Misogynistic Tweets Correlate With Violence Against Women

How online social behavior covaries with real-world outcomes remains poorly understood. We examined the relationship between the frequency of misogynistic attitudes expressed on Twitter and incidents of domestic and family violence that were reported to the Federal Bureau of Investigation. We tracked misogynistic tweets in more than 400 areas across 47 American states from 2013 to 2014. Correlation and regression analyses found that misogynistic tweets were related to domestic- and family-violence incidents in those areas. A cross-lagged model showed that misogynistic tweets positively predicted domestic and family violence 1 year later; however, this effect was small. Results were robust to several known predictors of domestic violence. Our findings identify geolocated online misogyny as co-occurring with domestic and family violence. Because the longitudinal relationship between misogynistic tweets and domestic and family violence was small and conducted at the societal level, more research with multilevel data might be useful in the prediction of future violence.

The role of mating context and fecundability in women's preferences for men's facial masculinity and beardedness

The ovulatory shift hypothesis proposes that women's preferences for masculine physical and behavioral traits are greater at the peri-ovulatory period than at other points of the menstrual cycle. However, many previous studies used self-reported menstrual cycle data to estimate fecundability rather than confirming the peri-ovulatory phase hormonally. Here we report two studies and three analyses revisiting the ovulatory shift hypothesis with respect to both facial masculinity and beardedness. In Study 1, a large sample of female participants (N = 2,161) self-reported their cycle phase and provided ratings for faces varying in beardedness (clean-shaven, light stubble, heavy stubble, full beards) and masculinity (-50%, -25%, natural, +25% and +50%) in a between-subjects design. In Study 2, 68 women provided the same ratings data, in a within-subjects design in which fertility was confirmed via luteinising hormone (LH) tests and analysed categorically. In Study 2, we also measured salivary estradiol (E) and progesterone (P) at the low and high fertility phases of the menstrual cycle among 36 of these women and tested whether shifts in E, P or E:P ratios predicted face preferences. Preferences for facial masculinity and beardedness did not vary as predicted with fecundability in Study 1, or with respect to fertility as confirmed via LH in Study 2. However, consistent with the ovulatory shift hypothesis, increasing E (associated with cyclical increases in fecundability) predicted increases in preferences for relatively more masculine faces; while high P (associated with cyclical decreases in fecundability) predicted increases in preferences for relatively more feminine faces. We also found an interaction between E and preferences for facial masculinity and beardedness, such that stubble was more attractive on un-manipulated than more masculine faces among women with high E. We consider discrepancies between our findings and those of other recent studies and suggest that closer scrutiny of the stimuli used to measure masculinity preferences across studies may help account for the many conflicting findings that have recently appeared regarding cycle phase preference shifts for facial masculinity.

Aggression in Women: Behavior, Brain and Hormones

We review the literature on aggression in women with an emphasis on laboratory experimentation and hormonal and brain mechanisms. Women tend to engage in more indirect forms of aggression (e.g., spreading rumors) than other types of aggression. In laboratory studies, women are less aggressive than men, but provocation attenuates this difference. In the real world, women are just as likely to aggress against their romantic partner as men are, but men cause more serious physical and psychological harm. A very small minority of women are also sexually violent. Women are susceptible to alcohol-related aggression, but this type of aggression may be limited to women high in trait aggression. Fear of being harmed is a robust inhibitor of direct aggression in women. There are too few studies and most are underpowered to detect unique neural mechanisms associated with aggression in women. Testosterone shows the same small, positive relationship with aggression in women as in men. The role of cortisol is unclear, although some evidence suggests that women who are high in testosterone and low in cortisol show heightened aggression. Under some circumstances, oxytocin may increase aggression by enhancing reactivity to provocation and simultaneously lowering perceptions of danger that normally inhibit many women from retaliating. There is some evidence that high levels of estradiol and progesterone are associated with low levels of aggression. We highlight that more gender-specific theory-driven hypothesis testing is needed with larger samples of women and aggression paradigms relevant to women.

No compelling positive association between ovarian hormones and wearing red clothing when using multinomial analyses

Several studies report that wearing red clothing enhances women's attractiveness and signals sexual proceptivity to men. The associated hypothesis that women will choose to wear red clothing when fertility is highest, however, has received mixed support from empirical studies. One possible cause of these mixed findings may be methodological. The current study aimed to replicate recent findings suggesting a positive association between hormonal profiles associated with high fertility (high estradiol to progesterone ratios) and the likelihood of wearing red. We compared the effect of the estradiol to progesterone ratio on the probability of wearing: red versus non-red (binary logistic regression); red versus neutral, black, blue, green, orange, multi-color, and gray (multinomial logistic regression); and each of these same colors in separate binary models (e.g., green versus non-green). Red versus non-red analyses showed a positive trend between a high estradiol to progesterone ratio and wearing red, but the effect only arose for younger women and was not robust across samples. We found no compelling evidence for ovarian hormones increasing the probability of wearing red in the other analyses. However, we did find that the probability of wearing neutral was positively associated with the estradiol to progesterone ratio, though the effect did not reach conventional levels of statistical significance. Findings suggest that although ovarian hormones may affect younger women's preference for red clothing under some conditions, the effect is not robust when differentiating amongst other colors of clothing. In addition, the effect of ovarian hormones on clothing color preference may not be specific to the color red.

High estradiol and low progesterone are associated with high assertiveness in women

Sexual selection theory posits that women are more selective than men are when choosing a mate. This evolutionary theory suggests that "choosiness" increases during the fertile window because the costs and benefits of mate selection are highest when women are likely to conceive. Little research has directly investigated reproductive correlates of choice assertion. To address this gap, in the present research we investigated whether fertility, estradiol, and progesterone influenced general assertiveness in women. We recruited 98 naturally cycling, ethnically diverse women. Using a within-subjects design and ovarian hormone concentrations at fertile and non-fertile menstrual cycle phases, we measured implicit assertiveness and self-reported assertive behavior. To see if fertility-induced high assertiveness was related to increased sexual motivation, we also measured women's implicit sexual availability and interest in buying sexy clothes. Results showed that high estradiol and low progesterone predicted higher assertiveness. Sexual availability increased during periods of high fertility. Low progesterone combined with high estradiol predicted greater interest in buying sexy clothes. Results held when controlling for individual differences in mate value and sociosexual orientation. Our findings support the role of fluctuating ovarian hormones in the expression and magnitude of women's assertiveness. High assertiveness during the fertile window may be a psychological adaptation that promotes mate selectivity and safeguards against indiscriminate mate choice when conception risk is highest.

Standardized protocols for characterizing women's fertility: A data-driven approach

Experts are divided on whether women's cognition and behavior differs between fertile and non-fertile phases of the menstrual cycle. One of the biggest criticisms of this literature concerns the use of indirect, imprecise, and flexible methodologies between studies to characterize women's fertility. To resolve this problem, we provide a data-driven method of best practices for characterizing women's fertile phase. We compared the accuracy of self-reported methods and counting procedures (i.e., the forward- and backward-counting methods) in estimating ovulation using data from 140 women whose fertility was verified with luteinizing hormone tests. Results revealed that no counting method was associated with ovulation with >30% accuracy. A minimum of 39.5% of the days in the six-day fertile window predicted by the counting methods were non-fertile, and correlations between counting method conception probabilities and actual conception probability were weak to moderate, rs=0.11-0.30. Poor results persisted when using a lenient window for predicting ovulation, across alternative estimators of the onset of the next cycle, and when removing outliers to increase the homogeneity of the sample. By contrast, combining counting methods with a relatively inexpensive test of luteinizing hormone predicted fertility with accuracy >95%, but only when specific guidelines were followed. To this end, herein we provide a cost-effective, pragmatic, and standardized protocol that will allow researchers to test whether fertility effects exist or not.