What Everyone Else Is Eating: A Systematic Review and Meta-Analysis of the Effect of Informational Eating Norms on Eating Behavior

A nudge in the right direction: the role of food choice architecture in changing populations' diets

Populations' diets typically fall short of recommendations. The implication of this on ill health and quality of life is well established, as are the subsequent health care costs. An area of growing interest within public health nutrition is food choice architecture; how a food choice is framed and its influence on subsequent food selection. In particular, there is an appeal to manipulating the choice architecture in order to nudge individuals' food choice. This review outlines the current understanding of food choice architecture, theoretical background to nudging and the evidence on the effectiveness of nudge strategies, as well as their design and implementation. Interventions emphasising the role of nudge strategies have investigated changes to the accessibility, availability and presentation of food and the use of prompts. Empirical studies have been conducted in laboratories, online and in real-world food settings, and with different populations. Evidence on the effectiveness of nudge strategies in shifting food choice is encouraging. Underpinning mechanisms, not yet fully explicated, are proposed to relate to salience, social norms and the principle of least effort. Emerging evidence points to areas for development including the effectiveness of choice architecture interventions with different and diverse populations, and the combined effect of multiple nudges. This, alongside further examination of theoretical mechanisms and guidance to engage and inspire across the breadth of food provision, is critical. In this way, the potential of choice architecture to effect meaningful change in populations' diets will be realised.

A Systematic Review on Sex- and Gender-Sensitive Research in Public Mental Health During the First Wave of the COVID-19 Crisis

Background: Sex and gender are important modifiers of mental health and behavior in normal times and during crises. We investigated whether they were addressed by empirical, international research that explored the mental health and health behavior ramifications after the onset of the COVID-19 pandemic. Methods: We systematically searched the databases PsyArXiv, PubMed, PsycInfo, Psyndex, PubPsych, Cochrane Library, and Web of Science for studies assessing mental health outcomes (main outcomes) as well as potential risk and protective health behavior (additional outcomes) up to July 2, 2020. Findings: Most of the 80 publications fulfilling the selection criteria reflected the static difference perspective treating sex and gender as dichotomous variables. The focus was on internalizing disorders (especially anxiety and depression) burdening women in particular, while externalizing disorders were neglected. Sex- and gender-specific evaluation of mental healthcare use has also been lacking. With respect to unfavorable health behavior in terms of adherence to prescribed protective measures, men constitute a risk group. Interpretations: Women remain a vulnerable group burdened by multiple stresses and mental health symptoms. The neglect of sex- and gender-specific evaluation of aggression-related disorders, substance addiction, and mental healthcare use in the early stage represents a potentially dangerous oversight. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020192026, PROSPERO 2020 CRD42020192026.

Motivation for and Effect of Cooking Class Participation: A Cross-Sectional Study Following the 2011 Great East Japan Earthquake and Tsunami

We explored the association between the motivation for and effects of cooking class participation in disaster-affected areas following the 2011 Great East Japan Earthquake and Tsunami. We conducted questionnaire surveys in January and February 2020, and applied three Poisson regression models to a cross-sectional dataset of participants, analyzing three perceived participation effects: increase in new acquaintances and friends, increase in excursion opportunities, potential for gaining motivation, and a new sense of life purpose. We also applied the interaction term of motivation variables and usual eating patterns (eating alone or with others). We obtained 257 valid responses from 15 cooking venues. The interaction term for participants’ motivation and eating patterns was associated with their perceived participation effects. “Motivation for nutrition improvement × eating alone” was positively associated with an increase in new acquaintances and friends (IRR: 3.05, 95% CI, 1.22–7.64). “Motivation for increasing personal cooking repertoire × eating alone” was positively associated with increased excursion opportunities (IRR: 5.46, 95% CI, 1.41–21.20). In contrast, the interaction effect of “motivation of increasing nutrition improvement × eating alone” was negatively associated with increased excursion opportunities (IRR: 0.27, 95% CI, 0.12–0.69). The results show that the cooking class was effective, as residents’ participation improved their nutritional health support and increased their social relationships.

Influence of obesity prevalence on social norms and weight control motivation: a cross-sectional comparison of the Netherlands and the UK

This cross-sectional survey study explored associations between perceived bodyweight norms, psychological need satisfaction and motivation for weight control among 500 adult residents of two countries with different overweight/obesity prevalence: the UK (63% prevalence) and the Netherlands (50%). A hypothesised model of the effects of descriptive norms (i.e. perceptions of what is typical for most people) and injunctive norms (i.e. perceptions of what is typically approved by others) on autonomous motivation, mediated through basic psychological need satisfaction, was analysed using structural equation modelling. Descriptive norms did not differ between countries, yet UK adults reported a lower-weight injunctive norm. Perceiving higher bodyweights to be normal negatively predicted motivation to manage one's bodyweight mediated through an undermining effect on psychological need satisfaction. Perceiving higher bodyweights to be normal may have the potential to reduce individual motivation for weight control, but the sensitivity of people's perceptions to objective differences in overweight prevalence appears limited.

Urban environment and dietary behaviours as perceived by residents living in socioeconomically diverse neighbourhoods: A qualitative study in a Mediterranean context

Scholars have determined that low socioeconomic status (SES) is associated with unhealthy dietary behaviours and that local food environments shape food inequality. Less is known about how residents' perceptions of their food environment affect their dietary behaviours. We conducted 37 semistructured interviews and 29 focus groups in three socioeconomically distinct neighbourhoods in Madrid. We identified the following main categories related to social and physical food environments: (a) perceptions of healthy and unhealthy dietary behaviours, (b) children's relationships with food, (c) precariousness and (d) residential food retailer types. Older adults were perceived as healthier consumers, whereas younger people were identified as fast-food consumers. In the low- and middle-SES neighbourhoods, residents saw home-cooked legume-based stews as healthy food. In the high-SES neighbourhood, television cooking programs were highlighted as a positive influence. In the low- and middle-SES neighbourhoods, grandparents played an essential role in the transmission of healthy eating habits to their grandchildren. In the high-SES neighbourhood, children's diets at home were determined by school menus. In the low- and middle-SES neighbourhoods, participants talked about a black market where food could be purchased. Food retailers with low-quality foods were also highlighted. In all neighbourhoods, residents missed traditional food stores, and in the low- and middle-SES neighbourhoods, immigrant-run food stores were not well accepted. Our study presents the concepts shaping how neighbourhood SES differences affect dietary behaviours according to residents of a large Mediterranean city.

Peer Support Groups for Weight Loss

Purpose of Review

Social support, especially from peers, has been found to contribute to successful weight loss and long-term weight loss maintenance. Peer support groups may represent a particularly effective intervention technique for weight loss. This review focuses upon peer support weight loss interventions with the objective of identifying common elements of successful programs.

Recent Findings

Peer support interventions often consist of expert-led educational content, supplemented by peer-led activities or discussion. Peer groups may provide support to individuals who have little social support in their normal lives. Interventions are often designed for pre-existing groups, especially high-risk groups such as women from ethnic minorities. Men are underrepresented in weight loss programs and often perceive “dieting” as feminine. However, several peer programs for male sports fans have successfully resulted in weight loss and fostering support for healthy lifestyle among male peers. In addition to professionally created peer support groups, many online weight loss communities are created and moderated by peers. Online communities allow participants to share peer support similar to in-person formats.

Summary

Many peer support interventions show significant short-term weight loss. Group members frequently report that peer support was critical to their weight loss success. A sense of community among likeminded individuals with similar goals was frequently cited. Online peer support groups are becoming increasingly prevalent, may fulfill similar needs to in-person groups, and have additional advantages in accessibility, and access to a larger peer network, and may facilitate long-term adherence.

Factors influencing dietary behaviours in urban food environments in Africa: a systematic mapping review

Objective:

To identify factors influencing dietary behaviours in urban food environments in Africa and identify areas for future research.

Design:

We systematically reviewed published/grey literature (protocol CRD4201706893). Findings were compiled into a map using a socio-ecological model on four environmental levels: individual, social, physical and macro.

Setting:

Urban food environments in Africa.

Participants:

Studies involving adolescents and adults (11–70 years, male/female).

Results:

Thirty-nine studies were included (six adolescent, fifteen adolescent/adult combined and eighteen adult). Quantitative methods were most common (twenty-eight quantitative, nine qualitative and two mixed methods). Studies were from fifteen African countries. Seventy-seven factors influencing dietary behaviours were identified, with two-thirds at the individual level (45/77). Factors in the social (11/77), physical (12/77) and macro (9/77) environments were investigated less. Individual-level factors that specifically emerged for adolescents included self-esteem, body satisfaction, dieting, spoken language, school attendance, gender, body composition, pubertal development, BMI and fat mass. Studies involving adolescents investigated social environment-level factors more, for example, sharing food with friends. The physical food environment was more commonly explored in adults, for example, convenience/availability of food. Macro-level factors associated with dietary behaviours were food/drink advertising, religion and food prices. Factors associated with dietary behaviour were broadly similar for men and women.

Conclusions:

The dominance of studies exploring individual-level factors suggests a need for research to explore how social, physical and macro-level environments drive dietary behaviours of adolescents and adults in urban Africa. More studies are needed for adolescents and men, and studies widening the geographical scope to encompass all African countries.

Neighbourhood fast food exposure and consumption: the mediating role of neighbourhood social norms

Background

The association between the residential fast food environment and diet has gained growing attention. However, why the food environment affects food consumption is under-examined. This study aimed to investigate neighbourhood social norms with respect to fast food consumption as a potential mediating pathway between residential fast food outlet exposure and residents’ fast food consumption.

Methods

A correlational study was conducted in which a nationwide sample of 1038 respondents living across The Netherlands completed a survey. Respondents reported their fast food consumption (amount/week) as well as perceived descriptive and injunctive norms regarding fast food consumption in their neighbourhood. Fast food outlet exposure was measured by the average count of fast food outlets within a 400 m walking distance buffer around the zip-codes of the respondents, using a retail outlet database. Regression models were used to assess associations between residential fast food outlet exposure, fast food consumption, and social norm perceptions, and a bootstrapping procedure was used to test the indirect -mediation- effect. Separate analyses were performed for descriptive norms and injunctive norms.

Results

There was no overall or direct association between residential fast food outlet exposure and residents’ fast food consumption. However, fast food outlet exposure was positively associated with neighbourhood social norms (descriptive and injunctive) regarding fast food consumption, which in turn were positively associated with the odds of consuming fast food. Moreover, results of the bootstrapped analysis provided evidence of indirect effects of fast food outlet exposure on fast food consumption, via descriptive norms and injunctive norms.

Conclusions

In neighbourhoods with more fast food outlets, residents were more likely to perceive fast food consumption in the neighbourhood as more common and appropriate. In turn, stronger neighbourhood social norms were associated with higher fast food consumption. Acknowledging the correlational design, this study is the first that implies that neighbourhood social norms may be a mediating pathway in the relation between the residential fast food environment and fast food consumption. Future research may examine the role of neighbourhood social norms in other contexts and explore how the changing food environment may shift our consumption norms.

The Effectiveness of the Good Affordable Food Intervention for Adults with Low Socioeconomic Status and Small Incomes

Good Affordable Food (GAF) is a small-group nutrition education intervention for adults with low socioeconomic status and small incomes. It aims to empower participants to save money on groceries and consume healthier diets. This paper reports the short-term and longer-term effects on behavioural determinants and self-reported behavioural changes. A quasi-experimental control group design was applied with a baseline measurement, a post-test immediately after the intervention, and a follow-up measurement after six months. The study included 237 participants (intervention group: n = 131; control group: n = 106) at baseline, 197 at post-test, and 152 at follow-up. Data were collected by telephone, mostly using closed interview questions. Positive short-term and longer-term effects were found for attitude towards the costs of healthy foods, food label use, and the use of liquid butter or oil to prepare hot meals. Short-term intervention effects related to knowledge towards saving money on groceries, self-efficacy towards healthy eating, portion size awareness, and mindful eating. GAF was effective in changing some determinants and behaviours related to cost and food consumption, however, mostly in the short term. Thereby, it is an example of combining pricing and health information in nutrition education that developers of effective nutrition education for low-income groups can build on.

Automatic, wearable-based, in-field eating detection approaches for public health research: a scoping review

Dietary intake, eating behaviors, and context are important in chronic disease development, yet our ability to accurately assess these in research settings can be limited by biased traditional self-reporting tools. Objective measurement tools, specifically, wearable sensors, present the opportunity to minimize the major limitations of self-reported eating measures by generating supplementary sensor data that can improve the validity of self-report data in naturalistic settings. This scoping review summarizes the current use of wearable devices/sensors that automatically detect eating-related activity in naturalistic research settings. Five databases were searched in December 2019, and 618 records were retrieved from the literature search. This scoping review included N = 40 studies (from 33 articles) that reported on one or more wearable sensors used to automatically detect eating activity in the field. The majority of studies (N = 26, 65%) used multi-sensor systems (incorporating > 1 wearable sensors), and accelerometers were the most commonly utilized sensor (N = 25, 62.5%). All studies (N = 40, 100.0%) used either self-report or objective ground-truth methods to validate the inferred eating activity detected by the sensor(s). The most frequently reported evaluation metrics were Accuracy (N = 12) and F1-score (N = 10). This scoping review highlights the current state of wearable sensors' ability to improve upon traditional eating assessment methods by passively detecting eating activity in naturalistic settings, over long periods of time, and with minimal user interaction. A key challenge in this field, wide variation in eating outcome measures and evaluation metrics, demonstrates the need for the development of a standardized form of comparability among sensors/multi-sensor systems and multidisciplinary collaboration.

Role of the Built and Online Social Environments on Expression of Dining on Instagram

Online social communities are becoming windows for learning more about the health of populations, through information about our health-related behaviors and outcomes from daily life. At the same time, just as public health data and theory has shown that aspects of the built environment can affect our health-related behaviors and outcomes, it is also possible that online social environments (e.g., posts and other attributes of our online social networks) can also shape facets of our life. Given the important role of the online environment in public health research and implications, factors which contribute to the generation of such data must be well understood. Here we study the role of the built and online social environments in the expression of dining on Instagram in Abu Dhabi; a ubiquitous social media platform, city with a vibrant dining culture, and a topic (food posts) which has been studied in relation to public health outcomes. Our study uses available data on user Instagram profiles and their Instagram networks, as well as the local food environment measured through the dining types (e.g., casual dining restaurants, food court restaurants, lounges etc.) by neighborhood. We find evidence that factors of the online social environment (profiles that post about dining versus profiles that do not post about dining) have different influences on the relationship between a user's built environment and the social dining expression, with effects also varying by dining types in the environment and time of day. We examine the mechanism of the relationships via moderation and mediation analyses. Overall, this study provides evidence that the interplay of online and built environments depend on attributes of said environments and can also vary by time of day. We discuss implications of this synergy for precisely-targeting public health interventions, as well as on using online data for public health research.

Descriptive Normative Nutrition Messages to Maximize Effect in a Videogame: Narrative Review

Messages containing descriptive norms have been manipulated and tested for effects on dietary intake in a number of studies. The effects have been mostly small or nonexistent. This narrative review analyzed the structural elements of the nutrition messages most likely related to effectiveness. Elements examined included the following: source, similarity of source to the participant, reference group, identification with or evaluative significance of the reference group, delivery, salience, background, tailoring, gain-loss framing, and whether an assessment of the group norm was conducted before designing the descriptive norm message. Most studies incorporated few of the reviewed structural elements, and message manipulations appeared weak. Controlled, systematic studies are needed to examine the effect of the structural elements, singly and in combination, on behavior and its mediators. Videogames are designed to be delivered in the same way to players; therefore, they offer a controlled environment for extensively and systematically manipulating structural elements of messages and examining the resulting behavioral effects. How this might be accomplished was described. Experimental research was identified as being necessary to delineate the individual and combined element effects, thereby contributing to the body of literature on videogame design and effectiveness.

Identifying social norms in physical aspects of food environments: A photo study

It is widely accepted that physical food environments can contribute to unhealthy eating, but less is known about how physical cues in these environments actually stimulate eating. Our study starts from the assumption that social norms are embedded in physical cues and aims to make an inventory of physical cues that communicate what is socially accepted as normal and/or appropriate to eat in a Dutch outside-the-home food context. In Study 1, we conducted a qualitative study in which photographs taken in self-service food environments were analyzed using strategies from photo documentation and semiology. Grounded theory was applied to identify a wide variety of specific physical cues that were ultimately grouped into 18 higher level categories of physical cues (e.g. consumption traces, product availability). Most cue categories were associated with either descriptive or injunctive social norms, but some were associated with both types. In Study 2, we aimed to quantitatively cross-validate the social norm interpretations among laypeople (N = 173) by focusing on two selected photographs. More than half of the physical cues that participants identified in these photographs as being influential had been identified in Study 1 as cues bearing a normative message. The results further indicated that other people's behavior is easier to recognize in physical food environments than signals about what ought to be done. Given the great variety of identified physical cues associated with social norms, we posit that social norms are widely embedded in food environments and might guide eating behavior. Further research should study the effects of these cues on behavior and test whether the underlying process can be attributed to social norm interpretations.

Served Portion Sizes Affect Later Food Intake Through Social Consumption Norms

Portion sizes of commercially available foods have increased, and there is evidence that exposure to portion sizes recalibrates what is perceived as 'normal' and subsequently, how much food is selected and consumed. The present study aims to explore the role of social (descriptive and injunctive) and personal portion size norms in this effect. Across two experiments, participants were either visually exposed to (Study 1, N = 329) or actually served (Study 2, N = 132) a smaller or larger than normal food portion. After 24 h, participants reported their intended consumption (Study 1) or served themselves and consumed (Study 2) a portion of that food and reported perceived portion size norms. In Study 1, visual exposure to portion size did not significantly affect intended consumption and perceived portion size norms. In Study 2, participants consumed a smaller portion of food when they were served a smaller rather than a larger portion the previous day, which was mediated by perceived descriptive and injunctive social (but not personal) portion size norms. Results suggest that being served (but not mere visual exposure to) smaller (relative to larger) portions changes perceived social norms about portion size and this may reduce future consumption of that food.

The effectiveness of a social media intervention for reducing portion sizes in young adults and adolescents

Objective

Adolescents and young adults select larger portions of energy-dense food than recommended. The majority of young people have a social media profile, and peer influence on social media may moderate the size of portions selected.

Methods

Two pilot interventions examined whether exposure to images of peers’ portions of high-energy-dense (HED) snacks and sugar-sweetened beverages (SSBs) on social media (Instagram) would influence reported desired portions selected on a survey. Confederate peers posted ‘their’ portions of HED snacks and SSBs on Instagram. At baseline and intervention end participants completed surveys that assessed desired portion sizes.

Results

In intervention 1, undergraduate students (n = 20, mean age=19.0 years, SD=0.65) participated in a two-week intervention in a within-subjects design. Participants reported smaller desired portions of HED snacks and SSBs following the intervention, and smaller desired portions of HED snacks for their peers. In intervention 2, adolescents (n = 44, mean age = 14.4 years, SD = 1.06) participated in a four-week intervention (n = 23) or control condition (n = 21) in a between-subjects design. Intervention 2 did not influence adolescents to reduce their reported desired portion sizes of HED snacks or SSBs relative to control.

Conclusions

These preliminary studies demonstrated that social media is a feasible way to communicate with young people. However, while the intervention influenced young adults’ reported desired portions and social norms regarding their peers’ portions, no significant impact on desired reported portion sizes was found for HED snacks and SSBs in adolescents. Desired portion sizes of some foods and beverages may be resistant to change via a social media intervention in this age group.

Social Learning of Acquiring Novel Feeding Habit in Mandarin Fish (Siniperca chuatsi)

Social learning plays important roles in gaining new foraging skills and food preferences. However, the potential role and molecular mechanism of social learning in acquiring new feeding habits is less clear in fish. In the present study, we examined the success rate of feeding habit domestication from live prey fish to dead prey fish, as well as the food intake of dead prey fish in mandarin fish with or without feeders of dead prey fish as demonstrators. Here, we found that mandarin fish can learn from each other how to solve novel foraging tasks, feeding on dead prey fish. In addition, the analysis of gene expressions and signaling pathways of learning through Western blotting and transcriptome sequencing shows that the expression of the c-fos, fra2, zif268, c/ebpd and sytIV genes were significantly increased, and the anorexigenic pomc and leptin a expressions were decreased in fish of the learning group. The phosphorylation levels of protein kinase A (PKA) and Ca²⁺/calmodulin-dependent protein kinase II (CaMKII) in the learning group were significantly higher than those of the control group, while the phosphorylation level of S6 ribosomal protein (S6) was lower. With the inhibitors of PKA and CaMKII signaling and the chromatin immunoprecipitation (ChIP) assay, we further found that the social learning of new feeding habits in mandarin fish could be attributed to the activation of the CaMKII signaling pathway and then the stimulation of the expression of the c-fos gene, which might be an important transcriptional factor to inhibit the expression of the anorexigenic gene pomc, resulting in the food intake of dead prey fish in mandarin fish. Altogether, our results support the hypothesis that social learning could facilitate the acquisition of novel feeding habits in fish, and it considerably increases the rate of subsequent individual food intake and domestication through the interaction between the learning gene c-fos and the appetite control gene pomc.

A review of evidence supporting current strategies, challenges, and opportunities to reduce portion sizes

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.

The impact of descriptive norms on motivation to participate in cancer screening - Evidence from online experiments

OBJECTIVE

The current study tested in two online experiments whether manipulating normative beliefs about cancer screening uptake increases intention to attend colorectal screening among previously disinclined individuals.

METHODS

2461 men and women from an Internet panel (Experiment 1 N = 1032; Experiment 2, N = 1423) who initially stated that they did not intend to take up screening were asked to guess how many men and women they believe to get screened for colorectal cancer. Across participants, we varied the presence/absence of feedback on the participant's estimate, as well as the stated proportion of men and women doing the screening test.

RESULTS

Across the two experiments, we found that receiving one of the experimental messages stating that uptake is higher than estimated significantly increased the proportion of disinclined men and women becoming intenders. While, we found a positive relationship between the communicated uptake and screening intentions, we did not find evidence that providing feedback on the estimate has an added benefit.

CONCLUSION

Screening intention can be effectively manipulated through a high uptake message.

PRACTICE IMPLICATIONS

Communication of high screening uptake is an easy and effective way to motivate disinclined individuals to engage in colorectal cancer screening.

Nudging to get our food choices on a sustainable track

Food production is one of the major contributors to environmental damage. Adaptations in our food choices are needed to preserve resources for the needs of future generations. More sustainable consumption patterns have been encouraged by economic incentives, laws, education and communication campaigns. Nonetheless, consumers still find difficulties in trying to change their current food habits. This review takes a behavioural approach in encouraging sustainable food choices among consumers. From a nudging perspective, many behavioural changes can be encouraged in a non-obtrusive way by adapting the complex food environment in which consumers are operating. These interventions do not restrict consumers' choices but rather adapt the choice architecture wherein food decisions are made. Drawing on the literature from diverse theoretical perspectives, we provide an overview of the application of nudging for more sustainable food choices and highlight where more research is needed. More specifically, we discuss research that used nudging to engender cognitive impact (i.e. the use of labels or visibility enhancements), affective responses (i.e. sensorial and social influence cues) and behavioural effects (i.e. adjustments in convenience and product size). We conclude that this review only shows the tip of the iceberg of the research on nudging and sustainable consumption that is likely forthcoming in the next few years, following the successes of nudging applications in other domains. Nonetheless, each individual nudging intervention requires careful examination. Personal predispositions towards the environment should be considered when designing interventions, demonstrating the complementarity of nudging with education on sustainable consumption.

Testing verbal quantifiers for social norms messages in cancer screening: evidence from an online experiment

BACKGROUND

Studies have shown that presenting correct information about group norms to correct misperceptions of norms can influence health behaviours. In two online studies we investigated how different ways of communicating the current uptake of 43% of the English Bowel Scope Screening (BSS) programme affects intention among disinclined men and women.

METHODS

In the first study, 202 participants were asked to interpret eight quantifiers for 43% uptake ('few', 'many', 'a considerable number', 'a large number', 'a great number', 'a lot', 'numerous' and 'nearly half') and to indicate how misleading they perceived each of them to be. In the second study, with 1245 participants, we compared the motivational impact of two quantifiers ('a large number' and 'nearly half' which were associated with the highest perceived uptake (48.9%) and considered least misleading in study 1 respectively) with a control message that did not contain any information on uptake, and a message which communicated actual uptake as a proportion (43%).

RESULTS

While we found that both verbal quantifiers increased screening intentions compared with the control group (from 7.8 to 12.5%, aOR 1.72; 95%CI 1.00-2.96 in the case of 'a large number' and 14.3%, aOR 2.02; 95%CI 1.20-3.38 for 'nearly half'), simply communicating that 43% do the test, however, had no impact on intentions (9.9% vs. 7.8% aOR 1.25; 95%CI 0.73-2.16).

CONCLUSION

Verbal quantifiers can be used to improve the perception of low uptake figures and avoid a demotivating effect.

Effects of Food Environments and Eating Environments on Consumers’ Food Consumption Volume

Even though the influences of eating environments and the food environments on consumption have been discussed, little has been done to examine whether the food environments would be influenced by the eating environments. For example, the size of plate has been proved to have impact on consumers’ consumption volume; it is still unknown whether the eating environment would interact with the food environment and in turn influences consumers’ consumption volume. This research explores the underlying mechanisms how consumers are influenced by the size of bowl when they consume food. In addition, eating environments are also incorporated to discuss their effects on the relationship between bowl size and consumers’ consumption volume. The results indicate people who receive a large bowl with large chopsticks exhibit greater food consumption than those who receive a small bowl with small chopsticks. However, when people use tableware inconsistently, they exhibit similar food consumption. Under bright illumination, people given large bowls with large chopsticks exhibit greater food consumption than those given small bowls with small chopsticks; however, when people use inconsistently sized tableware, they exhibit similar food consumption. Under dim illumination, no significant differences in food consumption amount are evident in association with bowl and chopstick sizes.

Exploring the Experiences of People with Obesity Using Portion Control Tools-A Qualitative Study

Large portion sizes increase consumption and eating smaller portions is recommended as a weight control strategy. However, many people report difficulties enacting this advice. This study examined the experience of individuals using two commercially available portion-control tools to try to manage their weight. In a crossover design, 29 adults with obesity (18 women) who had attended a previous weight loss intervention in the community were invited to use two portion-control tool sets over a period of four weeks (two weeks each) and to complete a semi-structured questionnaire about their experience. The tools were a guided crockery set (sector plate, calibrated bowl, and calibrated glass) and a set of calibrated serving spoons (one for starch, one for protein, and one for vegetables). Data were analyzed using thematic framework analysis. A key theme was related to the educational benefits of the tools, such as generating awareness, guidance, and gaining an independent ability to judge appropriate portions. Other key themes were tool usability, acceptability, and feasibility of usage. Barriers identified by participants included unclear markings/instructions and the inconvenience of using the tool when eating away from home. Overall, the tools were perceived to be educationally useful, easy to use, and potentially effective for learning to control portions, which suggested that these instruments could help in weight management interventions alongside other strategies. Elements of the tool design could influence the ability of participants to adhere to using the tool, and hence allow the educational effect to be mediated.

Social modelling of health behaviours: Testing self-affirmation as a conformity-reduction strategy

OBJECTIVES

Social conformity negatively affects health. Exposure to peers who model unhealthy alcohol or food consumption increases personal consumption. Self-affirmation alters processes related to the motivations underlying conformity. We therefore tested whether self-affirmation reduces conformity to unhealthy behaviour and does so by reducing affiliation needs and/or increasing self-regulation.

DESIGN

In two studies, participants were randomized to one of four conditions in a 2 (low vs. high peer modelling) × 2 (self-affirmed vs. not) design.

METHODS

In Study 1 (N = 153), a confederate modelled low or high alcohol consumption. Participants' alcohol consumption was recorded; mimicry of confederates' sips was coded. In Study 2 (N = 122), written information indicated others' snack food intake during the study. Participants' food consumption was recorded. Affiliative interest was assessed in both studies. Inhibitory control and private self-awareness were assessed in Studies 1 and 2, respectively.

RESULTS

In Study 1, participants exposed to heavy drinking consumed significantly more alcohol and mimicked the confederate more frequently than participants exposed to the light drinking model. Self-affirmation did not reduce this tendency, nor did it affect affiliative interest or inhibitory control. Exploratory analysis supported that mimicry mediated the peer modelling-consumption relationship. In Study 2, participants ate more when they believed others had eaten a lot, as opposed to little. Self-affirmation did not reduce this tendency and did not affect affiliative interest. Self-affirmed participants had higher private self-awareness than those who were not self-affirmed, but self-awareness did not affect consumption.

CONCLUSION

Peer behaviour strongly influences personal consumption. Self-affirmation did not reduce behavioural conformity. Statement of contribution What is already known on this subject? Exposure to peers who engage in high consumption of alcohol and unhealthy foods is associated with increased personal consumption. Few studies have examined strategies to reduce conformity to consumption behaviours. What does this study add? Across two studies, self-affirmation did not reduce behavioural conformity, despite its' positive effects on private self-awareness. Conformity in face-to-face interactions is largely driven by mimicry.

Lower socioeconomic status is associated with higher intended consumption from oversized portions of unhealthy food

Socioeconomic status is one of the strongest predictors of obesity, and of living in deprived neighbourhoods with unhealthy food environments. Little is known, however, about the psychological processes that translate features of such environments into socioeconomic differences in eating behaviour. One important feature of unhealthy food environments is the prevalence of oversized portions of unhealthy food. The present study tested whether individuals with lower socioeconomic status intend to consume more from large portions than those with higher socioeconomic status, and examined the psychological processes underlying this effect. A large-scale online experiment was conducted in which participants (N = 511) indicated how much they would eat from small and large portions of healthy and unhealthy snacks. The mediating effects of trait impulsivity and perceptions of how much was considered appropriate to eat were also assessed. Participants with lower socioeconomic status intended to eat more from the large portions than from the small portions of the unhealthy snacks, which would equate to a potential 15-22% increase in energy intake. These effects were partially mediated by trait impulsivity and perceptions of how much is appropriate to eat. These findings point to a significant health burden of low socioeconomic status: when exposed to unhealthy food environments, specific psychological processes might increase the amount of unhealthy food those with lower socioeconomic intend to consume. This study critically informs the emerging understanding of the psychology of socioeconomic status and eating behaviour.

Do Emotions Cause Eating? The Role of Previous Experiences and Social Context in Emotional Eating

Emotional eating is defined as an increase in eating following negative emotion. Self-reported emotional eating has been associated with physical-health concerns. However, experimental studies indicate that negative-mood inductions do not reliably lead to increased eating in healthy eaters, not even among those with a high desire to eat when emotional. We argue that experimental studies will help us understand emotional eating only if they account for the following ideas: (a) Emotional eating may require that people learn to associate emotion with eating, (b) emotional eating may follow only specific discrete emotions, and (c) emotional eating may depend on social context. Each of these points suggests a fruitful direction for future research. Specifically, future studies must acknowledge, identify, and account for variations in the extent to which people have learned to associate emotions with eating; assess or elicit strong discrete emotions; and systematically examine the effect of social context on emotional eating.

C. P, Kuikel J, Newell J, Peters R, Prestwich A, King R. Developing a socio-ecological model of dietary behaviour for people living with diabetes or high blood glucose levels in urban Nepal: A qualitative investigation

Instances of non-communicable diseases such as diabetes are on the rise globally leading to greater morbidity and mortality, with the greatest burden in low and middle income countries [LMIC]. A major contributing factor to diabetes is unhealthy dietary behaviour. We conducted 38 semi structured interviews with patients, health professionals, policy-makers and researchers in Kathmandu, Nepal, to better understand the determinants of dietary behaviour amongst patients with diabetes and high blood glucose levels. We created a social ecological model which is specific to socio-cultural context with our findings with the aim of informing culturally appropriate dietary behaviour interventions for improving dietary behaviour. Our findings show that the most influential determinants of dietary behaviour include cultural practices (gender roles relating to cooking), social support (from family and friends), the political and physical environment (political will, healthy food availability) and individuals' motivations and capabilities. Using these most influential determinants, we suggest potentially effective dietary interventions that could be implemented by policy makers. Our findings emphasise the importance of considering socio-cultural context in developing interventions and challenges one-size-fits-all approaches which are often encouraged by global guidelines. We demonstrate how multifaceted and multi layered models of behavioural influence can be used to develop policy and practice with the aim of reducing mortality and morbidity from diabetes.

Comparing and contrasting responses to tobacco control and obesity policies: a qualitative study

OBJECTIVE

To explore people's perceptions of, and responses to, obesity and tobacco policies with a particular focus on motivation; and to compare and contrast responses to explore the potential for translating learning across domains.

DESIGN

A theoretically informed comparative qualitative study involving semi-structured interviews with two groups of participants (smokers and ex-smokers; those who have previously or are currently attempting to lose weight). Data were analysed inductively using thematic analysis and interpreted through the lens of Self-Determination Theory.

SETTING

Community-based.

PARTICIPANTS

Interviews were conducted with five smokers and four ex-smokers around tobacco policy, and seventeen people acting to control their weight around obesity policy.

RESULTS

Three primary themes were identified. (i) Participants believed social norms to be crucial to supporting health behaviour change and responses to policy; not smoking was perceived as socially normal, whereas being physically active and eating healthily were perceived to go against social norms. (ii) Policies influencing the physical environment were perceived to support stopping smoking (e.g. smoke-free laws, advertising bans), but to undermine attempts to lose or control weight (e.g. high visibility, availability and low cost of energy-dense foods). (iii) While policies for both domains were considered necessary and legitimate, both groups found policy interventions neither motivating nor undermining of their sense of autonomy.

CONCLUSIONS

The results suggest those trying to lose weight respond similarly to obesity-related policy as smokers do to tobacco policy. Environmental interventions are perceived to be more helpful than appealing to people's motivation to change for their own sake.

Social influence shifts valuation of appetitive cues in early adolescence and adulthood

Other people can profoundly affect one's opinions and decisions. In the current study, we compared the effects of peer influence on responses to a primary reward-food-in both young adolescents and adults. Food is critical for survival, and in addition to its rewarding properties, habits and practices surrounding eating are heavily influenced by social and cultural norms. To address the impact of peer influence on food valuations, young adolescents ages 10-14 and young adults ages 18-22 rated the desirability of foods before and after seeing peer opinions about those foods. We then compared the degree to which participants changed their ratings of food desirability as a function of the type of social information received (e.g., peers liking a food more or less than did the participant). We found that all participants' ratings conformed to the peer ratings and that adolescents had less stable valuations across all conditions over time. These results provide evidence for the effectiveness of peer influence in shifting valuations of appetitive stimuli and can inform interventions aimed at improving healthy eating choices. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

How does anonymous online peer communication affect prevention behavior? Evidence from a laboratory experiment

While the importance of social networks for health behaviors is well-recognized, relatively little is known regarding the accuracy of anonymous online communication and its impact on health behavior. In 2012, we conducted a laboratory experiment in Boston, Massachusetts with 679 individuals to understand how anonymous online communication affects individual prevention decisions. Participants had to opt for or against investing in prevention over three sessions, each consisting of 15 experimental rounds. In the third session only, participants could share their experiences with a group of 1-3 other anonymous participants after each round. Groups exchanged an average of 16 messages over the 15 rounds of the third session. 70% of messages contained information about the subject's prevention decision and the resulting health outcome. Participants were more likely to communicate when they prevented than when they did not, with prevention failures resulting in the highest probability of sending a message. Nonetheless, receiving an additional message reporting prevention increased the odds a subject would prevent by 32 percent. We find that participants tend to adopt the prevention behavior reported by others, with less weight given to the reported outcomes of prevention, suggesting that social networks may influence behaviors through more than just information provision.

Two observational studies examining the effect of a social norm and a health message on the purchase of vegetables in student canteen settings

There is some evidence from laboratory-based studies that descriptive social-norm messages are associated with increased consumption of vegetables, but evidence of their effectiveness in real-world settings is limited. In two observational field studies taking an ecological approach, a vegetable-related social norm (e.g. "Did you know that most students here choose to eat vegetables with their meal?"), and a health message (e.g. "Did you know that students who choose to eat vegetables have a lower risk of heart disease?") were displayed in two different student canteens. Purchases were observed during three stages: baseline, intervention (when the posters were displayed) and immediate post-intervention (when the posters had been removed). Study 1 (n = 7598) observed the purchase of meals containing a portion of vegetables and Study 2 (n = 4052) observed the purchase of side portions of vegetables. In Study 1, relative to baseline, the social-norms intervention was associated with an increase in purchases of vegetables (from 63% to 68% of meals; OR = 1.24, CI = 1.03-1.49), which was sustained post-intervention (67% of meals; OR = 0.96, CI = 0.80-1.15). There was no effect of the health message (75% of meals at baseline, and 74% during the intervention; OR = 0.98, CI = 0.83-1.15). In Study 2, relative to baseline, there was an effect of both the social norm (22.9% of meals at baseline, rising to 32.5% during the intervention; OR = 1.62, CI = 1.27-2.05) and health message (rising from 43.8% at baseline to 52.8%; OR = 0.59, CI = 0.46-0.75). The increase was not sustained post-intervention for the social norm intervention (22.1%; OR = 0.59, CI = 0.46-0.75), but was sustained for the health intervention (48.1%; OR = 0.83, CI = 0.67-1.02). These results support further testing of the effectiveness of such messages in encouraging healthier eating and indicate the need for larger-scale testing at multiple sites using a randomised-controlled design.

Sexual health information-seeking behavior on a social media site: predictors of best answer selection

Purpose

The purpose of this paper is to identify sexual health information needs and the cognitive and affective factors correlated with the best answer chosen by social Q&A users.

Design/methodology/approach

The study collected questions and answers regarding sexual health information on a social Q&A site, and analyzed the questions and a paired sample composed of best and non-best answers (n=480).

Findings

The main information needs of consumers are human development, sexual behavior, and sexual health. Best answers are more likely to include both cognitive (higher level of readability, risky information, social norms) and affective factors (empathy, positive/negative feelings, and optimistic information) than non-best answers.

Research limitations/implications

The study illuminates the roles of social Q&A as a unique platform to discuss sensitive health topics due to the fact that consumers use such social media sites as critical complementary health information sources.

Practical implications

If health information providers develop information with the factors that the study suggests, not only will it be more adopted by consumers, but it will also ameliorate the quality concerns about online health information.

Originality/value

Previous studies only investigated the most prevalent factors, rather than the most effective ones, which have a greater influence on best answer selection. This study compares the best answers and the non-best answers to overcome the limitations of the previous studies. Above all, the study applied the persuasion concepts to address the cognitive and affective perspectives to the answer evaluations of social Q&A.

Improving cardiometabolic health through nudging dietary behaviours and physical activity in low SES adults: design of the Supreme Nudge project

Background

Initiating and maintaining a healthy lifestyle -including healthy eating and sufficient physical activity- is key for cardiometabolic health. A health-promoting environment can facilitate a healthy lifestyle, and may be especially helpful to reach individuals with a lower socio-economic status (SES). In the Supreme Nudge project, we will study the effects of pricing and nudging strategies in the supermarket – one of the most important point-of-choice settings for food choices – and of a context-specific mobile physical activity promotion app. This paper describes the stepwise and theory-based design of Supreme Nudge, which aims to develop, implement and evaluate environmental changes for a sustained impact on lifestyle behaviours and cardiometabolic health in low SES adults.

Methods

Supreme Nudge uses a multi-disciplinary and mixed methods approach, integrating participatory action research, qualitative interviews, experimental pilot studies, and a randomized controlled trial in a real-life (supermarket) setting. First, we will identify the needs, characteristics and preferences of the target group as well as of the participating supermarket chain. Second, we will conduct a series of pilot studies to test novel, promising and feasible intervention components. Third, a final selection of intervention components will be implemented in a full-scale randomised controlled supermarket trial. Approximately 1000 low SES adults will be recruited across 8–12 supermarkets and randomised at supermarket level to receive 1) no intervention (control); 2) environmental nudges such as food product placement or promotion; 3) nudges and a tailored physical activity app that provides time- and context specific feedback; 4) pricing interventions, nudges, and the physical activity app. The effects on dietary behaviours and physical activity will be evaluated at 3, 6 and 12 months, and on cardiometabolic health at 6 and 12 months. Finally, we will evaluate the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of the intervention, and we will use insights from System Innovation and Transition Management theories to define the best strategies for implementation and upscaling beyond the study period.

Discussion

The Supreme Nudge project is likely to generate thorough evidence relevant for policy and practice on the effects of a mixed method and multi-disciplinary intervention targeting dietary behaviours and physical activity.

Trial registration

The real-life trial has been registered on 30 May 2018, NTR7302.

Misperceived norms and personal sugar-sweetened beverage consumption and fruit and vegetable intake among students in the United States

Perceptions of peer food and beverage consumption norms may predict personal consumption. Yet actual peer norms may be misperceived. Data were collected from adolescents in grades 6-12 (n = 5841) in 13 schools across six regionally diverse states via an anonymous online survey. The male and female averages for the number of sugar-sweetened beverages (SSBs) personally consumed per day were significantly lower than average perceptions of the typical number of SSBs consumed by peers. Inversely, the male and female averages for the number of fruit and vegetable (FV) servings personally consumed per day were significantly higher than average perceptions of typical FVs consumed by peers. Among the majority of male and female grade cohorts, the median SSB consumption was 1 drink per day and the median FV intake was 3 servings per day. Regression analyses found a strong relationship between personal consumption and perceived peer norms about male and female consumption (β  = 0.56, p < .001 for perceived male norm among male students and β  = 0.52, p < .001 for perceived female norm among female students about SSB consumption, for example), adjusting for sociodemographic characteristics and actual consumption norms. Overall, 65% and 67% of students overestimated average SSB consumption among males and females in their grade cohort, respectively, while less than 5% underestimated these norms. In addition, 49% and 52% of students underestimated average FV intake among males and females in their grade cohort, respectively, while only about 25-30% overestimated the norm. There was little difference in male and female students' estimations of peer norms. Unhealthy misperceptions of SSB norms and FV norms existed across all student categories and grade cohorts, which may contribute to unhealthy personal dietary patterns.

Associations between local descriptive norms for overweight/obesity and insufficient fruit intake, individual-level diet, and 10-year change in body mass index and glycosylated haemoglobin in an Australian cohort

Background

Descriptive norms (what other people do) relate to individual-level dietary behaviour and health outcome including overweight and obesity. Descriptive norms vary across residential areas but the impact of spatial variation in norms on individual-level diet and health is poorly understood. This study assessed spatial associations between local descriptive norms for overweight/obesity and insufficient fruit intake (spatially-specific local prevalence), and individual-level dietary intakes (fruit, vegetable and sugary drinks) and 10-year change in body mass index (BMI) and glycosylated haemoglobin (HbA_1c).

Methods

HbA_1c and BMI were clinically measured three times over 10 years for a population-based adult cohort (n = 4056) in Adelaide, South Australia. Local descriptive norms for both overweight/obesity and insufficient fruit intake specific to each cohort participant were calculated as the prevalence of these factors, constructed from geocoded population surveillance data aggregated for 1600 m road-network buffers centred on cohort participants’ residential addresses. Latent growth models estimated the effect of local descriptive norms on dietary behaviours and change in HbA_1c and BMI, accounting for spatial clustering and covariates (individual-level age, sex, smoking status, employment and education, and area-level median household income).

Results

Local descriptive overweight/obesity norms were associated with individual-level fruit intake (inversely) and sugary drink consumption (positively), and worsening HbA_1c and BMI. Spatially-specific local norms for insufficient fruit intake were associated with individual-level fruit intake (inversely) and sugary drink consumption (positively) and worsening HbA_1c but not change in BMI. Individual-level fruit and vegetable intakes were not associated with change in HbA_1c or BMI. Sugary drink consumption was also not associated with change in HbA_1c but rather with increasing BMI.

Conclusion

Adverse local descriptive norms for overweight/obesity and insufficient fruit intake are associated with unhealthful dietary intakes and worsening HbA_1c and BMI. As such, spatial variation in lifestyle-related norms is an important consideration relevant to the design of population health interventions. Adverse local norms influence health behaviours and outcomes and stand to inhibit the effectiveness of traditional intervention efforts not spatially tailored to local population characteristics. Spatially targeted social de-normalisation strategies for regions with high levels of unhealthful norms may hold promise in concert with individual, environmental and policy intervention approaches.

Eating for Two? Protocol of an Exploratory Survey and Experimental Study on Social Norms and Norm-Based Messages Influencing European Pregnant and Non-pregnant Women's Eating Behavior

The social context is an important factor underlying unhealthy eating behavior and the development of inappropriate weight gain. Evidence is accumulating that powerful social influences can also be used as a tool to impact people's eating behavior in a positive manner. Social norm-based messages have potential to steer people in making healthier food choices. The research field on nutritional social norms is still emerging and more research is needed to gain insights into why some people adhere to social norms whereas others do not. There are indications stemming from empirical studies on social eating behavior that this may be due to ingratiation purposes and uncertainty reduction. That is, people match their eating behavior to that of the norm set by their eating companion(s) in order to blend in and be part of the group. In this project, we explore nutritional social norms among pregnant women. This population is particularly interesting because they are often subject to unsolicited advice and experience social pressure from their environment. In addition, their pregnancy affects their body composition, eating pattern, and psychosocial status. Pregnancy provides an important window of opportunity to impact health of pregnant women and their child. Nevertheless, the field of nutritional social norms among pregnant women is understudied and more knowledge is needed on whether pregnant women use guidelines from their social environment for their own eating behavior. In this project we aim to fill this research gap by means of an exploratory survey (Study 1) assessing information about social expectations, (mis)perceived social norms and the role of different reference groups such as other pregnant women, family, and friends. In addition, we conduct an online experiment (Study 2) testing to what extent pregnant women are susceptible to social norm-based messages compared to non-pregnant women. Moreover, possible moderators are explored which might impact women's susceptibility to social norms as well as cultural aspects that co-determine which social norms and guidelines exist. The project's findings could help design effective intervention messages in promoting healthy eating behavior specifically targeted to European pregnant women.

Promoting Water Consumption on a Caribbean Island: An Intervention Using Children's Social Networks at Schools

Sugar-sweetened beverage (SSB) consumption and the associated childhood obesity are major concerns in the Caribbean, creating a need for interventions promoting water consumption as a healthy alternative. A social network-based intervention (SNI) was tested among Aruban children to increase their water consumption and behavioral intention to do so and, consequently, to decrease SSB consumption and the associated behavioral intention. In this study, the moderating effects of descriptive and injunctive norms were tested. A cluster randomized controlled trial was completed in schools (mean age = 11 years ± SD = 0.98; 54% girls). Children were assigned to the intervention group (IG; n = 192) or control group (CG; n = 185). IG children were exposed to peer influencers promoting water consumption and CG children were not. Regression analyses showed that water consumption increased for IG children with a high injunctive norm score (p = 0.05); however, their intention to consume more water remained unchanged (p = 0.42). Moreover, IG children showed a decrease in SSB consumption (p = 0.04) and an increase in their intention to consume less SSB (p = 0.00). These findings indicate that SNIs are a promising instrument for health behavioral changes for Aruba and other islands in the Caribbean region.

Effects of Social Norms Information and Self-Affirmation on Sugar-Sweetened Beverage Consumption Intentions and Behaviors

The separate and combined efficacy of a social norms and a self-affirmation intervention to motivate decreased sugar-sweetened beverage (SSB) consumption was examined in two experiments. College students were randomly assigned to receive information about SSB consumption risks, norms, both, or neither. In addition, participants performed either a self-affirmation or control task. Self-affirmation only weakly affected SSB consumption intentions and behaviors. However, participants in Experiment 2 who received risks information, norms information, or both reported greater SSB reduction intentions than did those who received no information. Two-weeks later, those who received both types of information reported more frequent behavior change preparations, and it appears this effect may have been partially mediated by the changes in intentions to reduce SSB consumption.

Implications of Peer Pressure for Adolescent Nursing Research: A Concept Analysis Approach

The influence of peers is widely held as a significant factor in child and adolescent development. As health care providers seek ways to improve the health of children and adolescents, peer pressure must be examined. This article analyzes peer pressure and its relationship to the health of children and adolescents. Defining attributes of peer pressure are discussed, including incomplete identity formation, the presence of a peer influence, and a need for approval. Antecedents and consequences of peer pressure are also explored. Methods of measuring peer pressure are discussed, along with implications for health care research in the pediatric population.