Changing how I feel about the food: experimentally manipulated affective associations with fruits change fruit choice behaviors

Guidelines for assessment of affect-related constructs

Research on affect-related constructs as determinants of health behavior is increasing. The Affect and Health Behavior Framework (AHBF) provides a schematic structure to label, organize, and integrate affect-related constructs. To further facilitate research and theory development in health behavior science, the purpose of the present paper is to provide a critical review and guidelines for assessment of the affect-related constructs in the AHBF. The paper is organized based on the categories of constructs in the AHBF: Affective response to health behavior, incidental affect, affect processing, and affectively charged motivation. Future research should work toward parsing constructs where possible as well as identifying overlap. Researchers are advised to consider conceptual underpinnings and methodological nuances when assessing affect-related constructs in order to build a cumulative science of affective determinants of health behavior.

Considering Social Identity Threat Alongside the Health Belief Model to Examine Mask-Wearing Intentions of Black, Latinx, and Asian Individuals in the U.S. During COVID-19

During the COVID-19 pandemic, U.S. public health officials have recommended various safety protocols to "stop the spread", and atop the list is wearing a mask. Individuals from particular racial groups have also contended with a surge of racial profiling and race-based discrimination that has positioned mask-wearing as a risky yet health-promoting behavior. Using the health belief model (HBM), this study considers how racism and health intersect by examining the emotions, behavioral intentions, and health outcomes of mask-wearing among Black, Latinx, and Asian individuals. Cross-sectional survey data from 521 participants from across the United States were collected and analyzed using quantitative analyses. Results did not indicate significant differences in mask-wearing intentions between racial groups as predicted by the health belief model constructs; however, group differences in experiences of racism did shape perceptions of and behaviors related to mask-wearing. Mask-wearing was also related to more positive emotional experiences, and social cues to action predicted intentions to wear a mask. Implications for encouraging health-promoting behaviors across diverse populations during public health crises are discussed.

Comparing the effects of inhibitory control training and evaluative conditioning for unhealthy food behaviours

Cognitive Bias Modification (CBM) is hypothesised to reduce unhealthy food preference and consumption through the completion of computerised cognitive training tasks. While there is evidence to suggest that two popular CBM paradigms (Inhibitory Control Training (ICT) and Evaluative Conditioning (EC)) can have a positive influence on food-related outcomes, issues (and inconsistencies) related to task standardisation and control group design make it difficult to evaluate their standalone efficacy. In a pre-registered laboratory study using a mixed experimental design, our aim was to directly compare a single session of ICT and EC on implicit preference, explicit choice and ad-libitum food intake, while ensuring appropriate active control groups were utilised for each training type (in addition to a passive control group). The results revealed that there were no significant differences in terms of implicit preferences, ad-libitum food consumption or food choice. These results provide limited evidence to support the use of CBM as a psychological intervention for unhealthy food choice or consumption. Further work is needed to isolate mechanisms of effect for successful training and identify the most effective CBM protocols for implementation in future studies.

The role of associative learning in healthy and sustainable food evaluations: An event-related potential study

Individuals in industrialized societies frequently include processed foods in their diet. However, overconsumption of heavily processed foods leads to imbalanced calorie intakes as well as negative health consequences and environmental impacts. In the present study, normal-weight healthy individuals were recruited in order to test whether associative learning (Evaluative Conditioning, EC) could strengthen the association between food-types (minimally processed and heavily processed foods) and concepts (e.g., healthiness), and whether these changes would be reflected at the implicit associations, at the explicit ratings and in behavioral choices. A Semantic Congruency task (SC) during electroencephalography recordings was used to examine the neural signature of newly acquired associations between foods and concepts. The accuracy after EC towards minimally processed food (MP-food) in the SC task significantly increased, indicating strengthened associations between MP-food and the concept of healthiness through EC. At the neural level, a more negative amplitude of the N400 waveform, which reflects semantic incongruency, was shown in response to MP-foods paired with the concept of unhealthiness in proximity of the dorsal lateral prefrontal cortex (DLPFC). This implied the possible role of the left DLPFC in changing food representations by integrating stimuli's features with existing food-relevant information. Finally, the N400 effect was modulated by individuals' attentional impulsivity as well as restrained eating behavior.

Implicit emotion regulation improves arithmetic performance: An ERP study

Available evidence suggests that emotions influence arithmetic, and explicit emotion regulation modulates the effect of anxiety on arithmetic performance. However, neural mechanisms by which implicit emotion regulation affects these phenomena remain unclear, particularly under distinct affective priming contexts. Twenty-two college students were required to perform multiple tasks in sequence, including an idioms matching task, a multiplication computational estimation task (MCE task), an emotion judgement task (EJ task), and an emotion assessment task (EA task). Behavioral performance was measured via accuracy and response time during the MCE task, and ratings of the EA task, while eletrophysiological response was measured via the contingent negative variation (CNV) elicited by completing the MCE task. Decreased response time and emotional intensity ratings were observed for priming emotion regulation idioms compared to priming neutral idioms. Priming emotion regulation idioms attenuated early CNV amplitudes under happiness priming, and attenuated both early and late CNV amplitudes under fear priming. These results suggested that implicit reappraisal and suppression are promising strategies to enhance arithmetic performance and alleviate the adverse effects of affective priming, especially under fear priming.

All I Need Is Two: The Clinical Potential of Adding Evaluative Pairing Procedures to Cognitive Behavioral Therapy for Changing Self-, Body- and Food-Related Evaluations

Pairing procedures are among the most frequently used paradigms for modifying evaluations of target stimuli related to oneself, an object, or a specific situation due to their repeated pairing with evaluative sources, such as positive or negative images or words. Because altered patterns of evaluations can be linked to the emergence and maintenance of disordered cognitions and behaviors, it has been suggested that pairing procedures may provide a simple yet effective means of complementing more complex intervention approaches, such as cognitive behavioral therapy (CBT). Here, we summarize recent studies that explored the clinical potential of pairing procedures for improving self-esteem, body satisfaction, and food and consumption preferences. While no study has yet combined pairing procedures with CBT, there are several successful examples of pairing procedures in clinically relevant domains and clinical populations. We discuss potential sources of heterogeneity among findings, provide methodological recommendations, and conclude that pairing procedures may bear clinical potential as an add-on to classical psychotherapy.

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.

The Effect of Hunger and Satiety on Mood-Related Food Craving

In addition to hunger, which results from food deprivation, fasting, or restrained eating, food craving is thought to be one of the major factors influencing eating behavior. Although food craving occurs in healthy humans with normal eating behavior, research suggests pronounced food craving to be a risk factor for binging food, which in turn might cause weight gain and obesity. In addition, negative mood seems to induce binge eating, although the underlying processes are not clearly understood. To examine these effects on momentary food craving more closely, we implemented a food cue-reactivity paradigm in 33 normal-weight females (mean age = 25.1 years, mean BMI = 21.6). Mood (negative vs. neutral) and state of food deprivation (hunger vs. satiety) were varied systematically. Self-rated craving was significantly higher in hungry compared to sated states. Moreover, in neutral mood, high-caloric foods modulated craving, i.e., hungry and sated participants preferred savory food and sweet food, respectively. In negative mood, this differential effect of savory and sweet items was absent. In summary, the state of hunger has a huge impact on food craving, which is further modulated by emotional state. Future research should consider hunger to be of high relevance for effects investigated in food-related paradigms. Our findings in healthy women of normal weight support etiological models of disturbed eating behavior and are in line with common interventions targeting eating schedules and mood regulation.

Emotional State During Tasting Affects Emotional Experience Differently and Robustly for Novel and Familiar Foods

Emotional state during food consumption is expected to affect food pleasantness. We hypothesize that a negative emotional state reduces food pleasantness and more so for novel foods than for familiar foods because novel foods have not yet been associated with previous emotions. Furthermore, we expect this effect to be stronger when judging the food again from memory without tasting. We induced a positive emotional state in 34 participants by telling them that they earned a monetary bonus and induced a negative emotional state in 35 other participants by subjecting them to a social stress test. After this emotion induction, both groups tasted and rated a (for them) novel soup (sumashi soup) and a familiar soup (vegetable soup). Several explicit and implicit measures of food pleasantness (rated valence, EsSense25, willingness-to-take-home and sip size) indicated that while the negative emotion group did not experience the soups as less pleasant than the positive emotion group, there was an interaction between food familiarity and emotional group. The positive emotion group experienced novel and familiar soups as equally pleasant, whereas the negative emotion group experienced the novel soup as relatively unpleasant and the familiar soup as pleasant. The latter result is consistent with a comforting effect of a familiar taste in a stressful situation. This effect remained in the ratings given 1 week later based on memory and even after retasting. Our results show that emotional state affects food pleasantness differently for novel and familiar foods and that such an effect can be robust.

Predicting long-term healthy eating behaviour: understanding the role of cognitive and affective attitudes

OBJECTIVES

There are few tests of the ability of cognitive and affective attitudes to predict long-term performance of health behaviours. We assessed relationships between cognitive and affective attitudes and healthy eating behaviour over periods of 4, 6 and 10 years. Design: A prospective survey measuring cognitive and affective attitudes at baseline (T1) and 6 years (T2), and self-report healthy eating behaviour at baseline (T1), 6 (T2) and 10 (T3) years later in a sample of UK adults recruited through General Practice (N = 285). Results: When considered simultaneously, affective attitude (T1 and T2) predicted healthy eating behaviour cross-sectionally (at T1 and T2) and prospectively (over 4 [T2-T3], 6 [T1-T2] and 10 [T1-T3] years) whereas cognitive attitude did not. Stability of affective attitude (T1-T2) moderated the affective attitude-behaviour relationship in some (T1-T2, T1-T3), but not all (T2-T3), prospective analyses. Change in affective attitude, but not cognitive attitude (T1-T2), predicted change in behaviour over 6 (T1-T2) and 10 (T1-T3) years. Conclusions: The findings indicate that affective attitudes can be significant predictors of healthy eating behaviour over prolonged time periods suggesting they may be useful targets for interventions designed to produce long-term change in eating behaviour.

The influence of affect on HPV vaccine decision making in an HPV vaccine naïve college student population

The HPV vaccine is recommended for all adolescents starting at age 11, but coverage is low, especially in the young adult population. The CDC is prioritizing catch-up vaccination and has expanded recommendations for all young adults to age 26. College students may be ideal targets for HPV vaccine interventions as they typically have on-site clinics that offer prevention services and students are in the position to make decisions about their own healthcare. We examined the risk perceptions of 101 HPV vaccine-naïve college students, both in terms of risk cognition (beliefs about susceptibility to HPV-related cancers and genital warts) and affect (worry and fear regarding HPV-related health outcomes) as they relate to HPV vaccine intentions. Participants completed an online survey, reporting absolute and comparative risk perceptions for HPV-related cancers/genital warts, fear and worry related to getting HPV-related cancer and/or genital warts, desire for positive emotions, affective associations with the HPV vaccine, and intentions to get the HPV vaccine. More fear/worry about vaccination was directly associated with increased vaccine intentions. The perceived risk to intentions relation included an indirect effect via fear/worry. Desire for positive affect strengthened this relation. Positive affective associations with the HPV vaccine were also related to increased vaccine intentions. Given the public health impact of increasing HPV vaccine coverage for young adults, educational strategies framing the HPV vaccine positively while decreasing fear/worry related to negative health outcomes might increase interest in on-campus catch-up vaccination.

A Health Game Targeting Children's Implicit Attitudes and Snack Choices

Objective: The present study investigated whether a health game can be used to affect children's implicit attitudes toward food (IAsTF) and subsequent snack choices. Materials and Methods: The health game used was based on an evaluative conditioning paradigm. The experiment followed a between-subjects design with two conditions (health game vs. control), N = 79 (12.42 years ±1.64, body mass index: 25.06 ± 7.40). IAsTF were assessed at baseline and postintervention using an implicit association test (IAT). Baseline IAT scores were used to categorize IAsTF as healthy (favoring fruits) versus unhealthy IAsTF (favoring chocolates). In addition, three digital snack choices were recorded. Results: No main effect of condition on posttest IAsTF was found. However, baseline IAsTF moderated the effect of condition on posttest IAsTF; participants with less healthy baseline IAsTF playing the health game had healthier posttest IAsTF compared to those playing the control game. Regarding the snack choices, participants playing the health game favored fruit over chocolate in one of the snack choices. Baseline IAsTF did not moderate the effect of condition on snack choices. Conclusion: Tentative support was found that health games can be used to improve IAsTF, in particular among participants with less healthy ones at baseline.

Is it disgusting or am I just easily disgusted? The relation between situational disgust, dispositional disgust, and colonoscopy intentions

OBJECTIVE

While early detection is an effective way to reduce mortality from colorectal cancer, screening rates are low. An underlying factor in screening completion failure may be experiences of disgust when learning about screening and/or dispositional disgust.

METHOD

Participants recruited via Amazon MTurk (N = 296) read information about colonoscopy and completed an online survey assessing both dispositional forms of disgust (i.e. trait disgust and disgust sensitivity) and situational forms, including state disgust and disgust associated with colonoscopy. Participants reported intentions to discuss colonoscopy with a provider and to prepare for and complete screening.

RESULTS

Greater state disgust and the degree to which one associated disgust with colonoscopy predicted lower screening, preparation and provider discussion intentions. By contrast, neither trait disgust nor disgust sensitivity was associated with intentions. Both disgust sensitivity and trait disgust moderated the state disgust to intentions relation.

CONCLUSIONS

This is one of few investigations of disgust examining the relation between specific types and colonoscopy intentions. Screening uptake may be improved by identifying specific components of disgust that have an effect on colonoscopy intentions. Future work focusing on the interplay between different disgust mechanisms as they relate to colonoscopy behaviour is important for intervention development.

Affective components of perceived risk mediate the relation between cognitively-based perceived risk and colonoscopy screening

Perceived risk is a common component of health decision making theory. When affective components of risk are assessed as predictors of a behavior, they are usually examined separately from cognitive components. Less frequently examined are more complex interplays between affect and cognition. We hypothesized that cognitive and affective risk components would both have direct effects on colonoscopy behavior/intentions and that affective components would mediate the relationship of cognitively-based perceived risk to colonoscopy screening. In two secondary analyses, participants reported their cognitive and affective perceived risk for colorectal cancer, past colonoscopy behavior, and future screening intentions. In both studies, cognitive and affective risk components were associated with increased screening behavior/intentions and cognitive risk components were mediated through affective risk. Given the impact of early detection on colorectal cancer prevention, educational strategies highlighting both components of risk may be important to increase screening rates.

Moving beyond categorization to understand affective influences on real world health decisions

This paper provides an overview of affect and health decision-making research, with a focus on identifying gaps, opportunities, and challenges to guide future research. We begin by defining common categorical distinctions of affective processes that influence health decisions: integral (i.e., related to the decision) and incidental (i.e., normatively unrelated to the decision) influences, and current (experienced in the moment) and anticipated ("cognitive representations" of future affect) affect. We then summarize key discoveries within the most common categories of affective influences on health decision making: current integral affect, current incidental affect, and anticipated integral affect. Finally, we highlight research gaps, challenges, and opportunities for future directions for research aimed at translating affective and decision science theory to improve our understanding of, and ability to intervene upon, health decision making.

Food Addiction: Implications for the Diagnosis and Treatment of Overeating

With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term 'food addiction' is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.

Assessing the Relationship Between Implicit and Explicit Evaluations of Fruit and Vegetable Consumption by Cancer Survivors

BACKGROUND

Currently, little is known about the implicit evaluations that cancer survivors have for health behaviors, such as eating fruits and vegetables. Understanding both the implicit and explicit evaluations of fruit and vegetable consumption among cancer survivors may aid future interventions for changing motivations and intentions in this higher risk population.

METHODS

A cross-sectional study at a university cancer center assessed explicit and implicit evaluations of fruit and vegetable consumption among 122 cancer survivors. The explicit evaluations regarding fruit and vegetable consumption were self-report data. To obtain implicit evaluations, participants completed an implicit evaluation task, the Affect Misattribution Paradigm. Moderating variables of time since first cancer treatment and if participants had a prior cancer occurrence were also self-reported.

RESULTS

Simple correlations found no significant association between the implicit and explicit evaluations of fruit and vegetable consumption. Moderation regression analyses showed that the implicit and explicit evaluations became negatively associated as time since first treatment increased and when participants had a prior cancer occurrence.

CONCLUSION

The results support the view that implicit and explicit measures of fruit and vegetable consumption diverge for cancer survivors, consistent to implicit and explicit evaluations in other domains and samples. Further, the association between these evaluations differed depending on time since first treatment and if they have been treated for a prior cancer occurrence. By knowing more about implicit and explicit positive evaluations, and their moderators, it may be possible for interventionists to alter cancer survivors' motivation and intention to eat fruits and vegetables.

The Effects of Positive Affect and Episodic Future Thinking on Temporal Discounting and Healthy Food Demand and Choice Among Overweight and Obese Individuals: Protocol for a Pilot 2×2 Factorial Randomized Controlled Study

BACKGROUND

Unhealthy behaviors (eg, poor food choices) contribute to obesity and numerous negative health outcomes, including multiple types of cancer and cardiovascular and metabolic diseases. To promote healthy food choice, diet interventions should build on the dual-system model to target the regulation and reward mechanisms that guide eating behavior. Episodic future thinking (EFT) has been shown to strengthen regulation mechanisms by reducing unhealthy food choice and temporal discounting (TD), a process of placing greater value on smaller immediate rewards over larger future rewards. However, these interventions do not target the reward mechanisms that could support healthy eating and strengthen the impact of EFT-anchored programs. Increasing positive affect (PosA) related to healthy food choices may target reward mechanisms by enhancing the rewarding effects of healthy eating. An intervention that increases self-regulation regarding unhealthy foods and the reward value of healthy foods will likely have a greater impact on eating behavior compared with interventions focused on either process alone.

OBJECTIVE

This study aimed to introduce a protocol that tests the independent and interactive effects of EFT and PosA on TD, food choice, and food demand in overweight and obese adults.

METHODS

This protocol describes a factorial, randomized, controlled pilot study that employs a 2 (affective imagery: positive, neutral) by 2 (EFT: yes, no) design in which participants are randomized to 1 of 4 guided imagery intervention arms. In total, 156 eligible participants will complete 2 lab visits separated by 5 days. At visit 1, participants complete surveys; listen to the audio guided imagery intervention; and complete TD, food demand, and food choice tasks. At visit 2, participants complete TD, food demand, and food choice tasks and surveys. Participants complete a daily food frequency questionnaire between visits 1 and 2. Analyses will compare primary outcome measures at baseline, postintervention, and at follow-up across treatment arms.

RESULTS

Funding notification was received on April 27, 2017, and the protocol was approved by the institutional review board on October 6, 2017. Feasibility testing of the protocol was conducted from February 21, 2018, to April 18, 2018, among the first 32 participants. As no major protocol changes were required at the end of the feasibility phase, these 32 participants were included in the target sample of 156 participants. Recruitment, therefore, continued immediately after the feasibility phase. When this manuscript was submitted, 84 participants had completed the protocol.

CONCLUSIONS

Our research goal is to develop novel, theory-based interventions to promote and improve healthy decision-making and behaviors. The findings will advance decision-making research and have the potential to generate new neuroscience and psychological research to further understand these mechanisms and their interactions.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN11704675; http://www.isrctn.com/ISRCTN11704675 (Archived by WebCite at http://www.webcitation.org/760ouOoKG).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/12265.

Feel good now or regret it later? The respective roles of affective attitudes and anticipated affective reactions for explaining health-promoting and health risk behavioral intentions

Evidence supporting the incorporation of affective constructs, such as affective attitudes and anticipated regret, into theoretical models of health behavior has been mounting in recent years; however, the role of positive anticipated affective reactions (e.g., pride) has been largely unexplored. The purpose of the present investigation was to assess how affective attitudes and anticipated affective reactions (both pride and regret for performing a behavior or not) may provide distinct utility for understanding intentions to perform health-promoting and health risk behaviors over and above cognitive attitudes and other established theoretical constructs from the theory of planned behavior (TPB). Participants (N = 210) were recruited via Amazon's Mechanical Turk to complete a one-time online battery assessing TPB and affective constructs. Self-reported intentions served as the main outcome measure, and hierarchical linear modeling was used to examine the effects of TPB and affective constructs across behaviors. Controlling for TPB constructs, more positive affective attitudes and greater anticipated regret, but not anticipated pride, predicted intentions to engage in future health behaviors. Anticipated affective reactions contributed explanatory variance for intentions to perform health risk behaviors, but anticipated pride and regret were not associated with intentions to perform health risk behaviors. Contributions made via the inclusion of both positively and negatively valence anticipated affective reactions for both action and inaction (performing a behavior or not) across a range of health promoting and health risk behaviors are discussed, as well as implications for future intervention work.

Interventions to Engage Affective Forecasting in Health-Related Decision Making: A Meta-Analysis

Background

People often use affective forecasts, or predictions about how a decision will make them feel, to guide medical and health decision making. However, these forecasts are susceptible to biases and inaccuracies that can have consequential effects on decision making and health.

Purpose

A meta-analysis was performed to determine the effectiveness of intervening to address affective forecasting as a means of helping patients make better health-related choices.

Methods

We included between-subjects experimental and intervention studies that targeted variables related to affective forecasting (e.g., anticipated regret, anticipated affect) as a means of changing health behaviors or decisions. We determined the overall effect of these interventions on targeted affective constructs and behavioral outcomes, and whether conceptual and methodological factors moderated these effects.

Results

A total of 133 independent effect sizes were identified from 37 publications (N = 72,020). Overall, affective forecasting interventions changed anticipated regret, d = 0.24, 95% confidence interval (CI) (0.15, 0.32), p < .001, behavior, d = 0.29, 95% CI (0.13, 0.45), p < .001, and behavioral intentions, d = 0.19, 95% CI (0.11, 0.28), p < .001, all measured immediately postintervention. Interventions did not change anticipated positive and negative affect, and effects on intentions and regret did not extend to follow-up time points, ps > .05. Generally, effects were not moderated by conceptual model, intervention intensity, or behavioral context.

Conclusions

Affective forecasting interventions had a small consistent effect on behavioral outcomes regardless of intervention intensity and conceptual framework, suggesting such constructs are promising intervention targets across several health domains.

The interplay between feelings and beliefs about condoms as predictors of their use

OBJECTIVE

Negative feelings about condoms are a key barrier to their use. Using the behavioural affective associations model, we examined the joint effects of affective associations and cognitive beliefs about condoms on condom use.

DESIGN

In Study 1 (N = 97), students completed measures of their affective associations and cognitive beliefs about sex and condoms, sexual activity and condom use. In Study 2 (N = 171), a measure of behavioural intentions and condom selection task were added.

MAIN OUTCOME MEASURES

Condom use measured in Study 1 as (1) current condom use, and (2) willingness to use condoms; in Study 2 as: (1) behavioural intentions, (2) number of condoms selected.

RESULTS

Affective associations with sex and condoms were behaviour-specific, were directly associated with the respective behaviour, and mediated the relations of cognitive beliefs to behaviour, ps < .05. In Study 2, affective associations were associated with behavioural intentions and the number of condoms selected, ps < .05; cognitive beliefs were indirectly associated with these outcomes through affective associations, indirect effects: ps < .05.

CONCLUSIONS

Affective associations are a behaviour-specific and proximal predictor of condom use, mediating the effect of cognitive beliefs, suggesting they may be a particularly viable intervention target.

Positive affective processes underlie positive health behaviour change

Positive health behaviours such as physical activity can prevent or reverse many chronic conditions, yet a majority of people fall short of leading a healthy lifestyle. Recent discoveries in affective science point to promising approaches to circumvent barriers to lifestyle change. Here, we present a new theoretical framework that integrates scientific knowledge about positive affect with that on implicit processes. The upward spiral theory of lifestyle change explains how positive affect can facilitate long-term adherence to positive health behaviours. The inner loop of this spiral model identifies nonconscious motives as a central mechanism of behavioural maintenance. Positive affect experienced during health behaviours increases incentive salience for cues associated with those behaviours, which in turn, implicitly guides attention and the everyday decisions to repeat those behaviours. The outer loop represents the evidence-backed claim, based on Fredrickson's broaden-and-build theory, that positive affect builds a suite of endogenous resources, which may in turn amplify the positive affect experienced during positive health behaviours and strengthen the nonconscious motives. We offer published and preliminary evidence in favour of the theory, contrast it to other dominant theories of health behaviour change, and highlight attendant implications for interventions that merit testing.

Developing a scale to assess health regulatory focus

RATIONALE

Regulatory focus (i.e., focus on motivation to achieve gains or avoid losses and non-gains) is used to tailor health behavior change interventions, improving efficacy, but is currently assessed by scales that are not health-specific and may capture a version of the construct that is not ideally matched to the rationale for tailoring.

OBJECTIVE

We developed and validated a Health Regulatory Focus Scale (HRFS), which assesses tendencies to avoid negative health consequences (prevention focus) or achieve positive health outcomes (promotion focus).

METHODS

Across four studies (and a scale development study in supplementary online materials), we established convergent, discriminant, and predictive validity for the HRFS. In studies examining predictive validity, main outcome measures were health behavior intentions, including intentions to reduce alcohol use, quit smoking, eat a healthy diet, exercise, be screened for cancer, and engage in general cancer preventive behaviors.

RESULTS

The promotion and prevention sub-scales performed well in confirmatory factor analyses. Single-factor models had significantly poorer fit than models delineating promotion and prevention. The sub-scales were differentially (and only modestly) correlated with related constructs (anxiety, optimism, information avoidance, ambiguity/fatalism). Higher HRFS-Promotion focus generally corresponded with greater health behavior intentions. Conversely, higher HRFS-Prevention focus corresponded with lower health behavior intentions. Associations were largely maintained even when controlling for established regulatory focus measures, supporting the assertion that the HRFS would predict unique variance in health behavior intentions.

CONCLUSION

The HRFS has the potential to improve the precision with which framed health messages change behavior, as it may assess a version of regulatory focus that is more ideally matched to rationale for tailoring interventions.

Learning to Dislike Chocolate: Conditioning Negative Attitudes toward Chocolate and Its Effect on Chocolate Consumption

Evaluative conditioning (EC) procedures can be used to form and change attitudes toward a wide variety of objects. The current study examined the effects of a negative EC procedure on attitudes toward chocolate, and whether it influenced chocolate evaluation and consumption. Participants were randomly assigned to the experimental condition in which chocolate images were paired with negative stimuli, or the control condition in which chocolate images were randomly paired with positive stimuli (50%) and negative stimuli (50%). Explicit and implicit attitudes toward chocolate images were collected. During an ostensible taste test, chocolate evaluation and consumption were assessed. Results revealed that compared to participants in the control condition, participants in the experimental condition showed more negative explicit and implicit attitudes toward chocolate images and evaluated chocolate more negatively during the taste test. However, chocolate consumption did not differ between experimental and control conditions. These findings suggest that pairing chocolate with negative stimuli can influence attitudes toward chocolate, though behavioral effects are absent. Intervention applications of EC provide avenues for future research and practices.

Sensation Seeking and Online Gaming Addiction in Adolescents: A Moderated Mediation Model of Positive Affective Associations and Impulsivity

Based on the Dual Systems Model (Somerville et al., 2010; Steinberg, 2010a) and the biosocial-affect model (Romer and Hennessy, 2007) of adolescent sensation seeking and problem behaviors, the present study examined how (affective associations with online games as a mediator) and when (impulsivity as a moderator) did sensation seeking influence online gaming addiction in adolescence. A total of 375 Chinese male adolescents (mean age = 16.02 years, SD = 0.85) from southern China completed anonymous questionnaires regarding sensation seeking, positive affective associations with online games, impulsivity, and online gaming addiction. Our findings revealed that sensation seeking, positive affective associations with online games and impulsivity were each significantly and positively associated with online gaming addiction in adolescents. Positive affective associations mediated the relationship between sensation seeking and online gaming addiction. Further, impulsivity moderated the relationship between positive affective associations and online gaming addiction, such that the association between positive affective association and online gaming addiction was stronger for high than for low impulsivity adolescents. These findings underscore the importance of integrating the biosocial-affect model and the Dual Systems Model to understand how and when sensation seeking impacts adolescent online gaming addiction.

Structure and content of affective associations with health behaviours: Is the behaviour 'good OR bad' or 'good AND bad'

OBJECTIVE

The feelings and emotions individuals associate with health-related behaviours influence engagement in those behaviours. However, the structure and the content of these affective associations have not been examined. The studies reported here examined competing hypotheses about the structure (unidimensional or bidimensional) and content (generalised affect or specific emotions) of affective associations with two health-related behaviours: physical activity and fruit/vegetable consumption.

DESIGN

For each behaviour, participants (fruit and vegetable consumption n = 149; physical activity n = 199) completed an assessment of the association of 40 positive and 51 negative affect concepts with the behaviour.

MAIN OUTCOME MEASURES

Ratings of affective associations with each behaviour.

RESULTS

Confirmatory factor analyses comparing unidimensional and bidimensional affect structure models showed that the structure of individuals' affective associations was bidimensional for both behaviours - positive and negative affective associations were shown to be separate and distinct constructs. Exploratory factor analyses supported a model of affective associations as generalised affect for both behaviours.

CONCLUSION

Affective associations with both physical activity and with fruit/vegetable consumption consist of separate positive and negative dimensions of generalised affect. These findings lead to recommendations for research and intervention development based on the implications for how affective associations might operate to influence behavioural decision-making.

Adding a reward increases the reinforcing value of fruit

Adolescents' snack choices could be altered by increasing the reinforcing value (RV) of healthy snacks compared with unhealthy snacks. This study assessed whether the RV of fruit increased by linking it to a reward and if this increased RV was comparable with the RV of unhealthy snacks alone. Moderation effects of sex, hunger, BMI z-scores and sensitivity to reward were also explored. The RV of snacks was assessed in a sample of 165 adolescents (15·1 (sd 1·5) years, 39·4 % boys and 17·4 % overweight) using a computerised food reinforcement task. Adolescents obtained points for snacks through mouse clicks (responses) following progressive ratio schedules of increasing response requirements. Participants were (computer) randomised to three experimental groups (1:1:1): fruit (n 53), fruit+reward (n 60) or unhealthy snacks (n 69). The RV was evaluated as total number of responses and breakpoint (schedule of terminating food reinforcement task). Multilevel regression analyses (total number of responses) and Cox's proportional hazard regression models (breakpoint) were used. The total number of responses made were not different between fruit+reward and fruit (b -473; 95 % CI -1152, 205, P=0·17) or unhealthy snacks (b410; 95 % CI -222, 1043, P=0·20). The breakpoint was slightly higher for fruit than fruit+reward (HR 1·34; 95 % CI 1·00, 1·79, P=0·050), whereas no difference between unhealthy snacks and fruit+reward (HR 0·86; 95 % CI 0·62, 1·18, P=0·34) was observed. No indication of moderation was found. Offering rewards slightly increases the RV of fruit and may be a promising strategy to increase healthy food choices. Future studies should however, explore if other rewards, could reach larger effect sizes.

What to expect when you're exercising: An experimental test of the anticipated affect-exercise relationship

OBJECTIVE

Anticipated affect may influence exercise behavior via experienced affective responses and intentions. Cognitive manipulations of anticipated affect may inform exercise intervention design. The purpose of this study was to experimentally test the effects of an expectation-based manipulation of affective responses to exercise on anticipated, experienced, and remembered affect and adherence to a 7-day exercise prescription.

METHOD

Participants (N = 98) were randomly assigned to a positive anticipated affect manipulation, a negative anticipated affect manipulation, or a no affect manipulation control. They reported anticipated, experienced, and remembered affect during and after a standardized 30-min bout of treadmill exercise at an intensity just below ventilatory threshold. Participants were asked to try to complete the prescribed exercise daily for 1 week. Differences in affect and exercise behavior were examined across conditions, as were relationships between affect measures, intentions and behavior.

RESULTS

The manipulation influenced anticipated and experienced affective responses, but not behavior. Participants generally expected exercise to be less pleasant and more fatiguing that it actually was. Anticipated, experienced, and remembered affect were associated with intentions to exercise. Intentions and remembered affect were both directly associated with exercise behavior.

CONCLUSIONS

Moderate-to-vigorous exercise can be more pleasant than people expect it to be. Additionally, encouraging exercisers to focus on the positive affective outcomes of exercise can yield a more positive affective experience than those who focus on negative affective outcomes or do not focus on affective outcomes at all. The role of affect in both reflective and automatic motivation to exercise is discussed. (PsycINFO Database Record

The reasoned/reactive model: A new approach to examining eating decisions among female college dieters and nondieters

Female college students are prone to unhealthy eating patterns that can impact long-term health. This study examined female students' healthy and unhealthy eating behaviors with three decision-making models. Specifically, the theory of reasoned action, prototype/willingness model, and new reasoned/reactive model were compared to determine how reasoned (logical) and reactive (impulsive) factors relate to dietary decisions. Females (N=583, M_age=20.89years) completed measures on reasoned cognitions about foods (attitudes, subjective norms, nutrition knowledge, intentions to eat foods), reactive cognitions about foods (prototypes, affect, willingness to eat foods), dieting, and food consumption. Structural equation modeling (SEM) revealed the new reasoned/reactive model to be the preeminent model for examining eating behaviors. This model showed that attitudes were related to intentions and willingness to eat healthy and unhealthy foods. Affect was related to willingness to eat healthy and unhealthy foods, whereas nutrition knowledge was related to intentions and willingness to eat healthy foods only. Intentions and willingness were related to healthy and unhealthy food consumption. Dieting status played a moderating role in the model and revealed mean-level differences between dieters and nondieters. This study highlights the importance of specific factors in relation to female students' eating decisions and unveils a comprehensive model for examining health behaviors.

Too Depleted to Try? Testing the Process Model of Ego Depletion in the Context of Unhealthy Snack Consumption

BACKGROUND

The process model proposes that the ego depletion effect is due to (a) an increase in motivation toward indulgence, and (b) a decrease in motivation to control behaviour following an initial act of self-control. In contrast, the reflective-impulsive model predicts that ego depletion results in behaviour that is more consistent with desires, and less consistent with motivations, rather than influencing the strength of desires and motivations. The current study sought to test these alternative accounts of the relationships between ego depletion, motivation, desire, and self-control.

METHODS

One hundred and fifty-six undergraduate women were randomised to complete a depleting e-crossing task or a non-depleting task, followed by a lab-based measure of snack intake, and self-report measures of motivation and desire strength.

RESULTS AND CONCLUSIONS

In partial support of the process model, ego depletion was related to higher intake, but only indirectly via the influence of lowered motivation. Motivation was more strongly predictive of intake for those in the non-depletion condition, providing partial support for the reflective-impulsive model. Ego depletion did not affect desire, nor did depletion moderate the effect of desire on intake, indicating that desire may be an appropriate target for reducing unhealthy behaviour across situations where self-control resources vary.

The efficacy of nudge theory strategies in influencing adult dietary behaviour: a systematic review and meta-analysis

Background

Obesity has become a world-wide epidemic and is spreading to countries with emerging economies. Previously tested interventions are often too costly to maintain in the long term. This leaves a need for improved strategies for management of the epidemic. Nudge Theory presents a new collection of methods, deemed “nudges”, which have the potential for low-cost and broad application to guide healthier lifestyle choices without the need for restrictive regulation. There has not yet been a large-scale examination of the effectiveness of nudges, despite several policy making bodies now considering their use.

Methods

To address this gap in knowledge, an adapted systematic review methodology was used to collect and consolidate results from current Nudge papers and to determine whether Nudge strategies are successful in changing adults’ dietary choices for healthier ones.

Results

It was found that nudges resulted in an average 15.3 % increase in healthier dietary or nutritional choices, as measured by a change in frequency of healthy choices or a change in overall caloric consumption. All of the included studies were from wealthy nations, with a particular emphasis on the United States with 31 of 42 included experiments.

Conclusions

This analysis demonstrates Nudge holds promise as a public health strategy to combat obesity. More research is needed in varied settings, however, and future studies should aim to replicate previous results in more geographically and socioeconomically diverse countries.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3272-x) contains supplementary material, which is available to authorized users.

Affective forecasting and medication decision making in breast-cancer prevention

OBJECTIVE

Over 2 million American women at elevated risk for breast cancer are eligible to take chemoprevention medications such as tamoxifen and raloxifene, which can cut in half the risk of developing breast cancer, but which also have a number of side effects. Historically, very few at-risk women have opted to use chemoprevention medications. Affective forecasting theory suggests that people may avoid these medications if they expect taking them to increase their health-related stress.

METHOD

After receiving an individually tailored decision aid that provided personalized information about the risks and benefits of these medications, 661 women at elevated risk of breast cancer were asked to make 3 affective forecasts, predicting what their level of health-related stress would be if they took tamoxifen, raloxifene, or neither medication. They also completed measures of decisional preferences and intentions, and at a 3-month follow-up, reported on whether or not they had decided to use either medication.

RESULTS

On the affective forecasting items, very few women (<10%) expected the medications to reduce their health-related stress, relative to no medication at all. Participants with more negative affective forecasts about taking a chemoprevention medication expressed lower preferences and intentions for using the medications (Cohen's ds from 0.74 to 0.79) and were more likely to have opted against using medication at follow-up (OR range = 1.34-2.66).

CONCLUSION

These findings suggest that affective forecasting may explain avoidance of breast-cancer chemoprevention medications. They also highlight the need for more research aimed at integrating emotional content into decision aids. (PsycINFO Database Record

Barreiras e fatores promotores do consumo de frutas e hortaliças entre usuários do Programa Academia da Saúde

RESUMO Objetivo: Investigar barreiras e fatores promotores do consumo de frutas e hortaliças entre usuários do Programa Academia da Saúde. Métodos: Estudo qualitativo conduzido em seis polos do Programa Academia da Saúde em Belo Horizonte, Minas Gerais. Foram realizadas entrevistas semiestruturadas com 62 usuários. A análise de conteúdo foi desenvolvida com auxílio dosoftware NVivo10. Resultados: As principais barreiras identificadas foram: comércio inadequado, baixo poder aquisitivo, preço, carência de iniciativas públicas, falta de tempo, preguiça, fruta ser considerada apenas uma alternativa alimentar e não realizar o jantar. Os fatores promotores mais citados foram: saúde, prevenção/controle de doenças, gostar, hortaliça ser considerada como parte da refeição, criação e origem familiar, melhoria da situação financeira, comércio próximo e estratégias de compra. Conclusão: É necessário ampliar o acesso às frutas e às hortaliças por meio do fortalecimento das iniciativas públicas para aumento da produção e diminuição dos preços desses alimentos e ampliação do comércio local. As intervenções educativas devem focar a construção de outros sentidos para o consumo que não se restrinjam ao discurso saúde-doença e soluções viáveis que facilitem o consumo de frutas e hortaliças no cotidiano, seja pela proposição de estratégias de aquisição de frutas e hortaliças ou pela ampliação de habilidades culinárias para preparações mais práticas.

Harnessing the power of disgust: a randomized trial to reduce high-calorie food appeal through implicit priming

BACKGROUND

In our increasingly obesogenic environment, in which high-calorie convenience foods are readily available, food choices can drastically affect weight and overall health. Learned food preferences, which are developed through repeated pairings with positively and negatively valenced stimuli, can contribute to obesity susceptibility if positive attitudes toward high-calorie foods are developed. Thus, the modification of automatic associations with food may be a viable strategy to promote healthier eating behaviors.

OBJECTIVE

In this study, we investigated the ability of an implicit priming (IP) intervention to alter responses to visual food cues by using an evaluative conditioning approach. The main objective was to implicitly (i.e., below conscious perception) associate disgust with high-calorie foods with the aim of reducing liking of these foods.

DESIGN

Participants were randomly assigned to active or control IP. In active IP (n = 22), high-calorie food images were implicitly primed with negatively valenced images, and low-calorie food images were implicitly primed with positively valenced images. In control IP (n = 20), all food images were primed with neutral images of fixation crosses. Food images were rated on the desire to eat immediately before and after IP.

RESULTS

A significant main effect of calorie (high compared with low; P < 0.001) and a significant calorie-by-group (active compared with control) interaction (P = 0.025) were observed. Post hoc tests identified a significantly greater high-calorie rating decline after active IP than after control IP (P = 0.036). Furthermore, there was significantly greater change in high-calorie ratings than in low-calorie ratings in the active group (P = 0.001). Active IP effects extended to high-calorie foods not specifically included in the intervention, which suggested an effect generalization. Moreover, a greater change in high-calorie ratings than in low-calorie ratings persisted 3-5 d after active IP (P < 0.007), which suggested lasting effects.

CONCLUSION

This study provides initial evidence that IP can be used to alter high-calorie food preferences, which could promote healthier eating habits.

Planning versus action: Different decision-making processes predict plans to change one's diet versus actual dietary behavior

Most health decision-making models posit that deciding to engage in a health behavior involves forming a behavioral intention which then leads to actual behavior. However, behavioral intentions and actual behavior may not be functionally equivalent. Two studies examined whether decision-making factors predicting dietary behaviors were the same as or distinct from those predicting intentions. Actual dietary behavior was proximally predicted by affective associations with the behavior. By contrast, behavioral intentions were predicted by cognitive beliefs about behaviors, with no contribution of affective associations. This dissociation has implications for understanding individual regulation of health behaviors and for behavior change interventions.