Predicting adolescent breakfast consumption in the UK and Australia using an extended theory of planned behaviour

Psychometric properties and measurement invariance across gender of the Italian version of the tempest self-regulation questionnaire for eating adapted for young adults

The prevalence of overweight and obesity in young adults has increased dramatically in recent decades. The unhealthy eating habits that develop at this time can often lead to negative health consequences in the future. It is therefore important to learn about self-regulation and self-control strategies and help young adults to have healthy eating behaviours. This study aims to present an Italian version of the Tempest Self-Regulation Questionnaire for Eating (TESQ-E) adapted for young adults. The instrument assesses self-regulation and self-control strategies to counteract the desire and temptation to eat unhealthy food and to choose healthy foods. A total of 645 students (271 males and 374 females with an average age of 24.82 and SD = 4.34) took part in the study. The results of the confirmatory factor analysis supported the six first-order factors model concerning specific self-regulation strategies and a higher-order structure of the TESQ-E [χ² (152) = 336.480, p < 0.001; CFI = 0.95; RMSEA = 0.04; SRMR = 0.04]: three correlated second-order factors (addressing the temptation directly, addressing the psychological meaning of temptation, and addressing the goal directly) and one-third-order factor (self-regulatory competence). The results also confirmed the strong measurement invariance of the TESQ-E across gender. To have reliable comparisons across males and females, the latent mean differences tests were performed on the six specific self-regulation strategies. The analysis showed that females appear to prefer strategies that directly address the goal by expressing explicit intentions or plans to eat in a healthy way. Convergence validity was tested through correlations with Eating-Self-Efficacy Brief Scale (ESEBS), Emotional Eating Scale (EES), Scale of Attitudes towards Healthy Eating (SAHE), and Body Mass Index (BMI). In conclusion, the TESQ-E appears to be a psychometrically sound questionnaire that can be effectively used with young adults to measure self-regulation strategies in eating in order to plan personalised interventions for the prevention and control of the metabolic syndrome, and to reduce a wide range of diet-related diseases.

A Dual-Process Model Applied to Two Health-Promoting Nutrition Behaviours

We tested a dual process model incorporating constructs that reflect both performing the target behaviour (behaviour directed habit) and habits that run counter to the target behaviour (opposing behaviour habit) in accounting for variance in two health behaviours: eating the recommended serves of fruits and vegetables a day and restricting sugar-sweetened beverage consumption. A prospective correlational design with two waves of data collection separated by one week was adopted. Participants (N = 606) comprising middle school students (n = 266) and university students (n = 340) completed an initial survey comprising self-report measures of past behaviour, intention, and habit to perform the target behaviour and habits that run counter to the target behaviour. One week later, participants (N = 414) completed a self-reported measure of behaviour. Results revealed that behaviour directed habits predicted fruit and vegetable consumption in both samples, while opposing behaviour habits predicted restriction of sugar-sweetened beverages in the middle-school sample only, with a moderating effect also observed. Current findings indicate that habits specifying avoidance of the target behaviour did not predict future behaviour. However, the moderating effect observed provides preliminary evidence that strong habits to perform a behaviour may override habit to avoid the behaviour.

The application of the theory of planned behavior to nutritional behaviors related to cardiovascular disease among the women

BACKGROUND

Nutritional factors have been identified as preventable risk factors for cardiovascular disease; this study aimed to investigate the application of the Theory of Planned Behavior (TPB) in nutritional behaviors related to cardiovascular diseases among the women in Fasa city, Fars province, Iran.

METHODS

The study was conducted in two stages. First, the factors affecting nutritional behaviors associated with cardiovascular disease on 350 women who were referred to Fasa urban health centers were determined based on the TPB. In the second stage, based on the results of a cross-sectional study, quasi-expeimental study was performed on 200 women covered by Fasa health centers. The questionnaire used for the study was a questionnaire based on TPB. The questionnaire was completed by the experimental and control groups before and three months after the intervention. Data were analyzed by SPSS software using logistic regression, paired t-test, independent sample t-test, and chi-square test. The level of significance is considered 0.05.

RESULT

The constructs of attitude, subjective norms, and perceived behavioral control (PBC) were predictors of nutritional behaviors associated with cardiovascular disease in women. The constructs predicted 41.6% of the behavior. The results showed that mean scores of attitude, subjective norms, PBC, intention, nutritional performance related to the cardiovascular disease before intervention were, respectively, 24.32, 14.20, 18.10, 13.37 and 16.28, and after the intervention, were, respectively, 42.32, 25.40, 33.72, 30.13 and 41.38. All the constructs except the attitude in the intervention group were significantly higher (p < 0.001) than the control group.

CONCLUSION

The results of the present study showed that the educational intervention based on the TPB would be consider an effective educational and promotinal strategy for the nutritional behaviors to prevent cardiovascular disease in women. Considering the role of mothers in providing family food baskets and the effect of their nutritional behaviors on family members, the education of this group can promote healthy eating behaviors in the community and family.

Determinants of restaurant consumers' intention to practice COVID-19 preventive behavior: an application of the theory of planned behavior

BACKGROUND/OBJECTIVES

The purpose of this study was to examine the effects of knowledge about coronavirus disease 2019 (COVID-19), attitude, subjective norm, and perceived behavioral control on behavioral intentions to practice COVID-19 preventive behaviors using the theory of planned behavior (TPB).

SUBJECTS/METHODS

A total of 519 restaurant customers' responses was collected in this study through an online self-administered questionnaire. Descriptive statistical analysis was performed on socio-demographic factors. One-way analysis of variance and t-test were conducted to determine differences in the constructs from the TPB according to age and sex. The hypotheses were tested using structural equation modeling (SEM).

RESULTS

SEM revealed the positive effect of knowledge about COVID-19 on attitude, subjective norm, and perceived behavioral control to prevent the spread of COVID-19 in restaurants. Attitude, subjective norm, behavior intention, and knowledge positively affected COVID-19 preventive behavior intentions in restaurants.

CONCLUSIONS

The results of this study confirmed that the TPB is helpful in elucidating the determinants of consumers' intention to practice COVID-19 preventive behavior in restaurants. These findings can help policy makers and professionals provide material for further public health interventions and inform them about awareness-raising, guidelines, and health education programs.

Developing and Testing an Instrument to Measure the Factors Affecting the Salt Restriction Behaviors among Women

Background: High salt intake is considered as one of the most important causes of hypertension and cardiovascular diseases. Measuring and identifying factors contributing to people's salt intake behaviors is important to evaluate effectiveness of interventions focusing on salt reduction behaviors. The purpose of this study was to develop and test a new theory of planned behavior (TPB)- based instrument to measure factors influencing three different salt intake behaviors (adding salt during cooking, at the table, purchasing salty food) among women.

Study design: A mixed-method study.

Methods: After the face and content validity of developed instrument were established, a representative sample of women (N= 300, age (SD):42.82(12.10)) were recruited to assess the construct validity using Partial Least Square confirmatory factor analysis. Coefficient alpha and composite reliability (CR) were used to establish reliability of instrument. The content validity index (CVI) and content validity ratio (CVR) were used to assess the content validity.

Results: Assessing validity and reliability of instrument led to 56-item questionnaire. CVI was more than 0.70 and CVR more than 0.56. Internal consistency as assessed by Cronbach's alpha was acceptable. Convergent and discriminant validity were established. The GOF index for behavior one was 0.250, for behavior two was 0.414 and behavior three was 0.374. The results of confirmatory factor analysis indicate that TPB model has an acceptable fit with data.

Conclusion: Our instrument provides a validated and reliable tool for assessing different aspects of salt intake behaviors in women to evaluate effectiveness of interventions focusing on salt reduction behaviors.

Improving Cycling Behaviors of Dockless Bike-Sharing Users Based on an Extended Theory of Planned Behavior and Credit-Based Supervision Policies in China

Motivating users' civilized cycling plays a significant role in alleviating the troubles of dockless bike-sharing programs (DBSPs) and promoting the sustainable development of bike-sharing organizations. Based on the theory of planned behavior (TPB) and observed practices in China, this study develops a theoretical framework to examine how attitudes (ATT), subjective norms (SN), perceived behavioral control (PBC), and personal norms (PN) motivate users' civilized cycling behavior through civilized cycling intentions. Furthermore, the moderating effect of perceived policy effectiveness (PPE) between users' civilized cycling intention and their actual behavior is tested. Using structural equation model-multiple group analysis (SEM-MGA) for a sample of 874 valid questionnaire responses in Beijing and Shanghai, China, our results reveal that (1) ATT, PBC, and PN are positively related to both users' civilized cycling intentions and their actual behavior, while SN positively affect users' civilized cycling intention only; (2) users' civilized cycling intentions mediate the relationship between the four influencing factors and their actual behavior; and (3) PPE plays a moderating role for the effect of users' civilized cycling intentions on their actual civilized cycling behavior. Our results indicate that the four influencing factors can encourage users' civilized cycling behavior, especially when civilized cycling intention exists. Policies like credit-based supervision mechanisms could promote users' civilized-cycling intentions, which could then be transformed into actual behavior.

Factors Influencing Young People's Intention toward Municipal Solid Waste Sorting

With the rapid growth of urban economy and population in China, the output of municipal solid waste (MSW) has dramatically increased becoming a constant threat to residents’ living environment and health. The classification intention of residents plays a pivotal role in solving the problem of MSW disposal. While numerous studies have examined the classification behavior of MSW from the perspective of ordinary residents and households, few studies have attempted to understand young people’s sorting intention. The novelty of this research is to explore the determinants that affect young people’s intention toward municipal solid waste sorting (MSWS) by extending the predictive factors of environmental concern and personal moral obligation into the theory of planned behavior (TPB). A sample of 524 young respondents from Hebei Province in China were used to conduct a structural equation model (SEM) validation. The empirical results revealed that, according to the rankings of significance, personal moral obligation, perceived behavioral control, and subjective norm had positive influences on young people’s intention toward MSWS, while attitude and environmental concern did not. Furthermore, the multi-group comparison showed that, compared with the male and rural group, the intention of female and urban respondents to classify MSW was not affected by subjective norms. Some targeted managerial implications were ultimately proposed to promote young people’s intention toward MSWS. This study contributes to the existing knowledge system of MSWS by revealing the classification intention of young people as a group. The findings and implications provide the government with useful insights for encouraging young people to actively participate in MSWS.

Factors Influencing Nutritional Behavior Among Patients With Metabolic Syndrome

Introduction. Lifestyle modification and adherence to healthy diet is crucial in the prevention and management of metabolic syndrome (MetS). Aim: The aim of the current study was to identify factors affecting healthy nutritional behaviors among patients with MetS. Methods: In this cross-sectional study, a total of 322 adults with a mean age of 40.55 ± 5.97 years were included. The diagnosis of MetS was based on the criteria suggested by the International Diabetes Federation. Nutritional attitudes, subjective norms, intention, and nutritional behaviors were assessed through a questionnaire designed by researchers. Results: The finding indicated that nutritional attitude and gender of participants were predicting factors of behavioral intention. Furthermore, nutritional attitude, behavioral intention, gender, and level of education could predict nutritional behavior in patients. However, subjective norm was a weak predictor of behavioral intention and nutritional behavior. Conclusions: The findings suggest that attitude and intention, but not subjective norms, along with some sociodemographic variables were able to predict the nutritional behavior of MetS patients that could be a basis for designing educational interventions for health promotion among them.

The Association Between Maternal Factors and Preadolescent Breakfast Skipping: The Mediating Role of Preadolescent Attitudes Toward Breakfast

BACKGROUND

Although skipping breakfast is common among children and adolescents, daily breakfast consumption is a healthy habit that is particularly important in childhood. There is a link between children's attitudes toward breakfast, breakfast-skipping behaviors, and maternal factors. Evidence demonstrating a clear relationship between maternal factors and preadolescent attitudes and behaviors toward breakfast skipping is scarce.

AIMS

This study aims to examine the mediation effect of preadolescent attitudes toward breakfast on the associations between maternal involvement (encouragement and control of breakfast eating) and preadolescent breakfast skipping.

METHODS

A cross-sectional descriptive study was conducted across Jordan in public and private primary schools in 2015. A sample of 1,915 preadolescent students (10-11 years) and their mothers (N = 1,299) was generated through proportional cluster stratification sampling. The interrelationships were examined among the participants' demographics, the number of preadolescent skipped breakfasts during a given week, self-reported attitudes toward breakfast, and perceived maternal encouragement and control of breakfast-eating variables.

RESULTS

Analysis revealed that preadolescent attitudes toward breakfast and mothers' involvement in preadolescent breakfast were negatively correlated with preadolescent breakfast skipping. Linear regressions revealed that maternal involvement (i.e., encouragement and control of breakfast eating, and educational attainment levels) was predictive of preadolescent attitudes toward breakfast consumption. Multiple regressions using bootstrapping analysis showed that preadolescent attitudes partially mediated the effect of mothers' control and encouragement of breakfast consumption over preadolescent breakfast-skipping behavior.

LINKING EVIDENCE TO ACTION

Results suggest that preadolescent attitudes, maternal encouragement, and control of breakfast eating influenced preadolescent breakfast skipping. These findings emphasize the importance of carefully assessing preadolescent attitudes toward breakfast, maternal encouragement, and control of breakfast consumption when developing interventions aimed at reducing breakfast-skipping behavior.

Associations between perceived friends' support of healthy eating and meal skipping in adolescence

OBJECTIVE

Meal skipping is a relatively common behaviour during adolescence. As peer influence increases during adolescence, friendship groups may play a role in determining eating patterns such as meal skipping. The current study examined cross-sectional and longitudinal associations between perceived friends' support of healthy eating and breakfast and lunch skipping among adolescents.

DESIGN

Survey of intrapersonal, social and environmental factors that may influence eating patterns at baseline (2004/05) and follow-up (2006/07).

SETTING

Thirty-seven secondary schools in Victoria, Australia.

SUBJECTS

Sample of 1785 students aged 12-15 years at baseline.

RESULTS

Adolescents who reported that their friends sometimes or often ate healthy foods with them were less likely (adjusted OR; 95 % CI) to skip breakfast (sometimes: 0·71; 0·57, 0·90; often: 0·54; 0·38, 0·76) or lunch (sometimes: 0·61; 0·41, 0·89; often: 0·59; 0·37, 0·94) at baseline than those who reported their friends never or rarely displayed this behaviour. Although this variable was associated with lunch skipping at follow-up, there was no evidence of an association with breakfast skipping at follow-up. There was no evidence of an association between perceived encouragement of healthy eating, and an inconsistent relationship between perceived discouragement of junk food consumption, and meal skipping.

CONCLUSIONS

Friends eating healthy foods together may serve to reduce meal skipping during early adolescence, possibly due to the influence of directly observable behaviour and shared beliefs held by those in the same friendship group. Verbal encouragement or discouragement from friends may be less impactful an influence on meal skipping (than directly observable behaviours) in adolescents.

Different Psychosocial Factors Are Associated With Different Intention and Self-Efficacy Toward Eating Breakfast Among Japanese Breakfast Skippers

A cross-sectional study was conducted among 7593 adults to clarify lifestyle and psychosocial characteristics of breakfast skippers with different intention and self-efficacy toward eating breakfast. Data were obtained from Japan’s national survey in 2009. Multinomial logistic regression analyses were performed to examine the characteristics of each breakfast skipper (having intention and self-efficacy toward eating breakfast [IS], having intention but not self-efficacy [INS], and not having intention to eat breakfast [NI]) compared with breakfast eaters. IS men were less likely to demonstrate understanding of healthy eating. INS and NI men were more likely to eat alone. INS and NI women were less likely to demonstrate understanding of healthy eating. NI men and women were less likely to report weight management behavior. Current smoking and being sleep-deprived were commonly associated with breakfast skipping in both sexes. Our results suggested the need for approaches considering type of breakfast skippers (eg, different intention and self-efficacy).

Applying an extended theory of planned behaviour to predict breakfast consumption in adolescents

BACKGROUND/OBJECTIVES

Breakfast skipping increases during adolescence and is associated with lower levels of physical activity and weight gain. Theory-based interventions promoting breakfast consumption in adolescents report mixed findings, potentially because of limited research identifying which determinants to target. This study aimed to: (i) utilise the Theory of Planned Behaviour (TPB) to identify the relative contribution of attitudes (affective, cognitive and behavioural) to predict intention to eat breakfast and breakfast consumption in adolescents and (ii) determine whether demographic factors moderate the relationship between TPB variables, intention and behaviour.

SUBJECTS/METHODS

Questionnaires were completed by 434 students (mean 14±0.9 years) measuring breakfast consumption (0-2, 3-6 or 7 days), physical activity levels and TPB measures. Data were analysed by breakfast frequency and demographics using hierarchical and multinomial regression analyses.

RESULTS

Breakfast was consumed everyday by 57% of students, with boys more likely to eat a regular breakfast, report higher activity levels and report more positive attitudes towards breakfast than girls (P<0.001). The TPB predicted 58% of the variation in intentions. Overall, the model was predictive of breakfast behaviours (P<0.001), but the relative contribution of TPB constructs varied depending on breakfast frequency. Interactions between gender and intentions were significant when comparing 0-2- and 3-6-day breakfast eaters only highlighting a stronger intention-behaviour relationship for girls.

CONCLUSIONS

Findings confirm that the TPB is a successful model for predicting breakfast intentions and behaviours in adolescents. The potential for a direct effect of attitudes on behaviours should be considered in the implementation and design of breakfast interventions.

From perceived autonomy support to intentional behaviour: Testing an integrated model in three healthy-eating behaviours

A motivational model integrating self-determination theory, the theory of planned behaviour, and the health action process approach was tested in three samples in three behavioural contexts: fruit and vegetable, breakfast, and snack consumption. Perceived support for autonomous (self-determined) forms of motivation from parents and autonomous motivation from self-determination theory were hypothesised to predict intention and behaviour indirectly via the mediation of attitude and perceived behavioural control from the theory of planned behaviour. It was also expected that planning strategies would mediate the effect of intention on behaviour. Relations in the proposed models were expected to be similar across the behaviours. A two-wave prospective design was adopted. Three samples of high-school students (total N = 1041; 59.60% female; M age = 17.13 years ± 1.57) completed measures of perceived autonomy support, autonomous motivation, theory of planned behaviour constructs, planning strategies and behaviour for each of the three behavioural contexts. Three months later, 816 participants (62,24% female; M age: 17.13 years, SD = 1.58) of the initial sample self-reported their behaviour referred to the previous three months. Structural equation models provided support for the key hypothesised effects of the proposed model for the three health-related behaviours. Two direct effects were significantly different across the three behaviours: the effect of perceived autonomy support on perceived behavioural control and the effect of attitude on intention. In addition, planning strategies mediated the effect of intention on behaviour in fruit and vegetable sample only. Findings extend knowledge of the processes by which psychological antecedents from the theories affect energy-balance related behaviours.

A systematic literature review and meta-analysis: The Theory of Planned Behavior's application to understand and predict nutrition-related behaviors in youth

BACKGROUND

Efforts to reduce unhealthy dietary intake behaviors in youth are urgently needed. Theory-based interventions can be effective in promoting behavior change; one promising model is the Theory of Planned Behavior (TPB).

PURPOSE

The aim of this study was to determine, using a systematic literature review, how the TPB has been applied to investigate dietary behaviors, and to evaluate which constructs are associated with dietary behavioral intentions and behaviors in youth.

METHODS

Publications were identified by searching electronic databases, contacting experts in the field, and examining an evolving Internet-based TPB-specific bibliography. Studies including participants aged 2-18years, all TPB constructs discernible and measured with a description of how the variables were assessed and analyzed, were published in English and peer-reviewed journals, and focused on nutrition-related behaviors in youth were identified. Accompanying a descriptive statistical analysis was the calculation of effect sizes where possible, a two-stage meta-analysis, and a quality assessment using tenants from the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statements.

RESULTS

Thirty-four articles, including three intervention studies, were reviewed. The TPB was most often used to evaluate healthy eating and sugary snack and beverage consumption. Attitude had the strongest relationship with dietary behavioral intention (mean r=0.52), while intention was the most common predictor of behavior performance (mean r=0.38; both p<0.001). All three interventions revealed beneficial outcomes when using the TPB (e.g. η(2)=0.51 and ds=0.91, 0.89, and 0.79); extending the Theory with implementation intentions may enhance its effectiveness (e.g. η(2)=0.76).

CONCLUSIONS

Overall, the TPB may be an effective framework to identify and understand child and adolescent nutrition-related behaviors, allowing for the development of tailored initiatives targeting poor dietary practices in youth. However, support from the literature is primarily from observational studies and a greater effort towards examining these relationships within intervention studies is needed.

Factors associated with nutrition label use among female college students applying the theory of planned behavior

BACKGROUND/OBJECTIVES

Use of nutrition labels in food selection is recommended for consumers. The aim of this study is to examine factors, mainly beliefs explaining nutrition label use in female college students based on the Theory of Planned Behavior (TPB).

SUBJECTS/METHODS

The subjects were female college students from a university in Seoul, Korea. The survey questionnaire was composed of items examining general characteristics, nutrition label use, behavioral beliefs, normative beliefs, corresponding motivation to comply, and control beliefs. The subjects (n = 300) responded to the questionnaire by self-report, and data from 275 students were analyzed using t-test or χ²-test.

RESULTS

The results showed that 37.8% of subjects were nutrition label users. Three out of 15 behavioral beliefs differed significantly by nutrition label use. Nutrition label users agreed more strongly on the benefits of using nutrition labels including 'comparing and selecting better foods' (P < 0.001), 'selecting healthy foods' (P < 0.05). The negative belief of 'annoying' was stronger in non-users than in users (P < 0.001). Three out of 7 sources (parents, siblings, best friend) were important in nutrition label use. Twelve out of 15 control beliefs differed significantly by nutrition label use. These included beliefs regarding constraints of using nutrition labels (e.g., time, spending money for healthy foods) and lack of nutrition knowledge (P < 0.001). Perceived confidence in understanding and applying the specifics of nutrition labels in food selection was also significantly related to nutrition label use (P < 0.001).

CONCLUSIONS

This study found that the beliefs, especially control beliefs, suggested in the TPB were important in explaining nutrition label use. To promote nutrition label use, nutrition education might focus on increasing perceived control over constraints of using nutrition labels, acquiring skills for checking nutrition labels, as well as the benefits of using nutrition labels and receiving support from significant others for nutrition label use.

An examination of the demographic predictors of adolescent breakfast consumption, content, and context

Background

Breakfast consumption is important to health; however, adolescents often skip breakfast, and an increased understanding of the breakfast consumption patterns of adolescents is needed. The purpose of this study was to identify the predictors of breakfast eating, including the content and context, in an adolescent sample from Australia and England.

Methods

Four-hundred and eighty-one students completed an online questionnaire measuring breakfast skipping, and breakfast content (what was eaten) and context (who they ate with, involvement in preparation). Logistic regression was conducted to investigate the predictors of skipping breakfast, breakfast context, and consumption of the ten most commonly consumed foods. Chi-square analyses were used to examine differences in breakfast content according to context.

Results

Most students (88%) had consumed breakfast on the day of the survey; breakfast skipping was more common in England (18%) than in Australia (8%). Country, gender, socioeconomic status, and body mass index (BMI) were all predictors of breakfast content and context. Whether adolescents ate with others and/or were involved in breakfast preparation predicted the content of breakfast consumed.

Conclusions

This study provides a comprehensive examination of the factors underlying breakfast consumption (content and context) and has important implications for the development of evidence-based interventions to improve rates of breakfast consumption and the quality of food consumed amongst adolescents.