Self-affirmation increases acceptance of health-risk information among UK adult smokers with low socioeconomic status

Effects of self-affirmation on university students' processing of health risk messages related to sedentary behavior

OBJECTIVE

Examine effects of self-affirmation on university students' processing of health risk messages related to sedentary behavior.

PARTICIPANTS

Eighty-eight students from a Canadian university (females = 53; males = 35; Mage = 21.74, SD = 5.36) participated during the 2018-2019 academic year.

METHODS

Participants were randomized to a self-affirmation (n = 43) or control group (n = 45), watched a video conveying sedentary behavior risk messages, and completed measures of acceptance, derogation, risk perceptions, negative affect, and intentions. A one-way between-groups multivariate analysis of variance (MANOVA) examined effects of condition on the combined set of outcome variables.

RESULTS

Self-affirmation had no observable effect on any outcome variables.

CONCLUSION

Self-affirmation did not appear to impact students' reactions to sedentary behavior risk messages. Given the lack of a manipulation check, however, this finding must be interpreted with caution. The Trigger and Channel framework offers a useful account of factors that influence self-affirmation effects. Implications and future research directions are discussed.

Moral foundations and HPV vaccine acceptance in the United States: State, parental, and individual factors

RATIONALE

Appeals to intuitive morality may present a novel approach to addressing vaccine hesitancy.

OBJECTIVE

To better understand the relationship between morality and vaccination by employing Moral Foundations Theory to studies surrounding the HPV vaccination at multiple different levels of decision making.

METHOD

We employed three different study modalities which examined moralities link to vaccination by employing Moral Foundations Theory. A state-wide ecological study aimed to understand population level trends. Two randomized control interventional studies were then created to understand the effects of Moral Foundations Theory based interventions on both parents of children and individual decision makers.

RESULTS

We demonstrated a negative association at the state level between the purity moral foundations and HPV vaccination rates (β = -.75, SE 0.23; p < .01) and a positive association between loyalty and HPV vaccination rates (β = 0.62 SE 0.24; p < .05). The parental study built upon this by demonstrating negative association between higher moral purity scores and attitudes towards the HPV vaccine and intention to vaccinate their children (β = -0.27 SE 0.07; p < .001). Our final study demonstrated a Moral Foundations Theory based intervention was associated with an increase in the odds of indicating an intention to receive the HPV vaccination (adjusted Odds Ratio (aOR) 2.59, 95% Confidence Interval (CI) 1.62-4.14). This equates to a 20% increase in the predicted probability of the intention to receive an HPV vaccine (39% CI (36%-42%) vs 60% CI (57%-63%).

CONCLUSIONS

Together, these studies demonstrate that moral foundations, specifically the purity foundation, appear to have a strong and consistent relationship with HPV vaccination. They also demonstrate the how moral values-based interventions may serve as a novel approach to increase HPV vaccine uptake with potential to be employed to target vaccine hesitancy more broadly.

Can Self-affirmation Encourage HIV-Prevention? Evidence from Female Sex Workers in Senegal

We test an intervention aiming to increase condom usage and HIV testing in a stigmatized population at high risk of contracting HIV: female sex workers (FSWs) in Senegal. Some sex work is legal in Senegal, and condoms and HIV tests are freely available to registered FSWs-but FSWs may be reluctant to get tested and use condoms, in part because doing so would entail acknowledging their risk of contracting HIV and potentially expose them to stigma. Drawing on self-affirmation theory, we hypothesized that reflecting on a source of personal pride would help participants acknowledge their risk of HIV, intend to use condoms more frequently, and take an HIV test. Prior research suggests that similar self-affirmation interventions can help people acknowledge their health risks and improve their health behavior, especially when paired with information about effectively managing their health (i.e., self-efficacy information). However, such interventions have primarily been tested in the United States and United Kingdom, and their generalizability outside of these contexts is unclear. Our high-powered experiment randomly assigned participants (N = 592 FSWs; N = 563 in the final analysis) to a self-affirmation condition or a control condition and measured their risk perceptions, whether they took condoms offered to them, and whether (after randomly receiving or not receiving self-efficacy information) they took an HIV test. We found no support for any of our hypotheses. We discuss several explanations for these null results based on the stigma attached to sex work and HIV, cross-cultural generalizability of self-affirmation interventions, and robustness of previous findings.

Self-Affirmation and Image/Performance Enhancing Drug Use in Recreational Exercise

Objectives: The use of image and performance enhancement drugs (IPEDs) in recreational sport represents an emerging public health and societal problem. The present study investigated whether self-affirmation changed exercisers' intentions to use IPEDs, via the effects of mental construal and message acceptance. Method: Sixty-eight exercisers who self-reported IPEDs use participated in the study and were randomly assigned to either a self-affirmation or a control group. All participants read a health-related message about the 10 consequences of IPEDs and subsequently completed a survey measuring message acceptance, mental construal, doping intentions and IPEDs-related social cognitive variables. Results: There were no significant differences between the self-affirmed and the control groups. Hierarchical linear regression analysis further showed that message acceptance, subjective norms, and situational temptation were significantly associated with intentions to use IPEDs. Conclusion: Our findings raise the possibility that for recreational exercisers IPED's use is seen mostly as a health-related matter than a socio-moral transgression.

Self‐affirmation reduces uncertainty aversion for potential gains

Decisions about one's health are often accompanied by uncertain outcomes, which may be either positively or negatively valenced. The presence of this uncertainty, which can range along a continuum from risk to ambiguity (i.e., decisions in which the outcome probabilities are known or unknown), can be perceived as threatening, and individuals tend to be averse to uncertain outcomes, and will attempt to avoid uncertainty when possible. We proposed that one way to reduce uncertainty aversion could be to provide opportunities to affirm one's core values, or "self-affirmation." Prior research has suggested that self-affirmation promotes health behaviour by providing a buffer against potential threats to the self. However, the degree to which self-affirmation affects decision-making is still unclear. Across two studies, we tested the effects of a self-affirmation manipulation on risk (Study 1) and ambiguity (Study 2) preferences for both potential gains and losses. In both studies, we found that, compared to the non-affirmed group, affirmed individuals were more accepting of uncertainty when the decision involved potential gains, but not for potential losses. Further, for risky decisions, the increased acceptance of uncertainty came at the expense of making choices consistent with expected value, such that self-affirmed individuals made more disadvantageous choices than non-affirmed individuals. Our results suggest both benefits and costs of self-affirmation in the context of risky choice, an important finding given the many applications of self-affirmation in behavioral decision making contexts.

The Effects of Self vs. Group Affirmation and Message Framing on College Students' Vape-Free Campus Policy Support

A growing number of American colleges and universities have become vape-free campuses in response to the high e-cigarette use prevalence among young adults. However, little is known about communication or social-psychological factors associated with campus members' support for a tobacco policy prohibiting e-cigarette use on the campus (vape-free policy support). The present study explores the main and interaction effects of affirmation and message framing on the vape-free policy support among college students who vary in their vaping status. We conducted a computer-based experiment with a two (affirmation: self vs. group) by two (message framing: gain vs. loss) by two (vaping status: vapers vs. non-vapers) between-subjects design. Our analysis indicated that self-affirmation is associated with a higher level of vape-free policy support than group-affirmation. The main effects of message framing as well as two-way interactions between framing and affirmation were not statistically significant. A notable finding was the three-way interaction effect among affirmation, framing, and vaping status. For vapers, the level of policy support was the highest when they were self-affirmed and exposed to a gain-framed message. For non-vapers, the level of policy support was the highest when they were self-affirmed and exposed to a loss-framed message. Our findings suggest that colleges may use varied approaches in communicating a vape-free campus policy based on the target students' vaping status, and the group-pride or collective identity appeals may not be effective in promoting such policy.

Self-affirmation inductions to reduce defensive processing of threatening health risk information

OBJECTIVE

Self-affirmation reduces defensiveness toward threatening health messages. In this study, we compared several possible self-affirmation inductions in order to identify the most effective strategy.

DESIGN

Women at increased risk for breast cancer (i.e. who drink 7+ drinks per week) were recruited through Amazon Mechanical Turk (N = 1,056), randomly assigned to one of 11 self-affirmation conditions, and presented with an article about the link between alcohol intake and breast cancer risk.

MAIN OUTCOME MEASURES

Participants answered questions that measured key indices of message acceptance (risk perception, message endorsement), future alcohol consumption intentions, and action plans to reduce alcohol intake.

RESULTS

Participants who affirmed health vs. non-health values did not differ in behavioral intentions or action plans to reduce alcohol intake. General values vs. health essay affirmations led to higher odds of reporting some vs. no action plans to reduce alcohol consumption. Essay- vs. questionnaire-based inductions led to higher breast cancer worry and intentions to reduce alcohol consumption.

CONCLUSION

Overall, self-affirmation inductions that include an explicit focus on values (general or health-related) and self-generation of affirming thoughts through essay writing, are most potent in changing behavioral intentions and action plans to change future health behavior.

Information Avoidance, Self-affirmation, and Intentions to Receive Genomic Sequencing Results Among Members of an African Descent Cohort

BACKGROUND

Information avoidance tendencies have been found to be associated with lower intentions to pursue medically actionable genomic sequencing results, but less so among individuals who engage more in spontaneous self-affirmation. Yet these results were obtained with a largely non-Hispanic White, high-SES cohort.

PURPOSE

To assess these variables, their magnitude, and their associations in an African-descent cohort as part of the same ClinSeq® exome sequencing program.

METHODS

Participants reported levels of spontaneous self-affirmation, information avoidance, and intentions to receive three types of results - medically actionable, non-medically actionable, and carrier status as part of a baseline survey.

RESULTS

Relative to the original, non-Hispanic White cohort, those in the African-descent cohort had higher levels of spontaneous self-affirmation and lower intentions of learning about carrier genomic results; they reported comparable levels of information avoidance and intentions to receive other results. Information avoidance was negatively associated with intention to receive non-actionable results in the African-descent cohort, as found in the initial cohort, with no moderating effect of spontaneous self-affirmation. Information avoidance, spontaneous self-affirmation, and their interaction were not associated with intentions to receive actionable results (contrary to findings in the initial cohort), or carrier results.

CONCLUSIONS

Individuals of African descent may engage in relatively more spontaneous self-affirmation, and do not appear to engage in more information avoidance. Their information avoidance tendencies were associated with pursuit of non-actionable sequencing results, with no moderating effect of self-affirmation, and were not associated with pursuit of actionable results or carrier results.

Racial and Ethnic Disparities in Laryngeal Cancer Care

There is a long history of racial and ethnic disparities in healthcare and they continue to persist in contemporary society. These disparities have the potential to negatively affect morbidity and mortality in racial and ethnic minorities diagnosed with laryngeal cancer. Diagnosis, medical treatment, and rehabilitation for laryngeal cancer have improved considerably, leading to improvements in overall survival rates and physical, social, and psychological functioning. Yet members of minority and underrepresented groups are at an increased risk for experiencing reduced access to quality care and delays between diagnosis and treatment, and as a result have lower survival rates. Increasing health providers' awareness of racial and ethnic disparities in laryngeal cancer is necessary to facilitate changes in patient and provider education, clinical practice, and health policies. The purpose of this review is to summarize current literature on disparities in laryngeal cancer diagnosis, treatment, and rehabilitation among Black and Hispanic patients. We present recent data from the Surveillance, Epidemiology, and End Results database to examine trends in laryngeal cancer and patient, provider, and health systems factors that may perpetuate these disparities. In addition, we offer interventions to address racism and other racial and ethnic biases in laryngeal cancer care and describe research and legislative actions that are needed to reduce disparities in this area.

Association of Spontaneous and Induced Self-Affirmation With Smoking Cessation in Users of a Mobile App: Randomized Controlled Trial

Background

Most smokers attempt to stop using cigarettes numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the individual’s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats.

Objective

This study examines whether self-affirmation is associated with smoking cessation in the context of a cessation app. Two types of self-affirmation are examined: tendency to spontaneously self-affirm, and self-affirmation inductions added to a publicly available smoking cessation app (Smoke-Free Quit Smoking Now). In addition, this study explores whether optimism and emotional states (happiness, anger, anxiousness, hopefulness, sadness) predict smoking cessation.

Methods

All users who met the inclusion criteria, provided consent to participate, and completed a baseline assessment, including all individual difference measures, were randomized to 1 of 4 conditions. Half of the participants were randomly assigned to complete a self-affirmation induction upon study entry. Orthogonally, half of the participants were randomly assigned to receive self-affirming text notifications during their quit attempt or to receive conventional notifications. The induction and the text notifications were fully automated, and all data were collected through self-assessments in the app. Self-reported smoking cessation was assessed 1 month and 3 months following study entry.

Results

The study enrolled 7899 participants; 647 completed the 1-month follow-up. Using an intent-to-treat analysis at the 1-month follow-up, 7.2% (569/7899) of participants self-reported not smoking in the previous week and 6.4% (503/7899) self-reported not smoking in the previous month. Greater tendency to spontaneously self-affirm predicted a greater likelihood of cessation (P<.001) at 1 month after controlling for smoking-related variables. Neither self-affirmation induction influenced cessation. In addition, spontaneous self-affirmation did not moderate the relationship between self-affirmation inductions and cessation. Greater baseline sadness was associated with a lower likelihood of reporting successful cessation. Optimism predicted past-week cessation at the 1-month follow-up, and both happiness and anger predicted past-month cessation at the 1-month follow-up; however, none of these potential predictors moderated the relationship between self-affirmation conditions and successful cessation.

Conclusions

Spontaneous self-affirmation may be an important psychological resource for managing threats to self-concept during the smoking cessation process. Sadness may hinder quit attempts. Future research can explicate how spontaneous versus induced self-affirmation can promote smoking cessation and examine boundary conditions for the effectiveness of disseminated self-affirmation interventions.

Trial Registration

ISRCTN Registry 56646695; https://www.isrctn.com/ISRCTN56646695

Effects of self-affirmation on responses toward graphic cigarette warning labels: testing the mediating role of perceived susceptibility and self-efficacy

Purpose

The purpose of this study is to examine the effects of self-affirmation on African American smokers' intentions to quit smoking sooner and desire to stop smoking altogether in response to viewing graphic cigarette warning labels. It also tested the mediating role of perceived susceptibility and self-efficacy in explaining the impact of self-affirmation.

Design/methodology/approach

African American smokers (N = 158) were recruited to participate in a controlled experiment. Participants first completed a short questionnaire about their demographic background and smoking-related attitudes and behavior. They were then randomly assigned to engage in either a self-affirmation task or a control task and viewed two graphic cigarette warning labels subsequently. Participants then responded to a questionnaire about their perceived susceptibility to smoking-related diseases, perceived self-efficacy to quit smoking, intentions to quit smoking and desire to stop smoking altogether.

Findings

Results showed that engaging in self-affirmation prior to exposure to graphic cigarette warning labels increased African American smokers' perceived susceptibility to smoking-related diseases, but decreased their perceived self-efficacy to quit smoking. Furthermore, self-affirmation indirectly enhanced smokers' intentions to quit smoking sooner and desire to stop smoking altogether through increased perceived susceptibility. It also had an unexpected negative indirect effect on intentions to quit smoking sooner through decreased self-efficacy.

Originality/value

This study is one of the few studies that investigates the effect of self-affirmation on African American smokers' responses toward graphic cigarette warning labels.

Attenuated self-serving bias in people with internet gaming disorder is related to altered neural activity in subcortical-cortical midline structures

BACKGROUND

To protect and maintain the positivity of self-concept, normal people usually show a self-serving bias (internal attribution of positive events and external attribution of negative events) by the motives of self-enhancement and self-protection. Additionally, self-serving assessments predominantly activate the subcortical-cortical midline structures (CMS) in healthy individuals. However, little is known about self-serving bias and its underlying neural correlates among individuals with Internet gaming disorder (IGD).

METHODS

Twenty-four participants with IGD and 25 recreational Internet gaming users (RGUs) were scanned while attributing the causes of positive/negative self- and other-related events that could occur in both the game-world and real-world contexts. Region-of-interest (within CMS regions) and parametric analysis were performed to investigate the neural correlates of self-serving bias in IGD.

RESULTS

Behaviorally, the IGD participants attributed more negative and fewer positive events to themselves than RGU participants in both contexts. Neurally, during the attributions of negative events, the IGD participants exhibited increased ventromedial prefrontal cortex (vmPFC) activation in both contexts compared with RGU participants. Higher vmPFC activation was associated with weaker self-protective motivation in the IGD group. Meanwhile, during the attributions of positive events, the IGD participants exhibited decreased precuneus/posterior cingulate cortex activation in the real world compared with RGU participants. Parametric analysis showed a reduced positive correlation between precuneus activation and self-attribution ratings of positive events in the real world in the IGD group relative to the RGU group.

CONCLUSION

These results suggest that individuals with IGD show an attenuated self-serving bias and altered brain activity within CMS regions involved in self-attribution, providing evidence for the negative self-concept and weakened abilities in both self-enhancement and self-protection in IGD.

Self-Affirmation Moderates Self-Congruency Effect in Health Messaging

Previous research found that health risk messages framed to be congruent with people's independent or interdependent self-construal were not consistently more effective than incongruent messages. We argue that people potentially process the self-construal congruent health risk messages in a biased manner. To test this proposition, we examined the role of self-affirmation, which is expected to reduce defensive processing, in college nonsmokers' responses to an antismoking message congruent vs. incongruent with their dominant self-construals. Results from an online experiment suggested that self-affirmation moderated the self-congruency effect. Specifically, among college nonsmokers endorsing a dominant interdependent self-construal, self-congruency effect emerged only when the group was engaged in self-affirmation. Among college nonsmokers endorsing a dominant independent self-construal, with no prior affirmation, the group reported self-incongruent messages better than the self-congruent messages. After being engaged in self-affirmation, the group reported similar effects for self-congruent and self-incongruent messages. Theoretical and practical implications of our findings are discussed.

Social cognitions and smoking behaviour: Temporal resolution matters

Objectives Health behaviour theories outline how cognitions predict behaviours, but rarely specify the temporal relation between cognitions and behaviours. It is not known whether these predictive relationships vary depending on temporal resolution or whether the relative influence of cognitions varies with measurement schedules. The current exploratory study therefore investigates whether the associations between behavioural cognitions (self-efficacy, intention, and risk perception) and smoking vary when measured momentarily, at day level, or using the more common baseline-follow-up design. Design EMA study involving 36 continuing smokers over 17 days. Participants logged cigarettes and reported their cognitions at baseline, daily (evening), and in response to momentary surveys. Methods Random-effects models were used to compare the effects of cognitions measured at different time points on (1) the number of cigarettes smoked daily and (2) the time interval until the next cigarette smoked. Results Self-efficacy and risk perception measured at baseline significantly predicted cigarettes smoked each day, but this effect became non-significant when daily measurements of cognitions were included in the model. Momentary smoking behaviour was predicted by momentary measurements of risk perception, with no significant effects of social cognitions at baseline. Conclusions Relationships between cognitions and behaviours vary according to the temporal resolution of the measurement schedule. Ensuring that the temporal resolution of assessment is appropriate for the temporal dynamics of the behaviour being assessed is important. Future research is needed to investigate the potential for leveraging specific cognitive processes depending on temporal importance in order to increase health-promoting behaviours. Statement of contribution What is already known on this subject? Social cognitions including intentions, risk perception, and self-efficacy have been observed to predict smoking. Little is known about the role of time in the cognition-behaviour relationship. Cognitions have been observed to fluctuate, but instability is typically not considered in research design. What does this study add? Daily measurement of social cognitions predicts behaviour better than measurements taken at baseline. Momentary smoking behaviour is predicted by momentary cognitions at the intra-individual level. Temporal resolution of measurement should be considered when investigating cognition-behaviour relationships.

Self-Affirmation Reduces Delay Discounting of the Financially Deprived

Financial deprivation is associated with excessive discounting of delayed rewards. In the present research, we argue that this counterproductive tendency may be driven, at least in part, by the aversive and self-threatening nature of experiencing financial deprivation. Accordingly, we propose that self-affirmation-an intervention known to buffer negative consequences of psychological threats-may reduce delay discounting of the financially deprived. Results of two high-powered, preregistered experiments support this proposition. Specifically, in Study 1 (n = 546), we show that among participants with relatively lower income, self-affirmation effectively reduces delay discounting. In Study 2 (n = 432), we manipulate the feeling of financial deprivation and demonstrate that self-affirmation reduces delay discounting among those who feel financially deprived. We also examine the underlying process of this effect and find that self-affirmation bolsters a sense of personal control among those who feel financially deprived, which in turn reduces their delay discounting (Study 2). Overall, our findings suggest that the relationship between financial deprivation and delay discounting is malleable and psychological interventions that attenuate self-threats and bolster a sense of personal control can be applied to reduce myopic tendencies of the poor.

Effect of Psychological Distance on Intention in Self-Affirmation Theory

In previous studies, self-affirmation has been shown to have no effect or have a negative impact on intention to change. We applied construal level theory to examine possible reasons for inconsistencies among findings in existing self-affirmation studies. In Study 1, when female college students in their 20s (N = 113) received health threat information with a psychologically proximal breast cancer message, it induced low-level construal and increased specific physical activity intention. In Study 2, when self-affirmed participants were exposed to health threat information with a psychologically distal Alzheimer's disease message, there was no increase in specific physical activity intention. These results suggest that when a discrepancy exists between the psychological distance of health threat information and the intention reflecting the construal level, no change of intention occurs, even in self-affirmed individuals.

Reinstating the Resourceful Self: When and How Self-Affirmations Improve Executive Performance of the Powerless

Research has found that lack of power impairs executive functions. In the present research, we show that this impairment is not immutable. Across three studies and focusing on inhibitory control as one of the core facets of executive functions, our investigation shows that self-affirmation attenuates the previously documented decrements in inhibitory control of the powerless (Studies 1-3). We also examine boundary conditions of this effect and demonstrate that self-affirmation is most effective insofar as the powerless lack self-esteem (Study 2). Finally, we directly test the underlying process of this effect and demonstrate that self-affirmation increases an efficacious self-view among the powerless, which in turn improves their inhibitory control abilities (Study 3). Overall, we conclude that reinstating an efficacious self-view through self-affirmation offsets the impairments in inhibitory control abilities of the powerless and reduces the cognitive performance gap between the powerless and the powerful.

Adapting a self-affirmation intervention for use in a mobile application for smokers

Self-affirmation interventions can reduce defensive responses to threats to the self, but have had limited reach to the general population. We sought to create an effective and feasible version of the Kindness Questionnaire self-affirmation intervention for use on a mobile device outside the traditional university laboratory setting and by non-student participants. In an online experiment, 603 cigarette smokers (M_age= 37.5 years, SD = 10.2) were randomly assigned to one of six conditions in a 2 (Self-Affirmation: Self-Affirmation, No Self-Affirmation Control) × 3 (Example Type: Written, Imagined, No Examples) fully-crossed design. Participants read a message about the health harms of smoking. None of the self-affirmation variations were effective or feasible: the self-affirmation showed null effects on the primary outcomes of message acceptance, perceived message effectiveness, and reactance. It also backfired by reducing intentions to quit smoking and risk perceptions. Participants spent little time reading the health message, and those in the written self-affirmation condition infrequently provided detailed responses. Translating interventions developed and tested for efficacy in laboratory settings to "real-world" settings is necessary but challenging.

Reconceptualizing Self-Affirmation With the Trigger and Channel Framework: Lessons From the Health Domain

Self-affirmation—a theory-based technique to affirm the adaptive adequacy of the self—can promote positive behavior change and adaptive outcomes, although effects are variable. We extend a novel framework (Trigger and Channel), proposing three conditions that facilitate self-affirmation-induced behavior change: (a) presence of psychological threat, (b) presence of resources to foster change, and (c) timeliness of the self-affirmation with respect to threat and resources. Using health behavior as a focus, we present meta-analytic evidence demonstrating that when these conditions are met, self-affirmation acts as a psychological trigger into a positive channel of resources that facilitate behavior change. The presence of a timely threat and the availability of timely resources independently predicted larger self-affirmation effects on behavior change, and the two interacted synergistically to predict still larger effects. The results illustrate the conditionality of self-affirmation effects and offer guidelines for when, where, and for whom self-affirmation will be most effective.

Analysis of self-evaluated ethical competence of midwifery students at a selected nursing college in the Free State

BACKGROUND

 It is imperative to know whether the students who have undergone a specific training perceive themselves as confident and competent in handling ethical dilemmas, in the face of contemporary ethical challenges. Such evaluation is significant especially for nursing and midwifery students who have undergone training that stipulates adherence to a code of ethics and professional norms. At present, such knowledge is limited, and this has an impact for ethics education.

OBJECTIVES

 The article aims to describe the self-evaluated ethical competence of midwifery students and to contrast the findings to the content of the ethics instruction received. Based on outcomes, the article aims to convey the claim to nursing institutions that current strategies that rely on teaching nursing ethics without appraising the context of a situation are ineffective in fostering ethical competence amongst students.

METHOD

 This study made use of a set of self-reflection reports in which the midwifery nursing students narrated their experiences in handling ethical issues.

RESULTS

 Analysis of the self-reflective reports revealed that one of the three dimensions of ethical competence was limited. There was evidence of moral perception, moral action and substandard moral reasoning. The principles that were mostly referred to within the narratives were autonomy and beneficence.

CONCLUSION

 The findings support the argument that teaching principlism and enforcing a code of ethics without contextualising it coerces the student to conform without questioning their beliefs. Thus, ethical competence amongst the midwifery students may be described in terms of compliance to principles with limited reflection on the situation as a whole.

Leveraging Self-Affirmation to Improve Behavior Change: A Mobile Health App Experiment

Background

mHealth interventions can help to improve the physical well-being of participants. Unfortunately, mHealth interventions often have low adherence and high attrition. One possible way to increase adherence is instructing participants to complete self-affirmation exercises. Self-affirmation exercises have been effective in increasing many types of positive behaviors. However, self-affirmation exercises often involve extensive essay writing, a task that is not easy to complete on mobile platforms.

Objective

This study aimed to adapt a self-affirmation exercise to a form better suited for delivery through a mobile app targeting healthy eating behaviors, and to test the effect of differing self-affirmation doses on adherence to behavior change goals over time.

Methods

We examined how varied self-affirmation doses affected behavior change in an mHealth app targeting healthy eating that participants used for 28 days. We divided participants into the 4 total conditions using a 2×2 factorial design. The first independent variable was whether the participant received an initial self-affirmation exercise. The second independent variable was whether the participant received ongoing booster self-affirmations throughout the 28-day study. To examine possible mechanisms through which self-affirmation may cause positive behavior change, we analyzed three aspects of self-affirmation effects in our research. First, we analyzed how adherence was affected by self-affirmation exercises. Second, we analyzed whether self-affirmation exercises reduced attrition rates from the app. Third, we examined a model for self-affirmation behavior change.

Results

Analysis of 3556 observations from 127 participants indicated that higher doses of self-affirmation resulted in improved adherence to mHealth intervention goals (coefficient 1.42, SE 0.71, P=.04). This increased adherence did not seem to translate to a decrease in participant attrition (P value range .61-.96), although our definition of attrition was conservative. Finally, we examined the mechanisms by which self-affirmation may have affected intentions of behavior change; we built a model of intention (R²=.39, P<.001), but self-affirmation did not directly affect final intentions (P value range .09-.93).

Conclusions

Self-affirmations can successfully increase adherence to recommended diet and health goals in the context of an mHealth app. However, this increase in adherence does not seem to reduce overall attrition. The self-affirmation exercises we developed were simple to implement and had a low cost for both users and developers. While this study focused on an mHealth app for healthy eating, we recommend that other mHealth apps integrate similar self-affirmation exercises to examine effectiveness in other behaviors and contexts.

The BeHealthyR Study: a randomized trial of a multicomponent intervention to reduce stress, smoking and improve financial health of low-income residents in Rotterdam

BACKGROUND

Compared to higher socioeconomic status (SES) groups, those in lower SES groups are financially strained, experience higher rates of smoking-related morbidity, are in poorer health and have reduced life expectancy. This is especially true for the city of Rotterdam, where a large inequality in health is observed between low and high SES groups. The BeHealthyR study (Dutch: Grip en Gezondheid) is a randomized controlled trial (RCT) which will evaluate the impact of a theory-based multicomponent behavior intervention aiming to reduce stress, smoking, and improve financial health by means of a group-based stress management program combining cognitive and behavioral techniques, and nudges in low-SES residents living in Rotterdam.

METHODS

The BeHealthyR study is a three-arm RCT. Between February 2018 and July 2019, low-SES participants who perceive stress, smoke, are financially strained and reside in Rotterdam (one of the four largest cities in The Netherlands) are recruited. Subsequently, participants are randomly assigned to either a stress management condition (SM), stress management with a buddy condition (SM-B) or a control condition (CC). Participants in the SM and SM-B conditions will attend four weekly group sessions (1.5 h/session) and a follow-up session eight weeks later. The SM condition includes psychoeducation and exercises, and cognitive and behavioral intervention techniques. Demographic data and objective measures will be collected at baseline (T0), four weeks post-baseline (T1), and twelve weeks post-baseline (T2). Primary outcome measures are to reduce stress, smoking and improve financial health. We hypothesize that low-SES participants in the intervention conditions, compared with those in the control condition, will experience less stress, smoke less and have improved financial health.

DISCUSSION

This study is a group-based intervention which aims to investigate the effects of a theory-based behavioral change intervention employing several components on reducing stress, smoking, and improving financial health in low-SES residents living in Rotterdam. If effective, the findings from the present study will serve to inform future directions of research and clinical practice with regard to behavioral change interventions for low-SES groups.

TRIAL REGISTRATION

ClinicalTrials.gov (ID: NCT03553979 ). Registered on January 1 2018.

Integrating Self-Affirmation and Implementation Intentions: Effects on College Student Drinking

Background

High levels of alcohol consumption are an enduring health risk among college students. Integrating multiple, complementary behavior change theories may offer a promising approach to promote reductions in alcohol consumption.

Purpose

The current study tested if integrating self-affirmation and implementation intentions would be more effective than a self-affirmation only, implementation intentions only, or control condition at reducing alcohol consumption in college students over a 2-week period.

Method

Two hundred and ninety-three college students who reported drinking in the past month were randomly assigned to a condition in a 2 (self-affirmation: values vs. control writing task) × 2 (implementation intentions: formed vs. not formed) between-subjects factorial design. Participants first completed a self-affirmation or control writing task, then read an article describing the risks of drinking. Next, all participants reported their common drinking behaviors and contexts, and then selected two harm-reduction strategies forming (or not forming) implementation intentions to use the strategies. Alcohol consumption was measured 1 and 2 weeks after the experiment.

Results

Participants in the integrated self-affirmation and implementation intention condition were most likely to abstain from drinking 1 week later. Affirmed participants continued to be more likely to abstain from drinking 2 weeks later.

Conclusions

The findings support the efficacy of integrating self-affirmation and implementation intentions to reduce college student drinking (ClinicalTrials.gov number NCT02926794).

Risk Perceptions After Receiving Multiple Risk Feedback

How do people respond to multiple risk feedback in a real-life context? Based on theoretical assumptions, three different predictions for risk perceptions were tested: (a) relative accuracy in risk perceptions, (b) self-defensive responses according to self-affirmation theory, and (c) compensatory responses according to the compensatory health belief model. Participants of a community health screening ( N = 725) received multiple risk indicator feedback for actual blood pressure, blood glucose, and blood lipid levels. Consistent multiple risk feedback profiles encompassed three consistent readings (three normal or three elevated readings). Mixed risk profiles included one elevated and two normal readings. Results indicate relative accuracy in responses: an elevated reading triggered higher risk perception of the respective risk factor. Importantly, the effect was not modulated by the presence of normal readings as assumed by the self-defensive or compensatory response perspective, indicating that people accurately integrate multiple risk indicator feedback as it is often provided in real life.

Using Self-affirmation to Increase the Effects of Emotive Health Warnings on Smoking: A Randomized Exploratory Trial

Introduction

Emotive health messages are widely used tools in tobacco control. However, under some circumstances, they can be less effective than desired by eliciting defensive responses in smokers.

Aims

This study tests whether enhancing a currently used emotive graphic smoking health warning with a self-affirmation component reduces cigarette consumption and whether potential effects are stronger in heavier smokers, as suggested by previous research.

Methods

Participants (n = 265) were randomly allocated to a self-affirmation (reflecting on personal values and positive traits using a questionnaire) or matched control condition before viewing an emotive graphic health message from a current Australian government public health campaign. The primary outcome (cigarettes per day [CPD]) was assessed both before and a week following the intervention.

Results

No main effect of self-affirmation on smoking, but as hypothesized, a significant interaction between baseline smoking and self-affirmation was found that showed that heavier smokers (>21 CPD) who self-affirmed significantly reduced CPD compared to nonaffirmed smokers.

Conclusions

These findings support the use of self-affirmation to enhance smoking awareness campaigns in heavier smokers.

Implications

This study shows that enhancing emotive graphic smoking health messages with self-affirmation (the act of reflecting on positive aspects of oneself) increases their effectiveness in heavier smokers. This suggests that self-affirmation might be a particularly useful tool for health promotion targeting heavier smokers. This study adds to previous research in that it is the first to test the add-on effects of self-affirmation to current graphic health messages on smoking rather than smoking-related cognitions.

Targeting hardcore smokers: The effects of an online tailored intervention, based on motivational interviewing techniques

OBJECTIVES

Hardcore smokers have smoked for many years and do not intend to quit. They also seem unreceptive to information about smoking cessation. We developed a 30-min, tailored web-based intervention that includes motivational interviewing principles. It aims to increase hardcore smokers' intention to quit and their receptivity to information about smoking cessation.

DESIGN

In a two-arm experiment, we compared outcome scores of the experimental intervention (n = 346) with those of a control intervention (n = 411).

METHODS

Our main outcomes were receptivity to information about quitting, intention to quit, quitting self-efficacy, and interest in a subsequent online intervention. Our secondary outcomes were cigarettes smoked per day and quit attempts. All outcomes were measured directly post-experiment (t₁ ), after 2 weeks (t₂ ), and after 2 months (t₃ ).

RESULTS

At t₁ , hardcore smokers in the intervention condition were more receptive to information about quitting than controls. At both t₂ and t₃ , those in the experimental group had reduced the number of cigarettes more than those in the control group. At t₂ , but not t₃ , more participants in the experimental group had reduced their cigarette consumption by at least 50% than among controls. We found no significant differences in intention to quit, quitting self-efficacy, interest in a subsequent online quitting intervention, and number of quit attempts.

CONCLUSIONS

The intervention increased hardcore smokers' receptivity to information about smoking cessation and decreased their cigarette consumption by about 1 cigarette per day. Although the results are positive, the clinical relevance may be limited. We recommend further developing this intervention for practical use in health care settings. Statement of contribution What is already known on this subject? Hardcore smokers have smoked for many years and do not intend to quit. There are currently no online interventions for hardcore smokers. What does this study add? This study tested an online intervention for hardcore smokers. The intervention increased hardcore smokers' receptivity to information about quitting. It also helped to reduce the number of cigarettes per day.

Persuasiveness of anti-smoking messages: self-construal and message focus

Purpose

The purpose of this paper is to examine the role of independent vs interdependent self-construal in non-smokers’ responses to an anti-smoking message that focuses on either personal or relational consequences of smoking.

Design/methodology/approach

Two web-based experimental studies were conducted among US college non-smokers. In the first study, participants’ self-construal was measured. Then participants were randomly assigned to view an anti-smoking message emphasizing either relational or personal consequences of smoking. Message evaluation, smoking attitudes, and behavioral intentions were assessed after message exposure. The second study followed the same procedure except that participants’ self-construal was manipulated by randomly assigning participants to an independent or interdependent self-construal priming task prior to message exposure.

Findings

Both studies showed a noticeable pattern of interaction between message focus and self-construal: non-smokers with a salient interdependent self-construal responded more favorably to an anti-smoking message emphasizing personal (vs relational) consequences of smoking whereas non-smokers with a salient independent self-construal responded more favorably to an anti-smoking message emphasizing relational (vs personal) consequences of smoking. However, the interaction effect was small in the first study.

Originality/value

Findings from this study are original in that they run counter to the general belief that messages matching people’s self-perceptions will be more persuasive. On the other hand, matching health risk messages with people’s dominant self-construal may reduce the messages effectiveness due to defensive processing. As a result, communication practitioners should take a great caution of tailoring threatening smoking prevention messages to target audiences’ self-perceptions.

Self-affirmation increases defensiveness toward health risk information among those experiencing negative emotions: Results from two national samples

OBJECTIVE

Self-affirmation can promote health behavior change and yield long-term improvements in health via its effect on receptiveness to risk information in behavior change interventions. Across 2 studies, we examined whether the emotional state of the person presented with health risk information moderates self-affirmation effectiveness.

METHOD

Data were collected from 2 U.S. national samples (n = 652, n = 448) via GfK, an Internet-based survey company. Female alcohol consumers completed an emotion induction (fear, anger, or neutral). They then completed a standard self-affirmation (or no-affirmation) essay-writing task, and subsequently received a health message linking alcohol to breast cancer.

RESULTS

There was a significant interaction between emotion and self-affirmation conditions, such that self-affirmation reduced the specificity of health behavior change plans among those experiencing negative emotion (Study 1: B = -0.55, p < .001), with consistent but not significant effects for anger (Study 2: B = -.47, p = .069. Among self-affirmed participants, essays were rated as significantly less self-affirming for individuals experiencing negative emotion (or anger). Mediation analyses limited to the self-affirmation condition revealed an indirect effect of negative emotion condition on health behavior change plan specificity via self-affirmation ratings of essay content in Study 1: β = 0.04, p = .041.

CONCLUSIONS

The salutary effect of self-affirmation on plan specificity was reversed with negative emotion. These findings may be attributed to disruption of the self-affirmation process. Individuals who enter interventions using self-affirmation in a negative emotion state may be less prepared to benefit from other intervention content, and may even be less likely to change health behaviors as a result of the intervention. (PsycINFO Database Record

Integrating Self-Affirmation with Health Risk Messages: Effects on Message Evaluation and Response

This study tested a new method of using self-affirmation theory to increase adaptive responses to health risk messages. Participants' self-concepts were affirmed via text integrated with risk messages (public service announcements/PSAs) rather than by methods used in most previous studies that have limited applicability for campaigns employing mediated messages. Participants were exposed to health risk PSAs either including or not including affirming text to examine relative effects on message evaluation and adaptive responses. The moderating effect of personal relevance of the behavior on responses was also examined. Participants exposed to PSAs with integrated, affirming text (affirmed participants) reported more positive attitudes toward the PSA, greater self-efficacy, and greater intention to reduce risky behavior than participants exposed to messages without affirming text (non-affirmed participants). Compared to non-affirmed participants, affirmed participants also reported weaker perceptions of risk severity and equivalent perceptions of susceptibility. The personal relevance of the behavior did not moderate any effects of self-affirmation. Implications for health campaigns that employ mass-mediated messages are discussed.

"It's my business, it's my body, it's my money": experiences of smokers who are not planning to quit in the next 30 days and their views about treatment options

BACKGROUND

Current evidence-based smoking cessation treatments in the UK are only offered to smokers ready to quit within 30 days. This study reports the experiences of smokers who are not ready to quit and explores the types of intervention approaches that might engage them.

METHODS

Five focus groups were conducted with smokers who had no plans to quit within 30 days (n = 32, 44 % female). Verbatim transcripts were analyzed thematically using Nvivo 10 software.

RESULTS

Participants were ambivalent towards their own smoking, but the majority indicated they would like to quit someday. Smoking was seen both to hinder and facilitate social interactions, depending on the social norms of the participant's social circle. Participants reported that, when they perceive pressure to quit smoking, they respond defensively; concurrently, existing approaches to encouraging smoking cessation were seen as unappealing. In contrast, the importance of intrinsic motivation to quit was emphasized, and interventions that were tailored, increased intrinsic motivation and kept the smoker engaged in activities incompatible with smoking were preferred.

CONCLUSIONS

Despite not planning to quit in the next 30 days, the majority of participants wanted to quit smoking at some point. Even if existing services were offered to smokers not planning to quit in the next 30 days, it is unlikely that these services would meet the needs of this population. Future research should explore novel approaches to appeal specifically to smokers not planning to quit in the next 30 days, such as encouraging engagement with activities incompatible with smoking and fostering non-smoking habits.

A Pilot Test of Self-Affirmations to Promote Smoking Cessation in a National Smoking Cessation Text Messaging Program

Background

Although effective smoking cessation treatments, including mHealth interventions, have been empirically validated and are widely available, smoking relapse is likely. Self-affirmation, a process through which individuals focus on their strengths and behaviors, has been shown to reduce negative effects of self-threats and to promote engagement in healthier behavior.

Objective

To assess the feasibility of incorporating self-affirmations into an existing text messaging-based smoking cessation program (Smokefree TXT) and to determine whether self-affirmation led to greater engagement and higher cessation rates than the standard intervention.

Methods

Data were collected from smokers (n=1261) who subscribed to a free smoking cessation program and met eligibility criteria. The intervention lasted 42 days. The original design was a 2 (Baseline affirmation: 5-item questionnaire present vs absent) × 2 (Integrated affirmation: texts present vs absent) factorial design. Only 17 eligible users completed all baseline affirmation questions and these conditions did not influence any outcomes, so we collapsed across baseline affirmation conditions in analysis. In the integrated affirmation conditions, affirmations replaced approximately 20% of texts delivering motivational content.

Results

In all, 687 users remained enrolled throughout the 42-day intervention and 81 reported smoking status at day 42. Among initiators (n=1261), self-affirmation did not significantly improve (1) intervention completion, (2) days enrolled, (3) 1-week smoking status, or (4) 6-week smoking status (all Ps>.10); and among the 687 completers, there were no significant effects of affirmation on cessation (Ps>.25). However, among the 81 responders, those who received affirmations were more likely to report cessation at 6 weeks (97.5%; 39 of 40) than those not given affirmations (78.1%; 32 of 41; χ²(1)=7.08, P=.008).

Conclusion

This proof-of-concept study provides preliminary evidence that self-affirmation can be integrated into existing text-based cessation programs, as the affirmations did not lead to any adverse effects (ie, less engagement or lower rates of cessation). Among those who reported smoking status at the end of the intervention period (6.4% of eligible respondents), affirmations facilitated cessation. This study provides a “proof-of-concept” that brief, low-touch interventions may be integrated into a text messaging program with potential benefits, minimal disruption to the program or users, and little cost. Many questions remain regarding how self-affirmation and similar approaches can promote engagement in population interventions.

A pilot randomised test of a self-affirmation implementation intention intervention to reduce dietary salt intake

Self-affirmation may reduce defensive processing towards health messages. We tested the effects of a self-affirmation implementation intentional intervention with regard to salt risk message acceptance, estimates of daily-recommended intake and self-reported intake. Participants ( n = 65) who consumed over 6 g/day of salt were randomised into three conditions: self-affirmation, self-affirming implementation intention and control. Participants attended the laboratory and completed a 2-week follow-up. There was no effect of the condition on message acceptance, salt estimation and 2-week salt intake. Across conditions, 2-week salt intake was reduced. We found no evidence for either intervention with regard to salt risk message acceptance and behaviour change.

Online Self-Affirmation Increases Fruit and Vegetable Consumption in Groups at High Risk of Low Intake

BACKGROUND

This study tested the efficacy of self-affirmation in promoting fruit and vegetable consumption in a sample of participants comprising two groups at high risk of low consumption: young adults and mothers of school-aged children with low social economic status (SES).

METHODS

Baseline fruit and vegetable consumption was recorded for 85 participants (n = 26 mothers with low SES). Following randomisation to condition (Self-Affirmed or Non-Affirmed), participants viewed targeted, online, health recommendations about fruit and vegetable consumption. Fruit and vegetable intake was reported online every day for the following seven days.

RESULTS

Self-affirmed participants reported consuming significantly more portions of fruit and vegetables (SA M = 3.96, NA M = 2.81). Analyses of simple slopes indicated that the effect was greatest amongst lowest baseline consumers.

CONCLUSIONS

The findings demonstrate the efficacy of self-affirmation in increasing fruit and vegetable consumption in individuals who are at risk of having a low intake and whose consumption put them at the greatest risk of negative health outcomes. Application of these findings could help to reduce health care costs, through the use of cost-effective online interventions and reductions in treatment costs. Further research is needed to capitalise on the increased tailoring that online intervention allows in order to optimise the effects of self-affirmation.

Reactions to FDA-Proposed Graphic Warning Labels Affixed to U.S. Smokers' Cigarette Packs

INTRODUCTION

Graphic warning labels have been shown to be more effective than text-only labels in increasing attention and perceived health risks, but most U.S. studies have involved single exposures in laboratory or Internet settings.

METHODS

We recruited a convenience sample (N = 202) of U.S. adult smokers from population subgroups with higher rates of smoking and smoking-related deaths who had participated in a larger survey about graphic warning labels. Participants were randomized to get 1 of 9 graphic + text labels or a text-only label. Research staff affixed a warning label sticker to participants' cigarette pack(s) at enrollment. Color graphic labels covered slightly more than the lower half of packs. Black and white labels of current U.S. text-only warnings covered the existing side warning to prompt attention to the label (i.e., attention control). Participants received extra stickers of the same label for subsequent packs, and completed 3 telephone interviews in 1 week.

RESULTS

Participants reported low avoidance (<34%) and consistent use of the stickers (91%). Smokers consistently paid more attention to graphic than text-only labels. Only 5 of the 9 graphic warning labels were significantly associated with greater thoughts of health risks. Thinking about quitting and stopping smoking did not differ by label. Qualitative data illustrated differences in the "stickiness," self-referencing, and counterarguments of graphic warning labels.

CONCLUSIONS

U.S. smokers' reactions to graphic warning labels on their own packs were similar to other, more controlled studies. Qualitative findings underscore the need for warning labels that encourage self-referential processing without increasing defensive reactions.

Evidence that brief self-affirming implementation intentions can reduce work-related anxiety in downsize survivors

BACKGROUND AND OBJECTIVES

Workers were recruited from a UK further education college during a period of organizational downsizing. This study assessed the effects of a brief health psychology intervention on work-related stress in downsize survivors.

DESIGN AND METHODS

Sixty-six employees were randomly allocated to one of two conditions: one in which they were asked to create a work-related self-affirming implementation intention (WS-AII) or a control. Feelings of anxiety and depression were measured before and after the intervention or control task and three weeks later. Job satisfaction, self-efficacy, and self-esteem were also measured.

RESULTS

There were statistically significant differences between the WS-AII condition and the control. Workers who created WS-AIIs reported an immediate reduction in anxiety. This reduction was also observed in their appraisal of job-related anxiety three weeks later. There were no significant effects of WS-AIIs on depression, job satisfaction, or self-esteem. There was, however, a significant effect on self-efficacy with workers in the WS-AII condition reporting greater self-efficacy.

CONCLUSIONS

The present findings suggest that the integration of brief health psychology interventions, such as the WS-AII, into existing organizational practice may be of benefit to the well-being of employees.

Health messaging to individuals who perceive ambiguity in health communications: the promise of self-affirmation

The perception that extant health messages about risk factors for a disease are ambiguous can be associated with greater anxiety and reduced interest in taking precautionary action. In this experiment, 247 female alcohol consumers who perceived varying degrees of ambiguity in current cancer prevention messages read an unambiguous article about the documented link between alcohol consumption and breast cancer. Before reading the article, half were given the opportunity to self-affirm by reflecting on an important value-a technique previously shown to enhance receptivity to threatening messages. The authors found that self-affirmation increased message acceptance among those who perceived relatively higher levels of ambiguity in cancer communications. Also, the relation between perceived ambiguity and risk perception became positive among self-affirmed participants, suggesting they had become less defensive. Self-affirmation may be an effective technique to use when delivering health communications to audiences who perceive a lack of consistency in prevention messages.

The psychology of change: self-affirmation and social psychological intervention

People have a basic need to maintain the integrity of the self, a global sense of personal adequacy. Events that threaten self-integrity arouse stress and self-protective defenses that can hamper performance and growth. However, an intervention known as self-affirmation can curb these negative outcomes. Self-affirmation interventions typically have people write about core personal values. The interventions bring about a more expansive view of the self and its resources, weakening the implications of a threat for personal integrity. Timely affirmations have been shown to improve education, health, and relationship outcomes, with benefits that sometimes persist for months and years. Like other interventions and experiences, self-affirmations can have lasting benefits when they touch off a cycle of adaptive potential, a positive feedback loop between the self-system and the social system that propagates adaptive outcomes over time. The present review highlights both connections with other disciplines and lessons for a social psychological understanding of intervention and change.

The moderating impact of self-esteem on self-affirmation effects

OBJECTIVES

This study explored whether self-esteem would moderate the effectiveness of a self-affirmation manipulation at increasing openness to personally relevant health-risk information.

DESIGN

The study employed a prospective experimental design.

METHOD

Participants (N = 328) completed either a self-affirmation manipulation or a control task, prior to reading information detailing the health-related consequences of taking insufficient exercise. They then completed a series of measures assessing their cognitions towards exercise and their derogation of the information. Exercise behaviour was assessed at 1-week follow-up.

RESULTS

Self-esteem moderated the impact of self-affirmation on the majority of outcomes. For participants with low self-esteem, the self-affirmation manipulation resulted in more positive attitudes and intentions towards exercise, together with lower levels of derogation of the health-risk information. By contrast, there was no effect of the self-affirmation manipulation on outcomes for participants with high self-esteem.

CONCLUSION

Findings suggest that self-affirmation manipulations might be of particular benefit for those with low self-esteem in terms of promoting openness towards health-risk information. This is promising from a health promotion perspective, as individuals with low self-esteem often represent those most in need of intervention. Statement of contribution What is already known on this subject? Self-affirmation has been shown to result in more open processing of personally relevant health-risk information. Individuals low in self-esteem tend to process such information more defensively than those high in self-esteem. What does this study add? It explores whether self-esteem moderates the impact of self-affirmation on responses to health-risk information. Findings suggest that individuals with low self-esteem benefit most from the self-affirmation manipulation. This has important applied implications, as individuals with low self-esteem may be most in need of intervention.