Self-regulatory cognitions, social comparison, and perceived peers’ behaviors as predictors of nutrition and physical activity: a comparison among adolescents in Hungary, Poland, Turkey, and USA

Demographic, clinical, and sociocognitive determinants related to physical activity and dietary intake in patients with ovarian cancer: A cross-sectional study

OBJECTIVE

To study physical activity and dietary intake among patients with ovarian cancer and to examine which demographic, clinical, and sociocognitive determinants are associated with these behaviours.

METHODS

This cross-sectional study included 139 patients with ovarian cancer scheduled for (neo)adjuvant chemotherapy. Physical activity was measured with the Physical Activity Scale for the Elderly questionnaire (PASE). Dietary intake was measured with a questionnaire assessing energy and protein intake and a questionnaire assessing adherence to the World Cancer Research Fund (WCRF) lifestyle recommendations. Demographic, clinical, and sociocognitive (e.g., self-efficacy) determinants of physical activity and dietary intake were examined using backward linear regression analyses.

RESULTS

Patients reported a median PASE score of 50 (IQR 24-94), a mean ± SD dietary intake of 1831 ± 604 kcal/day and 76 ± 27 g protein/day. Patients adhered to 3 out of 5 WCRF lifestyle recommendations. The absence of comorbidities, lower physical outcome expectations, and higher cancer specific outcome expectations were independently associated with higher physical activity levels. Higher age, lower cancer specific outcome expectations, and higher diet-related self-efficacy were significantly associated with adhering to more WCRF lifestyle recommendations, whilst no variables associated with total caloric or protein intake were identified.

CONCLUSIONS

Patients with ovarian cancer have low physical activity levels and a suboptimal diet, particularly low fruit and vegetable consumption and dietary fibre intake. Interventions aiming to improve physical activity and dietary intake could focus on increasing self-efficacy and outcome expectations, and should consider age and comorbidity as factors that may impact behaviour.

TRIAL REGISTRATION

Netherlands Trial Registry NTR6300.

Comparing the impact of personal trainer guidance to exercising with others: Determining the optimal approach

This study aimed to examine the effects of supervised fitness training under the guidance of a personal trainer and those of competitive fitness training with others and reveal the effects of specific differences between them in a detailed manner. The study's participants consisted of 66 healthy male adults (age: 29.2 ± 5.4 years). The participants were divided into three groups: the individual training group (n = 21), which served as the control group; the exercising with a partner group (n = 22); and the group trained by a personal trainer (n = 23). Each participant was subsequently assessed using one repetition maximum bench press, squats, skeletal muscle mass, fat mass, and a questionnaire regarding nutritional plan and injury to compare the effects of training sessions over a period of 12 weeks. Among the three groups, only the group trained by a personal trainer showed an obvious enhancement in fat reduction compared to baseline (-1.61 kg, p = 0.033), which was suggestive of a salient trend that far surpassed those of the individual training group and the exercising with a partner group. Regarding squats, only the group trained by a personal trainer showed a significant change compared to the individual training group (p = 0.003). Regarding the participants' consistent use of a nutritional plan, only the group trained by a personal trainer exhibited a palpable tendency (p < 0.001); furthermore, the effect of preventing injury in the group trained by a personal trainer was more notable than that in the individual training group and the exercising with a partner group. Our results indicate that a fitness personal trainer service is effective in expediting the process of achieving fitness goals in a relatively safe manner, thereby substantiating the diversified values of the fitness personal trainer service.

Behaviour change techniques in physical activity-focused interventions for young people at risk of problematic substance use: A systematic review and meta-analysis

AIM

This systematic review investigates behaviour change techniques in interventions promoting physical activity for young people aged 12-25 years at heightened risk of problematic substance use, and the effect of these techniques on physical activity participation and substance use outcomes.

METHODS

Four databases (PsycINFO, CINAHL, SPORTDiscus and Medline) were searched between November 2020 and November 2022 for randomized and non-randomized controlled studies according to inclusion criteria. Meta-analyses were calculated using weighted, standardized averages of effect sizes (Hedges' g).

RESULTS

Twenty-eight studies were included, 14 studies in the meta-analysis (intervention n = 1328; control n = 845). Reported BCTs included behavioural instructions, social comparison and goal setting. There was a significant effect of behaviour change techniques on combined substance use outcomes, such as cravings and consumption, for interventions reporting multiple behaviour change techniques (g = -0.33, p < .001, 95% CI [-0.50,-0.16]) or one single behaviour change technique (g = -1.84, p < .001, 95% CI [-2.89,-0.8]). Limitations include unexplained variance and limited reporting of relevant behaviour change technique data in the included studies.

CONCLUSION

The results indicate that using behaviour change techniques in interventions that promote physical activity for young people has an effect on substance use. Further research needs to be completed comparing the impact of the number and type of behaviour change technique, and improved reporting of intervention content is required.

Correlates of Dietary Behaviors Among Young Emirati Males Completing Compulsory Military Service

INTRODUCTION

It is important to understand the correlates of different dietary behaviors in a military context in the United Arab Emirates (UAE) to guide intervention development to prevent and treat obesity as it has a significant impact at the country and regional level. This study aimed to assess different dietary behaviors and their association with potential correlates including age, marital status, educational level, smoking status, screen time, dietary knowledge, eating self-efficacy, and general self-efficacy.

MATERIALS AND METHODS

The study used a cross-sectional design and included 153 (M = 25.9 years, SD = ± 3.2) military recruits completing their basic training at a single military camp in the UAE. Dietary behaviors of these recruits were measured using the Arab Teens Lifestyle Study. Other potential correlates included dietary knowledge, general self-efficacy, and eating efficacy. The ethical approval was obtained from the research ethics committee in the UAE university.

RESULTS

Daily intake of fruits, vegetables, and breakfast was reported by 14.4%, 25.5%, and 22.9% of the military recruits, respectively. Almost half of the recruits (46.4%) consumed sugar-sweetened drinks more than 3 times a week, 39.2% consumed fast food more than 3 times a week, and 37.3% consumed sweets/chocolates more than 3 times a week. Bivariate regression analyses revealed that eating self-efficacy was positively associated with breakfast and dairy food consumption, although it was inversely associated with sugar, fast-food, and French fries intake. Age was significantly and inversely associated with sugar, fast-food, and energy drink intake. Moreover, nutrition knowledge was significantly and positively correlated with vegetable intake and negatively correlated with energy drink consumption. Multiple regressions showed that lower age and lower eating self-efficacy were found to be the main predictors for sugar-sweetened drinks (adjusted R2 = 0.112) and fast-food intake (adjusted R2 = 0.084). Also, a higher dietary knowledge score was a predictor of vegetable intake (adjusted R2 = 0.093), although age and smoking predict energy drink intake (adjusted R2 = 0.225).

CONCLUSIONS

The results show that unhealthy eating patterns are common among new recruits in the UAE military. The study suggests that age, eating self-efficacy, and nutrition knowledge are the main correlates of selected dietary behaviors. Interventions are advised to target these correlates to achieve healthier dietary habits inside the military.

The effects of exposure to social media images of thin and average size women on body satisfaction among young women: Emotion regulation and self-efficacy as modulating factors

Although appearance comparison has emerged as an important mechanism underlying the detrimental effects of exposure to idealized social media images on body image among young women, little is known regarding the role of the direction of these comparisons. In addition, to date, little attention has been paid to the role of self-regulation processes in these effects. A sample of 260 female students (M_age = 19.6) from a University in Paris completed an online survey where they were randomly assigned to view thin-ideal or average size social media images of women. Participants reported on state body satisfaction before and after exposure, as well as state appearance comparison and direction of appearance comparison, and trait emotion regulation difficulties and self-efficacy. Findings revealed no main effect of condition. However, among participants who engaged in upwards appearance comparison the thin-ideal condition was associated with greater decreases in body satisfaction. In addition, three-way interactions revealed that emotional regulation difficulties and self-efficacy both further moderated these effects. These findings suggest that self-regulation processes may be important to account for in the effects of exposure to social media images on body satisfaction among young women.

Comparison of the Effects of Different Forms of Nutrition Education on Adolescent Male Soccer Players

The purpose of this study was to compare the educational effects on nutrition knowledge of two teaching methods targeting adolescent male soccer players through learning online from WeChat account articles (WeChat group) or taking classroom courses (classroom group). The study investigates whether such teaching methods can improve self-efficacy and nutrition knowledge for athletes. A total of 41 U15 (age 15) youth male soccer players, 21 in the classroom group and 20 in the WeChat group, participated in the experiment by receiving the same nutrition education separately for 12 weeks. An athlete nutrition KAP questionnaire and self-efficacy questionnaire were conducted before the intervention, immediately after the intervention, and 6 weeks and 12 weeks after the intervention. As a result, the nutritional knowledge score and the total score of the athlete nutrition KAP questionnaire in the classroom group increased significantly and were notably higher than those in the WeChat group. Self-efficacy scores improved significantly in both groups. In conclusion, the study showed that the level of nutritional knowledge of U15 male soccer players was mediocre, and both forms of nutrition education can significantly improve the level of nutritional knowledge and self-efficacy of the players. In comparison, the educational effect of classroom teaching is significantly greater and more consistent than that of learning from WeChat public articles.

Validierung einer Skala zur Erfassung der depressionsbezogenen Selbstwirksamkeitserwartung (DSW)

Zusammenfassung. Erste Befunde indizieren, dass Patientinnen und Patienten mit stark ausgeprägter depressionsbezogener Selbstwirksamkeitserwartung bessere Behandlungsergebnisse erzielen und ein geringeres Rückfallrisiko aufweisen. Bisher existieren jedoch nur englischsprachige validierte Instrumente zur Erfassung des Konstrukts. In der vorliegenden Studie erfolgte eine psychometrische Überprüfung der deutschsprachigen Adaptation (DSW-Skala) der Self-efficacy for Managing Depression Scale ( Bush et al., 2001 ) anhand von N = 377 primärärztlichen Patientinnen und Patienten mit depressiver Symptomatik, die zu Behandlungsbeginn sowie nach 3, 6 und 12 Monaten untersucht wurden. Die Ergebnisse belegten eine gute interne Konsistenz der Skala (Cronbachs α ≥ .85) und akzeptable Retest-Reliabilität ( rtt = .63). Die Responsivität der Skala sowie eine vergleichbare Messstruktur über alle Messzeitpunkte hinweg wurden nachgewiesen. Multiple Regressionsanalysen belegten die Vorhersagekraft der DSW-Skala bezüglich der depressiven Symptomatik über 6 Monate. Die Ergebnisse zeigen, dass die DSW-Skala gängige psychometrische Standards erfüllt, sodass die Skala als zeitökonomisches und reliables Messinstrument in der Praxis und Forschung eingesetzt werden kann.

Predictive effect of resilience on self-efficacy during the COVID-19 pandemic: The moderating role of creativity

INTRODUCTION

To appraise the relationship and mechanism between resilience and self-efficacy in the context of the COVID-19 pandemic, we proposed a model to investigate the effect of resilience on self-efficacy and the moderating effect of creativity in this regard.

METHODS

Scales that measured resilience, creative behavior, and self-efficacy were rated by 881 college students in China to establish the moderating model.

RESULTS

The results showed that resilience and self-efficacy of participating college students were positively correlated, which meant that high resilience could predict a high level of self-efficacy. Moderating analysis using the SPSS PROCESS plug-in showed that creativity was an important element of resilience that positively affected self-efficacy and that this moderating effect was more significant in participants with a high degree of creativity.

DISCUSSION

These findings can provide a better understanding of the relationship between resilience and self-efficacy in demonstrating the traumatic impact of the COVID-19 pandemic on adolescent mental health and academic performance.

Structural equation model of physical activity in Turkish schoolchildren: an application of the integrated behavioural model

OBJECTIVES

Childhood obesity is increasingly prevalent in the developing world including Turkey. This study examined constructs of the integrated behavioural model associated with physical activity in a sample of schoolchildren in Ankara, Turkey using structural equation modelling.

DESIGN

Cross-sectional survey by probability sampling.

SETTING

Fifteen schools of different socioeconomic strata in Ankara, Turkey with grade 4 students.

PARTICIPANTS

2066 (969 girls and 1097 boys) grade 4 schoolchildren and their parents selected using a probability-based sampling frame.

PRIMARY OUTCOME MEASURES

Three primary outcomes were used: moderate-to-vigorous physical activity, team sport participation, sedentary behaviour.

RESULTS

Data were collected from 2066 fourth-grade children from schools of three socioeconomic strata. Missing data were imputed using multiple imputation. To examine the integrated behavioural model, a structural equation model containing latent constructs for physical activity outcome expectancies, self-efficacy, home environment and social norms were fitted with the three outcomes above. Adequate model fit was achieved in the structural equation model (χ²=1821.97, df=872, p<0.001, Comparative Fit Index=0.91, Tucker Lewis Index=0.91, root mean square error of approximation=0.02, standardised root mean square residual=0.04). All scale items were significantly associated with their respective latent constructs (all p<0.001). Several significant pathways between latent constructs and outcomes of interest were observed (p<0.05). Self-efficacy was positively associated with moderate-to-vigorous physical activity (p<0.001) and team sport participation (p<0.001) and negatively associated with sedentary behaviour (p<0.001). Negative outcome expectancies were negatively associated with moderate-to-vigorous physical activity (p<0.01) and sedentary behaviour (p<0.01) while positive outcome expectancies were positively associated with team sport behaviour (p<0.001) and negatively associated with sedentary behaviour (p<0.05). Home support was positively associated with moderate-to-vigorous physical activity (p<0.01) and team sport participation (p<0.05). Finally, physical activity social norms were negatively associated with sedentary behaviour only (p<0.05).

CONCLUSIONS

This study supported the extension to Turkish children of the integrated behavioural model in relation to physical activity behaviours. Results illustrate multiple targets for interventions to increase physical activity.

Towards Understanding Post-Socialist Migrants’ Access to Physical Activity in the Nordic Region: A Critical Realist Integrative Review

Experiences of, and access and barriers to, physical activity (PA) differ between individuals. This becomes perpetuated in a migration context. Although there is super-diversity between migrant groups, health research rarely accounts for this cultural diversity. More concerningly, the matter of context is rarely scrutinized or juxtaposed with the specifics of certain ethnic groups. This integrative review assessed the evidence on post-socialist migrants’ PA levels, constraints, and enablers for PA in the Nordic region. The results show that post-socialist female migrants have an especially high risk of being physically inactive. The qualitative work elucidates socio-cultural factors that impose specific constraints on females when attempting to engage in PA. Furthermore, in scrutinizing the context, Nordic nature (Friluftsliv) is a viable way for migrants to access PA with additional health benefits (e.g., mental). However, the Nordic environment also poses specific PA challenges, such as harsh winters. This can be understood by considering post-socialist migrants’ prior use of, and attitude to, nature. The review highlights the importance of understanding specifics about both migrant groups and contexts through a critical-realist lens in the pursuit of providing PA opportunities. Future PA programs need to understand the contextual, sociohistorical, and cultural settings in which they and migrants are embedded.

Generalized self-efficacy and compliance with health behaviours related to COVID-19 in the US

OBJECTIVE

Investigate the role of generalized self-efficacy (GSE) in compliance with COVID-19 health behaviours such as wearing masks and social distancing.

DESIGN

Two studies conducted online in the US: 312 adults in Study 1 and 253 adults in Study 2.

MAIN OUTCOME MEASURES

In Study 1, participants reported compliance with four health behaviours related to COVID-19: social distancing, hand washing, avoiding non-essential travel, and wearing masks. In Study 2, participants reported expected compliance with wearing masks when it was framed as a national requirement, a state requirement, or a recommendation.

RESULTS

In Study 1, GSE positively affected reported compliance with COVID-19 health behaviours. This result was mediated by the perception that these behaviours would offer enhanced control. Psychological reactance negatively affected reported compliance, while trust in science-based institutions and perceived threat from COVID-19 exerted positive effects. In Study 2, requiring (vs. recommending) masks led to higher willingness to comply with COVID-19 health behaviours. This was moderated by GSE, which significantly impacted compliance only when masks were required rather than recommended.

CONCLUSION

Higher GSE predicted increased compliance with health behaviours related to COVID-19, such as wearing masks. This effect was strongest when these behaviours were framed as required rather than recommended.

The relation of servant leadership with followers' organizational citizenship behaviour (OCB): mediating role of generalized self-efficacy (GSE) and organization–based self-esteem (OBSE)

Purpose

This study aims to understand the relationship between servant leadership (SL) and followers’ organizational citizenship behaviour (OCB) along with the mediational role of generalized self-efficacy (GSE) and organization-based self-esteem (OBSE) on the relationship.

Design/methodology/approach

A review of literature on leadership has been carried out to formulate a conceptual model that has focussed on the relationship between SL and followers’ OCB. The paper has also drawn the role of GSE and OBSE with relation to SL and followers’ OCB.

Findings

The literature has highlighted the importance of SL in promoting followers’ OCB, GSE and OBSE, and the positive relation of GSE and OBSE with followers’ OCB is also demonstrated.

Research limitations/implications

This is a conceptual work that has drawn from secondary material. A further empirical examination can help validate the ideas that have been proposed here.

Practical implications

This paper has highlighted the role of SL in organizations. It has also provided ample scope for practitioners to rethink about their current leadership style/approach and to plan their approach in such a way that can facilitate followers’ OCB, GSE and OBSE, which may result in organizational productivity and sustainability.

Originality/value

This paper has tried to connect two mediators, i.e. GSE and OBSE with SL in the Indian context that has been studied differently concerning different contexts, and that may add a new dimension to the discourse on SL.

Fruit and vegetables consumption among school-going adolescents: Findings from the baseline survey of an intervention program in a semi-urban area of Dhaka, Bangladesh

INTRODUCTION

Interventions aimed at promoting healthy eating habits in adolescence can help prevent chronic diseases and promote healthy ageing. The aim of this paper is to describe the fruit and vegetables consumption habits of adolescents in Dhaka, Bangladesh as well as to identify the socio-environmental, personal, and behavioral factors that influence these habits.

MATERIALS AND METHODS

The baseline data from an intervention study involving 823 grade ten students from two randomly selected secondary schools in a semi-urban area of Dhaka were analyzed. The intake of fruit and vegetables was measured in terms of serving size per day. Hierarchical multiple regression was used to assess the ability of socio-environmental factors such as social support, perceived barriers, and living with patient with chronic diseases; personal factors such as knowledge, self-rated practice, behavioral intention, and body mass index; and behavioral factors such as physical activity, sedentary hours, and sleep duration to predict the level of daily fruit and vegetables intake, after controlling the effect of demographic characteristics of adolescents.

RESULTS

The average daily consumption of fruit and vegetables was 1.22 and 1.99 servings, respectively. Only one-fifth of the respondents (21%) reported eating five servings of fruit and vegetables a day. Inaccessibility at home was reported as the most perceived barrier for both fruit and vegetables intake. Adolescents' higher fruit and vegetables intake was found to be associated with higher maternal educational attainment, more social support, adequate self-rated practice, positive behavioral intention, higher body mass index, better physical activity, and adequate daily sleeping.

CONCLUSION

The findings revealed insufficient fruit and vegetables intake among adolescents in a semi-urban area of Bangladesh and associated socio-environmental, personal, and behavioral factors that were utilized in developing an intervention program for this transient age group.

TRIAL REGISTRATION

Trial was registered at ClinicalTrials.gov (NCT03975335) https://clinicaltrials.gov/ct2/show/NCT03975335 on June 01, 2019.

Developing Messages Tailored to Self-construal, Time-orientation, and Perspective Taking to Promote 6-Month Exclusive Breastfeeding

Exclusive breastfeeding brings tremendous benefits to the mother and the baby but simultaneously poses great challenges. Research has been limited regarding the effectiveness of persuasive messages to promote exclusive breastfeeding, which leaves us with little understanding of how to enhance the exclusive breastfeeding rates. Guided by the message tailoring literature, this research employed a 2 (self- vs. other-oriented benefits) X 2 (short- vs. long-term benefits) X 2 (acknowledgment of disadvantages: yes vs. no) plus a no-message control condition between-subject factorial design and recruited 521 pregnant women to test the effectiveness of the persuasive messages. A significant interaction between perceived short- and long-term benefits of exclusive breastfeeding and participants' time orientation was yielded. Additionally, a three-way interaction emerged among the three message manipulations, which shed light on future research on message tailoring. Theoretical and practical implications are discussed.

Social predictors of daily relations between college women's physical activity intentions and behavior

Women perform less physical activity (PA) than men, and this gap widens during college. This study examined college women's daily PA intentions and behavior, and whether social support or social comparison orientation (SCO) moderated the PA intention-behavior relation. College women (N = 80) completed measures of social support and SCO at baseline. For seven consecutive days, participants completed an electronic survey to assess PA intentions and wore an activity monitor to assess minutes of moderate-to-vigorous intensity physical activity (MVPA). Results indicated that intended and performed MVPA minutes were weakly related (p = 0.17, sr = 0.16). Social support did not moderate the intention-behavior relation, but SCO did (p = 0.04, sr = 0.21). Participants with stronger (vs. weaker) SCO, particularly a tendency to compare downward (i.e., to worse-off others), showed smaller discrepancies between intended and completed MVPA. College women frequently fail to achieve PA goals, but stronger tendencies to make (downward) social comparisons may minimize this gap and be a target for intervention.

Rationale and Design of the Women's Health And Daily Experiences Project: Protocol for an Ecological Momentary Assessment Study to Identify Real-Time Predictors of Midlife Women's Physical Activity

BACKGROUND

Midlife women are at an elevated risk for cardiovascular disease (CVD) and associated mortality. Those who have additional risk conditions such as obesity or hypertension report specific barriers to engaging in cardioprotective behaviors such as physical activity (PA). Considerable effort has been devoted to understanding PA determinants and designing interventions for midlife women, although with suboptimal success, as increasing PA could meaningfully attenuate CVD risk. An updated approach to understanding PA among midlife women could improve upon existing resources by focusing on novel psychosocial influences on PA in this population (ie, body satisfaction, social interactions, social comparisons, mood state) and within-person relations between these influences and PA in the natural environment.

OBJECTIVE

The overarching goal of Project WHADE (Women's Health And Daily Experiences) is to use an ecological momentary assessment (EMA) approach to capture ecologically valid relations between midlife women's psychosocial experiences and PA as they engage in their normal daily activities. The primary aim of the study is to identify within-person psychosocial predictors of variability in PA (ie, experiences associated with higher vs lower PA for a given individual).

METHODS

Midlife women (aged 40-60 years) with one or more additional risk markers for CVD (eg, hypertension) will be recruited from primary care clinics and the general community (target n=100). Eligible women will complete an initial survey and a face-to-face baseline session before engaging in a 10-day EMA protocol. Psychosocial experiences will be assessed using a brief self-report via a smartphone 5 times per day, and PA will be assessed throughout waking hours using a research-grade monitor. Participants will return for a brief exit interview at the end of 10 days. Multilevel models that address the nested structure of EMA data will be used to evaluate the study aims.

RESULTS

Recruitment and enrollment are ongoing, and a total of 75 women have completed the protocol to date. Data collection is expected to be completed in Fall 2020.

CONCLUSIONS

Project WHADE is designed to identify naturally occurring psychosocial experiences that predict short-term variability in midlife women's PA. As such, the results of this study should advance the current understanding of PA among midlife women by providing further insight into within-person psychosocial influences on PA in this group. In the future, this information could help inform the design of interventions for this population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19044.

Associations between self-efficacy and sedentary behaviour: a meta-analysis

Objective: The study sought to synthesize research on the relationship between time spent engaged in sedentary behaviours (SB) and self-efficacy. Analyses investigated whether such associations are moderated by age, conceptualization of self-efficacy, conceptualization of SB, and/or SB measurement.Design and Main Outcome Measures: The review was registered with PROSPERO (no. CRD42018086899). Studies including associations between self-efficacy and SB were identified through a systematic search of six databases. Inclusion criteria were met by k = 26 original studies.Results: A random effect meta-analysis showed that higher levels of self-efficacy were associated with lower levels of SB (r = -.158, 95% CI [-.220, -.094]). Moderator analyses indicated that associations between self-efficacy and SB may be similar in strength across age groups, the conceptualizations of self-efficacy or SB and SB measurements.Conclusion: The findings provide preliminary guidance for future interventions targeting reduction of SB, although more longitudinal research is needed to draw causal inferences.

Vicarious Experience to Affect Physical Activity in Women: A Randomized Control Trial

People compare themselves to others for self-evaluation, practical information, and motivation for healthy behaviors. The effect of active peer models on comparative thinking is unknown. The purpose of this 12-week, randomized, two-group pilot study was to evaluate the effect of a workplace peer modeling intervention on self-efficacy, motivation, and comparative thinking. The attention control group (ACG; n = 24) received general health information. The intervention group (n = 26) met with active peer models, received an exercise prescription and information. No significant group by time interaction effects were found. Comparisons on ability (how well am I doing), opinions (what should I think or believe), future self (think about my future), and modeling (be like someone else) all increased in the intervention group (n = 21) but decreased in the ACG (n = 22). Active peer models may support physical activity behavior change through specific lines of comparative thinking.

Social Comparison Features in Physical Activity Promotion Apps: Scoping Meta-Review

Background

Smartphone apps promoting physical activity (PA) are abundant, but few produce substantial and sustained behavior change. Although many PA apps purport to induce users to compare themselves with others (by invoking social comparison processes), improvements in PA and other health behaviors are inconsistent. Existing literature suggests that social comparison may motivate PA for some people under some circumstances. However, 2 aspects of work that apply social comparison theory to PA apps remain unclear: (1) how comparison processes have been operationalized or harnessed in existing PA apps and (2) whether incorporating sources of variability in response to comparison have been used to tailor comparison features of apps, which could improve their effectiveness for promoting PA.

Objective

The aim of this meta-review was to summarize existing systematic, quantitative, and narrative reviews of behavior change techniques in PA apps, with an emphasis on social comparison features, to examine how social comparison is operationalized and implemented.

Methods

We searched PubMed, Web of Science, and PsycINFO for reviews of PA smartphone apps. Of the 3743 initial articles returned, 26 reviews met the inclusion criteria. Two independent raters extracted the data from these reviews, including the definition of social comparison used to categorize app features, the percentage of apps categorized as inducing comparison, specific features intended to induce comparison, and any mention of tailoring comparison features. For reference, these data were also extracted for related processes (such as behavioral modeling, norm referencing, and social networking).

Results

Of the included review articles, 31% (8/26) categorized app features as prompting social comparison. The majority of these employed Abraham and Michie’s earliest definition of comparison, which differs from versions in later iterations of the same taxonomy. Very few reviews specified what dimension users were expected to compare (eg, steps, physical fitness) or which features of the apps were used to induce comparison (eg, leaderboards, message boards). No review referenced tailoring of comparison features. In contrast, 54% (14/26) reviews categorized features for prompting behavioral modeling and 31% (8/26) referenced tailoring app features for users’ personal goals or preferences.

Conclusions

The heterogeneity across reviews of PA apps and the absence of relevant information (eg, about dimensions or features relevant for comparison) create confusion about how to best harness social comparison to increase PA and its effectiveness in future research. No evidence was found that important findings from the broader social comparison literature (eg, that people have differing preferences for and responses to social comparison information) have been incorporated in the design of existing PA apps. Greater integration of the mobile health (mHealth) and social comparison literatures may improve the effectiveness of PA apps, thereby increasing the public health impact of these mHealth tools.

International Registered Report Identifier (IRRID)

RR2-https://osf.io/nh4td/

Daily Relations between Social Perceptions and Physical Activity among College Women

OBJECTIVES

There is a need to develop more effective physical activity (PA) promotion programs for college women. Theory and evidence suggest that perceptions of the social environment play a role in college women's PA, though little is known about how these perceptions are associated with PA at the day level. The goal of this study was to examine relations between changes in college women's daily social perceptions and objectively assessed PA over seven days.

DESIGN

Daily diary method.

METHOD

College women (n = 80, M Age = 20, M BMI = 23.1 kg/m2) wore Fitbit wristbands and completed daily self-reports of (1) the quantity and perceived intensity of their social interactions (positive/negative), and (2) the occurrence of social comparisons (based on appearance/health/status) for seven days.

RESULTS

Multilevel models showed daily variability in predictors and outcomes (ps < 0.0001), as well as relations between within-person changes in social perceptions and PA. Increases in negative interactions (particularly those with friends) were consistently associated with decreases in daily PA, whereas increases in positive interactions showed limited relations (srs = -0.22-0.34). Days with health comparisons were days with greater PA for women who had stronger overall interest in comparisons, but were days with less PA for women with weaker overall interest (srs = 0.22-0.33). PA did not differ between days with vs. without appearance comparisons.

CONCLUSIONS

Social perceptions show meaningful day-to-day variability and relations with college women's daily PA, and specific associations may be useful for improving tailored interventions for college women.

Methods to Assess Social Comparison Processes Within Persons in Daily Life: A Scoping Review

Self-evaluations relative to others (i.e., social comparisons) have well-established implications for health and well-being, and are typically assessed via global, retrospective self-report. Yet, comparison is inherently a dynamic, within-person process; comparisons occur at different times, on a range of dimensions, with consequences that can vary by context. Global, retrospective assessment forces aggregation across contexts and reduces ecological validity, limiting its utility for informing a nuanced understanding of comparisons in daily life. Research across social and clinical psychology has implemented methods to assess comparisons naturalistically, involving intensive, repeated assessments of comparison occurrence, characteristics, and consequences in everyday life (via ecological momentary assessment or daily diaries). Although promising, this work to date lacks an overarching conceptual framework for guiding decisions about assessment design and implementation. To address this gap, the aims of this scoping review were: (1) to summarize available literature on within-person naturalistic assessment of social comparison, and (2) to provide a set of key considerations to inform future social comparison research using within-person naturalistic assessment. Searches in PubMed, PsycInfo, and CINAHL identified relevant articles published before June 2019. Articles were included if they described at least 3 comparison assessments within each participant, taken in the natural environment, and spaced no more than ~24 h apart (i.e., repeated momentary or daily assessment). In articles meeting these criteria (33 unique studies across 36 published papers), we summarized aspects of the comparison assessment, including recording methods, direction (e.g., upward, downward), target (e.g., friend, stranger), and dimension (e.g., status, appearance). Most studies assessed appearance comparisons (vs. other comparison dimensions) and collected information in response to signals (rather than initiated by participants). However, there was considerable heterogeneity in the number of assessments, assessment periods, recording modalities, and comparison predictors and outcomes assessed. Findings broadly establish heterogeneity in the aspects of comparison considered critical for within-person naturalistic assessment. We describe key decision points for future work to help advance within-person naturalistic assessment methods and improve the utility of such approaches to inform research, theory, and intervention.

The Association between Demographic Characteristics, Lifestyle Health Behaviours, and Quality of Life among Adolescents in Asia Pacific Region

Background: Given the risk of physical and psychosocial health that emerge in adolescents that are continuing into adulthood, identifying and addressing early signs of health-related quality of life (HRQoL) decline provides an opportunity to ensure that young people have a healthier progression through adolescence. Aim: To investigate the association between demographic characteristics, lifestyle health behaviours, and HRQoL of adolescents who live in Asia Pacific region, including Hong Kong in China, Beijing in China, Akashi in Japan, Seoul in South Korea, and Bangkok in Thailand. Methods: A cross-sectional self-reported survey carried out in a sample of 2296 adolescents that were aged 9-16 years (mean= 12.0; standard deviation [SD] = 1.63) was conducted in the five cities of the Asia Pacific region between January and August 2017. Demographic characteristics, adolescent lifestyle behaviours, and HRQoL were measured with demographic questionnaire, Adolescent Lifestyle Questionnaire's (ALQ) seven domains and Paediatric Quality of Life's (PedsQL 4.0) global score, respectively. Mixed multilevel model (MMLM) was used to fit the data. Results: After adjusting the demographic variables, one score increase in ALQ physical participation, nutrition, social support, and identity awareness are associated with an increase in PedsQL global score. On the contrary, one score increase in ALQ health practices is associated with a decrease in the PedsQL global score. The estimated mean of PedsQL global score of South Korea, Beijing, and Japan were better, while the score of Thailand and Hong Kong were poorer. Conclusions: Differentiating the impacts of promoting health behaviours among different countries can help in better understanding the health needs of adolescents in each country, especially in the Asia Pacific region, so that adequate and relevant resources can be allocated to reduce health-risk taking behaviours among this vulnerable group for health-promoting strategies.

Time perspective differences between depressed patients and non-depressed participants, and their relationships with depressive and anxiety symptoms

BACKGROUND

Time perspective (TP) can be described as an individual's attitude towards his personal past, present and future. Literature suggests that it plays a role in several areas of psychological functioning (self-efficacy, coping) and impacts actual thoughts and behaviors. However, TP has seldom been studied in mental health, despite previous studies suggesting that the temporal profile is altered in depressed patients. This study investigates the differences of TP between depressed patients and non-depressed participants, and its relationship with depressive and anxiety symptoms.

METHODS

45 patients diagnosed with major depressive disorder were compared to 43 non-depressed participants recruited in the general population. Participants were asked to answer time perspective (ZTPI), depression (BDI-13) and anxiety (STAI-Y) self-report inventories. Statistical analysis included comparisons of scores between depressed patients and non-depressed participants, correlation and regression analysis.

RESULTS

Results indicate that TP is significantly altered in depressed patients. They display a more negative view of their past, a less hedonistic perspective towards their present, and a more fatalistic perspective when compared to non-depressed participants. Regression analysis shows that depressive and anxiety symptoms are associated with negative past and fatalistic present, and similar results are found with correlation analysis.

LIMITATIONS

The size of the sample was small, and longitudinal studies are needed to understand the dynamics and causal relationship between TP and depression.

CONCLUSIONS

These results underline the importance of considering TP in depressed patients, and encourage an in depth study of the relationship between TP and mood disorders. Therapeutic perspectives are discussed.

Prospective Relations between Social Comparison Orientation and Weight Loss Outcomes

Maintenance of weight loss after behavioral intervention tends to be poor, and there is need for an improved understanding of factors that are associated with successful maintenance. Social comparison is known to be a powerful influence on treatment outcomes for group-based behavioral weight loss programs, but little is known about the role of individual differences in social comparison orientation (i.e., tendency to value comparison information) in this context. The goal of this study was to examine prospective relations between social comparison orientation and long-term weight loss outcomes (percent weight loss and aerobic-intensity physical activity) among participants in behavioral weight loss treatment. Participants (n = 161, M_Age = 54, M_BMI = 34.4 kg/m²) completed a measure of social comparison orientation at pre-treatment baseline. Height and weight were measured in the research center and aerobic-intensity physical activity was assessed via accelerometer at baseline, mid- and end-of-treatment, and at 6 and 12 months post-treatment (representing maintenance). Multilevel models tested prospective relations between comparison orientation and treatment outcomes over time, with emphasis on differences during the post-treatment maintenance phase. Stronger (vs. weaker) general comparison orientation was associated with better maintenance of aerobic-intensity physical activity. However, stronger (vs. weaker) orientation toward comparisons with better-off others (i.e., upward comparison) was associated with less weight loss success during and after treatment. Social comparison orientation thus shows meaningful relations with long-term maintenance of key outcomes in group-based behavioral weight loss treatment, and warrants further investigation in this context.

Using the Adolescent Time Inventory—Time Attitudes (ATI-TA) to assess time attitudes in Italian adolescents and young adults: Psychometric properties and validity

Time attitudes (TA) are evaluative feelings toward the past, present and future. Given the role of TA in psychological and behavioral outcomes, the aim of this study was to analyze the adequacy of the Adolescent Time Inventory—Time Attitudes (ATI-TA) scale among adolescents and young adults in Italy. The scale was administered to 638 students in order to test its psychometric properties and validity. The analyses confirmed the adequacy of the six-factor model and the reliability of the subscales. Additionally, the measurement invariance of the scale across genders and age groups (between adolescents up to the age of 18, and young adults above 18) was demonstrated. Specifically, gender invariance reached the level of equivalence of error variances/covariances, and the same level was partially reached for invariance across age groups. Evidence of the validity of the scale was also provided by obtaining significant correlations between the subscales, and self-esteem and strategic learning. Taken together, these results support the suitability of the ATI-TA to be used for research and clinical purposes.

Perceptions of a Peer Modeling Workplace Physical Activity Intervention for Women

A workplace physical activity (PA) study tested a novel use of peers to deliver the intervention. Peer models provided vicarious experience for living physically active lifestyles to a group of inactive women. The purpose of this study was to describe participants' perceptions of the peer modeling intervention. Nine women from the intervention group ( n = 26) participated in a 90-minute focus group. Qualitative description using thematic analysis was used to identify themes from the focus group transcript. Two themes about the intervention were "I am left wanting more" and "focus on food." Two themes about the peer models were "real people" and "it is doable." Focus group participants perceived the peer modeling PA intervention favorably; however, they desired more attention to healthy eating and more time with peer models. Replication of the study accounting for themes identified by focus group participants is needed to strengthen the peer modeling intervention.

Psychosocial Determinants of Food Acquisition and Preparation in Low-Income, Urban African American Households

BACKGROUND

Psychosocial factors are important determinants of health behaviors and diet-related outcomes, yet relatively little work has explored their relation to food-purchasing and preparation behaviors in low-income populations.

AIM

To evaluate the psychosocial factors associated with food-related behaviors.

METHODS

Cross-sectional data collected from 465 low-income African American adult caregivers in the baseline evaluation of the B'more Healthy Communities for Kids obesity prevention trial. Questionnaires were used to assess household sociodemographic characteristics, food sources frequently used, and food preparation and food acquisition behaviors. Multiple linear regression models explored the associations between caregiver psychosocial variables and food-related behaviors, controlling for caregivers' age, sex, household income, household size, and food assistance participation.

RESULTS

Caregivers purchased prepared food at carry-outs on average 3.8 times (standard deviation [ SD] = 4.6) within 30 days. Less healthy foods were acquired 2 times more frequently than healthier foods ( p < .001). Higher food-related behavioral intention and self-efficacy scores were positively associated with healthier food acquisition (β = 0.7; 95% confidence interval [CI] [0.09, 1.4]; β = 0.04; 95% CI [0.02, 0.06]) and negatively associated with frequency of purchasing at prepared food sources (β = -0.4; 95% CI [-0.6, -0.2]; β = -0.5; 95% CI [-0.7, -0.3]), respectively. Higher nutrition knowledge was associated with lower frequency of purchasing food at prepared food venues (β = -0.7; 95% CI: [-1.2, -0.2]).

DISCUSSION

Our findings indicate a positive association between psychosocial determinants and healthier food acquisition and food preparation behaviors.

CONCLUSION

Interventions that affect psychosocial factors (i.e., food-related behavioral intentions and self-efficacy) may have the potential to increase healthier food preparation and food-purchasing practices among low-income African American families.

Users' intention to continue using social fitness-tracking apps: expectation confirmation theory and social comparison theory perspective

Introduction: The key step in changing health behavior is understanding why users continue to use fitness apps. Therefore, we intend to investigate the users' intention to continue using social fitness-tracking apps. Materials and Methods: We identify two major forces driving continuous behavior. Expectation confirmation is the internal driving force and social comparison is the external driving force. A survey was conducted to test this proposed research model. We obtained 211 valid questionnaires. Results: Our results indicate that activity amount ranking (p < 0.001) and activity frequency ranking (p < 0.001) positively affect confirmation and that confirmation (p < 0.001) also positively affects the continuous intention of individuals using fitness-tracking apps. In addition, the impact of activity amount ranking and activity frequency ranking on continuous intention is moderated by expectation confirmation. Meanwhile, as the upward comparison tendency increases, the positive effect of confirmation on continuous intention decreases (p < 0.001). Conclusions: Social rank expectation and confirmation are the primary driving forces of continuous intention in individuals using fitness-tracking apps. Social rank is a meaningful and straightforward measurement individuals can use to evaluate their activity performance. An upward comparison tendency weakens the effect of confirmation on continuous intention.

Sex Differences in the Association of Perceived Ambiguity, Cancer Fatalism, and Health-Related Self-Efficacy with Fruit and Vegetable Consumption

Adequate fruit and vegetable (FV) consumption is promoted as a means of preventing chronic health conditions, such as cardiovascular disease and cancer. This study investigated whether perceived ambiguity about cancer prevention recommendations, fatalistic beliefs about cancer, and health-related self-efficacy were associated with FV consumption and whether sex moderated these associations. Data from the five most recent waves (spanning 2011 to 2017) of the nationally representative Health Information National Trends Survey (N = 16,965) were used. Participants reported levels of perceived ambiguity, cancer fatalism, health-related self-efficacy, and daily FV consumption. Perceived ambiguity and cancer fatalism were negatively associated with FV consumption, ps <.001, whereas health-related self-efficacy was positively associated with FV consumption, b = 0.34, p < .001. Sex moderated these associations, ps <.05. Perceived ambiguity and cancer fatalism were more strongly associated with less FV consumption for men, bs < -0.31, ps <.001, than women, bs < -0.14, ps <.01. In contrast, health-related self-efficacy was more strongly associated with more FV consumption for women, b = 0.43, p < .001, than men, b = 0.26, p < .001. These results suggest that tailoring health messaging to target sex-specific barriers may improve their effectiveness.

Social Comparison Orientation in Monozygotic and Dizygotic Twins

Twin research has offered evidence that monozygotic (MZ) twins are more socially close than dizygotic (DZ) twins, but has not paid much attention to the way twins compare themselves with their co-twin. The few studies in this area suggest that ‘horizontal comparisons’ (social comparison motivated by solidarity or communion with others) matter more for MZ twins than for DZ twins, at least when the co-twin is the social comparison standard. Consistent with this view, we predicted higher interest in MZ twins relative to DZ twins to select their co-twin rather than other people in general as the social comparison standard. The Social Comparison Orientation (SCO) scale, which measures the inclination to compare with others in a horizontal rather than vertical mode (comparing either upward or downward), was administered in 90 MZ pairs and 57 same-sex DZ pairs (63% female; average age 18.06 years) from the Netherlands Twin Register. MZ twin pairs showed significantly higher SCO scores than DZ twin pairs (with a large effect size) on the co-twin SCO, whereas the two groups did not differ from each other on the general SCO excluding the co-twin as social comparison standard. In MZ twin pairs, anxiety was associated with social comparison with others in general, not with their co-twin. For both scales, twin resemblance was explained by additive genetic variance. The present findings provide direct evidence that horizontal comparisons with the co-twin are of particular importance for MZ twins.

The Influence of Peers on Diet and Exercise Among Adolescents: A Systematic Review

Adolescents' diet and exercise are modifiable factors contributing to high rates of adolescent obesity. Diverse contextual factors, including family, social environment, and peers, affect adolescents' diet and exercise behaviors. Because peer influence increases during adolescence, peers' contributions to adolescents' diet and exercise behaviors should be examined as potential targets for intervention to reduce the prevalence of adolescent obesity. The purpose of this systematic review is to identify research examining the contribution of peers to diet and exercise of adolescents. The electronic databases PubMed, CINAHL, Web of Science, and SCOPUS were searched. A total of 24 unique articles were included: seven examined diet only, fourteen studied exercise only, and three explored diet and exercise. This review provided evidence that diet and exercise of adolescents were significantly associated with those of their peers. However, these associations differed depending on gender, the type of diet and exercise, and closeness of friends. Findings from this review suggest that peers could be possible targets for interventions to promote healthier diet and exercise among adolescents; however, more studies are needed to identify specific peer influences and develop tailored interventions.

The relationship between time perspective and self-regulatory processes, abilities and outcomes: a protocol for a meta-analytical review

INTRODUCTION

Both theoretical and empirical evidence suggests that time perspective is likely to influence self-regulatory processes and outcomes. Despite the theoretical and practical significance of such relations, the relationship between time perspective and self-regulatory processes and outcomes across different measures, samples and life domains, including health, has yet to be explored.

METHODS AND ANALYSIS

The proposed review will develop a taxonomy for classifying measures according to the self-regulatory process, ability or outcome that they are likely to reflect. Electronic scientific databases will be searched, along with relevant conference abstract booklets and citation lists. Additionally, a call for unpublished data will be submitted to relevant bodies. To be eligible for inclusion, studies must include a measure of time perspective and a measure of at least one self-regulatory process, ability and/ or outcome. Eligibility will not be restricted by publication date, language, type of sample or setting. The bivariate correlations will be extracted (or calculated) and submitted to a random-effects meta-analysis. The sample-weighted average effect size, heterogeneity, risk of bias and publication bias will be calculated, and the effects of categorical and continuous moderator variables on the effect sizes will be determined.

ETHICS AND DISSEMINATION

The proposed meta-analysis will synthesise previously conducted research; thus, ethical approval is not required. The findings will be submitted for publication in an international peer-reviewed journal and reported as part of the first author’s PhD thesis. The findings will also be disseminated to the research community and, where appropriate, to other interested parties through presentations at relevant academic and non-academic conferences.

Face-to-Face and Online Networks: College Students' Experiences in a Weight-Loss Trial

This study aimed to understand how college students participating in a 2-year randomized controlled trial (Project SMART: Social and Mobile Approach to Reduce Weight; N = 404) engaged their social networks and used social and mobile technologies to try and lose weight. Participants in the present study (n = 20 treatment, n = 18 control) were approached after a measurement visit and administered semi-structured interviews. Interviews were analyzed using principles from grounded theory. Treatment group participants appreciated the timely support provided by the study and the integration of content across multiple technologies. Participants in both groups reported using non-study-designed apps to help them lose weight, and many participants knew one another outside of the study. Individuals talked about weight-loss goals with their friends face to face and felt accountable to follow through with their intentions. Although seeing others' success online motivated many, there was a range of perceived acceptability in talking about personal health-related information on social media. The findings from this qualitative study can inform intervention trials using social and mobile technologies to promote weight loss. For example, weight-loss trials should measure participants' use of direct-to-consumer technologies and interconnectivity so that treatment effects can be isolated and cross-contamination accounted for.

Health Communication With Same-Sex and Other-Sex Friends in Emerging Adulthood

Objective We examined health-related communication between same-sex and other-sex friends and how communication was related to health-related behavior. Participants Data from 243 emerging adults attending college ( Mage = 18.96, SD = 1.43; 55.6% male) were analyzed. Methods Participants completed measures assessing the frequency in which they talked about and made plans to engage in exercise and nutrition-related behaviors with friends, as well as how often they engaged in exercise and nutrition-related behaviors. Results In general, participants reported more health-related communication with same-sex friends. Health-related communication with same-sex friends was positively related to health behaviors for men and women. However, the pattern of results differed for men and women depending on the topic of communication and the behavior being examined. Conclusion Our study extends the literature by examining the role of sex of friends in health communication and planning and how interactions with friends relate to health-promoting behavior.

High on Attractiveness, Low on Nutrition: An Over-Time Comparison of Advertising Food Products on Israeli Television

This content analysis examines Israeli television food advertising. It compares 2008-2009 and 2012-2013, two periods immediately before and several years after regulatory, educational, and public-advocacy efforts have been advanced to raise awareness of and tackle the television-obesity link. Advertisements were drawn from a composite week sample aired on Israeli broadcast channels from 4:00 p.m. until midnight in each of the two periods. Nearly a quarter of ads were for food products, even after a significant drop over the years. The most common food categories included candies and sweetened drinks, whereas fruit and vegetables were among the least common products advertised. The most prevalent central message in food advertisements was that the product makes for an economically sensible purchase, with a much lower focus on the health qualities of the food products. Food advertisements were characterized by a very short duration and an increased reliance on emotional, rather than cognitive, appeal, especially in ads for low-nutrient foods. A significant increase was observed in 2012-2013 in the reliance on thin models in food advertisements, and these were most often associated with high levels of physical attractiveness, promoting the thin ideal. Findings are discussed in light of theory, previous research conducted worldwide, and audience effects. Implications are addressed for health and media industry regulation efforts.

Psychosocial predictors of changes in adolescent girls' physical activity and dietary behaviors over the course of the Go Girls! group-based mentoring program

Changes in social cognitions targeted within a group-based mentoring program for adolescent girls were examined as predictors of changes in physical activity (PA) and dietary behavior (in two separate models) over the course of the 7-week program. Data were collected from 310 participants who participated in the program. Multilevel path models were used to assess changes in psychosocial variables predicting changes in behavioral outcomes from pre- to post-program. Analyses revealed that 24.4 and 12.3% of the variance in increases in PA and dietary behavior, respectively, was explained by increases in affective and instrumental attitudes, self-regulatory efficacy (SRE), and intentions. Increases in intentions partially mediated the effects of increases in SRE and affective attitudes on increases in PA behavior. In relation to improvements in dietary behavior, increases in intentions and SRE directly predicted improvements in dietary behavior. These findings suggest potential psychological mechanisms through which a group-based mentoring program may lead to changes in adolescent girls' health-enhancing PA and dietary behaviors.

Physical activity and time preference

This paper investigates the link between time preference (whether a person is more present or future oriented) and time spent participating in physical activity. Using data on time spent engaged in physical activity from the National Longitudinal Surveys of Youth 1979 cohort, 2006 wave, where time preference is proxied by the expected share of money saved from a hypothetical $1000 cash prize. I find that time preference is a significant predictor of the amount of time spent participating in both vigorous and light-to-moderate physical activity for women and vigorous physical activity for men. The results are robust to various sample restrictions and alternative measures of time preference. The findings in this paper fill in a gap in the relationship between time preference and body composition by examining one of the pathways through which the former might affect the latter using a large, nationally representative dataset.