How well does the theory of planned behaviour predict alcohol consumption? A systematic review and meta-analysis

School-Level Longitudinal Predictors of Alcohol, Cigarette, and Marijuana Use

This study analyzed measures aggregated at the school level to identify key predictors of drinking alcohol, binge drinking, smoking cigarettes, and using marijuana. Using data collected from 6th through 12th grade students between 2011 and 2015, we identify school-level variables that predict school-level prevalence in the subsequent year. Data included prior year assessments of: (1) school-wide prevalence, (2) perceived ease of access to drugs, (3) perceived adult disapproval of drug use, (4) perceived peer disapproval of drug use, and (5) perceived prevalence of drug use. We regressed grade-level behaviors on predictor variables from the previous school year. In middle schools, prior grade prevalence and prior grade perceived norms were significant predictors of subsequent grade prevalence. For high schools, prior year prevalence, aggregated peer norms, and perceived ease of access predicted subsequent use. These analyses provide evidence that a school's culture is predictive of changes in prevalence over time.

Am I a responsible drinker? The impact of message frame and drinker prototypes on perceptions of alcohol product information labels

BACKGROUND

Current alcohol product labelling tends to include ambiguous messages such as 'drink responsibly'. Consumers who identify as responsible drinkers may not pay heed to health warning messages, believing that they are not the intended target.

AIMS

We aimed to determine how responses to responsible drinking labels would differ from responses to positively and negatively framed health messages. We also explored if prototype perceptions would moderate the message impact.

METHODS

A between groups, three arm (ambiguous, positive or negative messages) experiment recruited 465 participants. Outcomes were drinking intentions and label acceptability (novelty, believability, personal relevance, and potential to change behaviour). Measures of heavy and responsible drinker prototype perceptions were included for exploratory moderation analyses.

RESULTS

Positive and negative messages were rated significantly more likely to change behaviour than ambiguous messages. There was also a moderation effect: participants with stronger favourability and similarity to the responsible drinker prototype intended to drink more alcohol in the future after exposure to negatively framed labels, but not after exposure to ambiguous or positively framed labels.

DISCUSSION

Drink responsibly' messages are unlikely to lead to behaviour change. Incorporating theoretical moderators may have value in developing our understanding of the impact of alcohol product labelling.

Preventive behavior intention for a viral outbreak among college students: The case of Mpox

OBJECTIVE

Examine college students' behavior intention to reduce viral outbreak transmission in the context of Mpox, and what preventive messaging strategies would be most effective in future transmissible disease outbreaks based on the Reasoned Action Approach (RAA).

PARTICIPANTS

Undergraduates at a mid-Atlantic U.S. University.

METHODS

An online survey (n = 266) conducted at the height of the recent Mpox outbreak in the U.S., asked about five target behaviors to reduce Mpox transmission, including RAA determinants for each behavior.

RESULTS

Highest intention was safe sex practices, lowest were vaccination and sexual abstinence, and sharing dishes and fabrics were in between. RAA determinants differed by target behavior, although attitudes were significantly positively associated with intention for all five behaviors.

CONCLUSIONS

College students are potentially open to preventative behaviors to reduce viral transmission during an outbreak. However, specific target behavior matters and messaging should focus on differing RAA determinants depending on target behavior.

Free to be Healthy? Free Will Beliefs are Positively Associated With Health Behavior

Previous research has demonstrated that a stronger belief in free will contributes to a variety of socially desirable behaviors. We assessed the correlation between free will beliefs and health behaviors. Four studies (N = 1172) provide evidence that belief in free will is positively associated with health protective behaviors (e.g., physical activity, fruit and vegetable consumption, low fat diet) and negatively associated with health risk behaviors (e.g., alcohol consumption, smoking, unhealthy snacking). In relation to the respective health protective and health risk behaviors, we found free will beliefs were more strongly correlated with physical activity and alcohol consumption, respectively. We also found free will beliefs were associated with key social cognition determinants (e.g., attitude, subjective norm, perceived behavioral control, and intention). Overall, our results suggest that belief in free will can have important consequences for health behavior. This contributes to current theorizing about the implications of believing in free will.

Sipping a sustainable life: Exploring drivers and barriers in consumer attitudes toward non or low alcoholic spirits

Alcohol consumption continues to be prevalent and is on the rise in many countries, posing a grave risk for the health and wellbeing of millions and creating a strain on health services worldwide. A hopeful trend has emerged, however, as consumers' growing preference for healthier, sustainable lifestyles has led traditional alcoholic brands to innovate, launching reduced or non-alcoholic (NoLo) options. This aligns with the SDGs and is reflected in NoLo spirits representing four of Spain's top ten disruptive innovations of 2022. This paper uses a mixed methodology in a qualitative-quantitative sequential approach to gain insight into this phenomenon. The study involved 13 in-depth interviews with HoReCa (an acronym for Hotels, Restaurants, and Caterings) professionals and four focus groups among consumers. Second, behavioral reasoning theory (BRT) was used in a quantitative study aiming to explore motivations for and against consuming NoLo spirits. Data from a survey of 620 participants was conducted and analyzed using SEM-PLS to measure the antecedents of consumer's behavioral intention towards NoLo spirits and to gauge the potential for marketing opportunities. The research reveals that the purchase intention of NoLo spirits is strongly related to health consciousness, while enjoying the effects of alcohol for fun and entertainment, and the social pressure to drink hinders its consumption. In addition, it was found that "reasons for" are more substantial than "reasons against" the consumption of those beverages, differing significantly by age group. Results offer implications for theory and practice, including recommendations for practitioners and regulators willing to improve sustainability in the industry. Further, this paper helps augment the innovation adoption literature by using BRT in the paradoxical context of consumers' increasing alcohol abuse despite their professed attempts to adopt healthier lifestyles.

I can't believe I missed that! How the fear of missing out impacts on alcohol behaviours

BACKGROUND

The Fear of Missing Out (FoMO), which is often experienced over missing opportunities for social gains associated with drinking, has been linked to heavy episodic drinking and experiencing negative consequences. The UK Coronavirus (COVID-19)-related lockdown provided a unique context to study FoMO's ability to predict of alcohol consumption. The aim of the current study was to test if FoMO predicted alcohol consumption during a time of social restrictions.

METHODS

One hundred and five UK adults (aged 18-30, 61% female) participated in a study using an ecological momentary assessment design. Surveys were completed on smartphones and assessed FoMO and drinking intentions, three time a day (morning, afternoon, evening) over three consecutive weekends (Friday, Saturday, Sunday). Alcohol consumption was recorded once per day, based on previous day consumption.

RESULTS

Repeated mixed model analyses found FoMO significantly predicted quantity of alcohol consumption (b =.05, p =.01) and drinking intentions (b =.47, p <.001), but did not predict frequency of consumption. Being male (b = 2.93, p =.02) and higher intentions (b = 0.5, p <.001) predicted higher quantity of consumption. Drinking intentions was the only variable to predict frequency of consumption (b =.004, p <.001).

CONCLUSIONS

The study showed FoMO can predict quantity of alcohol consumption and drinking intentions, which are linked to increased negative consequences. Future studies should assess FoMO against other predictive factors. Results provide an insight into how a social predictor influenced alcohol consumption during a time of restrictions.

The role of psychosocial factors and biological sex on rural Thai adolescents' drinking intention and behaviours: A structural equation model

AIMS

To examine the contributions of psychosocial factors (attitude towards drinking, perceived drinking norms [PDNs], perceived behavioural control [PBC]), and biological sex on drinking intention and behaviours among rural Thai adolescents.

DESIGN

A cross-sectional study design.

METHODS

In 2022, stratified by sex and grade, we randomly selected 474 rural Thai adolescents (Mage  = 14.5 years; SD = 0.92; 50.6% male) from eight public district schools in Chiang Mai Province, Thailand, to complete a self-administered questionnaire. Structural equation modelling with the weighted least square mean and variance adjusted was used for data analysis.

RESULTS

All adolescents' psychosocial factors contributed significantly to the prediction of drinking intention, which subsequently influenced their drinking onset, current drinking and binge drinking pattern in the past 30 days. PDNs emerged as the strongest psychosocial predictor of drinking intention, followed by PBC. Rural adolescents' drinking intention significantly mediated the relationship between all psychosocial factors and drinking behaviours either fully or partially. The path coefficient between drinking attitude and drinking intention was significantly different between males and females.

CONCLUSION

Different from previous studies focus on adolescents' drinking attitude, rural Thai adolescents' PDNs play a significant role on their drinking intention and subsequently their drinking onset and patterns. This nuanced understanding supports a paradigm shift to target adolescents' perceived drinking norms as a means to delay their drinking onset and problematic drinking behaviours.

IMPACT

Higher levels of perceived drinking norms significantly led to the increase in drinking intention among adolescents. Minimizing adolescents' perceptions of favourable drinking norms and promoting their capacity to resist drinking, especially due to peer pressure, are recommended for nursing roles as essential components of health education campaigns and future efforts to prevent underage drinking.

PATIENT OR PUBLIC CONTRIBUTION

In this study, there was no public or patient involvement.

Influencing factors of health screening among retirees: an extended TPB approach

Background

Health screenings are promoted worldwide as they help detect and prevent overall health issues. Despite expanding coverage, the participation rate among the retired population has not significantly increased. Given the special role of health screenings in promoting health and healthy aging, understanding the behavioral intentions, and influencing factors of retirees' voluntary participation in health screenings is crucial. This study aims to explore the participation intentions in health screenings among the Chinese retired population by integrating the Theory of Planned Behavior (TPB) and Self-Efficacy (SE).

Methods

This study used a cross-sectional design to conduct an online questionnaire among 311 retirees in 2023. The questionnaire, tailored for the Chinese retired population, combines the TPB theory and Self-Efficacy theory, including demographic structure, the basic structure of TPB, and SE.

Results

A Structural Equation Modeling (SEM) approach was used to identify factors related to health screening behaviors. Of the respondents, 311 completed the survey (88.9% response rate). The most crucial determinant of health examination behavior was behavioral intention, with a correlation score of (1.524, p < 0.001). Significant correlates of behavioral intention included Subjective Norms (SN) and Self-Efficacy (SE), followed by Perceived Behavioral Control (PBC) and Attitude (AT), with correlation scores of (0.401, p < 0.001), (0.339, p < 0.001), (0.082, p < 0.001), and (0.060, p < 0.05), respectively.

Conclusion

This study provides insights for enhancing the willingness and behavior of retirees to participate in health screenings.

Watching the fall of Roe v. Wade: Media exposure relates to U.S. women's alcohol use intentions

OBJECTIVE

The Supreme Court of the United States' decision in Dobbs v. Jackson Women's Health Organization in June 2022 overturned Roe v. Wade and ended federal protection of abortion rights. Given the drastic policy changes as a result of the ruling and high exposure to media related to abortion, women opposed to the decision may have experienced distress, which could trigger maladaptive coping strategies, such as alcohol use. The present research examined how consuming abortion-related media in the weeks following the Dobbs decision impacted alcohol use intentions among women of reproductive age residing in the 13 "trigger law" states that immediately restricted abortion access.

METHOD

A sample of 196 women (Mage = 30.52, SD = 6.9) residing in trigger law states answered questions about abortion-related media consumption, views toward the Dobbs ruling, negative affect, and alcohol use intentions.

RESULTS

Consuming more abortion-related media predicted higher alcohol use intentions for women who opposed the ruling, but not those who were in favor of abortion restrictions.

CONCLUSIONS

This timely study provides evidence of how the Dobbs ruling is associated with health ramifications beyond reproduction, yielding insights about how high media exposure to large-scale, distressing events may put those most affected-women of reproductive age in states that enacted new policies restricting abortion access-at risk for alcohol use. Findings highlight an imperative direction for future research as abortion restrictions continue to be spotlighted in U.S. media and state legislatures. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Risk Factors for Quantity of Cannabis Use Per Day among College Students Who Violated Their University Drug Use Policy

Background

Cannabis use among college students represents a continued public health issue. The objective was to assess risk factors and reasons for cannabis use among students who violated their university's drug use policy, and whether risk factors influenced cannabis use quantity.

Methods

This cross-sectional survey study included 99 college students enrolled at a large U.S. public university. Descriptive statistics were calculated, and an ordinary least squares regression analysis was conducted.

Results

Students reported using cannabis an average of 7.4 (SD = 10.2) days in the past month, with 8% reporting daily use. On average, students consumed slightly over 0.25 (SD = 0.25) grams per day, with 40% reporting greater than one gram per day. The average age of onset of cannabis use was 16.8 (SD = 1.8) years old. The top reasons for cannabis use were to: relax or relieve tension (75.8%), feel good or get high (62.6%), and have a good time with friends (60.6%). Students perceived an average of 47% of their peers engaged in past-month cannabis use and only slight risk was associated with regular use. Students perceived their loved ones would mostly approve of a reduction in their cannabis use. Regression results indicated past-month cannabis frequency (p = .002) and being of racial/ethnic minority descent (p = .05) were positively associated with quantity of cannabis per day, while perceived risk of regular cannabis use (β = -0.21) was negatively associated.

Conclusion

Evidence-based cannabis interventions for students who violate their university's drug use policies are critically needed that aim to reduce cannabis use and mitigate its associated negative consequences.

Theory of Planned Behavior and alcohol use in adolescents in Ecuador. Structural linear regression analysis

The general aim is to identify the explanatory potential of alcohol use intentions in drinking behaviors in a sample of adolescents in Ecuador. The method consists of a descriptive, explanatory, and cross-sectional study using SEM techniques. The participants were 384 adolescents (57% male and 43% female), aged 14-18 years (M = 16.51; SD = 2.64), who are students attending between the 1st and 3rd year of high school in a public educational institution in Ambato, Ecuador. Like principal results, the presence of alcohol use intention is moderate; the practice of alcohol use is low and mostly does not represent a risk, although 3.9% of the participants could report significant problems with consumption. Intentionality and drinking covary positively with low and moderate intensity. Drinking Intentionality explained 15.3% of the variance of drinking. We conclude that the Alcohol Use Intentions are a predictor of adolescent drinking behaviors.

Extended reality-based choice experiment to assess the impact of offshore wind turbines in historic center: The case of Manfredonia

This paper proposes a novel four-step methodology to achieve an extended-reality-based choice experiment in historic and touristic centers. The study exploits the case of Manfredonia (a seaside town in southern Italy) to apply the new approach and investigates public attitudes and preferences towards the installation of offshore wind turbines in the area. The novelty of the proposed work is twofold: i) for the first time, a structured methodological approach is defined for the development of a hybrid extended-reality-based choice experiment; ii) the perception of the visual impact of offshore wind turbines is assessed in a touristic and historic city in southern Italy exploiting the proposed approach. Our findings underscore the importance of continuously monitoring public perceptions to maintain and promote support for sustainable energy solutions, particularly in relation to the perception of wind energy's visual impact. In particular, 65% of respondents express their worries about wind power plants impact on the landscape. Moreover, the positive coefficient of the visual impact (0.011) suggests a positive utility of respondents from a higher off-shore turbines' density and a marginal willingness to accept a compensation of about 13€ for the visual impact and of about 33€ for the distance from the shore. In this context the use of extended reality technology in choice experiment scenarios significantly improves the results and enhances the understanding of the landscape impact of offshore wind farms.

The theory of planned behavior and alcohol protective behavioral strategies: a prospective study examining the role of habit and gender invariance

OBJECTIVES

Alcohol Protective Behavioral Strategies (PBS) have consistently shown to be effective in reducing alcohol use and its associated consequences. We aimed to examine the explanatory value of the Theory of Planned Behavior (TPB) for using five PBS, studying the role of habit, and its potential variation across genders.

METHODS

Targeted sampling was used to recruit 339 young adults in the community (women = 50.7%; mean age = 2.21[SD = 2.21]), who completed baseline and 2-month follow-up questionnaires.

RESULTS

The explained variance of the TPB ranged from 58-68% for intention to use PBS, and 18-50% for behavior. The inclusion of habit produced increases of 17-26% in explained variance in intention, while explained variance in behavior remained similar. Habit was the strongest predictor of intention to use PBS, followed by attitude. Except for one behavior (drinking slowly), habits did not moderate the intention-behavior relationship, and the explanatory value of the TPB did not differ across genders.

CONCLUSIONS

Our findings support the utility of the TPB as an explanatory model of alcohol PBS, along with the need to include habits within the framework of dual-process models. Interventions aimed at promoting alcohol PBS could be optimized by targeting attitudes towards PBS and habits.

Salient Beliefs Associated with Unsanctioned Adult Cannabis Use in an Evolving Socio-Political Environment

Background: The changing cannabis legal climate in the United States has been associated with increased prevalence of use, more favorable general attitudes, and cultural norms toward its use among young adults. The purpose of this study was to conceptualize salient beliefs governing illicit cannabis use within a state where medical use is legal and adult use remains illegal. Methods: Following an initial qualitative pilot, a prospective study (baseline and a 30-day follow-up) that utilized an electronic survey design was conducted. Students at a large US university (N = 514) completed a baseline assessment of cannabis use and Theory of Planned Behavior (TPB) constructs, and 169 completed the follow-up assessing actual behavior. Results: Roughly 60% reported illicit cannabis use. Attitude and subjective norms accounted for 57% of the variation in intention for cannabis use in the next 30 days, while intention and perceived behavioral control (PBC) explained 51% of the variation in prospective use. The majority of salient beliefs identified exhibited moderate to strong correlations with intention and behavior among the larger sample. Close friends and partners were identified as important referents, outcome expectations of relaxation, improved social functioning, and more enjoyment, as well as environmental factors, such as proximity to use, safe utilization location, and continued illegality of adult use exhibited strong associations to intention and behavior. Conclusions: The practical utility of the salient belief measures identified herein presents a useful foundation for interventions aimed at reducing illicit cannabis utilization among young adults.

(Mis)understanding alcohol use disorder: Making the case for a public health first approach

'Alcohol use disorder' (AUD) is used by several contemporary conceptualizations to identify, treat and prevent problems associated with alcohol use. Such conceptualizations encompass diagnostic classifications and broader frameworks for policy and practice. However, current AUD concepts are subject to multiple tensions and limitations in capturing and responding to the complex and heterogeneous nature of alcohol problems. Further, public understandings of alcohol problems are heavily divergent from professional AUD concepts and remain embedded within an 'alcoholism' master narrative in which disease model stereotypes come with multiple costs for prevention and 'recovery'. The persistence of a problematic 'alcoholism' paradigm reflects the coalescing of multiple forces including the cognitive appeal of reductionism, motives to stigmatize and 'other', and an over-emphasis on AUD as an individually located biomedical problem. Public misperceptions of AUD as a matter of the individual, the individual's essence, and misconceived notions of responsibility and control have been bolstered by industry interests and the ascension of neuroscience and genetics, in turn diverting attention from the importance of the environmental and commercial determinants of health and the effectiveness of under-utilized public health policies. We call for multiple stakeholders to support efforts to prioritize a public health first approach to advancing AUD research, policy and treatment in order to make significant advances in AUD prevention and treatment. We offer several recommendations to assist in shifting public understanding and scientific limitations in AUD concepts and responses.

Effects of Workplace Variables on Workers Intentions to Misuse Prescription Opioids

OBJECTIVE

Workers in industries with high rates of opioid dispensing as well as those with high rates of non-fatal work-related injuries are at greater risk for opioid misuse, which can lead to addiction, overdose, or death.

METHODS

Using secondary cross-sectional data collected from 856 healthcare workers, this pilot study examines a conceptual model for workers' intentions to seek out prescription opioids and intentions to use opioids at higher doses over longer periods.

RESULTS

Results showed significant protective effects of beliefs, injunctive and subjective norms, and behavioral control on intentions to seek out opioids. On intentions to use higher doses over a longer time, knowledge, beliefs, behavioral control, patient-provider communication, workplace safety, and workplace autonomy had significant protective effects.

CONCLUSIONS

Findings from this study could be used to inform future multilevel interventions to prevent opioid misuse among employee populations.

Alcohol and cannabis use among rural university students: A quantitative analysis of barriers to care, student resilience, and school climate

Objective: This article examines impacts of student resilience, school climate, and barriers to mental health care on problematic drinking behavior and cannabis use among rural university students. Participants: A total of 948 students from a public university in a southeastern state that completed the 2019-2020 Healthy Minds Study. Methods: Cross-tabulations and multivariate logistic regression analyses were employed to test study hypotheses. Results: Students who binge drink are more likely to engage in problematic drinking behaviors than students who do not binge drink; students who engage in problematic drinking are more likely to use cannabis than those who do not engage in problematic drinking. As students face more barriers to mental health care, they are more likely to engage in problematic drinking and cannabis use; students who are more resilient are less likely to engage in problematic drinking. Conclusions: To promote health and wellbeing, universities must understand factors that impact substance use among students.

Sense of control and likelihood of prescription drug misuse 10-years later among middle-aged and older adults

Objectives: Sense of control (i.e. one's beliefs about their ability to influence life circumstances) has been linked to various psychological outcomes. However, it is unknown if sense of control is protective against prescription drug misuse (PDM). The present study sought to evaluate if sense of control is associated with reduced odds of PDM 9 to 10 years later among a sample of middle-aged and older adults.Methods: Data were evaluated from participants (M = 54 years, SD = 10.86; N = 2,108) of the second and third waves of the Midlife in the United States study. Logistic regression models were used to assess whether baseline sense of control (Wave 2) predicted odds of PDM 9 to 10 years later (Wave 3).Results: Findings revealed that greater sense of control at baseline was related to reduced odds of subsequent PDM (OR = 0.78; 95% CI: 0.64, 0.95), adjusting for baseline PDM, sociodemographic characteristics, health behaviors, psychological factors, number of prescription medications, and health. When assessing the subscales of sense of control separately, constraints (OR = 1.19; 95% CI: 1.00, 1.42), but not mastery (OR = 0.96; 95% CI: 0.80, 1.12), was predictive of odds of subsequent PDM. Further, being female was associated with greater odds of PDM (OR = 1.46; 95% CI: 1.02, 2.09), but did not moderate the association between sense of control and PDM.Conclusions: Sense of control may be a novel and viable target for interventions (e.g. using mobile phone apps) aimed at mitigating prescription drug misuse.

Prescribing Medications for Alcohol Use Disorder: A Qualitative Study of Primary Care Physician Decision Making

PURPOSE

Over 29 million Americans have alcohol use disorder (AUD). Though there are effective medications for AUD (MAUD) that can be prescribed within primary care, they are underutilized. We aimed to explore how primary care physicians familiar with MAUD make prescribing decisions and to identify reasons for underuse of MAUD within primary care.

METHODS

We conducted semistructured interviews with 19 primary care physicians recruited from a large online database of medical professionals. Physicians had to have started a patient on MAUD within the last 6 months in an outpatient setting. Inductive and deductive thematic analysis was informed by the theory of planned behavior.

RESULTS

Physicians endorsed that it is challenging to prescribe MAUD due to several reasons, including: (1) somewhat negative personal beliefs about medication effectiveness and likelihood of patient adherence; (2) competing demands in primary care that make MAUD a lower priority; and, (3) few positive subjective norms around prescribing. To make MAUD prescribing a smaller component of their practice, physicians reported applying various rules of thumb to select patients for MAUD. These included recommending MAUD to the patients who seemed the most motivated to reduce drinking, those with the most severe AUD, and those who were also receiving other treatments for AUD.

CONCLUSIONS

There is a challenging implementation context for MAUD due to competing demands within primary care. Future research should explore which strategies for identifying a subset of patients for MAUD are the most appropriate and most likely to improve population health and health equity.

Behaviour change, the itchy spot of healthcare quality improvement: How can psychology theory and skills help to scratch the itch?

Despite the clear utility and transferability, National Health Service (NHS) quality improvement initiatives have yet to benefit fully from what is already known within health psychology. Thus far, evidence from established, seminal behaviour change theory and practice have been ignored in favour of newly developed models and frameworks. Further, whilst there is a growing interest in what is commonly referred to as 'human factors' of change and improvement, there is scant transferability of known psychologically informed implementation skills into routine NHS Improvement practice. The science and practice of healthcare improvement is growing, and the behaviour change aspect is critical to sustainable outcomes. Therefore, this paper offers practical guidance on how seminal psychological behaviour change theory and motivational interviewing (a person-centred skills-based approach specifically developed to support people through change) can be combined to better address individual and organisational change within a healthcare improvement context.

Predicting the Adoption of a Sustainable Diet in Adults: A Cross-Sectional Study in Italy

Shifting food choices towards sustainability entails the analysis of dietary behavior determinants. This study aimed to explain and predict the intention to follow a sustainable diet and its adoption in a representative sample of adults (n = 838) in Italy. An online survey based on the theory of planned behavior (TPB) was developed. The adoption of a sustainable diet was measured as self-perceived behavior, adherence to the Mediterranean diet (MD), and food consumption frequencies. Psychometric analysis and correlations between attitude, subjective norms, and perceived behavioral control (PBC) with both intention and behavior assessments were evaluated. Structural equation models were used to test whether and to what extent attitude, subjective norms, and PBC explained intention and behavior. Significant associations were found between TPB constructs and the behavior measures underlining the main role of intention and PBC in affecting behavior. The applied TPB models explained behavioral intention at most (78%). The results suggested promising interventions in narrowing the attitude-behavior gap to encourage specific adult population groups in Italy to adopt virtuous food consumption habits. Beside the implementation of price mechanism strategies, educational initiatives to increase awareness about food and diet sustainability issues and the reinforcement of the perceived control on food consumption at the individual level are recommended.

Blunted neural reward response to alcohol and greater alcohol motivation in binge drinkers in a randomized clinical experiment

BACKGROUND

Alcohol stimulates cerebral blood flow (CBF) in brain reward regions. However, neural processes that support sustained alcohol motivation after the first drink are not well understood.

METHODS

Using a novel placebo-controlled, randomized, crossover experiment, 27 individuals who binge drink (BD; 15 M, 12 F) and 25 social drinkers (SD; 15 M, 10 F) underwent a behavioral test of self-motivated alcohol consumption using an Alcohol Taste Test (ATT) involving alcoholic and nonalcoholic beer on separate days. The test was followed immediately by perfusion functional magnetic resonance imaging (fMRI). On both days, participants then engaged in a post-scan ATT with placebo beer to assess sustained alcohol self-motivation without active alcohol effects. Linear mixed effects models were used to examine the effects of drinking group on the placebo-controlled effect of initial alcohol motivation on brain perfusion (whole brain corrected p < 0.001, cluster corrected p < 0.025) and on the relationship between placebo-controlled brain perfusion and sustained alcohol motivation.

RESULTS

Initial alcohol self-motivation in the alcohol relative to placebo session led to markedly decreased activation in the medial orbitofrontal cortex (OFC) and the ventral striatum in BD relative to SD, indicative of neural reward tolerance. The BD group also showed an enhanced neural response in behavioral intention regions of the supplementary motor area (SMA) and inferior frontal gyrus (IFG) regions. Moreover, there was greater sustained alcohol motivation in BD than SD in the post-scan ATT in the alcohol relative to placebo session. Correspondingly, only in BD and only in the alcohol session, lower alcohol-induced OFC response correlated with concurrent sensitized SMA response, and each predicted the subsequent sustained higher alcohol motivation in the post-scan ATT.

CONCLUSIONS

Alcohol-related OFC tolerance may play an important role in sustained alcohol motivation. Furthermore, both specific alcohol-related neural reward tolerance and premotor sensitization responses may contribute to escalating alcohol motivation to drive excessive alcohol intake, even in individuals without alcohol use disorder.

A cross-national study on adolescent substance use: Intentions, peer substance use, and parent-adolescent communication

This longitudinal two-wave cross-national study investigated whether intentions, friends' substance use, and parent-adolescent substance-use specific communication predict adolescent alcohol and cannabis use 1 year later, while estimating reversed links. The temporal order between these two substances was also examined. We used multi-group cross-lagged panel modeling on data from 2 ethnically and socioeconomically diverse samples: Sint Maarten (N = 350; M_age  = 14.19) and the Netherlands (N = 602; M_age  = 13.50). Results showed that in the Netherlands, cannabis use predicts more subsequent problems (alcohol use, intention to use cannabis, and affiliation with cannabis-using friends). But for Sint Maarten, alcohol use predicts more subsequent problems (cannabis use, intention to use alcohol, and affiliation with alcohol-using friends). These opposing results demonstrate that caution is warranted when generalizing results across countries.

Intention to Engage in Alcohol Use during Pregnancy: The Role of Attitudes and Prototypes

Background: There is no known risk-free level of alcohol use in pregnancy. Despite this, many still believe that occasional drinking is safe. To-date, there is limited evidence of the influences on women's decisions about low to moderate alcohol use in pregnancy. The aim of this study was to explore alcohol use intentions during pregnancy, using variables from the theory of planned behavior, the prototype/willingness model and personality variables. The study also investigated whether priming participants with exposure to prototypes describing different alcohol use behaviors had an impact on intentions.Methods: Participants, 746 women aged 20 to 45 years, were randomized to be prompted to think of one of two different "types" of behaviors, i.e., small level of alcohol use in pregnancy and ambiguous level of alcohol use in pregnancy. They then completed measures of theoretical variables, impulsivity, venturesomeness, and self-efficacy. Participants then answered whether they intended to use alcohol during a future pregnancy.Results: Over half of the variance in intentions to consume alcohol while pregnant were predicted by the final model (R2= .527, F (1, 438) = 13.201, p < .001). Positive attitudes toward alcohol use in pregnancy, from the theory of planned behavior, were the most significant predictor of intentions and intentions did not differ between groups according to prototype exposure.Conclusions: Future research should aim to explore the efficacy of interventions to reduce low to moderate alcohol use in pregnancy that utilize both the theory of planned behavior and prototype/willingness model to target determinants of intentions.

Barriers and facilitators to maternal death surveillance and response at a busy urban National Referral Hospital in Uganda

Background: Preventable maternal and newborn deaths remain a global concern, particularly in low- and- middle-income countries (LMICs) Timely maternal death surveillance and response (MDSR) is a recommended strategy to account for such deaths through identifying contextual factors that contributed to the deaths to inform recommendations to implement in order to reduce future deaths. Implementation of MDSR is still suboptimal due to barriers such as inadequate skills and leadership to support MDSR. With the leadership of WHO and UNFPA, there is momentum to roll out MDSR, however, the barriers and enablers for implementation have received limited attention. These have  implications for successful implementation. The aim of this study was: To assess barriers and facilitators to implementation of MDSR at a busy urban National Referral Hospital as perceived by health workers, administrators, and other partners in Reproductive Health. Methods: Qualitative study using in-depth interviews (24), 4 focus-group discussions with health workers, 15 key-informant interviews with health sector managers and implementing partners in Reproductive-Health. We conducted thematic analysis drawing on the Theory of Planned Behaviour (TPB).   Results: The major barriers to implementation of MDSR were: inadequate knowledge and skills; fear of blame / litigation; failure to implement recommendations; burn out because of workload   and inadequate leadership- to support health workers. Major facilitators were involving all health workers in the MDSR process, eliminate blame, strengthen leadership, implement recommendations from MDSR and functionalize lower health facilities (especially Health Centre -IVs). Conclusions: The barriers of MDSR include knowledge and skills gaps, fear of blame and litigation, and other health system factors such as erratic emergency supplies, and leadership/governance challenges. Recommendation: Efforts to strengthen MDSR for impact should use health system responsiveness approach to address the barriers identified, constructive participation of health workers to harness the facilitators and addressing the required legal framework.

A Study of Reasons for Self-Disclosure on Social Media among Chinese COVID-19 Patients: Based on the Theory of Planned Behavior Model

BACKGROUND

With a massive population of internet users, China has witnessed a shift in the behavior of social media users towards the COVID-19 pandemic, transitioning from reticence to frequent sharing of information in response to changing circumstances and policy adjustments of the disease. This study aims to explore how perceived benefits, perceived risks, subjective norms, and self-efficacy influence the intentions of Chinese COVID-19 patients to disclose their medical history on social media, and thus to examine their actual disclosure behaviors.

METHODS

Based on the Theory of Planned Behavior (TPB) and Privacy Calculus Theory (PCT), a structural equation model was constructed to analyze the influence paths among perceived benefits, perceived risks, subjective norms, self-efficacy, and behavioral intentions to disclose medical history on social media among Chinese COVID-19 patients. A total of 593 valid surveys were collected via a randomized internet-based survey, which constituted a representative sample. Firstly, we used SPSS 26.0 to conduct reliability and validity analyses of the questionnaire, as well as the tests of demographic differences and correlations between variables. Next, Amos 26.0 was employed to construct and test the model fit degree, identify the relationships among latent variables, and conduct path tests.

RESULTS

Our findings revealed the following: (1) There were significant gender differences in the self-disclosure behaviors of medical history on social media among Chinese COVID-19 patients. (2) Perceived benefits had a positive effect on self-disclosure behavioral intentions (β = 0.412, p < 0.001); perceived risks had a positive effect on self-disclosure behavioral intentions (β = 0.097, p < 0.05); subjective norms had a positive effect on self-disclosure behavioral intentions (β = 0.218, p < 0.001); self-efficacy had a positive effect on self-disclosure behavioral intentions (β = 0.136, p < 0.001). (3) Self-disclosure behavioral intentions had a positive effect on disclosure behaviors (β = 0.356, p < 0.001).

CONCLUSIONS

Our study, by integrating TPB and PCT to examine the influencing factors of the self-disclosure behaviors among Chinese COVID-19 patients on social media, found that perceived risks, perceived benefits, subjective norms, and self-efficacy had a positive influence on the self-disclosure intentions of Chinese COVID-19 patients. We also found that self-disclosure intentions, in turn, positively influenced disclosure behaviors. However, we did not observe a direct influence of self-efficacy on disclosure behaviors. Our study provides a sample of the application of TPB in the context of social media self-disclosure behavior among patients. It also introduces a novel perspective and potential approach for individuals to address the feelings of fear and shame related to illness, particularly within the context of collectivist cultural values.

The Relationship between Drunkorexia, Alcohol, and Blackouts Among College Students: An Exploratory Study

College drinkers commonly report blacking out (i.e., alcohol-induced amnesia), and those who drink with the intention to blackout are at risk for harmful consequences. Drunkorexia (i.e., restriction of calories on planned drinking days) is a high-risk behavior potentially associated with blacking out. Informed by the Theory of Planned Behavior (TPB), this study explores blackout experiences and intentions to blackout association with drunkorexia. College students (n=2335) who primarily identified as female and White participated via an online survey. Participants received a $3 coupon for completion of the study. Consistent with the literature, 40% and 60.7% participants reported experiencing blackouts and drunkorexia respectively in the last year. Informed by the TPB, a structural equation model assessed if more frequency blackout experiences (IV) related to drunkorexia behaviors (DV1) and alcohol behaviors (DV2), and if there was a significant indirect effect through blackout intention. The model fit the data well (CFI=.98, TLI=.95) and suggests that more frequent blackout experiences relate to more drunkorexia experiences (R²=.04) and higher levels of alcohol consumption (R²=.44). In addition, the relationship between blackout experiences and drunkorexia flows through intentions to blackout (i.e., a significant indirect effect). Findings are consistent with TPB, which suggests intentions predict health behavior. Future interventions should consider modifying intentions and other possible TPB constructs to minimize high risk alcohol consumption and drunkorexia behaviors.

Beyond Individual Cognitions: Time for Intervention Science to Focus on Health Context and Audience

Intervention science faces a hazardous paradox: on the one hand, vulnerable populations (eg, patients, people from low socioeconomic background, older adults) are those for whom adoption of healthy behaviors is most urgent; on the other hand, behavior change models are less predictive, and interventions less successful, in these populations. This commentary presents 4 reasons that may explain this issue: (1) research mostly focuses on what causes behavior and how to change it, at the expense of investigating among whom and under what conditions models are valid; (2) models put an undue emphasis on individual cognitions; (3) most studies are not conducted on vulnerable populations; and (4) most researchers are from high-income countries. Several avenues are proposed to address this issue: (1) providing a central place to the context and audience in health behavior change modelization, through collaborations with researchers from other disciplines and countries, and with members of the targeted audience; (2) better reporting samples' sociodemographic characteristics and increasing samples' diversity; and (3) using more rigorous and innovative designs (eg, powered randomized controlled trials, N-of-1 trials, intensive longitudinal studies). In conclusion, it becomes urgent to change the way we do research: the social utility and credibility of intervention science depend on it.

Energy labelling of alcoholic drinks: An important or inconsequential obesity policy?

Alcohol is calorie dense, but unlike food products, alcoholic drinks tend to be exempt from nutritional labelling laws that require energy content information to be displayed on packaging or at point of purchase. This review provides a perspective on the likely efficacy of alcoholic drink energy labelling as a public health policy to reduce obesity and discusses key questions to be addressed by future research. First, the contribution that alcohol makes to population level daily energy intake and obesity is outlined. Next, consumer need for alcohol energy labelling and the potential impacts on both consumer and industry behavior are discussed. Pathways and mechanisms by which energy labelling of alcoholic drinks could reduce obesity are considered, as well as possible unintended consequences of alcoholic drink energy labelling. Would widespread energy labelling of alcoholic drinks reduce obesity? The unclear effect that alcohol has on population level obesity, the modest contribution calories from alcohol make to daily energy intake and limited impact nutritional labelling policies tend to have on behavior, suggest alcohol energy labelling may have limited impact on population obesity prevalence as a standalone policy. However, there are a number of questions that will need to be answered by future research to make definitive conclusions on the potential for alcohol energy labelling policies to reduce obesity.

Correlates of Alcohol Use Likelihood for Latino Immigrant Youth in an Emerging Context

Using a three-wave prospective longitudinal design spanning 3 years, we assessed alcohol use likelihood trajectories and their correlates among a community sample of Latino immigrant adolescents in the emerging immigrant context of Western Oregon. Results from growth mixture modeling revealed two distinct classes: lower risk youth who reported little likelihood of alcohol use but whose trajectory was increasing, and higher risk youth who reported higher likelihood of alcohol use and whose trajectory was stable. We found significant differences between the two classes such that lower risk youth reported greater levels of Latino cultural orientation and parental monitoring, whereas higher risk youth reported greater levels of family cultural stress and delinquency. Results are discussed in terms of prior research and theory.

Planned versus unplanned drinking and cannabis use: Do facets of trait impulsivity influence daily risk?

OBJECTIVE

Planned and unplanned substance use have been examined as predictors of heavier alcohol and cannabis use and problems at the between-person level. However, it remains unclear whether planned versus unplanned use is riskiest at the day-level, and for whom. The present study tested whether day-level planned versus unplanned alcohol and cannabis use were associated with higher alcohol and cannabis consumption and negative consequences that day and whether two impulsive traits, lack of premeditation and positive urgency, moderated associations.

METHOD

Young adults (N = 409; 50.9% female) completed five bursts of daily surveys, each consisting of a morning and afternoon report across 14 consecutive days. During a baseline session, participants reported their impulsivity (UPPS-P). During afternoon surveys, participants reported their plans to use alcohol/cannabis that night. During morning surveys, participants reported number of drinks consumed/hours spent high yesterday and negative consequences experienced.

RESULTS

Planned drinking days were associated with a greater number of drinks and negative consequences, whereas planned cannabis use days were associated with more hours spent high but not negative consequences. In the drinking quantity model, there was a significant interaction for planned versus unplanned drinking by positive urgency. Planned drinking was associated with heavier alcohol consumption across levels of positive urgency; however, unplanned drinking was associated with heavier consumption for individuals with higher (vs. lower) levels of positive urgency.

CONCLUSIONS

Day-level planned drinking and cannabis use are important factors to target in just-in-time interventions. However, interventions focused on planned and unplanned drinking may be particularly effective for individuals with higher levels of positive urgency. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining Attitude, Norms, and Intentions as Predictors of Prospective Change in Alcohol-Induced Blackouts

OBJECTIVE

Alcohol-induced blackouts are a marker of risk such that they are strong independent predictors of experiencing other adverse alcohol-related social and health effects. Existing work informed by the Theory of Planned Behavior suggests that several of the constructs contained within it, such as perceived norms, personal attitudes toward consumption, and drinking intentions, are reliable predictors of alcohol use, related problems, and blackout experiences. However, research to date has not examined these theoretical antecedents as predictors of change in the occurrence of alcohol-induced blackout. The current work aimed to evaluate descriptive (the rate a behavior occurs) and injunctive (the approval of a behavior) norms, attitudes toward heavy drinking, and drinking intentions as predictors of the prospective change in experiencing a blackout.

METHOD

Using existing data from two samples (Sample 1: N = 431, 68% male; Sample 2: N = 479, 52% male), students mandated to complete an alcohol intervention completed surveys at baseline and 1- and 3-month follow-ups. Latent growth curve models evaluated perceived norms, positive attitude toward heavy drinking, and drinking intention as prospective predictors of the change in blackout over 3 months.

RESULTS

Across both samples, descriptive and injunctive norms and drinking intentions were not significantly predictive of the change in blackout. Only attitude toward heavy drinking significantly predicted prospective change (the slope factor) in blackout in both samples.

CONCLUSIONS

Given the strong association between heavy drinking attitudes and change in blackout, attitudes may represent an important and novel target for prevention and intervention efforts.

A theory based examination of factors associated with male body hair removal

Male body hair removal has implications for men's mental health such as anxiety about body image. Based on the Theory of Planned Behaviour and relevant additional constructs, this research examined factors associated with young men's upper body and pubic hair removal. Young men residing in Australia completed a pilot survey, online survey (N = 655) of predictors of intention (plans) to remove body hair and a 4-week follow up survey (n = 222) reporting body hair removal behaviour. Attitudes about body hair removal, pressure from others, perceptions of control and similarity to prototypical young men who removed body hair were associated with intention for upper body (60%) and pubic (48%) hair removal. Intention was significantly associated with body hair removal behaviours. These findings indicate social pressure was associated with young men's decisions to remove body hair, pointing to sources of potential intervention.

Development of a Web-Based Alcohol Prevention Program Linking School-Child-Family for Intermediate Elementary Students

Family strongly influences student health behavior. However, alcohol-preventive education programs that link parents and school for intermediate-elementary school students remain scarce. Although online educational programs constitute effective interventions to intentionally improve health behaviors, traditional methods are used to implement alcohol- prevention programs for students. In this study, we aimed to (1) develop an online school-child-family alcohol-prevention program based on the theory of planned behavior and (2) examine the preliminary effects of the program on intention to consume alcohol among intermediate-elementary school students. This single-group, pre- and posttest study enrolled 46 Grade 3 students from a public elementary school in a metropolitan South Korea city and ascertained the preliminary effects of a 5-week online alcohol-prevention program by using the alcohol drinking prevention behavior scale. Attitudes, perceived behavioral control, and intention of alcohol-preventive behaviors significantly improved (p < .05) whereas subjective norms did not. The online alcohol-prevention program based on the theory of planned behavior and school-child-family linkage beneficially influenced intention, attitude, and perceived behavioral control for alcohol-prevention behavior, and the effectiveness and convenience of this program underscores its potential application as an educational intervention to improve health behaviors of intermediate-elementary school students.

To Drink or Not to Drink: Is That the Question? Examining Correspondence and Predictive Validity of Morning Drinking Intentions for Young Adults' Drinking Behaviors and Consequences

The Theory of Planned Behavior suggests that intentions are significant and proximal determinants of behavior. The purpose of this study was to test the predictive validity of drinking intentions for subsequent same-day drinking behaviors and negative consequences. Regularly drinking young adults (N = 222, 21-29 years, 84% undergraduates) completed an ecological momentary assessment (EMA) protocol and wore an alcohol monitor for five consecutive 24-h periods spanning 6 days (Wednesday-Monday). Each morning, participants reported their drinking intentions for the day and their previous day's alcohol consumption and the number of negative drinking consequences. Multilevel models showed that, at the within-person level, on days when people reported intending to drink, to get drunk, or to drink more than usual, they had higher odds of drinking, consumed more drinks, and had higher peak transdermal alcohol concentrations later that day. However, drinking occurred on 28% of days without drinking intentions, suggesting intentions were an imperfect signal for future drinking behavior. Morning drinking intentions also predicted experiencing more negative consequences, even after controlling for alcohol consumption. On average, young adults' morning-reported drinking-related intentions predicted increased odds of same-day drinking behavior and alcohol-related consequences. However, drinking frequently occurred on days participants did not intend to drink, suggesting that focusing only on drinking intention days will result in many missed prevention opportunities. Together, these results suggest the need for additional research to increase the predictive value of drinking intention assessments and for prevention interventions aimed at helping individuals follow through on their intentions not to drink.

Are Dietary Supplements a Gateway to Doping? A Retrospective Survey of Athletes' Substance Use

Background: It is proposed that the use of dietary supplements might lead to the use of doping substances. This has been termed the gateway hypothesis. However, within an athletic sample, no research has examined the order in which these substances are consumed and what may explain the progression from dietary supplement use to doping. Objective: To identify whether dietary supplement use precedes doping and examine what moderates the dietary supplement-doping relationship. Methods: Competitive athletes (N=1,081, 42.0% female; Age=29.3±10.8 years) completed an online survey measuring dietary supplement use, doping use, doping subjective norms and age of using a supplement and/or doping substance. Results: Dietary supplement users were 11 times more likely to dope than non-users (OR=11.28, 95% CI = 2.72 to 46.77). Age for first use of a dietary supplement was younger than use of a doping substance (mean difference=-4.5±5.1 years old, p<0.001, d=0.90). Over three-quarters of doping users reported using a dietary supplement first (77.1%), whereas a small proportion of athletes started using dietary supplements and doping at the same time (12.5%) and some used doping substances before using dietary supplements (10.4%). Moderation analysis revealed that dietary supplement users may be more likely to dope because of a more favourable social acceptance of using prohibited substances than non-users. Conclusions: Data suggest that dietary supplement use is more likely to precede doping. However, not all doping users begin with using dietary supplements, which highlights the importance of measuring the temporal order of dietary supplement and doping use in future research.

Community Safety Behavior in Response to Coronavirus Pandemic

The purpose of this study is to explore the behavior and lifestyle of individuals in response to the coronavirus that the safety behavior of people in the coronavirus disease of 2019 pandemic. Hence, the study integrates the theory of planned behavior and the health belief model to understand the behavioral change in response to the coronavirus pandemic. The current study is qualitative therefore, a survey-based online questionnaire was used for data collection from university students and staff (faculty and nonfaculty) residing in top-tier cities of Pakistan, nonprobability convenient sampling was used to approach the audience. A two-stage approach was used to test the model using partial least square (variance-based structural equation modeling). The reliability and validity of the measurement model indicate that the data is reliable and valid. Outcomes prove all the relationships as proposed by the study, except for the impact of perceived barriers on intention and individual safety behavior. Perceived barriers act as obstacles that abstain individuals from following the standard operating procedures. The research agenda provides new insights into the fields of marketing, health care, consumer behavior, and behavioral studies. It contributes to the existing literature in the field of social marketing by studying the behavior and changes in the behavior of people in the global pandemic.

Improving Sleep Among Teachers: an Implementation-Intention Intervention

BACKGROUND

Insufficient sleep is common among teachers and is associated with diverse health risks. This study aimed to predict intention and sleep duration by applying the Theory of Planned Behavior (TPB) and to examine the effectiveness of an implementation-intention intervention to improve sleep duration and quality.

METHOD

Sixty-nine teachers (M = 36.8 years, SD = 10.4) were assigned to an active control group (CG) or intervention group (IG). At baseline, TPB variables were assessed and participants of the IG received instructions to develop implementation intentions to reach the goal of sleeping 8 h on average. During a 3-week intervention period, all participants wore an activity tracker (Fitbit Charge HR) to measure sleep duration and kept diaries to assess sleep quality, physical activity, and stress. After 1 month, a 1-week follow-up, including a booster for the IG, was conducted.

RESULTS

Forty-two percent of variance in sleep duration were explained by control variables, past behavior, perceived behavioral control, and intention. Mixed ANOVAS with baseline covariates found a large main effect with longer sleep duration in the IG. A time x group interaction suggested that only the IG slept significantly longer in the follow-up period compared to the intervention period. For sleep quality, a medium-sized main effect for study group was found and a time x group interaction indicated higher sleep quality in the IG for week 3 and the follow-up.

CONCLUSION

The TPB was effective in predicting sleep intention and duration. Implementation intentions accompanied by daily monitoring and a booster appear to be promising for improving sleep.

Efficacy of theory-based interventions aimed at reducing binge drinking in adolescents: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND AND AIMS

Binge drinking is a widespread practice among adolescents worldwide and is associated with various harmful consequences. Theory-based interventions are a promising approach to prevent this drinking behaviour in this population. The aim of the present review was to determine: (1) the characteristics of theory-based interventions targeting binge drinking in adolescents, (2) the impact of such interventions on binge drinking, and (3) the quality of theoretical implementation.

METHODS

For this systematic review, randomised controlled trials were eligible for inclusion if the binge drinking-targeting intervention was based at least on one theoretical framework, and if the population's mean age was between 10 and 18 years. Two authors extracted relevant data. A meta-analysis was conducted to evaluate the effect of interventions on binge drinking. Effect sizes were calculated with the Hedges's g. Binge drinking was measured as a continuous or dichotomous outcome. The quality of theoretical implementation of interventions was measured using an existing "theory coding scheme".

RESULTS

Sixteen studies were identified. Ten were based on a single theory, and six on a combination of theories. The number and type of behaviour change techniques used in each intervention varied greatly. Theory-based interventions led to a small but significant decrease in binge drinking (Hedges's g = 0.10; 95% confidence interval = 0.04, 0.16). The quality of theoretical implementation was globally low, and the reciprocal link between behaviour change techniques and theoretical constructs was unclear for most studies.

CONCLUSIONS

Theory-based interventions have a small but significant beneficial impact on decreasing binge drinking in adolescents. Future research should try to be more effective in matching theoretical determinants of behaviour with the content of the intervention.

Effect and feasibility of gamification interventions for improving physical activity and health-related outcomes in cancer survivors: an early systematic review and meta-analysis

BACKGROUND

Despite the well-documented advantages of regular physical activity (PA), patients with cancer show suboptimal participation. By using game design elements, gamification could be used to motivate individuals to engage in PA. It has been demonstrated that gamification interventions positively affect children, adolescents and older adults in health-related contexts. There are, however, inconsistent findings regarding the impact of gamification interventions on cancer survivors' PA and health-related outcomes, according to the literature.

OBJECTIVES

The aim of this study is to examine the effectiveness and feasibility of gamification interventions for improving PA and health-related outcomes among cancer survivors.

METHODS

A systematic review and meta-analysis were conducted following the Cochrane Handbook and PRISMA guidelines. Eight English databases and three Chinese databases were searched to identify eligible articles from inception to February 2022. Two reviewers independently performed the literature screening and data extraction. The Cochrane Risk of Bias tool was used to assess the risk of bias. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) Working Group levels of evidence was used to evaluate the certainty of the findings.

RESULTS

Ten randomised controlled trials (RCTs) published between 2014 and 2022 were included. The meta-analysis revealed no significant differences in the step counts and for moderate to vigorous PA, and the certainty of the findings was very low, according to GRADE. Meta-analysis for most outcomes could not be performed owing to the fewer included studies and significant heterogeneity. Most studies reported positive effects in improving moderate PA, sedentary behaviour, fatigue and at least one domain of quality of life. This review proved that gamified interactions are associated with low adverse event rates.

CONCLUSION

Gamification interventions could be a feasible way to promote the adoption of mobile health (mHealth) technology in patients with cancer. Individual studies have demonstrated some positive effects of gamification interventions on PA and health-related outcomes. However, limited studies, small sample sizes and methodological heterogeneity weaken the evidence. Larger, well-designed RCTs are required to confirm the impact of gamification interventions on PA and health-related outcomes in cancer survivors.

Assessing the impact of pre-test education on patient knowledge, perceptions, and expectations of pharmacogenomic testing to guide antidepressant use

Pharmacogenomic (PGx) testing is an increasingly utilized technology that offers the potential for precision drug selection to treat depression. Though PGx-guided therapy is associated with increased rates of remission of depression symptoms, for many patients, treatment will not change based on PGx testing results. Lack of consensus guidelines for pre-test counseling may hinder the communication of PGx testing limitations, and patients often have high expectations for test outcomes. To explore this issue, we created and evaluated the impact of a pre-test education video for patients with depression. Individuals in the education group (n = 198) viewed this brief video about PGx testing prior to completing a survey that explored knowledge, perception, and expectations of PGx testing developed using a theoretical framework to measure intention to test. Individuals in the survey-only group (n = 189) completed the same survey but were not provided with any PGx educational materials. Analyses demonstrate efficacy of the video in improving knowledge of PGx. The education group also reported more positive attitudes and greater perceived control over pursuing PGx testing compared to the survey-only group. Further analyses identified significant differences in expectations, attitudes, and intention to pursue PGx testing based on number of previous medication trials. Path analyses identified the best model for predicting PGx testing intention, specifically that social norms and ease of testing have a strong positive association, and knowledge has a strong negative association with patients' intentions to test across the full sample, the education group, and the survey-only group. The findings of this study serve as a foundation for future tailored educational initiatives in the PGx testing space.

Men's reactions to gender inequality in the workplace: From relative deprivation on behalf of women to collective action

Over recent years, the role of men as women's allies in the struggle for gender equality has become increasingly important. Previous research has shown that often men do not fight gender inequalities as they fail to recognize the severity of discrimination against women (e.g., in hiring). In this study (N = 427), we examined whether men who experienced relative deprivation on behalf of women-a form of relative deprivation that stems from the awareness that women hold a less privileged position in society-were more motivated to engage in collective action to support gender equality in the workplace. The findings showed that men's feelings of deprivation on behalf of women were associated with a greater willingness to engage in collective action for gender equality. This relationship was sequentially mediated by two emotional reactions related to deprivation-increased guilt about gender inequalities and decreased fear of a potential backlash-and the moral conviction of acting for gender equality. These results suggest that men's awareness of gender inequality at work is an important antecedent to their acting in solidarity with women and that emotions and moral conviction are two psychological processes that turn cognition into behavior. Action to reduce gender inequalities should make men more sensitive to seeing that they hold a privileged position in society and to recognizing the pervasive and harmful nature of women's deprivation.

The Intervening Role of Conversational Frequency and Valence in a School-Based Health Intervention

School-based health interventions are potentially an effective method to communicate health messages to adolescents. Unfortunately, effectiveness of such interventions is limited. Research in other contexts has shown that interpersonal communication can influence the effectiveness of health programs, but this has not been thoroughly tested for school-based health interventions. Therefore, our study investigated interpersonal communication (i.e., conversational valence and frequency) in a school-based intervention context. We used a three-wave randomized-controlled trial with 1056 students to study three aims. The first aim was to investigate the influence of a health intervention on conversational frequency and valence about drinking, snacking, and exercising. Our second aim was to investigate the influence of conversational frequency and valence on (predictors of) drinking, snacking, and exercising. Our third aim was to investigate whether the health intervention indirectly influenced the program outcomes through conversational frequency and valence. Findings showed that conversational frequency and valence were related to (predictors of) the three behaviors. Additionally, findings showed that the intervention did not influence conversational frequency and valence. Accordingly, findings showed no indirect influence of the intervention on program outcomes through conversational frequency and valence. Our findings show the potential of interpersonal communication for health behaviors and predictors; however, they also stress the importance of a health intervention to properly influence interpersonal communication. If health interventions can successfully influence interpersonal communication, intervention effectiveness can be improved.

The effect of information overload and perceived risk on tourists' intention to travel in the post-COVID-19 pandemic

Since the COVID-19 pandemic, the tourism economy has been seriously affected. China has implemented a direct traveling management mechanism and recovered from the pandemic faster than the rest of the world. However, the COVID-19 situation is complicated and uncontrollable because of the available unclear information including difficult medical terminologies. This study attempts to find the determinants of the travel intention of China's tourists in the post-COVID-19 epidemic. Along with information overload and perception risk, an expanded research model of the Theory of Planned Behavior (TPB) was employed to propose the theoretical framework of this study. A survey was conducted among 518 tourists who spend their holiday in Hainan, which is a popular tourist destination in China. The empirical results show that information overload positively and significantly impacted perceived risk. Furthermore, perceived risk negatively affects the intention to travel. Perceived risk also negatively affected the attitude toward traveling. However, response self-efficacy did not have a significant effect on the intention to travel. Finally, based on the analysis results, this study proposes relevant research contributions and practical recommendations with management implications for the travel industries.

Measuring the effects of misinformation exposure and beliefs on behavioural intentions: a COVID-19 vaccination study

Misinformation has been a pressing issue since the beginning of the COVID-19 pandemic, threatening our ability to effectively act on the crisis. Nevertheless, little is known about the actual effects of fake news on behavioural intentions. Does exposure to or belief in misinformation about COVID-19 vaccines affect people's intentions to receive such a vaccine? This paper attempts to address this question via three preregistered experiments (N = 3463). In Study 1, participants (n = 1269) were exposed to fabricated pro- or anti-vaccine information or to neutral true information, and then asked about their intentions to get vaccinated. In Study 2, participants (n = 646) were exposed to true pro- and anti-vaccine information, while Study 3 (n = 1548) experimentally manipulated beliefs in novel misinformation about COVID-19 vaccines by increasing exposure to the information. The results of these three studies showed that exposure to false information about the vaccines had little effect on participants' intentions to get vaccinated, even when multiple exposures led them to believe the headlines to be more accurate. An exploratory meta-analysis of studies 1 and 3, with a combined sample size of 2683, showed that exposure to false information both supporting and opposing COVID-19 vaccines actually increased vaccination intentions, though the effect size was very small. We conclude by cautioning researchers against equating exposure to misinformation or perceived accuracy of false news with actual behaviours.

The importance of prototype similarity for physical activity: Cross-sectional and longitudinal associations in a large sample of young adolescents

OBJECTIVES

Physical activity declines during adolescence. The Theory of Planned Behaviour (TPB) is a useful framework for investigating activity but leaves variance unexplained. We explored the utility of a dual-process approach using the TPB and the Prototype Willingness Model (PWM) to investigate correlates of physical activity, and 1-year change in physical activity, among a large sample of adolescents.

DESIGN

A cross-sectional and longitudinal analysis of baseline and follow-up data from the Fit to Study cluster-randomized trial.

METHODS

A total of 9,699 secondary school pupils at baseline and 4,632 at follow-up (mean age = 12.5 years) completed measures of past week physical activity and constructs from both behaviour-change models, at time-points 1 year apart. Cross-sectional analyses used multilevel, stepwise regression models to measure the strength of associations between model constructs and physical activity, and variance in behaviour explained by PWM over and above TPB. In longitudinal analyses, change scores were calculated by subtracting follow-up from baseline scores. Models controlling for trial treatment status measured the strength of associations between change scores, and variance explained.

RESULTS

At baseline, after controlling for past behaviour, physically active prototype similarity had the strongest relationship with activity after the intention to be active. Change in prototype similarity had the strongest relationship with change in activity after the change in intention and attitudes. Prototype perceptions and willingness explained additional variance in behaviour.

CONCLUSION

A dual-process model incorporating prototype perceptions could more usefully predict physical activity than models based on rational expectations alone. Behaviour-change interventions promoting an active self-image could be tested for effects on physical activity.

Driving mechanism of subjective cognition on farmers’ adoption behavior of straw returning technology: Evidence from rice and wheat producing provinces in China

Straw burning is one of the important causes of environmental pollution in rural China. As an important green production technology, straw returning is beneficial to the improvement of rural environment and the sustainable development of agriculture. Based on the improved planned behavior theory, taking the survey data of 788 farmers in Shandong, Henan, Hubei, and Hunan provinces as samples, this paper uses a multi-group structural equation model to explore the driving mechanism of subjective cognition on the adoption behavior of farmers’ straw returning technology. The results show that behavioral attitude, subjective norm, and perceived behavioral control, which represent subjective cognition, all have significant driving effects on farmers’ intention to adopt straw returning technology. Behavioral intention plays a mediating role in the process of subjective cognition driving farmers’ adoption behavior of straw returning technology. Government support has a moderating role in the path from farmers’ behavioral intention to behavioral response. The subjective cognition of different types of farmers has a significant driving effect on the adoption intention of straw returning technology, but the driving strength weakens with the increase of the degree of farmers’ concurrent occupation. This study provides guidance for improving the government’s straw returning policy and regulating straw returning behavior.