The theory of planned behaviour and discrete food choices: a systematic review and meta-analysis

Nutrition Knowledge, Attitudes, and Lifestyle Practices That May Lead to Breast Cancer Risk Reduction among Female University Students in Lebanon

Research has identified both nonmodifiable and modifiable risk factors for breast cancer (BC), with accumulating evidence showing that adopting adequate dietary practices could decrease the risk of this disease. This study aimed to assess nutrition knowledge, attitudes, and lifestyle practices (KAP) that may lead to BC risk reduction among female university students in Lebanon and examine the determinants of their practices. A cross-sectional survey was conducted using a convenience sampling method, comprising 356 (response rate: 71.2%) female students at the American University of Beirut aged 18 to 25 years with no history of BC. Participants completed a pre-tested questionnaire addressing the objectives of the study. The modified Bloom's cut-off of 75% was used to categorize knowledge and practice scores as poor or good and attitudes as negative or positive. Large proportions of students had poor knowledge (68.3%), negative attitudes (65.4%), and poor practices (98.0%) scores. Pursuing a health-related major and having a higher GPA were associated with better knowledge and attitudes while being older and having a lower degree of stress were associated with positive attitudes only. Having a lower body mass index (BMI) was associated with better practice scores. Better knowledge significantly predicted higher intake of fruits and vegetables. Overall knowledge and attitudes were significantly correlated with each other, but neither was significantly correlated with overall practice. These findings underscore the importance of implementing public health programs geared towards improving nutrition KAP that may lead to BC risk reduction.

Parental support in esports through the lens of the theory of planned behaviour

Esports have grown substantially in the last decade and may be an effective way of engaging and exposing the youth, who is not actively participating in traditional sports, to the benefits of sports related performance environments. However, due to negative stereotypes about gamers and concerns about esports, parents might be hesitant to support their children's esports participation and may instead actively discourage it. The purpose of this perspective article was to discuss the determinants of parental support based on the theory of planned behaviour. Parents attitudes seem to be mostly negative and their perceived behavioral control is likely low due to a lack of knowledge about esports. The subjective norms are mixed and seem to be growing progressively more positive. Based on the theory of planned behaviour, parents seem unlikely to support their children's esport participation, however, more research is needed. Recommendations on how to increase the likelihood of parental support are discussed.

Theory of planned behavior and college student 24-hour dietary recalls

Objective: The transition to college is marked by poorer eating behaviors, making emerging adulthood a particularly salient intervention point for improving lifelong health. The present study aims to better understand what psychosocial factors predict eating behaviors of college students using the Theory of Planned Behavior (TPB). Participants & Methods: Dietary recalls were analyzed the Healthy Eating Index (HEI)-2015 scoring system for 67 university students between the ages of 18 and 25 (70.1% female; 49.3% White, 20.9% Black/African American, 13.4% Asian). Results: Haye's PROCESS Model 6 was used. The full model accounted for a significant amount of variance in HEI-2015 scores (F[3, 63] = 3.09, p = .033, R2 = .12). The final model suggested a significant indirect effect of PBC on the relation between ATT and HEI-2015 (β = .859, SE = .637, 95% CI [.009, 2.482]). Conclusions: Although some college students might have favorable attitudes, only those who believe this is within their control actually ate a (somewhat) healthier diet.

A Reasoned Action Approach to Limiting Excessive Social Media Usage Among Adults

The literature on social media suggests a link between use and negative mental health consequences. Numerous theoretical perspectives have attempted to explain the underlying mechanisms for this relationship but are lacking a clear explanation for why some individuals may be negatively impacted by their social media use. Despite a plethora of research on this relationship, minimal research has examined the act of limiting social media use as a promotional behavior. This study takes a fresh approach by investigating attitudinal components that predict intentions to limit social media use via the reasoned action approach. US adults (N = 298) participated in an online survey on excessive social media use. Attitudes, perceived norms, and perceived behavioral control were significant predictors of intentions to limit social media use. In addition, perceived behavioral control was hypothesized to moderate both the attitude to intention and norm to intention relationships in that these associations would be stronger for those with higher control beliefs. Results showed that strong control beliefs strengthened the attitudes to intentions relationship but weakened the norm to intention relationship. Future practical and research directions are discussed to promote limiting social media use and further investigate the negative mental health outcomes of excessive social media.

Predicting discretionary food consumption using temporal self-regulation theory and food reward sensitivity

Discretionary foods account for over a third of the average adult's total daily energy intake. But its excess consumption is a risk factor for obesity, Type 2 diabetes, and other diet-related diseases. This study aimed to use temporal self-regulation theory (intention, past behaviour, habit, self-regulatory capacity) and food reward sensitivity to identify predictors of discretionary food consumption. Two hundred and seventy-three participants aged between 18 and 80 (M = 42.55, SD = 17.07) comprising of mostly females (79.5%) and those residing in Australia (93.4%), completed a two-part online survey, one week apart. Participants completed measures of intention, past behaviour, habit, self-regulatory capacity, food reward sensitivity and demographic information at time one, and discretionary food consumption at time two. Data was analysed using a hierarchical multiple regression analysis. All variables in combination accounted for a significant 40.3% of the variance in discretionary food consumption (R2 = 0.40, p < .001). However, past behaviour and intention were the only unique significant predictors of discretionary food consumption. No significant moderation effects found. Findings offer insight into the motivators of discretionary food consumption, which can inform the development of effective interventions to reduce discretionary food consumption. Past behaviour should be considered, and intention targeted in interventions to reduce discretionary food consumption.

The theory of planned behavior and dietary behaviors in competitive women bodybuilders

BACKGROUND

Women bodybuilders build their ideal physique by manipulating their diet, supplement, and exercise regimens to extreme levels. Excess protein intake and dietary supplement use is ubiquitous in women bodybuilders preparing for a competition, i.e., in-season competitors, however the impetus for these two dietary behaviors are relatively unknown. The Theory of Planned Behavior (TPB) has been used to explain dietary behaviors. The purpose of the study was to examine how the TPB can explain protein intake and dietary supplement use in in-season competitors.

METHODS

Using a cross-sectional design, an online questionnaire was developed, validated, and administered to collect dietary supplement use, TPB variables, and other measures from 112 in-season competitors. Protein intake was assessed using multiple 24-h dietary recalls. Associations between TPB and protein intake and dietary supplement use were determined with multiple regression analysis while adjusting for confounders.

RESULTS

For protein intake: attitude, subjective norm, and perceived behavioral control explained 8% of the variance in intention; subjective norm independently predicted intention. Behavioral beliefs predicted attitude; subjective norm was predicted by trainer/coach, workout partners, and social media influencers. For dietary supplement use: intention explained 5% of the variance in dietary supplement use; attitude, subjective norm, and perceived behavioral control together explained 38% of the variance in intention. Attitudes towards dietary supplements use were predicted by five factors (not a waste of money, help improve physique, sustain energy levels, provide enough calories, help with recovery). Primary determinants of subjective norm were fellow competitors, social media influencers, and trainer/coach. Perceived behavioral control was predicted by three factors (ease of purchase, affordability to purchase, availability to purchase).

CONCLUSIONS

TPB predicted dietary supplement use in women bodybuilders during in-season but there was little evidence for the prediction of protein intake using the TPB. Health professionals should develop effective interventions using strategies that align health education messages with in-season competitors' outcome beliefs and collaborate with their referent others to influence safer and effective dietary supplement use.

Factors Influencing Consumption Intention of Insect-Fed Fish among Italian Respondents

The rise in the world's demand for fish is increasingly met by aquaculture. However, this sector still shows various criticalities in terms of sustainability of practices, first and foremost, that of feed availability. Nowadays, the use of insect meal represents one of the potential sustainable solutions, but consumption intention of fish fed with insect meal and the factors affecting it have not yet been adequately understood. This study investigates 318 Italian consumers' intentions to buy fish fed with insect meal using an extended version of the Theory of Planned Behavior, including consumers' moral attitude and sustainability consciousness as additional constructs. The results of structural equation models show that consumers' high sustainability consciousness (6.16 on a scale from 1 to 7) does not influence their consumption intention of this product. Also, the two moderating variables involved in the model, i.e., the country of origin and price sensitivity, do not significantly affect consumers' intentions. Since the analysis demonstrates that, for consumers, insect meal-fed fish conforms to their moral principles and a significant positive attitude toward this practice it could be argued that fish fed with insect meal can match the demand from consumers who feel responsible for their consumer behavior. Although the limited area of investigations and the high education of interviewed do not allow for generalizing of the results, this paper provides pivotal food for thought for companies, policymakers, and academics responding to previous research calls on understanding the role of some constructs of consumption intention and highlighting the levers on which to act to foster the consumption intention of insect-fed fish.

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.

Consumer Intention towards Buying Edible Beef Offal and the Relevance of Food Neophobia

Enhancing the willingness to eat edible offal can be a valuable strategy to mitigate the greenhouse gas (GHG) emissions related to growing meat production and to provide food with high protein content to a growing global population. Although some edible offal is considered delicacies, we hardly find such foods in Western countries' everyday diet, and their human consumption has decreased during the last decades. This study analyses the consumer purchase intention of BEEF edible offal using an extended version of the Theory of Planned Behaviour (TPB), where food neophobia and food disgust sensitivity play an essential role in determining consumers' willingness to eat beef edible offal. An online survey was conducted among a sample of Italian adult regular meat eaters (n = 720), stratified by age, gender, education and residence. The results showed a direct negative impact of food neophobia on the intention to consume offal. Further, we were able to quantify a negative indirect impact of food neophobia on intention through the mediation of food disgust sensitivity and attitudes, subjective norms and perceived behavioural control, which all exert an essential role in determining the willingness to consume beef edible offal. We found that the mediated impact of food neophobia on the intention to consume beef offal is much higher than the direct impact. In conclusion, recommendations and implications, such as promoting cooking shows with celebrity chefs, new products or new packaging of edible offal, were developed based on the results to increase edible beef consumption.

Using the theory of planned behavior to predict factors influencing fast-food consumption among college students

PURPOSE

The purpose of this research is to examine the behavioral factors that impact fast food consumption (FFC) among college students in Pakistan by applying the theory of planned behavior (TPB).

METHODS

Cross-sectional survey was distributed to college students in Pakistan. The questionnaire examines the factors associated with six categories: demographics, FFC pattern, intention for FFC, attitudes toward FFC, Subjective Norms (SN), and Perceived Behavioral Control (PBC). Data analysis was conducted using SPSS and SPSS AMOS software using descriptive statistics, inferential statistics (chi-square, t-test, Pearson correlation, and multiple regression analysis), and structural equation modeling (SEM) Analysis.

RESULTS

A total of 220 questionnaires were completed (97 males and 123 females). There were significant differences in FFC association with gender. Among the constructs of TPB, behavioral intention (BI) and SN are the strongest predictors of the FFC (p < .05). TPB has significantly predicted FFC behavior with a variance of R² 0.603. The SEM analysis shows that the data collected were incompatible with the theoretical TPB model, making it unfeasible to test our five hypotheses or interpret the results due to the poor fit of the model with the data.

CONCLUSIONS

To ensure a good fit of the data with the specified TPB model in SEM analysis, the number of indicators should be limited (≤ 30), or the sample size should be greater (N ≥ 500). Pakistani college students' FFC is mainly influenced by friends and the increased popularity of fast food, despite their knowledge of its negative health effects. Educational programs should target specific harmful effects of fast food, and SN and BI are the strongest predictors of FFC among TPB constructs. These findings can be useful for developing targeted interventional health strategies and future research.

Food consumption and the Covid-19 pandemic: The role of sustainability in purchasing choices

The paper addresses the consumption issue in the post-Covid-19 pandemic era, finding a possible interpretative model in the theory of planned behaviour. To this end, a sample was selected, and multivariate statistical analysis showed that the aspects of sustainability, health and well-living represent possible keys to understanding purchasing and consumption behaviour in the recovery and return to "normality". The mass media, the advice of experts, and the optimism of small things (from an emotional and social point of view) also have a correlated effect on the purchase of food, health and the environment, as well as production methods, origin and supply chain, packaging and ethical and social responsibility, in line with the much desired ecological transition.

COVID-19 vaccine hesitancy and its associated factors in Malaysia

The success of the COVID-19 vaccination programme to achieve herd immunity depends on the proportion of the population inoculated. COVID-19 vaccination hesitancy is a barrier to reaching a sufficient number of people to achieve herd immunity. This study aims to determine the prevalence of COVID-19 vaccine hesitancy and to identify the reasons contributing to vaccine hesitancy using the Theory of Planned Behavior. A cross-sectional online survey was conducted between May 2021 to June 2021. Using exponential non-discriminative snowball sampling, participants were recruited via social media and telecommunication platforms. We used a questionnaire that obtained information on participant socio-demographics, vaccine hesitancy, pseudoscientific practices, conspiracy beliefs, subjective norms, perceived behavioural control, main reasons for not intending to get the COVID-19 vaccine; influential leaders, gatekeepers and anti-or pro-vaccination lobbies; and global vaccine hesitancy. A total of 354 responses (mean age = 32.5 years old ±13.6; 70.3% females) were included for analysis. The prevalence of COVID-19 vaccine hesitancy was 11.6%. COVID-19 vaccine hesitancy was significantly and positively associated with those who agreed with influential leaders, gatekeepers, and anti- or pro-vaccination lobbies (adjusted B coefficient = 1.355, p = 0.014), having a “wait and see” attitude to see if the COVID-19 vaccine is safe (adjusted B coefficient = 0. 822, p <0.001), perceiving that the vaccine will give them COVID-19 (adjusted B coefficient = 0.660, p <0.002), planned to use masks/others precautions instead (adjusted B coefficient = 0.345, p = 0.038) and having higher scores in conspiracy beliefs (adjusted B coefficient = 0.128, p <0.001). Concern about the costs associated with the vaccine (adjusted B coefficient = -0.518, p <0.001), subjective norms (adjusted B coefficient = -0.341, p <0.001), and perceived behavioural control (adjusted B coefficient = -0.202, p = 0.004) were negatively associated with vaccine hesitancy. COVID-19 vaccine hesitancy in Malaysia is low. Several factors were identified as being associated with vaccine hesitancy. Factors associated with vaccine hesitancy would be useful in tailoring specific interventions involving positive messages by influential leaders, which address vaccine misinformation and the wait-and-see attitude which may delay the uptake of COVID-19 vaccines.

Food Choices and Hypertension Among Rural Thais: Evidence From a Discrete Choice Experiment

Objective: The rural northern region of Thailand exhibits the highest rate of hypertension. This study explored hypertensive-related food choices between normotensive and hypertensive people residing in rural northern Thailand to determine which food attributes influence their choices. Methods: The study conducted a discrete choice experiment (DCE) survey among Thai adults residing in rural northern Thailand (n = 403) to estimate the relative importance of four food attributes, including food preparation, price, taste, and amount of salt. A mixed logit model was used to analyze the data from the DCE. Results: The first and second most important attributes in both hypertensive and normotensive groups were the amount of salt and food preparation at home, respectively, followed by price and taste. Specifically, the normotensive group was more attentive to the amount of salt in their food than their hypertensive counterparts. Conclusion: Intervention programs in rural communities may benefit from focusing their attention on embracing low-salt cultural foods and providing guidance on how to add flavor without additional salt or reduce high sodium seasonings without losing flavor when cooking.

Associations of Eating Identities With Self-Reported Dietary Behaviors and Body Mass Index

Objective:

To inform dietary interventions, it is important to understand antecedents of recommended (henceforth: healthy) dietary behaviors, beyond dietary beliefs and self-efficacy. We used the validated “Eating Identity Type Inventory” to assess the extent to which participants identified as healthy eaters, meat eaters, emotional eaters or picky eaters. We examined correlations between participants' race/ethnicity and other socio-demographic characteristics and affinity with these eating identities, how affinity with these eating identities correlated with self-reports of dietary beliefs, self-efficacy, dietary behaviors and Body Mass Index (BMI), and how well affinity with these eating identities predicted self-reported dietary behaviors and BMI, as compared to self-reported dietary beliefs and self-efficacy.

Methods

In an online survey, a diverse sample of 340 Los Angeles County adults reported eating identities, dietary beliefs, and self-efficacy, dietary behaviors and BMI.

Results

Pearson correlations revealed that identifying more as a healthy eater was positively associated with self-reports of being non-Hispanic White, non-Hispanic mixed race, older, and college-educated, while identifying more as a meat eater was positively associated with self-reports of being non-Hispanic Black, younger, and male (α = 0.05). Pearson correlations also showed that healthy eaters had more accurate dietary beliefs and self-efficacy, and emotional eaters had lower self-efficacy (α = 0.05). In linear regressions, identifying more as a healthy eater was associated with self-reporting healthier dietary behaviors and lower BMI, and identifying more as a meat eater and emotional eater was associated with reporting less healthy dietary behaviors and higher BMI, even after accounting for correlations with socio-demographics, dietary beliefs, and self-efficacy (α = 0.05).

Conclusions

Our findings highlight the importance of eating identities in understanding dietary behaviors and outcomes, with implications for dietary interventions.

Extending the Theory of Planned Behavior for Explaining Dietary Quality: The Role of Financial Scarcity and Food Insecurity Status

OBJECTIVE

To examine whether an extended Theory of Planned Behavior (TPB) that included finance-related barriers better explained dietary quality.

DESIGN

Cross-sectional survey.

PARTICIPANTS

One-thousand and thirty-three participants were included from a Dutch independent adult panel.

MAIN OUTCOME

Dietary quality.

ANALYSIS

Five TPB models were assessed: a traditional TPB, a TPB that included direct associations between attitude and subjective norm with dietary quality, a TPB that additionally included financial scarcity or food insecurity, and a TPB that additionally included financial scarcity and food insecurity simultaneously. Structural relationships among the constructs were tested to compare the explanatory power.

RESULTS

The traditional TPB showed poorest fit (χ²/degrees of freedom = 11; comparative fit index = 0.75; root mean square error of approximation [95% confidence interval], 0.10 [0.091-0.12]; standardized root mean square residual = 0.049), the most extended TPB (including both financial scarcity and food insecurity) showed best fit (χ²/degrees of freedom = 3.3; comparative fit index = 0.95; root mean square error of approximation [95% confidence interval], 0.050 [0.035-0.065]; standardized root mean square residual = 0.018). All 5 structure models explained ∼42% to 43% of the variance in intention; however, the variance in dietary quality was better explained by the extended TPB models, including food insecurity and/or financial scarcity (∼22%) compared with the traditional TBP (∼7%), indicating that these models better explained differences in dietary quality.

CONCLUSIONS AND IMPLICATIONS

These findings highlight the importance of accounting for finance-related barriers to healthy eating like financial scarcity or food insecurity to better understand individual dietary behaviors in lower socioeconomic groups.

Parent-Child Communication regarding Sport-Related Concussion: An Application of the Theory of Planned Behavior

Extant research has discussed the importance of social climates surrounding sport-related concussion (SRC) reporting, especially the need to address parents/guardians' role in concussion management. This study explores parents/guardians' intentions toward SRC-related conversations with their children and their seeking of conversational resources via the Theory of Planned Behavior (TPB). Data collected from 292 parents/guardians of 1^st-12^th graders who play contact sports are examined via a structural equation model. The results indicate that parents/guardians' intention toward communicating with their child about SRC reporting was determined by their attitudes and subjective norms but that perceived behavioral control was not a significant predictor of intention. Furthermore, parents/guardians' intention toward having these conversations was predictive of whether they sought information to aid these conversations. This study answers calls to address parents/guardians' involvement in SRC management and provides preliminary information for persuading parents/guardians to have conversations with their children about SRC reporting.

Consumer purchase intention towards a quick response (QR) code for antibiotic information: an exploratory study

Increasing awareness of antimicrobial resistance (AMR) has raised concerns surrounding antimicrobial use (AMU) in food-producing animals and has focused attention towards livestock production free from antibiotic use. As antibiotic-free livestock production proliferates in the UK, there is an increasing need to implement a system, such as the use of a QR code, to provide consumers with reliable antibiotic information while ensuring that animal welfare standards are upheld. Subsequently, this study aims to explore UK consumers’ perceptions and purchase intention towards QR code labelled pork, and to identify determinants of its purchase, incorporating various theoretical constructs from the Theory of Planned Behaviour. Based on results, consumers’ perceptions, perceived control, and attitudes towards QR code labelled pork are the main determinants of purchase intention. QR code labelled pork may offer a suitable alternative to antibiotic-free labelling as it provides consumers with antibiotic information without inadvertently communicating that conventionally produced pork is unsafe.

On the Effect of Employer Offered Leave of Work on Participation in Continuing Vocational Education and Training - Investigating the Intention-Behavior Relation

The availability of time is a deciding factor for participation of adults in continuing vocational education and training (CVET). In view of the importance of time for participation, the present study investigates the impact of employer offered leave of work on employees’ participation behavior in CVET. Leave of work provides a specific timeframe for CVET by enabling the use of working time as learning time. The rationale of the intention-behavior relation as theorized by the theory of planned behavior provides the theoretical framework for the study. The theory allows the integration of individual and contextual factors (e.g., the work environment) in explaining individual behavior and the underpinning decision-making process. The theory conceptualizes time as an element of behavioral control that is required to act on an intention. Behavioral control is theorized to moderate the intention-behavior relation. Two modes of behavioral control are distinguished. We use employer offered leave of work as a proxy for actual behavioral control and the degree of perceived behavioral control regarding the availability of temporal resources to participate in CVET to investigate the theorized moderating role of behavior control on the intention-behavior relation. To test the hypotheses, two waves of panel data from the German National Educational Panel Study (NEPS) are used. Aiming at causal inferences, hybrid logit models are employed. We find that a participation intention is a significant predictor of CVET participation. However, the results provide no evidence regarding the theorized moderating role of actual behavioral control in terms of an employer offered leave of work on the intention-behavior relation. Furthermore, the results provide evidence that the degree of perceived behavioral control regarding the availability of temporal resources to participate in CVET does neither moderate the intention-behavior relation nor is a proxy for actual behavioral control. Finally, we discuss possible future developments of the theory of planned behavior by integrating action-theoretical assumptions from the value-expectancy theory.

Predictors of intention to reduce meat consumption due to environmental reasons - Results from Poland and Slovakia

The current study examines the determinants of the intention to reduce meat consumption for pro-environmental reasons. The research model includes variables from the Theory of Planned Behavior (TPB) and the Norm Activation Model (NAM). The research was conducted in Poland and Slovakia, which are similar in terms of economic, social, and cultural conditions, located next to each other in the same climate zone, but differ greatly in terms of meat consumption and the direction of its change. Whereas in Poland, the meat consumption trend is rising, it is declining in Slovakia. The results of this study revealed that only attitude toward the impact of meat consumption reduction on the environment and personal norms related positively to intention to reduce meat consumption due to environmental reasons in both countries. However, in the country with decreasing meat consumption (Slovakia), the influence of attitude on intention was much stronger than in the country with increasing meat consumption (Poland). This study is the first to examine which predictors of intention to reduce meat consumption due to environmental reasons are simultaneous in two countries that have significantly different meat consumption levels and directions of change.

Predicting intention of Norwegian dental health-care workers to use nanomaterials: An application of the augmented theory of planned behavior

Due to the rapid development of nanotechnology and its integration into dentistry, there is a need for information on the factors influencing the decision of dental health-care workers to use nanomaterials. Based on a national survey among Norwegian dentists and dental hygienists, this study applied the theory of planned behavior (TPB), augmented with past behavior and perceived risk, to predict the intention to use dental nanomaterials in the future and to assess whether an augmented TPB model operates equivalently across professional groups. Structural equation modelling was used to assess whether the hypothesized model fits the data. Of 1792 eligible participants, 851 responded to an electronic survey. Attitudes and perceived behavioral control had the strongest effect on intention, followed by past behavior and subjective norms. Risk perceptions had an indirect effect on intention. Multigroup comparison confirmed invariance of the model across professional groups. This study supports the validity of the augmented TPB model to explain the intention of Norwegian dentists and dental hygienists to use nanomaterials. The strongest influence on intention is given by the attitudes toward nanomaterials and perceived confidence in their use. The findings of the study have implications for management of the use of nanomaterials in dentistry by policy makers.

Do socio-structural factors moderate the effects of health cognitions on COVID-19 protection behaviours?

OBJECTIVE

Adherence to protection behaviours remains key to curbing the spread of the SARS-CoV-2 virus that causes COVID-19, but there are substantial differences in individual adherence to recommendations according to socio-structural factors. To better understand such differences, the current research examines whether relationships between health cognitions based on the Reasoned Action Approach (RAA) and eight COVID-19 protection behaviours vary as a function of participant-level socio-structural factors.

METHODS

Within-person design with behaviours nested within participants in a two-wave online survey (one week delay) conducted during the UK national lockdown in April 2020. A UK representative sample of 477 adults completed baseline measures from the RAA plus perceived susceptibility and past behaviour for eight protection behaviours, and self-reported behaviour one week later. Moderated hierarchical linear models with cross-level interactions were used to test moderation of health cognitions by socio-structural factors (sex, age, ethnicity, deprivation).

RESULTS

Sex, ethnicity and deprivation moderated the effects of health cognitions on protection intentions and behaviour. For example, the effects of injunctive norms on intentions were stronger in men compared to women. Importantly, intention was a weaker predictor of behaviour in more compared to less deprived groups. In addition, there was evidence that perceived autonomy was a stronger predictor of behaviour in more deprived groups.

CONCLUSION

Socio-structural variables affect how health cognitions relate to recommended COVID-19 protection behaviours. As a result, behavioural interventions based on social-cognitive theories might be less effective in participants from disadvantaged backgrounds.

Understanding Meal Choices in Young Adults and Interactions with Demographics, Diet Quality, and Health Behaviors: A Discrete Choice Experiment

BACKGROUND

Our understanding of meal choices is limited by methodologies that do not account for the complexity of food choice behaviors. Discrete choice experiments (DCEs) rank choices in a decision-making context.

OBJECTIVES

This study aimed to rank the relative importance of influences on meal choices in young adults and examine interactions by subgroups.

METHODS

Adults (18-30 y) living in Australia were recruited via social media to complete an Internet-based DCE and survey. Participants were presented with 12 choice sets about a typical weekday meal, consisting of 5 attributes (taste, preparation time, nutrition content, cost, and quality). Diet quality (Dietary Guideline Index) was calculated from brief dietary questions. Conditional logit models ranked meal attributes, including interactions by sex, education, area-level disadvantage, diet quality, and weight status.

RESULTS

In total, 577 adults (46% female, mean ± SD age 23.8 ± 3.8 y) completed the DCE and survey. Nutrition content was the most important influence on meal choice (B: 1.48; 95% CI: 1.31, 1.64), followed by cost (B: -0.75; 95% CI: -0.87, -0.63), quality (B: 0.58; 95% CI: 0.49, 0.67), taste (B: 0.55; 95% CI: 0.45, 0.65), and preparation time (B: -0.42; 95% CI: -0.52, -0.31). Females, those with higher diet quality, and those with a BMI (in kg/m2) <25 had higher preferences for better nutrition content. Females had higher preferences for better taste and lower preferences for higher-cost meals. Participants with higher education had higher preferences for better nutrition content. Participants living in higher area-level disadvantage areas had higher preferences for longer preparation time.

CONCLUSIONS

Nutrition content was the most important influence on young adults' meal choices. Preferences differed by sex, socioeconomic position, diet quality, and weight status. Findings show the suitability of DCEs for understanding food choice behaviors in young adults and support the need for meal-based interventions to be tailored according to demographic and health characteristics.

Assessing the impact of an educational intervention program based on the theory of planned behavior on the nutritional behaviors of adolescents and young adults with PCOS in Iran: a field trial study

BACKGROUND

Polycystic ovary syndrome is the most common endocrine disorder among adolescents and adults. Given the importance of healthy nutritional behaviors in management of this disease, the present study was conducted to determine the impact of an educational intervention program based on the theory of planned behavior on the nutritional behaviors of adolescents and young adults with polycystic ovary syndrome.

METHODS

In this field trial study, 72 participants aged between 15 and 21 years old from four gynecology clinics in Shiraz, Iran, were assigned into the intervention and control groups. Educational intervention program was implemented based on the theory of planned behavior over 4 sessions during two weeks. The data collection tools were researcher-made questionnaires of demographic information, knowledge assessment, and assessment of theory of planned behavior constructs, as well as a questionnaire for assessing consumption of food groups, fast food, and snacks. The data were collected at two stages (once at baseline and once three months after the intervention), and then the changes in knowledge, attitude, subjective norms, the perceived behavioral control, behavioral intention, and nutritional behavior were analyzed using descriptive and inferential statistical methods (t-test, Chi-square, Mann- Whitney U, and Wilcoxon tests; as well as one- way ANOVA, repeated measures ANOVA, and ANCOVA, respectively).

RESULTS

Statistically significant increases were observed in the mean scores of knowledge, attitude, subjective norms, the perceived behavioral control, behavioral intention, and nutritional behavior in the intervention group by passing three months from the intervention compared to the scores before the intervention (P < 0.001). However, these differences were not statistically significant in the control group (P > 0.05). Moreover, the mean scores of knowledge, attitude, subjective norms, perceived behavioral control, behavioral intention, and nutritional behavior had no statistically significant difference before the intervention between the two groups; however, this was statistically significant by passing three months from the intervention (P < 0.001).

CONCLUSION

Considering the effect of an educational intervention program based on the theory of planned behavior on creating healthy nutritional behaviors in adolescents and young adults with polycystic ovary syndrome, it is recommended to use it in order to improve the nutritional health of them.

TRIAL REGISTRATION

IRCT, IRCT20160224026756N6. Registered 18 Aug 2018, https://en.irct.ir/user/trial/32693/view.

Predicting Behavioral Intentions to Prevent or Mitigate COVID-19: A Cross-Cultural Meta-Analysis of Attitudes, Norms, and Perceived Behavioral Control Effects

We examined the effectiveness of attitudes, subjective norms, and perceived behavioral control (PBC) of the theory of planned behavior on COVID-19 relevant behavioral intentions and behaviors. We conducted a meta-analysis of 335 effect sizes from 83 samples across 31 countries ( N = 68,592). We found strongest effects for PBC, but contrary to previous research also moderately strong effects of subjective norms. Focusing on systematic context effects: (a) norm–behavior associations at individual level were strengthened if population norms were stronger; (b) collectivism strengthened norm effects in line with cultural theories, but also attitude and PBC associations, suggesting that COVID-relevant behaviors show collective action properties; (c) in line with cultural theory, tightness–looseness strengthened normative effects on behaviors; and (d) contrary to post-modernization theory, national wealth weakened attitude and PBC associations. These analyses provide new theoretical and practical insights into behavioral dynamics during an acute public health crisis.

Choice Drivers for Quality-Labelled Food: A Cross-Cultural Comparison on PDO Cheese

This study aims at examining the consumers’ preferences and drivers affecting the choice of quality-labelled food products, i.e., protected designation of origin (PDO) labelled cheese. We applied the theory of planned behaviour (TPB) to analyse the purchase of Parmigiano Reggiano PDO and Comté PDO hard cheeses in Italy and France, respectively. A cross-sectional sample of 808 consumers (400 French and 408 Italian) completed a questionnaire. Structural equation modelling (SEM) indicated perceived behavioural control (PBC) and attitude to be significant predictors of intention to purchase PDO-labelled cheese in France and Italy. Subjective and moral norms affected intention in France. Intention significantly influenced the hard cheese purchase behaviour. The results confirm that the TPB model predicted the self-reported measure of behaviour more than the observed one, measured with a discrete choice experiment, in both countries. The TPB interrelationships varied between countries, suggesting that food systems operators and public authorities should carefully target their intervention to stimulate the demand of PDO-labelled products.

GMO Food Labels Do Not Affect College Student Food Selection, Despite Negative Attitudes towards GMOs

US Public Law 114-216 dictates that food producers in the United States of America will be required to label foods containing genetically modified organisms (GMOs) starting in 2022; however, there is little empirical evidence demonstrating how U.S. consumers would use food labels that indicate the presence or absence of GMOs. The aim of this two-phase study was to determine how attitudes towards GMOs relate to food choices and how labels indicating the presence or absence of GMOs differentially impact choices among college students-the age group which values transparent food labeling more than any other. Participants (n = 434) made yes/no choices for each of 64 foods. In both phases of the study, participants were randomly assigned to seeing GMO Free labels, contains GMOs labels, or no GMO labels. Across the two phases, 85% of participants reported believing that GMOs were at least somewhat dangerous to health (42% believed GMOs to be dangerous), yet in both studies, although eye-tracking data verified that participants attended to the GMO labels, these labels did not significantly affect food choices. Although college consumers may believe GMOs to be dangerous, their food choices do not reflect this belief.

Historical Theoretical Perspectives to Consider in the Application of Community-Based Interventions for African Americans and Communities of Color

Using theory as a framework for community-based interventions in African American members provides the principles and guidance needed to generate nursing knowledge. However, choosing an appropriate theoretical framework to guide community-based interventions can be challenging. The aim of this manuscript is to examine the use of three historical models or theories (the Health Belief Model, the Theory of Planned Behavior, and Bandura's Self-Efficacy Theory), which are still being used today, to better understand their applications in community-based interventions.

Ranking of meal preferences and interactions with demographic characteristics: a discrete choice experiment in young adults

BACKGROUND

The diet of young adults is poor, yet little is known about the relative importance of influences on healthy eating in a decision-making context. The aim of this exploratory study was to understand the relative ranking of influences on meal choices in young adults and to investigate interactions between meal preferences and demographic and health characteristics.

METHODS

Adults aged 18-30 years (n = 92, mean age: 23.9 (SD 3.4) years) completed an online discrete choice experiment. Participants were presented with 12 choice sets reflecting a typical weekday meal and were asked to choose between four meal options. Each meal consisted of a combination of five meal attributes (preparation time, cost, taste, familiarity and nutrition content) that each had three attribute levels. Data were analysed using conditional logit models. Subgroup analyses were performed by sex, education, income, weight status and meeting fruit and vegetable recommendations.

RESULTS

Comparing the highest and lowest attribute levels, meal preferences were higher for better taste (B = 0.38; 95% CI: 0.12, 0.63), familiarity (B = 0.37; 95% CI: 0.21, 0.54) and nutrition content (B = 1.11; 95% CI: 0.81, 1.41) and lower for increased preparation times (B = -0.33; 95% CI: - 0.53, - 0.12) and cost (B = -0.50; 95% CI: - 0.75, - 0.24). Nutrition content was the most important influence on meal choice. Cost was the second most important, followed by taste, familiarity and preparation time. Compared to males, females had a higher preference for better nutrition content, taste and familiarity and a lower preference for increased cost. Higher educated participants had a higher preference for better nutrition content, familiarity and taste compared to lower educated participants. Young adults who met recommendations for fruit and vegetable intake had a higher preference for better nutrition content compared to participants who did not meet recommendations.

CONCLUSION

Nutrition content was the most important influence on young adults' meal choices, followed by cost, taste, familiarity and preparation time. Preferences varied by demographics and health characteristics, suggesting that the focus of dietary interventions may benefit from being tailored to specific young adult groups.

The effect of theory-based educational intervention on correct principles of manual material handling among men

BACKGROUND

Changing human behavior for the purposes of improving the way people work is an integral part of most educational interventions. This study aimed to evaluate the effect of a model based on the theory of planned behavior (TPB) on correct principles of manual material handling (MMH) among male soldiers.

SUBJECTS AND METHODS

This study was a quasi-experimental, pretest-posttest research with a control group. Furthermore, 140 soldiers, from an area located in the city of Bandar Abbas, Iran, were selected through a simple random sampling and they were divided into two groups: intervention and control (70 subjects in each group). The data were collected using a three-part questionnaire including demographic information, the theory constructs, and MMH behavior. The intervention group was given the relevant education, and after 2 months, the both groups were evaluated.

RESULTS

Based on regression analysis, attitude toward behavior and perceived behavioral control were predictors for correct principles of MMH. There were significant differences between the mean scores of the theory constructs before and after the education in intervention group (P < 0.001); however, no significant differences were observed in the theory constructs in the control group after the intervention. Before the education, the mean score of MMH of the intervention group was 38.30 ± 6.45; but after, the education, this changed into 44.20 ± 6.01, and significantly increased (P < 0.001).

CONCLUSIONS

Educational intervention based on the TPB was effective in improving behavior for correct MMH in soldiers. Thus, the use of such educational programs according to the constructs of the planned behavior theory is recommended.

Chrononutrition during Pregnancy: A Review on Maternal Night-Time Eating

Evidence from women working night shifts during pregnancy indicates that circadian rhythm disruption has the potential to adversely influence pregnancy outcomes. In the general population, chronodisruption with the potential to affect pregnancy outcomes may also be seen in those with high energy intakes in the evening or at night. However, maternal night eating during pregnancy remains understudied. This narrative review provides an overview of the prevalence, contributing factors, nutritional aspects and health implications of night eating during pregnancy. We derived evidence based on cross-sectional studies and longitudinal cohorts. Overall, night eating is common during pregnancy, with the estimated prevalence in different populations ranging from 15% to 45%. The modern lifestyle and the presence of pregnancy symptoms contribute to night eating during pregnancy, which is likely to coexist and may interact with multiple undesirable lifestyle behaviors. Unfavorable nutritional characteristics associated with night eating have the potential to induce aberrant circadian rhythms in pregnant women, resulting in adverse metabolic and pregnancy outcomes. More research, particularly intervention studies, are needed to provide more definite information on the implications of night eating for mother-offspring health.

Go/no-go for food: Attention bias and intention to eat unhealthy food

OBJECTIVE

The current research evaluated whether Go/No-go training for highly palatable (HP) food affected attention bias for HP food (an automatic/implicit outcome) and intention to eat unhealthy food (a controlled/explicit outcome).

METHOD

A sample of Australian adults representative for age, gender and Body Mass Index (BMI) (N = 561, M_age = 46.31 years, SD = 16.75, 52.3% women, M_BMI = 27.11, SD = 6.34) completed self-report measures of dietary psychological constructs and food image modified Stroop tasks as measures of pre- and post-test attention bias for HP food. After random assignment of participants to two conditions, a Go/No-go intervention was used to train HP food targeted inhibitory control in the experimental group, or general inhibitory control in the control group. All research tasks were delivered online.

RESULTS

The experimental, HP food inhibitory control training group reported intention to eat less unhealthy food than the control group, F (1, 637) = 4.81, R² = 0.09, p = .029. Counter to expectations, the experimental group exhibited a heightened attention bias to HP food images after the training, F (1, 637) = 9.48, R² = 0.39, p = .002.

CONCLUSION

Go/No-go training for food may improve both top-down and bottom-up inhibitory control, using both automatic and controlled processes. Further, it may not be effective in lowering attention bias for HP food, but may be effective in lowering unhealthy food intake despite raising attention bias for HP food. Further research that tests these effects using varied reaction time tasks is needed to confirm these results and to explore possible alternative explanations.

Predicting limiting 'free sugar' consumption using an integrated model of health behavior

Excess intake of 'free sugars' is a key predictor of chronic disease, obesity, and dental ill health. Given the importance of determining modifiable predictors of free sugar-related dietary behaviors, we applied the integrated behavior change model to predict free sugar limiting behaviors. The model includes constructs representing 'reasoned' or deliberative processes that lead to action (e.g., social cognition constructs, intentions), and constructs representing 'non-conscious' or implicit processes (e.g., implicit attitudes, behavioral automaticity) as predictors of behavior. Undergraduate students (N = 205) completed measures of autonomous and controlled motivation, the theory of planned behavior (TPB) measures of explicit attitude, subjective norms, perceived behavioral control (PBC), and intentions, past behavior, implicit attitude, and behavioral automaticity at an initial point in time, and free sugar limiting behavior and behavioral automaticity two weeks later. A Bayesian structural equation model indicated that explicit attitude, subjective norms, and PBC predicted behavior via intention. Autonomous motivation predicted behavior indirectly through all TPB variables, while controlled motivation predicted behavior only via subjective norms. Implicit attitudes and behavioral automaticity predicted behavior directly and independently. Past behavior predicted behavior directly and indirectly through behavioral automaticity and intentions, but not implicit attitudes. Current findings suggest pervasive effects of constructs representing both reasoned and non-conscious processes and signpost potential targets for behavioral interventions aimed at minimizing free sugar consumption.

Do German Student Biology Teachers Intend to Eat Sustainably? Extending the Theory of Planned Behavior with Nature Relatedness and Environmental Concern

Non-sustainable food choices are responsible for many global challenges, such as biodiversity loss and climate change. To achieve a transformation toward sustainable nutrition, it is crucial to implement education for sustainable development (ESD), with the key issue “nutrition”, in schools and teacher training. Biology teachers are crucial for promoting ESD competences. Thus, the main aim of the study is to investigate the social and environmental psychological factors that may affect the intention of student biology teachers to eat sustainably as an integral part of their action competence needed for teaching this topic effectively. We conducted a paper-pencil questionnaire (N = 270, Mage = 22.9; SD = 2.8) based on the theory of planned behavior (TPB) and expanded the model by integrating environmental concern and nature relatedness. A path model is reported to show the relationships between the variables. The results show that the extended TPB model is suitable for predicting the intention to eat sustainably. Nature relatedness and altruistic concern positively predict attitudes and the intention to eat sustainably. This study suggests further research on the importance of (student) teachers’ nutritional behavior, as a possible determinant of the intention to teach this topic in their future school career.

Determinants of prebiotic vegetable consumption: the extended theory of planned behaviour

Background

Prebiotic vegetables such as leek and salsify may contribute to preventing obesity by changing the composition of the gut microbiota. To increase consumption of prebiotic vegetables, the aim of the study was to document the prevalence and determinants of (prebiotic) vegetable consumption.

Methods

An online, correlational questionnaire was administered to participants using a mixed approach (1078 online, 200 face-to-face). Participants were a representative sample (gender, age, level of education, province, population density and (un)employment) of 1278 adults of the Walloon region in Belgium. The frequency and determinants of prebiotic vegetable consumption were measured using an extension of the Theory of Planned Behaviour including habits, actual control and compensatory health beliefs. Descriptive analyses were performed followed by hierarchic multiple regression analyses.

Results

The descriptive results showed that for all categories (leek, salsify, vegetables in general) an improvement in both intentions and prevalence of the actual behaviour is necessary to experience the health benefits of (prebiotic) vegetables. Intentions and habits were important predictors of consumption for all types of vegetables, and hedonic attitudes and subjective norms were important predictors of intention. Perceived control and rational attitudes were predictors of intention to consume only for vegetables in general. Finally, environmental factors such as price, availability and actual control predict consumption but their influence differs depending on the vegetable.

Conclusions

The findings can be used to inform interventions that aim to increase (prebiotic) vegetable consumption. Umbrella terms such as ‘healthy food’ or ‘vegetables’ do not capture the differences between the specific foods regarding the demographic and socio-psychological determinants of their consumption. This is the first research to investigate the determinants of prebiotic vegetable consumption.

Social-Psychological Factors in Food Consumption of Rural Residents: The Role of Perceived Need and Habit within the Theory of Planned Behavior

To address the problem of malnutrition in poor rural areas of China, this study aims to examine the effects of social-psychological factors in food consumption of rural residents in poor counties of Southwest China. In addition, it investigates the role of perceived need and habit within the theory of planned behavior (TPB) in predicting food consumption. A survey with random sampling was conducted on rural residents (n = 424), and the theoretical frameworks of both the standard and extended TPB were applied for comparison purposes. Structural equation modeling was applied to test the relationships among constructs. Consumption of five food items was studied, respectively: meat, eggs, dairy, fish, and fruits. Results showed that incorporation of perceived need and habit substantially increased the explanatory power of the TPB, but these factors only had significant direct effects on intention rather than behavior. Perceived need and habit are stronger predictors of intention than any other TPB construct for consumption of all food items except for meat. We found indirect effects of the constructs in the extended TPB model on consumption to be different across food items. Practical implications to improve consumption of different food items were proposed accordingly.

Purchase Intention of Specialty Coffee

The main aims of this study are: (1) to test whether the theory of planned behavior (TPB) is useful to explain the intention to purchase specialty coffee; (2) to analyze whether people more involved in social responsibility could manifest a different response from those not so interested in this matter concerning specialty coffee. The sample is composed of 489 specialty coffee consumers from Brazil. The statistical tool for testing the measurement and structural model was partial least squares. Then a multigroup analysis was performed to meet the second objective; the software SmartPLS was utilized. The main contributions of this study are that we can explain the intention to use specialty coffee in a sample of Brazilian consumers using the classical TPB model. Moreover, we demonstrate the moderating effect of consumer perception of corporate social responsibility in this general model.

Sustainable food waste management towards circular bioeconomy: Policy review, limitations and opportunities

Research attention is increasingly drawn on constructing a circular bioeconomy and enhancing the value of material flows. Circular bioeconomy aims to achieve sustainable consumption and production with reduction of greenhouse gas emission. This study identifies research gaps on how circular bioeconomy can be achieved through sustainable food waste management by comparing the similarities and differences in concepts of bioeconomy and circular economy, reviewing the benefits and limitations of the existing policies, and evaluating the global situations of food waste and its management on household and commercial basis to promote circular bioeconomy. Future development on food waste management is expected to capitalise on the multi-functionality of products, boundary and allocation in a circular system, and trade-off between food waste and resources. With future technological advances, food waste management in circular bioeconomy policy can facilitate the accomplishment of sustainable development goals.

From Values to Behavior: Proposition of an Integrating Model

Human values are at the heart of our lives. We all hold a set of values that influence our actions. The protection of the natural environment is no exception to this rule. That is why the study of human values is key to reaching the imperative of sustainability. In this conceptual paper, we aim to (1) integrate the key theories and models explaining the influence of human values on behavior and to (2) identify factors that might have previously been overlooked. Drawing from a range of disciplines, this article proposes an integrated model mapping the influence of human values on behavior. It also puts forward the concept of consequences as an emerging factor that could play an important role in this relationship. Recommendations are to extend the research to an empirical investigation of the model and to develop the definition of the concept of consequences and the role they play in the influence of values on consumer behavior.

Effects of interventions based on the theory of planned behavior on sugar-sweetened beverage consumption intentions and behavior

There is increasing concern about the health risks of added dietary sugar, perhaps particularly when consumed in beverages that contain no essential nutrients (e.g., sodas). The purpose of this experiment was to examine the relative and combined efficacy of three interventions based on the theory of planned behavior (TPB) for motivating reductions in sugar sweetened beverage (SSB) consumption. Four-hundred-thirty undergraduates were randomised in a 2*2*2 factorial design. Participants received either information designed to increase awareness of the risks of SSB consumption or control information, and received either information about SSB consumption norms or no norms information, and either made plans to reduce their SSB consumption or engaged in a control planning task. Results demonstrated that the interventions, separately and in conjunction, resulted in greater intentions to reduce SSB consumption in the future, and there was evidence that these effects were mediated by the effects the interventions had on the TPB constructs. Further, the risks information resulted in more behaviors indicative of preparations to alter SSB consumption and those who engaged in the SSB planning task reported significantly lower SSB consumption at follow-up compared to controls. The three interventions utilized showed promise for altering SSB consumption intentions and behavior and, given their brevity and low cost, have potential to be developed into large scale community-based interventions that may lead to meaningful public health benefits.