Decision making and effort in the self-regulation of hypertension: testing two competing theories

Brief lifestyle advice in cardiac care: an experimental study on message source and framing

OBJECTIVE

Communicating risk information and offering lifestyle advice are important goals in cardiac rehabilitation. However, the most effective way and the most effective source to communicate this information are not yet known. Therefore, we examined the effect of source (cardiologist, physiotherapist) and framing (gain, loss) of brief lifestyle advice on patients' intention-to-change-lifestyle.

METHODS

In an online experimental study, 636 cardiac patients (40% female, 67 (10) yrs.) were randomly assigned to one of four textual vignettes. Effect of source and framing on intention-to-change-lifestyle (assessed using a 5-point Likert scale) was analysed using analysis of covariance (ANCOVA).

RESULTS

Patients expressed positive intention-to-change-lifestyle after receiving advice from the cardiologist (M = 4.1) and physiotherapist (M = 3.9). However, patients showed significantly higher intention-to-change-lifestyle after receiving advice from the cardiologist (0.58 [0.54-0.61]) when compared with the physiotherapist (0.52 [0.48-0.56]), (F[1,609] = 7.06, P = 0.01). Gain-framed and loss-framed advice appeared equally effective. However, communicating risks (loss) was remembered by only 9% of patients, whereas 89% remembered benefits (gain).

CONCLUSIONS

Our study shows the value of cardiologists and physiotherapists communicating brief lifestyle advice, as cardiac patients expressed positive intention for lifestyle change after receiving advice, irrespective of framing. Lifestyle advice should include benefits due to better recall.

Research on the Influence Mechanism of Intention to Proximity Travel under the COVID-19

The outbreak of COVID-19 has brought increasing attention to proximity travel. This mode of travel is a convenient travel setup for both tourists and neighboring destinations. With the help of the model of goal-directed behavior (MGB), this study investigates the influence of tourists' perception of epidemic risk on their intentions for proximity travel during the normalization of epidemic prevention and control. This study takes Shenzhen, China as the research area, and carried out the investigation in the context of normalization of the epidemic in China. A total of 489 pieces of valid sample data were collected through questionnaire surveys. Statistical analysis software, such as SPSS26.0 and AMOS23.0, were used to analyze the collected data information quantitatively, including descriptive statistical analysis, reliability and validity test, CFA and SEM. The results showed that attitude, subjective norms, positive anticipated emotions, and perceptual behavior control have significant positive effects on travel desire. Travel desire has a significant positive impact on travel intention, whereas negative anticipated emotions have no significant effect on travel desire. Meanwhile, the epidemic risk perception has a significant positive effect on attitudinal travel desire and travel intention. Under the background of the COVID-19, the stronger that the epidemic risk is perceived by tourists, the more the desire and intention to proximity travel are enhanced.

Health Behavior Theory and Hypertension Management: Comparisons Among Black, White, and American Indian and Alaska Native Patients

In the United States, hypertension is more common among individuals from racial and ethnic minority groups. Hypertension control rates are also lower for minority group members compared with White Americans. However, little research has employed well-established theoretical perspectives on health behavior, such as the Theory of Planned Behavior (TPB) and the Model of Goal-Directed Behavior (MGB), to better understand racial differences in rates of hypertension control. The present study examines the psychological processes involved in efforts to control blood pressure, through the lens of the TPB augmented by the MGB, in hypertensive patients of three racial groups: American Indian/Alaska Native, Black/African American, and White. Participants completed measures of past efforts to control blood pressure, attitudes, norms, perceived behavioral control, intentions, and anticipated emotions. Analyses employed confirmatory factor analysis and cross-groups path analysis. Measurement of the theoretical constructs and core putative mediators of blood pressure control intentions were largely similar across racial groups. With regard to the patterns of relationships among the constructs, differences among the groups were most apparent in pathways from past efforts to both cognitive and affective theoretical antecedents of intentions. These findings contribute to the sparse literature on factors involved in racial differences in hypertension control rates and may inform future interventions aimed at increasing hypertension control behaviors. Trial Registration ClinicalTrials.gov, NCT03028597, registered 23 January 2017, https://clinicaltrials.gov/ct2/show/NCT03028597; ClinicalTrials.gov, NCT04414982, registered 4 June 2020 (retrospectively registered), https://www.clinicaltrials.gov/ct2/show/NCT04414982.

Korean Domestic Tourists' Decision-Making Process under Threat of COVID-19

The purpose of this study is to build a theoretical framework to explain Korean domestic tourists' decision-making process under COVID-19 by applying an extended model of goal-directed behavior. The role of positive expectation of COVID-19, the effect of mass media, and perception of government policy were considered as new variables in the process of tourism decision-making. The results of this present study show that positive and negative anticipated emotion, positive expectation, and the frequency of past behavior positively influence the desire for travel domestically within the next three months, while the effect of mass media negatively affected the desire for travel domestically within the next three months. Two anticipated emotions and positive expectations were positive antecedents of the desire for travel domestically within this year. The anticipated emotions and the effect of mass media affected the desire to travel domestically next year. The results of this tourist's decision-making research will offer government, the tourism sector, and policy decision-makers better insights for establishing tourism policy responses and create safe destinations to help an adequate recovery and development of the tourism industry.

A Cultural Dance Program Improves Hypertension Control and Cardiovascular Disease Risk in Native Hawaiians: A Randomized Controlled Trial

BACKGROUND

Native Hawaiians have higher hypertension (HTN) and cardiovascular disease (CVD) rates than non-Hispanic whites, calling for culturally responsive interventions to close this gap.

PURPOSE

We tested the effects of a 6-month behavioral intervention, a cultural dance program based on hula (the customary dance of Hawai'i), for improving blood pressure (BP) and CVD risk among Native Hawaiians with uncontrolled HTN.

METHODS

In a randomized controlled trial, we tested the effects of the hula-based intervention among 263 Native Hawaiians with uncontrolled HTN (systolic ≥ 140 or ≥ 130 mmHg if diabetes) and no CVD at enrollment. All participants received a brief culturally tailored heart health education before random assignment to the hula-based intervention (n = 131) or the education-only waitlist control (n = 132). Intervention received hula lessons and group-based activities for 6 months. Control received only 1-week education through 6 months.

RESULTS

Intervention yielded greater reductions in systolic (-15.3 mmHg) and diastolic (-6.4 mmHg) BP than control (-11.8 and -2.6 mmHg, respectively) from baseline to 6 months (p < .05). At 6 months, 43% of intervention participants compared to 21% of controls achieved a HTN stage <130/80 mmHg (p < .001). The 10-year CVD risk reduction was two times greater for the intervention group than the control group based on the Framingham Risk Score calculator. All improvements for intervention participants were maintained at 12 months.

CONCLUSIONS

This trial represents one of the few rigorously conducted examinations of an Indigenous practice leveraged for health promotion, with implications for other ethnic populations.

Predicting Continued Participation in Government-Initiated Public Sports Clubs: The Role of Prior Knowledge and Awareness through Health Communications

Physical activity is the most effective preventive medicine in enhancing our physical health and subjective wellbeing. Since 2013, the South Korean government has introduced and developed the public sports club system as a way to promote exercise and the health of the general public. The current study investigated factors underlying the general public’s desires and intentions to join or participate in a public sports club (PSC) using the model of goal-directed behavior (MGB). Data were collected from 254 college students who had prior experience of participating in at least one PSC and were primarily analyzed using structural equation modeling (SEM). The results suggest that, among the five MGB determinants, the positive anticipated emotions and perceived behavioral control were significantly associated with participants’ desires, and, in turn, their desires were significantly related to their intention to participate in PSCs. Meanwhile, the respondents’ prior experience was marginally but significantly associated with desire but not with behavioral intention. Prior knowledge (through health communications) was significantly related to attitude, desire, and behavioral intention. Overall, the findings support the use of positive anticipated emotions, perceived behavioral condition, prior knowledge, and desire as indicators of participation behavior in the PSC context, and may aid the development of health communication and interventions aimed at encouraging future participation.

Role of Non-Pharmaceutical Interventions for COVID-19 in Cruise Tourists’ Decision-Making Process: An Extended Model of Goal-Directed Behavior

This study developed an extended model of goal-direct behavior (EMGB) to investigate the role of non-pharmaceutical interventions (NPIs) in predicting latent cruise travelers’ decision-making process in the COVID-19 pandemic context to foster the growth of a sustainable cruise business. An online survey was conducted for Korean respondents with experience of being on a cruise, and a total of 288 valid data were collected. The proposed model was examined using SmartPLS 3.0. Results show that in general, antecedents of MGB affected the desire, which in turn influenced cruise travelers’ behavioral intentions. Desire was also found to affect NPIs, which influenced behavioral intentions. Results reveal that the perception of COVID-19 affected NPIs and behavioral intention during COVID-19. Findings provide academia with theoretical implications and cruise managers with practical implications.

Model of goal directed behavior for limiting Latino preschoolers' television viewing: validity and reliability

Background

Accurately measuring parents’ attitudes and beliefs regarding limiting their children’s TV viewing is important to inform the design and evaluation of effective interventions. This manuscript assesses the internal consistency reliability, test-retest reliability, convergent validity, and construct validity of the Model of Goal Directed Behavior (MGDB) scales among parents of Latino preschoolers to characterize Latino parents’ attitudes and beliefs toward limiting their preschoolers’ TV viewing.

Method

Participants included parents of Latino preschoolers in the United States, 3–5 years old (n = 186). Parents completed a socio-demographic survey and the 105-item MGDB questionnaire (Attitudes, Perceived Positive/Negative Behavioral Control, Subjective Norms, Positive and Negative Anticipated Emotions, Habits, Self-Efficacy, Desires, and Intentions surrounding their child’s TV viewing) which was used to measure internal consistency reliability and construct validity. A subsample of participants completed the questionnaire twice to measure test-retest reliability. Further, parents completed a 7-day TV viewing diary for their preschooler, and a TV parenting practices questionnaire as measures of convergent validity.

Results

Internal consistency reliability was generally acceptable for the MGDB scales (Cronbach’s alphas> 0.7), except for the Desires scale, which was revealed to have two factors and the Attitudes and Perceived Behavioral Control scales. Test-retest reliability over 2 months had negligible to moderate correlations (r’s = 0.28 to 0.61). Two structural equation models were conducted. One yielded acceptable model fit (x² (97) = 113.65, p = .119) and the other had questionable model fit (x² (97) = 125.39; p = .028). Testing convergent validity, only two MGDB scales (Habits and Self-Efficacy) were positively correlated with the TV parenting practices questionnaire (r’s = 0.33 to 0.51), and none were meaningfully correlated with preschoolers’ mean daily TV viewing.

Conclusions

Initial reliability and validity for some of the MGDB scales appear acceptable among parents of Latino preschoolers. Refinement of the instrument and testing among larger samples is necessary to fully evaluate psychometric properties. This instrument may be useful for characterizing Latino parents’ attitudes and beliefs toward limiting their preschoolers’ TV viewing and informing future TV reduction interventions.

Trial registration

Clinical Trials NCT01216306 Registered October 6, 2010.

Using Values Affirmation to Reduce the Effects of Stereotype Threat on Hypertension Disparities: Protocol for the Multicenter Randomized Hypertension and Values (HYVALUE) Trial

Background

Medication nonadherence is a significant, modifiable contributor to uncontrolled hypertension. Stereotype threat may contribute to racial disparities in adherence by hindering a patient’s ability to actively engage during a clinical encounter, resulting in reduced activation to adhere to prescribed therapies.

Objective

The Hypertension and Values (HYVALUE) trial aims to examine whether a values-affirmation intervention improves medication adherence (primary outcome) by targeting racial stereotype threat.

Methods

The HYVALUE trial is a patient-level, blinded randomized controlled trial comparing a brief values-affirmation writing exercise with a control writing exercise among black and white patients with uncontrolled hypertension. We are recruiting patients from 3 large health systems in the United States. The primary outcome is patients’ adherence to antihypertensive medications, with secondary outcomes of systolic and diastolic blood pressure over time, time for which blood pressure is under control, and treatment intensification. We are comparing the effects of the intervention among blacks and whites, exploring possible moderators (ie, patients’ prior experiences of discrimination and clinician racial bias) and mediators (ie, patient activation) of intervention effects on outcomes.

Results

This study was funded by the National Heart, Lung, and Blood Institute. Enrollment and follow-up are ongoing and data analysis is expected to begin in late 2020. Planned enrollment is 1130 patients. On the basis of evidence supporting the effectiveness of values affirmation in educational settings and our pilot work demonstrating improved patient-clinician communication, we hypothesize that values affirmation disrupts the negative effects of stereotype threat on the clinical interaction and can reduce racial disparities in medication adherence and subsequent health outcomes.

Conclusions

The HYVALUE study moves beyond documentation of race-based health disparities toward testing an intervention. We focus on a medical condition—hypertension, which is arguably the greatest contributor to mortality disparities for black patients. If successful, this study will be the first to provide evidence for a low-resource intervention that has the potential to substantially reduce health care disparities across a wide range of health care conditions and populations.

Trial Registration

ClinicalTrials.gov NCT03028597; https://clinicaltrials.gov/ct2/show/NCT03028597 (Archived by WebCite at http://www.webcitation.org/72vcZMzAB).

International Registered Report Identifier (IRRID)

DERR1-10.2196/12498

Kā-HOLO Project: a protocol for a randomized controlled trial of a native cultural dance program for cardiovascular disease prevention in Native Hawaiians

Background

As a major risk factor for cardiovascular and cerebrovascular disease (CVD), hypertension affects 33% of U.S. adults. Relative to other US races and ethnicities, Native Hawaiians have a high prevalence of hypertension and are 3 to 4 times more likely to have CVD. Effective, culturally-relevant interventions are needed to address CVD risk in this population. Investigators of the Kā-HOLO Project developed a study design to test the efficacy of an intervention that uses hula, a traditional Hawaiian dance, to increase physical activity and reduce CVD risk.

Methods

A 2-arm randomized controlled trial with a wait-list control design will be implemented to test a 6-month intervention based on hula to manage blood pressure and reduce CVD risk in 250 adult Native Hawaiians with diagnosed hypertension. Half of the sample will be randomized to each arm, stratified across multiple study sites. Primary outcomes are reduction in systolic blood pressure and improvement in CVD risk as measured by the Framingham Risk Score. Other psychosocial and sociocultural measures will be included to determine mediators of intervention effects on primary outcomes. Assessments will be conducted at baseline, 3 months, and 6 months for all participants, and at 12 months for intervention participants only.

Discussion

This trial will elucidate the efficacy of a novel hypertension management program designed to reduce CVD risk in an indigenous population by using a cultural dance form as its physical activity component. The results of this culturally-based intervention will have implications for other indigenous populations globally and will offer a sustainable, culturally-relevant means of addressing CVD disparities.

Trial registration

ClinicalTrials.gov: NCT02620709, registration date November 23, 2015.

Tracing How Normative Messages May Influence Physical Activity Intention

Normative messages have been shown to increase intention to do physical activity. We traced how "positive" and "negative" normative messages influenced physical activity intention by comparing constructs of the model of goal-directed behavior with descriptive norms (MGDB + DNs) across control and treatment groups in an experiment. For this purpose, 16-24-year-old respondents (n = 1,200) in Bulgaria, Croatia, and Romania were asked about their age, sex, and levels of physical activity before being exposed to positive and negative normative messages and completing a questionnaire with MGDB + DNs scales. Different MGDB + DNs constructs were influenced by the normative messages: compared with the control, the negative message group showed stronger attitudes (p = .003) and the positive message group showed higher positive anticipated emotions (p = .005). The positive message's effect is consistent with the literature on conformity to social norms. The negative message's effect lends itself to interpretations based on social identity and deviance regulation theories.

Applying the Model of Goal-Directed Behavior, Including Descriptive Norms, to Physical Activity Intentions: A Contribution to Improving the Theory of Planned Behavior

The theory of planned behavior (TPB) has received its fair share of criticism lately, including calls for it to retire. We contribute to improving the theory by testing extensions such as the model of goal-directed behavior (MGDB, which adds desire and anticipated positive and negative emotions) applied to physical activity (PA) intention. We also test the inclusion of a descriptive norms construct as an addition to the subjective norms construct, also applied to PA, resulting in two additional models: TPB including descriptive norms (TPB + DN) and MGDB including descriptive norms (MGDB + DN). The study is based on an online survey of 400 young adult Internet users, previously enrolled in a subject pool. Confirmatory factor analysis (CFA) showed that TPB and TPB + DN were not fit for purpose, while MGDB and MGDB + DN were. Structural equation modelling (SEM) conducted on MGDB and MGDB + DN showed that the inclusion of descriptive norms took over the significance of injunctive norms, and increased the model's account of total variance in intention to be physically active.

Predicting use of effective vegetable parenting practices with the Model of Goal Directed Behavior

OBJECTIVE

To model effective vegetable parenting practices using the Model of Goal Directed Vegetable Parenting Practices construct scales.

DESIGN

An Internet survey was conducted with parents of pre-school children to assess their agreement with effective vegetable parenting practices and Model of Goal Directed Vegetable Parenting Practices items. Block regression modelling was conducted using the composite score of effective vegetable parenting practices scales as the outcome variable and the Model of Goal Directed Vegetable Parenting Practices constructs as predictors in separate and sequential blocks: demographics, intention, desire (intrinsic motivation), perceived barriers, autonomy, relatedness, self-efficacy, habit, anticipated emotions, perceived behavioural control, attitudes and lastly norms. Backward deletion was employed at the end for any variable not significant at P<0·05.

SETTING

Houston, TX, USA.

SUBJECTS

Three hundred and seven parents (mostly mothers) of pre-school children.

RESULTS

Significant predictors in the final model in order of relationship strength included habit of active child involvement in vegetable selection, habit of positive vegetable communications, respondent not liking vegetables, habit of keeping a positive vegetable environment and perceived behavioural control of having a positive influence on child's vegetable consumption. The final model's adjusted R 2 was 0·486.

CONCLUSIONS

This was the first study to test scales from a behavioural model to predict effective vegetable parenting practices. Further research needs to assess these Model of Goal Directed Vegetable Parenting Practices scales for their (i) predictiveness of child consumption of vegetables in longitudinal samples and (ii) utility in guiding design of vegetable parenting practices interventions.

Psychometric assessment of scales for a Model of Goal Directed Vegetable Parenting Practices (MGDVPP)

Background

Vegetable intake has been related to lower risk of chronic illnesses in the adult years. The habit of vegetable intake should be established early in life, but many parents of preschoolers report not being able to get their child to eat vegetables. The Model of Goal Directed Behavior (MGDB) has been employed to understand vegetable parenting practices (VPP) to encourage a preschool child’s vegetable intake. The Model of Goal Directed Vegetable Parenting Practices (MGDVPP) provides possible determinants and may help explain why parents use effective or ineffective VPP. Scales to measure effective and ineffective vegetable parenting practices have previously been validated. This manuscript presents the psychometric characteristics and factor structures of new scales to measure the constructs in MGDVPP.

Methods

Participants were 307 parents of preschool (i.e. 3 to 5 year old) children, used for both exploratory (EFA) and confirmatory factor analyses (CFA). Data were collected via an internet survey. First, EFA were conducted using the scree plot criterion for factor extraction. Next, CFA assessed the fit of the exploratory derived factors. Then, classical test theory procedures were employed with all scales. Finally, Pearson correlations were calculated between each scale and composite effective and ineffective VPP as a test of scale predictive validity.

Results

Twenty-nine subscales (164 items) within 11 scales were extracted. The number of items per subscale ranged from 2 to 13, with three subscales having 10 or more items and 12 subscales having 4 items or less. Cronbach’s alphas varied from 0.13 to 0.92, with 17 being 0.70 or higher. Most alphas <0.70 had only three or four items. Twenty-five of the 29 subscales significantly bivariately correlated with the composite effective or ineffective VPP scales.

Discussion

This was the initial examination of the factor structure and psychometric assessment of MGDVPP scales. Most of the scales displayed acceptable to desirable psychometric characteristics. Research is warranted to add items to those subscales with small numbers of items, test their validity and reliability, and characterize the model’s influence on child vegetable consumption.

A model of goal directed vegetable parenting practices

The aim of this study was to explore factors underlying parents' motivations to use vegetable parenting practices (VPP) using the Model of Goal Directed Vegetable Parenting Practices (MGDVPP) (an adaptation of the Model of Goal Directed Behavior) as the theoretical basis for qualitative interviews. In-depth interviews with parents of 3-5-year-old children were conducted over the telephone by trained interviewers following a script. MGDVPP constructs provided the theoretical framework guiding script development. Audio-recordings were transcribed and analyzed, with themes coded independently by two interviewers. Fifteen participants completed the study. Interviews elicited information about possible predictors of motivations as they related to VPP, and themes emerged related to each of the MGDVPP constructs (attitudes, positive anticipated emotions, negative anticipated emotions, subjective norms, and perceived behavioral control). Parents believed child vegetable consumption was important and associated with child health and vitality. Parents described motivations to engage in specific VPP in terms of emotional responses, influential relationships, food preferences, resources, and food preparation skills. Parents discussed specific strategies to encourage child vegetable intake. Interview data suggested parents used diverse VPP to encourage child intake and that varied factors predicted their use. Understanding these factors could inform the design of interventions to increase parents' use of parenting practices that promote long-term child consumption of vegetables.

The impact of non-pharmaceutical interventions for 2009 H1N1 influenza on travel intentions: A model of goal-directed behavior

Theoretically, in the tourism context this study introduced a new concept of non-pharmaceutical intervention (NPI) for influenza, and tested the impact of NPI on the behavioral intention of potential international tourists. This study also extended the model of goal-directed behavior (MGB) by incorporating the new concepts of NPI, and the perception of 2009 H1N1. The model found that desire, perceived behavioral control, frequency of past behavior, and non-pharmaceutical interventions predicted tourists' intention but perceptions of 2009 H1N1 had nil effect on desire and intention. Personal non-pharmaceutical interventions were theorized as adaptive behavior of tourists intending to travel during a pandemic which should be supported by tourism operators on a system-wide basis. Practically, this study dealt with the issue of influenza 2009 H1N1 with the study findings and implications providing government agencies, tourism marketers, policy-makers, transport systems, and hospitality services with important suggestions for NPI and international tourism during pandemics.

The Role of Desire in The Prediction of Intention

This paper is based on the notion that desire represents an important motivational aspect of the decision-making process. Thus, we examined the hypotheses that desire (1) predicts behavioral intentions and (2) mediates the effects of theory of planned behavior (TPB) components and past behavior on an individual’s intention to quit smoking. The analysis is based on three separate conditions in which the intention to quit smoking during the next 1, 4, or 6 months, respectively, was measured; the three conditions contained identical variables. The results of the hierarchical regression analysis show that there are sufficient grounds for including desire as an additional predictor in the TPB model. The results also show that desire mediates the effects of attitudes, norms, and past behavior on intention. However, the mediating role of desire was not obtained for the relationship between PBC and intention. Theoretical implications and recommendations for future research are suggested.

The addition of anticipated regret to attitudinally based, goal-directed models of information search behaviours under conditions of uncertainty and risk

Social science attempts to incorporate emotions into models of judgment and decision making have faced significant theoretical challenges, as well as produced conflicting empirical results. The following study first contributes to the body of knowledge by providing a theoretical explanation for the observed conflicting results from such models. In fact, both extant theory and the results reported herein suggest that a certain amount of variability in results should be expected from empirical investigations based on such models, particularly related to differences in respondents' level of affective versus cognitive involvement. Second, an argument is presented for considering a special case of Perugini and Bagozzi's (2001) Model of Goal-directed Behaviours (MGBs) when investigating these issues using attitude-based explanations of goal-related behaviours. Specifically, empirical evidence is presented for broadening the MGB model by including anticipated regret as an explanatory variable independent of other anticipated emotions, and deepening the theory by calling for multidimensional conceptualizations of the attitude and perceived behavioural control constructs. The implications of the reported study are presented and discussed.

Mammography screening and the theory of planned behavior: suggestions toward an extended model of prediction

Mammography screening is probably the most effective method for the early detection of breast cancer. Existing models of health behavior, such as the theory of planned behavior, could improve their predictive validity and, therefore, their ability to promote health-related interventions by identifying additional factors associated with health decision making. This review provides an overview of research on factors related to mammography screening within the context of the theory of planned behavior and identifies the potential benefits of adding motivational factors, such as time perspective, optimism, and risk perception, in an attempt to enhance its explanatory power.

The up- and down-regulation of amusement: experiential, behavioral, and autonomic consequences

A growing body of research has examined the regulation of negative emotions. However, little is known about the physiological processes underlying the regulation of positive emotions, such as when amusement is enhanced during periods of stress or attenuated in the pursuit of social goals. The aim of this study was to examine the psychophysiological consequences of the cognitive up- and down-regulation of amusement. To address this goal, participants viewed brief, amusing film clips while measurements of experience, behavior, and peripheral physiology were collected. Using an event-related design, participants viewed each film under the instructions either to (a) watch, (b) use cognitive reappraisal to increase amusement, or (c) use cognitive reappraisal to decrease amusement. Findings indicated that emotion experience, emotion-expressive behavior, and autonomic physiology (including heart rate, respiration, and sympathetic nervous system activation) were enhanced and diminished in accordance with regulation instructions. This finding is a critical extension of the growing literature on the voluntary regulation of emotion, and has the potential to help us better understand how people use humor in the service of coping and social goals.

Crisis and chaos in behavioral nutrition and physical activity

Resnicow & Vaughn challenged the field of behavioral nutrition and physical activity to conduct research in new ways. They challenged the predictiveness of our models, sensitivity to initial conditions, factors predisposing to change and measurement procedures. While the predictiveness of our models will reflect the sophistication of our thinking and research, and the sensitivity to initial conditions is subsumed under the sophistication of our models, research on conditions predisposing to change (e.g. epiphanies), more longitudinal designs, refined measurement procedures and testing of critical issues can only enhance the quality of our research. Improved research quality should lead to enhanced efficacy and effectiveness of our interventions, and thereby our making meaningful contributions to mitigating the chaos in our field and the crisis from the rising epidemic of obesity.