Understanding the behavioral determinants of adolescents' water consumption: A cross-country comparative study

Substituting the consumption of sugar-sweetened beverages (SSB) with that of water can have a positive effect on adolescents' health. However, despite the attention on this topic in the Global North, it is relatively understudied in other regions of the world, such as the Caribbean. To guide the development of future interventions, understanding the factors determining water consumption among Caribbean adolescents is important. This study examined the behavioral determinants of water consumption among adolescents in Aruba (the Caribbean) and compared them to those in the Netherlands (Western Europe). We used a theoretical model that integrates the dominant theoretical perspectives in the field of public health, including theories of planned behavior, social norms, and intrinsic motivation. This cross-country study included 1,584 adolescents from Aruba and the Netherlands (52% girls; M = 12.34 years; SD = 2.14). The data were analyzed using regression analyses. This study found that in Aruba, adolescents with higher scores of intrinsic motivation, friends' descriptive norms, attitudes, and behavioral control regarding water consumption drank more water. Moreover, the associations between water consumption and both intrinsic motivation as well as friends' descriptive norms for adolescents in Aruba were stronger than those found in the Netherlands. These associations imply that it is even more important for Aruban adolescents than Dutch adolescents to be intrinsically motivated or to perceive their friends often consuming water to drink more water. The cross-country comparison implies that future interventions in Aruba aimed at increasing adolescents' water consumption as an alternative to SSB should focus on enhancing their intrinsic motivation while considering their friends' social norms.

The Usefulness of Web-Based Communication Data for Social Network Health Interventions: Agent-Based Modeling Study

BACKGROUND

Social network interventions are an effective approach to promote physical activity. These interventions are traditionally designed using self-reported peer nomination network data to represent social connections. However, there is unexplored potential in communication data exchanged through web-based messaging apps or social platforms, given the availability of these data, the developments in artificial intelligence to analyze these data, and the shift of personal communication to the web sphere. The implications of using web-based versus offline social networks on the effectiveness of social network interventions remain largely unexplored.

OBJECTIVE

This study aims to investigate the differences in the impact of social network interventions on physical activity levels (PALs) between networks derived from web-based communication and peer nomination data.

METHODS

We used the data on sociometric questionnaires, messages from a web-based communication app, and PAL (number of steps per day) of 408 participants in 21 school classes. We applied social network analysis to identify influential peers and agent-based modeling to simulate the diffusion of PAL and explore the impact of social network interventions on PAL among adolescents in school classes. Influential peers (n=63) were selected based on centrality measures (ie, in-degree, closeness, and betweenness) to spread the intervention. They received health education, which increased their PAL by 17%. In sensitivity analyses, we tested the impact of a 5%, 10%, and 20% increase in PAL among influential peers.

RESULTS

There was a 24%-27% overlap in selected influential peers between the 2 network representations. In general, the simulations showed that interventions could increase PAL by 5.0%-5.8% within 2 months. However, the predicted median impact on PAL was slightly higher in networks based on web-based communication data than peer nomination data for in-degree (5.7%, IQR 5.5%-6.1% vs 5.5%, IQR 5.2%-5.8%; P=.002), betweenness (5.6%, IQR 5.4%-5.9% vs 5.0%, IQR 4.7%-5.3%; P<.001), and closeness centrality (5.8%, IQR 5.6%-6.1% vs 5.3%, IQR 5.0%-5.6%; P<.001). A large variation in impact was observed between school classes (range 1.5%-17.5%). Lowering the effectiveness of health education from 17% to 5% would reduce the overall impact of the social network intervention by 3-fold in both networks.

CONCLUSIONS

Our findings showed that network interventions based on web-based communication data could increase PAL. Web-based communication data may therefore be a valuable addition to peer nomination data for future social network intervention design. Artificial intelligence methods, including agent-based modeling, can help to design these network interventions and provide insights into the role of network characteristics in their effectiveness.

Risk on Demand? A Quantitative Content Analysis of the Portrayal of Risky Health Behaviors in Popular on Demand Content

Video on Demand (VOD) has become the most popular way for adolescent viewers to consume entertainment media, often without parental supervision. Given the potential for modeling, this study aims to investigate the prevalence and nature with which risky health behaviors are portrayed in popular VOD programs. A quantitative content analysis of trending programs (N = 529) from popular VOD-platforms investigated the prevalence, co-occurrence, tone, social context, and consequences with which alcohol use, tobacco use, drug use, unsafe sexual behavior, reckless behavior, and self-harm behaviors are portrayed in popular VOD programs. In addition, we analyzed the demographic characteristics of the characters who portrayed the risk behaviors Risk behaviors were portrayed frequently, with substance use behaviors (i.e. alcohol, smoking, drugs) being most prevalent and most likely to co-occur. Reckless behavior, self-harm behaviors, and explicitly unsafe sexual behaviors were much less common. Findings show that risk behavior was often portrayed in a normalized manner, with alcohol and smoking, in particular, being portrayed as neutral behaviors that rarely have consequences. Most risk-taking characters were (young) adult white males, mirroring the general overrepresentation of this demographic in popular media. Risk behavior was rarely problematized in popular on demand content. Potential consequences for adolescent viewers are discussed.

Moral Beauty During the COVID-19 Pandemic: Prosocial Behavior Among Adolescents and the Inspiring Role of the Media

In this study, we examined whether adolescents helped others during the COVID-19 pandemic and how stories in the media inspired them in doing so. Using an online daily diary design, 481 younger adolescents (M = 15.29, SD = 1.76) and 404 older adolescents (M = 21.48, SD = 1.91) were followed for 2 weeks. Findings from linear mixed effects models demonstrated that feelings of being moved by stories in the media were related to giving emotional support to family and friends, and to helping others, including strangers. Exposure to COVID-19 news and information was found to spark efforts to support and help as well and keeping physical distance in line with the advised protective behaviors against COVID-19. Moreover, helping others was related to increased happiness. Overall, the findings of this study highlight the potential role of the media in connecting people in times of crisis.

The effect of a multi-component school-based social network intervention on children's body mass index: a four-arm intervention study

Objective: Schools are considered an important setting for stimulating healthy weight. The current study is unique in examining effects of a multi-component school-based social network intervention on children's body mass index z-scores (zBMI).Methods: Four schools were randomly allocated to one of four conditions: a social network intervention using influence agents focusing on water consumption, physical activity, a combination of the two, or a passive control condition. Participants included a total of 201 6- to-11-year-old children (53.7% girls; Mage = 8.51, SDage = 0.93). At baseline, 149 (76.0%) participants had a healthy weight, 29 (14.8%) had overweight and 18 (9.2%) had obesity.Results: Linear mixed effect models indicated that a multi-component school-based social network intervention targeting both water consumption and physical activity was most effective in decreasing children's zBMI.Conclusion: This study suggests that schools can contribute to the intervention of childhood obesity-even without involving the parents-by targeting both children's water consumption and physical activity through influential peers, but more research is needed to identify mechanisms of change.

Scientific-Consensus Communication About Contested Science: A Preregistered Meta-Analysis

Scientific-consensus communication is among the most promising interventions to minimize the gap between experts' and the public's belief in scientific facts. There is, however, discussion about its effectiveness in changing consensus perceptions and beliefs about contested science topics. This preregistered meta-analysis assessed the effects of communicating the existence of scientific consensus on perceived scientific consensus and belief in scientific facts. Combining 43 experiments about climate change, genetically modified food, and vaccination, we found that a single exposure to consensus messaging had a positive effect on perceived scientific consensus (g = 0.55) and on belief in scientific facts (g = 0.12). Consensus communication yielded very similar effects for climate change and genetically modified food, whereas the low number of experiments about vaccination prevented conclusions regarding this topic. Although these effects are small, communicating scientific consensus appears to be an effective way to change factual beliefs about contested science topics.

Arranging the fruit basket: A computational approach towards a better understanding of adolescents' diet-related social media communications

This study investigated the contents and linguistic styles that adolescents use in their dietary communications on social media. The main aim of the study was to describe adolescents' social media communication practices with regards to diet, in order to better understand dietary social influences and how to effectively intervene in them. The current study made use of an online communication dataset (N = 72,384 messages) of adolescents in primary and secondary school (N = 1038, 9-16 y/o). We analyzed the message content using tailor-made diet- and health-related dictionaries and LDA topic modeling. The linguistic style of the messages was investigated by assessing the sentiment and underlying psychological dimensions. Further, we used multivariate linear regressions to test how each message dimension was related to message liking, which was considered as an indicator of a message's influence potential regarding peers' dietary behaviors. The results confirmed that adolescents show a preference to discuss neutral-to-unhealthy dietary items most often. No association emerged between message content (i.e., message healthiness and topics) and the number of likes that a message received, while messages with more positive sentiment and higher subjectivity received slightly more likes. Also, our findings confirm that visual dietary content is more often liked than textual descriptions alone. The findings indicate that the content and the healthiness of a message does not explain its popularity among adolescents. Rather, the way how diet-related content is formulated (i.e., in a positive and subjective tone) emerged as a more important predictor for message liking.

Physical Distancing and Social Media Use in Emerging Adults and Adults During the COVID-19 Pandemic: Large-scale Cross-sectional and Longitudinal Survey Study

Background

Although emerging adults play a role in the spread of COVID-19, they are less likely to develop severe symptoms after infection. Emerging adults’ relatively high use of social media as a source of information raises concerns regarding COVID-19–related behavioral compliance (ie, physical distancing) in this age group.

Objective

This study aimed to investigate physical distancing among emerging adults in comparison with adults and examine the role of using social media for COVID-19 news and information in this regard. In addition, this study explored the relationship between physical distancing and using different social media platforms and sources.

Methods

The secondary data of a large-scale longitudinal national survey (N=123,848) between April and November 2020 were used. Participants indicated, ranging from 1 to 8 waves, how often they were successful in keeping a 1.5-m distance on a 7-point Likert scale. Participants aged between 18 and 24 years were considered emerging adults, and those aged >24 years were considered adults. In addition, a dummy variable was created to indicate per wave whether participants used social media for COVID-19 news and information. A subset of participants received follow-up questions to determine which platforms they used and what sources of news and information they had seen on social media. All preregistered hypotheses were tested with linear mixed-effects models and random intercept cross-lagged panel models.

Results

Emerging adults reported fewer physical distancing behaviors than adults (β=−.08, t_86,213.83=−26.79; P<.001). Moreover, emerging adults were more likely to use social media for COVID-19 news and information (b=2.48; odds ratio 11.93 [95% CI=9.72-14.65]; SE 0.11; Wald=23.66; P<.001), which mediated the association with physical distancing but only to a small extent (indirect effect: b=−0.03, 95% CI −0.04 to −0.02). Contrary to our hypothesis, the longitudinal random intercept cross-lagged panel model showed no evidence that physical distancing was not influenced by social media use in the previous wave. However, evidence indicated that social media use affects subsequent physical distancing behavior. Moreover, additional analyses showed that the use of most social media platforms (ie, YouTube, Facebook, and Instagram) and interpersonal communication were negatively associated with physical distancing, whereas other platforms (ie, LinkedIn and Twitter) and government messages had no or small positive associations with physical distancing.

Conclusions

In conclusion, we should be vigilant with regard to the physical distancing of emerging adults, but the study results did not indicate concerns regarding the role of social media for COVID-19 news and information. However, as the use of some social media platforms and sources showed negative associations with physical distancing, future studies should more carefully examine these factors to better understand the associations between social media use for news and information and behavioral interventions in times of crisis.

Testing a first online intervention to reduce conformity to cyber aggression in messaging apps

Early adolescents frequently use mobile messaging apps to communicate with peers. The popularity of such messaging apps has a critical drawback because it increases conformity to cyber aggression. Cyber aggression includes aggressive peer behaviors such as nasty comments, nonconsensual image sharing, and social exclusion, to which adolescents subsequently conform. Recent empirical research points to peer group norms and reduced accountability as two essential determinants of conformity to cyber aggression. Therefore, the current study aimed to counteract these two determinants in a 2 (peer group norms counteracted: yes, no) x 2 (reduced accountability counteracted: yes, no) design. We created four intervention conditions that addressed adolescents’ deficits in information, motivation, and behavioral skills. Depending on the condition (peer group norms, reduced accountability, combination, or control), we first informed participants about the influence of the relevant determinant (e.g., peer group norms). Subsequently, participants performed a self-persuasion task and formulated implementation-intentions to increase their motivation and behavioral skills not to conform to cyber aggression. Effectiveness was tested with a messaging app paradigm and self-report among a sample of 377 adolescents (M_age = 12.99, SD_age = 0.84; 53.6% boys). Factorial ANCOVAs revealed that none of the intervention conditions reduced conformity to cyber aggression. Moreover, individual differences in susceptibility to peer pressure or inhibitory control among adolescents did not moderate the expected relations. Therefore, there is no evidence that our intervention effectively reduces conformity to cyber aggression. The findings from this first intervention effort point to the complex relationship between theory and practice. Our findings warrant future research to develop potential intervention tools that could effectively reduce conformity to cyber aggression.

Motivating Social Influencers to Engage in Health Behavior Interventions

Social influencers are widely known as the promotors of purchase behavior as well as for their potential to change health behaviors among individuals in their social networks. For social influencers to be successful in changing behaviors, it is essential that they convey their message in an authentic, original, credible, and persistent manner. In the context of health behavior interventions, this requires a focus on the motivation of social influencers to engage in the intervention. This perspective article describes the importance of motivating social influencers to engage in the desired health behaviors themselves and to promote it within their social network. We briefly describe the current state of knowledge and our empirical experience in implementing health interventions with social influencers. Using insights from self-determination theory, we demonstrate how social influencers can be motivated optimally in health behavior interventions and, thereby, improving the success of the intervention. To illustrate these insights and guide intervention practice, we provide concrete examples of techniques that can be applied in health interventions involving social influencers. We conclude with directions for further research and intervention practice to improve the delivery of health behavior interventions.

Explaining Children's News Avoidance During the COVID-19 Pandemic

Despite growing concerns that children (8-13 years old) tend to avoid the news, the reasons why have received little research attention. Therefore, the current study aims to develop and test a model conceptualizing the relations between children's news consumption, news avoidance, emotional responses (negative emotions and anxiety-related behaviors), and parent and child mitigation strategies. The model was tested using data collected during the first year of the COVID-19 pandemic. The current, preregistered, survey study was part of a longitudinal project and used data from the second wave. Data were collected in November/December 2020 among 510 children (M age = 10.40; 53.72% girls). Findings showed that children who consumed more news during the pandemic avoided pandemic news less often. Children who experienced more anxiety-related behaviors regarding pandemic news avoided pandemic news more often. The relation between news consumption and emotional responses was stronger for children who experienced restrictive parental mediation more often, indicating that this was not an effective parental mediation strategy for tempering their emotional responses. Children with higher levels of emotional responses used reactive coping strategies more often. However, this did not seem to be an effective strategy against pandemic news avoidance because none of the strategies had a negative relation with pandemic news avoidance. Distancing was even positively related to pandemic news avoidance. Although the current study was not able to fully unravel how news avoidance-related constructs relate to one another, we were able to get some important insights guiding future research. Specifically, it is of crucial importance to unravel the mechanisms that increase the chance of children's news avoidance and those that mitigate it, to build interventions to counteract news avoidance and to protect children from the negative emotional consequences by news consumption.

Boosting Understanding and Identification of Scientific Consensus Can Help to Correct False Beliefs

Some people hold beliefs that are opposed to overwhelming scientific evidence. Such misperceptions can be harmful to both personal and societal well-being. Communicating scientific consensus has been found to be effective in eliciting scientifically accurate beliefs, but it is unclear whether it is also effective in correcting false beliefs. Here, we show that a strategy that boosts people's understanding of and ability to identify scientific consensus can help to correct misperceptions. In three experiments with more than 1,500 U.S. adults who held false beliefs, participants first learned the value of scientific consensus and how to identify it. Subsequently, they read a news article with information about a scientific consensus opposing their beliefs. We found strong evidence that in the domain of genetically engineered food, this two-step communication strategy was more successful in correcting misperceptions than merely communicating scientific consensus. The data suggest that the current approach may not work for misperceptions about climate change.

How media appeals depicting social eating contexts increase the appetitive motivational processing of healthy foods

Research suggests that depictions of social groups can improve the processing of pronutritional media promoting healthy foods. Drawing on a framework of motivational processing, which regulates the automatic emotional and attentional responses to stimuli with adaptive significance to the organism (Cacioppo, Gardner, & Berntson, 1999; Compton, 2003; Ito, Cacioppo, & Lang, 1998), two mixed-factorial experiments examined how adolescents process pronutritional media depicting various social versus alone eating contexts. Based on motivational theories of information processing and emotional contagion, we predicted that pronutritional media depicting social eating contexts capture attention, emotion, and memory formation, indicative of appetitive motivational processing. Study 1 (N = 58; aged 12-18; 54% female) examined how the depicted social eating contexts improve the processing of pronutritional media by increasing their attentional selection, attentional processing, the emotional affect, and arousal responses to them. As the models' faces-which automatically attract priority processing-are oriented towards the foods in the social eating contexts, the pronutritional images depicting social eating contexts were predicted to attract greater attention and mental resources, and to further direct them to the foods. Study 2 (N = 165; aged 12-18; 53% female) investigated how the depicted social eating contexts further improve the processing of the healthy foods in the pronutritional media, by directing the visual attentional focus to the foods and attracting memory formation for them. Visual attentional focus was assessed through eye-tracking and memory was operationalized via visual recognition. As hypothesized, healthy foods became noticeable, highly-arousing, and memorable stimuli with adaptive significance to the organism when promoted through depictions of shared meals in social groups. The findings illustrate how healthy foods can be promoted more effectively through depictions of social eating contexts, and how the appetitive motivational processing explicates their greater effectiveness.

Mood and emotional reactivity of adolescents during the COVID-19 pandemic: short-term and long-term effects and the impact of social and socioeconomic stressors

Adolescence is a formative period for socio-emotional development which is threatened by the COVID-19 pandemic. The current longitudinal study examined two aims: (1) the short- and long-term effects of the pandemic on young people's mood (i.e. vigor, tension, and depression levels) and emotional reactivity (i.e. fluctuations in daily mood), and (2) the impact of stressors on mood, emotional reactivity, self-oriented (i.e. maladaptive behavior towards COVID-19 rules) and other-benefitting behaviors (i.e. behavior aimed at helping and comforting others). We conducted an online two-week daily diary study among 462 Dutch adolescents (Mage = 15.27 years, 64% females) and 371 young adults (Mage = 21.49 years, 81% females) in May 2020, with a follow-up in November 2020 (N = 238 and 231, respectively adolescents and young adults). In May 2020, young adults and older relative to younger adolescents showed higher levels and more fluctuations in tension and depression and lower levels of vigor. Vigor levels decreased and tension and depression levels increased between May 2020 and November 2020, especially for younger adolescents. There were positive associations between instability of negative emotions (i.e. tension and depression fluctuations) and the exposure to stressors (i.e. family stress and inequality of online homeschooling) in the adolescent sample. Together, this study demonstrates vulnerability regarding young people's mood and emotional reactivity during the COVID-19 pandemic, especially for adolescents who experience more stressors.

Children's Emotions after Exposure to News: Investigating Chat Conversations with Peers as a Coping Strategy

Hardly any research has been conducted regarding coping strategies that children can use in response to negative news, although they are frequently exposed to and emotionally affected by such news. Chat conversations with peers about the news could be a coping strategy for children in this regard. To investigate this, children (N = 307; 46.3% girls; M_age = 10.51; SD_age = 0.98; range 8–13 years old) participated in a preregistered experiment in which their emotions were measured before and after exposure to a news video on a smartphone and also after a postexposure activity (i.e., chatting about the news as an experimental condition versus chatting about something else or solving a puzzle as control conditions). The results showed that the decrease in negative emotions and the increase in positive emotions were weaker for children who chatted about the news than for those in the control conditions. Thus, seeking social support in online chat conversations did not have the anticipated effect—and might even have an adverse effect.

Promoting water consumption among Dutch children: an evaluation of the social network intervention Share H2O

Background

There is a need to develop and improve interventions promoting healthy drinking behaviors among children. A promising method could be to stimulate peer influence within children’s social networks. In the Share H₂O social network intervention (SNI), peer influence was utilized by selecting a subset of influential children and training them as ‘influence agents’ to promote water consumption—as an alternative to SSBs. Previous research has mainly focused on the process of selecting influence agents. However, the process of motivating influence agents to promote the behavior has hardly received any research attention. Therefore, in the SNI Share H₂O SNI, this motivation process was emphasized and grounded in the self-determination theory (SDT). This study evaluated the implementation of the Share H₂O SNI, focusing on whether and how applying SDT-based techniques can motivate the influence agents and, indirectly, their peers.

Methods

This study included data collected in the Netherlands from both the influence agents (n = 37) and the peers (n = 112) in the classroom networks of the influence agents.

Self-reported measurements assessed the influence agents’ enjoyment of the training, duration and perceived autonomy support during the training, and changes in their intrinsic motivation and water consumption before and after the start of the intervention. Changes in the peers’ intrinsic motivation, perceived social support, and social norms were measured before and after the start of the intervention.

Results

The influence agents enjoyed the training, the duration was adequate, and perceived it as autonomy supportive. There was an increase in the influence agents’ intrinsic motivation to drink water and their actual water consumption. Providing personal meaningful rationales seemed to have motivated the influence agents. The intrinsic motivation and perceived descriptive norm of the peers remained stable. The peers reported an increase in their perceived social support and injunctive norm concerning water drinking after the intervention. Influence agents appeared to mainly use face-to-face strategies, such as modeling, talking to peers, and providing social support to promote the behavior.

Conclusions

The current findings provided preliminary evidence of the promising effects of using SDT-based techniques in an SNI to motivate the influence agents and, indirectly, their peers.

Trial registration

NTR, NL6905, Registered 9 January 2018, https://www.trialregister.nl/trial/6905

Investigating and Improving the Accuracy of US Citizens' Beliefs About the COVID-19 Pandemic: Longitudinal Survey Study

BACKGROUND

The COVID-19 infodemic, a surge of information and misinformation, has sparked worry about the public's perception of the coronavirus pandemic. Excessive information and misinformation can lead to belief in false information as well as reduce the accurate interpretation of true information. Such incorrect beliefs about the COVID-19 pandemic might lead to behavior that puts people at risk of both contracting and spreading the virus.

OBJECTIVE

The objective of this study was two-fold. First, we attempted to gain insight into public beliefs about the novel coronavirus and COVID-19 in one of the worst hit countries: the United States. Second, we aimed to test whether a short intervention could improve people's belief accuracy by empowering them to consider scientific consensus when evaluating claims related to the pandemic.

METHODS

We conducted a 4-week longitudinal study among US citizens, starting on April 27, 2020, just after daily COVID-19 deaths in the United States had peaked. Each week, we measured participants' belief accuracy related to the coronavirus and COVID-19 by asking them to indicate to what extent they believed a number of true and false statements (split 50/50). Furthermore, each new survey wave included both the original statements and four new statements: two false and two true statements. Half of the participants were exposed to an intervention aimed at increasing belief accuracy. The intervention consisted of a short infographic that set out three steps to verify information by searching for and verifying a scientific consensus.

RESULTS

A total of 1202 US citizens, balanced regarding age, gender, and ethnicity to approximate the US general public, completed the baseline (T0) wave survey. Retention rate for the follow-up waves- first follow-up wave (T1), second follow-up wave (T2), and final wave (T3)-was high (≥85%). Mean scores of belief accuracy were high for all waves, with scores reflecting low belief in false statements and high belief in true statements; the belief accuracy scale ranged from -1, indicating completely inaccurate beliefs, to 1, indicating completely accurate beliefs (T0 mean 0.75, T1 mean 0.78, T2 mean 0.77, and T3 mean 0.75). Accurate beliefs were correlated with self-reported behavior aimed at preventing the coronavirus from spreading (eg, social distancing) (r at all waves was between 0.26 and 0.29 and all P values were less than .001) and were associated with trust in scientists (ie, higher trust was associated with more accurate beliefs), political orientation (ie, liberal, Democratic participants held more accurate beliefs than conservative, Republican participants), and the primary news source (ie, participants reporting CNN or Fox News as the main news source held less accurate beliefs than others). The intervention did not significantly improve belief accuracy.

CONCLUSIONS

The supposed infodemic was not reflected in US citizens' beliefs about the COVID-19 pandemic. Most people were quite able to figure out the facts in these relatively early days of the crisis, calling into question the prevalence of misinformation and the public's susceptibility to misinformation.

Understanding the complexities of Bluetooth for representing real-life social networks: A methodology for inferring and validating Bluetooth-based social network graphs

Bluetooth (BT) data has been extensively used for recognizing social patterns and inferring social networks, as BT is widely present in everyday technological devices. However, even though collecting BT data is subject to random noise and may result in substantial measurement errors, there is an absence of rigorous procedures for validating the quality of the inferred BT social networks. This paper presents a methodology for inferring and validating BT-based social networks based on parameter optimization algorithm and social network analysis (SNA). The algorithm performs edge inference in a brute-force search over a given BT data set, for deriving optimal BT social networks by validating them with predefined ground truth (GT) networks. The algorithm seeks to optimize a set of parameters, predefined considering some reliability challenges associated to the BT technology itself. The outcomes show that optimizing the parameters can reduce the number of BT data false positives or generate BT networks with the minimum amount of BT data observations. The subsequent SNA shows that the inferred BT social networks are unable to reproduce some network characteristics present in the corresponding GT networks. Finally, the generalizability of the proposed methodology is demonstrated by applying the algorithm on external BT data sets, while obtaining comparable results.

A Health Game Targeting Children's Implicit Attitudes and Snack Choices

Objective: The present study investigated whether a health game can be used to affect children's implicit attitudes toward food (IAsTF) and subsequent snack choices. Materials and Methods: The health game used was based on an evaluative conditioning paradigm. The experiment followed a between-subjects design with two conditions (health game vs. control), N = 79 (12.42 years ±1.64, body mass index: 25.06 ± 7.40). IAsTF were assessed at baseline and postintervention using an implicit association test (IAT). Baseline IAT scores were used to categorize IAsTF as healthy (favoring fruits) versus unhealthy IAsTF (favoring chocolates). In addition, three digital snack choices were recorded. Results: No main effect of condition on posttest IAsTF was found. However, baseline IAsTF moderated the effect of condition on posttest IAsTF; participants with less healthy baseline IAsTF playing the health game had healthier posttest IAsTF compared to those playing the control game. Regarding the snack choices, participants playing the health game favored fruit over chocolate in one of the snack choices. Baseline IAsTF did not moderate the effect of condition on snack choices. Conclusion: Tentative support was found that health games can be used to improve IAsTF, in particular among participants with less healthy ones at baseline.

Exploring the directionality in the relationship between descriptive and injunctive parental and peer norms and snacking behavior in a three-year-cross-lagged study

Background

People’s eating behavior is assumed to be influenced by what other people do (perceived descriptive norms) and what others approve of (perceived injunctive norms). It has been suggested that adolescents are more susceptible to peer norms than parental norms, because they experience a strong need for group acceptance that leads to conforming to peer group norms. The current study examined changes in snacking behavior and four types of social norms (i.e., parental and peer descriptive and injunctive norms) that promoted fruit and vegetable intake among adolescents. This study was the first to examine whether snacking behavior also influenced norm perceptions by testing the directionality of these associations.

Methods

The study consisted of 819 participants (M [SD] age = 11.19 [1.36]; 46.1% boys), collected at three time points (T1 = 2016, T2 = 2017 and T3 = 2018) during the MyMovez project. Self-reported frequency of snack consumption, perceived parental and peer descriptive and injunctive norms were assessed. The primary analysis consisted of a series of cross-lagged autoregressive models specified in a structural equation modeling framework.

Results

Model comparisons testing the descriptive and injunctive norms in separate models and in an additional combined model revealed evidence for bi-directional associations between norms and snacking behavior. Descriptive peer and parent norms were not found to have an effect on subsequent snacking behaviors. Perceived injunctive parental norms were positively associated with healthy snack food intake and negatively associated with unhealthy snack intake (forward direction). Injunctive peer norms were negatively associated with healthy snack food intake. In addition, higher unhealthy snack food intake was negatively associated with the perception of descriptive and injunctive parental norms 1 year later (reversed direction). We did not find peer norms to be more closely associated with changes in snacking behaviors compared to parental norms.

Conclusions

Parents expecting their children to snack healthy had a positive influence on healthy snacking behavior whereas only acting as a healthy role model did not. Future research should address the possible interaction between descriptive and injunctive norms. Research should also take into account the bi-directional relations between eating behaviors and normative perceptions.

Testing the Effectiveness of a Disclosure in Activating Children's Advertising Literacy in the Context of Embedded Advertising in Vlogs

Watching vlogs of social media influencers has become a favorite pastime for children and adolescents. For advertisers, vlogs are an excellent way to reach young viewers. As such, vlogs have become a powerful marketing tool. However, for children and adolescents it is often unclear whether a vlog contains advertising, which raises questions regarding the fairness and transparency of this type of advertising. If children do not recognize the commercial intent of in-vlog advertising, then they are unlikely to activate their advertising literacy, which may serve as a critical coping mechanism. The aim of this study was to investigate if a sponsorship disclosure stimulates children and adolescents' (7-16 years old) to activate their advertising literacy when exposed to embedded advertising in vlogs and, subsequently, if advertising literacy activation is related to children's brand attitude. Furthermore, we investigated whether the relation between exposure to a sponsorship disclosure and advertising literacy activation was moderated by children's dispositional advertising literacy and their age. An innovative aspect of the current study is that advertising literacy activation was measured in two ways: with a self-reported questionnaire and via an indirect measurement task (Advertising Literacy Activation Task). The results showed that the children who were exposed to a sponsorship disclosure did not activate their advertising literacy to a higher extent than the children who were not exposed to such a disclosure. This might be because of the high prominence of the brand in the vlog; thus children may not have needed the disclosure to realize that the vlog was sponsored and accordingly activate their advertising literacy. The results also showed that stronger attitudinal advertising literacy activation led to a more negative brand attitude. Interestingly, this effect was only found when attitudinal advertising literacy was assessed with a questionnaire and not when it was assessed with the indirect measurement task. Thus, children who were more critical toward the in-vlog advertisement through self-reporting also had a more negative brand attitude. This suggests that direct and indirect measurements of advertising literacy activation reveal different processes through which children make sense of, and are affected by, advertising.

Testing a Social Network Intervention Using Vlogs to Promote Physical Activity Among Adolescents: A Randomized Controlled Trial

There is a need to stimulate physical activity among adolescents, but unfortunately, they are hard to reach with traditional mass media interventions. A promising alternative is to carry out social network interventions. In social network interventions, a small group of individuals (influence agents) is selected to promote health-related behaviors within their social network. This study investigates whether a social network intervention is more effective to promote physical activity, compared to a mass media intervention and no intervention. Adolescents (N = 446; M_age = 11.35, SD_age = 1.34; 47% male) were randomly allocated by classroom (N = 26, in 11 schools) to one of three conditions: social network intervention, mass media intervention, or control condition. In the social network intervention, 15% of the participants (based on peer nominations) was approached to become an influence agent, who created vlogs about physical activity that were shown during the intervention. In the mass media intervention, participants were exposed to vlogs made by unfamiliar peers (i.e., vlogs of the social network intervention). The control condition did not receive vlogs about physical activity. All participants received a research smartphone to complete questionnaires and a wrist-worn accelerometer to measure physical activity. The trial was registered a priori in the Dutch Trial Registry (NTR6903). There were no differences in objectively measured physical activity between this social network intervention and the control condition in the short-term, but there was an unexpected increase in the control condition compared to the social network intervention in the long-term. No differences between the social network intervention and mass media intervention were observed. The current study does not provide evidence that this social network intervention is effective in increasing physical activity in adolescents. Exploratory analyses suggest that this social network intervention increased the perceived social norm toward physical activity and responses to the vlogs were more positive in the social network intervention than in the mass media intervention. These initial results warrant further research to investigate the role of the social norms and the added benefit of using influence agents for social network interventions.

Clinical Trial Registration:https://www.trialregister.nl/, identifier NTR6903.

The Impact of Social Media Influencers on Children's Dietary Behaviors

Over the past years vlogs rapidly have become an attractive platform for food industries, sponsoring social media influencers to promote their products. As with more traditional media, social media influencers predominantly promote unhealthy drinks and foods that are high in sugar, fat, and salt - consumption of which may increase the risk of overweight, obesity, and non-communicable diseases. The aim of the current Brief Research Report is to examine the impact of vlogs on children's unhealthy dietary behaviors. Drawing on longitudinal survey data from 453 8- to 12-year-old children, we analyzed the longitudinal relations between children's frequency of watching vlogs and their consumption of unhealthy beverages and snacks. Structural path modeling analyses of three waves of data with 1-year intervals showed that children's self-reported frequency of watching vlogs influenced consumption of unhealthy beverages 2 years later. The analyses did not yield significant relations for Unhealthy Snacks Consumption. The strength of the observed longitudinal relation between children's Frequency of Watching Vlogs and Consumption of unhealthy beverages was comparable to previous findings regarding more traditional types of food marketing.

Identifying Influence Agents That Promote Physical Activity Through the Simulation of Social Network Interventions: Agent-Based Modeling Study

Background

Social network interventions targeted at children and adolescents can have a substantial effect on their health behaviors, including physical activity. However, designing successful social network interventions is a considerable research challenge. In this study, we rely on social network analysis and agent-based simulations to better understand and capitalize on the complex interplay of social networks and health behaviors. More specifically, we investigate criteria for selecting influence agents that can be expected to produce the most successful social network health interventions.

Objective

The aim of this study was to test which selection criterion to determine influence agents in a social network intervention resulted in the biggest increase in physical activity in the social network. To test the differences among the selection criteria, a computational model was used to simulate different social network interventions and observe the intervention’s effect on the physical activity of primary and secondary school children within their school classes. As a next step, this study relied on the outcomes of the simulated interventions to investigate whether social network interventions are more effective in some classes than others based on network characteristics.

Methods

We used a previously validated agent-based model to understand how physical activity spreads in social networks and who was influencing the spread of behavior. From the observed data of 460 participants collected in 26 school classes, we simulated multiple social network interventions with different selection criteria for the influence agents (ie, in-degree centrality, betweenness centrality, closeness centrality, and random influence agents) and a control condition (ie, no intervention). Subsequently, we investigated whether the detected variation of an intervention’s success within school classes could be explained by structural characteristics of the social networks (ie, network density and network centralization).

Results

The 1-year simulations showed that social network interventions were more effective compared with the control condition (beta=.30; t100=3.23; P=.001). In addition, the social network interventions that used a measure of centrality to select influence agents outperformed the random influence agent intervention (beta=.46; t100=3.86; P<.001). Also, the closeness centrality condition outperformed the betweenness centrality condition (beta=.59; t100=2.02; P=.046). The anticipated interaction effects of the network characteristics were not observed.

Conclusions

Social network intervention can be considered as a viable and promising intervention method to promote physical activity. We demonstrated the usefulness of applying social network analysis and agent-based modeling as part of the social network interventions’ design process. We emphasize the importance of selecting the most successful influence agents and provide a better understanding of the role of network characteristics on the effectiveness of social network interventions.

Mind-Wandering and Mindfulness as Mediators of the Relationship Between Online Vigilance and Well-Being

As mobile technology allows users to be online anywhere and at all times, a growing number of users report feeling constantly alert and preoccupied with online streams of online information and communication-a phenomenon that has recently been termed online vigilance. Despite its growing prevalence, consequences of this constant orientation toward online streams of information and communication for users' well-being are largely unclear. In the present study, we investigated whether being constantly vigilant is related to cognitive consequences in the form of increased mind-wandering and decreased mindfulness and examined the resulting implications for well-being. To test our assumptions, we estimated a path model based on survey data (N = 371). The model supported the majority of our preregistered hypotheses: online vigilance was indeed related to mind-wandering and mindfulness, but only mindfulness mediated the relationship with decreased well-being. Thus, those mentally preoccupied with online communication were overall less satisfied with their lives and reported less affective well-being when they also experienced reduced mindfulness.

Self-Persuasion on Facebook Increases Alcohol Risk Perception

In this experiment, we examined if participating in a Facebook group by generating antialcohol arguments (self-persuasion) is more effective than reading antialcohol posts of others (direct persuasion) in changing alcohol consumption, risk perception, and attitudes. In addition, it was examined if submitting posts moderated these effects. Participants logged into their Facebook account and joined a group that contained posts with antialcohol arguments. They either generated their own arguments with or without posting them, or read those present in the group with or without posting that they had read them. Next, participants rated movie clips in a 30-minute ad libitum drinking session in dyads, and their alcohol consumption was measured. Finally, measures of alcohol risk perception and attitudes were completed. Results show that generating antialcohol arguments-regardless of whether they are posted online-is effective in increasing alcohol risk perception but does not affect immediate alcohol consumption.

Investigating the impact of a health game on implicit attitudes towards food and food choice behaviour of young adults

Improving diets by stimulating fruit and vegetable consumption might be beneficial, in particular when they substitute energy-dense products. The aim of present study was to investigate whether a health game can be used to positively affect healthy implicit attitudes (IAs) towards food and subsequent food choice behaviour of young adults. A 2 (Time: baseline vs. post-test) x 2 (Condition: health game vs. control game) x 2 (Baseline IAs: healthy IAs vs. less healthy IAs) mixed-subjects design was used with 125 participants (age: M = 20.17, SD = 1.88). IAs towards food were assessed at baseline and post-test using an Implicit Association Test (IAT). Additionally, food choice behaviour was assessed after game play. At baseline, the majority of participants had healthy IAs (i.e., favouring fruit over chocolate snacks). At post-test, significantly less healthy IAs were observed in the control condition, while this reduction was not significant in the health game condition. Regarding food choice behaviour, participants with healthy baseline IAs were more likely to select fruit in the health game condition than participants with healthy baseline IAs in the control game condition. However, participants with less healthy baseline IAs were less likely to select fruit in the health game condition than in the control condition. We found tentative support that health games can be used to influence IAs towards food and positively affect food choice behaviour. However, this influence was only observed for those with healthy baseline IAs. The current version of the health game would primarily benefit those already healthy and could negatively affect those that need the intervention most, so modifications are recommendable.

A randomized controlled trial testing a social network intervention to promote physical activity among adolescents

BACKGROUND

The current study examined the effectiveness of a social network intervention to promote physical activity among adolescents. Social network interventions utilize peer influence to change behavior by identifying the most influential individuals within social networks (i.e., influence agents), and training them to promote the target behavior.

METHOD

A total of 190 adolescents (46.32% boys; M age = 12.17, age range: 11-14 years) were randomly allocated to either the intervention or control condition. In the intervention condition, the most influential adolescents (based on peer nominations of classmates) in each classroom were trained to promote physical activity among their classmates. Participants received a research smartphone to complete questionnaires and an accelerometer to measure physical activity (steps per day) at baseline, and during the intervention one month later.

RESULTS

A multilevel model tested the effectiveness of the intervention, controlling for clustering of data within participants and days. No intervention effect was observed, b = .04, SE = .10, p = .66.

CONCLUSION

This was one of the first studies to test whether physical activity in adolescents could be promoted via influence agents, and the first social network intervention to use smartphones to do so. Important lessons and implications are discussed concerning the selection criterion of the influence agents, the use of smartphones in social network intervention, and the rigorous analyses used to control for confounding factors.

TRIAL REGISTRATION

Dutch Trial Registry (NTR): NTR6173 . Registered 5 October 2016 Study procedures were approved by the Ethics Committee of the Radboud University (ECSW2014-100614-222).

Youth's social network structures and peer influences: study protocol MyMovez project - Phase I

Background

Youth are an important target group for social network interventions, because they are particularly susceptible to the adaptation of healthy and unhealthy habits and behaviors of others. They are surrounded by ‘social influence agents’ (i.e., role models such as family, friends and peers) that co-determine their dietary intake and physical activity. However, there is a lack of systematic and comprehensive research on the implementation of a social network approach in health campaigns. The MyMovez research project aims to fill this gap by developing a method for effective social network campaign implementation. This protocol paper describes the design and methods of Phase I of the MyMovez project, aiming to unravel youth’s social network structures in combination with individual, psychosocial, and environmental factors related to energy intake and expenditure. In addition, the Wearable Lab is developed to enable an attractive and state-of-the-art way of collecting data and online campaign implementation via social networks.

Methods

Phase I of the MyMovez project consists of a large-scale cross-sequential cohort study (N = 953; 8-12 and 12-15 y/o). In five waves during a 3-year period (2016-2018), data are collected about youth’s social network exposure, media consumption, socialization experiences, psychological determinants of behavior, physical environment, dietary intake (snacking and drinking behavior) and physical activity using the Wearable Lab. The Wearable Lab exists of a smartphone-based research application (app) connected to an activity tracking bracelet, that is developed throughout the duration of the project. It generates peer- and self-reported (e.g., sociometric data and surveys) and experience sampling data, social network beacon data, real-time physical activity data (i.e., steps and cycling), location information, photos and chat conversation data from the app’s social media platform Social Buzz.

Discussion

The MyMovez project - Phase I is an innovative cross-sequential research project that investigates how social influences co-determine youth’s energy intake and expenditure. This project utilizes advanced research technologies (Wearable Lab) that provide unique opportunities to better understand the underlying processes that impact youths’ health-related behaviors. The project is theoretically and methodologically pioneering and produces a unique and useful method for successfully implementing and improving health campaigns.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5353-5) contains supplementary material, which is available to authorized users.

Promoting Water Consumption on a Caribbean Island: An Intervention Using Children's Social Networks at Schools

Sugar-sweetened beverage (SSB) consumption and the associated childhood obesity are major concerns in the Caribbean, creating a need for interventions promoting water consumption as a healthy alternative. A social network-based intervention (SNI) was tested among Aruban children to increase their water consumption and behavioral intention to do so and, consequently, to decrease SSB consumption and the associated behavioral intention. In this study, the moderating effects of descriptive and injunctive norms were tested. A cluster randomized controlled trial was completed in schools (mean age = 11 years ± SD = 0.98; 54% girls). Children were assigned to the intervention group (IG; n = 192) or control group (CG; n = 185). IG children were exposed to peer influencers promoting water consumption and CG children were not. Regression analyses showed that water consumption increased for IG children with a high injunctive norm score (p = 0.05); however, their intention to consume more water remained unchanged (p = 0.42). Moreover, IG children showed a decrease in SSB consumption (p = 0.04) and an increase in their intention to consume less SSB (p = 0.00). These findings indicate that SNIs are a promising instrument for health behavioral changes for Aruba and other islands in the Caribbean region.

Self-persuasion in media messages: Reducing alcohol consumption among students with open-ended questions

Self-persuasion (self-generation of arguments) is often a more effective influence technique than direct persuasion (providing arguments). However, the application of this technique in health media communications has received limited attention. In two experiments, it was examined whether self-persuasion can be successfully applied to antialcohol media communications by framing the message as an open-ended question. In Experiment 1 (N = 131) cognitive reactions to antialcohol posters framed either as open-ended questions or statements were examined. In Experiment 2 (N = 122) the effectiveness of this framing to reduce actual alcohol consumption was tested. Experiment 1 demonstrated that exposure to an antialcohol poster framed as an open-ended question resulted in more self-generated arguments for drinking less alcohol and more favorable message evaluations than framing the same message as a statement. Experiment 2 showed that the self-persuasion poster did not affect the choice to consume alcohol but did reduce alcohol consumption for individuals who chose to drink any alcohol, compared with a direct persuasion poster or no intervention. Together, the results demonstrated the potential of self-persuasion in persuasive media messages for interventions aimed at alcohol consumption reduction specifically and for health communication in general. (PsycINFO Database Record

User Statistics for an Online Health Game Targeted at Children

OBJECTIVE

Given that many households in western countries nowadays have home access to the Internet, developing health-promoting online interventions has the potential to reach large audiences. Studies assessing usage data of online health interventions are important and relevant but, as of yet, scarce. The present study reviewed usage data from Monkey Do, an existing online health game developed specifically for children from 4 to 8 years old. In addition, the effect of advertising on usage was examined.

MATERIALS AND METHODS

In an observational study, a web-based analysis program was used to examine usage data of all visits to the online health game for the first 31 months following the launch. We reported descriptives for usage data. We analyzed the relationship between advertising and usage with a Mann-Whitney U test, and used a Pearson's chi-square test to investigate the association between advertising and the number of first-time visitors.

RESULTS

In the period of data analysis, there were 224,859 sessions. Around 34% of the visitors played the game more than once. Compared with first-time visitors, the average session time of returning visitors was doubled. The game was most frequently accessed via search engine query, on a desktop computer (compared to mobile devices). Advertising was found to be positively related to the number of sessions and the number of first-time visitors.

CONCLUSIONS

Placing a game online can reach a large audience, but it is important to also consider how to stimulate retention. Furthermore, repeated advertisement for an online game appears to be necessary to maintain visitors over time.

A social network-based intervention stimulating peer influence on children's self-reported water consumption: A randomized control trial

The current pilot study examined the effectiveness of a social network-based intervention using peer influence on self-reported water consumption. A total of 210 children (52% girls; M age = 10.75 ± SD = 0.80) were randomly assigned to either the intervention (n = 106; 52% girls) or control condition (n = 104; 52% girls). In the intervention condition, the most influential children in each classroom were trained to promote water consumption among their peers for eight weeks. The schools in the control condition did not receive any intervention. Water consumption, sugar-sweetened beverage (SSB) consumption, and intentions to drink more water in the near future were assessed by self-report measures before and immediately after the intervention. A repeated measure MANCOVA showed a significant multivariate interaction effect between condition and time (V = 0.07, F(3, 204) = 5.18, p = 0.002, pη(2) = 0.07) on the dependent variables. Further examination revealed significant univariate interaction effects between condition and time on water (p = 0.021) and SSB consumption (p = 0.015) as well as water drinking intentions (p = 0.049). Posthoc analyses showed that children in the intervention condition reported a significant increase in their water consumption (p = 0.018) and a decrease in their SSB consumption (p < 0.001) over time, compared to the control condition (p-values > 0.05). The children who were exposed to the intervention did not report a change in their water drinking intentions over time (p = 0.576) whereas the nonexposed children decreased their intentions (p = 0.026). These findings show promise for a social network-based intervention using peer influence to positively alter consumption behaviors.

TRIAL REGISTRATION

This RCT was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12614001179628). Study procedures were approved by the Ethics Committee of the Faculty of Social Sciences at Radboud University (ECSW2014-1003-203).

The association between BMI development among young children and (un)healthy food choices in response to food advertisements: a longitudinal study

Background

Previous studies have focused on the acute effects of food advertisements on the caloric intake of children; however, the long-term effects of this food cue reactivity on weight gain have not been examined. The main aim of this study was to explore if reactivity to food cues in an advertisement was associated with weight status two years later.

Methods

Children wo had previously taken part in an experiment investigating the impact of advergames on food intake had their height and weight re-measured two years later, for assessment of body mass index (BMI). A within-subject design was used to test the associations between food choices and BMI over time. In the previous experiment, children played an advergame that promoted energy-dense snacks, fruit, or nonfood products, or did not play an advergame (control condition). After playing the game, the free intake of energy-dense snacks and fruits was measured.

Results

Children who ate more apple after playing an advergame promoting energy-dense snacks had a lower BMI two years later. Consumption of energy-dense snacks after playing an advergame promoting energy-dense snacks was not associated with BMI two years later. In other condition, no association was found between food intake and BMI after two years .

Conclusions

The findings suggest that coping with environmental cues that trigger unhealthy eating behavior is associated with the body mass index of young children two years later. This might imply that learning to respond to food cues by choosing healthy options might prevent children from excessive weight gain.

This trial was registered at as ISRCTN17013832.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0340-7) contains supplementary material, which is available to authorized users.

Media Exposure and Health in Europe: Mediators and Moderators of Media Systems

This study examined media exposure as an explanatory factor for individual and cross-national differences in self-assessed general health. In studying media exposure, traditional media (television, radio, and newspapers) and contemporary media (internet) were separately considered. Aside from hypotheses about the relation between media exposure and general health, we also tested hypotheses regarding the mediating role of social isolation and mean world syndrome as well as the moderating role of different media systems across countries. Therefore, we used European Social Survey 2010, covering 25 European countries (n = 36,692). The results of our multilevel regression analyses indicated that exposure to television was negatively related to general health, whereas exposure to radio and newspapers were positively related to health. For contemporary media, findings indicated consistent positive relations between internet exposure and health across. Furthermore, limited support was found for the mediating role of social isolation and the mean world syndrome in the link between media exposure and health. Across media systems, findings for the relations between exposure to the various types of media and health proved to be robust.

The role of attentional bias in the effect of food advertising on actual food intake among children

This study examined the potential moderating role of attentional bias (i.e., gaze duration, number of fixations, latency of initial fixation) in the effect of advergames promoting energy-dense snacks on children's snack intake. A randomized between-subject design was conducted with 92 children who played an advergame that promoted either energy-dense snacks or nonfood products. Eye movements and reaction times to food and nonfood cues were recorded to assess attentional bias during playtime using eye-tracking methods. Children could eat freely after playing the game. The results showed that playing an advergame containing food cues increased total intake. Furthermore, children with a higher gaze duration for the food cues ate more of the advertised snacks. In addition, children with a faster latency of initial fixation to the food cues ate more in total and ate more of the advertised snacks. The number of fixations on the food cues did not increase actual snack intake. Food advertisements are designed to grab attention, and this study shows that the extent to which a child's attention is directed to a food cue increases the effect of the advertisement.

Impulsivity, "advergames," and food intake

BACKGROUND AND OBJECTIVES

Previous studies have focused on the effect of food advertisements on the caloric intake of children. However, the role of individual susceptibility in this effect is unclear. The aim of this study was to examine the role of impulsivity in the effect of advergames that promote energy-dense snacks on children's snack intake.

METHODS

First, impulsivity scores were assessed with a computer task. Then a randomized between-subject design was conducted with 261 children aged 7 to 10 years who played an advergame promoting either energy-dense snacks or nonfood products. As an extra manipulation, half of the children in each condition were rewarded for refraining from eating, the other half were not. Children could eat freely while playing the game. Food intake was measured. The children then completed questionnaire measures, and were weighed and measured.

RESULTS

Overall, playing an advergame containing food cues increased general caloric intake. Furthermore, rewarding children to refrain from eating decreased their caloric intake. Finally, rewarding impulsive children to refrain from eating had no influence when they were playing an advergame promoting energy-dense snacks, whereas it did lead to reduced intake among low impulsive children and children who played nonfood advergames.

CONCLUSIONS

Playing an advergame promoting energy-dense snacks contributes to increased caloric intake in children. The advergame promoting energy-dense snacks overruled the inhibition task to refrain from eating among impulsive children, making it more difficult for them to refrain from eating. The findings suggest that impulsivity plays an important role in susceptibility to food advertisements.