Very small effects of an imagery-based randomised trial to promote adherence to wearing face coverings during the COVID-19 pandemic and identification of future intervention targets.

OBJECTIVE: Mental imagery interventions are a cost-effective way of promoting health behaviour change. We tested a mental imagery intervention designed to promote adherence to wearing face coverings during the COVID-19 pandemic.Design: A four-arm randomised controlled trial to explore potential mechanisms of action. Main outcome measures: Measures of behaviour (frequency of self-reported face covering adherence), theory of planned behaviour constructs (i.e. intention, attitudes, subjective norms, and perceived behavioural control), personality traits, imagery ability and barrier self-efficacy were measured at baseline (T1). Behaviour was also assessed at four-week follow-up (T2).Results: Of 297 participants, a majority always wore face coverings (N = 216, 73% overall sample). Logistic regression analyses revealed no intervention effects on changes in adherence to wearing face coverings, though T1 wearing of face coverings and being male predicted T2 behaviour. Subgroup analysis of participants self-reporting 'suboptimal T1 adherence, revealed that T2 non-adherence was predicted by being a non-student and by subjective norms and lower T1 intention to wear face coverings.Conclusion: Imagery-based interventions to increase face covering wearing adherence may exert significant public health effects but only when conducted on a very large scale. Our findings suggest that interventions should target men and disrupt habitual past behaviour.

Calling time on responsible drinking: A qualitative study of perceptions of information on alcohol product labels.

OBJECTIVES: This study aimed to explore (a) how people interpret responsible drinking messages on alcohol product labels, and (b) the acceptability of including health information on labels. DESIGN: Qualitative interviews. METHODS: Face-to-face semi-structured interviews were conducted with 20 people aged 21-63; 18 were classified risky drinkers using AUDIT-C. They were shown three sets of alcohol product labels: one including three responsible drinking messages (drink responsibly), one with three positively worded health messages (drinking less reduces risks) and one with three negatively worded health messages (drinking more increases risks). Health messages included information about cancer, liver and heart disease. RESULTS: Thematic analysis identified three themes: ambiguity about alcohol labelling; identifying oneself as responsible; and acceptability of enhanced product labelling. Participants were critical of responsible drinking messages and wary of conflicting health information in the media. They positioned themselves as responsible, knowledgeable drinkers and distanced themselves from problem drinkers. They did not appear to support the inclusion of health information on labels; however, novel information was considered more impactful. CONCLUSIONS: Responsible drinking messages were seen by our sample as an alcohol industry ploy. Although health messages about cancer were seen as potentially impactful, the ability of consumers to position themselves as unproblematic drinkers means that they may not see the information on the label as relevant to themselves. Understanding factors that increase the personal relevance of messages is needed, alongside an exploration of a wider range of methods for alcohol health communication.

Mental imagery interventions to promote face covering use among UK university students and employees during the COVID-19 pandemic: study protocol for a randomized controlled trial.

BACKGROUND: The 2020 COVID-19 pandemic has witnessed wide-ranging efforts to minimize the spread of the virus and to protect those most vulnerable to becoming unwell following viral infection. Core COVID-19 preventive measures include social distancing, regular hand washing, and wearing face coverings in public places. Understanding links between social cognitive factors relating to beliefs/skills is important in the context of the COVID-19 pandemic, as this can suggest which factors might be targeted via behaviour change interventions to promote adherence to COVID-19 preventative behaviours. In this context, mental imagery exercises-self-directed imagining of an anticipated outcome or processes linked to a defined behaviour/activity-offer a well-evidenced, relatively simple behaviour change intervention. In the mental imagery invention reported in this protocol, individuals will be randomly assigned to one of four separate conditions (outcome imagery, process imagery, outcome and process imagery, control). METHODS: The primary objective of this randomized controlled study is to assess the effectiveness of a mental imagery intervention on wearing face coverings, as a defined core COVID-19 preventative behaviour. Participants will consist of UK university students and university employees of any age. Participants will be randomized to complete an 'outcome imagery' or a 'process imagery' exercise, both exercises (i.e. a combined condition) or neither exercise (i.e. a control condition). A total of 260 individuals will be recruited into the study. Outcomes for all study condition arms will be assessed at baseline (Time 1), immediately post-intervention (Time 2), and at 1-month follow-up (Time 3). The primary outcome is frequency of wearing face covering, as reported at T2 and T3. Secondary outcomes include intervention effects on face covering attitudes, social norms, perceived behavioural control and barrier self-efficacy at T2 and T3. Putative moderators of intervention effects are conscientiousness, narcissism and 'light triad' personality traits. DISCUSSION: This trial will contribute toward the currently sparse evidence base concerning behaviour change techniques designed to promote COVID-19 preventative behaviours among UK university students and university employees. TRIAL REGISTRATION: ClinicalTrials.gov (U.S. National Library of Medicine) NCT04583449 . Retrospectively registered on 20 October 2020.

'When I open it, I have to drink it all': Push and pull factors shaping domestic alcohol consumption during the COVID-19 pandemic UK Spring 2020 lockdown.

INTRODUCTION: The closure of licensed venues during the COVID-19 pandemic meant that most alcohol has been consumed at home during lockdown periods in the UK, a phenomenon that remains under-researched despite the public health implications. METHODS: This article draws on a study consisting of online semi-structured interviews and focus groups with 20 UK drinkers, conducted between the first and second 2020 UK lockdowns. The study aimed to explore changing and enduring UK drinking practices within home spaces during the pandemic. RESULTS: Our findings illuminate specific ways in which assemblages and contextual factors may come together to encourage or mitigate against the consumption of any (or excessive) volumes of alcohol at home during the lockdown. For example, the physical presence of alcohol bottles may both encourage consumption (e.g. compulsion to finish an open bottle of wine) and cue reflection on one's drinking (through the potentially confronting presence of empty bottles after domestic drinking). We also highlight the significance of the home as a space separate from-and different to-public drinking spaces. DISCUSSION AND CONCLUSIONS: With the increasing normalisation of domestic drinking during a global pandemic, this paper illuminates several factors that may encourage or curtail domestic alcohol consumption and invites us to consider the importance of assemblages, space and context. Such findings have wider applicability; for example, consideration of specific (and perhaps unique) push and pull factors of home spaces could inform future alcohol policy, health promotion messages and how guidance around 'moderation' or risky drinking is communicated.

'Maturing Out' as dilemmatic: Transitions towards relatively light drinking practices among UK University students.

OBJECTIVES: University students in the UK engage in relatively high alcohol consumption levels, yet young adults, including students, now drink less than previously and abstain more. Against this cultural backdrop, our objective was to further understanding of 'maturing out' of excessive drinking practices among students by focusing on drinking transitions that had taken place during university years. DESIGN: A qualitative interview study. METHODS: Semi-structured interviews were conducted with ten 18- to 27-year-old UK undergraduate university students who self-identified as light or non-drinkers. Interviews were audio-recorded, and anonymized interview transcripts were subjected to an experience-focused application of thematic analysis. RESULTS: Participants reported dilemmas involved in transitions from relatively high to low levels of alcohol consumption. One dilemma was characterized by managing to drink less (or nothing) without cutting off social options with university friends/peers. A second dilemma concerned not wishing to fully abandon the pleasures and increased social confidence that alcohol consumption could afford. Results also demonstrated that self-reported drinking could contradict participants' self-defined 'light drinker' status. CONCLUSIONS: This study reinforces the view that 'maturing out' involves more than simply having gained new responsibilities during young adulthood. Recognition of these dilemmatic features of drinking transitions could be drawn on in novel campus-based interventions. Such interventions may help strengthen realistic and sustainable moderate drinking by guiding students to anticipate potential difficulties involved in planned reductions in personal drinking but may also help foster students' ability to view drinking choices as in transition rather than as permanent and enduring.

Understanding Motivation to Adhere to Guidelines for Alcohol Intake, Physical Activity, and Fruit and Vegetable Intake Among U.K. University Students.

BACKGROUND: To encourage people to lead healthier lifestyles, governments in many countries publish guidelines for alcohol intake, physical activity (PA), and fruit and vegetable (FV) intake. However, there is a need for better understanding of whether people understand such guidelines, consider them useful, and adhere to them. University students are a group worthy of attention because although they are less likely than older adults to exceed U.K. weekly alcohol intake guidelines or to be inactive, they are also less likely to meet FV consumption targets. Furthermore, because behavior during youth predicts adult behavior, it is important to identify influences on healthier behavior. METHOD: An online survey was completed by 559 U.K. university students. Key outcome variables were knowledge of guidelines, motivation to adhere to them, and adherence to them. RESULTS: A total of 72% adhered to guidelines for alcohol intake, 58% for PA, and 20% for FV intake. Students generally had poor or moderate knowledge of guidelines, perceived them as only moderately useful, and were only moderately motivated to adhere to them. Greater motivation to adhere to guidelines was not significantly related to more accurate knowledge. However, it was related to greater familiarity, and perceiving guidelines as useful and realistic, and greater conscientiousness. DISCUSSION: There is a need to ensure that students understand the U.K. guidelines for alcohol intake, PA, and FV intake. However, simply increasing knowledge may not lead to greater adherence to the guidelines: There is also a need to focus on improving perceptions of how useful and realistic they are.

Possibilities and pitfalls? Moderate drinking and alcohol abstinence at home since the COVID-19 lockdown.

The global 'lockdowns' and social distancing measures triggered by the COVID-19 pandemic have brought about unprecedented social changes, including the sudden, temporary closure of licensed venues and significant modifications to leisure and drinking practices. In this piece, we argue that these changes invite researchers to consider the short and longer-term consequences in terms of continuities and changes to the practices and symbolism of alcohol consumption both within and beyond domestic spaces. We do this by drawing on illustrations from our emergent qualitative research involving internet-mediated semi-structured interviews and focus groups with 20 participants from the UK (aged 26-65) concerning experiences of drinking in and beyond 'lockdown'. In sharing these early findings, we hope to highlight themes relevant to understanding drinking behaviour during the COVID-19 pandemic and to stimulate dialogue for immediate research priorities in this area. Key topic areas in our data appear to concern; variability in heavy/moderate/light/non-drinking practices while drinking at home, lockdown as an opportunity to reassess relationships with alcohol, and the symbolic role of alcohol in internet-mediated communications and interactions. Longstanding policymaker and practitioner concerns with managing public drinking and public order may have been unsettled by a growth in home-based drinking, although, as we argue, such changes were in motion before the global pandemic. We propose that a greater understanding of the challenges and opportunities the pandemic presents for (re)negotiating relationships with alcohol may offer wider lessons around how individuals and communities might be supported via innovative policy measures to change their relationships with alcohol both during and beyond lockdown.

Negative Experiences of Non-Drinking College Students in Great Britain: an Interpretative Phenomenological Analysis.

Research relating to alcohol use amongst university students primarily examines the effects of binge drinking. Researchers rarely focus on a range of drinking styles including light or non-drinking. This study was designed to gain an in-depth understanding of the lived experiences of female, first year UK undergraduates, who do not drink alcohol. Semi-structured interviews were conducted with eight participants. Narratives were analysed using interpretative phenomenological analysis (IPA; by Smith and Osborn (Sage 51-80, 2003). Three superordinate themes were identified: "managing the feeling that you don't belong" highlights the importance of managing social interactions as a non-drinker; "experiencing social exclusion" recognises the impact on social bonding as a result of insufficient socialising opportunities; and "experiencing peer pressure and social stigma" highlights the scrutiny and labelling participants endured. These findings provide an understanding of some of the difficulties experienced by these undergraduates as a result of their non-drinking status. Implications of this research are discussed and areas for future research are outlined.

Imagery interventions in health behavior: A meta-analysis.

OBJECTIVE: Imagery-based interventions represent an inexpensive, potentially effective technique for changing health behavior and promoting adaptive health outcomes. However, research adopting mental imagery techniques in health behavior interventions has shown considerable variability in effects across studies. In the present analysis we present a quantitative synthesis of the effectiveness of mental imagery interventions in health behavior and tested effects of key moderators. METHOD: A systematic database search for studies adopting imagery interventions in health behavior and related outcomes was conducted with additional manual searches and direct author contact for unpublished studies. Data were extracted for imagery intervention effects on behavioral, psychological, and physiological outcomes, and for candidate moderators. RESULTS: Twenty-six studies of mental imagery intervention effects comprising 33 independent data sets met eligibility criteria for inclusion in the review. Mental imagery interventions led to nontrivial, small averaged corrected effect sizes on postintervention behavior, intention, perceived control, and attitude, and a small-to-medium sized effect on postintervention physiological measures. Substantive heterogeneity in the effects meant that a search for moderators was warranted. Moderator analyses indicated larger effects of imagery interventions on health behaviors in studies on older, nonstudent samples, when detailed instructions were provided, in studies with higher methodological quality scores, and in studies of longer duration. Effect sizes for imagery on behavioral and physiological outcomes were larger than effects on psychological outcomes. CONCLUSION: Results support effects of mental imagery interventions on health behaviors, identify conditions in which they may be more effective, and point to how future imagery interventions might be optimized. (PsycINFO Database Record

Benefits and drawbacks of social non-drinking identified by British university students.

INTRODUCTION AND AIMS: Promoting the benefits of not drinking alcohol during social occasions where other peers may be drinking ('social non-drinking') may support more moderate drinking among young people. We analysed free-text responses from university students to gauge the frequency/focus of identified benefits of, and drawbacks to, social non-drinking. We also assessed whether/how identified benefits and drawbacks were associated with recent drinking behaviour and psychological correlates of harmful drinking. DESIGN AND METHODS: Secondary data analyses were conducted on 511 free-text responses provided by students participating in a health intervention. Template analysis was used to identify potential benefits of social non-drinking. Links between responses relating to social non-drinking and behavioural/psychological measures were assessed. RESULTS: 46.2% of female students and 42.0% of male students had engaged in social non-drinking in the previous week. Overarching benefits of social non-drinking included: improved physical and psychological health; increased self-esteem/agency; a higher quality social life and having a more stable/productive life. Hostility/ambivalence to social non-drinking was evident in 26.6% of responses. Among women only, endorsing higher self-esteem and agency as a benefit of social non-drinking was associated with increased intention to heed government drinking recommendations (ß = 0.10, P = 0.036). DISCUSSION AND CONCLUSIONS: Focus on social non-drinking may help encourage more moderate drinking among young people by articulating positives of social non-drinking while raising awareness of a changing normative context in which non-drinking is increasingly more common among young people.

Motivations for reducing alcohol consumption: An international survey exploring experiences that may lead to a change in drinking habits.

AIMS: Brief interventions delivered by doctors and other healthcare practitioners might be meaningfully enhanced by understanding what individual experiences might lead patients to cut down. The aim of the current paper was to explore the experiences that might lead people to reduce their alcohol consumption and to compare these findings between respondents from 21 different countries. METHODS: Global Drug Survey is an online cross sectional, opportunistic anonymous survey. This paper includes 72,209 respondents from 21 counties with over 250 respondents (60.8% male). RESULTS: Almost a third (32.9%) of participants reported that they would like to drink less alcohol over the next 12months, and a third thought their GP would tell them to cut down if they were honest about their drinking. The primary experiences that were rated as most likely to lead to a change in behaviour were related to physical health, sexual assault and having to seek emergency medical treatment. Respondents from Germany were more likely to select embarrassment as a motivation to reduce drinking than those from other counties. Females were more likely to report indicate motivations related to sexual regret, sexual assault or seeking treatment. Older participants and those in the low risk audit category were more likely to report embarrassment or forgetfulness as potential motivation for change. CONCLUSION: Understanding the different motivations that may lead individuals to change their drinking behaviours can be used to inform targeted brief interventions and targeted public health guidance.

Understanding the Association Between Relative Sociability Prototypes and University Students' Drinking Intention.

BACKGROUND: Evaluations of "the prototypical nondrinker" and of "the prototypical regular drinker" have been demonstrated to hold associations with more harmful drinking behavior, yet the extent to which the relative evaluation of these prototypes is associated with drinking intention remains to be tested. OBJECTIVES: To explore whether relatively unfavorable nondrinker prototypes are associated with increased drinking intention and whether this relationship is moderated by personality variables. METHODS: Among a student sample (n = 543), alcohol-related sociability prototype measures were used to compute an index of the perceived sociability of regular drinkers relative to nondrinkers ("relative sociability prototypes"). Measures of drinking intention, conscientiousness, extraversion and sensation seeking impulsivity were also taken. RESULTS: Most students perceived the prototypical nondrinker unfavorably relative to the prototypical regular drinker (91%, n = 493). Simple slopes analyses indicated that extraversion moderated the strength of the relationship between relative sociability prototypes and drinking intention such that relatively negative evaluations of nondrinkers were only associated with increased intention to get drunk among more extraverted students. CONCLUSIONS/IMPORTANCE: Prospective data and behavioral measures are needed to substantiate these findings, which suggest links between relative evaluations of nondrinkers, harmful drinking intention and personality traits. Evidence suggests that by challenging prejudicial beliefs concerning nondrinkers (as "unsociable") and by targeting more extraverted students, safer drinking plans might be encouraged.

Efficacy of a non-drinking mental simulation intervention for reducing student alcohol consumption.

OBJECTIVES: To assess the impact of a mental simulation intervention designed to reduce student alcohol consumption by asking participants to imagine potential positive outcomes of and/or strategic processes involved in not drinking during social occasions. DESIGN: English university students aged 18-25 years (n = 211, Mage = 20 years) were randomly allocated to one of four intervention conditions. The dependent variables were weekly alcohol consumption, heavy episodic drinking (HED) frequency and frequency of social occasions at which participants did not drink alcohol when others were drinking alcohol ('episodic non-drinking'). Measures of alcohol-related prototypes (i.e., prototypical non-drinker, prototypical regular drinker) were used to compute sociability prototype difference scores as a potential mediator of any intervention effects. All measures were taken at baseline and at 2- and 4-week follow-up. METHODS: Participants completed one of four exercises involving either imagining positive outcomes of non-drinking during a social occasion (outcome condition); imagining strategies required for non-drinking during a social occasion (process condition); imagining both positive outcomes and required strategies (combined condition); or completing a drinks diary task (control condition). RESULTS: Latent growth curve analyses revealed a more substantial rate of decrease in weekly unit consumption and HED frequency among outcome condition and process condition participants, relative to control condition participants. Non-significant differences were found between the combined condition and the control condition. Across the whole sample, an inverted U-shape trend indicated an initial increase in episodic non-drinking before it returned to baseline levels. CONCLUSION: This study provides preliminary evidence that mental simulation interventions focused on non-drinking can successfully promote behaviour change. Statement of contribution What is already known on this subject? UK drinking recommendations advise two 'dry days' per week (NHS, 2014). Benefits of, and strategies involved in, social non-drinking exist (Conroy & de Visser, 2014). Mental simulation interventions may help reduce student drinking (Hagger, Lonsdale, & Chatzisarantis, 2012; Hagger, Lonsdale, Koka et al., 2012). What does this study add? Demonstrates efficacy of a novel 'non-drinking' mental simulation exercise. Suggests that healthier alcohol prototypes can be encouraged via a health promotion intervention. Shows potential utility of 'episodic non-drinking' as an indicator of health-adherent drinking.

The importance of authenticity for student non-drinkers: An interpretative phenomenological analysis.

Our article illustrates the importance of authenticity to student non-drinkers. Semi-structured interviews focussing on the lived experiences of five non-drinking students were subjected to interpretative phenomenological analysis. We present four inter-related themes: 'Retaining authenticity by not drinking', 'Tainting the self by drinking alcohol', 'Feeling trapped by superimposition and self-exposition' and 'Doing what you want to do with your life'. Self-authenticity informed the decision not to drink, became relevant within conversations about non-drinking and underscored issues of choice and agency raised by alcohol consumption. Entrenched assumptions about alcohol's self-realising utility are challenged in our discussion, and future research recommendations are suggested.

Being a non-drinking student: an interpretative phenomenological analysis.

Recent research suggests that safer student alcohol consumption might be assisted by understanding how social occasions are managed by non-drinkers. In-depth, semi-structured interviews with five 19-22 year old non-drinking English undergraduates were subjected to interpretative phenomenological analysis. We present five inter-linked themes: 'living with challenges to non-drinking'; 'seeing what goes on in drinking environments'; 'dealing with conversations about non-drinking (making excuses vs. coming out)'; 'knowing which friends care about you'; and 'the importance of minimising "legroom" for peer pressure'. Participants felt under persistent peer scrutiny (as a form of peer pressure) and could feel alienated in drinking environments. Talking about non-drinking was characterised by whether to 'come out' (as a non-drinker) or 'fake it' (e.g. 'I'm on antibiotics'). Loyal friendships were reported as particularly important in this context. The decision not to drink was experienced as providing a successful buffer to peer pressure for former drinkers. Our findings unsettle traditional health promotion campaigns which advocate moderate drinking among students without always suggesting how it might be most successfully accomplished and offer tentative guidance on how non-drinking during specific social occasions might be managed more successfully. Findings are discussed in relation to extant literature and future research directions are suggested.

'Man up!' Discursive constructions of non-drinkers among UK undergraduates.

This study adopted a discursive approach to explore how not drinking alcohol (non-drinking) is construed in relation to masculine identity among 12 undergraduate interviewees. Three prominent discourses were revealed. First, non-drinking was constructed as something strange requiring explanation. Second, contradictory discourses constructed non-drinking as, simultaneously, unsociable yet reflective of greater sociability. Third, non-drinking was constructed as something which has greater negative social consequences for men than for women. Opportunities for challenging traditional gender role expectations are considered.