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.

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 .

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.

The effect of positive and negative movie alcohol portrayals on transportation and attitude toward the movie.

BACKGROUND: This study examined the effects of alcohol portrayals on transportation and attitude toward a movie. In addition, we examined whether positive and negative movie alcohol portrayals affect transportation into and attitude toward the movie. METHODS: A within-subject design was used in which participants were exposed to 8 different movie clips containing alcohol (positive or negative context) or no alcohol portrayals in a controlled laboratory setting. A total of 159 college students (84 males and 75 females) ages 18 to 30 participated in the experiment. Transportation and attitude toward the movie were measured after each movie clip. RESULTS: Participants were more transported into and had a more positive attitude toward movie clips with alcohol portrayals compared to the same movie clips with no alcohol portrayal. In addition, participants were more transported into movie clips with negative alcohol (NA) portrayals compared to clips with positive alcohol (PA) portrayals. For attitude toward the movie, opposite results were found. Participants had a more positive attitudes toward clips with PA portrayals compared to clips with NA portrayals. CONCLUSIONS: The way alcohol is portrayed in movies may contribute to how people evaluate and get transported in movies.

Television watching and the emotional impact on social modeling of food intake among children.

The main goal of this study was to test whether exposure to happy, neutral, or sad media content influences social modeling effects of (snack) food intake in young children. The study was conducted at 14 Dutch urban and suburban primary schools. The participants (N=112) were asked to watch a movie with a same-sex normal-weight confederate who was instructed to eat either nothing or a standardized amount of snack food (10 chocolate-coated peanuts). The study involved a 3 (movie clips: happy, neutral, and sad)×2 (peer's food intake: no intake versus a standardized intake) between-participants design. A significant interaction between the movie clip condition and intake condition was found (F(2,102)=3.30, P=.04, Cohen's f(2)=.20). Positive as well as negative emotions were found to lead to adjustment to the intake of a peer, as compared to that of children in the neutral movie condition. The findings suggest that children eat more mindlessly when watching an emotional movie and, therefore, respond more automatically to a peer's food intake, whereas children may be less susceptible to a peer's intake while watching a neutral movie. As young children are not in the position to choose their food consumption environment yet, parents and schools should provide consumption settings that limit eating in front of the television.

The effect of alcohol advertising on immediate alcohol consumption in college students: an experimental study.

BACKGROUND: Survey studies have emphasized a positive association between exposure to alcohol advertising on television (TV) and the onset and continuation of drinking among young people. Alcohol advertising might also directly influence viewers' consumption of alcohol while watching TV. The present study therefore tested the immediate effects of alcohol advertisements on the alcohol consumption of young adults while watching a movie. Weekly drinking, problem drinking, positive and arousal expectancies of alcohol, ad recall, attitude, and skepticism toward the ads were tested as moderators. METHODS: An experimental design comparing 2 advertisement conditions (alcohol ads vs. nonalcohol ads) was used. A total of 80 men, young adult friendly dyads (ages 18 to 29) participated. The study examined actual alcohol consumption while watching a 1-hour movie with 3 advertising breaks. A multivariate regression analysis was used to examine the effects of advertisement condition on alcohol consumption. RESULTS: Assignment to the alcohol advertisement condition did not increase alcohol consumption. In addition, no moderating effects between advertisement condition and the individual factors on alcohol consumption were found. CONCLUSIONS: Viewing alcohol advertising did not lead to higher alcohol consumption in young men while watching a movie. However, replications of this study using other samples (e.g., different countries and cultures), other settings (e.g., movie theater, home), and with other designs (e.g., different movies and alcohol ads, cumulative exposure, extended exposure effects) are warranted.

The effect of a fictitious peer on young children's choice of familiar v. unfamiliar low- and high-energy-dense foods.

The present experimental study was the first to investigate the impact of a remote (non-existent) peer on children's food choice of familiar v. unfamiliar low- and high-energy-dense food products. In a computer task, children (n 316; 50·3 % boys; mean age 7·13 (SD 0·75) years) were asked to choose between pictures of familiar and unfamiliar foods in four different choice blocks using the following pairs: (1) familiar v. unfamiliar low-energy-dense foods (fruits and vegetables), (2) familiar v. unfamiliar high-energy-dense foods (high sugar, salt and/or fat content), (3) familiar low-energy-dense v. unfamiliar high-energy-dense foods and (4) unfamiliar low-energy-dense v. familiar high-energy-dense foods. Participants who were not in the control group were exposed to the food choices (either always the familiar or always the unfamiliar food product) of a same-sex and same-age fictitious peer who was supposedly completing the same task at another school. The present study provided insights into children's choices between (un)familiar low- and high-energy-dense foods in an everyday situation. The findings revealed that the use of fictitious peers increased children's willingness to try unfamiliar foods, although children tended to choose high-energy-dense foods over low-energy-dense foods. Intervention programmes that use peer influence to focus on improving children's choice of healthy foods should take into account children's strong aversion to unfamiliar low-energy-dense foods as well as their general preference for familiar and unfamiliar high-energy-dense foods.

Alcohol portrayals in movies, music videos and soap operas and alcohol use of young people: current status and future challenges.

AIMS: To provide an overview of studies of the effects of alcohol portrayals in movies, music videos and soap operas on alcohol consumption among young people. Moreover, we highlight important issues that need to be addressed in future research. METHODS: This paper reviews the current literature on alcohol portrayals on-screen and the associated gaps and challenges in alcohol media research. RESULTS: Thirteen longitudinal studies, 8 cross-sectional studies and 6 experimental studies examined the effects of alcohol portrayals on-screen on alcohol consumption among young people. They showed a relation between on-screen alcohol exposure and onset and progression of alcohol consumption. A distinction can be made between long-term effects and immediate effects on alcohol consumption. Only lately, more attention has been paid to processes underlying the effects of on-screen alcohol exposure. CONCLUSION: Replication of findings and development of new research designs is essential. On-screen alcohol exposure does not affect everyone. It is important to test individual differences in susceptibility to on-screen alcohol portrayals. Further, not all media alcohol portrayal might provoke similar effects. It is therefore essential to test the effect of different types of alcohol portrayals.

Social norms in food intake among normal weight and overweight children.

This experimental study investigated whether children's food intake is influenced by a peer's intake directly and over time and whether this depends upon weight status. The study consisted of two sessions taking place at Dutch primary schools. During the first (social modeling) session, the participants (N=223) were asked to solve a puzzle with a same-sex normal weight confederate who was instructed to either eat nothing, a small or large amount. In the second session (about two days later), the participants had to solve the puzzle alone while they could freely eat. The study involved a three (no, low, high confederate intake) by two (normal weight, overweight) between-participants design. An interaction effect in the first session suggested that overweight children might be triggered to (over)eat when a peer eats a high amount of snack food, whereas the food intake of normal weight children seemed to depend on whether the confederate did actually eat, regardless of the amount. The guideline set during the first session persisted over time and influenced food intake during the second session, while differences between normal- and overweight children became insignificant. Peers can set an example as to what food intake is appropriate which could affect long-term food intake.

Moderation of distress-induced eating by emotional eating scores.

Earlier studies assessing the possible moderator effect of self-reported emotional eating on the relation between stress and actual food intake have obtained mixed results. The null findings in some of these studies might be attributed to misclassification of participants due to the use of the median splits and/or insufficient participants with extreme scores. The objective of the two current studies was to test whether it is possible to predict distress-induced eating with a self-report emotional eating scale by using extreme scorers. In study 1 (n=45) we used a between-subjects design and emotional eating was assessed after food intake during a negative or a neutral mood (induced by a movie). In study 2 (n=47) we used a within-subjects design and emotional eating was assessed well before food intake, which occurred after a control or stress task (Trier Social Stress Task). The main outcome measure was actual food intake. In both studies self-reported emotional eating significantly moderated the relation between distress and food intake. As expected, low emotional eaters ate less during the sad movie or after stress than during the neutral movie or after the control task, whereas high emotional eaters ate more. No such moderator effect was found for emotional eating in the entire sample (n=124) of study 1 using the median-split procedure or the full range of emotional eating scores. We conclude that it is possible to predict distress-induced food intake using self-reports of emotional eating provided that the participants have sufficiently extreme emotional eating scores.

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 (Mage = 12.99, SDage = 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.

Do we act upon what we see? Direct effects of alcohol cues in movies on young adults' alcohol drinking.

AIMS: Ample survey research has shown that alcohol portrayals in movies affect the development of alcohol consumption in youth. Hence, there is preliminary evidence that alcohol portrayals in movies also directly influence viewers' drinking of alcohol while watching movies. One process that might account for these direct effects is imitation. The present study therefore examined whether young people imitate actors sipping alcohol on screen. METHODS: We observed sipping behaviours of 79 young adults (ages 18-25) watching a 60-min movie clip, 'What Happens in Vegas', in a semi-naturalistic home setting. Each of the 79 participants was exposed to 25 alcohol cues. Two-level logistic regression analyses were used to analyse whether participants in general imitated actors' sipping during this clip. In addition, we applied proportional hazard models in a survival analysis framework (Cox regression) to test whether there was a difference in imitation of the cues between male and female participants, and to test whether the timing of the actors' sipping throughout the movie played a role. RESULTS: The findings showed that participants were more likely to sip in accordance with the actors' sipping than without such a cue. Further, we found that men were more likely to imitate actors' sipping than females and that participants tended to respond to actors' sipping at the beginning of the movie rather than at the end. CONCLUSION: Exposure to actors sipping alcohol in a movie seems to have an immediate impact on the drinking behaviour of viewers, via the mechanism of imitation.

Exposure to alcohol commercials in movie theaters affects actual alcohol consumption in young adult high weekly drinkers: an experimental study.

The present pilot study examined the effects of alcohol commercials shown in movie theaters on the alcohol consumption of young adults who see these commercials. A two (alcohol commercials vs. nonalcohol commercials) by two (high weekly alcohol consumption vs. low weekly alcohol consumption) between-participant design was used, in which 184 young adults (age: 16-28 years) were exposed to a movie that was preceded by either alcohol commercials or nonalcohol commercials. Participants' actual alcohol consumption while watching the movie ("Watchmen") was examined. An analysis of variance (ANOVA) was conducted to examine the effects of the commercial condition on alcohol consumption. An interaction effect was found between commercial condition and weekly alcohol consumption (p < .001). Alcohol consumption among high weekly alcohol drinkers was higher in the alcohol commercial condition than in the nonalcohol commercial condition, whereas no differences were found in alcohol consumption between commercial conditions among low weekly alcohol drinkers. No gender differences were found in the association between exposure to alcohol commercials, weekly drinking, and alcohol use. Thus, exposure to alcohol commercials prior to a movie in a movie theater can directly influence alcohol consumption among high weekly alcohol consumers.

Social modeling of food purchases at supermarkets in teenage girls.

Ample experimental research has demonstrated the impact of peer influence on food intake in adolescents and adults. However, none of these studies focused social modeling effects on food purchases in supermarkets. This study investigated whether the food purchase behavior of a confederate peer would be adopted by the participant. Teenage girls (N=89) were asked to perform a shopping task in a local supermarket. They had to shop with a same-sex confederate peer who had been instructed earlier to purchase either five low-kilocaloric food products, five average-kilocaloric or five high-kilocaloric food products. Significant main effects for the experimental purchase condition and hunger were found on the amount of kilocalories of the purchased food products. Teenage girls who shopped with a peer in the high-kilocaloric condition purchased higher kilocaloric food products relative to the girls who shopped with a peer in the low-kilocaloric condition. In addition, girls who reported to be hungry purchased higher kilocaloric food products in general. These findings might imply that teenage girls follow unhealthy food purchases of a peer during shopping. Health promotion might benefit from our findings by also focusing on food purchases and not only food intake.

Measuring thinspiration and fear of fat indirectly. A matter of approach and avoidance.

The concepts thinspiration and fear of fat are crucial regarding the development and maintenance of body image disturbances and eating pathology. This study aimed to advance our current understanding of these two motivational concepts. Unlike previous studies that have primarily relied on self report measures to investigate thinspiration and fear of fat, we applied an indirect measure, namely a Stimulus Response Compatibility (SRC) task. During our SRC task, undergraduate female students were instructed to symbolically approach and avoid pictures of thin and chubby models. Hence, the participants' reaction times during the SRC task provided an index of the automatic affective and motivational valence of the models. Results showed that participants were faster to approach than to avoid thin models, however, there was no difference in approach-avoidance responses regarding chubby models. Analyses revealed that the approach-avoidance responses were related to important eating-related, cognitive schemata, e.g., the participants' level of drive for thinness, thin-ideal internalization, body dissatisfaction and their weight control behaviors. These findings clearly support the application of an indirect measure such as the SRC task in order to examine the concepts thinspiration and fear of fat, and highlight the need for further research that validates and extends current results.

Sex differences in young adults' snack food intake after food commercial exposure.

Exposure to food commercials on television is considered to be related to elevated snack food intake in front of the television. However, this assumed relation has as yet not been fully established. The present study, therefore examined the direct effects of watching television food commercials on concurrent non-advertised snack food intake in young adults. In addition, possible sex differences were investigated. Participants (N=82, 50% male) watched a movie interrupted by two commercial breaks that contained either food commercials or neutral commercials. While watching, they could freely eat crisps and chocolate coated peanuts. Afterwards, participants filled out questionnaires and were weighed and measured. Regression analyses showed that men and women were differently affected by the food commercials. Food intake in women was higher when they watched the food commercials than when they watched the neutral commercials, whereas food intake in men was lower when they watched the food commercials than when they watched the neutral commercials. The results suggest that especially women are vulnerable for eating more snack food when exposed to food commercials.

Exposure to soda commercials affects sugar-sweetened soda consumption in young women. An observational experimental study.

The present study examines the direct effects of television commercials advertising soda on actual sugar-sweetened soda consumption among young women. An experimental-observational study design was used, in which 51 female students (ages 18-29) were exposed to a 35-min movie clip, interrupted by two commercial breaks consisting of soda or water commercials. Their actual soda consumption while watching the movie clip was examined. An analysis of variance was used to examine the effects of commercial condition on soda consumption. Thirst and first glass consumed before the first commercial break were added as covariates in the analyses. Results indicated that participants assigned to the condition with soda commercials consumed 1.3 ounces more soda than participants in the water commercial condition. Exposure to soda commercials while watching a movie can have a strong influence on increasing sugar-sweetened soda consumption in young women.

Maternal encouragement to be thin moderates the effect of commercials on children's snack food intake.

The present study experimentally tested the effects of adult targeted food commercials (energy-dense and light food products) on actual snack food intake in young children while watching television. Furthermore, the moderating role of maternal behaviors was investigated. The children (N=121, aged between 8 and 12 years) were exposed to a neutral movie that was interrupted by two commercial breaks. These breaks contained commercials promoting either energy-dense foods, low energy versions of the same energy-dense foods (light food commercials), or neutral commercials aimed at adults. Snack food intake during watching television was measured. Children filled out questionnaires and were weighed and measured afterwards. Children who perceived maternal encouragement to be thin ate slightly more when exposed to energy-dense food commercials and especially when exposed to light food commercials than when exposed to neutral commercials. In contrast, children who perceived no maternal encouragement to be thin ate more when exposed to neutral commercials than when exposed to either energy-dense food commercials or light food commercials. These findings suggest that exposure to adult targeted light food cues produced disinhibition in children who experienced maternal encouragement to be thin, resulting in elevated snack food intake.

Comparison of food recommendations varying in sustainability: Impact on dietary intake and motivation to follow recommendations.

Food recommendations increasingly focus on sustainability in addition to nutritional value. By providing participants with standard versus sustainable (plant-based) dietary recommendations for 3 weeks, the present research tested the impact of recommendations on dietary compliance. Furthermore, predictors of food intake were tested across food categories. Participants in the sustainable diet condition complied less with recommendations as compared to those in the standard diet condition and were less motivated to continue complying after the intervention. Taste was the main predictor of intake across food categories. Together, this stresses the importance of considering factors stimulating consumers' compliance when formulating food recommendations.

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.