Citizen neuroscience: Wearable technology and open software to study the human brain in its natural habitat.

Citizen science allows the public to participate in various stages of scientific research, including study design, data acquisition, and data analysis. Citizen science has a long history in several fields of the natural sciences, and with recent developments in wearable technology, neuroscience has also become more accessible to citizen scientists. This development was largely driven by the influx of minimal sensing systems in the consumer market, allowing more do-it-yourself (DIY) and quantified-self (QS) investigations of the human brain. While most subfields of neuroscience require sophisticated monitoring devices and laboratories, the study of sleep characteristics can be performed at home with relevant noninvasive consumer devices. The strong influence of sleep quality on waking life and the accessibility of devices to measure sleep are two primary reasons citizen scientists have widely embraced sleep research. Their involvement has evolved from solely contributing to data collection to engaging in more collaborative or autonomous approaches, such as instigating ideas, formulating research inquiries, designing research protocols and methodology, acting upon their findings, and disseminating results. In this article, we introduce the emerging field of citizen neuroscience, illustrating examples of such projects in sleep research. We then provide overviews of the wearable technologies for tracking human neurophysiology and various open-source software used to analyse them. Finally, we discuss the opportunities and challenges in citizen neuroscience projects and suggest how to improve the study of the human brain outside the laboratory.

Health support of people with intellectual disability and the crucial role of support workers.

BACKGROUND: People with intellectual disability have a poorer health status than the general population. In The Netherlands, support workers play a key role in meeting health support needs of people with intellectual disability. Research on how people with intellectual disability and their support workers experience the support worker's role in preventing, identifying, and following up health needs of people with intellectual disability is scarce. To enhance health support of people with intellectual disability it is crucial that we understand how health support is delivered in everyday practice. Therefore, this study investigated experiences of people with intellectual disability and support workers with the health support of people with intellectual disability. METHOD: Data collection consisted of six focus group (FG) discussions with between four and six participants (N = 27). The FGs consisted of three groups with support workers (n = 15), two groups with participants with mild to moderate intellectual disability (n = 8), and one group with family members as proxy informants who represented their relative with severe to profound intellectual disability (n = 4). The data was analysed thematically on aspects relating to health support. RESULTS: We identified three main themes relevant to the health support of people with intellectual disability: 1) dependence on health support, 2) communication practices in health support, and 3) organizational context of health support. Dependence on health support adresses the way in which support workers meet a need that people with intellectual disability cannot meet themselves, and communication practices and organizational context are identified as systems in which health support takes place. CONCLUSION: This study investigated experiences with the health support of people with intellectual disability from the perspectives of people with intellectual disability and support workers. We discuss the dependence of people with intellectual disability and the complexity of health support in everyday practice. We provide practical implications that can strengthen support workers in the provision of health support for people with intellectual disability in everyday practice. The findings of this study emphasize the need for intellectual disability care-provider organizations to establish policies around consistency in support staff to make it easier to identify and follow up health needs, and an environment where support staff can develop their expertise concerning communication practices, lifestyle choices, and identifying and following up health needs.

Toward Inclusive Approaches in the Design, Development, and Implementation of eHealth in the Intellectual Disability Sector: Scoping Review.

BACKGROUND: The use of eHealth is more challenging for people with intellectual disabilities (IDs) than for the general population because the technologies often do not fit the complex needs and living circumstances of people with IDs. A translational gap exists between the developed technology and users' needs and capabilities. User involvement approaches have been developed to overcome this mismatch during the design, development, and implementation processes of the technology. The effectiveness and use of eHealth have received much scholarly attention, but little is known about user involvement approaches. OBJECTIVE: In this scoping review, we aimed to identify the inclusive approaches currently used for the design, development, and implementation of eHealth for people with IDs. We reviewed how and in what phases people with IDs and other stakeholders were included in these processes. We used 9 domains identified from the Centre for eHealth Research and Disease management road map and the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability framework to gain insight into these processes. METHODS: We identified both scientific and gray literature through systematic searches in PubMed, Embase, PsycINFO, CINAHL, Cochrane, Web of Science, Google Scholar, and (websites of) relevant intermediate (health care) organizations. We included studies published since 1995 that showed the design, development, or implementation processes of eHealth for people with IDs. Data were analyzed along 9 domains: participatory development, iterative process, value specification, value proposition, technological development and design, organization, external context, implementation, and evaluation. RESULTS: The search strategy resulted in 10,639 studies, of which 17 (0.16%) met the inclusion criteria. Various approaches were used to guide user involvement (eg, human or user-centered design and participatory development), most of which applied an iterative process mainly during technological development. The involvement of stakeholders other than end users was described in less detail. The literature focused on the application of eHealth at an individual level and did not consider the organizational context. Inclusive approaches in the design and development phases were well described; however, the implementation phase remained underexposed. CONCLUSIONS: The participatory development, iterative process, and technological development and design domains showed inclusive approaches applied at the start of and during the development, whereas only a few approaches involved end users and iterative processes at the end of the process and during implementation. The literature focused primarily on the individual use of the technology, and the external, organizational, and financial contextual preconditions received less attention. However, members of this target group rely on their (social) environment for care and support. More attention is needed for these underrepresented domains, and key stakeholders should be included further on in the process to reduce the translational gap that exists between the developed technologies and user needs, capabilities, and context.

Promoting water consumption among children: a three-arm cluster randomised controlled trial testing a social network intervention.

OBJECTIVE: To test the effectiveness of a social network intervention (SNI) to improve children's healthy drinking behaviours. DESIGN: A three-arm cluster randomised control trial design was used. In the SNI, a subset of children were selected and trained as 'influence agents' to promote water consumption-as an alternative to sugar-sweetened beverages (SSB)-among their peers. In the active control condition, all children were simultaneously exposed to the benefits of water consumption. The control condition received no intervention. SETTING: Eleven schools in the Netherlands. PARTICIPANTS: Four hundred and fifty-one children (Mage = 10·74, SDage = 0·97; 50·8 % girls). RESULTS: Structural path models showed that children exposed to the SNI consumed 0·20 less SSB per day compared to those in the control condition (ß = 0·25, P = 0·035). There was a trend showing that children exposed to the SNI consumed 0·17 less SSB per day than those in the active control condition (ß = 0·20, P = 0·061). No differences were found between conditions for water consumption. However, the moderation effects of descriptive norms (ß = -0·12, P = 0·028) and injunctive norms (ß = 0·11-0·14, both P = 0·050) indicated that norms are more strongly linked to water consumption in the SNI condition compared to the active control and control conditions. CONCLUSIONS: These findings suggest that a SNI promoting healthy drinking behaviours may prevent children from consuming more SSB. Moreover, for water consumption, the prevailing social norms in the context play an important role in mitigating the effectiveness of the SNI.

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.

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; Mage = 10.51; SDage = 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.

The reciprocal effects of physical activity and happiness in adolescents.

BACKGROUND: Positive associations exist between physical activity and happiness in adolescents. However, previous studies have mostly used self-reported measures and cross-sectional designs. There is a need for more insight into the directionality and duration of this association. The current study was the first to investigate whether an increase in physical activity leads to happiness and whether adolescents become more physically active when they are happier. These two effects were studied between (on a day-to-day basis) and within days (on an hour-to-hour basis). METHODS: The study used data from the MyMovez project in which 1484 adolescents between the ages of 8 and 17 years wore an accelerometer on their wrist and answered experience sampling questions on happiness at random moments during the day for several weeks in 2016-2018. RESULTS: The preregistered analyses demonstrated an association between physical activity and happiness. More specifically, the number of steps per day predicted the experienced happiness on that day. In addition, a short-term reciprocal effect of physical activity and happiness was observed. Happiness was predicted by the number of steps accumulated in the previous hour and it also predicted the number of steps accumulated in the subsequent hour. However, convincing evidence was found that these effects did not occur in the long-term between days. The number of steps on the previous day did not predict happiness, nor did happiness predict the number of steps of the subsequent day. CONCLUSIONS: This study confirms an association between physical activity and happiness in adolescents and shows that in the short-term, physical activity promotes happiness and vice versa. Therefore, we conclude that physical activity is not only important for the physical health of youth, but also plays an important role in their mental well-being. In addition, this knowledge can be used to further understand the importance of physical activity in adolescents' health and help in promoting a healthy lifestyle among youth. TRIAL REGISTRATION: The data used are stored at the Data Archiving and Networked Services ( https://doi.org/10.17026/dans-zz9-gn44 ). Hypotheses, study design, sample, data collection procedure, measured variables, and plan of analysis were preregistered on the Open Science Framework (OSF, https://osf.io/5yk7r/ ).

Promoting healthy foods in the new digital era on Instagram: an experimental study on the effect of a popular real versus fictitious fit influencer on brand attitude and purchase intentions.

BACKGROUND: Most studies on social influencer marketing techniques have focused on the promotion of unhealthy foods whereas little is known about the promotion of healthier foods. The present experimental study investigated whether a popular real versus fictitious fit influencer is more successful in promoting healthy food products. In addition, we examined the role of parasocial interaction as an underlying mechanism of healthy food product endorsement. METHODS: We used a randomized between-subject design with 154 participants (mean age: 24.0 years). Viewers' product attitude and purchase intention were tested after exposure to an Instagram post by a popular real fit influencer (n = 77) or fictitious fit influencer (n = 77). RESULTS: Results showed that parasocial interaction mediated the relation between the type of influencer and product attitude as well as purchase intention. Parasocial interaction was higher for participants exposed to the popular real fit influencer compared to the fictitious fit influencer, leading to higher healthy food brand attitude and purchase intention. DISCUSSION: The findings showed that it is crucial for social influencers to establish a warm personal relationship and connection with the their followers when promoting a healthy product successfully. We suggest that the promotion of healthy foods could be more successful in public health when using popular fit influencers.

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.

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.

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.

Methodological and reporting quality in laboratory studies of human eating behavior.

The methodological quality and reporting practices of laboratory studies of human eating behavior determine the validity and replicability of nutrition science. The aim of this research was to examine basic methodology and reporting practices in recent representative laboratory studies of human eating behavior. We examined laboratory studies of human eating behavior (N = 140 studies) published during 2016. Basic methodology (e.g., sample size, use of participant blinding) and reporting practices (e.g., information on participant characteristics) were assessed for each study. Some information relating to participant characteristics (e.g., age, gender) and study methodology (e.g., length of washout periods in within-subjects studies) were reported in the majority of studies. However, other aspects of study reporting, including participant eligibility criteria and how sample size was determined were frequently not reported. Studies often did not appear to standardize pre-test meal appetite or attempt to blind participants to study aims. The average sample size of studies was small (between-subjects design studies in particular) and the primary statistical analyses in a number of studies (24%) were reliant on very small sample sizes that would be likely to produce unreliable results. There are basic methodology and reporting practices in the laboratory study of human eating behavior that are sub-optimal and this is likely to be affecting the validity and replicability of research. Recommendations to address these issues are discussed.

Reprint of "Methodological and reporting quality in laboratory studies of human eating behavior".

The methodological quality and reporting practices of laboratory studies of human eating behavior determine the validity and replicability of nutrition science. The aim of this research was to examine basic methodology and reporting practices in recent representative laboratory studies of human eating behavior. We examined laboratory studies of human eating behavior (N = 140 studies) published during 2016. Basic methodology (e.g., sample size, use of participant blinding) and reporting practices (e.g., information on participant characteristics) were assessed for each study. Some information relating to participant characteristics (e.g., age, gender) and study methodology (e.g., length of washout periods in within-subjects studies) were reported in the majority of studies. However, other aspects of study reporting, including participant eligibility criteria and how sample size was determined were frequently not reported. Studies often did not appear to standardize pre-test meal appetite or attempt to blind participants to study aims. The average sample size of studies was small (between-subjects design studies in particular) and the primary statistical analyses in a number of studies (24%) were reliant on very small sample sizes that would be likely to produce unreliable results. There are basic methodology and reporting practices in the laboratory study of human eating behavior that are sub-optimal and this is likely to be affecting the validity and replicability of research. Recommendations to address these issues are discussed.

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

UNLABELLED: 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).

Social modeling of eating: a review of when and why social influence affects food intake and choice.

A major determinant of human eating behavior is social modeling, whereby people use others' eating as a guide for what and how much to eat. We review the experimental studies that have independently manipulated the eating behavior of a social referent (either through a live confederate or remotely) and measured either food choice or intake. Sixty-nine eligible experiments (with over 5800 participants) were identified that were published between 1974 and 2014. Speaking to the robustness of the modeling phenomenon, 64 of these studies have found a statistically significant modeling effect, despite substantial diversity in methodology, food type, social context and participant demographics. In reviewing the key findings from these studies, we conclude that there is limited evidence for a moderating effect of hunger, personality, age, weight or the presence of others (i.e., where the confederate is live vs. remote). There is inconclusive evidence for whether sex, attention, impulsivity and eating goals moderate modeling, and for whether modeling of food choice is as strong as modeling of food intake. Effects with substantial evidence were: modeling is increased when individuals desire to affiliate with the model, or perceive themselves to be similar to the model; modeling is attenuated (but still significant) for healthy-snack foods and meals such as breakfast and lunch, and modeling is at least partially mediated through behavioral mimicry, which occurs without conscious awareness. We discuss evidence suggesting that modeling is motivated by goals of both affiliation and uncertainty-reduction, and outline how these might be theoretically integrated. Finally, we argue for the importance of taking modeling beyond the laboratory and bringing it to bear on the important societal challenges of obesity and disordered eating.

An Accessible Web-Based Survey to Monitor the Mental Health of People With Mild Intellectual Disability or Low Literacy Skills During the COVID-19 Pandemic: Comparative Data Analysis.

BACKGROUND: The COVID-19 pandemic and related control measures affected the mental health of all populations. Particular subgroups are underrepresented in mainstream surveys because they are hard to reach, and study measurements are not adapted to their skills. These subgroups include people with lower cognitive and literacy skills, such as people with mild intellectual disability (MID), who were considered vulnerable during the COVID-19 pandemic given their low socioeconomic status, small social networks, increased risks of health problems, and difficulties understanding health-related information. OBJECTIVE: This study examines the impact of the COVID-19 pandemic on mental health among people with MID or low literacy skills compared with those predominantly represented in national surveys. METHODS: A repeated cross-sectional study of people with MID or low literacy skills and a general population sample was conducted in the Netherlands. An easy-read web-based survey was co-designed with, and tested among, people with MID or low literacy skills and conducted in 3 rounds within 1 year of the COVID-19 pandemic (T1: November to December 2020, T2: March to April 2021, and T3: September to October 2021). The survey contained questions about demographics and 6 aspects of mental health: feeling happy, feeling energized, feeling stressed, worry, feeling lonely, and sleeping problems. RESULTS: Our adapted survey and recruitment procedure enabled 1059 persons with MID or low literacy skills to participate (T1: n=412, 38.9%; T2: n=351, 33.1%; and T3: n=296, 28%). They were significantly younger, had a lower level of education, and more often than not were born outside the Netherlands compared to the general population sample (P<.001). Approximately half of them (604/1059, 57.03%) received professional care. They displayed poorer mental health scores than the general population sample. The percentages of people with MID or low literacy skills who reported more negative feelings in T1 ranged from 20.6% (85/412) reporting feeling lonely often or almost always to 57.8% (238/412) reporting feeling happy almost never or sometimes. The general population sample's percentages were 5.4% (160/2930) and 32.2% (941/2918), respectively. Although scores improved over time in both populations, the disproportional effects remained. CONCLUSIONS: General COVID-19-related restrictions for the entire Dutch population affected people with MID or low literacy skills more negatively than the general population. Our study underscores the relevance of including these subpopulations in public health research because they are often overlooked in regular health data. An accessible web-based survey particularly targeted at this population enabled us to do so, and we reached a group of respondents significantly different from regular survey participants. This survey's results provided insights into the health of people with MID or low literacy skills and gained knowledge to be used by care organizations and policy makers to reduce health disparities during a pandemic and in general.

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.

Leverage point themes within Dutch municipalities' healthy weight approaches: A qualitative study from a systems perspective.

INTRODUCTION: Despite all efforts of national and local approaches, obesity rates continue to rise worldwide. It is increasingly recognized that the complexity of obesity should be further addressed by incorporating a systems perspective when implementing approaches. Such an approach has four interconnected system levels: events, structures, goals, and beliefs, in which small changes ('leverage points') can lead to substantial changes in the functioning of the entire system. The current research examined the functioning of five Dutch municipalities' healthy weight approaches (HWAs) and the leverage point themes that can be identified in their system. METHODS: Thirty-four semi-structured interviews were conducted with various stakeholders about the HWA, including policy advisors, care professionals, practice professionals, and citizens. An inductive thematic analysis was performed. RESULTS: Three main themes were identified: 1) HWA organization structure, 2) collaboration between professionals, and 3) citizen participation. Across all system levels, we identified leverage point themes. The upper-levels events and structures occurred the most and were explained by underlying goals and beliefs. Leverage point themes regarding "HWA organization structure" were municipal processes, such as perceived impact; diversity of themes, activities, and tasks; network; and communication strategies, such as messages about the HWA. Leverage point themes regarding "collaboration between professionals" were linking pins, indicating central players within the network; motivation and commitment including support base; and stimulating one another to work on the HWA by spurring other professionals into action. Lastly, leverage point themes under "citizen participation" included reaching the target group, e.g., look for entry points; and citizens' motivation, including customization. DISCUSSION: This paper provides unique insights into HWAs' leverage point themes that can lead to substantial changes in how the entire system functions and makes suggestions about underlying leverage points to help stakeholders improve their HWA. Future research could focus on studying leverage points within leverage point themes.