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.

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.

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

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

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

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

An integrated model of fruit, vegetable, and water intake in young adolescents.

OBJECTIVE: In this study, we tested an integrated model for why young adolescents consume fruit, vegetables, and water. The model was based on evidence from studies applying three dominant theoretical approaches, including planned behavior, social norms, and intrinsic motivation. METHOD: The integrated model was tested with structural equation modeling using four data-collection waves of the MyMovez Project (MyMovez, 2017) in which 953 young adolescents (53.9% girls; Mage = 11.19, SDage = 1.36) participated. Self-reported measures were used to assess young adolescents' fruit, vegetable, and water consumption, self-efficacy, attitude, social norms of parents and peers, behavioral intentions, and intrinsic motivation. RESULTS: The analyses revealed that young adolescents' intrinsic motivation to eat fruits and vegetables or drink water predicted changes in their fruit, vegetable, and water consumption. Furthermore, adolescents' perceived descriptive norm of parents (i.e., perception of the prevalence of their parents' water consumption) also predicted changes, but only for water consumption. CONCLUSION: The current findings show that young adolescents' intrinsic motivation (and, to some extent, parental social norms) is the strongest predictor of their consumption of fruit, vegetables, and water. It is important to note, behavioral intentions do not predict their actual behavior over time. Consequently, interventions should focus on increasing young adolescents' intrinsic motivation to perform the targeted behavior while incorporating the influence of the social context. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Strengthening Children's Advertising Defenses: The Effects of Forewarning of Commercial and Manipulative Intent.

This study investigated whether a forewarning of advertising's intent can increase children's (N = 159, 8-10 years old) defenses against television commercials to lower their desire for advertised products. Two different forewarnings were tested, one for advertising's commercial intent or warning for the promotional nature, and one for advertising's manipulative intent or warning for the deceptive nature. Results showed that only the warning of manipulative intent prior to advertising exposure was successful in increasing children's advertising defenses. This forewarning activated children's attitudinal advertising literacy (i.e., skepticism toward the commercial), which in turn led to lower advertised product desire. The forewarning of commercial intent was not effective in strengthening children's advertising defenses. These findings have important implications for interventions that aim to lower children's desire for (unhealthy) advertised products by activating their advertising literacy.