Psychological Pathways Through Which Social Norms and Social Identity Influence Eating Behavior: Testing a Conceptual Model.

BACKGROUND: Although interventions frequently promote healthy eating, failing to consider psychosocial factors, such as social norms, may limit the effectiveness of these efforts. Perceived social norms are a well-documented determinant of eating behavior; however, there is limited understanding of the processes through which, and for whom, this relationship emerges. Using identity-based motivation as a theoretical framework, we present a conceptual model identifying one route through which descriptive social norms-beliefs about how others behave-predict eating behavior, and test whether this process varies across social identities (e.g., self-perceived weight status). METHOD: Structured telephone interviews were conducted for a national sample of non-diabetic adults who identified as non-Hispanic White, non-Hispanic Black, or Mexican American (n = 990). RESULTS: Multigroup SEM analysis comparing individuals who self-identified as overweight (versus "about the right weight" and underweight) demonstrated that perceiving descriptive social norms that people do not eat healthy foods predicted greater perceived barriers to eating healthy foods. Perceived barriers, in turn, predicted stronger beliefs that body weight is uncontrollable, and this relationship was stronger for participants who self-identified as overweight (relative to participants who did not identify as overweight). These beliefs subsequently predicted greater self-reported consumption of unhealthy foods (e.g., sweets), but did not predict consumption of fruits or vegetables. CONCLUSIONS: This study extends our understanding of a psychosocial process that predicts consumption of unhealthy foods and underscores the importance of social identities for shaping responses to perceived norms.

Real and Perceived Discordance in Physicians and U.S. Adults' Beliefs Regarding the Causes and Controllability of Type 2 Diabetes.

Discordance between physicians and patients' health beliefs can impede health communication efforts. However, little research considers physicians' perceptions of patient beliefs, despite the importance of perceptions in shaping communication. In the current work, we examine instances of actual and perceived discordance between physicians and U.S. adults' beliefs regarding the causes and controllability of type 2 diabetes. 229 family physicians completed an online survey measuring their health beliefs and perceptions of their patients' beliefs. Physicians' responses were contrasted against beliefs from a national survey sample of 1,168 U.S. adults. T-tests assessed whether (a) physicians' beliefs diverged from the national sample's beliefs (actual discordance), (b) physicians perceived that their health beliefs diverged from their patients' beliefs (perceived discordance), and (c) physicians' perceptions of patient beliefs diverged from the national sample's beliefs (accuracy of perceived discordance). Findings revealed evidence of actual discordance; compared to the national sample, physicians were more likely to attribute type 2 diabetes to genes (versus lifestyle factors) and perceived greater control over developing diabetes. Moreover, although physicians perceived discordance between their own and their patients' beliefs, data from the national sample suggested that these gaps were less substantial than physicians expected. In particular, findings showed that physicians generally overestimated discordance, expecting that people would be less likely to (1) attribute the development of diabetes to lifestyle factors (versus genes), and (2) perceive control over developing diabetes, than was actually reported. Implications of actual and perceived discordance for effective health communication and patient education are discussed.

The Behavior of Same-Race Others and Its Effects on Black Patients' Attention to Publicly Presented HIV-Prevention Information.

Black Americans make up 13% of the U.S. population, yet account for 54% of HIV deaths and 44% of new HIV diagnoses. Why do Black Americans die from HIV at such a disproportionate rate? In the current study, we asked whether the presence and behavior of in-group peers in public health settings may influence Black Americans' attention to HIV information, given the racialized nature of HIV-stigma in Black American communities. In a quasi-experimental field study conducted in a public health clinic (N = 260), we found that Black patients were less likely to pay attention to HIV-prevention information in the presence of other Black patients, unless those patients were also paying attention to the information. In contrast, Black patients' attention was unaffected by the presence of White patients. We end by discussing the implications of these findings for health communication theories and health practice geared toward reducing racial-health disparities in the United States.

Disparities in attention to HIV-prevention information.

Compared to European-Americans, African-Americans have greater probability of becoming infected with HIV, as well as worse outcomes when they become infected. Therefore, adequate health communications should ensure that they capture the attention of African-Americans and do not perpetuate disadvantages relative to European-Americans. The objective of this report was to examine if racial disparities in attention to health information parallel racial disparities in health outcomes. Participants were clients of a public health clinic (Study 1 n = 64; Study 2 n = 55). Unobtrusive observation in a public health waiting room, message reading times, and response-time on a modified flanker task were used to examine attention to HIV- and flu-information across racial groups. In Study 1, participants were observed for the duration of their time in a public health clinic waiting room (average duration: 31 min). In Study 2, participants completed tasks in a private room at the public health clinic (average duration: 21 min). Across all attention measures, results suggest an interaction between race and information type on attention to health information. In particular, African-Americans differentially attended to information as a function of information type, with decreased attention to HIV- versus flu-information. In contrast, European-Americans attended equally to both HIV- and flu-information. As such, disparities in attention yielded less access to certain health information for African- than European-Americans in a health setting. The identified disparities in attention are particularly problematic because they disadvantage African-Americans at a time of great effort to correct racial disparities. Modifying the framing of health information in ways that ensure attention by all racial groups may be a strategy to increase attention, and thereby reduce disparities in health outcomes. Future research should find solutions that increase attentional access to health communications for all groups.

Regulating food consumption: Action messages can help or hurt.

OBJECTIVE: Previous research suggests that messages promoting active behavior change may inadvertently increase food consumption by promoting a general goal to act. We suggest that this is only the case for active-approach behaviors and that messages promoting active-avoidance behaviors may be used to effectively decrease food consumption. METHODS: Participants were presented with healthy eating messages pretested to vary on the dimensions of direction (approach vs. avoid) and amount (action vs. inaction) of behavior. After viewing the messages, participants selected and consumed a healthy or unhealthy snack during a taste test. RESULTS: There were no differences in snack selection (healthy vs. unhealthy) across message conditions. For messages promoting more active behavior, however, there was a significant difference in snack consumption such that participants viewing active-approach messages consumed significantly more food than participants viewing active-avoidance messages. This happened regardless of whether participants selected a healthy or unhealthy snack. For messages promoting less active behavior there was no difference in consumption between approach and avoidance based messages. CONCLUSIONS: These findings suggest that when viewing health messages that promote active behavior change, individuals are sensitive to the direction of action advocated by the message (approach vs. avoidance) and modulate consumption accordingly.

Too close for comfort: leveraging identity-based relevance through targeted health information backfires for Black Americans.

Communicators frequently make adjustments to accommodate receivers' characteristics. One strategy for accommodation is to enhance the relevance of communication for receivers. The current work uses information targeting-a communication strategy where information is disseminated to audiences believed to experience heightened risk for a health condition-to test whether and why targeting health information based on marginalized racial identities backfires. Online experimental findings from Black and White adults recruited via MTurk (Study 1) and Prolific Academic (Study 2) showed that Black Americans who received targeted (vs. nontargeted) health messages about HIV or flu reported decreased attention to the message and reduced trust in the message provider. White Americans did not differentially respond to targeting. Findings also demonstrated that (a) these negative consequences emerged for Black Americans due to social identity threat, and (b) these consequences predicted downstream cognitive and behavioral responses. Study 2 showed that these consequences replicated when the targeting manipulation signaled relevance directly via marginalized racial identities. Collectively, findings demonstrate that race-based targeting may lead to overaccommodation, thus precluding the expected benefits of relevance.

Increasing policy support for reducing racial health disparities.

Perceiving racial health disparities as unjust could catalyze or halt change.

Development and preliminary psychometric evaluation of the COPD-related Stigma Scale.

BACKGROUND: Stigma experiences contribute to psychological distress and negatively affect healthcare-seeking behavior in people with chronic obstructive pulmonary disease (COPD). Most evidence comes from qualitative research, and no well-established measure of COPD-related stigma exists. Prior research yielded a preliminary measure of COPD-related stigma, but it required item reduction and validation. OBJECTIVES: The purpose of this study was to revise the preliminary measure, reduce the number of items, identify underlying constructs, and evaluate the reliability and validity of the shortened version. METHODS: A descriptive, cross-sectional study was conducted. Participants (N = 148; mean = 64 ± 7.27 years) completed the 51-item preliminary COPD-related Stigma Scale (COPDSS). Item-level analysis was conducted before running exploratory factor analysis (EFA). Reliability was assessed using Cronbach's alpha. Convergent validity and known-groups validity were evaluated. RESULTS: In the item-level analysis, eight items were deleted, leaving 43 items for factor analysis. A four-factor model with 24 items (α = 0.93) was derived from EFA: social stigma (α = 0.95), felt stigma (α = 0.95), anticipated stigma-oxygen (α = 0.80), and smoking-related stigma (α = 0.81). The 24-item COPDSS was significantly correlated with the 8-item Stigma Scale for Chronic Illness (r = 0.83), the Hospital Anxiety and Depression Scale (r = 0.57), and the PROMIS Physical Function (r = -0.48). The 24-item COPDSS discriminated between known groups based on age (p = .03), use of inhalers (p = .002) and use of supplemental oxygen (p < .001), and psychological distress levels (ps < .001). CONCLUSION: Findings support the reliability and validity of the 24-item COPDSS. This instrument can be used to understand underlying stigma processes in people with COPD.

Effect of Extraneous Affect on Health Message Reception.

People often avoid paying attention to health messages. One reason is that health messages can evoke negative affect, which produces avoidance. Prior efforts to reduce disengagement focused on changing message content or buffering the self from threat, producing mixed effects. The present studies test whether inducing positively valenced, low-arousal affect independently of the message or the self, labeled extraneous affect, promotes health message receptivity. Across four studies (total N = 1,447), participants who briefly meditated (vs. a control listening task) paid more attention to messages (Study 1). Increased positive valence facilitated attention, which subsequently increased message comprehension (Studies 2-4), whereas reduced arousal directly increased message comprehension. These effects generalized across extraneous affect manipulations, settings, information domains, and levels of message threat. Taken together, extraneous affect can be leveraged to promote message receptivity. This contributes to a theoretical understanding of how affect impacts persuasion.

'You Are What You Read:' Is selective exposure a way people tell us who they are?

Selective exposure is the tendency to gather viewpoint-congenial versus viewpoint-uncongenial information. Extant models of selective exposure suggest this tendency occurs because people anticipate reading congenial (vs. uncongenial) information will cause more favourable intrapersonal consequences. However, these models ignore the notion that people's information choices are, in part, symbolic gestures designed to convey identity-relevant beliefs to an audience through information display. Drawing from perspectives that emphasize human consumption as symbolic and a way to signal one's identity, we suggest that selective exposure pertains not only to information processing but also to conveying identity through information display. Experiment 1 showed that people characterize information display as a way to communicate their views to an audience. Experiments 2-4 showed that people are averse to displaying uncongenial versus congenial information (without processing the information), anticipate feeling more uncomfortable and more inauthentic merely displaying (without processing) uncongenial versus congenial information, and that people's intentions to engage in selective exposure in daily life are a function of their belief that selective-exposure displays convey their identity. None of these studies or findings can be generated from extant selective-exposure theories. Thus, selective-exposure theories are likely incomplete because they ignore people's beliefs and goals regarding information display.

Beyond the most willing audiences: a meta-intervention to increase exposure to HIV-prevention programs by vulnerable populations.

OBJECTIVE: Enrollment in HIV-prevention interventions is more likely when the audience has safer rather than riskier HIV-relevant behavior. Thus, a meta-intervention was designed to increase participation by an audience of infrequent condom users in Florida. DESIGN: Participants (N = 400) were randomly assigned to 1 of 4 conditions varying the introduction to a counseling program. In the experimental condition, participants were told that the intervention gave participants options but might not change their behavior. In a standard-introduction condition, participants were told that the program was highly effective at changing participants' behaviors. There was also an information-control group containing a description of the program, and a no-information-control group solely containing an invitation. MAIN OUTCOME MEASURES: The outcome measure was actual participation in the offered counseling. RESULTS: Findings indicated that the experimental introduction was the most successful at yielding participation in the counseling program when the audience had low intentions to use condoms in the future. CONCLUSION: Intervention introductions countering participants' resistance to change increase participation in HIV-prevention counseling among reluctant clients. Other meta-interventions may be explored to systematically augment the effectiveness of evidence-based health-promotion interventions.

Increasing and decreasing motor and cognitive output: a model of general action and inaction goals.

General action and inaction goals can influence the amount of motor or cognitive output irrespective of the type of behavior in question, with the same stimuli producing trivial and important motor and cognitive manifestations normally viewed as parts of different systems. A series of experiments examined the effects of instilling general action and inaction goals using word primes, such as "action" and "rest." The first 5 experiments showed that the same stimuli influenced motor output, such as doodling on a piece of paper and eating, as well as cognitive output, such as recall and problem solving. The last 2 experiments supported the prediction that these diverse effects can result from the instigation of general action and inaction goals. Specifically, these last 2 studies confirmed that participants were motivated to achieve active or inactive states and that attaining them decreased the effects of the primes on behavior.

Seeing more and eating less: Effects of portion size granularity on the perception and regulation of food consumption.

Overeating and resulting obesity is a public health concern in the United States, and portion size is a factor that contributes to these problems (Zlatevska, Dubelaar, & Holden, 2014). The present research demonstrates that the granularity of labels used to describe portions also influences food consumption, independent of previously documented portion size effects. Across 6 studies and 7 different food items, we find a robust and reliable effect of portion size granularity labels on consumption intentions and food consumption. Having people think about food using fine-grained labels leads them to decrease their consumption intentions (Study 1, n = 80) and ultimately eat less food (Study 2a, n = 79; Study 2b, n = 79). This process operates by shifting people's perceptions of the size of foods (rather than changing levels of construal) whereby portions described with fine-grained labels (e.g., "15 gummy candies") are perceived to be bigger than portions described with gross-grained labels (e.g., "one serving;" Study 3, n = 200). In addition, granularity facilitates self-regulation of consumption for individuals with a weight-loss goal both when self-regulation is measured (Study 4, n = 160) and when we manipulate that mediator (Study 5, n = 300). Finally, a high-powered registered report replicated effects of granularity on consumption via shifts in perception and intentions with a diverse community sample (Study 6, n = 323). Implications for theory and practice are discussed. (PsycINFO Database Record

Nature, decay, and spiraling of the effects of fear-inducing arguments and HIV counseling and testing: a meta-analysis of the short- and long-term outcomes of HIV-prevention interventions.

OBJECTIVE: To examine the long-term efficacy of both fear-inducing arguments and HIV counseling and testing at encouraging and maintaining knowledge about HIV transmission and prevention, as well as condom use. DESIGN: Analyses were conducted with a sample of 150 treatment groups and 34 controls and included measures of change at an immediate follow-up and a delayed follow-up. MAIN OUTCOME MEASURES: The main outcome measures were perceived risk of HIV infection, knowledge about HIV, and condom use. RESULTS: Results indicated that receiving fear-inducing arguments increased perceptions of risk at the immediate follow-up but decreased knowledge and condom use, whereas resolving fear via HIV counseling and testing decreased perceptions of risk and increased knowledge and condom use at both the immediate and delayed follow-ups. The effects on perceived risk [corrected] decreased over time, but the effects on knowledge [corrected] condom use became more pronounced. CONCLUSION: Inducing fear is not an effective way to promote HIV-relevant learning or condom use either immediately following the intervention or later on. However, HIV counseling and testing can provide an outlet for HIV-related anxiety and, subsequently, gains in both knowledge and behavior change immediately and longitudinally.

Conceptualizing the Influence of Social Agents of Behavior Change: A Meta-Analysis of the Effectiveness of HIV-Prevention Interventionists for Different Groups.

A meta-analysis of 166 HIV-prevention interventions tested theoretical predictions about the effects of experts, lay community members, and similar and dissimilar others, as agents of change. In general, expert interventionists produced greater behavior change than lay community members, and the demographic and behavioral similarity between the interventionist and the recipients facilitated behavioral change. Equally importantly, there were differences across groups in the efficacy of various sources, especially among populations of low status and/or power. These findings support the hypothesis that unempowered populations are more sensitive to characteristics of the interventionists who can facilitate access to various resources. In addition, they suggest the need to ensure the availability of health professionals from diverse demographic and behavioral backgrounds.

A test of major assumptions about behavior change: a comprehensive look at the effects of passive and active HIV-prevention interventions since the beginning of the epidemic.

This meta-analysis tested the major theoretical assumptions about behavior change by examining the outcomes and mediating mechanisms of different preventive strategies in a sample of 354 HIV-prevention interventions and 99 control groups, spanning the past 17 years. There were 2 main conclusions from this extensive review. First, the most effective interventions were those that contained attitudinal arguments, educational information, behavioral skills arguments, and behavioral skills training, whereas the least effective ones were those that attempted to induce fear of HIV. Second, the impact of the interventions and the different strategies behind them was contingent on the gender, age, ethnicity, risk group, and past condom use of the target audience in ways that illuminate the direction of future preventive efforts.

Stigma Cues Increase Self-Conscious Emotions and Decrease Likelihood of Attention to Information about Preventing Stigmatized Health Issues.

Health communications are only effective if target audiences actually receive the messages. One potential barrier to effective health communication is the potential stigma of attending to health information, particularly for stigmatizing health issues. The purpose of the present paper was to examine when participants report self-conscious emotions (e.g., shame, embarrassment) in response to health communications, as well as likelihood of reading health information associated with these emotions. Across three studies, participants read information about preventing diseases that are either highly stigmatized or non-stigmatized. Increased accessibility of stigma cues by (a) manipulating the perceived absence vs. presence of others, or (b) measuring lower vs. higher rejection sensitivity resulted in increased self-conscious emotions in response to information about stigmatized health issues. In addition, stigma cues decreased the likelihood of reading information about stigmatized (but not non-stigmatized) health information. Implications for health outcomes and intervention design are discussed.

Stigma Cues Increase Self-Conscious Emotions and Decrease Likelihood of Attention to Information about Preventing Stigmatized Health Issues / Señales sobre Estigma Aumentan las Emociones Conscientes y Disminuyen la Probabilidad de Atención a la Información sobre Prevención de Cuestiones Estigmatizadas de Salud

Health communications are only effective if target audiences actually receive the messages. One potential barrier to effective health communication is the potential stigma of attending to health information, particularly for stigmatizing health issues. The purpose of the present paper was to examine when participants report self-conscious emotions (e.g., shame, embarrassment) in response to health communications, as well as likelihood of reading health information associated with these emotions. Across three studies, participants read information about preventing diseases that are either highly stigmatized or non-stigmatized. Increased accessibility of stigma cues by (a) manipulating the perceived absence vs. presence of others, or (b) measuring lower vs. higher rejection sensitivity resulted in increased self-conscious emotions in response to information about stigmatized health issues. In addition, stigma cues decreased the likelihood of reading information about stigmatized (but not non-stigmatized) health information. Implications for health outcomes and intervention design are discussed.

La comunicación en torno a la salud solo es efectiva si la audiencia meta recibe el mensaje. Una barrera potencial que tiene la comunicación efectiva sobre salud es el estigma potencial de hacer caso a la información sobre salud, particularmente en temas estigmatizados. El objetivo del presente estudio fue examinar cuándo reportan los participantes emociones conscientes (p.e. vergüenza, culpa) en respuesta a comunicación sobre salud, así como la probabilidad de leer información asociada con estas emociones. A través de tres estudios, los participantes leyeron información sobre prevención de enfermedades que son altamente estigmatizadas o que no lo son. El aumento de la accesibilidad de las señales sobre estigma mediante (a) la manipulación de la ausencia percibida vs. presencia de otros, o (b) la medición de alta o baja sensibilidad al rechazo, resultó en aumento de emociones conscientes en respuesta a la información sobre temas de salud estigmatizados. Además, las señales sobre estigma disminuyeron la probabilidad de lectura de información sobre información estigmatizada (no así para la no estigmatizada). Se discuten las implicaciones sobre consecuencias de salud y diseño de intervención.

Participation in counseling programs: high-risk participants are reluctant to accept HIV-prevention counseling.

HIV-prevention intervention effectiveness depends on understanding whether clients with highest need for HIV-prevention counseling accept it. With this objective, a field study with a high-risk community sample from the southeastern United States (N = 350) investigated whether initial knowledge about HIV, motivation to use condoms, condom-use-relevant behavioral skills, and prior condom use correlate with subsequent acceptance of an HIV-prevention counseling session. Ironically, participants with high (vs. low) motivation to use condoms, high (vs. low) condom-use-relevant behavioral skills, and high (vs. low) prior condom use were more likely to accept the HIV-prevention counseling. Moreover, the influence of motivation to use condoms, condom-use-relevant behavioral skills, and prior condom use on acceptance of the counseling was mediated by expectations that the counseling session would be useful. Methods to reduce barriers to recruitment of clients for counseling programs are discussed.

From brochures to videos to counseling: exposure to HIV-prevention programs.

This research tested the prediction that reading a preventive brochure leads people to watch a preventive video, and that watching this video in turn leads to an increase in the likelihood of participating in a preventive counseling session. A sample of men and women from a southeastern community in the United States was recruited for a general health survey with the objective of examining participation in HIV-prevention interventions. Unobtrusive measures of exposure to HIV-prevention brochures, an HIV-prevention video, and an HIV-prevention counseling session were obtained. Findings indicated that reading the brochures increased watching the video and that watching the video increased participation in the counseling session. The association between exposure to the video and exposure to the counseling was mediated by expectations that the counseling would be useful. Findings are discussed in terms of the need to ensure exposure to interventions to achieve intervention effectiveness.