Feasibility and acceptability of a theory-based online tool for reducing stress-induced eating.

Stress-induced eating is associated with various health risks like obesity and cardiovascular disease, exacerbated by the overconsumption of unhealthy foods. This study sought to investigate replacement coping strategies for stress-induced eating that participants can seek to implement using behaviour change techniques like implementation intentions. The study adopted a feasibility and acceptability design, with 258 participants (88.37% female) aged 17-75 years old who self-reported stress-induced eating. Participants were asked to identify cues for their stress-induced eating and evaluate the acceptability of eight potential replacement coping strategies. After selecting their preferred strategy, participants formed implementation intentions, linking the strategy with their previously identified cues. There were six themes of cues for stress-induced eating as identified by participants, including a range of external and internal stressors. Themes regarding the acceptability of the replacement coping strategies were organised based on constructs from integrated social cognition theories. Participant responses reflected cognitive and affective attitudes, and control and normative beliefs behind engagement in coping behaviour; further, automatic and volitional processes were described by participants as playing a role in whether a coping strategy was deemed as useful. Plans formulated by participants commonly detailed specific situations and strategies to utilise, though few described start times or durations of their plan. Action planning was found to significantly increase following formation of implementation intentions, and participants' descriptions supported the feasibility and acceptability of utilising implementation intentions to adopt alternative coping strategies to stress-induced eating. Future research should conduct a randomised controlled trial to assess the efficacy of the implementation intentions intervention in promoting uptake of replacement coping strategies to reduce stress-induced eating.

Improving Hand Hygiene Behavior Using a Novel Theory-Based Intervention During the COVID-19 Pandemic.

BACKGROUND: Promoting the adoption of personal hygiene behaviors known to reduce the transmission of COVID-19, such as avoiding touching one's face with unwashed hands, is important for limiting the spread of infections. PURPOSE: We aimed to test the efficacy of a theory-based intervention to promote the avoidance of touching one's face with unwashed hands to reduce the spread of COVID-19. METHODS: We tested effects of an intervention employing imagery, persuasive communication, and planning techniques in two pre-registered studies adopting randomized controlled designs in samples of Australian (N = 254; Study 1) and US (N = 245; Study 2) residents. Participants were randomly assigned to theory-based intervention or education-only conditions (Study 1), or to theory-based intervention, education-only, and no-intervention control conditions (Study 2). The intervention was delivered online and participants completed measures of behavior and theory-based social cognition constructs pre-intervention and one-week postintervention. RESULTS: Mixed-model ANOVAs revealed a significant increase in avoidance of touching the face with unwashed hands from pre-intervention to follow-up irrespective of intervention condition in both studies, but no significant condition effects. Exploratory analyses revealed significant effects of the theory-based intervention on behavior at follow-up in individuals with low pre-intervention risk perceptions in Study 2. CONCLUSIONS: Results indicate high adoption of avoiding touching one's face with unwashed hands, with behavior increasing over time independent of the intervention. Future research should confirm risk perceptions as a moderator of the effect theory-based interventions on infection-prevention behaviors.

Predicting Social Distancing Intention and Behavior During the COVID-19 Pandemic: An Integrated Social Cognition Model.

BACKGROUND: Social distancing is a key behavior to minimize COVID-19 infections. Identification of potentially modifiable determinants of social distancing behavior may provide essential evidence to inform social distancing behavioral interventions. PURPOSE: The current study applied an integrated social cognition model to identify the determinants of social distancing behavior, and the processes involved, in the context of the COVID-19 pandemic. METHODS: In a prospective correlational survey study, samples of Australian (N = 365) and U.S. (N = 440) residents completed online self-report measures of social cognition constructs (attitude, subjective norm, moral norm, anticipated regret, and perceived behavioral control [PBC]), intention, action planning, habit, and past behavior with respect to social distancing behavior at an initial occasion. Follow-up measures of habit and social distancing behavior were taken 1 week later. RESULTS: Structural equation models indicated that subjective norm, moral norm, and PBC were consistent predictors of intention in both samples. Intention, action planning, and habit at follow-up were consistent predictors of social distancing behavior in both samples. Action planning did not have consistent effects mediating or moderating the intention-behavior relationship. Inclusion of past behavior in the model attenuated effects among constructs, although the effects of the determinants of intention and behavior remained. CONCLUSIONS: Current findings highlight the importance of subjective norm, moral obligation, and PBC as determinants of social distancing intention and intention and habit as behavioral determinants. Future research on long-range predictors of social distancing behavior and reciprocal effects in the integrated model is warranted.

The lived experience of rescuing people who have driven into floodwater: Understanding challenges and identifying areas for providing support.

BACKGROUND: Drowning is a major public health issue, with risk increasing during times of flood. Driving into floodwater is a major risk factor for flood-related drowning and injury, and despite widespread public health campaigns, many people continue to undertake this risky behaviour and require rescue. PURPOSE: We aimed to identify key challenges faced by emergency services personnel when rescuing those who have driven into floodwater, and to identify strategies for supporting rescuers in this important role. METHODS: Australian flood rescue operators (N = 8) who had previously rescued a driver who had driven into floodwater participated in semi-structured interviews. Data were analysed using thematic analysis. RESULTS: Four challenges emerged from their experiences: involvement of untrained personnel; varying information provided by emergency telephone operators; behaviour of drivers complicating the rescue; people sightseeing floods or flood rescues or ignoring closed roads providing rescuers with sources of distraction and frustration. CONCLUSIONS: We propose five strategies for translating these results into practice, including: training and protocol development for (i) emergency personnel and (ii) telephone operators; (iii) training for rescuers regarding non-compliant rescuees; (iv) educating the public and (v) increasing compliance with closed roads. Current findings provide valuable insights into how rescuers can be supported in performing their roles, and implementation of these strategies has the potential to reduce fatalities occurring due to attempting to drive through floodwater. SO WHAT?: The strategies presented have the potential to reduce the frequency and improve the outcomes of floodwater rescues, aiding in the prevention of injury and death.

The Influence of University Students' Stress Mindsets on Health and Performance Outcomes.

Background: Emerging evidence indicates that holding particular stress mindsets has favorable implications for peoples' health and performance under stress. Purpose: The aim of the current study was to examine the processes by which implicit and explicit stress mindsets relate to health- and performance-related outcomes. Specifically, we propose a stress beliefs model in which somatic responses to stress and coping behaviors mediate the effect of stress mindsets on outcomes. Methods: Undergraduate university students (N = 218, n = 144 females) aged 17- 25 years completed measures of stress mindset, physical and psychological wellbeing, perceived stress, perceived somatic responses to stress, proactive behaviors under stress, and an implicit association test assessing an implicit stress mindset. At the end of the semester, students' academic performance was collected from university records. Results: Path analysis indicated significant indirect effects of stress mindset on psychological wellbeing and perceived stress through proactive coping behaviors and perceived somatic symptoms. Stress mindset directly predicted perceived stress and physical wellbeing, and physical wellbeing and academic performance were predicted by stress mindset through perceived somatic symptoms. Implicit stress mindset did not predict proactive behavior as anticipated. Conclusions: Current findings indicate that behaviors with the goal of proactively meeting demands under stress and perceived somatic symptoms are important mediators of the effect of stress mindset on health- and performance-related outcomes. The findings from this study provide formative data that can inform the development of future interventions aiming to encourage more adaptive responses to stress.

Predicting sugar consumption: Application of an integrated dual-process, dual-phase model.

Excess consumption of added dietary sugars is related to multiple metabolic problems and adverse health conditions. Identifying the modifiable social cognitive and motivational constructs that predict sugar consumption is important to inform behavioral interventions aimed at reducing sugar intake. We tested the efficacy of an integrated dual-process, dual-phase model derived from multiple theories to predict sugar consumption. Using a prospective design, university students (N = 90) completed initial measures of the reflective (autonomous and controlled motivation, intentions, attitudes, subjective norm, perceived behavioral control), impulsive (implicit attitudes), volitional (action and coping planning), and behavioral (past sugar consumption) components of the proposed model. Self-reported sugar consumption was measured two weeks later. A structural equation model revealed that intentions, implicit attitudes, and, indirectly, autonomous motivation to reduce sugar consumption had small, significant effects on sugar consumption. Attitudes, subjective norm, and, indirectly, autonomous motivation to reduce sugar consumption predicted intentions. There were no effects of the planning constructs. Model effects were independent of the effects of past sugar consumption. The model identified the relative contribution of reflective and impulsive components in predicting sugar consumption. Given the prominent role of the impulsive component, interventions that assist individuals in managing cues-to-action and behavioral monitoring are likely to be effective in regulating sugar consumption.

Evaluation of an implementation intentions intervention for managing university student stress.

University students consistently report high levels of stress, which has been associated with a range of adverse outcomes. Promoting adaptive coping behaviours, such as problem-focused coping for managing university stress, is therefore a timely area of investigation. Current coping intervention approaches target reasoned cognitive processes; however, recent research has suggested that automatic processes are more strongly associated with problem-focused coping behaviour. The current study examined the effect of an implementation intentions intervention, a technique that can support behaviour to be performed automatically by facilitating continued repetition of a plan, on problem-focused coping behaviour under stress and stress-related outcomes. Following a pilot study (N = 21), a preregistered randomized controlled trial was conducted with university students (N = 154) using an online survey. Participants completed baseline measures of problem-focused coping behaviour, behavioural automaticity, behavioural intentions, action planning, perceived stress, procrastination, and psychological wellbeing; before receiving the intervention or control condition stimuli, and then at a 2-week follow-up. Behavioural intention and action planning were also measured immediately post-intervention. The intervention had a significant medium-sized effect on action planning for problem-focused coping, but no other significant effects were detected. Exploratory assessment of plan quality revealed medium-sized correlations between plan quality and changes in problem-focused coping behaviour. Findings indicate that implementation intentions may be a promising approach for increasing planning for the use of problem-focused coping. Indicators of plan quality found to be associated with changes in problem-focused coping provide valuable avenues for intervention optimisation in future research.

An integrated dual-process model for coping behaviour.

Stress management interventions have traditionally aimed to change coping behaviour with little attention to mechanisms that drive behaviour change. We sought to test an integrated dual-process model, accounting for reasoned and automatic processes, for predicting problem-focussed coping behaviour. The study adopted a two-wave prospective correlational design with a 1-week follow-up. University students aged 17-25 (N = 272) completed survey measures online. At Time 1, participants completed self-report measures of attitude, subjective norm, perceived behavioural control, intention, behavioural automaticity, and past problem-focussed coping behaviour. At Time 2, participants completed follow-up measures of behavioural automaticity and problem-focussed coping behaviour. Structural equation modelling testing the hypothesised dual-process model exhibited a good fit to the data, accounting for 50.0% and 45.4% of the variance in intentions and problem-focussed coping behaviour, respectively. Attitude, subjective norm, perceived behavioural control, and past behaviour directly predicted intention. Intention, past behaviour, and behavioural automaticity directly predicted problem-focussed coping behaviour. Past behaviour also indirectly predicted problem-focussed coping behaviour via behavioural automaticity. Results suggest that problem-focussed coping behaviour tends to be regulated by reasoned psychological processes, and more strongly by automatic psychological processes. Future research aiming to increase problem-focussed coping should utilise behaviour change methods known to influence these processes.

Predicting physical distancing over time during COVID-19: testing an integrated model.

Objective: We applied an integrated social cognition model to predict physical distancing behavior, a key COVID-19 preventive behavior, over a four-month period. Design: A three-wave longitudinal survey design. Methods: Australian and US residents (N = 601) completed self-report measures of social cognition constructs (attitude, subjective norm, moral norm, perceived behavioral control [PBC]), intention, habit, and physical distancing behavior on an initial occasion (T1) and on two further occasions one week (T2) and four months (T3) later. Results: A structural equation model revealed that subjective norm, moral norm, and PBC, were consistent predictors of physical distancing intention on all three occasions. Intention and habit at T1 and T2 predicted physical distancing behavior at T2 and T3, respectively. Intention at T2 mediated effects of subjective norm, moral norm, and PBC at T2 on physical distancing behavior at T3, and habit at T1 and T2 mediated effects of behavior at T1 and T2 on follow-up behavior at T2 and T3, respectively. Conclusion: Normative (subjective and moral norms) and capacity (PBC) constructs were consistent predictors of physical distancing intention, and intention and habit were consistent predictors of physical distancing behavior. Interventions promoting physical distancing should target change in normative and personal capacity beliefs, and habit.Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2021.1968397 .

Changing stress mindsets with a novel imagery intervention: A randomized controlled trial.

Changing individuals' stress mindset has emerged as a technique that may be effective in aiding stress management, but there is limited data on the effects of this technique in managing stress in "real-world" contexts beyond a few days. This study aimed to (a) evaluate the efficacy of a novel imagery-based intervention in changing stress mindset and (b) evaluate the effect of the intervention on stress-related outcomes, compared to a control, after 2 weeks. The study adopted a preregistered randomized controlled trial design. University students (N = 150) attended a research laboratory twice over 2 weeks, receiving the intervention or control condition stimuli in Session 1, and completing measures in both sessions. Academic performance data was collected from university records. Mixed model ANOVAs revealed a large-sized difference in stress mindset among intervention group participants immediately following the intervention and at the follow-up relative to controls. There were also robust effects of the intervention on perceived distress, positive and negative affect, proactive behavior, and academic performance at the follow-up in individuals with high baseline perceived distress, although not in the whole sample. Findings indicate that the intervention is a promising approach for changing individuals' stress mindset and that changing stress mindset can have beneficial effects on coping with ecological stressors. Future research should use intensive longitudinal designs to examine momentary activation of stress mindset and responses to ecological stress. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychometric properties of the stress control mindset measure in university students from Australia and the UK.

INTRODUCTION: Beliefs about the consequences of stress, stress mindsets, are associated with health and performance outcomes under stress. This article reports the development and examination of the psychometric properties of a measure of stress mindset: The Stress Control Mindset Measure (SCMM). The measure is consistent with theory on mindsets about self-attributes and conceptualizes stress mindset as the extent to which individuals endorse beliefs that stress can be enhancing. METHODS: The study adopted a correlational cross-sectional survey design in two student samples. Undergraduate students from an Australian university (Sample 1, N = 218) and a UK university (Sample 2, N = 214) completed the SCMM and measures of health and well-being outcomes. RESULTS: Confirmatory factor analyses supported a four-factor structure and strict measurement invariance across samples (ΔCFI < 0.01). Reliability, convergent validity, discriminant validity, and concurrent validity of the overall SCMM were supported in both samples. Incremental validity was supported for most outcomes, accounting for significantly more variance (between 2.2% and 5.9%) in health and well-being outcomes than an existing measure. CONCLUSIONS: Current data provide preliminary support for the SCMM as a reliable and valid measure with good psychometric properties and theoretically consistent relations with health outcomes under stress. Findings provide initial evidence supporting the potential utility of the SCMM in future research examining relations between stress mindsets and health and performance outcomes.

Reasoned and implicit processes in heavy episodic drinking: An integrated dual-process model.

Objectives University students commonly engage in heavy episodic drinking (HED), which contributes to injury risk, deleterious educational outcomes, and economic costs. Identification of the determinants of this risky behaviour may provide formative evidence on which to base effective interventions to curb HED in this population. Drawing from theories of social cognition and dual-process models, this study tested key hypotheses relating to reasoned and implicit pathways to action for HED in a sample of Australian university students who drink alcohol. Design A two-wave correlational design was adopted. Methods Students (N = 204) completed self-reported constructs from social cognition theories with respect to HED at an initial time point (T1): attitude, subjective norm, perceived behavioural control, intentions, habit, past behaviour, and implicit alcohol identity. Four weeks later (T2), students self-reported their HED behaviour and habit. Results An initial path model indicated attitude and subjective norm predicted intentions, and intentions and implicit alcohol identity predicted HED. Inclusion of past behaviour and habit revealed direct effects of these on HED. Effects of T1 habit on HED were indirect through T2 habit, and there were indirect effects of past behaviour on HED through habit at both time points and the social cognition constructs. Direct effects of intentions and implicit alcohol identity, and indirect effects of attitude and subjective norm, on HED, were attenuated by the inclusion of past behaviour and habit. Conclusion Results indicate that university students' HED tends to be governed by non-conscious, automatic processes than conscious, intentional processes. Statement of contribution What is already known on this subject? Social cognitive factors are associated with risky alcohol consumption behaviours. Dual-process models are being used to explain health behaviours, such as heavy episodic drinking (HED). What does this study add? Past HED behaviour and HED habits have direct and indirect effects on students' HED behaviour. Past behaviour and habit attenuate the effects of intentions and implicit alcohol identity on HED.

The association between stress mindset and physical and psychological wellbeing: testing a stress beliefs model in police officers.

Objective: Emergency service workers like police officers experience high levels of stress in the course of their regular duties. Holding particular stress mindsets may help to mitigate the deleterious effects of stress and promote wellbeing in workers experiencing regular stress. The study aimed to examine the processes by which stress mindsets relate to health and wellbeing in police officers. A stress beliefs model in which perceived somatic symptoms and coping behaviours mediate effects of stress mindsets on outcomes was tested.Design: Police officers (N = 134) completed an online cross-sectional survey.Main outcome measures: Perceived somatic symptoms, proactive coping behaviours, physical and psychological wellbeing, and perceived stress.Results: Bayesian path analysis with informative priors revealed indirect effects of stress mindsets on psychological wellbeing and perceived stress through proactive coping behaviours and perceived somatic symptoms. Physical and psychological wellbeing, and perceived stress were predicted by stress mindsets directly, and through perceived somatic symptoms.Conclusion: The findings support model predictions that behaviours aimed at proactively meeting demands and perceived somatic symptoms mediated the relationship between stress mindset and health-related outcomes. The findings provide further foundational knowledge on mechanisms through which stress mindset is associated with outcomes and can inform future longitudinal and experimental research.

Application of the Health Action Process Approach to Social Distancing Behavior During COVID-19.

BACKGROUND: This study examined the social cognition determinants of social distancing behavior during the COVID-19 pandemic in samples from Australia and the US guided by the health action process approach (HAPA). METHODS: Participants (Australia: N = 495, 50.1% women; US: N = 701, 48.9% women) completed HAPA social cognition constructs at an initial time-point (T1), and one week later (T2) self-reported their social distancing behavior. RESULTS: Single-indicator structural equation models that excluded and included past behavior exhibited adequate fit with the data. Intention and action control were significant predictors of social distancing behavior in both samples, and intention predicted action and coping planning in the US sample. Self-efficacy and action control were significant predictors of intention in both samples, with attitudes predicting intention in the Australia sample and risk perceptions predicting intention in the US sample. Significant indirect effects of social cognition constructs through intentions were observed. Inclusion of past behavior attenuated model effects. Multigroup analysis revealed no differences in model fit across samples, suggesting that observed variations in the parameter estimates were relatively trivial. CONCLUSION: Results indicate that social distancing is a function of motivational and volitional processes. This knowledge can be used to inform messaging regarding social distancing during COVID-19 and in future pandemics.

Reducing alcohol consumption during pre-drinking sessions: testing an integrated behaviour-change model.

OBJECTIVE: Pre-drinking, the practice of consuming alcohol prior to attending a subsequent event, increases the risk of alcohol-related harm, and is common in undergraduate student populations. The current study tested an integrated behaviour change model to identify the motivational, social-cognitive, and implicit predictors of pre-drinking. DESIGN: University students (N = 289) completed an online questionnaire comprising measures of motivational and social-cognitive constructs related to reducing pre-drinking alcohol consumption and past behaviour, and an implicit association test for drinking identity. Participants reported their pre-drinking alcohol consumption at follow-up, 4 weeks from baseline. MAIN OUTCOME MEASURES: Self-reported pre-drinking alcohol consumption. RESULTS: A variance-based structural equation model revealed that few model hypotheses were supported. Although the effects of past behaviour, perceived behavioural control, and implicit drinking identity, on follow-up pre-drinking alcohol consumption were statistically significant, the effect of intention was not. CONCLUSIONS: Current findings indicate pre-drinking alcohol consumption is associated with past behaviour, perceived behavioural control and implicit drinking identity, and no intentions to reduce pre-drinking alcohol consumption. The finding raise questions over the validity of applying the integrated model in this context. Interventions should consider these factors and attempt to facilitate the formation of intentions that lead to subsequent behaviour.

Protocol for developing a mental imagery intervention: a randomised controlled trial testing a novel implementation imagery e-health intervention to change driver behaviour during floods.

INTRODUCTION: Drowning due to driving into floodwater accounts for a significant proportion of all deaths by drowning. Despite awareness campaigns such as 'If it's flooded, forget it', people continue to drive into floodwater. This causes loss of life, risk to rescuers and damage to vehicles. The aim of this study was to develop and evaluate an online e-health intervention to promote safe driving behaviour during flood events. METHODS AND ANALYSIS: The study will use a 2×3 randomised controlled trial in which participants are randomised into one of two conditions: (1) education about the risks of driving into floodwater or (2) education about the risks of driving into floodwater plus a theory-based behaviour change intervention using planning and imagery exercises. The effect of the intervention on the primary outcome, intention to drive through floodwater and the secondary outcomes will be assessed using a series of mixed-model analysis of covariances. ETHICS AND DISSEMINATION: The study has been approved by the Griffith University Human Research Ethics Committee. Participants will review a study information sheet and provide informed consent prior to commencing participation. Results will be disseminated through peer-reviewed publications, industry reports, media releases and at academic conferences. Deidentified data will be made publicly available following publication of the results. TRIAL REGISTRATION NUMBER: ACTRN12618001212246.

Alcohol use, aquatic injury, and unintentional drowning: A systematic literature review.

ISSUES: Drowning is a global public health issue, and there is a strong association between alcohol and risk of drowning. No previous systematic review known to date has identified factors associated with alcohol use and engagement in aquatic activities resulting in injury or drowning (fatal and non-fatal). APPROACH: Literature published from inception until 31 January 2017 was reviewed. Included articles were divided into three categories: (i) prevalence and/or risk factors for alcohol-related fatal and non-fatal drowning and aquatic injury, (ii) understanding alcohol use and aquatic activities, and (iii) prevention strategies. Methodological quality of studies was assessed using National Health and Medical Research Council (NHMRC) Level of Evidence and risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scales. KEY FINDINGS: In total, 74 studies were included (57 on prevalence and/or risk factors, 15 on understanding alcohol use, and two on prevention strategies). Prevalence rates for alcohol involvement in fatal and non-fatal drowning varied greatly. Males, boating, not wearing lifejackets, and swimming alone (at night, and at locations without lifeguards) were risk factors for alcohol-related drowning. No specific age groups were consistently identified as being at risk. Study quality was consistently low, and risk of bias was consistently high across studies. Only two studies evaluated prevention strategies. IMPLICATIONS: There is a need for higher quality studies and behavioural basic and applied research to better understand and change this risky behaviour. CONCLUSION: On average, 49.46% and 34.87% of fatal and non-fatal drownings, respectively, involved alcohol, with large variations among studies observed.