No(cebo) Vax: COVID-19 Vaccine Beliefs Are Important Determinants of Both Occurrence and Perceived Severity of Common Vaccines' Adverse Effects.

This study highlights the role of psychological influences in triggering and amplifying the adverse effects of the COVID-19 vaccine (i.e., nocebo effects). Fear, beliefs, and expectations about the COVID-19 vaccine, trust in health and scientific institutions, and stable personality traits were measured in 315 adult Italian citizens (145 men) during the 15-min waiting time after vaccination. The occurrence and severity of 10 potential adverse effects were assessed 24 hr later. Nonpharmacological variables predicted nearly 30% of the severity of the vaccine's adverse effects. Expectations are important determinants of adverse effects from vaccines, and the results of the path analyses show that these expectations stem primarily from people's vaccine beliefs and attitudes, which can be changed. Implications for increasing vaccine acceptability and limiting the nocebo effect are discussed.

Age as a moderator in the interplay among locus of control, coping, and quality of life of people with chronic pain.

OBJECTIVE: Identifying the factors that determine the quality of life of patients with chronic pain is an integral part of developing interventions to reduce the negative impact of persistent pain. Locus of control (LoC) could play an important role in adaptation to prolonged pain, but the results of studies are inconsistent. We examined the link between pain LoC and quality of life. Moreover, we investigated whether the relationship between LoC and quality of life is mediated by passive and active coping, and whether age moderates the LoC-coping relationship. METHODS: The study was cross-sectional, and variables (internal, chance and powerful-others LoC, pain coping strategies, average pain intensity, and quality of life) were assessed via questionnaires in a sample of 594 individuals (67% females) with chronic pain who were 18-72 (mean: 36) years of age. RESULTS: Mediation and moderated mediation analyses were conducted. Internal and external LoC were associated, respectively, with better and with worse quality of life. Passive coping mediated the association between the powerful-others dimension of LoC and poor quality of life. Additionally, indirect effects of internal LoC on quality of life via passive and active coping were found. The relationship between the powerful-others dimension of LoC and coping was stronger for middle-aged and older individuals than for younger individuals. CONCLUSIONS: This study contributes to a better understanding of the mechanisms linking LoC with quality of life of patients with chronic pain. Depending on the age, control beliefs might translate differently into strategies used to cope with pain, and thus into quality of life.

The Moderating Role of Emotion Regulation in the Association Between Stressors With Psychological and Biological Measures in Adolescence.

OBJECTIVE: This study explored the role of emotion regulation (ER) as a moderator in the stressor-adjustment outcome relationship while identifying the relevant stressors. METHODS: In 214 adolescents (10-18 years; 51.4% boys), stressors (parent and peer relations, negative events), psychological outcomes (adolescent perceived stress, psychopathology symptoms, negative affect), and biological measures related to the stress response (hair cortisol [HC], heart rate variability [HRV]) as well as ER strategies-maladaptive (MalER), adaptive (AdER), and their ratio (Mal/AdER)-were measured and analyzed via linear regression, adjusted for age, sex, and socioeconomic status. RESULTS: Parental rejection and bullying were the stressors with the strongest association with psychological outcomes (ß range = |0.217-0.352|, p < .05). In addition, parental rejection was associated with HC (ß = 0.242, p = .035), whereas none of the stressors were associated with HRV. MalER was linked to all, and AdER to most psychological outcomes (ß range = |0.21-0.49|, p < .05). MalER, but not AdER, was associated with HC (ß = 0.25, p = .009), whereas none of the ER strategy types were associated with HRV. Moreover, several associations between stressors and psychological outcomes were moderated by MalER and Mal/AdER, whereas AdER's role as a moderator was not confirmed. CONCLUSIONS: The study confirmed that adolescents' stressors are associated with both psychological and physiological outcomes and moderated by MalER or Mal/AdER. The lack of moderation by AdER directs toward the maladaptive shift theory. Investigations through a longitudinal, rather than a cross-sectional design, could further elucidate the current observations. Moreover, training in how to use ER effectively has a potential of increasing adolescents' stress resilience.

The role of expressive suppression in hallucinatory-like and delusion-like experiences. Findings in a non-clinical sample.

INTRODUCTION: Previous works concerning emotion regulation in psychosis highlighted the relationship between expressive suppression and negative psychotic symptoms, as well as between expressive suppression and auditory hallucinations. However, a direct association between suppression and delusions has not been observed. In the study we examined whether expressive suppression is associated with psychotic-like experiences and whether it may influence delusion-like experiences by changing the impact of cognitive biases on delusional beliefs. METHODS: Two hundred and twenty-one healthy individuals never diagnosed with psychiatric disorders completed self-report questionnaires measuring: delusion-like experiences, hallucinatory-like experiences, cognitive biases and expressive suppression. Regression and moderation analyses were performed. RESULTS: Regression analyses revealed that the overall level of suppression predicts hallucinatory-like experiences, but not delusion-like experiences. Suppression of anxiety and suppression of sadness were significant predictors of hallucinatory-like experiences, whereas suppression of anxiety predicted delusion-like experiences. A moderation analysis indicated that both the overall level of suppression and suppression of sadness moderate the relationship between belief inflexibility and delusion-like experiences in such a way that belief inflexibility increases delusion-like experiences only among individuals reporting a low level of suppression. CONCLUSIONS: Our findings confirmed that expressive suppression has a direct impact on hallucinatory-like experiences and suggest that the use of suppression may influence delusion-like experiences by moderating the impact of belief inflexibility on delusional thinking.

Skin picking in a non-clinical sample of young Polish adults. Prevalence and characteristics.

INTRODUCTION: The aim of the study was to examine the prevalence and characteristics of skin picking behaviors in a sample of young Polish adults. METHODS: Five hundred and thirty-four participants completed measurements of skin picking frequency and severity. They also retrospectively rated the intensity of affective states experienced before, during and after skin picking episodes. RESULTS: In total, 46.07% of the participants endorsed some forms of skin picking, and the prevalence of skin picking disorder (SPD) in the study sample amounted to 7.67%. The characteristics of skin picking episodes in young Polish adults were similar to those reported in previous studies conducted on different cultures. The results also showed that for the majority of individuals with skin picking, the intensity of particular emotions (i.e. fear, anxiety, guilt, shame, self-aversion, boredom, and sadness) decreased significantly in the period from before to after picking. CONCLUSION: Larger community studies are needed to assess the SPD prevalence in Polish general population.

Social Anxiety, Affect, Cortisol Response and Performance on a Speech Task.

BACKGROUND: Social anxiety is characterized by increased emotional reactivity to social stimuli, but results of studies focusing on affective reactions of socially anxious subjects in the situation of social exposition are inconclusive, especially in the case of endocrinological measures of affect. SAMPLING AND METHODS: This study was designed to examine individual differences in endocrinological and affective reactions to social exposure as well as in performance on a speech task in a group of students (n = 44) comprising subjects with either high or low levels of social anxiety. Measures of salivary cortisol and positive and negative affect were taken before and after an impromptu speech. Self-ratings and observer ratings of performance were also obtained. RESULTS: Cortisol levels and negative affect increased in both groups after the speech task, and positive affect decreased; however, group × affect interactions were not significant. Assessments conducted after the speech task revealed that highly socially anxious participants had lower observer ratings of performance while cortisol increase and changes in self-reported affect were not related to performance. CONCLUSIONS: Socially anxious individuals do not differ from nonanxious individuals in affective reactions to social exposition, but reveal worse performance at a speech task.

[Attentional bias training in reducing symptoms of anxiety]. / Trening tendencyjnosci uwagi w redukcji objawów lekowych.

Anxiety is related to attentional bias, i.e. a tendency to pay attention to threatening stimuli. This occurs both in individuals suffering from anxiety disorders, and in healthy individuals with elevated levels of trait anxiety. This article is an analysis of a research paradigm, used to modify attentional bias (CBM-A Cognitive Bias Modification - Attention). A growing number of studies indicate that with the help of computer methods such as a modified version of the dot-probe task we can train individuals to direct attention away from threatening stimuli, which in turn reduces symptoms of anxiety. This effect was observed in adults, adolescents and children suffering from social phobia, generalised anxiety disorder and subclinical symptoms of obsessive-compulsive disorder. Effectiveness of this method constitutes the evidence for attentional bias being among the causes of anxiety disorders. The article also analyses the still not completely clear mechanisms of CBM-A and limitations of this method.

Antecedents of Workaholism and Work Engagement: A Motivational Perspective in Research on Heavy Work Involvement.

In this perspective article, we propose encompassing the motivational perspective to enrich future studies on two forms of heavy work involvement (HWI): workaholism and work engagement. Based on the holistic definition of motivation, we build a theoretical instrumentation that includes four motivational categories that are presented and characterized by relevant key terms: I. Activation and energy of action; II. Action orientation and action realization; III. Competencies and cognitive processes; IV. Work environment and the context of action. We use these categories in an analysis of the latest contemporary research which has investigated the motivational determinants of both workaholism and work engagement. Our analysis shows that studies in this perspective are in the initial stages; we propose examples of theories and models as well as important precise questions embedded in each I-IV motivation category that can stimulate future research directions. The concluding comments include three main recommendations for future research on HWI.

Treatment of last resort? Psychological therapy seeking in chronic pain patients.

OBJECTIVE: Our goal was to assess how many chronic pain patients seek psychological treatment for their condition and what psychological and demographic characteristics are associated with that decision. METHODS: The association between pain intensity, quality of life and psychological treatment seeking was tested in two hypothetical models which differed according to beliefs about either external or internal control over pain. RESULTS: A minority of patients had experience with psychological treatment of chronic pain. Patients who had that experience were younger, suffered from more intense pain, and applied many more coping strategies than patients who never tried this kind of treatment. Intense pain and low quality of life motivated chronic pain patients to seek psychological treatment only if they believed that doctors could control their pain. DISCUSSION: The study results stress the importance of diversifying the methods used to treat chronic pain and educating patients about the benefits of psychological treatment. Low numbers of chronic pain patients who take advantage of psychological treatment indicate that encouragement from medical professionals might be necessary.

Interoception, emotion regulation strategies and skin-picking behaviors - Results of an intensive longitudinal study.

Compulsive skin-picking is associated with emotion regulation difficulties, whose origins remain unclear. Interoception, plays an important role in effective emotion regulation. This study examined the relationship between interoception, emotion regulation strategies, and skin-picking in 136 individuals (85% women, aged 18-41), including 71 engaging in skin-picking and 65 psychologically healthy controls. We were interested in between-group differences in maladaptive and adaptive emotion regulation and aspects of interoception as well as associations of the latter with skin-picking symptoms and use of emotion regulation strategies. At baseline, we assessed habitual emotion regulation strategies (rumination, suppression, distraction, engagement, arousal control, reappraisal) and Interoceptive Sensibility (e.g., emotional awareness, body listening, self-regulation, noticing) through self-report questionnaires. Moreover, Interoceptive Accuracy (IAc) was measured via a Heartbeat Counting Task. Additionally, Ecological Momentary Assessment (EMA) over seven days was used to register use of emotion regulation strategies and the occurrence and severity of skin-picking episodes during that period. At baseline, the skin-picking group exhibited lower IAc, emotional awareness, and higher habitual use of rumination than control group. Lower IAc was associated with higher odds of reporting skin-picking episodes assessed during EMA. Body listening correlated with a reduced sense of control over skin-picking during EMA. In total sample, self-regulation was related to lower odds of using rumination during EMA and noticing with less use of cognitive reappraisal. The study highlights the complex relationship between interoception, emotion regulation, and skin-picking, offering new insights into the mechanisms underlying skin picking disorder.

Placebo Hypoalgesia and Nocebo Hyperalgesia Induced by Observational Learning May Be Difficult to Disentangle in a Laboratory Setting.

Observational learning (OBL) (seeing pain/pain treatment in others) can evoke placebo hypoalgesia and nocebo hyperalgesia. Data that compare these effects and illuminates the role of expectations and empathy are scarce. Healthy participants (n = 105) were randomized to: 1) placebo OBL, 2) nocebo OBL, or 3) no-observation control group. OBL consisted of a model simulating pain relief or increase after a sham ointment was applied to one arm. Pain was evoked with thermal stimuli on both arms (ointment, contralateral) at baseline and postobservation. Expectations, pain ratings, and physiological data (eg, skin conductance level) were collected. A 3 × 2 × 2 (Group × Arm × Phase) mixed analyses of variance revealed a 3-way interaction that confirmed that OBL modulates pain: F(2, 93) = 6.08, P = .003, ηp2 = .12. Significant baseline-to-post-observation pain increases were shown in the nocebo OBL group, with a bigger increase for the arm with ointment (both P ≤ .007). In the placebo OBL group, pain was higher for the contralateral relative to the ointment arm (P < .001). Baseline-to-post-observation pain increase was significant for the contralateral arm (P < .001). Expectation mediated these effects. Skin conductance level decreased over time during ointment trials in the nocebo OBL group, suggesting reduced physiological arousal. The findings illustrate that OBL modulates pain through expectations. In the placebo OBL group, the pain did not decrease for the ointment but increased for the contralateral stimuli, which may reflect nocebo learning. Experimental OBL paradigms typically examine relative differences between ointment and contralateral cues. This can complicate disentangling placebo hypoalgesia and nocebo hyperalgesia in laboratory settings. Implications for existing theories are discussed. PERSPECTIVE: Data that systematically compare placebo hypoalgesia and nocebo hyperalgesia induced by OBL are scarce. The current work illustrates that these effects may be more difficult to disentangle than previously assumed, which could have implications for existing theories on OBL and placebo effects and their translation to clinical practice.

Arterial hypertension and progression of chronic kidney disease in children during 10-year ambulatory observation.

The aim of this study was the long-term retrospective analysis of chronic kidney disease (CKD) progression in children, especially with regard to the presence of hypertension (HTN). The average rate of progression of CKD was higher in patients with HTN than without HTN. Hypertension treatment requires multidrug schemes which need to be intensified with extended time of CKD duration.

Pain Rating is Worth a Thousand Words: Nocebo Hyperalgesia Induced by Verbal Modeling Prevails Over the Effects of Symbolic Modeling and Verbal Suggestion.

This study compares the effectiveness of verbal modeling, symbolic modeling, and verbal suggestion in inducing nocebo hyperalgesia. It is the first study to examine the contribution of stress to observationally induced nocebo hyperalgesia. This study's experimental groups represented various sources of social information: a group of people participating in the study (verbal modeling), a single participant (symbolic modeling), and an experimenter (verbal suggestion). During the experiment, participants received electrocutaneous stimuli at the same intensity, some of which were applied with a nocebo (sham device). Participants in the verbal modeling group were acquainted with pain ratings that had allegedly been provided by other participants. The ratings suggested that other participants experienced more pain in the nocebo trials than in the control trials. In the symbolic modeling group, participants observed a videotaped model experiencing more pain in the nocebo than in the control trials. In the verbal suggestion group, participants received a verbal suggestion of hyperalgesia in the nocebo trials and no suggestion in the control trials. No manipulations were used in the control group. To investigate whether nocebo hyperalgesia is stable over time, an additional extinction phase was conducted. Nocebo hyperalgesia was induced by verbal modeling only and was partially mediated by expectancy. Stress was a significant moderator of the induced effect. Nocebo hyperalgesia was extinguished during the extinction phase. The obtained results provide potential implications for minimizing nocebo hyperalgesia in clinical practice by, for instance, controlling patients' expectancies and stress levels. PERSPECTIVE: The study shows the role of pain-related information derived from other people in shaping negative treatment experiences in the individual. Because information from others has a particular impact on individuals experiencing stress, both this information and the stress level of patients should be monitored in the treatment process.

Emotion Regulation Moderates the Associations of Food Parenting and Adolescent Emotional Eating.

OBJECTIVE: To explore parental feeding practices and eating behavior as predictors of the child's emotional eating (EE) and child's emotion regulation (ER) as a potential moderator. DESIGN: Parental eating behavior (emotional, external, and restrained eating), 9 parental feeding practices (restriction, food as reward, food as ER, monitoring, healthy modeling, healthy environment, child control, and child involvement), ER, and EE were analyzed cross-sectionally and 5 parental practices longitudinally (subsample, n = 115). SETTING: Belgium. PARTICIPANTS: Two hundred eighteen adolescents (aged 13.7 ± 1.77 years) and parent dyads. MAIN OUTCOME MEASURES: Child's EE. ANALYSIS: Linear regression and moderation (cross-sectional) and linear mixed models (longitudinal). Models adjusted for multiple testing with a false discovery rate of 10% (Benjamini-Hochberg), age, sex, body mass index, socioeconomic status, and cohort. RESULTS: Cross-sectionally but not longitudinally, there was a positive association between predictors restriction and monitoring with the outcome child's EE (ß = 0.19, P = 0.006; ß = 0.17, P = 0.01, respectively). Restrained eating of the parent was negatively associated with the child's EE (ß = -0.22, P = 0.003). The child's maladaptive ER significantly moderated the associations of 5 feeding practices and parental EE with the child's EE. CONCLUSIONS AND IMPLICATIONS: Parents continue to play a role in the eating behavior of their adolescent offspring, not only through their feeding practices (restrictive parenting was most detrimental) but also by displaying restrained eating (beneficial). A child's ER appears as an important moderator of the established associations; however, more research is needed to better understand these observations.

Negative Affectivity Moderates the Relationship between Attentional Control and Focused Skin Picking.

Very little is known about the cognitive functioning of people with body-focused repetitive behaviours and the few existing studies provide mixed findings. The aim of this study was to investigate the interplay between attentional control, negative affectivity, and focused skin picking. We hypothesized that the control of attention is associated with focused style of skin picking and that this relationship is moderated by negative affectivity. The final sample consisted of 273 non-clinical subjects (79% women) aged 18 to 54 years; study variables were assessed using questionnaires. Moderation analysis was conducted, followed by a simple slope analysis, and the Johnson-Neyman technique was used to probe the interaction effect. We found that at the low level of negative affectivity, the relationship between attentional control and focused skin picking is negative, but not at the higher levels of this trait. Interestingly, when negative affectivity reaches very high intensity, the association between attentional control and skin picking becomes positive. This relationship seems to be quite complex and may depend on the way that cognitive abilities are used by the individual, as well as on the stage of cognitive processing that they are applied to. Further studies using behavioural measures of attention are needed to better understand this issue.

Validation and Psychometric Properties of the Polish Version of the Skin Picking Scale-Revised.

The Skin Picking Scale-Revised (SPS-R) is an 8-item self-report measure of skin picking behaviors. It includes two subscales related to skin picking symptom severity and picking-related impairments. The study aimed to assess the psychometric properties of the Polish version of the SPS-R in a sample of adults reporting skin picking. The sample of 764 participants was recruited from the general population through an online survey. Among them, 159 meet the criteria of pathological skin picking applied in the original SPS-R validation study, and 57 endorsed all of the DSM-5 criteria for excoriation disorder. The SPS-R was back-translated into Polish. Factor structure, reliability, convergent and divergent validity, and diagnostic accuracy were assessed. Confirmatory factor analyses revealed a two-factor structure of the scale. High internal consistency and convergent and divergent validity were confirmed for the total score as well as for the subscales. High prognostic ability of the SPS-R total score was also demonstrated using ROC analysis: ≥5 was accepted as an optimal cut-off point for distinguishing skin picking sufferers from healthy controls. The Polish version of the SPS-R shows good psychometric properties and appears to be a reliable measure of skin picking symptoms and picking-related impairment.

Is Addenbrooke's Cognitive Examination III Sensitive Enough to Detect Cognitive Dysfunctions in Patients with Focal Cerebellar Lesions?

OBJECTIVE: The main aim of the study was to evaluate whether the available brief test of mental functions Addenbrooke's cognitive examination III (ACE III) detects cognitive impairment in patients with cerebellar damage. The second goal was to show the ACE III cognitive impairment profile of patients with focal cerebellar lesions. METHOD: The study sample consisted of 31 patients with focal cerebellar lesions, 78 patients with supratentorial brain damage, and 31 subjects after spine surgery or with spine degeneration considered as control group, free of organic brain damage. The ACE III was used. RESULTS: Patients with cerebellar damage obtained significantly lower results in the ACE III total score and in several subscales: attention, fluency, language, and visuospatial domains than healthy controls without brain damage. With the cut-off level of 89 points, the ACE III was characterized by the sensitivity of 71%, specificity of 72%, and accuracy of 72%. The cerebellar cognitive impairment profile was found to be "frontal-like" and similar to that observed in patients with anterior supratentorial brain damage, with decreased ability to retrieve previously learned material and its preserved recognition, impaired word fluency, and executive dysfunction. The results are consistent with cerebellar cognitive affective syndrome. CONCLUSIONS: The ACE III can be used as a sensitive screening tool to detect cognitive impairments in patients with cerebellar damage.

Family structure in relation to body mass index and metabolic score in European children and adolescents.

BACKGROUND: Living in single parent and blended families or as an only child-compared to living in two-parent biological families or with siblings, respectively-is associated with a higher body mass index (BMI) in cross-sectional studies. However, longitudinal research addressing the children's BMI in this context is scarce. Further, little is known about the association between family structure and metabolic health. OBJECTIVES: This study aimed at investigating the association between both aspects of family structure with BMI and a metabolic score (MetS). METHODS: Cross-sectional data from 7804 children participating in the European multi-center I.Family study (2013/2014) and longitudinal data from 5621 children who also participated previously in the IDEFICS study (2007-2010) were used. Family structure was assessed by a detailed interview. BMI z-score and the MetS were based on measured anthropometry, blood pressure, high-density lipoprotein, blood glucose, and triglycerides. Linear regressions were performed to model associations between family structure with BMI and MetS. RESULTS: Children from single-parent families had higher BMI z-scores in the cross-sectional (ß = 0.09, 95% confidence interval [CI]: 0.001 to 0.18) and longitudinal analyses compared to those from two-parent families. Cross-sectionally, the number of siblings was associated with lower BMI z-scores (ß = -0.07, 95% CI: -0.10 to -0.03) and lower MetS (ß = -0.14, 95% CI: -0.26 to -0.01). Longitudinally, only children between baseline and follow-up had higher BMI z-scores at follow-up (ß = 0.07, 95% CI: 0.01 to 0.14) compared to stable siblings. CONCLUSION: Obesity prevention measures should focus on single-parent households and families with an only child.

The Moderating Role of the FKBP5 Gene Polymorphisms in the Relationship between Attachment Style, Perceived Stress and Psychotic-like Experiences in Non-Clinical Young Adults.

Numerous studies have reported that stressful life experiences increase the risk of psychosis and psychotic-like experiences (PLEs). Common variations of the FKBP5 gene have been reported to impact the risk of psychosis by moderating the effects of environmental exposures. Moreover, anxious and avoidant attachment styles have been shown to increase both the level of perceived stress and the risk for psychosis development. In the present cross-sectional study, we aimed to investigate whether variants of the FKBP5 gene moderate the effects of attachment styles and the level of perceived stress on the development of PLEs. A total of 535 non-clinical undergraduates were genotyped for six FKBP5 single nucleotide polymorphisms (SNPs) (rs3800373, rs9470080, rs4713902, rs737054, rs1360780 and rs9296158). The Psychosis Attachment Measure (PAM), the Perceived Stress Scale-10 (PSS-10) and the Prodromal Questionnaire 16 (PQ-16) were administered to assess attachment styles, the level of perceived stress and PLEs, respectively. Anxious attachment style, lower levels of perceived self-efficacy and higher levels of perceived helplessness were associated with a significantly higher number of PLEs. The main effects of attachment style on the severity of PLEs were significant in models testing for the associations with perceived self-efficacy and three FKBP5 SNPs (rs1360780, rs9296158 and rs9470080). The main effect of rs38003733 on the number of PLEs was observed, with GG homozygotes reporting a significantly higher number of PLEs in comparison to T allele carriers. In individuals with dominant anxious attachment style, there was a significant effect of the interaction between the FKBP5 rs4713902 SNP and self-efficacy on the severity of PLEs. Among rs4713902 TT homozygotes, a low level of perceived self-efficacy was associated with higher severity of PLEs. In subjects with non-dominant anxious attachment, a low level of perceived self-efficacy was associated with a higher number of PLEs, regardless of the genotype. Our results indicate that the FKBP5 gene might moderate the relationship between attachment, perceived stress and PLEs.

Development and cross-national investigation of a model explaining participation in WHO-recommended and placebo behaviours to prevent COVID-19 infection.

To protect themselves from COVID-19, people follow the recommendations of the authorities, but they also resort to placebos. To stop the virus, it is important to understand the factors underlying both types of preventive behaviour. This study examined whether our model (developed based on the Health Belief Model and the Transactional Model of Stress) can explain participation in WHO-recommended and placebo actions during the pandemic. Model was tested on a sample of 3346 participants from Italy, Japan, Poland, Korea, Sweden, and the US. It was broadly supported: objective risk and cues to action showed both direct and indirect (through perceived threat) associations with preventive behaviours. Moreover, locus of control, decision balance, health anxiety and preventive coping moderated these relationships. Numerous differences were also found between countries. We conclude that beliefs about control over health and perceived benefits of actions are critical to the development of interventions to improve adherence to recommendations.