Risk factors for smoking in adolescence: evidence from a cross-sectional survey in Switzerland.

BACKGROUND: Cigarette smoking during adolescence is a major public health concern with far-reaching health implications. Adolescents who smoke are at an increased risk of developing long-term health problems and are more likely to continue smoking into adulthood. Therefore, it is vital to identify and understand the risk factors that contribute to adolescent smoking - which in turn facilitate the development of targeted prevention and intervention programs. METHODS: Data was drawn from a cross-sectional survey conducted between October and December 2021, encompassing adolescents of adolescents aged 14 to 19 residing in Switzerland (n = 2,683). Multiple logistic regression analysis was employed to explore which demographic, household, behavioural and psychographic factors are associated with current smoking status. RESULTS: The regression results showed higher odds of smoking for female respondents (OR 1.39; p-value 0.007); older adolescents (OR 1.30; p-value < 0.001); those living in the French-speaking part of Switzerland (OR 1.39; p-value 0.021), in suburban areas (OR 1.35; p-value 0.023) and with a smoker in the same household (OR 2.41; p-value < 0.001); adolescents consuming alcohol (OR 4.10; p-value < 0.001), cannabis products (OR 6.72; p-value < 0.001) and hookah (OR 5.07; p-value < 0.001) at least once a month; respondents not engaging in sports (OR 1.90; p-value < 0.001) or music (OR 1.42; p-value 0.031) as top five leisure activities and those experiencing high stress levels at home (OR 1.74; p-value < 0.001). Adolescents with high scores in health awareness (OR 0.33; p-value < 0.001), on the relational self-esteem scale (OR 0.78; p-value 0.054) and on the general well-being scale (OR 0.52; p-value 0.022) were less likely to smoke than their counterparts with lower scores. High risk-seeking was associated with higher odds of smoking (OR 2.15; p-value < 0.001). CONCLUSIONS: Our results suggest the importance of a comprehensive approach at both individual and institutional levels to reduce smoking rates in adolescents. More specifically, a holistic strategy that encompasses adolescents, families, schools and policymakers ranging from strengthening adolescents' self-esteem, smoking cessation support for parents, to increasing engagement in musical and physical activities, and enhancing health awareness in the school curriculum.

Voluntary sports programs for individuals with mental health disorders: The trainer's view.

There is strong evidence that physical activities (PAs) are an important factor in increasing and maintaining mental health as well as in preventing relapse after mental health disorders. Physical activity is an important part of the treatment program in psychiatric hospitals. However, when individuals with mental health disorders (IMHD) leave the hospitals in Switzerland (CH), there are few possibilities to do physical activity in a given setting. One of them are voluntary sports groups for individuals with mental health disorders (SGPSY), which have been growing continuously in CH since 2016. Yet, little is known about these groups and their training settings. Therefore, the present study explores challenges, barriers, and enablers for participation in SGPSY from the point of view of the trainers of these groups. Additionally, as the sustainable implementation of SGPSY relies on the trainer, the study aims to identify reasons/motivations as well as the personality characteristics of the SGPSY trainers. Semi-structured interviews were conducted with 15 trainers of SGPSY in CH during spring 2022. Interviews were audiotaped, transcribed, and analyzed using thematic analysis in nVivo. Participants identified several intrapersonal (lack of motivation and fitness, mood problems, etc.), interpersonal (conflicts between participants), and structural barriers (time/location) that hinder IMHD from participating in SGPSY. The participating trainer reported that trainer might be helpful in overcoming the barriers by supporting IMHD as enablers. They rate social skills to be essential for the successful management and organization of SGPSY, as well as the ability to set boundaries to protect one's private life and sports skills expertise. The reasons for their engagement as trainers of SGPSY were the satisfaction of doing sports with IMHD and to improve the physical activities habits of IMHD. The findings of the study highlight the need to upskill the trainers of SGPSY in order to improve recruitment of the future trainers of SGPSY by focusing on the assessment of appropriate personality characteristics of trainers and their motives. Additionally, these findings should be integrated in the educational materials of Swiss disabled sports systems. Further research should validate the results from SGPSY participants' point of view.

Unconscious Bias among Health Professionals: A Scoping Review.

BACKGROUND: Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist. METHODS: We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021. RESULTS: A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies. CONCLUSIONS: Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.

Recommending Physical Activity for People with Intellectual Disabilities: The Relevance of Public Health Guidelines, Physical Activity Behaviour and Type of Contact.

People with an intellectual disability (ID) often exhibit more sedentary behaviour and are less physically active than the general population. While previous public health guidelines on physical activity (PA) did not specifically address the needs of people with an ID, the recent updates now include this population, with recommendations similar to those for the general population. However, it is unclear whether the information about these guidelines has reached the broader public and what factors may influence their implementation. To investigate these issues, an online survey was conducted in Austria, Germany and Switzerland, which examined the (a) PA recommendation for people with an ID, (b) awareness of current guidelines, (c) participants' own PA behaviour (IPAQ-SF) and (d) specific contact with people with an ID. Participants (n = 585) recommended similar levels of PA for people with an ID as for the general population, but knowledge of the guidelines did not affect their recommendation. However, participants' own PA behaviour and context-specific contact (e.g., in family or at work) were associated with the recommended PA levels. Therefore, promoting the relevance of PA and fostering contact with people with an ID might be suitable ways to increase PA in people with an ID.

Changes in socioeconomic resources and mental health after the second COVID-19 wave (2020-2021): a longitudinal study in Switzerland.

BACKGROUND: During the 2020/2021 winter, the labour market was under the impact of the COVID-19 pandemic. Changes in socioeconomic resources during this period could have influenced individual mental health. This association may have been mitigated or exacerbated by subjective risk perceptions, such as perceived risk of getting infected with SARS-CoV-2 or perception of the national economic situation. Therefore, we aimed to determine if changes in financial resources and employment situation during and after the second COVID-19 wave were prospectively associated with depression, anxiety and stress, and whether perceptions of the national economic situation and of the risk of getting infected modified this association. METHODS: One thousand seven hundred fifty nine participants from a nation-wide population-based eCohort in Switzerland were followed between November 2020 and September 2021. Financial resources and employment status were assessed twice (Nov2020-Mar2021, May-Jul 2021). Mental health was assessed after the second measurement of financial resources and employment status, using the Depression, Anxiety and Stress Scale (DASS-21). We modelled DASS-21 scores with linear regression, adjusting for demographics, health status, social relationships and changes in workload, and tested interactions with subjective risk perceptions. RESULTS: We observed scores above thresholds for normal levels for 16% (95%CI = 15-18) of participants for depression, 8% (95%CI = 7-10) for anxiety, and 10% (95%CI = 9-12) for stress. Compared to continuously comfortable or sufficient financial resources, continuously precarious or insufficient resources were associated with worse scores for all outcomes. Increased financial resources were associated with higher anxiety. In the working-age group, shifting from full to part-time employment was associated with higher stress and anxiety. Perceiving the Swiss economic situation as worrisome was associated with higher anxiety in participants who lost financial resources or had continuously precarious or insufficient resources. CONCLUSION: This study confirms the association of economic stressors and mental health during the COVID-19 pandemic and highlights the exacerbating role of subjective risk perception on this association.

European public mental health responses to the COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic increased multiple risk factors for mental health. Evidence-based, intersectoral public mental health responses are therefore critical. The primary aim of this study was to collate public mental health responses from across Europe. METHODS: We conducted a cross-sectional survey in March 2021. Participants were public and mental health professionals from across Europe. We developed an online instrument exploring five domains: changes in mental health supports during the pandemic; mental health support for vulnerable groups; multi-sectoral and service-user involvement; published mental health response plans; and perceived quality of overall country response. RESULTS: Fifty-two individuals from 20 European nations responded. Reported changes in mental health supports included an increase in online mental health supports (n = 18); but no change in long-term mental health funding (n = 13); and a decrease in access to early interventions (n = 9). Responses indicated mental health support for vulnerable groups was limited, as was multi-sectoral and service-user involvement. Few national mental health response plans existed (n = 9) and 48% of respondents felt their countries mental health response had been 'poor' or 'very poor'. CONCLUSIONS: Our results give insights into the changes in mental health support at a country level across Europe during the COVID-19 pandemic. They indicate countries were not prepared to respond and people with existing vulnerabilities were often neglected in response planning. To be prepared for future pandemics and environmental disasters Public Mental Health preparedness plans are highly needed. These must be developed cross-departmentally, and through the meaningful inclusion of vulnerable groups.

The effectiveness of skilled breathing and relaxation techniques during antenatal education on maternal and neonatal outcomes: a systematic review.

BACKGROUND: Several studies have investigated the relationship between antenatal education classes and pregnancy outcomes. These studies have shown positive effects on mothers, such as a lower epidural rate in the intervention groups. However, until now, the impact on outcomes for mothers and newborns of antenatal education classes that focus on breathing and relaxation techniques has not been examined. AIM: Investigate the effects of skilled breathing and relaxation techniques provided in antenatal education classes on maternal and neonatal birth outcomes. METHODS: The protocol for this study was registered with PROSPERO (ID: CRD42020192289). A systematic literature search was undertaken and completed in January 2022, using the databases MEDLINE, CINAHL, clinicalTrials.gov, Cochrane Library, Embase and MIDIRS according to a priori formulated PICO criteria: population (pregnant women), intervention (antenatal education classes with integrated breathing and relaxation techniques), comparison (antenatal education classes that do not include skilled breathing and relaxation techniques), and outcome (maternal and neonatal outcomes). The quality of the studies was assessed by two reviewers using the standardised instruments RoB 2 and ROBINS-I. RESULTS: Ten studies were included in this review, nine randomised controlled trials and one quasi-experimental study. The results indicate that skilled breathing and relaxation techniques may positively influence self-efficacy, the need for pharmacological support, specifically the use of epidural anaesthesia, and the memory of labour pain. No effects were found in relation to predefined neonatal outcomes. The quality of evidence on maternal and neonatal outcomes is inconsistent across studies, as different antenatal education classes with varying interventions, including breathing and relaxation techniques, were offered in the studies. CONCLUSIONS: Women who attended an antenatal education class with breathing and relaxation techniques appear to benefit from the intervention. This applies to the practical implementation and use of breathing and relaxation techniques during labour, increased self-confidence and self-efficacy, and a increased feeling of being in control during labour. This demonstrates the importance of information provision and a focus on breathing and relaxation techniques in antenatal education.

Facilitators and barriers to health enhancing physical activity in individuals with severe functional limitations after stroke: A qualitative study.

Background: Patients with chronic conditions are less physically active than the general population despite knowledge of positive effects on physical and mental health. There is a variety of reasons preventing people with disabilities from achieving levels of physical activities resulting in health benefits. However, less is known about potential facilitators and barriers for physical activity (PA) in people with severe movement impairments. The aim of this study was to identify obstacles and facilitators of PA in individuals with severe disabilities. Materials and methods: Using a qualitative approach to explore individuals' subjective perspectives in depth, five community-dwelling adults (age 52-72, 2 female, 3 male) living with chronic mobility impairments after stroke that restrict independent PA were interviewed. A semi structured topic guide based on the theoretical domains framework was utilized. The interview data was analyzed thematically, and the theoretical domains framework constructs were mapped onto the main and sub-categories. Results: The six main categories of facilitators and barriers along the capability, opportunity, motivation-behavior (COM-B) framework were: (1) physical capabilities, (2) psychological capabilities, (3) motivation reflective, (4) motivation automatic, (5) opportunity physical, and (6) opportunity social. The physical capabilities to independently perform PA were variable between participants but were not necessarily perceived as a barrier. Participants were highly motivated to maintain and/or increase their abilities to master their everyday lives as independently as possible. It became clear that a lack of physical opportunities, such as having access to adequate training facilities can present a barrier. Social opportunities in the form of social support, social norms, or comparisons with others can act as both facilitators and barriers. Conclusion: While confirming known barriers and facilitators that impact the ability of individuals with functional limitations to be active, the findings highlight the need and opportunities for comprehensive service models based on interdisciplinary collaborations.

Interprofessional Collaboration in Fall Prevention: Insights from a Qualitative Study.

(1) Background and objective: to explore the experiences of Swiss health care providers involved in a community fall prevention pilot project on barriers and facilitations in interprofessional cooperation between 2016 and 2017 in three regions of Switzerland. (2) Methods: semi-structured interviews with health care providers assessed their perspective on the evaluation of jointly developed tools for reporting fall risk, continuous training of the health care providers, sensitizing media campaigns, and others. (3) Results: One of the project's strengths is the interprofessional continuous trainings. These trainings allowed the health care providers to extend their network of health care providers, which contributed to an improvement of fall prevention. Challenges of the project were that the standardization of the interprofessional collaboration required additional efforts. These efforts are time consuming and, for some categories of health care providers, not remunerated by the Swiss health care system. (4) Conclusions: On a micro and meso level, the results of the present study indicate that the involved health care providers strongly support interprofessional collaboration in fall prevention. However, time and financial constraints challenge the implementation. On a macro level, potential ways to strengthen interprofessional collaboration are a core element in fall prevention.

Financial Reasons for Working beyond the Statutory Retirement Age: Risk Factors and Associations with Health in Late Life.

Despite an increasing trend of working life prolongation, little is known about the risk factors for financial reasons for working beyond the statutory retirement age (SRA), and how these reasons relate to health. The present study examined (1) the determinants of working beyond the SRA, (2) the workers' self-reported reasons for working beyond the SRA, and (3) the association between these reasons and health in late life. Cross-sectional data of 1241 individuals from the Swiss survey "Vivre/Leben/Vivere" were analyzed. The results showed that people with a low level of education and with a low income have an 80% higher risk of working beyond the SRA for financial reasons than for other reasons (p < 0.001). Moreover, self-rated health was not significantly associated with working beyond the SRA for financial reasons but was significantly associated with education and income (p < 0.01). In conclusion, while previous studies have already identified financial difficulties as one important reason for working beyond the SRA, the present study indicated the socioeconomic factors that are crucial for increasing the risk for working beyond the SRA. Thus, our results help to guide the adaptation of social policies for better maintaining and promoting the health of particularly vulnerable older workers.

What is the relapse risk during treatment? Survivor analysis of single and multiple relapse events in inpatients with alcohol use disorder as part of an observational study.

INTRODUCTION: During treatment for alcohol use disorder (AUD), about 40% of patients return to drinking. Whether the risk of relapse changes during treatment and how relapses may affect the risk of subsequent relapse are unclear, however. The current study, therefore, aims to identify when and with what probability relapses occur. METHODS: One hundred and three inpatients at an AUD treatment center participated in this observational study. The study documented relapse to drinking using breath analyzers, urine tests, and self-reported incidents for 42 days after the start of treatment. Time to the first relapse event and to any subsequent relapse event served as the outcome measures. The study determined the proportion of patients who had not experienced a relapse event at any given point by Kaplan-Meier estimates and Cox proportional hazards models. The study team computed the instantaneous probability of experiencing an event at any given point using generalized estimating equation (GEE) models of the binomial family with log-link and exchangeable correlation structure to estimate unadjusted and adjusted hazards. RESULTS: Whereas the hazards of experiencing a first relapse event declined steadily over the 42 days, the hazards of experiencing a subsequent relapse following an initial event remained stable. Both first-time and recurrent relapses were positively associated with the number of DSM-5 AUD criteria. CONCLUSION: Whereas the risk of relapse declines with each day of abstinence during treatment, it remains high after an individual relapse for the first time. This finding implies that therapy should focus on strengthening self-efficacy for low-risk groups and on relapse-prevention strategies for high-risk groups.

How effective is fine motor training in children with ADHD? A scoping review.

BACKGROUND: Motor deficiencies are observed in a large number of children with ADHD. Especially fine motor impairments can lead to academic underachievement, low self-esteem and frustration in affected children. Despite these far-reaching consequences, fine motor deficiencies have remained widely undertreated in the ADHD population. The aim of this review was to systematically map the evidence on existing training programs for remediating fine motor impairments in children with ADHD and to assess their effectiveness. METHODS: The scoping review followed the PRISMA-ScR guidelines. In March 2020, PsycINFO, MEDLINE (PubMed), Web of Science, Google Scholar and The Cochrane Database of Systematic Reviews were searched for evidence. The eligibility criteria and the data charting process followed the PICO framework, complemented by study design. The investigated population included children with a formal ADHD diagnosis (either subtype) or elevated ADHD symptoms aged between 4 and 12 years, both on and off medication. All training interventions aiming at improving fine motor skills, having a fine motor component or fine motor improvements as a secondary outcome were assessed for eligibility; no comparators were specified. RESULTS: Twelve articles were included in the final report, comprising observational and experimental studies as well as a review. Both offline and online or virtual training interventions were reported, often accompanied by physical activity and supplemented by training sessions at home. The training programs varied in length and intensity, but generally comprised several weeks and single or multiple training sessions per week. All interventions including more than one session were effective in the treatment of fine motor deficiencies in children with ADHD and had a wide range of additional positive outcomes. The effects could be maintained at follow-up. CONCLUSIONS: Fine motor training in children with ADHD can be very effective and multiple approaches including specific fine motor and cognitive training components, some kind of physical activity, feedback mechanisms, or multimodal treatments can be successful. Training programs need to be tailored to the specific characteristics of the ADHD population. A mHealth approach using serious games could be promising in this context due to its strong motivational components.

Professional Identity Formation in Health Promotion Practitioners: Students' Perspectives during an Undergraduate Program in Switzerland.

The health promotion (HP) community advocates for capacity building, quality assurance and political awareness of HP. Professional identity (PI) is of great relevance to these goals as persons who strongly identify with their profession better adopt their professional role, raising the quality, competence and common values within a professional group. However, investigations on the HP workforce are missing. In order to investigate PI formation in HP professionals, a longitudinal study was conducted with two student cohorts of a Swiss HP and prevention undergraduate program. Using a qualitative approach, focus groups were conducted at the beginning and end of the undergraduate program. Data were transcribed verbatim and condensed using thematic analysis. The results highlight the complexity of the HP's professional profile. While students experienced difficulties to capture the profile at the beginning of the program, at the end they developed an understanding of it. The practical experience within work placements helped students to grasp the profile and specify their future professional role. Several behavioral, cognitive and motivational aspects were identified that influence HP students' PI formation and can be fostered. For instance, universities can commit to public relations for HP practitioners and support the PI formation throughout the study program.

Professional Characteristics of Health Promotion: A Scoping Review of the German and International Literature.

Objective: This scoping review investigates current developments in the professional characteristics of health promotion (HP) with a focus on the German speaking part of Europe. The conceptualization of HP is a prerequisite for progressing HP professionalization and clarifying the interconnectedness between HP and Public Health. Methods: The search strategy was informed by sociological professionalization theories. Original publications were included in a content-based analysis. Results: Ninety publications (37 original publications) were identified in the review. The results are summarized in categories based on professional characteristics: 1) profession, 2) ethics, 3) education/training 4) competencies, and 5) quality. The professionalization of HP regarding the professional characteristics is less developed in the German compared to the international literature. Conclusion: The mixed findings emphasize the relevance of a common HP conceptualization. The HP core competencies, which have been developed by the International Union for Health Promotion and Education must be further promoted. A strong HP workforce within Public Health strengthens the HP status in policy contexts and society and its contribution to promoting health and tackling social inequalities in health.

WIPAKO® Winterthur interprofessional training concept "communication and cooperation in health professions": concept, development process and implementation.

Objective: The positioning and training of communicative and social competencies to improve interprofessional cooperation is and will be a challenge for educational institutions. The aim of this project was to reorient the interprofessional training elements of bachelor programs in terms of both content and structure, to improve the legally required practical relevance and to aim for a sustainable anchoring through the targeted design of the development process. WIPAKO® facilitates the acquisition of communicative and social competencies as a prerequisite for cooperation between the health and medical professions. Methodology: Once suitable process structures had been created, an interprofessional committee of experts defined the training elements (competencies, content, learning and teaching methods, learning objective review and evaluation) in an iterative consensus process based on various framework models and on the involvement of the various stakeholders in the individual study programs. Results: A training concept focusing on communicative and social competencies for interprofessional cooperation is available. The consistent interprofessional development of the concept promoted joint responsibility for training in the sense of an organizational development process. Conclusion: The outlined procedure for the conceptualization and implementation of a corresponding framework model and the framework model itself provide the basis for the empirical examination of competence acquisition and the sustainable anchoring of interprofessional training elements. This will provide suggestions for other educational institutions facing similar challenges.

Therapeutic success in relapse prevention in alcohol use disorder: the role of treatment motivation and drinking-related treatment goals.

Background: Changing addictive behavior is a complex process with high demands on motivation. The Transtheoretical Model of Behavior Change provides a theoretical framework for explaining and predicting behavioral change, although its predictive value for addiction is somewhat inconsistent.Objective: The aim of the present study is to extend the Transtheoretical Model of Behavior Change by investigating not only treatment motivation but also the predictive value of the type of drinking-related treatment goal. Additional predictors, such as substance-related and sociodemographic variables, are also included in analyses seeking to predict return to drinking during relapse prevention treatment for alcohol use disorder.Methods: In this observational study, 99 inpatients from a treatment center for alcohol use disorder were recruited. Treatment motivation was assessed in accordance with the Transtheoretical Model of Behavior Change, drinking-related treatment goal through a self-report questionnaire, and substance-related and sociodemographic variables via the clinic information system. Associations between the potential predictors and covariates were explored using stepwise logistic regression.Results: During treatment, 42.6% of participants had at least one relapse. Scoring higher on the action dimension at admission (OR = 0.81, p = .04) and being employed (OR = 0.37, p = .02) were significant predictors of abstinence during treatment.Conclusions: This study confirms that treatment motivation contributes to the prediction of treatment outcome, even when controlling for other variables. In future research, the underlying mechanisms of treatment motivation should be further explored.

Strategic Self-Regulation in Groups: Collective Implementation Intentions Help Cooperate When Cooperation Is Called for.

Groups need contributions that are personally costly to their members. Such cooperation is only adaptive when others cooperate as well, as unconditional cooperation may incur high costs to the individual. We argue that individuals can use We-if-then plans (collective implementation intentions, cIIs) to regulate their group-directed behavior strategically, helping them to cooperate selectively with group members in the situation planned for. In line with this prediction, a cII to consider group earnings increased cooperative decisions in a prisoners' dilemma game when playing against another group member but not when playing against a stranger (i.e., non-group member). Moreover, cIIs to cooperate in the prisoners' dilemma game did not increase cooperation in a structurally similar investment game that participants had not planned for. We discuss the role of collective planning in solving social dilemmas.

Changing behaviour in pregnant women: A scoping review.

OBJECTIVES: Behaviour change programmes (BCPs) for pregnant women are frequently implemented as part of health promotion initiatives. At present, little is known about the types of behaviour change programmes that are being implemented and whether these programmes are designed and delivered in accordance with the principles of high quality maternity care. In this scoping review, we provide an overview of existing interventions related to behaviour change in pregnancy with a particular emphasis on programmes that include empowerment components to promote autonomy and woman-led decision-making. METHODS: A systematic search strategy was applied to check for relevant papers in August 2017 and again in October 2018. RESULTS: Thirty studies met the criteria for inclusion. These studies addressed weight management, smoking cessation, general health education, nutrition, physical activity, alcohol consumption and dental health. The main approach was knowledge gain through education. More than half of the studies (n = 17) included three or more aspects of empowerment as part of the intervention. The main aspect used to foster women`s empowerment was skills and competencies. In nine studies midwives were involved, but not as programme leaders. CONCLUSIONS: Education for knowledge gain was found to be the prevailing approach in behaviour change programmes. Empowerment aspects were not a specific focus of the behaviour change programmes. This review draws attention to the need to design interventions that empower women, which may be beneficial through their live. As midwives provide maternal healthcare worldwide, they are well-suited to develop, manage, implement or assist in BCPs.

Planning and Performance in Small Groups: Collective Implementation Intentions Enhance Group Goal Striving.

There are two key motivators to perform well in a group: making a contribution that (a) is crucial for the group (indispensability) and that (b) the other group members recognize (identifiability). We argue that indispensability promotes setting collective ("We") goals whereas identifiability induces individual ("I") goals. Although both goals may enhance performance, they should align with different strategies. Whereas pursuing collective goals should involve more cooperation, pursuing individual goals should involve less cooperation. Two experiments support this reasoning and show that planning out collective goals with collective implementation intentions (cIIs or "We-plans") relies on cooperation but planning out individual goals with individual implementation intentions (IIs or "I-plans") does not. In Experiment 1, three-member groups first formed a collective or an individual goal and then performed a first round of a physical persistence task. Groups then either formed a respective implementation intention (cII or II) or a control plan and then performed a second round of the task. Although groups with cIIs and IIs performed better on a physical persistence task than respective control groups, only cII groups interacted more cooperatively during task performance. To confirm the causal role of these interaction processes, Experiment 2 used the same persistence task and manipulated whether groups could communicate: When communication was hindered, groups with cIIs but not groups with IIs performed worse. Communication thus qualifies as a process making cIIs effective. The present research offers a psychology of action account to small group performance.

Supporting Sustainable Food Consumption: Mental Contrasting with Implementation Intentions (MCII) Aligns Intentions and Behavior.

With growing awareness that sustainable consumption is important for quality of life on earth, many individuals intend to act more sustainably. In this regard, interest in reducing meat consumption is on the rise. However, people often do not translate intentions into actual behavior change. To address this intention-behavior gap, we tested the self-regulation strategy of mental contrasting with implementation intentions (MCII). Here, people identify and imagine a desired future and current obstacles standing in its way. They address the obstacles with if-then plans specifying when, where, and how to act differently. In a 5-week randomized controlled experimental study, we compared an information + MCII intervention with an information-only control intervention. As hypothesized, only MCII participants' intention of reducing their meat consumption was predictive of their actual reduction, while no correspondence between intention and behavior change was found for control participants. Participants with a moderate to strong intention to reduce their meat consumption reduced it more in the MCII than in the control condition. Thus, MCII helped to narrow the intention-behavior gap and supported behavior change for those holding moderate and strong respective intentions.