Flavor Sensing in Utero and Emerging Discriminative Behaviors in the Human Fetus.

The diet of pregnant women exposes fetuses to a variety of flavors consisting of compound sensations involving smell, taste, and chemesthesis. The effects of such prenatal flavor exposure on chemosensory development have so far been measured only postnatally in human infants. Here, we report the first direct evidence of human fetal responsiveness to flavors transferred via maternal consumption of a single-dose capsule by measuring frame-by-frame fetal facial movements. Pregnant women and their fetuses based in the northeast of England were involved in this study from 32 to 36 weeks' gestation. Fetuses exposed to carrot flavor (n = 35) showed "lip-corner puller" and "laughter-face gestalt" more frequently, whereas fetuses exposed to kale flavor (n = 34) showed more "upper-lip raiser," "lower-lip depressor," "lip stretch," "lip presser," and "cry-face gestalt" in comparison with the carrot group and a control group not exposed to any flavors (n = 30). The complexity of facial gestalts increased from 32 to 36 weeks in the kale condition, but not in the carrot condition. Findings of this study have important implications for understanding the earliest evidence for fetal abilities to sense and discriminate different flavors.

Foetal mouth movements: Effects of nicotine.

AIM: To assess whether foetal mouth movement frequency changes across gestation and whether there are differences between cigarette and e-cigarette exposure conditions in comparison to a non-exposed group of foetuses. METHOD: Pregnant women underwent 4-dimensional (4D) foetal ultrasound scans at 32 weeks (106 scans) and 36 weeks of gestational age (87 scans) at James Cook University Hospital, UK. The 4D scans were coded using the Fetal Observable Movement System (FOMS). Measures of maternal smoking status, stress, depression, anxiety, attachment and time of scan were also collected. There were four exposure groups: non-smokers, light smokers (<10 per day), heavy smokers (11-20 per day) and e-cigarette users. RESULTS: No significant differences in relative frequency of mouth movements between the exposure groups at 32- and 36 weeks of gestational age were found. Foetal mouth movements declined from 32 to 36 weeks of gestation for non-exposed and e-cigarette-exposed foetuses. CONCLUSION: Due to variability in foetal behaviour, examining mouth movements alone may not be the most appropriate method for assessing group differences. However, in line with other research, mouth movement frequency declined between 32- and 36 weeks of gestational age. A combination of foetal behavioural assessments is needed to assess the effects of cigarette and e-cigarette exposure on foetal neurobehavioural development.

Infant neurobehavioural consequences of prenatal cigarette exposure: A systematic review and meta-analysis.

AIM: Prenatal exposure to cigarettes leads to alterations in brain development during pregnancy. This has an impact on postnatal psychological and behavioural processes, affecting an infant's neurobehavioural profile with little known about which aspects are affected. The evidence was synthesised to assess the effects of prenatal cigarette smoke exposure on neurobehavioural outcomes within the first year of life. METHODS: Six databases were searched (Web of Science Core Collections, MEDLINE, PsycINFO, CINAHL, EBSCOhost eBook Collection and OpenGrey) in November 2018. Eligible studies (n = 17) had to include a measure of prenatal cigarette exposure and a neurobehavioural assessment ≤1 year of age. RESULTS: In the first year of life, specific areas of neurobehavioural functioning are related to prenatal cigarette exposure with eight out of 10 areas of neurobehaviour having significant medium (negative affect, attention, excitability, irritability and orientation) or small (muscle tone, regulation and difficult temperament) pooled effect sizes. Only lethargy and stress did not show any significant pooled effects. CONCLUSION: Prenatal cigarette exposure affects a significant range of behaviours during the first year of life.

A synthesis of meta-analytic evidence of behavioral interventions to reduce HIV/STIs.

To identify the mode of delivery, communicator, and content dimensions that make STI/HIV prevention interventions most successful at increasing condom use/protected sex or reducing STI/HIV incidence. A literature search for published meta-analyses of STI/HIV prevention interventions yielded 37 meta-analyses that had statistically tested the moderating effects of the dimensions. Significant and non-significant moderators from the coded dimensions were extracted from each meta-analysis. The most consistently significant moderators included matching the gender or ethnicity of the communicator to the intervention recipients, group targeting or tailoring of the intervention, use of a theory to underpin intervention design, providing factual information, presenting arguments designed to change attitudes, and providing condom skills and intrapersonal skills training. The absence of significant effects for intervention duration and expert delivery are also notable. The success of HIV/STI prevention interventions may be enhanced not only by providing skills training and information designed to change attitudes, but also by ensuring that the content is tailored to the target group and delivered by individuals of the same gender and ethnicity as the recipients.

Chemosensory continuity from prenatal to postnatal life in humans: A systematic review and meta-analysis.

Throughout pregnancy, fetuses are exposed to a range of chemosensory inputs influencing their postnatal behaviors. Such prenatal exposure provides the fetus with continuous sensory information to adapt to the environment they face once born. This study aimed to assess the chemosensory continuity through a systematic review and meta-analysis of existing evidence on chemosensory continuity from prenatal to first postnatal year. Web of Science Core. Collections, MEDLINE, PsycINFO, EBSCOhost ebook collection was searched from 1900 to 2021. Studies identified from the search were grouped according to type of stimuli the fetuses were exposed to prenatally that the neonatal infants' responses to were being evaluated, namely flavors transferred from the maternal diet, and the odor of their own amniotic fluid. Of the 12 studies that met the eligibility criteria for inclusion (k = 6, k = 6, respectively in the first and the second group of studies), and eight studies (k = 4, k = 4, respectively) provided sufficient data suitable for meta-analysis. Infants, during their first year of life, oriented their heads for significantly longer durations in the direction of the prenatally experienced stimuli with large pooled effect sizes (flavor stimuli, d = 1.24, 95% CI [0.56, 1.91]; amniotic fluid odor, d = 0.853; 95% CI [.632, 1.073]). The pooled effect size for the duration of mouthing behavior was significant in response to prenatal flavor exposure through maternal diet (d = 0.72; 95% CI [0.306, 1.136]), but not for the frequency of negative facial expressions (d = -0.87, 95% CI [-2.39, 0.66]). Postnatal evidence suggests that there is a chemosensory continuity from fetal to the first year of postnatal life.

Are distributional preferences for safety stable? A longitudinal analysis before and after the COVID-19 outbreak.

Policy makers aim to respect public preferences when making trade-offs between policies, yet most estimates of the value of safety neglect individuals' preferences over how safety is distributed. Incorporating these preferences into policy first requires measuring them. Arroyos-Calvera et al. (2019) documented that people cared most about efficiency, but that equity followed closely, and self-interest mattered too, but not enough to override preferences for efficiency and equity. Early 2020 saw the outbreak of the COVID-19 pandemic. This event would impose major changes in how people perceived and experienced risk to life, creating an opportunity to test whether safety-related preferences are stable and robust to important contextual changes. Further developing Arroyos-Calvera et al.'s methodology and re-inviting an international general population sample of participants that had taken part in pre-pandemic online surveys in 2017 and 2018, we collected an April 2020 wave of the survey and showed that overall preferences for efficiency, equity and self-interest were remarkably stable before and after the pandemic outbreak. We hope this offers policy makers reassurance that once these preferences have been elicited from a representative sample of the population, they need not be re-estimated after important contextual changes.

The Predictive Utility of Reward-Based Motives Underlying Excessive and Problematic Social Networking Site Use.

Compulsive seeking of reward is a hallmark feature of drug addiction, but the role of reward is less well understood in behavioural addictions. The present study investigated the predictive utility of ten reward-based motives, which we identified in the literature, in explaining excessive and problematic use of social networking sites (SNSs). These motives were examined in a cross-sectional survey of 411 young adults, revealing that prolonged use and excessive checking were predicted by distinctly different motives. More frequent checking of SNSs was most closely associated with motives related to obtaining social rewards (impression management/social comparisons/fear of missing out) and the desire to find/consume enjoyable content. In contrast, the amount of time an individual spends on SNSs was predicted by the desire to engage in negative social interactions or to fulfil personal needs (self-expression/documentation of life events). Problematic SNS use was best explained by the motivation to obtain social rewards and to a lesser extent by enjoyment and negative social potency (e.g., trolling) motives. Our results highlight the importance of social reward in explaining excessive and problematic SNS use, suggesting that a focus on reducing the desire to obtain social reward (e.g., through likes, social comparisons, continual connection) may be most beneficial in tackling problematic SNS behaviours.

The effects of absolute risks, relative risks, frequencies, and probabilities on decision quality.

It is important to understand how the quality of people's decision making may be affected by the format used to present treatment benefits. Two experiments compared the accuracy of presenting the benefits of cancer screening tests or vaccines using either absolute or relative risk formats that included baseline risk information. Moreover, the absolute and/or baseline risks were presented using either natural frequencies or probabilities. In both experiments, accuracy was measured by the sensitivity of choices to differences in absolute rather than relative risks. Experiment 1 showed no significant differences in sensitivity between the relative and absolute risk formats when the risks were presented as natural frequencies. Sensitivity was, however, poor in both probability versions. Experiment 2 tested the natural frequency versions more stringently by presenting choices with different levels of difficulty. The author found that decision quality was significantly less affected by increases in difficulty in the absolute risk format. Presenting baseline risks using natural frequencies may help to reduce the biasing effects of relative risks but decision quality may not be on a par with the accuracy of decisions made when absolute risks are presented in natural frequency formats.

Risk perception of cigarette and e-cigarette use during pregnancy: A qualitative postpartum perspective.

AIM: The aim of this exploratory qualitative analysis is to assess the perceptions of risks of cigarette and e-cigarette use during pregnancy. BACKGROUND: An important public health aim is a reduction of smoking at time of delivery (SATOD) from 10.6% to less than 6% by 2022 in the United Kingdom (UK). In order to successfully meet this target, we need to have a better understanding of the perceived risks associated with cigarette smoking. Additionally, the use of e-cigarettes is increasing in the general population, with pregnant women being supported to use such products if it helps them remain smoke free. However, in contrast to cigarette smoking, there is little definitive research assessing the safety of e-cigarette use during pregnancy, with most information disregarding the health of the growing fetus. E-cigarettes are of special interest, given they are an unlicensed product for use during pregnancy, yet women are being supported to use them as a method of harm reduction. A better understanding of perceived risks is essential. METHOD: Fourteen interviews were conducted one month postpartum with women who smoked during pregnancy and continued to smoke after the birth. Thematic analysis was conducted. FINDINGS: Two themes emerged for cigarette smoking; health and justifications. Six themes were identified for e-cigarette use; the unknown, experience, comparison to cigarettes, the product, advice and healthier option. A range of subthemes are discussed. CONCLUSION: Women provided a range of justifications for continuing to smoke during pregnancy. Women felt e-cigarettes were a riskier option than continuing to smoke.

The effects of prenatal cigarette and e-cigarette exposure on infant neurobehaviour: A comparison to a control group.

BACKGROUND: Infant neurobehaviour provides an insight into the development of the central nervous system during infancy, with behavioural abnormalities highlighting a cause for concern. Research has demonstrated that prenatal exposure to cigarettes leads to deficits within neurobehavioural development, along with negative birth outcomes detrimental to subsequent development. With the growing use of e-cigarettes amongst pregnant women, this study explores how prenatal e-cigarette exposure compares to prenatal cigarette exposure. METHODS: Eighty-three infants were involved in the study, either exposed prenatally to cigarettes or e-cigarettes or not exposed to either. Differences were assessed between these three groups for birth outcomes and scores on the Neonatal Behavioural Assessment Scale (NBAS) at one month of age. FINDINGS: Both cigarette and e-cigarette exposed infants had a significantly greater number of abnormal reflexes (p = ·001; p  =  ·002). For both self-regulation and motor maturity, cigarette exposed infants performed significantly worse (p = ·010; p = ·002), with e-cigarette exposed infants having decreased motor maturity (p = ·036) abilities and marginally decreased for self-regulation (p = ·057). Birth outcomes, namely birthweight, gestation and head circumference, did not differ for e-cigarette exposed infants compared with infants who were not prenatally exposed to nicotine. Cigarette exposed infants had a significantly lower birthweight (p = ·021) and reduced head circumference (p = ·008) in comparison to non-exposed infants. INTERPRETATION: To our knowledge, this is the first research study assessing a neurological outcome as a result of e-cigarette exposure. Findings of this have potentially important implications for public health policies regarding the safety and use of e-cigarettes throughout pregnancy. FUNDING: This research was funded by a doctoral training partnership scholarship via the ESRC, ES/P000762/1.

The efficiency-equity trade-off, self-interest, and moral principles in health and safety valuation.

Policy makers try to take account of public preferences when making trade-offs between policy options. Yet most estimates of the value of health and safety reflect only individuals' self-interested preferences, neglecting their preferences over the distribution of public resources. We conduct an experiment in which participants choose between policy options that differ in their efficiency (expected number of fatalities or cases of ill health they would prevent) and their equity (defined in terms of the balance of risk reductions for different sections of the population). The policy options were framed as interventions to improve a hypothetical city's water supply that would reduce the risk of death or ill health for people in different areas of the city to varying degrees. In order to examine whether self-interest would affect the trade-offs, we asked half of the sample about scenarios where they would personally benefit from some options. Our results suggest that efficiency is the most important single factor determining preferences between policy options, but decisions were influenced almost as much by equity as by efficiency. The effect of self-interest was smaller than that of the general concern for efficiency. We also elicited participants' stated moral principles regarding trade-offs between equity, efficiency and self-interest, and found that their expressed principles were well-aligned with their choices. Our findings contribute to the growing evidence that distributional concerns matter when evaluating health interventions.

Do time trade-off values fully capture attitudes that are relevant to health-related choices?

Previous research has shown that demographics, beliefs, and self-reported own health influence TTO values. Our hypothesis is that attitudes towards length and quality of life influence TTO values, but should no longer affect a set of related choices that are based on respondents' own TTO scores. A representative sample of 1339 respondents was asked their level of agreement to four statements relating to the importance of quality and length of life. Respondents then went on to value 4 EQ-5D 5L states using an online interactive survey and a related set of 6 pairwise health-related choice questions, set up, so that respondents should be indifferent between choice options. We explored the impact of attitudes using regression analysis for TTO values and a logit model for choices. TTO values were correlated with the attitudes and were found to have a residual impact on the choices. In particular, those respondents who preferred quality of life over length of life gave less weight to the differences in years and more weight to differences in quality of life in these choice. We conclude that although the TTO responses reflect attitudes, these attitudes continue to affect health-related choices.

Factors motivating the use of respiratory protection against volcanic ashfall: A comparative analysis of communities in Japan, Indonesia and Mexico.

Communities living near active volcanoes may be exposed to respiratory hazards from volcanic ash. Understanding their perception of the risks and the actions they take to mitigate against those risks is important for developing effective communication strategies. To investigate this issue, the first comparative study of risk perceptions and use of respiratory protection was conducted on 2003 residents affected by active volcanoes from three countries: Japan (Sakurajima volcano), Indonesia (Merapi and Kelud volcanoes) and Mexico (Popocatépetl volcano). The study was designed to test the explanatory value of a theoretical framework which hypothesized that use of respiratory protection (i.e., facemask) would be motivated by two cognitive constructs from protection motivation theory: threat appraisal (i.e., perceptions of harm/ worry about ash inhalation) and coping appraisal (i.e., beliefs about mask efficacy). Using structural equation modelling (SEM), important differences in the predictive ability of the constructs were found between countries. For example, perceptions of harm/ worry were stronger predictors of mask use in Japan and Indonesia than they were in Mexico where beliefs about mask efficacy were more important. The SEM also identified differences in the demographic variants of mask use in each country and how they were mediated by the cognitive constructs. Findings such as these highlight the importance of contextualising our understanding of protection motivation and, thus, the value of developing targeted approaches to promote precautionary behaviour.

Short Communication: Health Interventions in Volcanic Eruptions-Community Wearability Assessment of Respiratory Protection against Volcanic Ash from Mt Sinabung, Indonesia.

Inhalation of ash can be of great concern for affected communities, during and after volcanic eruptions. Governmental and humanitarian agencies recommend and distribute a variety of respiratory protection (RP), commonly surgical masks but, also, industry-certified N95-style masks. However, there is currently no evidence on how wearable they are within affected populations or how protective wearers perceive them being against volcanic ash (which will influence the likelihood of uptake of recommended interventions). Volunteers living near Mt. Sinabung, Sumatra, Indonesia, participated in a field wearability study, which included a high-efficiency mask certified to industry standards (N95-equiv.); a standard, pleated surgical mask (Surgical); a Basic flat-fold mask (Flat-fold), and the surgical mask plus a scarf tied over the top (Surgical Plus) to improve fit. These types of RP had all performed well during earlier laboratory filtration efficiency tests. The N95-equiv. mask had performed significantly better than the other RP in the subsequent total inward leakage volunteer trials, whilst the Flat-fold and Surgical masks performed poorly, letting in a third of PM2.5 particles (data published elsewhere). Thirty volunteers wore each mask for a 15-min walk before being asked to rate the comfort, breathability and perceived protection and fit of each. After wearing all of the masks, volunteers compared and identified their preferred type of protection. The feedback received from the volunteers suggested that the Surgical Plus and N95-equiv. masks were rated as being significantly hotter and more humid than other masks. The Flat-fold was rated to have better breathability than the other masks. The N95-equiv. mask was ranked as providing the best level of effectiveness of the four masks tested. Ultimately, when asked which type of mask they would choose to wear during ashfall, 33% selected the Flat-fold mask due to its comfort and simplicity, with the Surgical Plus being the least likely to be chosen of the four tested. The study findings are of benefit to agencies who need to make informed decisions on the procurement and distribution of RP for use by those affected in future eruptions and the provision of advice to communities on their usage.

A meta-analysis of the effects of presenting treatment benefits in different formats.

PURPOSE: The purpose of this article is to examine the effects of presenting treatment benefits in different formats on the decisions of both patients and health professionals. Three formats were investigated: relative risk reductions, absolute risk reductions, and number needed to treat or screen. METHODS: A systematic review of the published literature was conducted. Articles were retrieved by searching a variety of databases and screened for inclusion by 2 reviewers. Data were extracted on characteristics of the subjects and methodologies used. Log-odds ratios were calculated to estimate effect sizes. RESULTS: A total of 24 articles were retrieved that reported on 31 unique experiments. The meta-analysis showed that treatments were evaluated more favorably when the relative risk format was used rather than the absolute risk or number needed to treat format. However, a significant amount of heterogeneity was found between studies, the sources of which were explored using subgroup analyses and metaregression. Although the subgroup analyses revealed smaller effect sizes in the studies conducted on physicians, the metaregression showed that these differences were largely accounted for by other features of the study design. Most notably, variations in effect sizes were explained by the particular wordings that the studies had chosen to use for the relative risk and absolute risk reductions. CONCLUSIONS: The published literature has consistently demonstrated that relative risk formats produce more favorable evaluations of treatments than absolute risk or number needed to treat formats. However, the effects are heterogeneous and seem to be moderated by key differences between the methodologies used.

Pro-ana versus Pro-recovery: A Content Analytic Comparison of Social Media Users' Communication about Eating Disorders on Twitter and Tumblr.

Objectives: To compare how people communicate about eating disorders on two popular social media platforms - Twitter and Tumblr. Materials and Methods: Thematic analysis was conducted to characterize the types of communications posted, and a content analysis was undertaken of between-platform differences. Results: Three types of content (pro-ana, anti-ana, and pro-recovery) were posted on each platform. Overall, across both platforms, extreme pro-ana posts were in the minority compared to anti-ana and pro-recovery. Pro-ana posts (including 'thinspiration') were more common on Twitter than Tumblr, whereas anti-ana and pro-recovery posts were more common on Tumblr. Conclusion: The findings have implications for future research and health care relating to the treatment and prevention of eating disorders. Developers of future interventions targeting negative pro-ana content should remain aware of the need to avoid any detrimental impact on positive online support.

Exploring Differences between TTO and DCE in the Valuation of Health States.

There is recent interest in using discrete choice experiments (DCEs) to derive health state utility values, and results can differ from time tradeoff (TTO). Clearly, DCE is "choice based," whereas TTO is generally considered a "matching" task. We explore whether procedural adaptations to the TTO, which make the method more closely resemble a DCE, make TTO and choice converge. In particular, we test whether making the matching procedure in TTO less "transparent" to the respondent reduces disparities between TTO and DCE. We designed an interactive survey that was hosted on the Internet, and 2022 interviews were achieved in the United Kingdom in a representative sample of the population. We found a marked divergence between TTO and DCE, but this was not related to the "transparency" of the TTO procedure. We conclude that a difference in the error structure between TTO and choice and that factors other than differences in utility are affecting choices is driving the divergence. The latter has fundamental implications for the way choice data are analyzed and interpreted.

Are people unrealistically optimistic? It depends how you ask them.

OBJECTIVE: The present study investigated the extent to which direct (D) and indirect (ID) measures of unrealistic optimism truly capture people's beliefs about their comparative risk status. METHODS: Respondents (N = 425) were contacted in a general population survey. The D measure required respondents to estimate whether their personal chance of contracting an illness was above/below the average for people of the same age/gender. The ID measure was based on separate assessments of personal/others' chances. RESULTS: Poor concurrent validity between the measures implied that one or both was tapping into perceptions unrelated to comparative risk. This was explored by examining the relationships between the measures and various health problem attributes (e.g. perceived preventability,personal experience). A picture emerged that suggested the D measure did not seem to reflect the effects of social comparison as much as the ID measure, a crucial criterion for a measure intended to elicit comparative risk ratings. CONCLUSION: When measuring unrealistic optimism by asking 'Compared to other men/women your age how would you rate your chances of X?' researchers should be sensitive to the possibility that the question is being interpreted simply as 'How would you rate your chances of X?'.

The role of dispositional factors in moderating message framing effects.

OBJECTIVE: Health messages can be framed in terms of the benefits of adopting a recommendation (gain frame) or the costs of not adopting a recommendation (loss frame). In recent years, research has demonstrated that the relative persuasiveness of gain and loss frames can depend on a variety of dispositional factors. This article synthesizes this growing literature to develop our understanding of the moderators of framing. METHOD: A systematic review of published literature on gain and loss framing was conducted. Articles were retrieved that tested the interaction between framing and moderators representing individual differences in how people are predisposed to think, feel, and behave. The significance and direction of framing main effects and interactions were noted and effect size data extracted where available. RESULTS: Forty-seven reports published between January 1990 and January 2012 were retrieved that reported on 50 unique experiments testing 23 different moderators. Significant interactions with typically small to medium simple main effect sizes were found in 37 of the 50 studies. Consistent interactions were found for factors such as ambivalence, approach-avoidance motivation, regulatory focus, need for cognition, and self-efficacy beliefs. Less consistent effects were found for perceived riskiness of activity, issue involvement, and perceived susceptibility/severity. CONCLUSION: The relative effectiveness of gain- or loss-framed messages can depend on the disposition of the message recipient. Tailoring the frame to the individual therefore has the potential to maximize message persuasiveness.

Past and future implications of near-misses and their emotional consequences.

The Reflection and Evaluation Model (REM) of comparative thinking predicts that temporal perspective could moderate people's emotional reactions to close counterfactuals following near-misses (Markman & McMullen, 2003). The experiments reported in this paper tested predictions derived from this theory by examining how people's emotional reactions to a near-miss at goal during a football match (Experiment 1) or a close score in a TV game show (Experiment 2) depended on the level of perceived future possibility. In support of the theory it was found that the presence of future possibility enhanced affective assimilation (e.g., if the near-miss occurred at the beginning of the game the players who had nearly scored were hopeful of future success) whereas the absence of future possibility enhanced affective contrast (e.g., if the near-miss occurred at the end of the game the players who had nearly scored were disappointed about missing an opportunity). Furthermore the experiments built upon our theoretical understanding by exploring the mechanisms which produce assimilation and contrast effects. In Experiment 1 we examined the incidence of present-oriented or future-oriented thinking, and in Experiment 2 we examined the mediating role of counterfactual thinking in the observed effect of proximity on emotions by testing whether stronger counterfactuals (measured using counterfactual probability estimates) produce bigger contrast and assimilation effects. While the results of these investigations generally support the REM, they also highlight the necessity to consider other psychological mechanisms (e.g., social comparison), in addition to counterfactual thinking, that might contribute to the emotional consequences of near-miss outcomes.