Is the effect of menu energy labelling on consumer behaviour equitable? A pooled analysis of twelve randomized control experiments.

Menu energy labelling has been implemented as a public health policy to promote healthier dietary choices and reduce obesity. However, it is unclear whether the influence energy labelling has on consumer behaviour differs based on individuals' demographics or characteristics and may therefore produce inequalities in diet. Data were analysed from 12 randomized control trials (N = 8508) evaluating the effect of food and drink energy labelling (vs. labelling absent) on total energy content of food and drink selections (predominantly hypothetical) in European and US adults. Analyses examined the moderating effects of participant age, sex, ethnicity/race, education, household income, body mass index, dieting status, food choice motives and current hunger on total energy content of selections. Energy labelling was associated with a small reduction (f2 = 0.004, -50 kcal, p < 0.001) in total energy selected compared to the absence of energy labelling. Participants who were female, younger, white, university educated, of a higher income status, dieting, motivated by health and weight control when making food choices, and less hungry, tended to select menu items of lower energy content. However, there was no evidence that the effect of energy labelling on the amount of energy selected was moderated by any of the participants' demographics or characteristics. Energy labelling was associated with a small reduction in energy content of food selections and this effect was similar across a range of participants' demographics and characteristics. These preliminary findings suggest that energy labelling policies may not widen existing inequalities in diet.

Can Visual Cues to Portion Size Reduce the Number of Portions of Consumed? Two Randomized Controlled Trials.

BACKGROUND: Since 1950, the portion size of many snack foods has more than doubled and obesity rates have tripled. Portion size determines energy intake, often unwittingly. PURPOSE: This paper tests whether salient visual cues to portion size on the packaging of high fat, sugar, or salty (HFSS) snacks can reduce consumption. METHODS: Two preregistered randomized controlled trials (N = 253 and N = 674) measured consumption in a lab and the home environment. Cues were salient, labeled stripes that demarcated single portions. Participants were randomized to cue condition or control. Consumption was measured without awareness. RESULTS: The main preregistered effect of the visual cue was not statistically significant. There was some variation by subgroup. In Study 1, men were more likely to eat the whole can of potato chips than women but significantly reduced consumption when visual cues were on the pack. The effect size was large: the number of men eating more than the recommended portion fell by 33%. Study 2 monitored household consumption of chocolate biscuits (cookies) sent to family homes in gift packs. Again, the main effect was nonsignificant but there was significant subgroup variation. When the person receiving the biscuits was female, households were more likely to eat more than the recommended portion per person per day, but less likely when the visual cues were displayed. The gender of the eaters was not known. The effect size was again large: the number of households eating more than the recommended portion fell by 26%. Households with children were also less likely to open packs with visual cues compared to control packs. Both studies recorded significant increases in the likelihood of observing serving size information, together with confusion about what it means. CONCLUSIONS: The studies offer some evidence that salient visual cues could play a role in tackling the high consumption of unhealthy snacks, but the effects are confined to specific subgroups and warrant further investigation.

The effect of spatial location of calorie information on choice, consumption and eye movements.

We manipulated the presence and spatial location of calorie labels on menus while tracking eye movements. A novel "lab-in-the-field" experimental design allowed eye movements to be recorded while participants chose lunch from a menu, unaware that their choice was part of a study. Participants exposed to calorie information ordered 93 fewer calories (11%) relative to a control group who saw no calorie labels. The difference in number of calories consumed was greater still. The impact was strongest when calorie information was displayed just to the right of the price, in an equivalent font. The effects were mediated by knowledge of the amount of calories in the meal, implying that calorie posting led to more informed decision-making. There was no impact on enjoyment of the meal. The eye-tracking data suggested that the spatial arrangement altered individuals' search strategies while viewing the menu. This research suggests that the spatial location of calories on menus may be an important consideration when designing calorie posting legislation and policy.

Rising above It: Status Ambivalence in Older Adults.

BACKGROUND: Social status is the standing of a person or group in the social hierarchy, and is perceived to change across the life span from low social status in early life, to peak in midlife, and to a decline thereafter. As threats to subjective social status are known to be detrimental to individuals' health, it is important to better understand how older adults perceive themselves and others in terms of age-related social status. OBJECTIVE: We examined status ambivalence - the potential discrepancy between how older adults' perceive social status for themselves compared to older adults in general. METHOD: Study 1 used qualitative data from 37 semi-structured interviews with older adults to assess perceptions of social status. Study 2 used quantitative survey data from 114 older adults who completed explicit and implicit measures of social status. RESULTS: Study 1 (n = 37, meanage = 71.72, SDage = 5.69; 81.1% women) provided preliminary evidence for status ambivalence such that older adults reported unequivocal low social status for other older adults but a more ambivalent perception of their own social status. Study 2 (n = 114, meanage = 64.32, SDage = 8.98, 57.9% women) compared implicit and explicit measures of social status revealing that older adults consistently perceive older adults to have low social status but again show a more ambivalent perception of their own social status. CONCLUSION: We discuss status ambivalence as a potential protective mechanism in the context of negative societal perceptions of age-related social status that may be important for well-being in later life.

Strengths and Limitations of the MoCA for Assessing Cognitive Functioning: Findings From a Large Representative Sample of Irish Older Adults.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) is a very widely used test for mild cognitive impairment. Differing recommendations have been made regarding its utility in providing a profile of performance across several cognitive domains. OBJECTIVES: To examine the factor structure of the MoCA in a nationally representative population study of older Irish adults and evaluate its utility in providing domain-specific information. METHODS: A cross-sectional analysis of wave 1 data from the Irish Longitudinal Study on Ageing was undertaken. Data from a subset of 2342 participants assessed using the MoCA were analyzed using both confirmatory factor analytic (CFA) and exploratory factor analytic (EFA) methods. RESULTS: Mean age was 72.64 (range 65 to 98), 53% female. The CFA provided evidence of adequate overall model fit for a previously proposed 6-factor model. In contrast, EFA yielded a 3-factor solution and test items cross-loaded onto a number of factors with no clear pattern of underlying cognitive domains. Using EFA to explore the 6-factor model yielded good fit, but again test items cross-loaded onto a number of factors with no clear pattern evident. CONCLUSION: Lack of concordance between the CFA and EFA findings demonstrates that the correspondence between individual tests and their assumed cognitive domains is not robust, reflecting at least in part a current lack of consensus on how core cognitive constructs are defined and on what subcomponents can be subsumed under different cognitive domains. The MoCA should not be viewed as a substitute for more in-depth neuropsychological assessment when domain-specific information is required.

Trust in cervical screening and attributions of blame for interval cancers following a national controversy.

OBJECTIVES: This study investigated levels of trust and attributions of blame in connection with a cervical screening programme following a controversy related to the programme's audit, incorporating an experimental test of the effectiveness of new information materials. DESIGN: We compared responses in Ireland (N = 872) to equivalent responses in Scotland (N = 400). Participants in Ireland were randomly assigned to either a treatment group that received the information materials or a control group that did not. Participants then responded to questions about their trust in cervical screening and to whom they would attribute blame in a range of scenarios describing women diagnosed with cervical cancer between screening rounds. RESULTS: Results showed that the control group in Ireland had lower trust and attributed higher blame towards screening services than participants in Scotland. However, exposure to information materials in the treatment group improved trust and reduced blame. CONCLUSIONS: The findings suggest that public controversies influence perceptions of screening programmes and underscore the importance of transparent, choice-based communication in mitigating these effects. The findings have valuable implications for screening services worldwide as all screening programmes will have associated false negative and false positive results.

A scoping review and behavioural analysis of factors underlying overuse of antimicrobials.

Background: Overuse of antimicrobials is a challenging global issue that contributes to antimicrobial resistance. Despite widespread awareness of the problem among members of the medical community and various attempts to improve prescription practices, existing antimicrobial stewardship programmes are not always effective. In our view, this may reflect limited understanding of factors that influence prescription of antimicrobials as empirical therapy, implying a need to address the psychological mechanisms behind some of the specific behaviours involved. Objectives: To identify factors that influence the antimicrobials prescription as empirical therapy, and to relate these factors to findings from behavioural science. Methods: We conducted a scoping review of the literature on the factors underlying antimicrobial prescription decisions, following the protocol designed using PRISMA guidelines. Results and conclusions: From a final sample of 90 sources, we identified ten factors important in antimicrobial prescription decisions. In the second stage of our analysis, we grouped them into five final categories: (1) nature of the decision, (2) social influences, (3) individual differences, (4) characteristics of the patient, (5) context. We analyse these categories using a behavioural science perspective.

Is it riskier to meet 100 people outdoors or 14 people indoors? Comparing public and expert perceptions of COVID-19 risk.

People have limited capacity to process and integrate multiple sources of information, so how do they integrate multiple contextual risk factors for Coronavirus disease (COVID-19) infection? In June 2020, we elicited risk perceptions from a nationally representative sample of the public (N = 800) using three psychologically-distinct tasks. Responses were compared to a sample of medical experts who completed the same tasks. Relative to experts, the public perceived lower risk associated with environmental factors (such as whether a gathering takes place indoors or outdoors) and were less inclined to treat risk factors as multiplicative. Our results are consistent with a heuristic simply to "avoid people" and with a coarse (e.g., "safe or unsafe") classification of social settings. A further task, completed only by the general public sample, generated novel evidence that when infection risk competes with risk in another domain (e.g., a different medical risk), people perceive a lower likelihood of contracting the virus. These results inform the policy response to the pandemic and have implications for understanding differences between expert and lay perception of risk. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social cognition in bipolar disorder versus schizophrenia: comparability in mental state decoding deficits.

OBJECTIVES: Neuropsychological studies comparing patients with bipolar disorder (BD) to patients with schizophrenia (SZ) suggest milder cognitive deficits in BD patients and across a smaller range of functions. The present study investigated whether this pattern is also true for social cognition - a range of socially relevant abilities, including emotion perception and recognition, theory of mind, and social attributions - by comparing performance on measures of social cognition in patients with BD, SZ, and healthy participants. METHODS: One hundred and two patients with BD, 208 patients with SZ, and 132 healthy participants were assessed using a battery of tasks measuring basic neuropsychological and social cognition. RESULTS: We observed significant differences between patients with BD and healthy participants in a test of mental state decoding ('eyes task') that was at a level comparable to deficits seen in patients with SZ. By comparison, BD patients showed more subtle deficits in mental state reasoning ('hinting task') than those shown by patients with SZ. CONCLUSIONS: Mental state decoding difficulties are significant in BD. An important direction for further research will be to establish to what extent these deficits affect social and occupational functioning as a potential target for therapeutic intervention.

Experimental pre-tests of public health communications on the COVID-19 vaccine: A null finding for medical endorsement, risk and altruism.

OBJECTIVE: Vaccination campaigns against COVID-19 will only be successful if enough people want to take the vaccine. We tested a government communications intervention to encourage uptake. DESIGN: A pre-registered randomised controlled trial. METHODS: A large, nationally representative sample were randomly assigned to see one of eight posters. The posters varied by image (general practitioner or two hospital doctors) and message (control with public health guidance not related to vaccination, endorsement of the vaccine from the pictured doctor, endorsement with information about COVID-19 risk, endorsement with information about risk and appeal to get vaccinated to protect friends and family). The posters were presented as part of a larger study. The main outcomes were intention to be vaccinated and how soon people would be willing to be vaccinated. RESULTS: The posters induced different reactions indicating that participants had engaged with them. The hospital image was generally preferred to the GP image. Perhaps critically, all intervention messages were trusted less than a control message which did not mention the vaccine (Control Poster Mean = 5.65, SE = 0.09 vs. Poster M Mean = 5.18, SE = 0.09, p <.001; vs. Poster M + R Mean = 5.11, SE = 0.09, p <.001; vs. Poster M + R + F Mean = 5.33, SE = 0.09, p =.01). There were no effects of poster type on intention to take the vaccine or how soon people were willing to take it. CONCLUSION: Although the intervention messages were based on the strongest correlates of vaccine hesitancy identified by contemporaneous surveys, none was effective. More recent research suggests that focusing on the risk of COVID-19 may be less effective than focusing on the benefits of vaccination. Null findings can be as important as positive findings for designing public health campaigns. This study informed government communications about the COVID-19 vaccine.

Interventions to increase physical activity: An analysis of candidate behavioural mechanisms.

Physical inactivity is a significant driver of health and social inequalities, particularly affecting socioeconomically disadvantaged communities. This poses a major challenge to policymakers worldwide. Despite the large volume of original research and reviews that focus on the design and evaluation of interventions to increase physical activity, there remains little consensus on which interventions are likely to work. This paper discusses physical activity interventions through the lens of behavioural science. We consider the conclusions drawn by previous reviews of this literature and link them to potential behavioural mechanisms that might explain them. We categorise interventions into three broad types: physical environment, information provision and social context, and discuss specific components within each that are known to influence behaviour. The paper is not a systematic nor an exhaustive review. The recommendations are not for implementation without testing. Rather, the paper contributes an analysis of how existing evidence can be used to design research and interventions in future to test not just the main outcome, but the behavioural mechanisms that may determine success.

In the eye of the beholder: Can counter-stereotypes change perceptions of older adults' social status?

Negative age-related stereotypes often entail the perception that older adults have a lower social status than middle-aged adults. We hypothesized that older adults are perceived to have lower social status because they are less likely to be seen in prestigious occupational positions. People tend to infer general assumptions about group characteristics from exemplars. According to this, presenting a stereotype-inconsistent exemplar (i.e., older person in a high-status position) should change perceptions of older adults' social status. Study 1 (60 countries, N = 86,026, 18-99 years) showed that people in countries with an older relative to a younger political leader do not perceive as great a decline in social status from middle-aged to older adults. Study 2 (N = 131; 19-74 years) tested the causal link demonstrating that participants exposed to older exemplars holding a prestigious occupational position were significantly more likely to rate older adults as having a relative higher social status. We discuss implications for future interventions to change negative age-related stereotypes. (PsycINFO Database Record

Smartphone Applications Utilizing Biofeedback Can Aid Stress Reduction.

INTRODUCTION: Stress is one of the leading global causes of disease and premature mortality. Despite this, interventions aimed at reducing stress have low adherence rates. The proliferation of mobile phone devices along with gaming-style applications allows for a unique opportunity to broaden the reach and appeal of stress-reduction interventions in modern society. We assessed the effectiveness of two smartphone applications games combined with biofeedback in reducing stress. METHODS: We compared a control game to gaming-style smartphone applications combined with a skin conductance biofeedback device (the Pip). Fifty participants aged between 18 and 35 completed the Trier Social Stress Test. They were then randomly assigned to the intervention (biofeedback game) or control group (a non-biofeedback game) for thirty minutes. Perceived stress, heart rate and mood were measured before and after participants had played the games. RESULTS: A mixed factorial ANOVA showed a significant interaction between time and game type in predicting perceived stress [F(1,48) = 14.19, p < 0.001]. Participants in the biofeedback intervention had significantly reduced stress compared to the control group. There was also a significant interaction between time and game in predicting heart rate [F(1,48) = 6.41, p < 0.05]. Participants in the biofeedback intervention showed significant reductions in heart rate compared to the control group. DISCUSSION: This illustrates the potential for gaming-style smartphone applications combined with biofeedback as stress reduction interventions.

Negative perceptions of aging predict longitudinal decline in cognitive function.

Perceptions of aging have been shown to impact the psychological and physical health of older adults. Experimental studies have found that priming older adults with negative attitudes toward aging results in immediate declines in psychological, physical and cognitive functions. Longitudinal studies have supported this work illustrating the longer term impact of negative and positive perceptions of aging on psychological and physical health. However, it is surprising that there are a limited number of studies that have investigated the longitudinal association between perceptions of aging and cognitive function. The aim of this article is therefore to explore the association between perceptions of aging and cognitive function across a number of domains in a population representative sample of adults aged 50 and older. The sample was assessed twice over 2 years. Negative perceptions of aging at baseline were independently associated with longitudinal decline in verbal fluency and self-rated memory over a 2-year period after adjustment for physical and mental health. These findings suggest that negative perceptions of aging may play a role in cognitive decline in the older population. Furthermore, aging perceptions may be a modifiable factor to target for future interventions.

Mild cognitive decline. A position statement of the Cognitive Decline Group of the European Innovation Partnership for Active and Healthy Ageing (EIPAHA).

INTRODUCTION: Mild cognitive impairment (MCI) is a term used to describe a level of decline in cognition which is seen as an intermediate stage between normal ageing and dementia, and which many consider to be a prodromal stage of neurodegeneration that may become dementia. That is, it is perceived as a high risk level of cognitive change. The increasing burden of dementia in our society, but also our increasing understanding of its risk factors and potential interventions, require diligent management of MCI in order to find strategies that produce effective prevention of dementia. AIM: To update knowledge regarding mild cognitive impairment, and to bring together and appraise evidence about the main features of clinical interest: definitions, prevalence and stability, risk factors, screening, and management and intervention. METHODS: Literature review and consensus of expert opinion. RESULTS AND CONCLUSION: MCI describes a level of impairment in which deteriorating cognitive functions still allow for reasonable independent living, including some compensatory strategies. While there is evidence for some early risk factors, there is still a need to more precisely delineate and distinguish early manifestations of frank dementia from cognitive impairment that is less likely to progress to dementia, and furthermore to develop improved prospective evidence for positive response to intervention. An important limitation derives from the scarcity of studies that take MCI as an endpoint. Strategies for effective management suffer from the same limitation, since most studies have focused on dementia. Behavioural changes may represent the most cost-effective approach.

Negative perceptions of aging and decline in walking speed: a self-fulfilling prophecy.

INTRODUCTION: Walking speed is a meaningful marker of physical function in the aging population. While it is a primarily physical measure, experimental studies have shown that merely priming older adults with negative stereotypes about aging results in immediate declines in objective walking speed. What is not clear is whether this is a temporary experimental effect or whether negative aging stereotypes have detrimental effects on long term objective health. We sought to explore the association between baseline negative perceptions of aging in the general population and objective walking speed 2 years later. METHOD: 4,803 participations were assessed over 2 waves of The Irish Longitudinal Study on Ageing (TILDA), a prospective, population representative study of adults aged 50+ in the Republic of Ireland. Wave 1 measures - which included the Aging Perceptions Questionnaire, walking speed and all covariates - were taken between 2009 and 2011. Wave 2 measures - which included a second measurement of walking speed and covariates - were collected 2 years later between March and December 2012. Walking speed was measured as the number of seconds to complete the Timed Up-And-Go (TUG) task. Participations with a history of stroke, Parkinson's disease or an MMSE < 18 were excluded. RESULTS: After full adjustment for all covariates (age, gender, level of education, disability, chronic conditions, medications, global cognition and baseline TUG) negative perceptions of aging at baseline were associated with slower TUG speed 2 years later (B=.03, 95% CI = .01 to 05, p< .05). CONCLUSIONS: Walking speed has previously been considered to be a consequence of physical decline but these results highlight the direct role of psychological state in predicting an objective aging outcome. Negative perceptions about aging are a potentially modifiable risk factor of some elements of physical decline in aging.

Cognitive function in the prefrailty and frailty syndrome.

OBJECTIVES: To explore the relationship between cognitive function and frailty. DESIGN: A cross-sectional study using data from Wave 1 of The Irish Longitudinal Study on Ageing, a population representative study of adults aged 50 and older in the Republic of Ireland. SETTING: Community-dwelling adults completed a home- or health center-based nurse-led assessment. PARTICIPANTS: Individuals aged 50 and older without a history of stroke, Parkinson's disease, or severe cognitive impairment (Mini-Mental State Examination (MMSE) score <18) and not taking antidepressants (N = 4,649). MEASUREMENTS: A cognitive battery including MMSE, Montreal Cognitive Assessment, Color Trails Test, Cambridge Mental Disorders of the Elderly Examination memory and executive function subtests, 10-word recall, Sustained Attention to Response Task, and choice reaction time was used to generate composite scores of cognitive domains. Frailty was assessed according to weakness, slowness, exhaustion, low physical activity, and weight loss. RESULTS: After full adjustment, cognitive function across all domains except self-rated memory and processing speed was significantly worse in prefrail and frail participants (P < .05) than in those who were robust. Weakness and walking speed were most consistently linked to poorer cognition, whereas low activity and weight loss were not independently associated with any cognitive domain. Exhaustion was associated with global cognition (B = -0.18 ± 0.06), with some evidence of links to objectively measured and self-rated memory. CONCLUSION: Cognitive function is worse across multiple cognitive domains in prefrail and frail individuals aged 50 and older than in those who are robust, although the absolute differences are small after adjusting for confounding factors.

Frailty and cognitive impairment--a review of the evidence and causal mechanisms.

Incidence rates of cognitive impairment and dementia are rising with the ageing population. Meanwhile, the limited success of current treatments has led to a search for early markers of dementia which could predict future progression or improve quality of life for those already suffering from the disease. One focus has been on the correlation between physical and cognitive measures with an increasing interest in the association between frailty and cognitive decline. Frailty is an age-related syndrome described as the decreased ability of an organism to respond to stressors. A number of epidemiological studies have reported that frailty increases the risk of future cognitive decline and that cognitive impairment increases the risk of frailty suggesting that cognition and frailty interact within a cycle of decline associated with ageing. This paper reviews the evidence for an association between frailty and cognitive impairment and outlines some of the mechanisms that potentially underpin this relationship from brain neuropathology and hormonal dysregulation to cardiovascular risk and psychological factors.

Social dysfunction in schizophrenia: an investigation of the GAF scale's sensitivity to deficits in social cognition.

BACKGROUND: Schizophrenia is accompanied by significant impairment in psychosocial functioning, which is only partially explained by clinical symptom severity. Recently, these impairments have been strongly associated with deficits in neurocognition and social cognition. Although the Global Assessment of Function (GAF) scale remains the most widely used measure of psychosocial function in clinical practice, it is unclear whether this instrument is sensitive to changes in cognition, or merely provides a snapshot of symptom severity. To investigate this, we assessed whether variation in GAF score was explained by performance on measures of neurocognitive and social cognition, particularly after variation associated with symptom severity had been accounted for. METHODS: 216 patients with schizophrenia were assessed using the GAF scale, two theory of mind tasks (the 'Hinting' task and 'Reading the Eyes in the Mind' task), and a neuropsychological battery sensitive to the areas of deficit typically seen in schizophrenia - IQ, episodic memory, working memory and attentional control. RESULTS: Using linear regression analysis, symptom severity explained 24% of the variance in GAF scores (F(3, 188) = 21.14, p<.001). While neuropsychological performance explained a further 4.7% of variation (r(2)change = .047, Fchange (1, 187) = 12.63, p<.001), social cognition did not explain any further variance in functioning (r(2)change = .006, Fchange (1, 186) = 1.63, p = .20). CONCLUSION: These data indicate that GAF scores are primarily sensitive to variation in clinical symptoms severity and not at all sensitive to variation in social cognition, an important determinant of real world outcome. Doing so highlights the need to supplement the measurement of psychosocial function using the GAF in clinical practice with functional measures that are more sensitive to deficits in social cognition.