A Habit-Based Randomised Controlled Trial to Reduce Sugar-Sweetened Beverage Consumption: the Impact of the Substituted Beverage on Behaviour and Habit Strength.

BACKGROUND: Excess sugar consumption has been linked to numerous negative health outcomes, such as obesity and type II diabetes. Reducing sugar-sweetened beverage (SSB) consumption may reduce sugar intake and thus improve health. The aim of the study was to test the impact of the potentially different rewarding nature of water or diet drinks as replacements for SSB, using a habit and implementation intention-based intervention. METHOD: An online randomised, two-arm parallel design was used. One hundred and fifty-eight participants (mainly from the UK and USA) who regularly consumed SSBs (Mage = 31.5, 51% female) were advised to create implementation intentions to substitute their SSB with either water or a diet drink. Measures of SSB consumption, habit strength and hedonic liking were taken at baseline and at 2 months. Water or diet drink consumption was only measured at 2 months. RESULTS: There was a large and significant reduction in SSB consumption and self-reported SSB habits for both the water and diet drink groups, but no difference between groups. There were no differences in hedonic liking for the alternative drink, alternative drink consumption and alternative drink habit between the two groups. Reduction in SSB hedonic liking was associated with reduced SSB consumption and habit. CONCLUSION: This study demonstrates that an implementation intention-based intervention achieved substantial reductions in SSB consumption and habits. It also indicates that hedonic liking for SSBs and alternative drinks are associated with changes in consumption behaviour. Substituting SSBs with water or diet drinks was equally as effective in reducing SSB consumption.

Food healthiness versus tastiness: Contrasting their impact on more and less successful healthy shoppers within a virtual food shopping task.

A virtual shopping task was employed to illuminate why women who intend to shop healthily are differentially successful in doing so. Female undergraduates (N = 68) performed a modified approach and avoidance task that employed food items differing in healthiness and tastiness, and yielded relative speed to select and reject food items in a stylised supermarket. Participants categorised a food item either in terms of healthiness or tastiness, then pulled (selected) or pushed (rejected) the item using a joystick. Participants showed faster selection of tasty food after categorisation in terms of tastiness, irrespective of the food's healthiness. However, after categorisation in terms of healthiness, only more successful healthy food shoppers showed faster selection of healthy items regardless of tastiness. Less successful healthy food shoppers showed this effect only for tasty food, and displayed faster rejection of food items not considered tasty, regardless of their assessed healthiness. Thus, when participants who reported the greatest gap between their shopping intention and shopping behaviour were judging the healthiness of food items, their speed to select and reject items continued to be influenced by tastiness. This suggests that reducing incidental processing of food tastiness may reduce the intention-behaviour gap in healthy food shopping.

Breaking bad habits by improving executive function in individuals with obesity.

BACKGROUND: Two primary factors that contribute to obesity are unhealthy eating and sedentary behavior. These behaviors are particularly difficult to change in the long-term because they are often enacted habitually. Cognitive Remediation Therapy has been modified and applied to the treatment of obesity (CRT-O) with preliminary results of a randomized controlled trial demonstrating significant weight loss and improvements in executive function. The objective of this study was to conduct a secondary data analysis of the CRT-O trial to evaluate whether CRT-O reduces unhealthy habits that contribute to obesity via improvements in executive function. METHOD: Eighty participants with obesity were randomized to CRT-O or control. Measures of executive function (Wisconsin Card Sort Task and Trail Making Task) and unhealthy eating and sedentary behavior habits were administered at baseline, post-intervention and at 3 month follow-up. RESULTS: Participants receiving CRT-O demonstrated improvements in both measures of executive function and reductions in both unhealthy habit outcomes compared to control. Mediation analyses revealed that change in one element of executive function performance (Wisconsin Card Sort Task perseverance errors) mediated the effect of CRT-O on changes in both habit outcomes. CONCLUSION: These results suggest that the effectiveness of CRT-O may result from the disruption of unhealthy habits made possible by improvements in executive function. In particular, it appears that cognitive flexibility, as measured by the Wisconsin Card Sort task, is a key mechanism in this process. Improving cognitive flexibility may enable individuals to capitalise on interruptions in unhealthy habits by adjusting their behavior in line with their weight loss goals rather than persisting with an unhealthy choice. TRIAL REGISTRATION: The RCT was registered with the Australian New Zealand Registry of Clinical Trials (trial id: ACTRN12613000537752 ).

Self-regulation and obesity: the role of executive function and delay discounting in the prediction of weight loss.

Obesity rates are rising worldwide. Executive function and delay discounting have been hypothesized to play important roles in the self-regulation of behavior, and may explain variance in weight loss treatment success. First, we compared individuals with obesity (n = 82) to healthy weight controls (n = 71) on behavioral and self-report measures of executive function (working memory, inhibition and shifting) and delay discounting. Secondly, the individuals with obesity took part in a multidisciplinary weight loss program and we examined whether executive function and delay discounting predicted weight change. Individuals with obesity displayed weaker general and food-specific inhibition, and weaker self-reported executive function. Better behavioral working memory and better self-reported inhibition skills in daily life were predictive of greater weight loss. As findings are correlational, future studies should investigate the causal relationship between executive function and weight loss, and test whether intervening on executive function will lead to better prevention and treatment of obesity.

Understanding supplement use: an application of temporal self-regulation theory.

Vitamin and mineral supplement use is increasing worldwide. As evidence of the effects of these practices are equivocal at best, it is important to determine why individuals engage in vitamin and mineral supplement use through the application of a theoretical framework. The aim of this study was to employ temporal self-regulation theory (TST) to establish the determinants of supplement use. A cross-sectional design was used with a sample of 121 individuals who consume vitamins or minerals as dietary supplements. Hierarchical regression analyses were conducted to determine the influence of intention, habit, self-control, and the interaction between intention and habit and self-control on the frequency of supplement use. The model accounted for a significant proportion of variance in behaviour (R2 = .44) with intention and habit significantly related to supplement use. Self-control moderated the relationship between intention and behaviour indicating that intention was not related to behaviour when self-control was low. The TST model offers a satisfactory account of supplement use and provides avenues for interventions aimed at increasing safe and beneficial supplement use and decreasing potentially harmful supplement use.

A meta-analysis of the effect of new-media interventions on sexual-health behaviours.

BACKGROUND AND OBJECTIVES: Direct access to individuals in non-intrusive ways, as well as the technical abilities of new-media to provide tailored information in relatively inexpensive ways, creates a unique opportunity for the delivery of health-related information. The aim of the present research was to examine the effect that new-media-based sexual-health interventions have on sexual-health behaviours in non-clinical populations and to determine the factors that moderate the effect of technology-based sexual-health interventions on sexual--health behaviours. DATA SOURCES: A systematic literature search of the following databases was conducted: MEDLINE, psycINFO, Global health, and EMBASE, using terms that captured three subject areas-'Sexual-health', 'New Technology' and 'Intervention'. STUDY ELIGIBILITY CRITERIA: Randomised controlled trial, or a quasi-experiment; delivered exclusively via new-media; included sexual risk behaviour change as an outcome measure and delivered to non-clinical groups. RESULTS: Twelve studies tested the effect of new-media interventions on condom use, whereas nine tested the effect on sexually transmitted disease testing. Results indicated that new-media interventions led to significant increases in both outcomes; however, these effects were not homogeneous. Moderation analyses revealed that interactivity of the intervention, target population and study design influenced the efficacy of interventions on both sexual-health outcomes, whereas intervention duration influenced sexually transmitted infection testing. CONCLUSIONS AND IMPLICATIONS: Interventions aiming to improve condom use are more successful when an interactive component is used. Further research needs to be conducted to reach specific at-risk populations.

Two inhibitory control training interventions designed to improve eating behaviour and determine mechanisms of change.

Inhibitory control training has been shown to influence eating behaviour in the laboratory; however, the reliability of these effects is not yet established outside the laboratory, nor are the mechanisms responsible for change in behaviour. Two online Stop-Signal Task training interventions were conducted to address these points. In Study 1, 72 participants completed baseline and follow-up measures of inhibitory control, self-regulatory depletion, fat intake and body-mass index. Participants were randomly assigned to complete one of three Stop-Signal Tasks daily for ten days: food-specific inhibition--inhibition in response to unhealthy food stimuli only, general inhibition--inhibition was not contingent on type of stimuli, and control--no inhibition. While fat intake did not decrease, body-mass index decreased in the food-specific condition and change in this outcome was mediated by changes in vulnerability to depletion. In Study 2, the reliability and longevity of these effects were tested by replicating the intervention with a third measurement time-point. Seventy participants completed baseline, post-intervention and follow-up measures. While inhibitory control and vulnerability to depletion improved in both training conditions post-intervention, eating behaviour and body-mass index did not. Further, improvements in self-regulatory outcomes were not maintained at follow-up. It appears that while the training paradigm employed in the current studies may improve self-regulatory outcomes, it may not necessarily improve health outcomes. It is suggested that this may be due to the task parameters, and that a training paradigm that utilises a higher proportion of stop-signals may be necessary to change behaviour. In addition, improvements in self-regulation do not appear to persist over time. These findings further current conceptualisations of the nature of self-regulation and have implications for the efficacy of online interventions designed to improve eating behaviour.

Examining the predictive utility of an extended theory of planned behaviour model in the context of specific individual safe food-handling.

BACKGROUND: In order to minimise the occurrence of food-borne illness, it is recommended that individuals perform safe food-handling behaviours, such as cooking food properly, cleaning hands and surfaces before preparing food, keeping food at the correct temperature, and avoiding unsafe foods. Previous research examining the determinants of safe food-handling behaviour has produced mixed results; however, this may be due to the fact that this research examined these behaviours as a totality, rather than considering the determinants of each behaviour separately. As such, the objective for the present study was to examine the predictors of the four aforementioned safe food-handling behaviours by applying an extended theory of planned behaviour to the prediction of each distinct behaviour. METHOD: Participants were 170 students who completed theory of planned behaviour measures, with the addition of moral norm and habit strength at time 1, and behaviour measures one week later. RESULTS: While the influence of injunctive and descriptive norm and perceived behavioural control differed between behaviours, it appeared that moral norm was an important predictor of intention to engage in each of the four behaviours. Similarly, habit strength was an important predictor of each of the behaviours and moderated the relationship between intention and behaviour for the behaviour of avoiding unsafe food. CONCLUSION: The implication of these findings is that examining safe food-handling behaviours separately, rather than as a totality, may result in meaningful distinctions between the predictors of these behaviours.

Individual differences in executive function predict distinct eating behaviours.

Executive function has been shown to influence the performance of health behaviours. Healthy eating involves both the inhibitory behaviour of consuming low amounts of saturated fat, and the initiatory behaviour of consuming fruit and vegetables. Based on this distinction, it was hypothesised that these behaviours would have different determinants. Measures of inhibitory control and updating were administered to 115 participants across 2 days. One week later saturated fat intake and fruit and vegetable consumption were measured. Regression analyses revealed a double dissociation effect between the different executive function variables and the prediction of eating behaviours. Specifically, inhibitory control, but not updating, predict saturated fat intake, whilst updating, but not inhibitory control, was related to fruit and vegetable consumption. In both cases, better executive function capacity was associated with healthier eating behaviour. The results support the idea that behaviours that require stopping a response such as limiting saturated fat intake, have different determinants to those that require the initiation of a response such as fruit and vegetable consumption. The findings suggest that interventions aimed at improving these behaviours should address the relevant facet of executive function.

Self-regulation and the intention behaviour gap. Exploring dietary behaviours in university students.

The aim of this study was to explore whether two aspects of self-regulation (impulsivity and temporal orientation) could reduce the intention­behaviour gap for two dietary behaviours: fruit and vegetable consumption and saturated fat consumption. Australian undergraduate students (N = 154) completed questionnaires (the Barratt impulsiveness scale and the consideration of future consequences scale) and intention measures, and 1 week later behaviour was measured using the Block rapid food screener. After controlling for demographics, intention was associated with fruit and vegetable consumption, but the self-regulation measures did not further improve the variance accounted for. For saturated fat, gender was associated with consumption, such that males tended to consume more saturated fat. Intention was significantly associated with consumption, and impulsivity further improved the model such that those who were more impulsive tended to consume more saturated fat. These findings suggest that health protective and health risk behaviours, such as those investigated in the current study, may have different determinants.

An intervention designed to investigate habit formation in a novel health behaviour.

OBJECTIVES: Understanding how to help people form habits is important in improving health interventions. The impact of two behaviour change techniques on behaviour (cues and monitoring) was tested, and the role of psychosocial factors that may predict behaviour change and habit formation were investigated. Methods: Participants (N = 186) were randomised to one of six conditions (behaviour monitoring vs habit monitoring vs irrelevant behaviour monitoring and cued vs not cued) and instructed to engage in a specific, novel behaviour every day for the following 3 weeks. Participants completed measures of behaviour, habit strength, prospective memory, attitude, intention, self-efficacy and motivation at three time points (pre-, post- and one-week follow-up). Results: All participants increased habit strength and behaviour. Post-hoc, it was found that community members, compared to students, developed stronger habits and maintained the behaviour and habit strength at one-week follow-up. Intention, behaviour and habit strength post-intervention moderated behaviour and habit strength maintenance. Conclusion: This research furthers our understanding of how to help people form healthy habits. It was found that any intervention seems to be effective in forming a habit and changing behaviour. Moreover, intention, habit and behaviour were the most important predictors of behaviour change and habit formation maintenance.

Investigating mechanisms for recruiting and retaining volunteers: The role of habit strength and planning in volunteering engagement.

Volunteering rates in high-income countries are declining. Most research into understanding volunteering engagement has focused on conscious processes (e.g., motives), with little exploration of non-conscious antecedents of volunteering engagement. Adopting a new line of investigation, this research used temporal self-regulation theory to investigate the influence of both rational and automatic processes on volunteering engagement. Two related studies using different methodologies were conducted to investigate the influence of intention, planning, and habit strength on volunteering engagement. In both studies, intention and habit strength were significant predictors of volunteering engagement, with planning only significantly predicting volunteering engagement in Study 1. It was also found, in Study 2, that habit strength moderated the intention-behavior relationship. These findings highlight that both rational and automatic processes play a part in volunteering engagement and have implications for recruiting and retaining volunteers.

Comparing the Cost-Effectiveness of Campaigns Delivered via Various Combinations of Television and Online Media.

BACKGROUND: Reflecting the increasing prevalence of online media, many mass media health campaigns are now delivered using both television (TV) and online media formats. The aim of this study was to evaluate a smoking cessation mass media campaign according to the cost-effectiveness of the various combinations of TV and online media formats to inform future media buying decisions. METHODS: A quasi-experimental interrupted time series approach was employed. The campaign was delivered in seven 1-week bursts using TV, online video (OV), or online display (OD) (e.g., banner ads) formats in isolation and in various combinations over a 13-week period. Campaign bursts were separated by "off-weeks" in which no campaign materials were delivered. Assessed outcomes were the number of campaign response "events" recorded (campaign web page views, calls to a smoking cessation telephone service, and registrations for smoking cessation services). The cost-effectiveness of each individual and combined media format condition in terms of these outcome variables was calculated using attributed production and broadcasting costs. RESULTS: Overall, OD alone was found to be the most cost-effective means of achieving the nominated campaign outcomes, followed by a combination of OV and OD and a combination of TV and OV. The use of TV in isolation was the least cost-effective. CONCLUSION: The results of this evaluation indicate that online media constitute a promising means of enhancing the cost-effectiveness of smoking cessation campaigns. Future research assessing a broader range of outcomes, especially smoking cessation, is needed to provide a more comprehensive account of the cost-effectiveness of various campaign media.

Assessing Audience Members' Ability to Identify the Media Source of a Health Campaign Disseminated via Different Media.

Background: An important criterion for health campaign media selection is the ability to achieve campaign awareness among target audiences. However, existing campaign exposure metrics cannot be applied across both traditional and digital media, which complicates decision making. The present study assessed the validity of using self-report as a measure of the extent to which different types of media achieve campaign awareness to assist in determining appropriate media budget allocations. Methods: A quasi-experiment involving varying combinations of television, online video, and online display smoking cessation advertisements was conducted to determine whether audience members were able to accurately report the source of their exposure to the campaign. Results: Of the 719 Western Australian adults sampled (50% males, 50 females, 50% smokers, 50% non-smokers), 64% reported seeing the campaign in the previous 2 weeks. Of these, 91% reported seeing the advertisement on television, 8% on online video, and 21% on online display (respondents could select multiple media). Despite proportional scheduling of the three media over the discrete campaign periods, in most cases respondents assumed their exposure had occurred via television, regardless of the actual source of exposure. Conclusions: Among both smokers and non-smokers, television had primacy in memory regardless of the actual media used. As such, relying on self-reported recall is unlikely to constitute a reliable method of assessing target audience exposure to campaigns on different media where those media are all screen-based. The results highlight the need for alternative media effectiveness metrics that permit direct comparisons between traditional and digital media.

Does inhibitory control training improve health behaviour? A meta-analysis.

OBJECTIVES: Inhibitory control training has been hypothesised as a technique that will improve an individual's ability to overrule impulsive reactions in order to regulate behaviour consistent with long-term goals. METHODS: A meta-analysis of 19 studies of inhibitory control training and health behaviours was conducted to determine the effect of inhibitory control training on reducing harmful behaviours. Theoretically driven moderation analyses were also conducted to determine whether extraneous variables account for heterogeneity in the effect; in order to facilitate the development of effective intervention strategies. Moderators included type of training task, behaviour targeted, measurement of behaviour and training duration. RESULTS: A small but homogeneous effect of training on behaviour was found, d(+) = 0.378, CI95 = [0.258, 0.498]. Moderation analyses revealed that the training paradigm adopted, and measurement type influenced the size of the effect such that larger effects were found for studies that employed go/no-go (GNG) training paradigms rather than stop-signal task paradigms, and objective outcome measures that were administered immediately yielded the largest and most consistent effects on behaviour. CONCLUSIONS: Results suggest that GNG inhibitory control training paradigms can influence health behaviour, but perhaps only in the short-term. Future research is required to systematically examine the influence of training duration, and the longevity of the training effect. Determining these factors could provide the basis for cost-effective and efficacious health-promoting interventions.

Physical Activity and Transitioning to College: The Importance of Intentions and Habits.

OBJECTIVES: First generation students transitioning to college experience specific challenges that impact on their engagement in physical activity. Furthermore, this population experiences a context disruption that provides a unique opportunity to examine whether intention and habit predict physical activity. The aim of the current research was to determine the efficacy of the theory of planned behavior in the prediction of intention and behavior within this population, and to determine whether habit contributes to the prediction of physical activity. METHODS: In this observational study, a convenience sample of first generation college students (N = 101) completed measures of theory of planned behavior variables and habit strength at Time 1, and one week later reported physical activity. RESULTS: The theory of planned behavior was partially supported in this context, as intention was the only significant predictor of behavior. Habit strength accounted for additional variance in physical activity but did not moderate the relationship between intention and behavior. The hypothesized model accounted for 46.9% of the variance in physical activity, and intention (ß = .455) and habit (ß = .364) were significant predictors. CONCLUSIONS: Intention and habit exert independent effects on physical activity within this population, and are both suitable targets for intervention.

The Role of Habit and Perceived Control on Health Behavior among Pregnant Women.

OBJECTIVE: Many pregnant women do not adhere to physical activity and dietary recommendations. Research investigating what psychological processes might predict physical activity and healthy eating (fruit and vegetable consumption) during pregnancy is scant. We explored the role of intention, habit, and perceived behavioral control as predictors of physical activity and healthy eating. METHODS: Pregnant women (N = 195, Mage = 30.17, SDage = 4.46) completed questionnaires at 2 time points. At Time 1, participants completed measures of intention, habit, and perceived behavioral control. At Time 2, participants reported on their behavior (physical activity and healthy eating) within the intervening week. Regression analysis determined whether Time 1 variables predicted behavior at Time 2. Interaction terms also were tested. RESULTS: Final regression models indicated that only intention and habit explained significant variance in physical activity, whereas habit and the interaction between intention and habit explained significant variance in healthy eating. Simple slopes analysis indicated that the relationship between intention and healthy eating behavior was only significant at high levels of habit. CONCLUSIONS: Findings highlight the influence of habit on behavior and suggest that automaticity interventions may be useful in changing health behaviors during pregnancy.

Closing the intention-behaviour gap for sunscreen use and sun protection behaviours.

OBJECTIVE: Two studies were conducted with the aim of closing the intention-behaviour gap for sunscreen use and sun protection behaviours by examining the influence of self-regulatory capacity on the prediction of sunscreen use (Study 1) and self-regulatory capacity and habit on sun protection behaviours (Study 2). DESIGN: Studies were conducted online. Participants completed questionnaires and cognitive measures and then reported behaviour one week later. MAIN OUTCOME MEASURES: Questionnaires measuring intention and cognitive tasks measuring self-regulatory capacity were administered to 209 university students. One week later, participants reported behaviour. In Study 2, questionnaires measuring intentions, and habit and cognitive tasks measuring self-regulatory capacity were administered to 178 university students who reported behaviour one week later. RESULTS: Intention accounted for 7.1% of variance in sunscreen use, no measures of self-regulation accounted for variance in behaviour or moderated the intention-behaviour gap (Study 1). Intention, self-regulatory capacity and habit accounted for 56.1% of variance in sun protection behaviours (Study 2). Intention, self-regulatory ability and habit predicted behaviour, while habit moderated the intention-behaviour gap. CONCLUSION: Interventions aimed at increasing sun protection behaviours should take into account level of intention, self-regulatory capacity and habit. Individuals may benefit from habit formation strategies and self-regulation training.

Self-regulation versus habit: the influence of self-schema on fruit and vegetable consumption.

The aim of this study is to examine the determinants of fruit and vegetable (F&V) consumption with the application of the Theory of Planned Behaviour (TPB) and the additional variables of self-schema, habit and self-regulation. While it has been shown that those with a healthy-eater self-schema are more likely to carry out their healthy dietary intentions, the underlying processes that influence this relationship have received limited empirical attention. Recent findings on dietary behaviour suggest that self-regulatory ability and habit strength may have dissimilar effects on the intention-behaviour relationship within schematics and non-schematics. Self-report questionnaires regarding F&V consumption cognitions and two tests of self-regulation were administered to 209 university students. One week later, participants completed questionnaires on their behaviour. The TPB significantly predicted intentions and prospective behaviour. Self-schema did not moderate the relationship between intention and behaviour. However, within healthy-eater schematics, those with high intention and high self-regulatory ability were more likely to consume F&V, while within non-schematics, those with low intention and high habit strength were more likely to consume F&V. The findings support the use of the TPB in predicting F&V consumption and the validity of the self-schema distinction. Implications for designing interventions are discussed.

The role of executive function in bridging the intention-behaviour gap for binge-drinking in university students.

BACKGROUND: Alcohol consumption contributes to a significant proportion of disease and the high prevalence amongst young adults is a worldwide health concern. PURPOSE: To determine which aspects of executive function (EF) distinguish binge-drinkers from non binge-drinkers and to establish the role of EF in predicting behaviour. METHODS: Self-report questionnaires, four tests of self-regulation and a behaviour measure were administered to 153 students. RESULTS: The Theory of Planned Behaviour model was significant in predicting both intentions and behaviour. Although binge-drinkers and non binge-drinkers were found to differ on three of the four measures of EF, none predicted additional variance in behaviour. Planning ability and inhibition control moderated the relationship between intention and behaviour such that for individuals who intended to binge-drink, those with high planning ability or high inhibitory control were more likely to avoid doing so. CONCLUSIONS: Interventions targeting binge-drinking behaviour should aim to develop planning skills and inhibitory control.