Adolescent's explicit and implicit cigarette cognitions predict experimentation with both cigarettes and e-cigarettes.

Background: Past year, month, and lifetime adolescent e-cigarette use rates remain persistently high, despite falling cigarette use rates. Previous investigations have noted a strong relationship between an individual's positive and negative cognitions related to a behavior, and subsequent initiation of that behavior.Objective: This investigation was conducted to determine the impact positive and negative explicit and implicit cigarette-related cognitions may have on the use of cigarettes and e-cigarettes among at-risk, cigarette-naive adolescents.Methods: A three-year longitudinal investigation evaluated the relationship between cigarette-related cognitions and subsequent cigarette and e-cigarette use among 586 alternative high school students (female: 50.8%; mean age: 17.4 years; Hispanic/Latino: 75.0%) who had never smoked cigarettes at the baseline assessment. Multilevel logistic regression models were used to generate demographics-adjusted odds ratios (OR) and 95% confidence intervals (95% CI).Results: Students with higher positive explicit cigarette cognitions at the baseline had greater odds of subsequent cigarette use (OR = 1.72, 95% CI 1.11-2.68). If students also reported an increase over time in positive (OR = 3.45, 95% CI 2.10-5.68) or negative (OR = 1.93, 95% CI 1.03-3.61) explicit cigarette cognitions, the odds of cigarette use increased. The odds of dual use of cigarettes and e-cigarettes were greater among students who had higher negative implicit cigarette cognitions at the baseline (OR = 2.07, 95% CI 1.03-4.17) compared to those with lower levels of negative implicit cognitions.Conclusion: Prevention programming that focuses on decreasing positive cognitions related to nicotine and tobacco use may have greater overall effect on decreasing use compared to programs that only focus on increasing negative cognitions individuals form surrounding cigarette or e-cigarettes.

Validity and Reliability of a Revised S-UPPS-P Impulsive Behavior Scale: The Interplay between Impulsivity and Working Memory.

Impulsivity is a multidimensional construct. The UPPS-P model of impulsivity differentiates five distinct dimensions: negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking. The present study, reports the first translation and validation of the recently revised short form of the UPPS-P scale (S-UPPS-P) on a Persian-speaking sample, examining the relationship between impulsivity and working memory. who also completed the Positive and Negative Affect Scale (PANAS), the Buss and Perry Aggression Questionnaire, the Behavioral Inhibition and Activation Scales (BIS/BAS), and the Wechsler Digit Span Task (WDST). A series of confirmatory factor analyses, and Cronbach's alpha results supported the factor structure of the scale. The findings supported the S-UPPS-P model's hypothesized correlations with PANAS, aggressiveness, and the construct validity of the model. The results of hierarchical regression analysis showed that backward and forward digit span scores of the WDST predicted the S-UPPS-P impulsivity scores over the portion explained by BIS/BAS, PANAS, and aggression scores. To conclude, the revised S-UPPS-P Impulsive Behavior Scale was well supported even in a very different population than usually sampled, adding to growing evidence that it assesses distinct but interrelated aspects of the impulsivity construct. Our findings also suggest that attentional capacities and working memory play important roles in the prediction of impulsivity.

The prospective association between illicit drug use and nonprescription opioid use among vulnerable adolescents.

In recent years, more than half of all drug overdose deaths in United States involved an opioid. To address this epidemic, antecedents to opioid misuse must be identified and empirically validated. The objective of the current investigation was to examine whether illicit drug use was prospectively associated with nonprescription opioid use among adolescents from a vulnerable population with a greater prevalence of substance abuse. A population-based cohort study of 1060 adolescents from 29 alternative high schools in southern California was conducted over a two-year period. A total of 929 adolescents (mean age 17.5 years, 49.9% female, 76.4% Hispanic) who had not experimented with nonprescription opioids at the baseline assessment were included in the analytic sample. The outcome was self-reported use of nonprescription opioids within two years. The predictors tested were illicit drug use, illicit drug use excluding marijuana, and the use of nonmedical marijuana. Covariates included age, sex, ethnicity, socioeconomic status, parental education, weekly income, sensation seeking, stress, anxiety, depression, and the use of alcohol and nicotine products. Multilevel, covariate-adjusted logistic regression models indicated that the odds of experimentation with nonprescription opioids was greater among adolescents who had used illicit drugs or illicit drugs excluding marijuana. Nonmedical marijuana use alone was a statistically significant predictor in unadjusted but not covariate-adjusted models. While prior studies have examined the progression from nicotine, alcohol, and marijuana use to nonprescription opioid use, the present findings emphasize the importance of illicit drug use as a detectable and empirically supported risk factor for future opioid misuse.

Associations Between Family and Peer E-Cigarette Use With Adolescent Tobacco and Marijuana Usage: A Longitudinal Path Analytic Approach.

INTRODUCTION: Research indicates a link between adolescent e-cigarette use and combustible tobacco cigarette (CTC) initiation, and recent studies suggest their connection with marijuana uptake. Our 3-year longitudinal cohort study investigated the implications of adolescent, peer, and family e-cigarette use with adolescents' expectations and willingness to initiate CTC use, and subsequent CTC and marijuana use. AIMS AND METHODS: Relationships were examined in a secondary analysis of a 3-year longitudinal cohort subsample involving adolescents enrolled in alternative California high schools (N = 1025). Analyses examined responses over three yearly observations. Family, peer, and respondents' e-cigarette use, respondents' positive cigarette expectancies and willingness to use CTCs were assessed in the study's first year (T1). CTC use in the survey's second year (T2) and marijuana use in the third year (T3) were assessed via path analysis. RESULTS: Respondents reporting at least one family member or peer using e-cigarettes were more likely to use e-cigarettes at T1 than those whose peers/family members did not. They reported more positive expectancies about CTCs and greater willingness to initiate use. These variables predicted CTC use at T2, which directly anticipated marijuana use in the survey's third year (T3), as did adolescents' use of e-cigarettes at T1. All model relations were statistically significant. CONCLUSIONS: Analysis demonstrated the strong association of family members' and peers' behaviors with adolescent e-cigarette use, and the temporal precedence of e-cigarette use with subsequent CTC and marijuana uptake. The predictive implications of e-cigarettes for other dangerous substance use should be examined in future prevention campaigns. IMPLICATIONS: The presented study expands upon existing literature connecting adolescent e-cigarette use and later CTC and marijuana use. The findings indicate the significant implications of exposure to e-cigarette use by parents and peers and demonstrate in a longitudinal 4-year panel survey the direct and indirect predictive implications of e-cigarette use for CTC and marijuana uptake. The research illustrates the utility of programs and campaigns that target peer and family groups to maximize impacts on adolescent willingness to try CTCs, positive expectancies, and possible onset of CTC and marijuana use.

Acceptance of Drug Use Mediates Future Hard Drug Use Among At-Risk Adolescent Marijuana, Tobacco, and Alcohol Users.

Alternative high school (AHS) students typically report higher levels of alcohol and other drug use compared to students attending traditional high schools. Greater use of such drugs as heroin, methamphetamines, and cocaine in this at-risk population may be driven, in part, by a greater latitude of acceptance toward substance use in general, which may accelerate the transition from gateway drugs to hard drugs. Seven hundred seventy-seven adolescents (mean age 16.6; 56% female) were recruited from alternative high schools throughout Southern California. To understand the factors that may lead AHS students to use hard drugs, a model was tested in order to determine if AHS students' latitude of acceptance toward substance use was a mediator between the relationship of past use of gateway drugs and future use of hard drugs. Latitude of acceptance was found to be a statistically significant mediator of future hard drug use (b = 0.03, 95% confidence intervals = 0.01 to 0.05) among gateway drug users. An individual's latitude of acceptance to various drug use behaviors may be consistent with societal norms. However, after exposure to, or use of, gateway drugs, attitudes that are more permissive toward hard drug use may be encountered, the acceptance of hard drugs may expand, and the use of hard drugs may escalate. Interventions designed to reduce the use of hard drugs among at-risk youth may be more persuasive by crafting messages that are within the latitude of acceptance of the target population and prevent the acceptance of hard drug use.

Working Memory and Response Inhibition Effects on At-Risk Youth's Willingness to Use Multiple Nicotine and Tobacco Products.

Purpose: Past research has suggested that executive functions, such as working memory and response inhibition, predict the use of nicotine and tobacco products (NTPs). The current study extends prior research by assessing whether response inhibition and working memory are associated with at-risk youth's willingness to use NTPs. Methods: A sample of 1060 at-risk youth were recruited from alternative high schools in southern California. Participants were randomly assigned to complete the Symmetry Span Task, an indicator of working memory ability, or the cued Go/No-Go task, an indicator of response inhibition. Participants who reported never using NTPs (n = 348) indicated how willing they would be try NTPs. Results: Results from a cross-sectional zero-inflated negative binomial (ZINB) regression suggest that females with stronger working memory skills and individuals with weaker response inhibition skills were more likely to be unwilling to use NTPs. Conclusion: While further research is needed to determine whether executive functions can prospectively predict NTP use among at-risk youth, the current study indicates that both working memory and response inhibition may play a significant role.

E-cigarette Advertising Exposure, Explicit and Implicit Harm Perceptions, and E-cigarette Use Susceptibility Among Nonsmoking Young Adults.

Introduction: This study tested whether exposure to e-cigarette advertising increases e-cigarette use susceptibility among nonsmoking young adults by promoting explicit and implicit attitudes toward e-cigarettes as a safer and healthier alternative to combustible cigarettes. Methods: Young adult current nonsmokers who had never used an e-cigarette (n = 393; mean age = 22.1, standard deviation = 3.9; 66% women) were randomly assigned to one of the three conditions that involved viewing real-world, print e-cigarette ads. Two of the three conditions were experimental conditions where ads with different predominant themes (harm reduction ["Health"] versus social enhancement ["Social"] focused) were interspersed among ads of everyday objects. The third condition was the Control condition involving ads of everyday objects only. Participants provided data on explicit (ie, self-reported harm perceptions) and implicit (ie, Implicit Association Test) attitudes toward e-cigarette use and e-cigarette use intentions. Hypotheses were tested using structural equation modeling. Results: Relative to Control participants, participants in Health and Social conditions were more likely to show higher implicit attitudes toward e-cigarettes as a safer alternative to cigarettes. Only the Social condition, relative to Control, had a significant effect on lower explicit harm perceptions of e-cigarette versus cigarette use. The Social condition had a significant indirect effect on e-cigarette use susceptibility, mediated by explicit harm perceptions. Conclusions: Social enhancement-themed ads may communicate the reduced harm messages more strongly among young adults so as to affect both explicit and implicit attitudes and, through these, e-cigarette use susceptibility. Regulatory bodies may need to scrutinize reduced harm claims communicated through social enhancement-themed ads. Implications: The findings imply that implicit and explicit health benefit or reduced harm claims in e-cigarette marketing may be propagated via ads that use social enhancement gimmicks to attract youth and young adults. As the US Food and Drug Administration develops regulations on e-cigarette marketing, informed decisions need to be made that address harm reduction needs of current smokers as well as e-cigarette use onset among nonsmokers. In regard to the latter, e-cigarette marketing may need to be studied closely to monitor implicit and explicit health benefit claims that are coupled with the use of visual and textual gimmicks in ads that intend to make e-cigarettes more appealing to youth and young adults.

Share of Advertising Voice at the Point-of-Sale and Its Influence on At-Risk Students' Use of Alternative Tobacco Products.

INTRODUCTION: As adolescent tobacco use shifts from traditional cigarettes to alternative products, it is important to understand the influence of point-of-sale (POS) advertising on product use. This research investigated whether the percentage of POS advertising for a particular product, known as the share of advertising voice (SAV), moderated the relationship between exposure to POS tobacco advertisements and tobacco use among at-risk youth. METHODS: Longitudinal self-report data from 746 students attending 20 alternative high schools in southern California was merged with observational data cataloging 2101 advertisements for cigarettes, e-cigarettes, cigars, and smokeless tobacco from 87 tobacco retail outlets within a half mile of the schools. Four multilevel Poisson regression models examined whether SAV interacted with POS tobacco advertising exposure to influence the use of tobacco products 1 year later. RESULTS: Adolescent exposure to POS tobacco advertisements was significantly associated with increased use of all four tobacco products (p < .02). When SAV was added to the model as a moderator, the results showed a significant interaction, such that increasing the SAV for e-cigarettes was associated with greater use of that product (ß = 0.27, SE = 0.07, p < .001). The same moderating effect was found for smokeless tobacco (ß = 0.56, SE = 0.19, p = .004) but no moderating effect was observed for cigarettes or cigars. CONCLUSION: POS SAV has the potential to influence at-risk students' use of alternative tobacco products and may be a contributing factor to recent nationwide shifts in youth tobacco use. IMPLICATIONS: Future studies should monitor changes in SAV to gain insight into POS marketing trends that may be impacting youth tobacco use. In addition, state and local governments should consider implementing policies that limit the volume and proportion of POS tobacco advertising for all nicotine and tobacco products available in retail environments near schools. Restrictions placed on a single product may cause unintended shifts in product selection rather than a reduction in youth tobacco use.

Translation of basic research in cognitive science to HIV-risk: a randomized controlled trial.

Many people enrolled in drug diversion programs are not receiving evidence-based prevention for HIV or hepatitis. This study translated basic research from cognitive science to increase screening for infection and condom use in this population. A parallel three-condition randomized trial was conducted in a drug diversion sample (N = 358), comparing a memory practice condition with two active control conditions. Outcomes were condom use frequency and testing for infection (hepatitis B/C, HIV). At 3-month follow-up, participants in the memory practice condition were at least twice as likely (OR = 2.10 or greater, p < .01) to self-report testing compared to those in the control conditions and also reported more frequent condom use compared to a health education condition [B = .37, t(1) = 2.02, p = .02]. Basic research on memory can be effectively translated to brief interventions on infection screening and risk prevention in existing drug diversion programs.

Adolescent Substance Use and Sensation-Seeking on Sexual Behaviors Among Young Adults from Continuation High Schools.

BACKGROUND: Youth from continuation high schools report greater substance use and sensation-seeking than youth from regular high schools, yet their long-term consequences on age at sexual onset and the number of sexual partners are unknown. OBJECTIVE: To examine substance use, sensation-seeking and sexual behaviors by gender and race/ethnicity and the effects of substance use and sensation-seeking in adolescence on age at sexual initiation and numbers of sexual partners by young adulthood. METHODS: Baseline and 4-year follow-up data on youth from 14 continuation high schools in Southern California who participated in a drug abuse prevention intervention were analyzed. Structural equation modeling assessed whether or not substance use or sensation-seeking in adolescence predicted age at sexual onset and numbers of sexual partners by young adulthood. RESULTS: Latinos had lower sensation-seeking and frequency of substance use and a later age at sexual onset than non-Latinos. Males were more likely than females to have multiple lifetime and recent sexual partners. The effects of adolescent substance use on the number of sexual partners by young adulthood were mediated fully by their age at sexual initiation. Sensation-seeking had no direct or indirect effects on sexual behaviors. Conclusions/Importance: Factors leading to and actual sexual risk behaviors among youth from continuation high schools vary by race/ethnicity and gender. Targeting these antecedent factors by race/ethnicity and gender may improve prevention efforts.

The prevalence and marketing of electronic cigarettes in proximity to at-risk youths: An investigation of point-of-sale practices near alternative high schools.

This study examines the point-of-sale marketing practices used to promote electronic cigarettes at stores near schools that serve at-risk youth. One hundred stores selling tobacco products within a half mile of alternative high schools in Southern California were assessed for this study. Seventy percent of stores in the sample sold electronic cigarettes. Convenience stores heavily frequented by youth had the highest number of interior ads for e-cigarettes and were the most likely to employ in-store product placement strategies. Increased exposure to the promotion of these products at the point-of-sale poses a challenge for anti-smoking efforts directed toward vulnerable populations.

Self-regulation interventions to reduce consumption of sugar-sweetened beverages in adolescents.

This study evaluated the efficacy of self-regulation interventions through the use of drink-specific implementation intentions and drink-specific Go/No-Go training tasks as compensatory strategies to modify inhibitory control to reduce intake of sugar-sweetened beverages (SSB). In a between-subjects randomized manipulation of implementation intentions and Go/No-Go training to learn to inhibit sugary drink consumption, 168 adolescents reporting inhibitory control problems over sugary drinks and foods were recruited from high schools in southern California to participate. Analysis of covariance overall test of effects revealed no significant differences between the groups regarding calories consumed, calories from SSBs, grams of sugar consumed from drinks, or the number of unhealthy drinks chosen. However, subsequent contrasts revealed SSB implementation intentions significantly reduced SSB consumption following intervention while controlling for inhibitory control failure and general SSB consumption during observation in a lab setting that provided SSBs and healthy drinks, as well as healthy and unhealthy snacks. Specifically, during post-intervention observation, participants in the sugar-sweetened beverage implementation intentions (SSB-II) conditions consumed significantly fewer calories overall, fewer calories from drinks, and fewer grams of sugar. No effects were found for the drink-specific Go/No-Go training on SSB or calorie consumption. However, participants in SSB-II with an added SSB Go/No-Go training made fewer unhealthy drink choices than those in the other conditions. Implementation intentions may aid individuals with inhibitory (executive control) difficulties by intervening on pre-potent behavioral tendencies, like SSB consumption.

Functional imaging of an alcohol-Implicit Association Test (IAT).

This research assessed activation in neural substrates involved in implicit associative processes through functional magnetic resonance imaging of an alcohol-Implicit Association Test (IAT) focused on positive outcomes of alcohol use. Comparisons involved 17 heavy and 19 light drinkers, ranging in age from 18 to 22, during compatible and incompatible association task trials. Behaviorally, a significant IAT effect was found with heavy drinkers showing stronger positive implicit associations toward alcohol use than light drinkers. Imaging data revealed heavy drinkers showed greater activity during compatible trials relative to incompatible trials in the left putamen and insula while no significant difference in activity between conditions was found in the light drinkers. Light drinkers showed significantly more activity in the left orbital frontal cortex during both compatible and incompatible trials than heavy drinkers, and the dorsolateral prefrontal cortex was engaged more in both light and heavy drinkers during incompatible trials relative to compatible trials. Further, within-group analyses showed significant amygdala activity along with the putamen and insula among heavy drinkers during compatible trials relative to incompatible trials. These results are consistent with a dual process framework of appetitive behaviors proposing that (1) implicit associations underlying habit are mediated through neural circuitry dependent on the striatum, and (2) controlled behaviors are mediated through neural circuitry more dependent on the prefrontal cortex. This is the first study to evaluate the neural mechanisms elicited by an alcohol-IAT, providing an additional step toward increasing understanding of associative habit processes and their regulatory influence over addictive behaviors.

Inhibitory control effects in adolescent binge eating and consumption of sugar-sweetened beverages and snacks.

Inhibitory control and sensitivity to reward are relevant to the food choices individuals make frequently. An imbalance of these systems can lead to deficits in decision-making that are relevant to food ingestion. This study evaluated the relationship between dietary behaviors - binge eating and consumption of sweetened beverages and snacks - and behavioral control processes among 198 adolescents, ages 14 to 17. Neurocognitive control processes were assessed with the Iowa Gambling Task (IGT), a generic Go/No-Go task, and a food-specific Go/No-Go task. The food-specific version directly ties the task to food cues that trigger responses, addressing an integral link between cue-habit processes. Diet was assessed with self-administered food frequency and binge eating questionnaires. Latent variable models revealed marked gender differences. Inhibitory problems on the food-specific and generic Go/No-Go tasks were significantly correlated with binge eating only in females, whereas inhibitory problems measured with these tasks were the strongest correlates of sweet snack consumption in males. Higher BMI percentile and sedentary behavior also predicted binge eating in females and sweet snack consumption in males. Inhibitory problems on the generic Go/No-Go, poorer affective decision-making on the IGT, and sedentary behavior were associated with sweetened beverage consumption in males, but not females. The food-specific Go/No-Go was not predictive in models evaluating sweetened beverage consumption, providing some initial discriminant validity for the task, which consisted of sweet/fatty snacks as no-go signals and no sugar-sweetened beverage signals. This work extends research findings, revealing gender differences in inhibitory function relevant to behavioral control. Further, the findings contribute to research implicating the relevance of cues in habitual behaviors and their relationship to snack food consumption in an understudied population of diverse adolescents not receiving treatment for eating disorders.

Response inhibition moderates the association between drug use and risky sexual behavior.

BACKGROUND: HIV infection is problematic among all drug users, not only injection drug users. Drug users are at risk for contracting HIV by engaging in risky sexual behaviors. OBJECTIVE: The present study sought to determine whether inhibitory processes moderate the relationship between problematic drug use and HIV-risk behaviors (unprotected sex and multiple sex partners). METHODS: One hundred ninety-six drug offenders enrolled in drug education programs were administered a battery of computer-based assessments. Measures included a cued go/no-go assessment of inhibitory processes, the Drug Abuse Screening Test (DAST) assessment of problematic drug use, and self-report assessment of condom use and multiple sex partners. RESULTS: Findings revealed that response inhibition assessed by the proportion of false alarms on the cued go/no-go moderated the relationship between problematic drug use and an important measure of HIV risk (condom nonuse) among drug offenders. However, response inhibition did not moderate the relationship between problematic drug use and another measure of HIV risk: multiple sex partners. CONCLUSIONS: Among this sample of drug offenders, we have found a relationship between problematic drug use and condom nonuse, which is exacerbated by poor control of inhibition. These findings have implications for the development of HIV intervention components among high-risk populations.

Dual process interaction model of HIV-risk behaviors among drug offenders.

This study evaluated dual process interaction models of HIV-risk behavior among drug offenders. A dual process approach suggests that decisions to engage in appetitive behaviors result from a dynamic interplay between a relatively automatic associative system and an executive control system. One synergistic type of interplay suggests that executive functions may dampen or block effects of spontaneously activated associations. Consistent with this model, latent variable interaction analyses revealed that drug offenders scoring higher in affective decision making were relatively protected from predictive effects of spontaneous sex associations promoting risky sex. Among drug offenders with lower levels of affective decision making ability, spontaneous sexually-related associations more strongly predicted risky sex (lack of condom use and greater number of sex partners). These findings help elucidate associative and control process effects on appetitive behaviors and are important for explaining why some individuals engage in risky sex, while others are relatively protected.

Effects of a one-hour intervention on condom implementation intentions among drug users in Southern California.

Approximately 36% of HIV cases are related to substance abuse. Substance abusers, including non-injection drug users, are at a high-risk for contracting HIV due to risky behaviors, including unprotected sex. Due to these behavioral and infection risks, feasible interventions that focus on condom use within this population are imperative. The current study involved the development of brief intervention designed to increase implementation intentions (situation-linked action plans) to use condoms in convicted non-violent drug offenders participating in drug diversion programs in Southern California. Participants (n = 143) were randomized at the individual level to either waitlist control or experimental conditions. The randomized waitlist control group received the HIV survey for the pre-test before the intervention, while the experimental group received a neutral, non-HIV-related, survey at pre-test. The experimental group received the HIV survey as the post-test after the intervention (waitlist control group received the neutral, non-HIV-related, survey). One-tailed Mann Whitney U tests were used to compare the waitlist control and experimental groups. The experimental group was more likely to report stronger implementation intentions to use condoms (p <0.001). These results indicate in the short term that a brief, easily disseminated HIV intervention can be effective for increasing implementation intentions to use condoms in an extremely high HIV-risk population.

Deliberative and spontaneous cognitive processes associated with HIV risk behavior.

Dual process models of decision-making suggest that behavior is mediated by a spontaneous behavior selection process or by a more deliberative evaluation of behavioral options. We examined whether the deliberative system moderates the influence of spontaneous cognition on HIV-risk behaviors. A measure of spontaneous sex-related associations (word association), a measure of deliberative working memory capacity (operation span), and two measures of sexual behavior (condom use and multiple partners) were assessed in a cross-sectional study among 490 adult drug offenders. Significant effects were observed among men but not among women in two latent interaction models. In a novel finding, the accessibility of spontaneous safe sex-related associations was significantly more predictive of condom use among men with higher working memory capacity than among men with lower capacity. These results have implications for the design of interventions to promote safe sex practices.

Sweetened drink and snacking cues in adolescents: a study using ecological momentary assessment.

The objective of this study was to identify physical, social, and intrapersonal cues that were associated with the consumption of sweetened beverages and sweet and salty snacks among adolescents from lower SES neighborhoods. Students were recruited from high schools with a minimum level of 25% free or reduced cost lunches. Using ecological momentary assessment, participants (N=158) were trained to answer brief questionnaires on handheld PDA devices: (a) each time they ate or drank, (b) when prompted randomly, and (c) once each evening. Data were collected over 7days for each participant. Participants reported their location (e.g., school grounds, home), mood, social environment, activities (e.g., watching TV, texting), cravings, food cues (e.g., saw a snack), and food choices. Results showed that having unhealthy snacks or sweet drinks among adolescents was associated with being at school, being with friends, feeling lonely or bored, craving a drink or snack, and being exposed to food cues. Surprisingly, sweet drink consumption was associated with exercising. Watching TV was associated with consuming sweet snacks but not with salty snacks or sweet drinks. These findings identify important environmental and intrapersonal cues to poor snacking choices that may be applied to interventions designed to disrupt these food-related, cue-behavior linked habits.

Scary in the eye of the beholder: Attentional bias and attentional retraining for social anxiety.

Consistent with cognitive models of social anxiety, socially anxious individuals show cognitive biases that magnify their perceived level of threat in the environment. OBJECTIVES: The first objective was to determine whether attentional bias for socially threatening stimuli occurs after concomitant depression has been controlled. The second objective was to test the effectiveness of the Attention Control Training Program for Social Anxiety (ACTP-SA) for reducing social anxiety attentional bias and improving therapeutic indices in people with social anxiety. METHOD: In the first study, socially anxious (N = 30) and non-anxious individuals (N = 30) completed the Beck Depression Inventory-II, Spielberger's State-Trait Anxiety Inventory, Conner's Social Phobia Inventory, a social-anxiety Stroop test, and a clinical interview. In the second study, individuals with social anxiety (N = 30) were randomly assigned to an experimental group that received 4 sessions of ACTP-SA, or to a sham-intervention control condition. At the post-test and a 3-month follow-up, both groups completed the same measures as in Study 1. RESULTS: In Study 1, socially anxious individuals showed higher attentional bias for threatening stimuli than the controls, after depression had been controlled for. In Study 2, participants in the experimental group, compared with the controls, showed greater reductions in attentional bias, social anxiety, and trait anxiety at post-test and follow-up. CONCLUSIONS: The results underscore the importance of information processing biases in social anxiety and the benefits of attentional bias training as a complementary intervention for modifying symptoms of social anxiety.