Real-world nudging, pricing, and mobile physical activity coaching was insufficient to improve lifestyle behaviours and cardiometabolic health: the Supreme Nudge parallel cluster-randomised controlled supermarket trial.

BACKGROUND: Context-specific interventions may contribute to sustained behaviour change and improved health outcomes. We evaluated the real-world effects of supermarket nudging and pricing strategies and mobile physical activity coaching on diet quality, food-purchasing behaviour, walking behaviour, and cardiometabolic risk markers. METHODS: This parallel cluster-randomised controlled trial included supermarkets in socially disadvantaged neighbourhoods across the Netherlands with regular shoppers aged 30-80 years. Supermarkets were randomised to receive co-created nudging and pricing strategies promoting healthier purchasing (N = 6) or not (N = 6). Nudges targeted 9% of supermarket products and pricing strategies 3%. Subsequently, participants were individually randomised to a control (step counter app) or intervention arm (step counter and mobile coaching app) to promote walking. The primary outcome was the average change in diet quality (low (0) to high (150)) over all follow-up time points measured with a validated 40-item food frequency questionnaire at baseline and 3, 6, and 12 months. Secondary outcomes included healthier food purchasing (loyalty card-derived), daily step count (step counter app), cardiometabolic risk markers (lipid profile and HbA1c via finger prick, and waist circumference via measuring tape), and supermarket customer satisfaction (questionnaire-based: very unsatisfied (1) to very satisfied (7)), evaluated using linear mixed-models. Healthy supermarket sales (an exploratory outcome) were analysed via controlled interrupted time series analyses. RESULTS: Of 361 participants (162 intervention, 199 control), 73% were female, the average age was 58 (SD 11) years, and 42% were highly educated. Compared to the control arm, the intervention arm showed no statistically significant average changes over time in diet quality (ߠ- 1.1 (95% CI - 3.8 to 1.7)), percentage healthy purchasing (ß 0.7 ( - 2.7 to 4.0)), step count (ߠ- 124.0 (- 723.1 to 475.1), or any of the cardiometabolic risk markers. Participants in the intervention arm scored 0.3 points (0.1 to 0.5) higher on customer satisfaction on average over time. Supermarket-level sales were unaffected (ß - 0.0 (- 0.0 to 0.0)). CONCLUSIONS: Co-created nudging and pricing strategies that predominantly targeted healthy products via nudges were unable to increase healthier food purchases and intake nor improve cardiometabolic health. The mobile coaching intervention did not affect step count. Governmental policy measures are needed to ensure more impactful supermarket modifications that promote healthier purchases. TRIAL REGISTRATION: Dutch Trial Register ID NL7064, 30 May 2018, https://www.onderzoekmetmensen.nl/en/trial/20990.

Perceptions of antibiotic resistance among hospital healthcare professionals in high-income countries: A systematic review of causes, consequences, and solutions.

OBJECTIVE: Antibiotic resistance (ABR) is a major threat to public health. Hospital healthcare professionals are important stakeholders in curbing ABR. To be able to encourage healthcare professionals to act against ABR, information on their perceptions is needed. Yet, summary evidence on how healthcare professionals perceive ABR causes, consequences, and solutions is outdated. This review aims to elucidate these perceptions. METHODS: We searched MEDLINE, EMBASE, PsycINFO, and CINAHL for literature published until July 6th, 2022, and used Web of Science and Scopus to identify reports citing included studies. Reports of quantitative original research from high-income countries were included if they investigated hospital healthcare professionals' perceptions about ABR. Descriptive data and data on perceptions about causes, consequences, and solutions regarding ABR were extracted. PROSPERO registration: CRD42022359249. RESULTS: The database search and citation tracking yielded 13,551 and 694 papers respectively. Forty-eight reports from 46 studies were included in the review. These studies were performed between 1999 and 2023 and included between 8 and 1362 participants. Healthcare professionals perceived ABR as a problem that is more severe nationally than locally and they primarily recognize ABR as a distant and abstract problem. Studies mostly concurred on prescribing behavior as a cause and a solution for ABR, while external causes and solutions (e.g., in agriculture) elicited less agreement. CONCLUSIONS: Studies with a primary focus on the perceptions of healthcare professionals about ABR are limited. Healthcare professionals perceive prescribing behavior as a major cause of ABR and a focus area for ABR solutions.

Barriers and facilitators of implementation of new antibacterial technologies in patient care: an interview study with orthopedic healthcare professionals at a university hospital.

BACKGROUND: Antimicrobial resistance is a major global health threat. Therefore, promising new antibacterial technologies that could minimize our dependence on antibiotics should be widely adopted. This study aims to identify the barriers and facilitators of the adoption of new antibacterial technologies in hospital patient care. METHODS: Semi-structured interviews, based on the Consolidated Framework for Implementation Research, were conducted with healthcare professionals related to the orthopedics department of an academic hospital in The Netherlands. RESULTS: In total, 11 healthcare professionals were interviewed. Scientific evidence for the effectiveness of the technology was the most explicitly mentioned facilitator of adoption, but other (often contextual) factors were also considered to be important. At the level of the inner and outer setting, high costs and lacking coverage, competition from other firms, and problems with ordering and availability were the most explicit perceived barriers to adoption. Participants did not collectively feel the need for new antibacterial technologies. CONCLUSIONS: Barriers and facilitators of the adoption of new antibacterial technologies were identified related to the technology, the hospital, and external factors. The implementation climate might have an indirect influence on adoption. New antibacterial technologies that are scientifically proven effective, affordable, and easily obtainable will most likely be adopted.

Buffering against exposure to mental health misinformation in online communities on Facebook: the interplay of depression literacy and expert moderation.

BACKGROUND: The proliferation of health misinformation on social media is a growing public health concern. Online communities for mental health (OCMHs) are also considered an outlet for exposure to misinformation. This study explored the impact of the self-reported volume of exposure to mental health misinformation in misinformation agreement and the moderating effects of depression literacy and type of OCMHs participation (expert vs. peer-led). METHODS: Participants (n = 403) were recruited in Italian-speaking OCMHs on Facebook. We conducted regression analyses using PROCESS macro (moderated moderation, Model 3). Measures included: the Depression Literacy Questionnaire (Griffiths et al., 2004), the self-reported misinformation exposure in the OCMHs (3 items), and misinformation agreement with the exposure items (3 items). Whether participants were members of expert or peer-led OCMHs was also investigated. RESULTS: The final model explained the 12% variance in the agreement. There was a positive and significant relationship between misinformation exposure and misinformation agreement (ß = 0.3221, p < .001), a significant two-way interaction between misinformation exposure and depression literacy (ß = - 0.2179, p = .0014 ), and between self-reported misinformation exposure and type of OCMH (ß = - 0.2322, p = .0254), such that at higher levels of depression literacy and in case of participation to expert-led OCMHs, the relationship misinformation exposure-misinformation agreement was weaker. Finally, a three-way interaction was found (ß = 0.2497, p = .0144) that showed that depression literacy moderated the positive relationship between misinformation exposure and misinformation agreement such that the more misinformation participants were exposed to, the more they agreed with it unless they had higher levels of depression literacy; this, however, occurred only if they participated in peer-led groups. CONCLUSIONS: Results provide evidence that the more members reported being exposed to mental health misinformation, the more they tended to agree with it, however this was only visible when participants had lower depression literacy and were participating in peer-led OCMHs. Results of this study suggest that both internal factors (i.e., high depression literacy) and external factors (the type of online community individuals were participating in) can buffer the negative effects of misinformation exposure. It also suggests that increasing depression literacy and expert community moderation could curb the negative consequences of misinformation exposure related to mental health. Results will guide interventions to mitigate the effects of misinformation in OCMHs, including encouraging health professionals in their administration and implementing health education programs.

The Empowering Role of Web-Based Help Seeking on Depressive Symptoms: Systematic Review and Meta-analysis.

BACKGROUND: Most research on web-based help seeking for mental health problems has focused on the antecedents of this behavior. Therefore, little is known about the outcomes of web-based help seeking in general or in specific mental health issues. OBJECTIVE: This study was a systematic review and meta-analysis of the literature on the antecedents and consequences of web-based help-seeking behaviors for depressive symptoms. METHODS: A systematic literature search was carried out in 6 scientific databases, leading to 48 studies (for a total of 314,921 participants) included in the qualitative synthesis and 19 included in the meta-analysis. RESULTS: The results indicated a positive relationship between depressive symptoms and web-based help-seeking behaviors through online support groups (r=0.089; P=.009), and Generation Z (r=0.102; P=.008) tended to participate in support groups more than previous generations. In addition, web-based help seeking was positively related to empowerment (r=0.245; P=.004). Other forms of support reported included the internet and specific self-help tools, but no significant relationships were found with depressive symptoms. CONCLUSIONS: More studies examining the outcomes are needed, together with a more rigorous assessment of web-based help-seeking behaviors. Ultimately, we propose a summary framework for the literature on this topic, including the antecedents, patterns of use, and outcomes of web-based help seeking in the context of depressive symptoms.

The "Loci" of Misinformation and Its Correction in Peer- and Expert-Led Online Communities for Mental Health: Content Analysis.

BACKGROUND: Mental health problems are recognized as a pressing public health issue, and an increasing number of individuals are turning to online communities for mental health to search for information and support. Although these virtual platforms have the potential to provide emotional support and access to anecdotal experiences, they can also present users with large amounts of potentially inaccurate information. Despite the importance of this issue, limited research has been conducted, especially on the differences that might emerge due to the type of content moderation of online communities: peer-led or expert-led. OBJECTIVE: We aim to fill this gap by examining the prevalence, the communicative context, and the persistence of mental health misinformation on Facebook online communities for mental health, with a focus on understanding the mechanisms that enable effective correction of inaccurate information and differences between expert-led and peer-led groups. METHODS: We conducted a content analysis of 1534 statements (from 144 threads) in 2 Italian-speaking Facebook groups. RESULTS: The study found that an alarming number of comments (26.1%) contained medically inaccurate information. Furthermore, nearly 60% of the threads presented at least one misinformation statement without any correction attempt. Moderators were more likely to correct misinformation than members; however, they were not immune to posting content containing misinformation, which was an unexpected finding. Discussions about aspects of treatment (including side effects or treatment interruption) significantly increased the probability of encountering misinformation. Additionally, the study found that misinformation produced in the comments of a thread, rather than as the first post, had a lower probability of being corrected, particularly in peer-led communities. CONCLUSIONS: The high prevalence of misinformation in online communities, particularly when left uncorrected, underscores the importance of conducting additional research to identify effective mechanisms to prevent its spread. This is especially important given the study's finding that misinformation tends to be more prevalent around specific "loci" of discussion that, once identified, can serve as a starting point to develop strategies for preventing and correcting misinformation within them.

Effectiveness and acceptability of conversational agents for sexual health promotion: a systematic review and meta-analysis.

Digital health interventions for sexual health promotion have evolved considerably alongside innovations in technology. Despite these efforts, studies have shown that they do not consistently result in the desired sexual health outcomes. This could be attributed to low levels of user engagement, which can hinder digital health intervention effectiveness, as users do not engage with the system enough to be exposed to the intervention components. It has been suggested that conversational agents (automated two-way communication systems e.g. Alexa) have the potential to overcome the limitations of prior systems and promote user engagement through the increased interactivity offered by bidirectional, natural language-based interactions. The present review, therefore, provides an overview of the effectiveness and user acceptability of conversational agents for sexual health promotion. A systematic search of seven databases provided 4534 records, and after screening, 31 articles were included in this review. A narrative synthesis of results was conducted for effectiveness and acceptability outcomes, with the former supplemented by a meta-analysis conducted on a subset of studies. Findings provide preliminary support for the effectiveness of conversational agents for promoting sexual health, particularly treatment adherence. These conversational agents were found to be easy to use and useful, and importantly, resulted in high levels of satisfaction, use and intentions to reuse, whereas user evaluations regarding the quality of information left room for improvement. The results can inform subsequent efforts to design and evaluate these interventions, and offer insight into additional user experience constructs identified outside of current technology acceptance models, which can be incorporated into future theoretical developments.

(No) escape from reality? Cigarette craving in virtual smoking environments.

Cue-Exposure Therapy (CET) is considered an effective strategy to combat cigarette cravings and smoking relapses, but evidence is mixed. In this lab-based experimental study, we manipulated levels of realism for smoking scenarios in Virtual Environments (VE) and randomly exposed smokers and recent-quitters to one of two versions (low versus high realism) of these scenarios. Prior and after scenario exposure, valid measures of cigarette craving were obtained. Prior to exposure, we assessed nicotine dependence and smoking status (current smokers versus recent-quitter). Within-subject repeated measures analysis of covariance showed that there was an interaction of experimental condition with smoking status on cigarette craving. Amongst recent-quitters, high realistic scenarios produced stronger increases in craving than low realistic scenarios, but this effect was reversed in current smokers. It is concluded that VE technologies are a potentially relevant tool for smoking CET that warrant further exploration.

Intervening through Conversations: How Instructions Influence Conversational Valence and Binge Drinking Determinants.

A promising avenue for health behavior change is to influence conversational valence, that is, the extent to which people talk negatively or positively about health behaviors. However, no research to date has experimentally manipulated conversational valence, thereby inhibiting conclusions about causal inferences. This study aims to fill this gap by investigating the influence of conversational valence instructions on perceived conversational valence and subsequent binge drinking determinants. College students (N = 138) read either negative or positive conversational valence instructions. Subsequently, dyads engaged in a 5-min conversation about drinking, before self-reporting perceived conversational valence and binge drinking determinants (i.e., attitudes, norms, perceived behavioral control, and intentions). Results revealed that valence instructions influenced binge drinking determinants via perceived conversational valence. Those instructed to talk negatively about binge drinking reported healthier binge drinking determinants than those instructed to talk positively. Furthermore, this effect on binge drinking determinants was mediated by perceived conversational valence. These findings demonstrate that conversational valence about health can be manipulated through simple instructions and confirm the idea that conversational valence is causally linked to binge drinking determinants. Thereby, these findings show the potential that interpersonal communication in general, and conversational valence instructions, in particular, have when integrated in health interventions.

Reducing cardiometabolic risk in adults with a low socioeconomic position: protocol of the Supreme Nudge parallel cluster-randomised controlled supermarket trial.

BACKGROUND: Unhealthy lifestyle behaviours such as unhealthy dietary intake and insufficient physical activity (PA) tend to cluster in adults with a low socioeconomic position (SEP), putting them at high cardiometabolic disease risk. Educational approaches aiming to improve lifestyle behaviours show limited effect in this population. Using environmental and context-specific interventions may create opportunities for sustainable behaviour change. In this study protocol, we describe the design of a real-life supermarket trial combining nudging, pricing and a mobile PA app with the aim to improve lifestyle behaviours and lower cardiometabolic disease risk in adults with a low SEP. METHODS: The Supreme Nudge trial includes nudging and pricing strategies cluster-randomised on the supermarket level, with: i) control group receiving no intervention; ii) group 1 receiving healthy food nudges (e.g., product placement or promotion); iii) group 2 receiving nudges and pricing strategies (taxing of unhealthy foods and subsidizing healthy foods). In collaboration with a Dutch supermarket chain we will select nine stores located in low SEP neighbourhoods, with the nearest competitor store at > 1 km distance and managed by a committed store manager. Across the clusters, a personalized mobile coaching app targeting walking behaviour will be randomised at the individual level, with: i) control group; ii) a group receiving the mobile PA app. All participants (target n = 1485) should be Dutch-speaking, aged 45-75 years with a low SEP and purchase more than half of their household grocery shopping at the selected supermarkets. Participants will be recruited via advertisements and mail-invitations followed by community-outreach methods. Primary outcomes are changes in systolic blood pressure, LDL-cholesterol, HbA1c and dietary intake after 12 months follow-up. Secondary outcomes are changes in diastolic blood pressure, blood lipid markers, waist circumference, steps per day, and behavioural factors including healthy food purchasing, food decision style, social cognitive factors related to nudges and to walking behaviours and customer satisfaction after 12 months follow-up. The trial will be reflexively monitored to support current and future implementation. DISCUSSION: The findings can guide future research and public health policies on reducing lifestyle-related health inequalities, and contribute to a supermarket-based health promotion intervention implementation roadmap. TRIAL REGISTRATION: Dutch Trial Register ID NL7064, 30th of May, 2018.

To frame or not to frame? Effects of message framing and risk priming on mouth rinse use and intention in an adult population-based sample.

Good dental hygiene is key to public health. To promote dental hygiene behaviours, persuasive messages are key. Message framing is a popular theory that has seen mixed evidence. In this web-based experimental study, interaction effects of message frame, behavioural function, and risk priming were investigated on mouth rinse use and intentions in a representative sample of Dutch adults. Final included sample contained 549 participants (50.1% male, mean age = 47.4, SD = 16.1) and outcomes were immediate mouth rinse product choice, intentions to use mouth rinse, and mouth rinse behaviour at 2-week follow-up. Results demonstrated a theorized significant interaction between message frame and behavioural function were mouth rinse product choice. Two-week follow-up mouth rinse behaviour was affected by an interaction between message frame and risk prime. Message framing can thus be employed to promote dental health, but it requires attention to moderation effects which are inconsistent across behavioural outcomes.

Improving cardiometabolic health through nudging dietary behaviours and physical activity in low SES adults: design of the Supreme Nudge project.

BACKGROUND: Initiating and maintaining a healthy lifestyle -including healthy eating and sufficient physical activity- is key for cardiometabolic health. A health-promoting environment can facilitate a healthy lifestyle, and may be especially helpful to reach individuals with a lower socio-economic status (SES). In the Supreme Nudge project, we will study the effects of pricing and nudging strategies in the supermarket - one of the most important point-of-choice settings for food choices - and of a context-specific mobile physical activity promotion app. This paper describes the stepwise and theory-based design of Supreme Nudge, which aims to develop, implement and evaluate environmental changes for a sustained impact on lifestyle behaviours and cardiometabolic health in low SES adults. METHODS: Supreme Nudge uses a multi-disciplinary and mixed methods approach, integrating participatory action research, qualitative interviews, experimental pilot studies, and a randomized controlled trial in a real-life (supermarket) setting. First, we will identify the needs, characteristics and preferences of the target group as well as of the participating supermarket chain. Second, we will conduct a series of pilot studies to test novel, promising and feasible intervention components. Third, a final selection of intervention components will be implemented in a full-scale randomised controlled supermarket trial. Approximately 1000 low SES adults will be recruited across 8-12 supermarkets and randomised at supermarket level to receive 1) no intervention (control); 2) environmental nudges such as food product placement or promotion; 3) nudges and a tailored physical activity app that provides time- and context specific feedback; 4) pricing interventions, nudges, and the physical activity app. The effects on dietary behaviours and physical activity will be evaluated at 3, 6 and 12 months, and on cardiometabolic health at 6 and 12 months. Finally, we will evaluate the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of the intervention, and we will use insights from System Innovation and Transition Management theories to define the best strategies for implementation and upscaling beyond the study period. DISCUSSION: The Supreme Nudge project is likely to generate thorough evidence relevant for policy and practice on the effects of a mixed method and multi-disciplinary intervention targeting dietary behaviours and physical activity. TRIAL REGISTRATION: The real-life trial has been registered on 30 May 2018, NTR7302 .

Effects of preparatory and action planning instructions on situation-specific and general fruit and snack intake.

Evidence to date suggests heterogeneity in the effects of implementation intentions on health behaviour, including diet. Additional variables and study designs may impact on their effectiveness. Preparatory action, such as making sure fruits are available for consumption, may be an important additional variable. Likewise, most implementation intention research has focused on changes in general intake, yet implementation intention instructions typically require participants to consider behaviour in specific situations. Little is known on how implementation intentions impact situation-specific intake. The present study sought to add to the evidence base by comparing (1) the effects of action planning instructions versus preparatory planning instructions on (2) both situation-specific (as formulated in the implementation intention instruction) and general intake of fruits and in-between meal snack intake frequency. Fruit intake was assessed in average pieces per day, whereas snacking intake was assessed as average frequency in days per week. Using non-probability sampling, 243 undergraduate students who intended to have a healthy diet were randomized to either a standard information control condition, an action planning condition, or a preparatory planning condition. Planning manipulations were based on previous work. Two weeks later, general and situation-specific intake was assessed again in 181 participants. Data were analysed using 2 (time) x 3 (conditions) analyses of variance. Results showed that both planning manipulations were successful in decreasing snack intake frequency in the specified situation, with larger effect sizes for the action planning condition than for the preparatory planning condition. No effects were found on general snack intake frequency or fruit intake. Future planning interventions should more explicitly compare changes in situational and general intake, as well as simultaneously assessed decreases in unhealthy intake and increases in healthy intake.

Testing the effects of a message framing intervention on intentions towards hearing loss prevention in adolescents.

Adolescent hearing loss is a public health problem that has eluded effective intervention. A persuasive message strategy was tested for its effectiveness on adolescents' intention to listen to music at a reduced volume. The messages manipulated both type of message frame [positive consequences of listening to music at a reduced volume (gain-framed) versus negative consequences of not listening to music at a reduced volume (loss-framed)] and type of temporal context (short-term versus long-term consequences). Participants were recruited from four vocational and secondary education schools in the Netherlands and message exposure took place online during class hours. Two weeks prior to message exposure, adolescents provided data on intention and risk perception towards hearing loss and use of (digital) music players. After message exposure, 194 adolescents (mean age = 14.71 years, SD = 1.00, 37.8% males) provided immediate follow-up data on intention. Results revealed that intention to listen to music at a reduced volume increased in those exposed to a loss-framed message with short-term consequences. No changes were found in the other conditions. Messages that emphasize negative short-term consequences of not listening to music at a moderate volume have the ability to influence adolescents' intention towards hearing loss prevention.

Temporal Consequences, Message Framing, and Consideration of Future Consequences: Persuasion Effects on Adult Fruit Intake Intention and Resolve.

Message framing is a persuasive strategy that has seen mixed evidence for promoting fruit intake intentions, potentially because framed messages for fruit intake have not (a) explicitly compared short-term consequences versus long-term consequences, (b) considered individual-level differences in time perspective, and (c) used alternative measures of fruit intake intentions. In the present online study, the effects of persuasive messages created from temporal context (short term vs. long term) and message frame (gain framed vs. loss framed) were investigated on fruit intake intentions and resolve among a sample of Dutch adults who were categorized as either present oriented or future oriented. For intention and resolve, results showed a significant Type of Frame × Type of Temporal Context interaction, such that gain-framed messages were more persuasive when combined with long-term consequences and loss-framed messages were more persuasive when combined with short-term consequences. The effect sizes for these differences were similar for resolve and intention, but only differences for intentions were significant. No other effects were found. These results demonstrate that message framing theory may usefully consider the inclusion of temporal context of outcomes and alternative motivation measures to maximize their persuasive effects.

Online and Offline Conversations About Alcohol: Comparing the Effects of Familiar and Unfamiliar Discussion Partners.

Although research has demonstrated that interpersonal communication about alcohol influences drinking behaviors, this notion has mainly been examined in offline contexts with familiar conversation partners. The present study investigated how communication mode and familiarity influence conversational valence (i.e., how negatively or positively people talk) and binge drinking norms. During a 2 (offline vs. online communication) × 2 (unfamiliar vs. familiar conversation partner) lab experiment, participants (N = 76) were exposed to an anti-binge drinking campaign, after which they discussed binge drinking and the campaign. Binge drinking norms were measured 1 week before and directly after the discussion. Results revealed that conversations between unfamiliar conversation partners were positive about the campaign, especially in offline settings, subsequently leading to healthier binge drinking norms. We recommend that researchers further investigate the influence of communication mode and familiarity on discussion effects, and we suggest that health promotion attempts might benefit from eliciting conversations about anti-binge drinking campaigns between unfamiliar persons.

Subjective Reality: The Influence of Perceived and Objective Conversational Valence on Binge Drinking Determinants.

Previous studies have shown that interpersonal communication, and particularly perceived conversational valence (i.e., the perceived negativity or positivity of conversations) about health topics, influences health determinants. On the basis of 43 dyads (N = 86) discussing the topic of alcohol consumption, this study is the first to show that whereas perceived and objective conversational valence are positively related, only perceived conversational valence is a significant predictor of binge drinking attitudes and intentions. Thus, subjective reality matters more than objective reality. Furthermore, only the perceived valence of the participants' own contributions-and not of their conversation partners--influences binge drinking intentions, indicating that self-persuasion is more influential than persuasion by others. Thus, conversations in which discussants themselves express negative opinions about unhealthy behaviors can enhance public health.

Effects of Issue Involvement and Framing of a Responsible Drinking Message on Attitudes, Intentions, and Behavior.

To decrease the prevalence and the amount of alcohol consumption among students, health messages advocating responsible alcohol behavior can be used. However, it is unclear whether responsible drinking messages are most effective when they use a gain frame, presenting the advantages of responsible drinking, or a loss frame, presenting the disadvantages of irresponsible drinking. This study tests the effects of framing and the moderating role of involvement with the issue of responsible drinking. A three-wave, between-subjects, experimental study was conducted, in which participants (N = 90) were exposed to either a gain- or loss-framed message about responsible drinking behavior at Wave 2. At all three waves, attitudes, intentions and behavior toward responsible drinking were measured. Results showed that for participants with low issue- involvement, a gain frame led to more positive attitudes and intentions toward responsible alcohol use, whereas a loss frame did not have any effects for them. For participants with high issue involvement, a loss frame led to more positive attitudes and intentions toward responsible alcohol use, whereas a gain frame did not have an effect on attitude and only a delayed effect on intention. However, there were no effects of frame and issue involvement on adhering to the guideline of responsible alcohol use and average drinking behavior.

Predicting automaticity in exercise behaviour: the role of perceived behavioural control, affect, intention, action planning, and behaviour.

BACKGROUND: Habit formation has been proposed as a way to maintain behaviour over time. PURPOSE: Recent evidence suggests that constructs additional to repeated performance may predict physical automaticity, but no research has yet explored possible direct impacts of intention, planning, affect, and perceived behavioural control (PBC) on automaticity. METHOD: In a prospective study over a 2-week period amongst 406 undergraduate students (M age = 21.5 years [SD = 2.59], 27.4 % males), we investigated main and interaction effects of past exercise behaviour, PBC, intention, planning, and affect on exercise automaticity. RESULTS: Results showed that - controlling for past behaviour - PBC, affect, and planning were significant and positive predictors of exercise automaticity. Decomposing a significant interaction between PBC and planning when to exercise revealed that planning became less predictive of exercise automaticity at higher levels of PBC. CONCLUSION: Findings show that exercise automaticity is predicted by repeated performance and social-cognitive constructs. Further, interactions between social-cognitive predictors may be different for behavioural automaticity than for behavioural frequency.