[Perspective Paper "Future Prevention Research" - Current and Future Coordinated Research on Prevention and Health Promotion]. / Perspektivpapier "Zukunft Präventionsforschung": Koordinierte Forschung zu Prävention und Gesundheitsförderung ­ aktuell und in der Zukunft.

From 2014 to 2022, the BMBF has funded five research networks in prevention research and health promotion that are also jointly coordinated (Research Network Primary Prevention and Health Promotion, www.fp2g.net). The researchers have produced a large number of relevant research outputs with insights gained into essential aspects of prevention research and health promotion. The networks research focused on basic principles, application-relevant findings, and implementation conditions of long-term prevention and health promotion for non-communicable diseases (NCDs). The constraints imposed by the pandemic from 2020 onwards were partly addressed by integrating Corona-related research and transfer activities. The importance of resilience for dealing with multiple health and social challenges got increased attention and was analyzed and discussed during the pandemic. For prevention research, research questions such as how to better implement prevention measures through digital tools are gaining additional importance. Together, the research networks have presented achievements and desiderata for future research. This perspective paper with its nine theses formulated in conclusion is intended as a stimulus for discussion among funders as well as the communty of researchers on the subject of successful prevention and health promotion. It is explicitly part of the continuity of the memoranda on prevention research developed in 2012.

The Role of Personal Risk Experience-An Investigation of Health and Terrorism Risk Perception in Germany and Israel.

The present study examined the relationship between risk experience and risk perceptions in relation to the target (risk to the self vs. others) and for two different types of risk: acute risks (i.e., terrorist attacks) and cumulative health risks (i.e., alcohol consumption, tobacco consumption, and unhealthy eating) in two countries (Israel and Germany). An online survey (N = 571) was conducted to assess participants' previous personal experience with acute and cumulative risks and their personal and general risk perceptions. The results showed that personal experience with terrorism was related to increased personal and general risk perceptions, while personal experience with cumulative health risks was related to increased personal but not general risk perceptions. It is argued that an increase in risk perception with more risk experience can be explained by the amount of available information about people's personal as well as other people's risk status. The findings emphasize that the experience-risk perception relationship depends on the target of the risk and the type of risk experience.

Pessimistic health and optimistic wealth distributions perceptions in Germany and the UK: evidence from an online-survey.

BACKGROUND: Inequalities in health and wealth distributions are becoming pressing societal problems in many countries. How these inequalities are perceived and to what degree perceptions are aligned with actual distributions, is important for trust in public health services, social and economic policies, and policymakers. This study aims to assess perceived and desired levels of inequality in health and wealth in Germany and the UK. METHODS: The online-survey was filled out by 769 volunteers (322 from Germany, 447 from the UK), recruited from an existing commercial panel (Prolific Academic) or via Facebook advertisements in 2019. Perceived and ideal national health and wealth distributions were assessed and compared to actual health indicators (i.e. days absent from work, number of visits to general practitioners (GPs) and self-rated health), and actual wealth distributions with t-tests. RESULTS: A pronounced gap emerged between the estimated, ideal and actual inequality. Both samples strikingly underestimated the proportion of (very) good health in the national distribution by a factor of ~ 2.3 (participants estimated that 34% of the German and 36% of the UK population respectively are very healthy or healthy, while the actual proportion in the population was 75% in Germany and 84% in the UK, P < 0.001 for all). Moreover, actual health distributions were much closer to the desired than the perceived health distributions (78% of German and 72% of UK participants ideally being very healthy or healthy). A reversed pattern of results emerged for wealth in both samples, with wealth inequality being strikingly worse than desired and inequality being underestimated by a factor ~ 1.7 (P < 0.001 for all). Results were consistent across demographic groups. CONCLUSIONS: Respondents in both Germany and the UK have profoundly negative misperceptions regarding the distribution of health, which contrasts with starkly positive misperceptions regarding the distribution of wealth, indicating that the public is healthier but poorer than they think. More importantly, from a public health perspective, a high level of consensus emerged, with both healthy and wealthy participants misperceiving health and wealth distributions.

Stigmatization of Chinese and Asian-looking people during the COVID-19 pandemic in Germany.

BACKGROUND: The outbreak and global spread of COVID-19 was accompanied by an increase in reports of stigmatization of Chinese and Asian-looking people. The behavioral immune system provides a framework for stigmatization in response to infectious disease threats. Specifically, stigmatization might increase with rising levels of infectious disease threat. The present study aimed to examine this hypothesis during the early phase of the COVID-19 pandemic. METHODS: As part of the "EUCLID" project ( https://euclid.dbvis.de ), a total of 5011 persons from Germany were surveyed via an online-questionnaire between February 2nd and April 3rd, 2020, covering the progression of the COVID-19 pandemic over three time periods which were defined by critical events. RESULTS: There was no evidence for an increase in the stigmatization of Chinese and Asian-looking people across three topics, that is personal proximity, air travel, and medical measures upon arrival from China. CONCLUSIONS: The present findings provide good news in that participants showed an adaptive response to the infectious disease threat rather than displaying increased stigmatization. Further research is necessary to specify the conditions that increase the risk of stigmatization in response to infectious disease threats.

Dynamic Risk Perceptions in Times of Avian and Seasonal Influenza Epidemics: A Repeated Cross-Sectional Design.

Infectious diseases pose a serious threat to humans. Therefore, it is crucial to understand how accurately people perceive these risks. However, accuracy can be operationalized differently depending on the standard of comparison. The present study investigated accuracy in risk perceptions for three infectious diseases (avian influenza, seasonal influenza, common cold) using three different standards for accuracy: Social comparison (self vs. others' risk perceptions), general problem level (risk perceptions for diseases with varying threat levels), and dynamic problem level (risk perceptions during epidemics/seasons vs. nonepidemic/off-season times). Four online surveys were conducted using a repeated cross-sectional design. Two surveys were conducted during epidemics/seasons of avian influenza, seasonal influenza, and common cold in 2006 (n = 387) and 2016 (n = 370) and two surveys during nonepidemic/off-season times for the three diseases in 2009 (n = 792) during a swine flu outbreak and in 2018 (n = 422) during no outbreak of zoonotic influenza. While on average participants felt less at risk than others, indicating an optimistic bias, risk perceptions matched the magnitude of risk associated with the three infectious diseases. Importantly, a significant three-way interaction indicated dynamic accuracy in risk perceptions: Participants felt more at risk for seasonal influenza and common cold during influenza and cold seasons, compared with off-season times. However, these dynamic increases were more pronounced in the perceived risk for others than for oneself (optimistic bias). The results emphasize the importance of using multiple approaches to assess accuracy of risk perception as they provided different information on how accurately people gauge their risk when facing infectious diseases.

The four weeks before lockdown during the COVID-19 pandemic in Germany: a weekly serial cross-sectional survey on risk perceptions, knowledge, public trust and behaviour, 3 to 25 March 2020.

BackgroundDuring the COVID-19 pandemic, public perceptions and behaviours have had to adapt rapidly to new risk scenarios and radical behavioural restrictions.AimTo identify major drivers of acceptance of protective behaviours during the 4-week transition from virtually no COVID-19 cases to the nationwide lockdown in Germany (3-25 March 2020).MethodsA serial cross-sectional online survey was administered weekly to ca 1,000 unique individuals for four data collection rounds in March 2020 using non-probability quota samples, representative of the German adult population between 18 and 74 years in terms of age × sex and federal state (n = 3,910). Acceptance of restrictions was regressed on sociodemographic variables, time and psychological variables, e.g. trust, risk perceptions, self-efficacy. Extraction of homogenous clusters was based on knowledge and behaviour.ResultsAcceptance of restrictive policies increased with participants' age and employment in the healthcare sector; cognitive and particularly affective risk perceptions were further significant predictors. Acceptance increased over time, as trust in institutions became more relevant and trust in media became less relevant. The cluster analysis further indicated that having a higher education increased the gap between knowledge and behaviour. Trust in institutions was related to conversion of knowledge into action.ConclusionIdentifying relevant principles that increase acceptance will remain crucial to the development of strategies that help adjust behaviour to control the pandemic, possibly for years to come. Based on our findings, we provide operational recommendations for health authorities regarding data collection, health communication and outreach.

[Evidence-based primary prevention and health promotion: methods and procedures in 5 research consortia]. / Evidenzbasierung in Primärprävention und Gesundheitsförderung: Methoden und Vorgehensweisen in 5 Forschungsverbünden.

Between 2014 and 2022, the 5 German research networks AEQUIPA, CAPITAL4HEALTH, HLCA, PartKommPlus, and SMARTACT are investigating topics of primary prevention and health promotion with the aim of further deepening the evidence base in these areas. The work of the 5 research networks for primary prevention and health promotion is presented, analysed, and discussed from an internal perspective. A model of evidence-based public health serves as a structuring framework.The 5 research networks use a variety of access routes for the generation of evidence with regard to the participation of nonacademic, civil society actors and users. There is a wide range of study designs - from randomised controlled trials and systematic reviews to diverse qualitative designs. The use of models and theories supports the evidence base. Beyond evidence generation, all research networks focus on at least exemplary implementation of new evidence.Due to the diversity of methods, a diversified evidence-based approach can be realised, taking into account network-specific aspects. Structural circumstances limit the further systematic strengthening of the evidence base. In particular, the involvement of nonacademic, civil society actors for the work with hard-to-reach target groups often cannot be financed or is considered too time consuming under the given circumstances. The COVID-19 pandemic highlights the importance of a flexible spectrum of methods, employing both digital and analogue methods in a meaningful way.

Strong health messages increase audience brain coupling.

Mass media messaging is central for health communication. The success of these efforts, however, depends on whether health messages resonate with their target audiences. Here, we used electroencephalography (EEG) to capture brain responses of young adults - an important target group for alcohol prevention - while they viewed real-life video messages of varying perceived message effectiveness about risky alcohol use. We found that strong messages, which were rated to be more effective, prompted enhanced inter-subject correlation (ISC). In further analyses, we linked ISC to subsequent drinking behavior change and used time-resolved EEG-ISC to model functional neuroimaging data (fMRI) of an independent audience. The EEG measure was not only related to sensory-perceptual brain regions, but also to regions previously related to successful messaging, i.e., cortical midline regions and the insula. The findings suggest EEG-ISC as a marker for audience engagement and effectiveness of naturalistic health messages, which could quantify the impact of mass communication within the brains of small target audiences.

Impressions of HIV risk online: Brain potentials while viewing online dating profiles.

There is an increasing trend to use online dating to meet potential partners. Previous studies in off-line contexts indicate that people may judge the risk of sexually transmitted infections based on a person's appearance. Online dating profiles commonly present profile pictures and verbal self-descriptions. To examine the integration of verbal and visual risk information, the current event-related potential (ERP) study used a simulated dating platform in which verbal-descriptive information (low vs. high verbal risk) was presented, followed by a photograph (low vs. high visual risk). Results indicated main effects of verbal and visual risk. Specifically, high-risk compared with low-risk verbal profiles elicited a relative negative shift over occipitoparietal sensor sites between 260 ms and 408 ms. Furthermore, a sustained occipital negativity (132-500 ms) and central positivity (156-272 ms) was observed for high as compared with low visual risk profiles. There was also evidence for the integration of verbal and visual risk formation, as indicated by distinct positive ERP shift occurred between 272 ms and 428 ms over anterior temporal regions when a high-risk photograph was preceded by high-risk verbal information. This suggests that verbal-descriptive information is integrated with visual appearance early in the processing stream. The distinct response for high verbal and visual information extends the notion of an alarm function ascribed to risk perception by demonstrating integration about multiple sources. Simulating online dating platforms provides a useful tool to examine intuitive risk perception.

Boosting healthy food choices by meal colour variety: results from two experiments and a just-in-time Ecological Momentary Intervention.

BACKGROUND: Dietary guidelines typically specify rather complex goals and indicators for healthy food choices, such as nutrient and energy content patterns. However, translating these complex goals into practice in real life is often a major obstacle for many people. The present studies propose an intervention strategy for boosting healthy food choices by prompting consumers at a meaningful moment with a simple behavioural trigger, that is to eat a colourful lunch. Effectivity and feasibility of this intervention strategy were tested in two laboratory experiments and one real-life, smartphone-based Ecological Momentary Intervention. METHODS: In Studies 1 and 2, 83 / 42 participants self-served four meals (colourful, typical, healthy, and low-calorie) / three meals (colourful, typical, and varied) from a Fake Food Buffet. In Study 3, 80 participants recorded images of 1,210 lunch meals over a period of 3 weeks using mobile visual food recording. In the second week, participants additionally received a daily smartphone prompt to eat a colourful lunch. In all studies, participants were asked to rate the prompts' feasibility. RESULTS: Prompting participants to eat a colourful meal increased the proportion of healthy foods consumed compared to typical meals in all three studies. In Studies 1 and 2, colourful meals contained more fruit and vegetables, while in Study 3 the prompt increased vegetable consumption. Furthermore, participants evaluated colourful meals to be the tastiest (Study 1) and most pleasant, and reported that the prompt was easy to follow and act upon. CONCLUSIONS: Results suggest that prompting individuals to eat colourful meals is a promising strategy to facilitate healthy food choices in daily life. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00017552 (Study 3; retrospectively registered on 24th June 2019).

Understanding traditional and modern eating: the TEP10 framework.

Across the world, there has been a movement from traditional to modern eating, including a movement of traditional eating patterns from their origin culture to new cultures, and the emergence of new foods and eating behaviors. This trend toward modern eating is of particular significance because traditional eating has been related to positive health outcomes and sustainability. Yet, there is no consensus on what constitutes traditional and modern eating. The present study provides a comprehensive compilation of the various facets that seem to make up traditional and modern eating. Specifically, 106 facets were mentioned in the previous literature and expert discussions, combining international and interdisciplinary perspectives. The present study provides a framework (the TEP10 framework) systematizing these 106 facets into two major dimensions, what and how people eat, and 12 subdimensions. Hence, focusing only on single facets of traditional and modern eating is an oversimplification of this complex phenomenon. Instead, the multidimensionality and interplay between different facets should be considered to gain a comprehensive understanding of the trends, consequences, and underlying factors of traditional and modern eating.

Measuring eating motives in older adults with and without functional impairments with The Eating Motivation Survey (TEMS).

Gaining a better understanding which motives play a role in daily eating is crucial in order to develop personalized interventions promoting adequate diet. The Eating Motivation Survey (TEMS) is a comprehensive tool to assess manifold reasons for eating but has not been specifically applied in an older sample including very old persons and persons differing in functional status. Therefore, the first step of the study was to investigate whether the basic motives of TEMS are consistent in an older sample and comparable across older adults with and without functional impairments. Second, the study aimed at describing which motives underlie eating behavior in older age most often as well as to analyze the relationship between eating motives and functional status. 376 community-dwelling older persons aged 70 years and older filled in the brief survey version (15 motives à 3 items) of TEMS. The sample comprises 149 unimpaired and 227 impaired participants in terms of physical function. Confirmatory factor analysis yielded good model fit with RMSEA 0.036 and SRMR 0.048. Furthermore, multi-group analysis revealed a generally invariant factor structure across participants with and without functional impairments. Liking was rated to underlie eating behavior most often, followed by Health and Natural Concerns. Considering gender, age and BMI, significant associations between functional status and the motive Sociability emerged. Since the results suggest that the fifteen basic eating motives are generalizable in older age and across different functional states, TEMS might be a valuable tool in nutrition-related health promotion to developing individualized approaches considering health aspects as well as hedonistic factors.

The Eating Motivation Survey: results from the USA, India and Germany.

OBJECTIVE: Research has shown that there is a large variety of different motives underlying why people eat what they eat, which can be assessed with The Eating Motivation Survey (TEMS). The present study investigates the consistency and measurement invariance of the fifteen basic motives included in TEMS in countries with greatly differing eating environments. DESIGN: The fifteen-factor structure of TEMS (brief version: forty-six items) was tested in confirmatory factor analyses. SETTING: An online survey was conducted. SUBJECTS: US-American, Indian and German adults (total N 749) took part. RESULTS: Despite the complexity of the model, fit indices indicated a reasonable model fit (for the total sample: χ 2/df=4·03; standardized root-mean-squared residual (SRMR)=0·063; root-mean-square error of approximation (RMSEA)=0·064 (95 % CI 0·062, 0·066)). Only the comparative fit index (CFI) was below the recommended threshold (for the total sample: CFI=0·84). Altogether, 181 out of 184 item loadings were above the recommended threshold of 0·30. Furthermore, the factorial structure of TEMS was invariant across countries with respect to factor configuration and factor loadings (configural v. metric invariance model: ΔCFI=0·009; ΔRMSEA=0·001; ΔSRMR=0·001). Moreover, forty-three out of forty-six items showed invariant intercepts across countries. CONCLUSIONS: The fifteen-factor structure of TEMS was, in general, confirmed across countries despite marked differences in eating environments. Moreover, latent means of fourteen out of fifteen motive factors can be compared across countries in future studies. This is a first step towards determining generalizability of the fifteen basic eating motives of TEMS across eating environments.

Determinants of diet and physical activity (DEDIPAC): a summary of findings.

The establishment of the Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub, 2013-2016, was the first action taken by the 'Healthy Diet for a Healthy Life' European Joint Programming Initiative. DEDIPAC aimed to provide better insight into the determinants of diet, physical activity and sedentary behaviour across the life course, i.e. insight into the causes of the causes of important, non-communicable diseases across Europe and beyond. DEDIPAC was launched in late 2013, and delivered its final report in late 2016. In this paper we give an overview of what was achieved in terms of furthering measurement and monitoring, providing overviews of the state-of-the-art in the field, and building toolboxes for further research and practice. Additionally, we propose some of the next steps that are now required to move forward in this field, arguing in favour of 1) sustaining the Knowledge Hub and developing it into a European virtual research institute and knowledge centre for determinants of behavioural nutrition and physical activity with close links to other parts of the world; 2) establishing a cohort study of families across all regions of Europe focusing specifically on the individual and contextual determinants of major, non-communicable disease; and 3) furthering DEDIPAC's work on nutrition, physical activity, and sedentary behaviour policy evaluation and benchmarking across Europe by aligning with other international initiatives and by supporting harmonisation of pan-European surveillance.

The social image of food: Associations between popularity and eating behavior.

One factor that determines what we eat and why we eat is our social environment. In the present research, two online studies examined the relationship between food intake and social images. Specifically, the present research assessed the relationship between the food intake university students ascribed to peers who varied in popularity and own self-reported food intake, and whether this relationship was moderated by identification with the peer group. Participants (N = 97 in Study 1; N = 402 in Study 2) were randomly presented with one of four (Study 1) or two of eight (Study 2) vignettes describing a popular or unpopular student (male or female) from their university without receiving any information about the peer's eating behavior. Subsequently, healthy and unhealthy eating ascribed to the peers and own self-reported eating behavior were assessed. Results indicated that popular peers were perceived to eat more healthily than unpopular peers. Moreover, eating behavior ascribed to popular peers were associated with own healthy and unhealthy eating. Importantly, the relationship between healthy eating behavior ascribed to popular peers and own healthy eating behavior was moderated by identification with the student group - the more participants identified with their peers, the more their own eating was aligned with the healthy eating ascribed to a popular peer. Hence, the popularity of others seems to shape perceptions of the food they eat and may facilitate healthy eating via social influence.

Predictors of food decision making: A systematic interdisciplinary mapping (SIM) review.

The number of publications on consumer food decision making and its predictors and correlates has been steadily increasing over the last three decades. Given that different scientific disciplines illuminate this topic from different perspectives, it is necessary to develop an interdisciplinary overview. The aim of this study is to conduct a systematic interdisciplinary mapping (SIM) review by using rapid review techniques to explore the state-of-the-art, and to identify hot topics and research gaps in this field. This interdisciplinary review includes 1,820 publications in 485 different journals and other types of publications from more than ten disciplines (including nutritional science, medicine/health science, psychology, food science and technology, business research, etc.) across a period of 60 years. The identified predictors of food decision making were categorized in line with the recently proposed DONE (Determinants Of Nutrition and Eating behavior) framework. After applying qualitative and quantitative analyses, this study reveals that most of the research emphasizes biological, psychological, and product-related predictors, whereas policy-related influences on food choice are scarcely considered.

Comparative optimism about healthy eating.

The present study investigated people's perception of their own as compared to their peers' healthy eating and related these perceptions to actual healthy eating, BMI, and subsequent healthy eating behavior. Data were collected within the framework of the longitudinal cohort study Konstanz Life Study (T1: N = 770; T2: N = 510). Our results demonstrated an optimistic bias on the group level. Specifically, people rated their own eating behavior as healthier on average than that of their average peers. This comparative optimism occurred even when actual healthy eating was unfavorable and BMI was high. However, it increased with actual healthy eating behavior. Importantly, optimistic perceptions were positively related to the intention to eat healthily and healthy eating six months later. Hence, the results suggest that an optimistic comparative view of one's own healthy eating is grounded in reality and boosts rather than deters subsequent health behavior. This implies that there might not be a need to reduce optimistic perceptions of healthy eating behavior.

Communicating eating-related rules. Suggestions are more effective than restrictions.

BACKGROUND: A common social influence technique for curbing unhealthy eating behavior is to communicate eating-related rules (e.g. 'you should not eat unhealthy food'). Previous research has shown that such restrictive rules sometimes backfire and actually increase unhealthy consumption. In the current studies, we aimed to investigate if a milder form of social influence, a suggested rule, is more successful in curbing intake of unhealthy food. We also investigated how both types of rules affected psychological reactance. METHOD: Students (N = 88 in Study 1, N = 51 in Study 2) completed a creativity task while a bowl of M&M's was within reach. Consumption was either explicitly forbidden (restrictive rule) or mildly discouraged (suggested rule). In the control condition, consumption was either explicitly allowed (Study 1) or M&M's were not provided (Study 2). Measures of reactance were assessed after the creativity task. Subsequently, a taste test was administered where all participants were allowed to consume M&M's. RESULTS: Across both studies, consumption during the creativity task did not differ between the restrictive- and suggested-rule-conditions, indicating that both are equally successful in preventing initial consumption. Restrictive-rule-condition participants reported higher reactance and consumed more in the free-eating taste-test phase than suggested-rule-condition participants and control-group participants, indicating a negative after-effect of restriction. DISCUSSION: RESULTS show that there are more and less effective ways to communicate eating-related rules. A restrictive rule, as compared to a suggested rule, induced psychological reactance and led to greater unhealthy consumption when participants were allowed to eat freely. It is important to pay attention to the way in which eating-related rules are communicated.

Neural correlates of risk perception during real-life risk communication.

During global health crises, such as the recent H1N1 pandemic, the mass media provide the public with timely information regarding risk. To obtain new insights into how these messages are received, we measured neural data while participants, who differed in their preexisting H1N1 risk perceptions, viewed a TV report about H1N1. Intersubject correlation (ISC) of neural time courses was used to assess how similarly the brains of viewers responded to the TV report. We found enhanced intersubject correlations among viewers with high-risk perception in the anterior cingulate, a region which classical fMRI studies associated with the appraisal of threatening information. By contrast, neural coupling in sensory-perceptual regions was similar for the high and low H1N1-risk perception groups. These results demonstrate a novel methodology for understanding how real-life health messages are processed in the human brain, with particular emphasis on the role of emotion and differences in risk perceptions.

The bright side of stress-induced eating: eating more when stressed but less when pleased.

Previous research suggests that approximately 40% to 50% of the population increase food consumption under stressful conditions. The prevailing view is that eating in response to stress is a type of maladaptive self-regulation. Past research has concentrated mainly on the negative effects of social stress on eating. We propose that positive social experiences may also modulate eating behavior. In the present study, participants were assigned to social-exclusion, neutral, and social-inclusion conditions. In a subsequent bogus taste test, the amount of ice cream eaten and habitual stress-related eating were measured. After being socially excluded, people who habitually eat more in response to stress (stress hyperphagics) ate significantly more than people who habitually eat less in response to stress (stress hypophagics). Conversely, after being socially included, stress hyperphagics ate significantly less than stress hypophagics. The present findings provide the first evidence for complementary adjustments of food consumption across positive and negative situations. Implications of these findings for the relationship of stress and body weight are discussed.