Is evoking fear effective? Exploratory findings from a randomised experiment on the impacts of health warning labels on sugar-sweetened beverages.

OBJECTIVE: Health warning labels (HWL) have been suggested to be effective in reducing consumption of sugar-sweetened beverages (SSB). Yet, the efficacy and acceptability of SSB HWL of different formats (textual/pictorial) and severity remain unclear. This exploratory study aims to examine the extent and mechanism through which HWL of different formats and severity may affect responses towards the HWL and SSB consumption. DESIGN: Randomised online experiment. Participants were exposed to images of a hypothetical SSB bearing a HWL of one of three conditions: text-only HWL, moderately severe pictorial HWL and highly severe pictorial HWL. They then responded to theory-based affective, cognitive and behavioural measures. SETTING: Singapore. PARTICIPANTS: One hundred and twenty-seven young adult consumers from a public university. RESULTS: Direct effects were found for fear, avoidance, reactance and acceptability of the HWL, but not attitude, intention or motivation to consume less SSB. Pictorial (moderately severe and highly severe) HWL were associated with greater fear, avoidance, and reactance, and lower acceptability than text-only HWL. There was weak evidence that highly severe pictorial HWL resulted in greater reactance than moderately severe pictorial HWL. Fear mediated the effect of HWL of different severity levels on avoidance, reactance, intention and motivation, but not for attitude or acceptability. CONCLUSIONS: Exploratory findings indicate that although pictorial HWL were less acceptable, they may still be effective in influencing intention and motivation to reduce SSB consumption through the psychological mechanism of fear. Hence, graphic HWL should not be dismissed too quickly when considering strategies for reducing SSB consumption.

Intergenerational Hypertension Prevention Education for Children and Family Members: A Longitudinal Assessment.

INTRODUCTION: Many adults are unaware of hypertension risks. Fortunately, hypertension is preventable with lifestyle modifications and regular blood pressure (BP) monitoring. Through reverse socialization (RS), children, acting as information agents, can potentially influence adults' long-term health behaviours. AIM: This study aimed to assess the longitudinal effects of a RS-based intervention, with and without experiential component of performing home BP measurement, in enhancing hypertension awareness and motivating regular BP measurement among children and their adult family members (AFMs). METHODS: The intervention involves educating grade five children about hypertension and asking them to share this information with AFMs either using only information brochures (non-experiential intervention) or complemented with performing home BP measurement (experiential intervention). Hypertension knowledge and coping appraisals to perform regular BP measurement were assessed before, immediately post-program, and three-months post-program. RESULTS: Children's (n = 514) BP knowledge and confidence in sharing BP knowledge improved post-intervention and sustained longitudinally, but the effect was more pronounced among those in the experiential intervention. AFMs' (n = 251) self-efficacy to perform regular BP measurement and intention to prevent hypertension improved only for those in the experiential intervention. Improvement was sustained for self-efficacy only. AFMs' response cost reduced long-term for both intervention types. However, AFMs' hypertension knowledge and response efficacy were unchanged. CONCLUSIONS: Even one-off short RS-based interventions with children can be sufficient to increase hypertension awareness for AFMs. An experiential component in similar family-targeted RS programs can capitalize on improvements in self-efficacy and intention to effect sustained behaviour change in hypertension preventive behaviours.

Association between food availability and young people's fruits and vegetables consumption: understanding the mediation role of the theory of planned behaviour.

OBJECTIVE: To evaluate the relationship between fruits and vegetables (F&V) availability at home and young people's F&V consumption behaviour, and how the theory of planned behaviour (TPB) constructs could potentially mediate the relationship. DESIGN: Cross-sectional face-to-face survey questionnaire to assess the TPB constructs and home food availability assessed using open inventories method. F&V availability was categorised into low and high levels based on median split. SETTING: Singapore. PARTICIPANTS: Two hundred and ten households (each consisting one parent-child pair) recruited via stratified cluster sampling with child participants ranging from 9 to 16 years of age. RESULTS: Mediation analyses were conducted using structural equation modelling. The relationship between home F&V availability and F&V consumption behaviour did not have a significant direct association, but there were significant indirect effects through the routes of perceived behavioural control (PBC) and intention as well as attitude and intention. Specifically, higher level of F&V availability at home was related to more positive PBC and attitude towards F&V, and subsequently greater intention to consume F&V and higher consumption of F&V. CONCLUSIONS: Parents should make F&V more readily available at home as increased exposure to F&V could be related to enhanced liking, sense of control and intention to consume F&V and facilitate children's healthy diet.

Media exposure and parental mediation on fast-food consumption among children in metropolitan and suburban Indonesia

BACKGROUND AND OBJECTIVES: Fast-food companies have been reproached for rising obesity levels due to aggressive marketing tactics targeted at children. They have countered that parents should be held responsible considering their critical role as nutritional gatekeepers. This study examined the comparative effects of media exposure and parental mediation on Indonesian children's fast food consumption and how the effects compare in the metropolitan versus suburban areas. METHODS AND STUDY DESIGN: The sample consisted of 394 child-mother pairs comprising grade three and four children and their mothers from two schools each in Jakarta and Bogor representing 40.9% metropolitan sample and 59.1% suburban sample, respectively. The children completed a guided inclass survey, while the mothers completed a paper-and-pen survey at home. Measures comprised children's weekly media exposure to broadcast media, computer and mobile games, print media, and online and social media, active and restrictive parental mediation strategies, children's fast food consumption and nutrition knowledge. The relationship of media exposure and parental mediation with children's fast food consumption was analyzed using Structural Equation Modelling. RESULTS: Fast food consumption was positively influenced by exposure to broadcast media among metropolitan children, and by exposure to online and social media among suburban children. Active parental mediation was related to lower fast food consumption, but only for suburban children. CONCLUSIONS: Active parental mediation is critical in preventing fast food consumption. The media play a key role in influencing fast food consumption, and hence, literacy education is important to alleviate the adverse effects of exposure to junk food marketing.

Intergenerational transfer of blood pressure knowledge and screening: a school-based hypertension awareness program in Singapore.

OBJECTIVE: This study aims to examine the efficacy of a hypertension awareness education program in Singapore in reaching out to a wider population of diverse racial and intergenerational cohorts by dispatching grade five children as information intermediaries to their immediate and extended family members. METHOD: After receiving structured instruction and training on blood pressure screening, students were requested to share knowledge gained in school with their family members at home and practice blood pressure measurement on family volunteers. We assessed pre- and post-program blood pressure knowledge change, attitude toward screening, and the diffusion of blood pressure information. One adult family member was also asked to complete a short survey at the program end. RESULTS: A comparison of the students' (final n = 3926) pre- and post-program survey data showed that knowledge and attitudes towards knowledge sharing improved after participating in the program. The post-program survey also revealed that students generally felt confident and displayed positive attitudes in performing blood pressure screening on family members. On average, each student practiced blood pressure measurement on 3.04 people. Female family members were more likely to be targeted for knowledge sharing and screening than male family members. The family members' survey revealed positive attitudes towards screening, but family members were not confident about getting their measurements done regularly. CONCLUSION: The program met its objectives in raising the awareness of grade five children and provision of knowledge. It also met the larger objective of raising hypertension awareness in a wider population, especially those who otherwise might not directly receive health education and blood pressure screening.

Rights versus morality: online debate about decriminalization of gay sex in Singapore.

This article presents a quantitative content analysis of 10,473 comments from two opposing online petitions related to the legal status of a section of the penal code in Singapore used to ban sex between men. Results indicate numerous significant differences in how the two sides discussed the law and its significance. In particular, they used different types of arguments to support their views and expressed different kinds of concerns over the potential impact of changing or maintaining the law. The patterns of language use seem to reflect distinctly different approaches to the debate and suggest the difficulty of finding common ground amid this contentious social issue, but they also reveal similarities to how Western cultures have framed the debate.

Can exergames impart health messages? Game play, framing, and drivers of physical activity among children.

This study examines the effectiveness of incorporating exergaming into physical education lessons as a platform for imparting health education messages and influencing children's beliefs about and attitudes toward physical activity. The authors launched a 6-week intervention program using Nintendo Wii games coupled with protection motivation theory-based health messaging among 5th-grade school children in Singapore. Results indicated that when children who were exposed to threat-framed messages played Wii exergames during physical education lessons, they reported more positive physical activity attitude, self-efficacy, and perceived behavioral control than did those who underwent regular physical education lessons and were exposed to the same message. In addition, among children playing Wii, the threat and coping frames had similar effects on the degree of message influence on physical activity attitudes and beliefs. The implications for schools, parents, and health policy are discussed.