Realizing the Tobacco Endgame: Understanding and mobilizing public support for banning combustible cigarette sales in the United States.

BACKGROUND: There is little research on public support for banning the sale and purchase of combustible cigarettes even though a ban is an essential step towards achieving the endgame for tobacco products. PURPOSE: We report the first studies designed to (a) examine predictors of support for a ban (Study 1), and (b) test interventions to increase such support (Studies 2-4). METHODS: In Study 1, current, former, and never smokers (N = 479) were randomized to conditions measuring their willingness to ban the sale of cigarettes vs. an unspecified product. Smokers were randomized to a persuasive communication in Study 2 and a paradoxical thinking intervention in Study 3 (Ns = 300 and 302, respectively). In Study 4 (N = 336), we randomized smokers to self-persuasion and issue-framing interventions. RESULTS: Whereas nonsmokers were willing to ban the sale of both cigarettes and equivalent products, current and former smokers exempted cigarettes from a ban. Reactance to prohibition and perceived effectiveness predicted willingness to ban cigarette sales in all three smoking status groups (Study 1). Neither persuasive communication nor paradoxical thinking increased support for banning cigarette sales in Studies 2-3. However, self-persuasion and framing the ban as "protecting Americans from avoidable harm" both led to increased support for banning cigarette sales (Study 4). CONCLUSIONS: Reactance and doubt about the effectiveness of banning the sale of cigarettes are key barriers to supporting a ban. Self-persuasion and issue framing may be effective means of mobilizing policy support among smokers. The present research offers new insights relevant to promoting the "Tobacco Endgame" and helps specify directions for future research on public support for health policies.

Expanding the analysis of mechanisms of action in behavioral interventions: cognitive change versus cognitive activation.

OBJECTIVE: To understand the mechanisms of action underlying behavioral interventions, researchers typically examine whether the treatment changes cognitions and whether changes in cognition predict behavior (cognitive change). This current research explores an alternative mechanism whereby the intervention increases the impact of pre-existing cognitions on behavior (cognitive activation). We tested whether cognitive change or cognitive activation explains the impact of cigarette pack messages on smoking restraint. DESIGN: The research comprised a validation experiment (N = 135) and a 4-week RCT (N = 719) with smokers. MAIN OUTCOME MEASURES: At both baseline and follow-up of the RCT, smokers self-reported threat appraisals, coping appraisals, and smoking restraint. RESULTS: Intervention messages heightened the accessibility of threat appraisals compared to control messages (validation experiment). In the RCT, smoking restraint increased among intervention participants but not controls. Trial arm showed no corresponding change in threat or coping appraisals. However, trial arm interacted with baseline health cognitions such that synergies between threat appraisal components, and between threat appraisals and coping appraisals, predicted smoking restraint for intervention participants but not for controls. CONCLUSION: Our findings support a cognitive activation process whereby health messages on cigarette packs increase the impact of pre-existing threat appraisals on smoking restraint.

Does increasing autonomous motivation or perceived competence lead to health behavior change? A meta-analysis.

OBJECTIVE: Despite abundant observational and experimental tests, it is not yet clear whether enhancing autonomous motivation or perceived competence leads to health behavior change. We identified interventions that aimed to change these constructs and quantified the magnitude of changes in behavior observed when interventions generated increases in autonomous motivation, perceived competence, or both. METHOD: Computerized searches and additional strategies identified 67 articles that yielded 135 effect sizes relevant to our research questions. Random effects meta-analyses were conducted via STATA. RESULTS: Interventions increased autonomous motivation and perceived competence in 31% and 38% of tests, respectively. Increasing autonomous motivation led to a medium change in health behaviors (d+ = .47, 95% CI [.44, .83]) and increasing perceived competence generated a small-to-medium change (d+ = .34, 95% CI [.22, .47]). Interventions that failed to generate significant improvements in autonomous motivation and perceived competence had much smaller effects on behavior change (d+ = .13 and .10, respectively). There was little evidence of synergistic effects. Changing both autonomous motivation and perceived competence (d+ = .42) did not lead to a larger effect on behavior compared with changing autonomous motivation on its own (d+ = .61), but had a larger effect compared with changing perceived competence on its own (d+ = .21). CONCLUSION: The present review suggests that autonomous motivation and perceived competence are valid targets for interventions to promote health behavior change but also indicates that research is warranted to ensure that interventions more effectively engage these targets. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Self-determination theory interventions for health behavior change: Meta-analysis and meta-analytic structural equation modeling of randomized controlled trials.

OBJECTIVE: We conducted a meta-analysis of randomized controlled trials (RCTs) to promote health behavior change based on self-determination theory (SDT). The review aimed to (a) quantify the impact of SDT interventions on health behaviors, (b) test mediation by theoretically specified variables (autonomous motivation and perceived competence), and (c) identify moderators of intervention effectiveness. METHOD: Computerized searches and additional strategies identified 56 articles that yielded 65 independent tests of SDT interventions. Random effects meta-analysis and metaregressions were conducted via STATA; meta-analytic structural equation modeling (MASEM) was used to test mediation. RESULTS: The sample-weighted average effect size for SDT interventions was d+ = .23, and there were significant effects for physical activity, sedentary behavior, diet, alcohol consumption, and smoking cessation (.16 ≥ d+ ≥ .29). Effect sizes exhibited both publication bias and small sample bias but remained significantly different from zero, albeit of smaller magnitude, after correction for bias (d+ ≥ .15). MASEM indicated that autonomous motivation and perceived competence mediated intervention effects on behavior. Metaregression analyses indicated that features of the sample, intervention, or methodology generally did not moderate effect sizes. CONCLUSION: The present review indicates that SDT interventions have a significant but small effect on health behavior change and suggests several directions for future research. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Reducing exposure to ultraviolet radiation from the sun and indoor tanning: A meta-analysis.

Objective: Skin cancer is the most frequently diagnosed cancer and rates are increasing because of global warming. This article reports a meta-analysis of randomized controlled trials of behavioral interventions to reduce exposure to ultraviolet radiation (UVR). The review aimed to (a) quantify the magnitude of intervention effects on indoor tanning, sun exposure, and sunscreen use, and (b) determine which intervention strategies maximize behavior change. Method: Out of 17,437 records identified via literature searches, 190 independent tests (N = 89,365) met the inclusion criteria. Sample, intervention, and methodological characteristics, and change techniques were coded, and random effects meta-analyses and metaregressions were conducted. Results: The sample-weighted average effect size across all studies was d+ = .193 (95% confidence interval, CI [.161, .226]), and there were significant effects on indoor tanning, sun exposure, and sunscreen use (d+ = .080, .149, and .196, respectively). However, there was evidence of publication bias, and trim and fill analyses indicated that the corrected effects for sun exposure and sunscreen use were of very small magnitude (d+ ~ .06) and were not significantly different from zero for indoor tanning (d+ = -.011, 95% CI [-.096, .074]). Metaregression analyses identified several intervention strategies that predicted effect sizes. For instance, interventions delivered individually that promoted alternatives to tanning were associated with larger effect sizes for indoor tanning. Conclusion: Interventions to date have had only a modest impact on behavioral exposure to UVR. The present findings offer new insights into how the effectiveness of future interventions can be improved. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Predicting physical activity among cancer survivors: Meta-analytic path modeling of longitudinal studies.

OBJECTIVE: We conducted meta-analyses and meta-analytic structural equation modeling of longitudinal studies among cancer survivors to (a) quantify associations between psychosocial predictors and physical activity, (b) test how psychosocial predictors combine to influence physical activity, and (c) identify study, demographic, and clinical characteristics that moderate associations. METHOD: Eligible studies used a longitudinal, observational design, included a sample of cancer survivors, and measured both a psychosocial predictor at baseline and physical activity at a later time-point. Of 2,431 records located through computerized searches, 25 independent tests (N = 5,897) met the inclusion criteria for the review. Random effects meta-analyses and meta-analytic structural equation modeling were conducted. RESULTS: Eight psychosocial predictors of physical activity were identified. Self-efficacy (r+ = 0.26) and intentions (r+ = 0.33) were the strongest predictors in bivariate analyses. The structural equation models included attitudes, injunctive norms, self-efficacy, intentions, and physical activity (k = 22, N = 4,385). The model with the best fit, χ2(2) = 0.11, p = .95, root mean square error of approximation = .00, comparative fit index = 1.00, Tucker-Lewis index = 1.00, indicated that all specified paths were significant. Intentions were the strongest predictor of physical activity (ß = 0.27, p < .001), and attitudes and self-efficacy were strong predictors of intentions (both ßs = 0.29, ps < .001). Few significant moderators were observed. CONCLUSION: This review indicates that self-efficacy and intentions are direct predictors of physical activity in cancer survivors. Further, attitudes and norms predict physical activity through intentions. Findings inform intervention development to increase physical activity engagement among cancer survivors. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

What works in smoking cessation interventions for cancer survivors? A meta-analysis.

OBJECTIVE: We conducted a meta-analysis of randomized controlled trials designed to promote smoking cessation among cancer survivors to (a) assess how effective interventions are at increasing quit rates, and (b) determine which intervention strategies are associated with effect sizes. METHODS: Out of 10,848 records that were located using computerized searches and informal sources, 21 interventions met the inclusion criteria for the review. We developed a bespoke taxonomy of 36 categories of techniques designed to change smoking behavior, and coded sample, intervention, and methodological characteristics. Random effects meta-analysis and metaregressions were conducted. RESULTS: The sample-weighted average effect size for smoking cessation was d+ = .030, and was not significantly different from zero (95%CI = -.042 to .101). Effect sizes exhibited both publication bias and small sample bias. Metaregressions indicated that, out of the many potential moderators that were tested, just a single intervention feature was associated with effect sizes. Interventions delivered solely by nurses exhibited larger effects compared to interventions from other sources. CONCLUSION: The present review indicates that current smoking cessation interventions for cancer survivors are ineffective. High-quality and effective interventions are needed. We offer suggestions regarding promising intervention strategies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Setting Realistic Health Goals: Antecedents and Consequences.

BACKGROUND: People often fail to translate their intentions into health behaviors. PURPOSE: The present research examined a new potential moderator of intention-behavior relations, namely, how realistic or unrealistic are respective goal intentions. Goal realism was defined as the degree to which intentions are aligned with expectations (i.e., predicted performance). METHODS: A validation study (N = 81) examined our novel goal realism measure. Study 1 (N = 246) tested goal importance, fantasy proneness, and pathways thinking as predictors of realistic goal setting using a cross-sectional questionnaire design. Moderation of the intention-behavior relation was tested in prospective surveys of cervical cancer screening (Study 2, N = 854), physical activity (Study 3, N = 237), and performance of a suite of 15 health behaviors (Study 4, N = 378). RESULTS: The validation study offered preliminary evidence concerning the convergent and predictive validity of the goal realism measure. Study 1 showed that goal importance, fantasy proneness, and pathways thinking interacted to predict how realistic were intentions to perform 11 health behaviors. In Study 2, realistic intentions better predicted women's attendance for cervical cancer screening compared with unrealistic intentions. Study 3 confirmed this finding for a frequently performed behavior (physical activity). In Study 4, multilevel modeling of longitudinal data for 15 health behaviors again revealed a significant goal realism × intention interaction. Greater realism was associated with improved prediction of behavior by intention. The interaction term remained significant even when past behavior, perceived behavioral control, and other predictors were taken into account. CONCLUSIONS: The present findings offer new insights into the factors that lead to more realistic intentions and demonstrate that goal realism influences how effectively intentions are translated into action.

Promoting physical activity among cancer survivors: Meta-analysis and meta-CART analysis of randomized controlled trials.

OBJECTIVE: We conducted a meta-analysis of physical activity interventions among cancer survivors to (a) quantify the magnitude of intervention effects on physical activity and (b) determine what combination of intervention strategies maximizes behavior change. METHOD: Out of 32,626 records that were located using computerized searches, 138 independent tests (N = 13,050) met the inclusion criteria for the review. We developed a bespoke taxonomy of 34 categories of techniques designed to promote psychological change, and categorized sample, intervention, and methodological characteristics. Random effects meta-analysis and metaregressions were conducted; effect size data were also submitted to meta-analysis with classification and regression trees (i.e., meta-CART). RESULTS: The sample-weighted average effect size for physical activity interventions was d+ = .35, equivalent to an increase of 1,149 steps per day. Effect sizes exhibited both publication bias and small sample bias but remained significantly different from zero, albeit of smaller magnitude (d+ ≥ .20), after correction for bias. Meta-CART indicated that the major difference in effectiveness was attributable to supervised versus unsupervised programs (d+ = .49 vs. .26). Greater contact time was associated with larger effects in supervised programs. For unsupervised programs, establishing outcome expectations, greater contact time, and targeting overweight or sedentary participants each predicted greater program effectiveness, whereas prompting barrier identification and providing workbooks were associated with smaller effect sizes. CONCLUSION: The present review indicates that interventions have a small but significant effect on physical activity among cancer survivors and offers insights into how the effectiveness of future interventions might be improved. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sustaining attendance at a mental health service: A randomized controlled trial.

OBJECTIVE: A substantial proportion of psychotherapeutic treatments are prematurely terminated because the client discontinues attendance. Interventions have been developed to reduce premature termination, but these are only moderately effective and often place considerable burden on clients and services. This research evaluated a brief, low-cost self-regulation intervention (i.e., implementation intentions) designed to sustain attendance at a group psychoeducation program. METHOD: Clients (N = 82) who had been referred for a psychological intervention due to anxiety or depression were sent a questionnaire concerning their views of attendance. Participants were randomly assigned to form an implementation intention as part of the questionnaire or not (controls). Attendance was then monitored over the 5 scheduled sessions of an evidence-based psychoeducational intervention. RESULTS: Intention-to-treat analyses indicated that forming implementation intentions led to attendance at a greater number of sessions (M = 2.84 vs. 1.62), p < .01, and higher rates of completing the full course of treatment compared to controls (35% vs. 11%), p < .02. CONCLUSIONS: An intervention rooted in basic research on the psychology of action increased and sustained attendance at a mental health service. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The effect of cigarillo packaging elements on young adult perceptions of product flavor, taste, smell, and appeal.

INTRODUCTION: Product packaging has long been used by the tobacco industry to target consumers and manipulate product perceptions. This study examines the extent to which cigarillo packaging influences perceptions of product flavor, taste, smell, and appeal. METHODS: A web-based experiment was conducted among young adults. Participants viewed three randomly selected cigarillo packs, varying on pack flavor descriptor, color, type, branding, and warning-totaling 180 pack images. Mixed-effects models were used to estimate the effect of pack elements on product perceptions. RESULTS: A total of 2,664 current, ever, and never little cigar and cigarillo users participated. Cigarillo packs with a flavor descriptor were perceived as having a more favorable taste (ß = 0.21, p < .001) and smell (ß = 0.14, p < .001) compared to packs with no flavor descriptor. Compared to packs with no color, pink and purple packs were more likely to be perceived as containing a flavor (ß = 0.11, p < .001), and were rated more favorably on taste (ß = 0.17, p < .001), smell (ß = 0.15, p < .001), and appeal (ß = 0.16, p < .001). While warnings on packs decreased favorable perceptions of product taste (pictorial: ß = -0.07, p = .03) and smell (text-only: ß = -0.08, p = .01; pictorial: ß = -0.09, p = .007), warnings did not moderate the effects of flavor descriptor or color. CONCLUSIONS: To our knowledge, this study provides the first quantitative evidence that cigarillo packaging alters consumers' cognitive responses, and warnings on packs do not suffice to overcome the effects of product packaging. The findings support efforts at federal, state, and local levels to prohibit flavor descriptors and their associated product flavoring in non-cigarette products such as cigarillos, along with new data that supports restrictions on flavor cues and colors.

When does risk perception predict protection motivation for health threats? A person-by-situation analysis.

Although risk perception is a key concept in many health behavior theories, little research has explicitly tested when risk perception predicts motivation to take protective action against a health threat (protection motivation). The present study tackled this question by (a) adopting a multidimensional model of risk perception that comprises deliberative, affective, and experiential components (the TRIRISK model), and (b) taking a person-by-situation approach. We leveraged a highly intensive within-subjects paradigm to test features of the health threat (i.e., perceived severity) and individual differences (e.g., emotion reappraisal) as moderators of the relationship between the three types of risk perception and protection motivation in a within-subjects design. Multi-level modeling of 2968 observations (32 health threats across 94 participants) showed interactions among the TRIRISK components and moderation both by person-level and situational factors. For instance, affective risk perception better predicted protection motivation when deliberative risk perception was high, when the threat was less severe, and among participants who engage less in emotional reappraisal. These findings support the TRIRISK model and offer new insights into when risk perceptions predict protection motivation.

Situation selection is a particularly effective emotion regulation strategy for people who need help regulating their emotions.

Situation selection involves choosing situations based on their likely emotional impact and may be less cognitively taxing or challenging to implement compared to other strategies for regulating emotion, which require people to regulate their emotions "in the moment"; we thus predicted that individuals who chronically experience intense emotions or who are not particularly competent at employing other emotion regulation strategies would be especially likely to benefit from situation selection. Consistent with this idea, we found that the use of situation selection interacted with individual differences in emotional reactivity and competence at emotion regulation to predict emotional outcomes in both a correlational (Study 1; N = 301) and an experimental field study (Study 2; N = 125). Taken together, the findings suggest that situation selection is an effective strategy for regulating emotions, especially for individuals who otherwise struggle to do so.

How Can Implicit and Explicit Attitudes Both Be Changed? Testing Two Interventions to Promote Consumption of Green Vegetables.

BACKGROUND: Although correlational studies have demonstrated that implicit and explicit attitudes are both important in predicting eating behavior, few studies targeting food choice have attempted to change both types of attitudes. PURPOSE: We tested the impact of (a) an evaluative learning intervention that uses the self to change attitudes (i.e., a Self-Referencing task) and (b) a persuasive communication in modifying implicit and explicit attitudes towards green vegetables and promoting readiness to change. The study targeted individuals who explicitly reported they did not like or only moderately liked green vegetables. METHODS: Participants (N = 273) were randomly allocated to a 2 (self-referencing: present vs. absent) × 2 (persuasive message: present vs. absent) factorial design. The outcomes were implicit and explicit attitudes as well as readiness to increase consumption of green vegetables. RESULTS: Implicit attitudes increased after repeatedly pairing green vegetable stimuli with the self in the self-referencing task but did not change in response to the persuasive communication. The persuasive message increased explicit attitudes and readiness to change, but did not alter implicit attitudes. A three-way interaction with pre-existing explicit attitudes was also observed. In the absence of a persuasive message, the self-referencing task increased on readiness to change among participants with more negative pre-existing explicit attitudes. CONCLUSIONS: This study is the first to demonstrate that a self-referencing task is effective in changing both implicit attitudes and readiness to change eating behavior. Findings indicate that distinct intervention strategies are needed to change implicit and explicit attitudes towards green vegetables.