Ethics of early detection of disease risk factors: A scoping review.

BACKGROUND: Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture. METHODS: To identify key ethical considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher's Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers. RESULTS: After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals. CONCLUSIONS: The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies.

Exposure to images showing (non)adherence to physical distancing rules: Effect on adherence behavior and perceived social norms.

INTRODUCTION: Adherence to behavioral measures such as physical distancing are key to mitigating the effects of viral pandemics such as the COVID-19 pandemic. Adherence depends in part on people's perception of what others do (descriptive norms) or approve of (injunctive norms). This study examines the effects that exposure to images depicting people following or breaking physical distancing rules have on perceptions of descriptive and injunctive norms and subsequent adherence behavior. METHODS: An online between-subjects experiment (n = 315) was conducted, in which participants were exposed to a set of five photographs of different public spaces in which people either did or did not adhere to physical distancing rules (pre-registration: https://www.osf.io/uek2p). Participants' adherence behavior was measured using a triangulation of measures (incentivized online behavioral task, vignettes, intention measure). Perceptions of relevant social norms were also measured. RESULTS: Mann-Whitney tests showed no effects of condition on perceptions of descriptive and injunctive norms or on adherence behavior. Linear regressions showed that both component paths of the indirect effect (condition on norm perceptions, and norm perceptions on adherence behavior) were non-significant, hence mediation analyses were not conducted. CONCLUSIONS: Exposure to images of people following (compared to breaking) physical distancing rules did not affect adherence to such rules or perceived norms. We surmise that a single exposure to such images, especially in the context of COVID-19, is insufficient to affect behavior. We therefore recommend performing a comparable experiment in which participants are exposed repeatedly to images showing people (non)adhering to a specific behavior in a particular context for a longer period.

The Explanations People Give for Going to Bed Late: A Qualitative Study of the Varieties of Bedtime Procrastination.

Background/Objective: Bedtime procrastination is a prevalent cause of sleep deprivation, but little is known about why people delay their bedtimes. In the present research, we conducted a qualitative study with bedtime procrastinators to classify their self-reported reasons for later-than-intended bedtime. Participants: Participants (N = 17) were selected who frequently engaged in bedtime procrastination, but whose sleep was not otherwise affected by diagnosed sleep disorders or shift work. Method: We conducted in-depth, semistructured interviews and used thematic analysis to identify commonly recurring themes in the interviews. Results and conclusions: Three emerging themes were identified: deliberate procrastination, mindless procrastination, and strategic delay. For the form of procrastination we classified as deliberate procrastination, participants typically reported wilfully delaying their bedtime because they felt they deserved some time for themselves. For the category of mindless procrastination, a paradigmatic aspect was that participants lost track of the time due to being immersed in their evening activities. Finally, participants who engaged in strategic delay reported going to bed late because they felt they needed to in order to fall asleep (more quickly), which suggests that despite describing themselves as "procrastinating," their bedtime delay may actually be linked to undiagnosed insomnia. The conceptual distinctions drawn in this paper deepen our understanding of bedtime delay and may be helpful for designing effective interventions.

Too Depleted to Turn In: The Relevance of End-of-the-Day Resource Depletion for Reducing Bedtime Procrastination.

Bedtime procrastination is an important predictor of sleep insufficiency in the general population (Kroese et al., 2014b), but little is known about the determinants of this self-undermining behavior. As the phenomenon has been conceptualized in the literature as a form of self-regulation failure (Kroese et al., 2014a), we hypothesized that people's self-regulatory resources in the evening would be predictive of going to bed later than they intended. Specifically, we examined whether the cumulative effect of resisting desires, a measure of self-regulatory resource depletion (Hofmann et al., 2012b), relates to bedtime procrastination. Participants (N = 218) reported how many desires they had tried to resist during the previous day and the extent of their bedtime procrastination. Results show that people who attempted to resist more desires were more likely to engage in bedtime procrastination, suggesting that people may be less likely to stick to their intended bedtime after a particularly taxing day. Implications for intervention strategies are discussed.