Online-Mediated HIV Pre-exposure Prophylaxis Care and Reduced Monitoring Frequency for Men Who Have Sex With Men: Protocol for a Randomized Controlled Noninferiority Trial (EZI-PrEP Study).

BACKGROUND: Daily and event-driven HIV pre-exposure prophylaxis (PrEP) with oral tenofovir-emtricitabine is highly effective to prevent HIV in men who have sex with men (MSM). PrEP care generally consists of in-clinic monitoring every 3 months that includes PrEP dispensing, counseling, and screening for HIV and sexually transmitted infections (STIs). However, the optimal frequency for monitoring remains undetermined. Attending a clinic every 3 months for monitoring may be a barrier for PrEP. Online-mediated PrEP care and reduced frequency of monitoring may lower this barrier. OBJECTIVE: The primary objective of this study is to establish the noninferiority of online PrEP care (vs in-clinic care) and monitoring every 6 months (vs every 3 months). The secondary objectives are to (1) examine differences between PrEP care modalities regarding incidences of STIs, HIV infection, and hepatitis C virus infection; retention in PrEP care; intracellular tenofovir-diphosphate concentration; and satisfaction, usability, and acceptability of PrEP care modalities; and (2) evaluate associations of these study outcomes with sociodemographic, behavioral, and psychological characteristics. METHODS: This study is a 2×2 factorial, 4-arm, open-label, multi-center, randomized, controlled, noninferiority trial. The 4 arms are (1) in-clinic monitoring every 3 months, (2) in-clinic monitoring every 6 months, (3) online monitoring every 3 months, and (4) online monitoring every 6 months. The primary outcome is a condomless anal sex act with a casual partner not covered or insufficiently covered by PrEP (ie, "unprotected act") as a proxy for HIV infection risk. Eligible individuals are MSM, and transgender and gender diverse people aged ≥18 years who are eligible for PrEP care at 1 of 4 participating sexual health centers in the Netherlands. The required sample size is 442 participants, and the planned observation time is 24 months. All study participants will receive access to a smartphone app, which contains a diary. Participants are requested to complete the diary on a daily basis during the first 18 months of participation. Participants will complete questionnaires at baseline and 6, 12, 18, and 24 months. Dried blood spots will be collected at 6 and 12 months for assessment of intracellular tenofovir-diphosphate concentration. Incidence rates of unprotected acts will be compared between the online and in-clinic arms, and between the 6-month and 3-month arms. Noninferiority will be concluded if the upper limit of the 2-sided 97.5% CI of the incidence rate ratio is <1.8. RESULTS: The results of the main analysis are expected in 2024. CONCLUSIONS: This trial will demonstrate whether online PrEP care and monitoring every 6 months is noninferior to standard PrEP care in terms of PrEP adherence. If noninferiority is established, these modalities may lower barriers for initiating and continuing PrEP use and potentially reduce the systemic burden for PrEP providers. TRIAL REGISTRATION: ClinicalTrials.gov NCT05093036; https://tinyurl.com/28b8ndvj. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51023.

Understanding public perceptions toward sustainable healthcare through psychological network analysis of material preference and attitudes toward plastic medical devices.

Recent and potential future health-care users (i.e., the public) are important stakeholders in the transition toward environmentally sustainable healthcare. However, it remains unclear whether, according to the public, there is room for sustainable innovations in materials for plastic medical devices (PMD). This study explores preferences regarding conventional or bio-based PMD, and psychological mechanisms underlying these preferences. We administered two surveys among Dutch adults from a research panel. Results from the first survey (i.e., open-text survey on attitude elements; NStudy1 = 66) served as input for the second survey (i.e., Likert-scale survey on beliefs, emotions, perceived control, social norms, trust, related to current and bio-based PMD, and health and age; NStudy2 = 1001; Mage = 47.35; 54.4% female). The second survey was completed by 501 participants who, in the last two years, received care in which PMD were used, and 500 participants who did not. Cross-sectional psychological networks were estimated with data from the second study using the EBICglasso method. Results showed that participants preferred bio-based over conventional PMD, and this applied regardless of whether devices are used inside or outside of the body. Results also showed emotions play an important role, with emotions regarding bio-based PMD being strongly related to preference. Furthermore, comparing recent and potential future receivers of PMD revealed differences in preference but comparable relations between preference and other psychological variables. This study shows that receivers' perspectives should not be seen as potential barriers, but as additional motivation for transitioning toward sustainable healthcare. Recommendations for implementation are discussed.

A psychosocial network approach studying biomedical HIV prevention uptake between 2017 and 2019.

Biomedical HIV-prevention strategies (BmPS) among men who have sex with men (MSM), such as pre-exposure prophylaxis (PrEP) and viral load sorting (VLS), are essential but relatively new and their uptake gradual. Using an extension of the causal attitude network approach, we investigated which beliefs are related to uptake of PrEP and VLS at each time-point. We included 632 HIV-negative MSM from the Amsterdam Cohort Studies from four data-waves between 2017 and 2019. We estimated weighted, undirected networks for each time-point, where we included pairwise interactions of PrEP and VLS uptake and related beliefs. PrEP use increased from 10 to 31% (p < 0.001), while VLS was reported by 7-10% at each time-point. Uptake of both BmPS was directly related to the perceived positive impact of the strategy on one's quality of sex life and perceived supportive social norms. Overall network structure differed between time points, specifically in regard to PrEP. At earlier time points, perceptions of efficacy and affordability played an important role for PrEP uptake, while more recently social and health-related concerns became increasingly important.The network structure differed across data-waves, suggesting specific time changes in uptake motives. These findings may be used in communication to increase prevention uptake.

A Network Approach to Compliance: A Complexity Science Understanding of How Rules Shape Behavior.

To understand how compliance develops both in everyday and corporate environments, it is crucial to understand how different mechanisms work together to shape individuals' (non)compliant behavior. Existing compliance studies typically focus on a subset of theories (i.e., rational choice theories, social theories, legitimacy theories, capacity theories, and opportunity theories) to understand how key variables from one or several of these theories shape individual compliance. The present study provides a first integrated understanding of compliance, rooted in complexity science, in which key elements from these theories are considered simultaneously, and their relations to compliance and each other are explored using network analysis. This approach is developed by analyzing online survey data (N = 562) about compliance with COVID-19 mitigation measures. Traditional regression analysis shows that elements from nearly all major compliance theories (except for social theories) are associated with compliance. The network analysis revealed groupings and interconnections of variables that did not track the existing compliance theories and point to a complexity overlooked in existing compliance research. These findings demonstrate a fundamentally different perspective on compliance, which moves away from traditional narrow, non-network approaches. Instead, they showcase a complexity science understanding of compliance, in which compliance is understood as a network of interacting variables derived from different theories that interact with compliance. This points to a new research agenda that is oriented on mapping compliance networks, and testing and modelling how regulatory and management interventions interact with each other and compliance within such networks. Supplementary Information: The online version contains supplementary material available at 10.1007/s10551-022-05128-8.

How compliance with behavioural measures during the initial phase of a pandemic develops over time: A longitudinal COVID-19 study.

In this longitudinal research, we adopt a complexity approach to examine the temporal dynamics of variables related to compliance with behavioural measures during the COVID-19 pandemic. Dutch participants (N = 2399) completed surveys with COVID-19-related variables five times over a period of 10 weeks (23 April-30 June 2020). With these data, we estimated within-person COVID-19 attitude networks containing a broad set of psychological variables and their relations. These networks display variables' predictive effects over time between measurements and contemporaneous effects during measurements. Results show (1) bidirectional effects between multiple variables relevant for compliance, forming potential feedback loops, and (2) a positive reinforcing structure between compliance, support for behavioural measures, involvement in the pandemic and vaccination intention. These results can explain why levels of these variables decreased throughout the course of the study. The reinforcing structure points towards potentially amplifying effects of interventions on these variables and might inform processes of polarization. We conclude that adopting a complexity approach might contribute to understanding protective behaviour in the initial phase of pandemics by combining different theoretical models and modelling bidirectional effects between variables. Future research could build upon this research by studying causality with interventions and including additional variables in the networks.

Understanding change in COVID-19 vaccination intention with network analysis of longitudinal data from Dutch adults.

Prior research into the relationship between attitudes and vaccination intention is predominantly cross-sectional and therefore does not provide insight into directions of relations. During the COVID-19 vaccines development and enrollment phase, we studied the temporal dynamics of COVID-19 vaccination intention in relation to attitudes toward COVID-19 vaccines and the pandemic, vaccination in general, social norms and trust. The data are derived from a longitudinal survey study with Dutch participants from a research panel (N = 744; six measurements between December 2020 and May 2021; age 18-84 years [M = 53.32]) and analyzed with vector-autoregression network analyses. While cross-sectional results indicated that vaccination intention was relatively strongly related to attitudes toward the vaccines, results from temporal analyses showed that vaccination intention mainly predicted other vaccination-related variables and to a lesser extent was predicted by variables. We found a weak predictive effect from social norm to vaccination intention that was not robust. This study underlines the challenge of stimulating uptake of new vaccines developed during pandemics, and the importance of examining directions of effects in research into vaccination intention.

Tailored interventions into broad attitude networks towards the COVID-19 pandemic.

This study examines how broad attitude networks are affected by tailored interventions aimed at variables selected based on their connectiveness with other variables. We first computed a broad attitude network based on a large-scale cross-sectional COVID-19 survey (N = 6,093). Over a period of approximately 10 weeks, participants were invited five times to complete this survey, with the third and fifth wave including interventions aimed at manipulating specific variables in the broad COVID-19 attitude network. Results suggest that targeted interventions that yield relatively strong effects on variables central to a broad attitude network have downstream effects on connected variables, which can be partially explained by the variables the interventions were aimed at. We conclude that broad attitude network structures can reveal important relations between variables that can help to design new interventions.

The relationship between ambivalence towards supervisor's behavior and employee's mental health.

Ambivalence in social interactions has been linked to health-related outcomes in private relationships and recent research has started to expand this evidence to ambivalent leadership at the workplace by showing that ambivalent supervisor-employee relationships are related to higher stress levels in employees. However, the mental health consequences of ambivalent leadership have not been examined yet. Using a multilevel approach, this study estimated associations of ambivalent leadership with mental health indicators (depression, anxiety, vital exhaustion, fatigue) in 993 employees from 27 work groups. A total effect of ambivalent leadership was found for all four mental health measures, as well as within-group and between-group effects. The consistent relationships of ambivalent leadership with higher symptoms of mental ill-health at the individual- (i.e., within-group) and the group-level (i.e., between-group) support the existence of an un-confounded association, as well as group effects of collective ambivalence.

Meating Conflict: Toward a Model of Ambivalence-Motivated Reduction of Meat Consumption.

An increasing number of people are concerned about eating meat, despite enjoying doing so. In the present research, we examined whether the desire to resolve this ambivalence about eating meat leads to a reduction in meat consumption. Our model of ambivalence-motivated meat reduction proposes that the pervasive nature of evaluative conflict motivates meat avoidance, and we highlight two potential mechanisms involved: the anticipation of ambivalence reduction through behavioral change, and information seeking for contents that facilitate meat reduction. Study 1 drew on a cross-sectional 6-day food diary with 7485 observations in a quota sample to investigate why meat-related ambivalence arises and to demonstrate the correlation of ambivalence with meat reduction. Two experiments investigated the causal direction of this association by showing that ambivalence-induced discomfort motivated participants to eat less meat when they introspected on their preexisting incongruent evaluations (Study 2 and 3), which was mediated by the aforementioned mechanisms involved (Study 3; preregistered). The studies utilized diverse samples from Germany, England, and the US (total N = 1192) and support the proposed model by indicating that behavioral change is an important coping strategy to resolve ambivalent discomfort in the context of meat consumption. Our model of ambivalence-motivated meat reduction contributes to theorizing on the consequences of ambivalence and the psychology of (not) eating meat.

Attitude stability as a moderator of the relationships between cognitive and affective attitudes and behaviour.

Temporal stability is assumed to be an important basis for attitudes being strong predictors of behaviour, but this notion has been little tested. The current research reports tests of temporal stability in moderating the attitude-behaviour relationship, specifically in relation to cognitive attitude (i.e., evaluation implied by cognitions about an attitude object) and affective attitude (i.e., evaluation implied by feelings about the attitude object). In three prospective studies (Study 1: physical activity, N = 909; Study 2: multiple health behaviours, N = 281; Study 3: smoking initiation, N = 3,371), temporal stability is shown to moderate the cognitive and affective attitudes to subsequent behaviour relationship in two-, three-, and four-wave designs utilizing between- (Studies 1 and 3) and within-participants (Study 2) analyses and controlling for past behaviour. Effects were more consistent for affective attitudes (when affective and cognitive attitudes were considered simultaneously and past behaviour controlled). Moderation effects were attenuated, but remained significant, in three- and four-wave compared with two-wave designs. The findings underline the role of temporal stability as an indicator of strength and confirm the relative importance of affective over cognitive (components of) attitudes for predicting behaviour.

A Psychological Network Approach to Attitudes and Preventive Behaviors During Pandemics: A COVID-19 Study in the United Kingdom and the Netherlands.

Preventive behaviors are crucial to prevent the spread of the coronavirus causing COVID-19. We adopted a complex psychological systems approach to obtain a descriptive account of the network of attitudes and behaviors related to COVID-19. A survey study (N = 1,022) was conducted with subsamples from the United Kingdom (n = 502) and the Netherlands (n = 520). The results highlight the importance of people's support for, and perceived efficacy of, the measures and preventive behaviors. This also applies to the perceived norm of family and friends adopting these behaviors. The networks in both countries were largely similar but also showed notable differences. The interplay of psychological factors in the networks is also highlighted, resulting in our appeal to policy makers to take complexity and mutual dependence of psychological factors into account. Future research should study the effects of interventions aimed at these factors, including effects on the network, to make causal inferences.

Promoting physical distancing during COVID-19: a systematic approach to compare behavioral interventions.

In the wake of the COVID-19 pandemic, physical distancing behavior turned out to be key to mitigating the virus spread. Therefore, it is crucial that we understand how we can successfully alter our behavior and promote physical distancing. We present a framework to systematically assess the effectiveness of behavioral interventions to stimulate physical distancing. In addition, we demonstrate the feasibility of this framework in a large-scale natural experiment (N = 639) conducted during an art fair. In an experimental design, we varied interventions to evaluate the effect of face masks, walking directions, and immediate feedback on visitors' contacts. We represent visitors as nodes, and their contacts as links in a contact network. Subsequently, we used network modelling to test for differences in these contact networks. We find no evidence that face masks influence physical distancing, while unidirectional walking directions and buzzer feedback do positively impact physical distancing. This study offers a feasible way to optimize physical distancing interventions through scientific research. As such, the presented framework provides society with the means to directly evaluate interventions, so that policy can be based on evidence rather than conjecture.

Prevention challenges with current perceptions of HIV burden among HIV-negative and never-tested men who have sex with men in the Netherlands: a mixed-methods study.

INTRODUCTION: As biomedical advances improved HIV treatment, the perceptions of severity and anticipated consequences of HIV could have changed accordingly. This study investigates the current perceptions of severity and anticipated consequences of HIV infection and its association with sexual risk behaviour among HIV-negative and never-tested men who have sex with men (MSM) living in the Netherlands. METHODS: In-depth interviews with recently diagnosed HIV-positive MSM were used to develop a questionnaire measuring the perceived severity and anticipated consequences of HIV infection. The questionnaire was distributed online between April and July 2019. A structural equation model was constructed to explore the anticipated consequences contributing to the perceived HIV severity and to assess the association between the perceived severity and sexual risk behaviour. RESULTS: In total, 1,072 HIV-negative and never-tested MSM completed the questionnaire, of whom 28% reported recent sexual risk behaviour. Almost one-quarter of participants (23%) had a low perceived HIV severity, which was associated with more prevalent sexual risk taking (ß = -0.07, 95% CI = -0.12/-0.01). In this model, the perceived severity of HIV was more strongly associated with anticipated psychological consequences of HIV (ß = 0.34, 95% CI = 0.24 to 0.44) and to a lesser extent with anticipated negative consequences of HIV on sex/relationships (ß = 0.28, 95% CI = 0.19 to 0.38) and disclosure-related consequences (ß = 0.16, 95% CI = 0.07 to 0.26). Health-related consequences of HIV were not significantly associated with the severity perceptions (ß = 0.06, 95% CI = -0.03 to 0.14). CONCLUSIONS: Anticipated negative social and psychological consequences of HIV mostly contribute to high HIV-severity perceptions in MSM. A smaller subgroup of MSM does not perceive HIV as a serious disease, which is associated with increased sexual risk taking. Efforts to normalize living with HIV are essential but might present a challenge for HIV prevention as it could, for a minority of MSM, decrease the motivation to prevent HIV infection.

Smart Distance Lab's art fair, experimental data on social distancing during the COVID-19 pandemic.

In the absence of a vaccine, social distancing behaviour is pivotal to mitigate COVID-19 virus spread. In this large-scale behavioural experiment, we gathered data during Smart Distance Lab: The Art Fair (n = 839) between August 28 and 30, 2020 in Amsterdam, the Netherlands. We varied walking directions (bidirectional, unidirectional, and no directions) and supplementary interventions (face mask and buzzer to alert visitors of 1.5 metres distance). We captured visitors' movements using cameras, registered their contacts (defined as within 1.5 metres) using wearable sensors, and assessed their attitudes toward COVID-19 as well as their experience during the event using questionnaires. We also registered environmental measures (e.g., humidity). In this paper, we describe this unprecedented, multi-modal experimental data set on social distancing, including psychological, behavioural, and environmental measures. The data set is available on figshare and in a MySQL database. It can be used to gain insight into (attitudes toward) behavioural interventions promoting social distancing, to calibrate pedestrian models, and to inform new studies on behavioural interventions.

Factors Associated with Never Testing for HIV: Directions for Targeted Testing Interventions Among Men Who Have Sex with Men.

Men who have sex with men (MSM) and who are unaware of their HIV infection contribute to onward HIV transmission and are more likely to progress to severe illness. We therefore assessed determinants of never testing for HIV among MSM living in the Netherlands. Between April and July 2019, 950 HIV-negative and 122 never-tested MSM completed a cross-sectional survey on sociodemographics, HIV testing behavior, and sexual risk taking, which was distributed through gay networking sites/apps. In never-tested MSM, median age was 37 (interquartile range = 22-51) years and 37 (30%) reported recent sexual risk behavior. Never testing was associated with younger age [adjusted odds ratio (aOR) per year increase = 0.98, 95% confidence interval (CI) = 0.97-1.00, p = 0.015], having sex with men and women (aOR = 2.85, 95% CI = 1.57-5.62, p = 0.001), and not knowing others living with HIV (aOR = 3.85, 95% CI = 2.35-6.32, p < 0.001) in multi-variable logistic regression analysis. A significant interaction effect between education level and residential area was observed (p = 0.001). Among higher-educated MSM, those living outside a large urban area had higher odds of never testing compared to those living in an urban area (aOR = 6.26, 95% CI = 2.42-16.24, p < 0.001). Lower-educated MSM had higher odds of never testing irrespective of residential area (large urban area: aOR = 12.06, 95% CI = 4.00-36.38; outside large urban area: aOR 9.29, 95% CI = 3.64-23.76; p < 0.001 for both). Among MSM recently exposed to sexual risk, never testing was associated with having sex with men and women (aOR = 2.80, 95% CI = 1.09-7.18, p = 0.032) and not knowing others with HIV (aOR = 4.91, 95% CI = 1.97-12.24, p = 0.001). To conclude, testing interventions for those never tested should be tailored to residential area and education level, and inclusive of bisexuality.

The Burden of Living With HIV is Mostly Overestimated by HIV-Negative and Never-Tested Men Who Have Sex With Men.

To assess whether HIV-negative men who have sex with men (MSM) have realistic views of the current implications of living with HIV, we compared data of 950 tested HIV-negative and 122 never-tested MSM on anticipated consequences of an HIV-infection to the actual experiences of 438 MSM living with HIV. Data were collected with a self-reported, web-based survey conducted between May-June 2019 in the Netherlands. Results indicated that, compared to HIV-positive MSM, HIV-negative MSM significantly overestimated 95% (37/39) of items assessing HIV-related burden. Never-tested participants overestimated 85% (33/39) of items. Overestimation in never-tested MSM was modified with increasing age and having HIV-positive friends/relatives. The high level of overestimation suggests the ongoing need to correct for misperceptions, as this could help reduce stigma towards those living with HIV and diminish fear of an HIV-diagnosis. The latter might be important to improve testing uptake in older never-tested MSM with outdated views on HIV.

Benefits of being ambivalent: The relationship between trait ambivalence and attribution biases.

Ambivalence refers to the experience of having both positive and negative thoughts and feelings at the same time about the same object, person, or issue. Although ambivalence research has focused extensively on negative consequences, recently, scholars turned their lens to the positive effects of ambivalence, demonstrating beneficial effects on judgements and decision-making processes. So far, this work has focused on state ambivalence, which is ambivalence as a direct response to a specific stimulus. However, there are substantial individual differences in ambivalence: Some people are just more ambivalent than others. Taking a first step in understanding how these individual differences relate to judgement and decision-making, we examine the relationship between trait ambivalence and cognitive bias in social judgements tasks. Specifically, we look at two of the most pervasive and consequential attribution biases in person perception: correspondence bias and self-serving bias. We find a negative relationship between trait ambivalence and correspondence bias. The higher individuals are in trait ambivalence, the smaller their bias towards attributing behaviour to a person's disposition (Study 1A and B). We find the same for self-serving bias (Study 2A and B). In sum, we show that trait ambivalence is negatively related to cognitive bias in person perception.

Cognitive-Affective Inconsistency and Ambivalence: Impact on the Overall Attitude-Behavior Relationship.

This research explored whether overall attitude is a stronger predictor of behavior when underlying cognitive-affective inconsistency or ambivalence is low versus high. Across three prospective studies in different behaviors and populations (Study 1: eating a low-fat diet, N = 136 adults, eating five fruit and vegetables per day, N = 135 adults; Study 2: smoking initiation, N = 4,933 adolescents; and Study 3: physical activity, N = 909 adults) we tested cognitive-affective inconsistency and ambivalence individually and simultaneously as moderators of the overall attitude-behavior relationship. Across studies, more similar effects were observed for inconsistency compared with ambivalence (in both individual and simultaneous analyses). Meta-analysis across studies supported this conclusion with both cognitive-affective inconsistency and ambivalence being significant moderators when considered on their own, but only inconsistency being significant when tested simultaneously. The reported studies highlight the importance of cognitive-affective inconsistency as a determinant of the strength of overall attitude.

Ambivalence and Interpersonal Liking: The Expression of Ambivalence as Social Validation of Attitudinal Conflict.

Literature on attitude similarity suggests that sharing similar attitudes enhances interpersonal liking, but it remains unanswered whether this effect also holds for ambivalent attitudes. In the present research, we shed light on the role attitudinal ambivalence plays in interpersonal liking. Specifically, we examine whether people express ambivalence strategically to generate a positive or negative social image, and whether this is dependent on the attitudinal ambivalence of their perceiver. We test two alternative hypotheses. In line with the attitude-similarity effect, people should express ambivalence toward ambivalent others to enhance interpersonal liking, as sharing ambivalence might socially validate the latter's experience of attitudinal conflict. On the other hand, people might express more univalence, as ambivalence may drive ambivalent others toward the resolution of their attitudinal conflict, and univalent stances could help to achieve that goal. In two studies (N = 449, 149), people expressed similar attitudes to those of their perceivers, even when the latter experienced attitudinal conflict (Studies 1 and 2). Moreover, they composed an essay, the message of which validated their perceiver's attitudinal conflict (Study 2). In line with these results, we further observe that the more people experienced their ambivalence as conflicting, the more they liked others who similarly experienced attitudinal conflict (Study 1). These findings suggest that the expression of ambivalence can have important interpersonal functions, as it might lead to an enhanced social image when interacting with those coping with attitudinal conflict.

Social evaluations under conflict: negative judgments of conflicting information are easier than positive judgments.

In the current study, we used functional magnetic resonance imaging to investigate how the brain facilitates social judgments despite evaluatively conflicting information. Participants learned consistent (positive or negative) and ambivalent (positive and negative) person information and were then asked to provide binary judgments of these targets in situations that either resolved conflict by prioritizing a subset of information or not. Self-report, decision time and brain data confirm that integrating contextual information into our evaluations of objects or people allows for nuanced (social) evaluations. The same mixed trait information elicited or failed to elicit evaluative conflict dependent on the situation. Crucially, we provide data suggesting that negative judgments are easier and may be considered the 'default' action when experiencing evaluative conflict: weaker activation in dorsolateral prefrontal cortex during trials of evaluative conflict was related to a greater likelihood of unfavorable judgments, and greater activation was related to more favorable judgments. Since negative outcome consequences are arguably more detrimental and salient, this finding supports the idea that additional regulation and a more active selection process are necessary to override an initial negative response to evaluatively conflicting information.