An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial.

BACKGROUND: Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family-based setting. METHODS: A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2). RESULTS: Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30). CONCLUSIONS: Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts. TRIAL REGISTRATION: German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/20534.

Eating After Acute Psychosocial Stress in Healthy Men and Women: Sex Differences and Endocrine Mechanisms.

CONTEXT: Overweight and obesity have become a major health burden with a higher prevalence of obesity in women than in men. Mental stress has been discussed to play a role in this context. OBJECTIVE: We investigated endocrine mechanisms underlying eating after acute psychosocial stress and potential sex differences therein. METHODS: A total of 32 male and 31 female healthy participants underwent the Trier Social Stress Test before they tasted ice cream in a bogus taste test 15 minutes after stress. We repeatedly assessed the stress hormone cortisol and the satiety hormone cholecystokinin (CCK) in saliva as well as perceived hunger before and up to 1 hour after stress. RESULTS: Lower immediate total cortisol stress reactivity predicted higher hunger (Ps ≤ .004), but was not associated with food intake (Ps ≥ .90) or total CCK release (Ps ≥ .84). As compared to men, women ate less after stress (Ps < .001) and had consistently lower levels of hunger (Ps ≤ .024) and cortisol (Ps ≤ .008) as well as a lower immediate total cortisol stress reactivity (Ps = .002). Further, they differed in the kinetics of CCK over the total experimental procedure (Ps ≤ .011), in immediate reaction to stress (Ps ≤ .038), and after eating (Ps ≤ .072), with women's CCK levels continuously decreasing while men's CCK levels were reactive. CONCLUSION: We found evidence for lower immediate total cortisol stress reactivity relating to higher perceived hunger, with lower cortisol levels in women. Unlike in men, CCK levels in women were not reactive to acute stress and eating and decreased continuously. Our results may suggest a higher risk for stress-induced eating in women.

Perspective: A Conceptual Framework for Adaptive Personalized Nutrition Advice Systems (APNASs).

Nearly all approaches to personalized nutrition (PN) use information such as the gene variants of individuals to deliver advice that is more beneficial than a generic "1-size-fits-all" recommendation. Despite great enthusiasm and the increased availability of commercial services, thus far, scientific studies have only revealed small to negligible effects on the efficacy and effectiveness of personalized dietary recommendations, even when using genetic or other individual information. In addition, from a public health perspective, scholars are critical of PN because it primarily targets socially privileged groups rather than the general population, thereby potentially widening health inequality. Therefore, in this perspective, we propose to extend current PN approaches by creating adaptive personalized nutrition advice systems (APNASs) that are tailored to the type and timing of personalized advice for individual needs, capacities, and receptivity in real-life food environments. These systems encompass a broadening of current PN goals (i.e., what should be achieved) to incorporate "individual goal preferences" beyond currently advocated biomedical targets (e.g., making sustainable food choices). Moreover, they cover the "personalization processes of behavior change" by providing in situ, "just-in-time" information in real-life environments (how and when to change), which accounts for individual capacities and constraints (e.g., economic resources). Finally, they are concerned with a "participatory dialog between individuals and experts" (e.g., actual or virtual dieticians, nutritionists, and advisors) when setting goals and deriving measures of adaption. Within this framework, emerging digital nutrition ecosystems enable continuous, real-time monitoring, advice, and support in food environments from exposure to consumption. We present this vision of a novel PN framework along with scenarios and arguments that describe its potential to efficiently address individual and population needs and target groups that would benefit most from its implementation.

[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.

Traditional and modern eating in older adults: a comparison between an urban and rural sample from Gujarat, Western India.

Background: The present study aimed to investigate how often and to what degree older adults living in an area of Gujarat, Western India, enact traditional and modern eating behaviors. Specifically, we aimed to determine which facets of traditional eating are enacted rarely and which facets of modern eating are enacted often. Moreover, we hypothesized that urban older adults show a higher level of modern eating behaviors than rural older adults. Furthermore, we examined which traditional eating behaviors are more prevalent in rural older adults, and which are more prevalent in urban older adults. Methods: A trained research assistant administered a questionnaire in a face-to-face situation with 120 older adults in a rural and an urban area of Gujarat, Western India. Participants were asked how often and to what degree they perform 57 traditional and modern eating behaviors. Results: Overall, our sample of older Gujaratis reported a high level of traditional eating behaviors and a low level of modern eating behaviors. However, we also found, for example, a low level of the traditional eating facet of men getting preferential treatment and a high level of the modern eating facet of food being readily available. Moreover, most modern eating facets were more pronounced in the urban than in the rural sample. This was also the case for half of all traditional eating facets. Conclusion: Our sample of older adults living in an area of Gujarat displayed more modern eating behaviors in urban than in rural areas. At the same time, however, the urban sample showed also more traditional eating behaviors, such as eating more fruits, possibly because of better food availability. Altogether, results might hint at some signs of modernization among older adults in this area of Gujarat with regard to changing gender roles and better food availability.

Individual and collective protective responses during the early phase of the COVID-19 pandemic in 10 different countries: Results from the EUCLID online survey.

BACKGROUND: In times of unprecedented infectious disease threats, it is essential to understand how to increase individual protective behaviors and support for collective measures. The present study therefore examines factors associated with individual and collective pathways. METHODS: Data was collected through an online survey from 4483 participants (70.8% female, M = 41.2 years) across 10 countries from April 15, 2020 to June 2, 2020 as part of the "EUCLID" project (https://euclid.dbvis.de). Structural equation modeling was used to examine individual and collective pathways across and within countries. RESULTS: Overall, the adoption of individual protective behaviors and support for collective measures were high. Risk perception on the individual level and perceived effectiveness at the collective level were positively associated with both individual protective behaviors and support for collective measures. Furthermore, the model explained considerable variance in individual (40.7%) and collective protective behaviors (40.8%) and was largely replicated across countries. CONCLUSIONS: The study extends previous research by demonstrating that individual risk perception and perceived effectiveness of collective measures jointly affect individual protective health behaviors and support for collective measures. These findings highlight the need to jointly consider a variety of behavioral actions against infectious disease threats, acknowledging interactions between individual and collective pathways.

Similar or different? Comparing food cultures with regard to traditional and modern eating across ten countries.

Food cultures can play a role in health and well-being. This raises the questions of whether nation boundaries unite the food cultures of different regions and ethnic groups, what characterises food cultures from very different parts of the world, and what similarities and differences exist. The present study aimed to investigate these questions with regard to eating traditions and modern eating practices. In this cross-sectional study, we recruited 3722 participants from ten countries - Brazil, China, France, Germany, Ghana, India, Japan, Mexico, Turkey, and the USA. Participants represented 25 regional and ethnic groups. They were queried about 86 traditional and modern facets of their food cultures in interviews, paper-pencil and online questionnaires. First, hierarchical cluster analysis suggested nine distinct clusters of food cultures - the food cultures of the Brazilian, Chinese, Ghanaian, Indian, Japanese, Mexican, Turkish, African and Latin US American samples, and of European descendants. Interestingly, for seven of the ten investigated countries, nation boundaries united food cultures. Second, each of the nine food culture clusters was characterised by a unique pattern of traditional and modern eating practices. Third, the nine food culture clusters varied more in their traditional eating practices than their modern eating practices. These results might promote a better understanding of the link between food cultures and health and well-being that goes beyond nutrients. For instance, food cultures might be linked to well-being via strengthening people's sense of cultural identity. Moreover, the present results contribute to a better understanding of the complex interplay between food and culture, and could help in developing culturally competent interventions to improve diet and reduce the risk of eating-related diseases.

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.

Nudging sugar portions: a real-world experiment.

BACKGROUND: Sugar overconsumption is a major contributor to overweight and obesity, with daily consumption greatly exceeding the WHO's recommendations. The aim of the present study was to determine whether using a functionally modified sugar shaker as a food environment nudge could be an effective means to reduce the sugar used in hot beverages. METHODS: Sugar shakers were functionally modified to reduce the amount of sugar in each pour by 47%. A real-world experiment was conducted to compare the amount of added sugar per hot beverage during default and nudge conditions over the course of four weeks (17,233 hot beverages sold) in a university take-away café. In addition, 59 customers were surveyed to evaluate the acceptance of the intervention. RESULTS: Modifying the functional design of sugar shakers resulted in a reduction of added sugar by 20% (d = 1.35) compared to the default condition. In the survey, most participants evaluated the intervention strategy positively. CONCLUSION: The present real-world experiment demonstrates that a simple environmental intervention can significantly reduce sugar consumption in public places while meeting with consumer approval, making it a promising means of reducing sugar overconsumption.

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.

Barriers to and Facilitators for Using Nutrition Apps: Systematic Review and Conceptual Framework.

BACKGROUND: Nutrition apps are effective in changing eating behavior and diet-related health risk factors. However, while they may curb growing overweight and obesity rates, widespread adoption is yet to be achieved. Hence, profound knowledge regarding factors motivating and hindering (long-term) nutrition app use is crucial for developing design guidelines aimed at supporting uptake and prolonged use of nutrition apps. OBJECTIVE: In this systematic review, we synthesized the literature on barriers to and facilitators for nutrition app use across disciplines including empirical qualitative and quantitative studies with current users, ex-users, and nonusers of nutrition apps. METHODS: A systematic literature search including 6 databases (PubMed, Web of Science, PsychINFO, PSYNDEX, PsycArticles, and SPORTDiscus) as well as backward and forward citation search was conducted. Search strategy, inclusion and exclusion criteria, and the planned data extraction process were preregistered. All empirical qualitative and quantitative studies published in German or English were eligible for inclusion if they examined adolescents (aged 13-18) or adults who were either current users, ex-users, and nonusers of nutrition apps. Based on qualitative content analysis, extracted individual barriers and facilitators were grouped into categories. RESULTS: A total of 28 publications were identified as eligible. A framework with a 3-level hierarchy was designed which grouped 328 individual barriers and facilitators into 23 subcategories, 12 categories, and 4 clusters that focus on either the individual user (goal setting and goal striving, motivation, routines, lack of awareness of knowledge), different aspects of the app and the smartphone (features, usability of the app or food database, technical issues, data security, accuracy/trustworthiness, costs), positive and negative outcomes of nutrition app use, or interactions between the user and their social environment. CONCLUSIONS: The resulting conceptual framework underlines a pronounced diversity of reasons for (not) using nutrition apps, indicating that there is no "one-size-fits-all" approach for uptake and prolonged use of nutrition apps. Hence, tailoring nutrition apps to needs of specific user groups seems promising for increasing engagement.

Contagious Health Risk and Precautionary Social Distancing.

BACKGROUND: Since humans are social animals, social relations are incredibly important. However, in cases of contagious diseases such as the flu, social contacts also pose a health risk. According to prominent health behavior change theories, perceiving a risk for one's health motivates precautionary behaviors. The "behavioral immune system" approach suggests that social distancing might be triggered as a precautionary, evolutionarily learned behavior to prevent transmitting contagious diseases through social contact. This study examines the link between personal risk perception for an infectious disease and precautionary behavior for disease-prevention in the context of social relationships. METHODS: At 2-week intervals during the first semester, 100 Psychology freshmen indicated their flu risk perception, whether they had been ill during the previous week, and their friendships within their freshmen network for eight time points. RESULTS: Social network analysis revealed that participants who reported a high flu risk perception listed fewer friends (B = -0.10, OR = 0.91, p = 0.026), and were more likely to be ill at the next measuring point (B = 0.26, OR = 1.30, p = 0.005). Incoming friendship nominations increased the likelihood of illness (B = 0.14, OR = 1.15, p = 0.008), while the reduced number of friendship nominations only marginally decreased this likelihood (B = -0.07, OR = 0.93, p = 0.052). CONCLUSION: In accordance with the concept of a "behavioral immune system," participants with high flu risk perception displayed a social precautionary distancing even when in an environment, in which the behavior was ineffective to prevent an illness.

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.

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.

Lack of reassurance after unexpected positive health risk feedback - an analysis of temporal dynamics.

INTRODUCTION: How do people receive unexpected positive health risk information? While common motivational accounts predict acceptance, consistency accounts such as the cue-adaptive reasoning account (CARA) predict a 'lack of reassurance'. OBJECTIVES: We therefore tested (1) whether people prefer striving for positivity or retaining a sense of self-consistency ('lack of reassurance'), and (2) if there are systematic differences in short- and long-term reception, which would indicate temporal dynamics in processing. METHODS: As part of a longitudinal cohort study, participants of a community health screening (N = 1,055) received their actual cholesterol readings. Feedback reception was assessed immediately, at one month and six months. RESULTS: Processing trajectories for unexpected positive feedback showed a significant 'lack of reassurance' effect over time compared with expected positive feedback, while unexpected negative feedback was less threatening than expected negative feedback. CONCLUSIONS: The perseverance of this 'lack of reassurance' over time indicates that striving for consistency in self-views is a robust phenomenon, even if it means forfeiting a better view of one's own health.

[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.

Memorable meals: The memory-experience gap in day-to-day experiences.

Research shows that retrospective memory is often more extreme than in-the-moment experiences. While investigations into this phenomenon have mostly focused on distinct, one-time experiences, we examined it with respect to recurring day-to-day experiences in the eating domain, focusing on variables of the snapshot model-i.e., the most intense and the final experience. We used a smartphone-based Ecological Momentary Assessment to assess the food intake and eating happiness of 103 participants (82.52% female, Mage = 21.97 years) over eight days, and then calculated their best (positive peak), worst (negative peak) and final experiences. Remembered eating happiness was assessed immediately after the study (immediate recall) and after four weeks (delayed recall). A significant memory-experience gap was revealed at immediate recall (d = .53). Remembered eating happiness was predicted by the worst eating experience (ß = .41, p < .001), but not by the best or final eating experience. Analyzing changes over time did not show a significant memory-experience gap at delayed recall, but did reveal a similar influence of the worst eating experience (ß = .39, p < .001). Findings indicate that, in the domain of eating, retrospective memory is mainly influenced by negative experiences. Overall, the results indicate that the snapshot model is a valid conceptualization to explain recall of both outstanding and day-to-day experiences.

Investigating the Relationship between Perceived Meal Colour Variety and Food Intake across Meal Types in a Smartphone-Based Ecological Momentary Assessment.

Although most people are aware of the health benefits of consuming sufficient amounts of fruit and vegetables, many do not adhere to current dietary recommendations. Recent studies have suggested meal colour variety as an intuitive cue for healthy and enjoyable lunch meal choices. The present study extends this research by testing the "colourful = healthy" association across meal types. Using smartphone-based Ecological Momentary Assessment, 110 participants recorded 2818 eating occasions over a period of eight days. For each eating occasion, a picture, a short written description of the meal, the meal type (breakfast, lunch, afternoon tea, dinner, snack) and the perceived meal colour variety were recorded. Foods were classified into seven food groups based on the pictures and descriptions. Data were analysed using multilevel modelling. For all meal types except afternoon tea which did not include vegetables, perceived that meal colour variety was positively related to vegetable consumption (bs ≥ 0.001, ts ≥ 3.27, ps ≤ 0.002, quasi-R2s ≥ 0.06). Moreover, perceived meal colour variety was negatively associated with sweets consumption for breakfast, dinner and snacks (bs ≤ -0.001, ts ≤ -2.82, ps ≤ 0.006, quasi-R2s ≥ 0.01). The "colourful = healthy" association can be generalized across meal types and thus may be a promising strategy to promote a healthier diet.

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 Relation of Threat Level and Age With Protective Behavior Intentions During Covid-19 in Germany.

To contain the spread of Covid-19, engagement in protective behaviors across the population is of great importance. The present study investigated protective behavior intentions during the early phases of Covid-19 in Germany (February 2-April 3, 2020) as a function of threat level and age using data from 4,940 participants in the EUCLID project. Results indicated that the intention to engage in social distancing increased sharply with threat level. Intentions for personal hygiene also increased, although to a lesser extent. While age only had a small overall effect on behavioral intentions, differential patterns emerged. After the lockdown was introduced, the impact of age decreased for social distancing and hygiene behavior intentions but increased for seeing a doctor. Since containing the Covid-19 pandemic depends on high adoption rates of protective behaviors, future research should track sustained phases of the pandemic, including the easing of restrictions and possible new waves of infections.