Free-living physical activity and executive function: A multi-study analysis of age groups and times of day / Actividad física de vida libre y función ejecutiva: un análisis de múltiples estudios de grupos de edad y horas del día

Background: Executive Function (EF) is a potential mechanism linking physical activity (PA) and mental health. However, evidence regarding the association between free-living PA and EF is limited with mixed results. Across two studies, we examined associations between accelerometer-assessed moderate-to-vigorous PA (MVPA) and facets of EF in different age groups (Study 1) and at different times of day (Study 2). Method: In Study 1, we tested the association between MVPA and verbal fluency across seven days in 285 participants (children, adults, older adults). In Study 2, we tested between- and within-person associations between MVPA and working memory (afternoon, evening, next morning) across three 18-day bursts in 64 preadolescents. Results: Study 1 showed no association between MVPA and verbal fluency overall, but there was an interaction by age group: a positive association was evident in older adults only. In Study 2, we observed a positive between-person association between MVPA and subsequent afternoon and next morning working memory, but not within-person. In the evening, MVPA was not related to working memory. Conclusions: The association between free-living PA and EF differs between age groups and times of day. Future research should consider these factors when examining the association and its role for mental health.(AU)

Free-living physical activity and executive function: A multi-study analysis of age groups and times of day.

Background: Executive Function (EF) is a potential mechanism linking physical activity (PA) and mental health. However, evidence regarding the association between free-living PA and EF is limited with mixed results. Across two studies, we examined associations between accelerometer-assessed moderate-to-vigorous PA (MVPA) and facets of EF in different age groups (Study 1) and at different times of day (Study 2). Method: In Study 1, we tested the association between MVPA and verbal fluency across seven days in 285 participants (children, adults, older adults). In Study 2, we tested between- and within-person associations between MVPA and working memory (afternoon, evening, next morning) across three 18-day bursts in 64 preadolescents. Results: Study 1 showed no association between MVPA and verbal fluency overall, but there was an interaction by age group: a positive association was evident in older adults only. In Study 2, we observed a positive between-person association between MVPA and subsequent afternoon and next morning working memory, but not within-person. In the evening, MVPA was not related to working memory. Conclusions: The association between free-living PA and EF differs between age groups and times of day. Future research should consider these factors when examining the association and its role for mental health.

Barriers and facilitators of adherence to the use of ASICA, a digital app designed to support people previously treated for melanoma: concise report of a qualitative study.

We developed the Achieving Self-directed Integrated Cancer Aftercare (ASICA) in melanoma app to support monthly total-skin self-examinations (TSSE) by people previously treated for melanoma. A randomized 12-month trial demonstrated ASICA supported optimal monthly TSSE adherence in a third of participants (ClinicalTrials.gov NCT03328247). However, a further third of participants adhered well initially but subsequently dropped off, and a final third did not adhere at all. This follow-up qualitative study investigated trial participants' perceptions of barriers and facilitators to TSSE adherence using the app. Three former trial participants participated in a single focus group and 11 participated in new semistructured telephone interviews. These were analysed thematically alongside secondary analysis of 13 qualitative interviews conducted during the trial. All transcripts were recorded, transcribed and analysed thematically. Five themes encompassing barriers and facilitators to ASICA adherence emerged. These were: technology, role of others, tailoring, disease journey and competing priorities. These data will inform further development of ASICA to increase user adherence.

Describing, predicting and explaining adherence to total skin self-examination (TSSE) in people with melanoma: a 12-month longitudinal study.

OBJECTIVES: To describe trajectories in melanoma survivors' adherence to monthly total skin self-examination (TSSE) over 12 months, and to investigate whether adherence trajectories can be predicted from demographic, cognitive or emotional factors at baseline. DESIGN: A longitudinal observational study nested within the intervention arm of the ASICA (Achieving Self-Directed Integrated Cancer Aftercare) randomised controlled trial. SETTING: Follow-up secondary care in Aberdeen and Cambridge UK. PARTICIPANTS: n=104 adults (48 men/56 women; mean age 58.83 years, SD 13.47, range 28-85 years; mean Scottish Index of Multiple Deprivation score 8.03, SD 1.73, range 2-10) who had been treated for stage 0-IIC primary cutaneous melanoma in the preceding 60 months and were actively participating in the intervention arm of the ASICA trial. INTERVENTIONS: All participants were using the ASICA intervention-a tablet-based intervention designed to support monthly TSSE. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was adherence to guideline recommended (monthly) TSSE over 12 months. This was determined from time-stamped TSSE data recorded by the ASICA intervention app. RESULTS: Latent growth mixture models identified three TSSE adherence trajectories (adherent -41%; drop-off -35%; non-adherent -24%). People who were non-adherent were less likely to intend to perform TSSE as recommended, intending to do it more frequently (OR=0.21, 95% CI 0.06 to 0.81, p=0.023) and were more depressed (OR=1.31, 95% CI 1.06 to 1.61, p=0.011) than people who were adherent. People whose adherence dropped off over time had less well-developed action plans (OR=0.78, 95% CI 0.63 to 0.96, p=0.016) and lower self-efficacy about TSSE (OR=0.92, 95% CI 0.86 to 0.99, p=0.028) than people who were adherent. CONCLUSIONS: Adherence to monthly TSSE in people treated for melanoma can be differentiated into adherent, drop-off and non-adherent trajectories. Collecting information about intentions to engage in TSSE, depression, self-efficacy and/or action planning at outset may help to identify those who would benefit from additional intervention. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03328247).

How can we better prepare new doctors for the tasks and challenges of ward rounds?: An observational study of junior doctors' experiences.

PURPOSE: Ward rounds play a crucial role in the delivery of patient care in inpatient settings, but involve a complex mix of tasks, skills and challenges for junior doctors to negotiate. This study informs the development of high-quality training by identifying the activities that junior doctors perform, and those associated with stress during real-life ward rounds. MATERIALS AND METHODS: All activities performed by FY1 doctors (n = 60) over 2 ward rounds were coded in real-time by a trained observer using the work observation method by activity timing (WOMBAT). Doctors' heart rate was continuously recorded and non-metabolic peaks in heart rate used as a physiological indicator of stress. RESULTS: During ward rounds, FY1 doctors commonly engaged in indirect patient care, professional communication, documentation and observation. Very little time was spent on direct patient care (6%) or explicit supervision/education (0.01%). Heart rate data indicated that stress was highest during administrative tasks while interacting directly with patients while stepping out of rounds to complete personal tasks, when answering bleeps and while multi-tasking. CONCLUSIONS: Training that specifically covers the activities involved, skills required, and challenges inherent in real-life ward rounds may better prepare FY doctors for this complex area of practice.

Antibiotic prescribing for respiratory tract infection: exploring drivers of cognitive effort and factors associated with inappropriate prescribing.

BACKGROUND: Antibiotics are over-prescribed for upper respiratory tract infection (URTI). It is unclear how factors known to influence prescribing decisions operate 'in the moment': dual process theories, which propose two systems of thought ('automatic' and 'analytical'), may inform this. OBJECTIVE(S): Investigate cognitive processes underlying antibiotic prescribing for URTI and the factors associated with inappropriate prescribing. METHODS: We conducted a mixed methods study. Primary care physicians in Scotland (n = 158) made prescribing decisions for patient scenarios describing sore throat or otitis media delivered online. Decision difficulty and decision time were recorded. Decisions were categorized as appropriate or inappropriate based on clinical guidelines. Regression analyses explored relationships between scenario and physician characteristics and decision difficulty, time and appropriateness. A subgroup (n = 5) verbalized their thoughts (think aloud) whilst making decisions for a subset of scenarios. Interviews were analysed inductively. RESULTS: Illness duration of 4+ days was associated with greater difficulty. Inappropriate prescribing was associated with clinical factors suggesting viral cause and with patient preference against antibiotics. In interviews, physicians made appropriate decisions quickly for easier cases, with little deliberation, reflecting automatic-type processes. For more difficult cases, physicians deliberated over information in some instances, but not in others, with inappropriate prescribing occurring in both instances. Some interpretations of illness duration and unilateral ear examination findings (for otitis media) were associated with inappropriate prescribing. CONCLUSION: Both automatic and analytical processes may lead to inappropriate prescribing. Interventions to support appropriate prescribing may benefit from targeting interpretation of illness duration and otitis media ear exam findings and facilitating appropriate use of both modes of thinking.

Antibiotics are often used to treat the common cold and ear/nose/throat infections but typically do not work for these issues. We explored the reasons why this prescribing may happen and some of the difficulties doctors might experience when making these treatment decisions. Doctors reviewed written descriptions of patients and decided whether or not to prescribe antibiotics. Some of these doctors also took part in an interview where they 'thought aloud' (said what they were thinking as they were thinking it) while considering the patient descriptions. When the patient had been ill for four or more days, this made decisions more difficult. Sometimes decisions to prescribe due to this illness duration and due to findings from an ear exam were not in line with guidelines for prescribing. Some decisions to prescribe seemed to be more related to automatic habits, while others occurred after careful deliberation over the information. Doctors need more support to make decisions involving these factors and may benefit from strategies to help them use their automatic/habitual thinking and their deliberative thinking in the best ways.

Healthy snacks in hospitals: Testing the potential effects of changes in availability.

BACKGROUND: Hospitals offer snacks for sale to patients, staff and visitors. AIM: As food choice is heavily influenced by the options available, the present study (a) audited snack availability and purchase in NHS hospital sites across a large UK city; and (b) tested the potential effects of changes to this availability in an online choice experiment. METHODS: In Study 1 (audit), single-serve snacks (n=376) available in 76 hospital food retail units were audited. Purchasing data were obtained from six food retail units over four weeks (27,989 sales). In Study 2 (online experiment), participants (n=159) chose snacks from pictured ranges containing 25% (minority), 50% (equivalent) or 75% (majority) healthy options. RESULTS: Available single-serve snacks varied markedly in calorie (18-641 kcals), fat (0-39 g), sugar (0.1-76 g) and salt (0-2.9 g). Only 30% of available snacks were healthy options and only 25% of the most commonly purchased snacks were healthy options. In Study 2, snack choice was significantly associated with the availability of healthy options in the choice array (X2 (2)= 59.71, p<.01). More participants made healthy choices when product ranges contained 75% healthy options compared to 50% (p<.01) and 50% healthy options compared with 25% (p<.01). CONCLUSIONS: Healthy snacks are readily available in NHS sites but there is a greater relative variety of unhealthy snack products. Many consumers continue to purchase unhealthy items. Further increasing the availability and variety of healthy options may support consumers to make healthier choices.

Development of a behaviour change workplace-based intervention to improve nurses' eating and physical activity.

BACKGROUND: There is a critical need for an intervention to improve nurses' eating and physical activity behaviours. As nurses spend a substantial proportion of their waking hours at work, concerted efforts to deliver such interventions in the workplace is growing. This study formed part of a multiphase programme of research that aimed to systematically develop an evidence-based and theory-informed workplace intervention to promote changes in eating and physical activity among nurses. METHODS: The intervention was developed iteratively, in line with Medical Research Council complex intervention guidelines. It involved four activities: (1) identifying the evidence base, (2) understanding the determinants of nurses' eating and physical activity behaviour change through theory-based qualitative interviews and survey, (3) identifying intervention options using the Behaviour Change Wheel, and (4) specifying intervention content and implementation options using a taxonomy of behaviour change techniques. RESULTS: Data from 13 randomised controlled trials indicated that workplace-based behaviour change interventions targeted to this population are effective in changing behaviour. The evidence base was, however, limited in quantity and quality. Nurses' beliefs about important factors determining their eating and physical activity behaviour were identified across 16 qualitative interviews and 245 survey responses, and key determinants included environmental context and resources, behavioural regulation, emotion, beliefs about consequences, knowledge and optimism. Based on these findings, 22 behaviour change techniques suitable for targeting the identified determinants were identified and combined into a potential workplace intervention. CONCLUSIONS: An evidence-based and theory-informed intervention tailored to the target population and setting has been explicitly conceptualised using a systematic approach. The proposed intervention addresses previous evidence gaps for the user population of nurses. Further to this, such an intervention, if implemented, has the potential to impact nurses' eating and physical activity behaviours and in turn, the health of nurses and the quality of healthcare delivery.

Performance pay and low-grade stress: An experimental study.

BACKGROUND: Although recent economics literature suggests a link between performance-related pay (PRP) and ill health, this finding is contested on the grounds that this link is plagued by endogeneity between the two variables of interest. OBJECTIVE: This study investigates the adverse effects of performance-related pay on stress which is an important determinant of physical health. METHODS: Forty subjects were randomly assigned to two equal groups: either being paid by performance or being paid a flat fee. Both objective (saliva samples to measure cortisol elevation) and subjective (self-reported stress level) measures of stress were obtained before and after participation in the experiment. This experimental methodology purges the effects of self-selection into performance pay and identifies the direction of causation from performance-related pay to stress which is measured by cortisol levels. RESULTS: Those who were paid for their performance experienced higher levels of stress, both in terms of perceived stress and in terms of objectively measured cortisol levels, compared to those who were paid a flat fee for minimum performance. CONCLUSIONS: Performance-related pay induces objectively measurable stress. Self-reported stress levels and the objective stress measure obtained by measuring cortisol move in a similar direction for the PRP and non-PRP groups, but only the cortisol group shows statistically significant differences between the PRP and non-PRP. This also suggests that individuals underestimate the stress caused by performance pay.

Prompting consumers to make healthier food choices in hospitals: a cluster randomised controlled trial.

BACKGROUND: Hospitals in the UK offer snacks for sale to patients, staff and visitors. Despite the NHS's health promoting role, and tightening of regulations around which foods can be sold in hospitals, many snacks purchased in this setting are unhealthy. The present project tests the effectiveness of theory-based point of purchase prompts (PPPs; a form of cognitive nudge) designed to make it cognitively easier for consumers to compare available products and choose healthier options. METHODS: Hospital shops in Scotland (n = 30) were recruited into a cluster randomised controlled trial to test whether a PPP could reduce the average calorie, fat and/or sugar content of purchased snacks. Inclusion criteria stated that eligible sites; sold food; were located in a hospital; and were accessible to staff, patients and visitors. The PPP intervention was a theory-based sign (tailored to the available range in each location) designed to cognitively simplify healthier snack choices by facilitating cross-product comparison. Shops were randomised to display PPPs (intervention; n = 15) or not (control; n = 15) using block randomisation controlling for shop size. Data on all snacks purchased from participating shops were obtained from retailers for a 12-week baseline and 12-week follow-up period. Primary outcomes were the average calorie (kcals), fat(g) and sugar(g) content of snacks purchased each day. Secondary outcomes were the average customer spend per item purchased (£,p) and the total number of snacks purchased daily. Shop staff were not blinded to group assignment but data providers were. Data were analysed using mixed effects multi-level regression models. RESULTS: Data from > 1 million snack purchases were analysed. Snacks purchased from intervention sites were on average significantly lower in calorie (γ = - 1.84, p < .001) and sugar (γ = - 0.18, p = .030) at follow up relative to baseline but only the reduction in calories was significantly different to control. Average spend per item also reduced significantly in intervention (but not control) sites (γ = - 0.89, p < .001). The intervention had no effect on the fat content of snacks or the number of snacks sold. CONCLUSIONS: Simple, theory-based point of purchase prompts can produce small but statistically significant reductions in the energy content of snack purchases from hospital shops. TRIAL REGISTRATION: Retrospectively registered (8/Oct/2018) with ISRCTN (ID: ISRCTN90365793 ).

Clinical decisions and time since rest break: An analysis of decision fatigue in nurses.

OBJECTIVE: The present study investigates whether nurses working for a national medical telephone helpline show evidence of "decision fatigue," as measured by a shift from effortful to easier and more conservative decisions as the time since their last rest break increases. METHOD: In an observational, repeated-measures study, data from approximately 4,000 calls to 150 nurses working for the Scottish NHS 24 medical helpline (37% of the national workforce) were modeled to determine whether the likelihood of a nurse's decision to refer a patient to another health professional the same day (the clinically safest but most conservative and resource inefficient decision) varied according to the number of calls taken/time elapsed since a nurse's last rest break and/or since the start of shift. Analyses used mixed-effect logistic regression. RESULTS: For every consecutive call taken since last rest break, the odds of nurses making a conservative management decision (i.e., arranging for callers to see another health professional the same day) increased by 5.5% (p = .001, 95% confidence interval [CI: 2.2, 8.8]), an increase in odds of 20.5% per work hour (p < .001, 95% CI [9.1, 33.2]) or 49.0% (on average) from immediately after 1 break to immediately before the next. Decision-making was not significantly related to general or cumulative workload (calls or time elapsed since start of shift). CONCLUSIONS: Every consecutive decision that nurses make since their last break produces a predictable shift toward more conservative, and less resource-efficient, decisions. Theoretical models of cognitive fatigue can elucidate how and why this shift occurs, helping to identify potentially modifiable determinants of patient care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Why does work cause fatigue? A real-time investigation of fatigue, and determinants of fatigue in nurses working 12-hour shifts.

BACKGROUND: One of the striking regularities of human behavior is that a prolonged physical, cognitive, or emotional activity leads to feelings of fatigue. Fatigue could be due to (1) depletion of a finite resource of physical and/or psychological energy or (2) changes in motivation, attention, and goal-directed effort (e.g. motivational control theory). PURPOSE: To contrast predictions from these two views in a real-time study of subjective fatigue in nurses while working. METHODS: One hundred nurses provided 1,453 assessments over two 12-hr shifts. Nurses rated fatigue, demand, control, and reward every 90 min. Physical energy expenditure was measured objectively using Actiheart. Hypotheses were tested using multilevel models to predict fatigue from (a) the accumulated values of physical energy expended, demand, control, and reward over the shift and (b) from distributed lag models of the same variables over the previous 90 min. RESULTS: Virtually all participants showed increasing fatigue over the work period. This increase was slightly greater when working overnight. Fatigue was not dependent on physical energy expended nor perceived work demands. However, it was related to perceived control over work and perceived reward associated with work. CONCLUSIONS: Findings provide little support for a resource depletion model; however, the finding that control and reward both predicted fatigue is consistent with a motivational account of fatigue.

Time Perspective and All-Cause Mortality: Evidence From the English Longitudinal Study of Ageing.

BACKGROUND: Long-term future thinking has been associated with a range of favorable health behaviors. However, it is currently unclear whether this translates into an effect on morbidity and mortality. PURPOSE: The goal of this study was to study the relationship between time perspective and all-cause mortality and to examine the role of health behavior in explaining this association. METHODS: Participants (N = 9,949) aged 50 and over from the English Longitudinal Study of Ageing, a representative cohort of older English adults, estimated the length of their time horizon for financial planning (time perspective). Two thousand ninety-two deaths were recorded over a 9-year follow-up period (2002/2003-2012). Smoking, physical activity, and alcohol consumption were examined as factors that may underlie the time perspective-mortality link. RESULTS: Our prospective survival analyses showed that those who tend to plan for longer periods experienced a significantly reduced risk of all-cause mortality (HR = 0.83; 95% confidence interval [CI]: [0.80, 0.87], p < .001 per 1 SD increase in future time perspective). This association remained after adjusting for baseline socioeconomic status and health (HR = 0.92; 95% CI: [0.88, 0.97], p < .001). The link between time perspective and mortality was observed across the gradient of financial circumstances and did not appear to be due to reverse causality. Healthy behavior among the more future orientated explained 34% of the link between time perspective and mortality. CONCLUSIONS: Using a simply administered indicator of time perspective, this study suggests that a future-orientated time perspective may be an important predictor of reduced risk of death.

What do self-efficacy items measure? Examining the discriminant content validity of self-efficacy items.

OBJECTIVES: Self-efficacy - an individual's judgement of their ability to successfully perform a behaviour - is commonly used to explain and predict behaviour. It is measured through self-report questionnaires. These scales require good content validity, that is must measure the full scope and content of the construct without contamination from similar constructs. This study uses a systematic, transparent quantitative method (discriminant content validation, DCV) to assess the content validity of a variety of self-efficacy items and qualitatively explores participant interpretations of these items. DESIGN: A quantitative DCV and qualitative think-aloud study of self-efficacy item interpretation. METHODS: Participants (n = 21) were presented with items designed to measure self-efficacy and related constructs following standard DCV methodology. Items were rated against construct definitions to determine whether they measured a particular construct (yes/no). Judges' confidence in each assessment was also assessed (%) and used to establish quantitative estimates of content validity for each item. A qualitative think-aloud study explored the judgements made in a subset of participants. RESULTS: 8/8 self-efficacy items were found to measure self-efficacy; however, 2/8 of these also measured motivation. 6/8 items displayed discriminant content validity and thus can be considered 'pure' measures of self-efficacy. The think-aloud study indicated that item wording is a likely cause of item misinterpretation. CONCLUSIONS: Self-efficacy items vary in terms of their content validity with only some of the items assessed providing 'pure' measures of the self-efficacy construct. Item wording should be considered during study design to avoid misinterpretation. Statement of contribution What is already known on this subject? For decades, questions have been raised relating to the content validity of self-efficacy scales, with suggestions of possible construct contamination. Previous studies have shown that manipulation of the wording of self-efficacy scale items results in varied participant interpretations. While self-efficacy items have been found to be distinguishable from other similar constructs, it is equally important to ensure that they are uncontaminated by different constructs within the same theory. Otherwise, when the theory is used to investigate behaviour, variance attributable to self-efficacy may be attributed to a different construct or vice versa. The present study uses discriminant content validation to test this and a think-aloud study to explore participants' interpretation of classic self-efficacy items. What does this study add? The study uses discriminant content validity methodology to assess the content validity of self-efficacy scales. Self-efficacy items which are contaminated with content from other constructs are identified. Information is presented on 'pure' self-efficacy items which can be used to guide item selection in future studies.

Understanding perceived determinants of nurses' eating and physical activity behaviour: a theory-informed qualitative interview study.

BACKGROUND: Unhealthy eating and physical activity behaviours are common among nurses but little is known about determinants of eating and physical activity behaviour in this population. The present study used a theoretical framework which summarises the many possible determinants of different health behaviours (the Theoretical Domains Framework; TDF) to systematically explore the most salient determinants of unhealthy eating and physical activity behaviour in hospital-based nurses. METHODS: Semi-structured qualitative interviews based on the TDF were conducted with nurses (n = 16) to explore factors that behavioural theories suggest may influence nurses' eating and physical activity behaviour. Important determinants of the target behaviours were identified using both inductive coding (of categories emerging from the data) and deductive coding (of categories derived from the TDF) of the qualitative data. RESULTS: Thirteen of the fourteen domains in the TDF were found to influence nurses' eating and physical activity behaviour. Within these domains, important barriers to engaging in healthy eating and physical activity behaviour were shift work, fatigue, stress, beliefs about negative consequences, the behaviours of family and friends and lack of planning. Important factors reported to enable engagement with healthy eating and physical activity behaviours were beliefs about benefits, the use of self-monitoring strategies, support from work colleagues, confidence, shift work, awareness of useful guidelines and strategies, good mood, future holidays and receiving compliments. CONCLUSIONS: This study used a theory-informed approach by applying the TDF to identify the key perceived determinants of nurses' eating and physical activity behaviour. The findings suggest that future efforts to change nurses' eating and physical activity behaviours should consider targeting a broad range of environmental, interpersonal and intrapersonal level factors, consistent with a socio-ecological perspective.

Effect of Different Types of Physical Activity on Activities of Daily Living in Older Adults: Systematic Review and Meta-Analysis.

Physical activity is associated with greater independence in old age. However, little is known about the effect of physical activity level and activity type on activities of daily living (ADL). This review systematically analyzed the effects of physical activity level and activity type on ADL in older adults (mean age, 60+). Electronic search methods (up to March 2015) identified 47 relevant, randomized controlled trials. Random effects meta-analyses revealed significant, beneficial effects of physical activity on ADL physical performance (SMD = 0.72, 95% CI [0.45, 1.00]; p < .01), with the largest effects found for moderate physical activity levels, and for activity types with high levels of mental (e.g., memory, attention), physical (e.g., coordination, balance) and social (e.g., social interaction) demands. Inconsistent effects were observed on self-reported ADL measures. Interventions that include moderate physical activity levels with high mental, physical, and social demands may produce the greatest benefits on ADL physical performance.

Does real time variability in inhibitory control drive snacking behavior? An intensive longitudinal study.

OBJECTIVE: Laboratory eating studies and cross-sectional surveys indicate individuals with inefficient executive function (EF) consume more unhealthy snacks than others. However, the importance of EF in determining snacking behavior in the "real world" has not been established. Contemporary behavioral and self-control theories posit EF as a dynamic resource fluctuating over time. Consequently, a test of the relevance of EF to behavior within individuals is required. This study tested within- and between-person effects of real-time variability in objectively measured inhibitory control (a core facet of EF) on subsequent snacking behavior in daily life. METHOD: A community sample of 64 adults recorded snacking behavior and completed a short Go/No-Go test (assessing inhibitory control) hourly over 7 consecutive days, yielding a total well-powered sample of 6,284 data-points. Generalized linear mixed models using lagged effects examined within-person and between-person effects of inhibitory control efficiency on snacking behavior. RESULTS: When Go/No-Go test responses were 100 ms slower than the person-mean (indicating periods of poorer inhibitory control), snack consumption in the following hour was 25.67% higher, Exp (γ) = 1.26, p = .002, 95% confidence interval (CI) [1.06, 1.49]. Between-individuals, person-mean reaction time (RT) did not predict snack consumption, Exp (γ) = 1.02, p = .965, 95% CI [0.71, 1.46]. CONCLUSIONS: RT variability in inhibitory control efficiency is highly relevant to snacking behavior within individuals. Inhibitory control is an important driver of snacking in everyday life and an important target for interventions. (PsycINFO Database Record

A Bidirectional Relationship between Executive Function and Health Behavior: Evidence, Implications, and Future Directions.

Physically active lifestyles and other health-enhancing behaviors play an important role in preserving executive function into old age. Conversely, emerging research suggests that executive functions facilitate participation in a broad range of healthy behaviors including physical activity and reduced fatty food, tobacco, and alcohol consumption. They do this by supporting the volition, planning, performance monitoring, and inhibition necessary to enact intentions and override urges to engage in health damaging behavior. Here, we focus firstly on evidence suggesting that health-enhancing behaviors can induce improvements in executive function. We then switch our focus to findings linking executive function to the consistent performance of health-promoting behaviors and the avoidance of health risk behaviors. We suggest that executive function, health behavior, and disease processes are interdependent. In particular, we argue that a positive feedback loop may exist whereby health behavior-induced changes in executive function foster subsequent health-enhancing behaviors, which in turn help sustain efficient executive functions and good health. We conclude by outlining the implications of this reciprocal relationship for intervention strategies, the design of research studies, and the study of healthy aging.

Total skin self-examination at home for people treated for cutaneous melanoma: development and pilot of a digital intervention.

OBJECTIVES: To develop a digital intervention to prompt, support, and respond to the outcomes of total skin self-examinations (TSSEs) at home by people treated for cutaneous melanoma. DESIGN: A complex intervention development study. SETTING: Northeast Scotland. PARTICIPANTS: Semistructured scoping interviews; people previously treated for cutaneous melanoma (n=21). Pilot testing: people treated for melanoma stages 0-2C (n=20); general practitioners (n=6); and a nurse specialist in dermatology (n=1). INTERVENTION: A tablet-based digital intervention designed to prompt and support TSSEs comprising instructional videos and electronic reporting (including photographs) to a clinical nurse specialist in dermatology, with subsequent clinical triage. PRIMARY AND SECONDARY OUTCOME MEASURES: Qualitative assessment of intervention feasibility and acceptability, and quantitative assessment of intentions and confidence to perform TSSEs in pilot participants. RESULTS: The majority of pilot participants were strongly positive and adhered well to the intervention (n=15), with 7 of these reporting symptoms of concern at some point during the 6-month pilot. 4 patients complied intermittently, 3 reporting skin problems at least once during the pilot, and 1 withdrew. 2 patients underwent skin surgery as a result of participating in the pilot, with 1 diagnosed as having a recurrent melanoma and the other, a benign lesion. A number of practical issues to improve the usability of the intervention were identified. The proportion of participants reporting intention to check their skin at least monthly increased during the intervention as did confidence to conduct a skin check. CONCLUSIONS: People previously treated for cutaneous melanoma are prepared to use digital technology to support them in conducting TSSE. An intervention has been developed which is practical, effective and safe, and after addressing minor practical issues, could now be evaluated for clinical outcomes in a randomised clinical trial.

Snack purchasing is healthier when the cognitive demands of choice are reduced: A randomized controlled trial.

OBJECTIVE: Individuals with inefficient executive (higher level cognitive) function have a reduced ability to resist dietary temptation. The present study aimed to design and test a theory-based point-of-purchase intervention for coffee shops that reduced the calorie content of customers' purchases by reducing the need for executive function (EF) at the moment of choice. METHODS: Key facets of EF were identified by a multidisciplinary group and used to develop a point-of-purchase intervention (signage). This intervention was evaluated in a randomized controlled trial (RCT) in a public coffee shop on consumer purchases of >20,000 snacks and drinks over 12 weeks. A sample of customers (n = 128) was recruited to complete an embedded cross-sectional study measuring EF strength, dietary intentions, typical purchases, and purchases made after exposure to the intervention. RESULTS: The proportion of snack purchases that were high in calorie reduced significantly (t(10) = 2.34, p = .04) in intervention weeks relative to control. High calorie drink purchases were also lower in intervention than control weeks, however, this difference was not significant (t(10) = 1.56, p = .15). On average, customers purchased items containing 66 calories < usual after exposure to the intervention. The magnitude of the intervention's positive effect on customer behavior increased as EF strength decreased (ß = .24, p = .03). CONCLUSIONS: The calorie content of cafe purchases can be lowered by reducing the cognitive demands of healthy food choice at the moment of purchase, especially in those with poor EF. Environmental changes like these have the potential to help achieve population weight control.