An assessment tool for the international healthy eating report card for preschool-aged children: a cross-cultural validation across Australia, Hong Kong, Singapore, and the United States.

Objective: This study aimed to develop and validate a globally applicable assessment tool of the 43-item International Healthy Eating Report Card Scale (IHERCS) which was designed to assess preschool-aged children's eating behaviours and family home food environments (FHFEs) across different cultural settings. In particular, we examined the factor structure, internal consistency and measurement invariance of the IHERCS across four cultural samples, including Australia, Hong Kong, Singapore, and the US. Convergent and discriminant validity were then conducted. Methods: In this cross-cultural study, a total of 2059 parent-child dyads from these four regions were recruited, and the parents were asked to complete the IHERCS. An exploratory structural equational modelling approach was employed to examine two higher-order factor models of children's eating behaviours and FHFEs in the IHERCS and its cross-cultural measurement invariance. Results: The findings demonstrated robust factor structures of the scales of children's eating behaviours and FHFEs in the IHERCS (i.e., CFI and TLI > 0.90; RMSEA and SRMR < 0.08) and an acceptable level of internal consistency (i.e., Cronbach's α = 0.55-0.84). Full configural invariance and metric invariance were established across the four cultural contexts, but full scalar invariance was not achieved. Partial scalar invariance was found only in the scale of FHFEs. The convergent validity and discriminant validity were supported. Conclusion: Overall, the current findings provided preliminary support for the construct validity and measurement invariance of the IHERCS. It provides a reliable, valid and comprehensive assessment of eating behaviours and FHFEs among children in different cultural settings.

Executive function, perceived stress and eating behaviours among Chinese young adults.

Young adults in a transitional period may experience more stress and, hence, suffer from an increased risk of unhealthy eating. Executive function (EF) involves not only inhibitory control and mental flexibility (the 'cool' facet) to facilitate resistance to immediate temptations, but also affective decision making (the 'hot' facet) that helps to regulate emotional eating. The effects of different facets of EF and their interactions with perceived stress on eating behaviours remained underexplored. In this study, 594 young adults in their graduation year of post-secondary education were included. We used latent profile analysis to identify major patterns of eating behaviours and analysed their associations with perceived stress, and both the 'cool' and 'hot' facets of EF using multinominal logistic regression models. Latent profile analysis identified three clusters of eating patterns: non-approaching moderate eaters (N = 312, 52.5%), approaching eaters (N = 229, 38.6%), and approaching-and-avoidant eaters (N = 53, 8.9%). Logistic regression models found that the approaching-and-avoidant eating pattern was associated with higher perceived stress (OR = 3.16, p value = 0.007) and poorer affective decision-making (OR = 0.97, p value = 0.006). Stratified analysis further revealed that higher perceived stress was significantly associated with approaching-and-avoidant eating only among individuals with poorer affective decision-making. These findings suggest that individuals with poorer emotional regulation may face greater difficulties in regulating eating behaviours when experiencing higher stress. Interventions for people with a mixed pattern of approaching-and-avoidance eating should focus on providing support to regulate emotion-related eating.

Music Timing Differentiates Fatigue Perception and Performance during Isometric Strength Exercises: A Crossover Randomised Trial.

Music is well-known to elicit ergogenic effects on exercise performance; however, the moderating role of application timing remains unclear. This study examined the effects of the timing of music on fatigue perception and performance during isometric strength exercises. Using a within-subject, randomised crossover design, twelve recreationally active young adults performed two isometric strength tasks (plank-hold and wall-sit) in three separate conditions (MEE: music played during the entire exercise task; MDF: music played during fatigue alone; CON: no music). The total time to volitional exhaustion (TTE), time to the onset of fatigue perception (TFP), heart rate, and blood lactate responses were assessed during each trial. MEE resulted in a significantly longer TTE than CON in both the plank-hold (p < 0.05, d = 0.76) and wall-sit exercises (p < 0.05, d = 0.72), whereas MDF led to a significantly longer TTE than CON in wall-sit exercises alone (p < 0.05, d = 0.60). TFP was significantly longer in MEE than in CON in both the plank-hold (p < 0.05, d = 0.54) and wall-sit exercises (p < 0.05, d = 0.64). The music condition did not influence the heart rate or blood lactate changes in any of the trials. Our results suggest that listening to music during the entire exercise can delay the onset of fatigue perception in isometric strength tasks, whereas listening to music during fatigue has only a modest effect. Athletes and exercisers should consider extending music exposure throughout the entire exercise task to maximise performance benefits.

Beyond intention: Predicting children's COVID-19 vaccine uptake using the theory of planned behavior.

This prospective study tested if parental factors from the theory of planned behavior (TPB) predicted children's uptake of the COVID-19 vaccine and examined whether parents' intention to vaccinate children against COVID-19 would mediate such associations. Participants were 852 Hong Kong parents of 1076 children aged 5-12. At Time 1, parents reported on items measuring the TPB predictors (i.e. attitudes, subjective norms, and perceived behavioral control) and intention. At Time 2 (approximately 4 months after Time 1), parents reported whether their children had received the COVID-19 vaccine. Attitudes, perceived behavioral control, and intention predicted children's actual uptake of the COVID-19 vaccine. Intention mediated the relations between two TPB predictors, namely attitudes and subjective norms, and children's COVID-19 vaccination uptake. The TPB is considered a useful framework in the development of future COVID-19 vaccine programs for children to promote parents' intention and the subsequent uptake of the COVID-19 vaccine among children.

Children's Daily Living Routine Mediates the Relations Between Parent-Child Relationships and Child Adjustment Problems During School Suspension in Hong Kong.

Young children's adjustment problems were found to be prevalent during the COVID-19 pandemic. Such adjustment problems may be dependent on children's relationships with their parents and children's daily living routine in the family during the pandemic-related school suspension period. This study examines how children's routine mediated the associations between parent-child relationships and child adjustment problems during the fifth wave of the COVID-19 pandemic in Hong Kong, when schools were suspended. The study collected data from 937 parents (87.8% mothers) of children aged 5-12 (M = 7.35 years, SD = 2.09; 50.5% girls). Parents reported on parent-child relationships, children's daily living routine, and child adjustment problems in an online survey. Our findings from structural equation modeling indicate that parent-child closeness was negatively related to child adjustment problems, whereas conflict was positively related to child adjustment problems. Children's routine mediated the associations between parent-child relationships (i.e., closeness and conflict) and child externalizing problems. However, children's routine did not mediate the associations between parent-child relationships (i.e., closeness and conflict) and child internalizing problems. The findings show that parents should be helped to establish routine, especially in difficult times when young children experience turbulence in their daily life, so as to reduce their adjustment problems, in particular of an externalizing nature.

Young children's motivations and social cognitions toward swimming: Testing direct and moderation effects of sport competence in two large-scale studies.

Direct and moderation effects of swimming competence using an integrated model of self-determination theory (SDT) and theory of planned behaviour (TPB) were examined in two large-scale studies among young children. Specifically, we examined whether swimming competence had direct and moderation effects on social psychological variables of perceived need support, autonomous motivation, TPB social cognition constructs, and intention. In Study 1, using a cross-sectional survey of 4959 primary school children, swimming competence formed significant positive relationships with all model variables (ß =.061 to.330, p < .05) except intention (ß = -.009, p > .05), and its moderation effect on model parameters were small in size or not statistically significant. In Study 2, using a pre-post-test quasi-experiment among 1,609 primary school children, improvement of swimming competence was associated with change-scores in all model variables (ß =.046 to.230, p < .05) except subjective norm (ß =.049, p > .05). Swimming competence did not significantly moderate the parameter estimates of the integrated model (p > .05) at the change-score level. Findings indicate that swimming competence is associated with higher autonomous motivation; TPB social cognitions of attitude, subjective norm, and perceived behavioural control; and intention. However, swimming competence did not moderate the parameter estimates of the integrated model.

Children infected vs. uninfected with COVID-19: Differences in parent reports of the use of mobile phones to calm children, routines, parent-child relationship, and developmental outcomes.

Children were suggested to be at lower risk of developing the severe form of the COVID-19. However, children infected with COVID-19 may be more likely to experience biopsychosocial stressors associated with the pandemic and display poorer developmental outcomes. The current study is among the first to compare children infected and uninfected with COVID-19 on outcomes related to parents' use of mobile phones to calm children, routines, parent-child relationship, externalizing and internalizing problems, prosocial behavior, gratitude, and happiness. A total of 1,187 parents (88.6% mothers) of children aged 5 to 12 completed an online survey between April 2022 and May 2022 when schools were suspended during the 5th wave of resurgence in Hong Kong. Our findings showed no substantial differences in various psychological, social, emotional, and behavioral outcomes between infected and uninfected children. Our findings can be used to educate parents to reduce their fear and anxieties associated with their children's COVID-19 infection. Our findings also suggested that support during the pandemic should be provided to children and families regardless of whether children have been infected with COVID-19.

Motivation, injury prevention, and the incidence of sports injuries: A three-wave longitudinal test of self-determination theory.

This study applied self-determination theory (SDT) as a psychological framework to examine whether psychological need support and autonomous motivation are predictive of sports injury preventive behaviors and the incidence of sports injuries. 2042 secondary school students (mean age = 14.33, male = 44.3%) from China completed a survey of the study variables (using established scales) at three time points (baseline, 1-month follow-up, 3-month follow-up). Structural equation modeling examined the core tenets of SDT by testing if the change-scores of the SDT variables (i.e., psychological need support from PE teachers, students' motivation, and students' behavioral adherence) between baseline and 1-month follow-up, were predictive of sports injury incidence assessed at 3-month follow-up. Our model demonstrated acceptable goodness-of-fit parameters (CFI = 0.97, TLI = 0.96, RMSEA = 0.03, and SRMR = 0.05). The relationships between psychological need support, autonomous motivation, and behavioral adherence were both positive and significant. These SDT variables predicted the future incidence of sports injuries following the motivational pathways of SDT. Our study provides evidence of the predictive power of SDT variables on sports injury preventive behaviors and the incidence of sports injuries: Students who perceive their PE teachers as psychological need supportive possess higher autonomous motivation and behavioral adherence towards sports injury prevention, and are also less likely to encounter sports injuries in the future.

Promoting influenza prevention for older adults using the Health Action Process Approach: A randomized controlled trial.

Older adults are at greater risk of complications from seasonal influenza, and promoting uptake and adherence to preventive behaviors is key to attenuating this risk. The current study examined the efficacy of a theory-based telephone-delivered intervention to promote uptake and maintenance of influenza preventive behaviors in a sample of Hong Kong residents 65 years and older. The intervention adopted a three-group randomized controlled design (n = 312) with two intervention conditions, motivational and motivational + volitional, and a measurement-only control condition. The primary outcome variable was self-reported compliance with influenza preventive behaviors, including washing hands, avoiding touching eyes, nose, or mouth, and wearing face masks. Secondary outcomes were theory-based psychological variables. Influenza preventive behaviors in participants in the motivational + volitional intervention group were significantly improved 3 months post-intervention relative to those in the control condition. However, participants in the intervention group demonstrated no difference in behavior at 6 and 12 months post-intervention relative to the participants in the control group. Intervention effects were observed on the theory-based social support, action planning, and coping planning variables. Although short-term benefits of the intervention were observed, effects appeared to be short-lived and future research should investigate more intensive interventions that lead to greater behavioral maintenance.

Moral obligation to follow anti-COVID-19 measures strengthens the mental health cost of pandemic burnout.

BACKGROUND: It has been observed that people become gradually exhausted by receiving COVID-19-related information and adhering to the corresponding preventive measures as the pandemic unfolds. This phenomenon is known as pandemic burnout. Emerging evidence shows that pandemic burnout is related to poor mental health. This study extended the trendy topic by examining the idea that moral obligation, a crucial motivation driving people to follow the preventive measures, would amplify the mental health cost of pandemic burnout. METHODS: Participants were 937 Hong Kong citizens (88 % females, 62.4 % aged 31-40 years). They participated in a cross-sectional online survey reporting on pandemic burnout, moral obligation, and mental health problems (i.e., depressive symptoms, anxiety, and stress). RESULTS: Findings of moderation model analyses showed that higher levels of pandemic burnout and moral obligation were related to more mental health problems. Importantly, the "pandemic burnout-mental health problems" links were moderated by moral obligation, with those who felt more morally obliged to follow the measures reporting poorer mental health than those who felt less morally obliged to do so. LIMITATIONS: The cross-sectional design of the study may constrain the evidence about the directions and causality of the relationships. Participants were only recruited from Hong Kong and females were over-represented, thus limiting the generalizability of the findings. CONCLUSIONS: People who experience pandemic burnout while feeling more morally obliged to follow the anti-COVID-19 measures are at greater risk of mental health problems. They might need more mental health support from medical professionals.

Why do Hong Kong parents have low intention to vaccinate their children against COVID-19? testing health belief model and theory of planned behavior in a large-scale survey.

COVID-19 vaccines have been authorized for use in children in some societies. Parents' intention to vaccinate their children is context-specific. Drawing upon health belief model (HBM) and theory of planned behavior (TPB), this study contributed to a timely topic by examining the extent to which parents intended to vaccinate their children and its associated factors in Hong Kong, where the government announced children as young as five could take COVID-19 vaccines starting from 21 January 2022. A large-scale, online survey was conducted among 11,141 Hong Kong parents (86% mothers) of children aged 5-12 (N = 14,468, 49.5% girls). They reported on measures that assessed HBM constructs (i.e., perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action), TPB constructs (i.e., attitudes, subjective norms, and perceived behavioral control), and their intention to vaccinate each of their children. Results of descriptive statistics showed that Hong Kong parents' intention to vaccinate their children was very low (1.55 out of 5.00). Multilevel regression showed that after controlling for parents' and children's demographic variables (e.g., sex and age), parents' intention to vaccinate their children was higher if parents had higher levels of perceived susceptibility, perceived benefits, positive attitudes, and subjective norms and if they had lower levels of perceived barriers. Positive attitudes were the strongest correlate of parents' intention. These findings have important implications for public health by informing which factors authorities should address in order to boost Hong Kong parents' intention to vaccinate their children.

Descriptive epidemiology and correlates of children's swimming competence.

This study examined the swimming competence of primary school children, and how it was related to swimming activity, non-fatal aquatic events, and demographic factors. Primary school students (N = 4959; female = 2705, male = 2241; age range = 5 to 14 years) across 28 schools in the 15 districts of Hong Kong completed the Swimming Competence Questionnaire, and questions about their swimming experience, non-fatal aquatic events, and demographic variables. Descriptive statistics showed that over 60% of children could swim more than 5m, but less than 50% could swim over 25m. Over 50% of children were able to perform some basic swimming skills (e.g., holding breath underwater, floating, poolside/kickboard kicking, and treading water). Swimming competence was positively predicted by the demographic factors (i.e., age, sex, family income, and parents' highest education level), swimming experience, learning experience, and swimming location. Treading water was the only factor of swimming competence that established asignificant negative association with non-fatal aquatic events. Current results can be used to target key groups to improve children's swimming competence and reduce non-fatal aquatic events; children from lower socio-economic backgrounds and with less swimming experience should be encouraged to participate in more formal learn to swim lessons.

Physical activity in Indonesian University students: the contradictory roles of dispositional mindfulness and self-control.

Physical inactivity is now identified as one of the major risk factors for global mortality, including in Indonesia. Past research in Western settings have demonstrated the efficacy of self-determined or autonomous forms of motivation in predicting health-related behaviours, and that association between these variables could possibly be moderated by individual differences in mindfulness. In terms of mindfulness, individuals from different cultures may vary in their familiarity and acceptance of mindfulness in daily life. Moreover, the ways though which individuals exhibit qualities of mindfulness are often intertwined with their capacity for self-control. In this correlational study utilizing cloud-based online survey, samples of Indonesian undergraduates (N = 411, mean age = 20.202, SD = 1.406) completed self-report measures of trait mindfulness, trait self-control, autonomous motivation, and physical activity. Bootstrap multiple regression analysis indicated that association between autonomous motivation and physical activity is strengthened by trait self-control (p = .017), but conversely, weakened by trait mindfulness (p = .024). Cultural perspective may help explain the dynamics of mindfulness, self-control, autonomous motivation, and physical activity.

Promoting influenza prevention for elderly people in Hong Kong using health action process approach: study protocol.

BACKGROUND: People 65 years or older are at greater risk of serious complications from the seasonal influenza compared with young. To promote elderly people's behavioral compliance toward influenza prevention, the aim of the current project is to develop, implement, and evaluate a theory-based low-administration-cost intervention building on a leading psychological theory, the Health Action Process Approach (HAPA). METHODS: The target group is Hong Kong Chinese elderly people aged 65 or older who rarely or never adopt any preventive actions. This project will be conducted in three phases over 24 months. In phase 1, intervention program will be developed building on the HAPA theoretical framework which comprises both the initiation and maintenance of influenza prevention behaviors. In phase 2, intervention will be implemented and evaluated using a randomized controlled trial, including: (a) behavior initiation only, (b) behavior initiation + behavior maintenance, and (c) control group. Both the initiation and maintenance components will comprise weekly-delivered telephone-based individual intervention sessions in 3 months. In phase 3, outcome evaluation of behavioral and psychological variables and process evaluation will be conducted. The effectiveness of the intervention will be analyzed using a series of linear mixed models on each behavioral and psychological outcome variable. Structural equation modelling will be used to test the hypothesized theoretical sequence in the HAPA model. DISCUSSION: The proposed project is expected to design theory-based intervention materials to promote the influenza prevention behaviors in Hong Kong elderly people and provide information on its effectiveness and the potential changing mechanism of behavior initiation and maintenance. TRIAL REGISTRATION: This randomized controlled trial was funded by the Health and Medical Research Fund (HMRF), Food and Health Bureau of the Government of the Hong Kong Special Administrative Region (Ref: 16151222) and was registered on 13/10/2017 at CCRB Clinical Trials Registry of the Chinese University of Hong Kong, a Partner Registry of a WHO Primary Registry (Ref: CUHK_CCRB00567 ).

Predicting Athletes' Pre-Exercise Fluid Intake: A Theoretical Integration Approach.

Pre-exercise fluid intake is an important healthy behavior for maintaining athletes’ sports performances and health. However, athletes’ behavioral adherence to fluid intake and its underlying psychological mechanisms have not been investigated. This prospective study aimed to use a health psychology model that integrates the self-determination theory and the theory of planned behavior for understanding pre-exercise fluid intake among athletes. Participants (n = 179) were athletes from college sport teams who completed surveys at two time points. Baseline (Time 1) assessment comprised psychological variables of the integrated model (i.e., autonomous and controlled motivation, attitude, subjective norm, perceived behavioral control, and intention) and fluid intake (i.e., behavior) was measured prospectively at one month (Time 2). Path analysis showed that the positive association between autonomous motivation and intention was mediated by subjective norm and perceived behavioral control. Controlled motivation positively predicted the subjective norm. Intentions positively predicted pre-exercise fluid intake behavior. Overall, the pattern of results was generally consistent with the integrated model, and it was suggested that athletes’ pre-exercise fluid intake behaviors were associated with the motivational and social cognitive factors of the model. The research findings could be informative for coaches and sport scientists to promote athletes’ pre-exercise fluid intake behaviors.

Implicit versus explicit attitude to doping: Which better predicts athletes' vigilance towards unintentional doping?

OBJECTIVES: This preliminary study examined whether implicit doping attitude, explicit doping attitude, or both, predicted athletes' vigilance towards unintentional doping. DESIGN: A cross-sectional correlational design. METHODS: Australian athletes (N=143;Mage=18.13, SD=4.63) completed measures of implicit doping attitude (brief single-category implicit association test), explicit doping attitude (Performance Enhancement Attitude Scale), avoidance of unintentional doping (Self-Reported Treatment Adherence Scale), and behavioural vigilance task of unintentional doping (reading the ingredients of an unfamiliar food product). RESULTS: Positive implicit doping attitude and explicit doping attitude were negatively related to athletes' likelihood of reading the ingredients table of an unfamiliar food product, and positively related to athletes' vigilance towards unintentional doping. Neither attitude measures predicted avoidance of unintentional doping. Overall, the magnitude of associations by implicit doping attitude appeared to be stronger than that of explicit doping attitude. CONCLUSIONS: Athletes with positive implicit and explicit doping attitudes were less likely to read the ingredients table of an unknown food product, but were more likely to be aware of the possible presence of banned substances in a certain food product. Implicit doping attitude appeared to explain athletes' behavioural response to the avoidance of unintentional doping beyond variance explained by explicit doping attitude.

Linking Coach Interpersonal Style With Athlete Doping Intentions and Doping Use: A Prospective Study.

We brought together various lines of work on motivation, morality, and doping by testing a theory-based model prospectively linking contextual and personal motivational variables, moral attitudes, moral disengagement in doping, doping intentions, and doping use. Participants were 257 Greek athletes who completed a questionnaire pack at the beginning of a sport season. In the case of doping use, we also obtained data close to the end of the same season. The model showed that perceptions of controlling coach behaviors predicted athlete need frustration, which in turn predicted low moral functioning and doping intentions/doping use. The findings highlight pathways (direct and indirect) by which the social environment may impact on athletes' intentions and decisions to engage in doping and could pave the way for future antidoping interventions aimed at improving coaching interpersonal style.

The process by which perceived autonomy support predicts motivation, intention, and behavior for seasonal influenza prevention in Hong Kong older adults.

BACKGROUND: This study examined the effectiveness of a theoretical framework that integrates self-determination theory (SDT) and the theory of planned behavior (TPB) in explaining the use of facemasks to prevent seasonal influenza among Hong Kong older adults. METHODS: Data were collected at two time points in the winter in Hong Kong, during which influenza is most prevalent. At Time 1, older adults (N = 141) completed self-report measures of SDT (perceived autonomy support from senior center staff, autonomous motivation for influenza prevention) and TPB (attitude, subjective norm, perceived behavioral control, and intention for influenza prevention) constructs with respect to facemask used to prevent infection. Two weeks later, at Time 2, participants' acceptance of a facemask to prevent influenza in the presence of an experimenter with flu-like symptoms was recorded. RESULTS: Path analysis found that perceived autonomy support of senior center staff was positively and significantly linked to autonomous motivation for facemask use, which, in turn, was positively related to intentions to wear facemasks through the mediation of attitude, subjective norm, and perceived behavioral control. However, the effect of intention on facemask use was not significant. CONCLUSIONS: Results generally support the proposed framework and the findings of previous studies with respect to intention, but the non-significant intention-behavior relationship may warrant future research to examine the reasons for older adults not to wear facemasks to prevent seasonal influenza despite having positive intentions to do so.

Social psychological aspects of ACL injury prevention and rehabilitation: An integrated model for behavioral adherence.

Managing rehabilitation for ACL injury is dependent on uptake of, and compliance with, medical and safety recommendations. In this paper, we propose a multi-theory model that integrates self-determination theory and the theory of planned behavior to identify the motivational determinants ACL injury prevention and management behaviors and the processes involved.