Medicine plus mindset: A mixed-methods evaluation of a novel mindset-focused training for primary care teams.

OBJECTIVES: Patient mindsets influence health outcomes; yet trainings focused on care teams' understanding, recognizing, and shaping patient mindsets do not exist. This paper aims to describe and evaluate initial reception of the "Medicine Plus Mindset" training program. METHODS: Clinicians and staff at five primary care clinics (N = 186) in the San Francisco Bay Area received the Medicine Plus Mindset Training. The Medicine Plus Mindset training consists of a two-hour training program plus a one-hour follow-up session including: (a) evidence to help care teams understand patients' mindsets' influence on treatment; (b) a framework to support care teams in identifying specific patient mindsets; and (c) strategies to shape patient mindsets. RESULTS: We used a common model (Kirkpatrick) to evaluate the training based on participants' reaction, learnings, and behavior. Reaction: Participants rated the training as highly useful and enjoyable. Learnings: The training increased the perceived importance of mindsets in healthcare and improved self-reported efficacy of using mindsets in practice. Behavior: The training increased reported frequency of shaping patient mindsets. CONCLUSIONS: Development of this training and the study's results introduce a promising and feasible approach for integrating mindset into clinical practice. Practice Implications Mindset training can add a valuable dimension to clinical care and should be integrated into training and clinical practice.

A synthesis of evidence for policy from behavioural science during COVID-19.

Scientific evidence regularly guides policy decisions1, with behavioural science increasingly part of this process2. In April 2020, an influential paper3 proposed 19 policy recommendations ('claims') detailing how evidence from behavioural science could contribute to efforts to reduce impacts and end the COVID-19 pandemic. Here we assess 747 pandemic-related research articles that empirically investigated those claims. We report the scale of evidence and whether evidence supports them to indicate applicability for policymaking. Two independent teams, involving 72 reviewers, found evidence for 18 of 19 claims, with both teams finding evidence supporting 16 (89%) of those 18 claims. The strongest evidence supported claims that anticipated culture, polarization and misinformation would be associated with policy effectiveness. Claims suggesting trusted leaders and positive social norms increased adherence to behavioural interventions also had strong empirical support, as did appealing to social consensus or bipartisan agreement. Targeted language in messaging yielded mixed effects and there were no effects for highlighting individual benefits or protecting others. No available evidence existed to assess any distinct differences in effects between using the terms 'physical distancing' and 'social distancing'. Analysis of 463 papers containing data showed generally large samples; 418 involved human participants with a mean of 16,848 (median of 1,699). That statistical power underscored improved suitability of behavioural science research for informing policy decisions. Furthermore, by implementing a standardized approach to evidence selection and synthesis, we amplify broader implications for advancing scientific evidence in policy formulation and prioritization.

Body Mindsets are Associated With Pain and Threat-Related Risk Factors for Pain in Survivors of Childhood Cancer.

Pain is a common consequence of childhood cancer. While most research has examined biomedical predictors of post-cancer pain, biopsychosocial conceptualisations such as the cancer threat interpretation (CTI) model hold promise for guiding comprehensive pain management strategies. Guided by the CTI model, this cross-sectional study evaluated correlates of post-cancer pain in childhood cancer survivors including threat-related risk factors (bodily threat monitoring, fear of cancer recurrence, help-seeking) and mindsets about the body. In the preceding three months, 21.8% of the survivors reported chronic pain (>3 months), and 14.3% experienced pain most days. Greater bodily threat monitoring, more fear of cancer recurrence, and more help-seeking were associated with more pain. There was heterogeneity in the mindsets that survivors of childhood cancer hold about their bodies. Holding the mindset that the 'body is an adversary' was associated with more pain, greater bodily threat monitoring, and more fear of cancer recurrence. Holding the mindset that the 'body is responsive' was associated with less bodily threat monitoring, while the mindset that the 'body is capable' was associated with greater help-seeking. A path model demonstrated a significant combined indirect effect of the 'body is an adversary' mindset on pain through bodily threat monitoring and fear of cancer recurrence. Overall, this study supported that a sub-group of childhood cancer survivors experience persistent and interfering pain and provided cross-sectional support for threat-related correlates for pain aligning with the CTI model. Body mindsets were associated with pain and threat-related correlates and may represent a novel target to support survivors with pain. PERSPECTIVE: This article presents associations of body mindsets, threat-related risk factors, and pain in survivors of childhood cancer (aged 11-25), guided by the Cancer Threat Interpretation model. The study indicates that body mindsets may be novel targets to embed in comprehensive post-cancer pain management approaches to support young survivors with pain.

Changing cancer mindsets: A randomized controlled feasibility and efficacy trial.

OBJECTIVE: A cancer diagnosis and subsequent treatment can disrupt the full spectrum of physical, social, emotional, and functional quality of life. But existing psychological treatments are focused primarily on specific psychological symptoms as opposed to improving the overall patient experience. We studied the feasibility and efficacy of a novel digital intervention targeting patient mindsets-core assumptions about the nature and meaning of illness-designed to improve overall health-related quality of life (HRQoL) in newly diagnosed cancer patients undergoing treatment with curative intent. METHODS: Recently diagnosed (≤150 days) adult patients with non-metastatic cancers undergoing systemic treatment (N = 361) were recruited from across the United States to participate in this decentralized clinical trial. Patients were randomized 1:1 to receive the Cancer Mindset Intervention (CMI) or Treatment as Usual (TAU). Participants in the CMI group completed seven online modules over 10 weeks (2.5 h total) targeting mindsets about cancer and the body. The primary outcome was overall HRQoL, and secondary outcomes were coping behaviors and symptom distress. RESULTS: Patients in the CMI group reported significant (p < 0.001) improvements in adaptive mindsets about cancer and the body over time. Compared with the TAU condition, the CMI group reported significant improvements in overall HRQoL (B = 0.60; 95% CI 0.34-0.85; p < 0.001), increased engagement in adaptive coping behaviors (B = 0.03; 95% CI 0.02-0.04; p < 0.001), and reduced distress from physical symptoms (B = -0.29; 95% CI -0.44 to -0.14; p < 0.01). Effect sizes of these changes ranged from d = 0.42-d = 0.54. CONCLUSION: A brief mindset-focused digital intervention was effective at improving physical, social, emotional, and functional HRQoL, increasing adaptive coping behaviors, and reducing physical symptom distress in newly diagnosed cancer patients.

Changing Mindsets About Side Effects of the COVID-19 Vaccination: A Randomized Controlled Trial.

BACKGROUND: Side-effect concerns are a major barrier to vaccination against COVID-19 and other diseases. Identifying cost- and time-efficient interventions to improve vaccine experience and reduce vaccine hesitancy-without withholding information about side effects-is critical. PURPOSE: Determine whether a brief symptom as positive signals mindset intervention can improve vaccine experience and reduce vaccine hesitancy after the COVID-19 vaccination. METHODS: English-speaking adults (18+) were recruited during the 15-min wait period after receiving their second dose of the Pfizer COVID-19 vaccination and were randomly allocated to the symptom as positive signals mindset condition or the treatment as usual control. Participants in the mindset intervention viewed a 3:43-min video explaining how the body responds to vaccinations and how common side effects such as fatigue, sore arm, and fever are signs that the vaccination is helping the body boost immunity. The control group received standard vaccination center information. RESULTS: Mindset participants (N = 260) versus controls (N = 268) reported significantly less worry about symptoms at day 3 [t(506)=2.60, p=.01, d=0.23], fewer symptoms immediately following the vaccine [t(484)=2.75, p=.006, d=0.24], and increased intentions to vaccinate against viruses like COVID-19 in the future [t(514)=-2.57, p=.01, d=0.22]. No significant differences for side-effect frequency at day 3, coping, or impact. CONCLUSIONS: This study supports the use of a brief video aimed at reframing symptoms as positive signals to reduce worry and increase future vaccine intentions. CLINICAL TRIAL INFORMATION: Australian New Zealand Clinical Trials Registry: ACTRN12621000722897p.

Side-effect concerns are a major barrier to vaccination against COVID-19 and other diseases. Therefore, the purpose of this study was to determine whether a brief symptom as positive signals mindset intervention could improve vaccine experience and reduce vaccine hesitancy after the COVID-19 vaccination. Participants were recruited during the 15-min wait period after receiving their second dose of the Pfizer COVID-19 vaccination and were randomly allocated to a treatment as usual control condition or to a mindset intervention condition which entailed watching a 3:43-min video explaining how the body responds to vaccinations and how common side effects such as fatigue, sore arm, and fever are signs that the vaccination is helping the body boost immunity. Compared with participants in the control condition, participants in the mindset intervention condition reported significantly less worry about symptoms at day 3, fewer symptoms immediately following the vaccine and increased intentions to vaccinate against viruses like COVID-19 in the future. No significant differences emerged for side-effect frequency at day 3, coping, or impact. These finding provide initial support for cost- and time-efficient interventions to improve vaccine experience and reduce vaccine hesitancy without withholding information about side effects.

Evaluation of the "rethink stress" mindset intervention: A metacognitive approach to changing mindsets.

Experimental research has demonstrated that a stress-is-enhancing mindset can be induced and can improve outcomes by presenting information on the enhancing nature of stress. However, experimental evidence, media portrayals, and personal experience about the debilitating nature of stress may challenge this mindset. Thus, the traditional approach of focusing on the more "desired" mindset without arming participants against encounters with the less desired mindsets may not be sustainable in the face of conflicting information. How might this limitation be resolved? Here, we present three randomized-controlled interventions that test the efficacy of a "metacognitive approach." In this approach, participants are given more balanced information about the nature of stress along with metacognitive information on the power of their mindsets aimed at empowering them to choose a more adaptive mindset even in the face of conflicting information. In Experiment 1, employees of a large finance company randomized to the metacognitive mindset intervention reported greater increases in stress-is-enhancing mindsets and greater improvements in self-reported measures of physical health symptoms and interpersonal-skill work performance 4 weeks later compared to a waitlist control. Experiment 2, adapted to be distributed electronically via multimedia modules, replicates the effects on stress mindset and symptoms. Experiment 3 compares the metacognitive stress mindset intervention with a more traditional stress mindset manipulation. The metacognitive approach led to greater initial increases in a stress-is-enhancing mindset relative to the traditional intervention, and these increases were sustained after exposure to contradictory information. Taken together, these results provide support for a metacognitive approach to mindset change. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of Wearable Fitness Trackers and Activity Adequacy Mindsets on Affect, Behavior, and Health: Longitudinal Randomized Controlled Trial.

BACKGROUND: There is some initial evidence suggesting that mindsets about the adequacy and health consequences of one's physical activity (activity adequacy mindsets [AAMs]) can shape physical activity behavior, health, and well-being. However, it is unknown how to leverage these mindsets using wearable technology and other interventions. OBJECTIVE: This research examined how wearable fitness trackers and meta-mindset interventions influence AAMs, affect, behavior, and health. METHODS: A total of 162 community-dwelling adults were recruited via flyers and web-based platforms (ie, Craigslist and Nextdoor; final sample size after attrition or exclusion of 45 participants). Participants received an Apple Watch (Apple Inc) to wear for 5 weeks, which was equipped with an app that recorded step count and could display a (potentially manipulated) step count on the watch face. After a baseline week of receiving no feedback about step count, participants were randomly assigned to 1 of 4 experimental groups: they received either accurate step count (reference group; 41/162, 25.3%), 40% deflated step count (40/162, 24.7%), 40% inflated step count (40/162, 24.7%), or accurate step count+a web-based meta-mindset intervention teaching participants the value of adopting more positive AAMs (41/162, 25.3%). Participants were blinded to the condition. Outcome measures were taken in the laboratory by an experimenter at the beginning and end of participation and via web-based surveys in between. Longitudinal analysis examined changes within the accurate step count condition from baseline to treatment and compared them with changes in the deflated step count, inflated step count, and meta-mindset conditions. RESULTS: Participants receiving accurate step counts perceived their activity as more adequate and healthier, adopted a healthier diet, and experienced improved mental health (Patient-Reported Outcomes Measurement Information System [PROMIS]-29) and aerobic capacity but also reduced functional health (PROMIS-29; compared with their no-step-count baseline). Participants exposed to deflated step counts perceived their activity as more inadequate; ate more unhealthily; and experienced more negative affect, reduced self-esteem and mental health, and increased blood pressure and heart rate (compared with participants receiving accurate step counts). Inflated step counts did not change AAM or most other outcomes (compared with accurate step counts). Participants receiving the meta-mindset intervention experienced improved AAM, affect, functional health, and self-reported physical activity (compared with participants receiving accurate step counts only). Actual step count did not change in either condition. CONCLUSIONS: AAMs--induced by trackers or adopted deliberately--can influence affect, behavior, and health independently of actual physical activity. TRIAL REGISTRATION: ClinicalTrials.gov NCT03939572; https://www.clinicaltrials.gov/ct2/show/NCT03939572.

Negative consequences of self-presentation on disclosure of health information: A catch-22 for Black patients?

RATIONALE: Most patients assume that it is adaptive to present oneself in a positive light when interacting with medical professionals. Here in two studies focused on Black patients we ask: might this desire to present oneself well inhibit the disclosure of health-relevant information when patients are concerned about negative and stereotypic evaluations by their health care providers? OBJECTIVE: Specifically, we explore three important questions: First, whether self-presentational efforts (e.g., working hard to sound knowledgeable or "smart") are negatively associated with disclosure of health information (e.g., not taking certain medications); Second, whether patient-provider racial congruence (e.g. Black patients interacting with a Black vs. a White doctor) moderates that relationship; and third, more broadly, what factors promote or inhibit disclosure of health information for Black patients in medical interactions. METHODS: These questions were investigated using mixed methodology (survey, experimental, qualitative) studies on CloudResearch and Prolific. RESULTS: We found a potential catch-22: participants who spend more effort self-presenting tend to be less comfortable disclosing health information to their healthcare providers. Moreover, Study 1 (N = 321) indicated that the negative relationship between self-presentation and disclosure was significant in Black-incongruent (i.e., Black patient and White provider) and White-congruent (i.e., White patient and White provider) medical interactions. Study 2 (N = 361) did not find a significant moderation by race of the provider but instead suggested that the relationship between self-presentation and disclosure was moderated by expectations of unfair treatment. Exploratory qualitative analyses suggested that some Black participants face a dilemma when deciding whether to disclose information to their healthcare providers. They weigh the kind of information they will share, and how sharing some information might lead to embarrassment and judgment. CONCLUSION: Mitigating the potentially counteractive effects of self-presentation on disclosure and working to foster contexts that encourage honest disclosure of health information may help to reduce health care inequalities.

Leveraging Mobile Technology for Public Health Promotion: A Multidisciplinary Perspective.

Health behaviors are inextricably linked to health and well-being, yet issues such as physical inactivity and insufficient sleep remain significant global public health problems. Mobile technology-and the unprecedented scope and quantity of data it generates-has a promising but largely untapped potential to promote health behaviors at the individual and population levels. This perspective article provides multidisciplinary recommendations on the design and use of mobile technology, and the concomitant wealth of data, to promote behaviors that support overall health. Using physical activity as anexemplar health behavior, we review emerging strategies for health behavior change interventions. We describe progress on personalizing interventions to an individual and their social, cultural, and built environments, as well as on evaluating relationships between mobile technology data and health to establish evidence-based guidelines. In reviewing these strategies and highlighting directions for future research, we advance the use of theory-based, personalized, and human-centered approaches in promoting health behaviors.

"Harnessing the placebo effect: Exploring the influence of physician characteristics on placebo response": Correction.

Reports an error in "Harnessing the placebo effect: Exploring the influence of physician characteristics on placebo response" by Lauren C. Howe, J. Parker Goyer and Alia J. Crum (Health Psychology, 2017[Nov], Vol 36[11], 1074-1082). In the original article, changes were needed to clarify the timeframe over which allergic reactions were measured after the skin prick test (SPT) and the administration of the placebo cream, which was erroneously misrepresented in some cases being "0 to 6 minutes after cream application" when it should have stated "3 to 9 minutes after cream application." Corrections have been made to reflect this in the "Analytic Strategy for Physiological Results" section and in Figures 2 and 3 and the Figure Notes that accompany them. An additional supplemental figure (Figure S7) has also been added to the supplemental material available online to further clarify the timing of measurements, both in terms of time post-SPT and time post-cream application. The online version of this article has been corrected. (The following abstract of the original article appeared in record 2017-10534-001). OBJECTIVE: Research on placebo/nocebo effects suggests that expectations can influence treatment outcomes, but placebo/nocebo effects are not always evident. This research demonstrates that a provider's social behavior moderates the effect of expectations on physiological outcomes. METHODS: After inducing an allergic reaction in participants through a histamine skin prick test, a health care provider administered a cream with no active ingredients and set either positive expectations (cream will reduce reaction) or negative expectations (cream will increase reaction). The provider demonstrated either high or low warmth, or either high or low competence. RESULTS: The impact of expectations on allergic response was enhanced when the provider acted both warmer and more competent and negated when the provider acted colder and less competent. CONCLUSION: This study suggests that placebo effects should be construed not as a nuisance variable with mysterious impact but instead as a psychological phenomenon that can be understood and harnessed to improve treatment outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychosocial context and food healthiness in top-grossing American films.

OBJECTIVE: Healthy eating is shaped by the context. To understand how healthy eating is modeled in popular media, this systematic analysis quantified which contextual factors, character behaviors, and character demographics were associated with food healthiness in popular movies. METHOD: Two researchers content-coded the contextual factors, character behaviors, and character demographics depicted across 9,093 foods in 244 top-grossing Hollywood movies released from 1994-2018. Food healthiness was calculated using the Nutrient Profile Index (0 = least healthy, 100 = healthiest) and coder reliability was assessed. Mixed effects regression models tested whether food healthiness was associated with contextual factors (e.g., geographic locations, social consumption situations, celebrations, foreground placement), character behaviors (actual consumption, food evaluations), and character demographics. RESULTS: Confirming six preregistered hypotheses (all p < .001), foods were less healthy when they were in American versus non-American settings (95% CI: Cohen's d = .29-.39), part of social consumption situations (d = .19-.28) and celebrations (d = .04-.17), and in the foreground versus background (d = .15-.24). The foods that characters actually consumed (d = .30-.42) and evaluated positively (vs. negatively, d = .37-.76) were also less healthy. However, disconfirming a gender hypothesis, female characters did not consume healthier foods than males (d = -.11-.13, p = .45). CONCLUSIONS: Top-grossing Hollywood movies depict different contexts and different character behaviors for healthier versus less healthy foods. Research is needed to understand whether depicting healthy foods in different contexts impacts viewers' beliefs and behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

White patients' physical responses to healthcare treatments are influenced by provider race and gender.

The healthcare workforce in the United States is becoming increasingly diverse, gradually shifting society away from the historical overrepresentation of White men among physicians. However, given the long-standing underrepresentation of people of color and women in the medical field, patients may still associate the concept of doctors with White men and may be physiologically less responsive to treatment administered by providers from other backgrounds. To investigate this, we varied the race and gender of the provider from which White patients received identical treatment for allergic reactions and measured patients' improvement in response to this treatment, thus isolating how a provider's demographic characteristics shape physical responses to healthcare. A total of 187 White patients experiencing a laboratory-induced allergic reaction interacted with a healthcare provider who applied a treatment cream and told them it would relieve their allergic reaction. Unbeknownst to the patients, the cream was inert (an unscented lotion) and interactions were completely standardized except for the provider's race and gender. Patients were randomly assigned to interact with a provider who was a man or a woman and Asian, Black, or White. A fully blinded research assistant measured the change in the size of patients' allergic reaction after cream administration. Results indicated that White patients showed a weaker response to the standardized treatment over time when it was administered by women or Black providers. We explore several potential explanations for these varied physiological treatment responses and discuss the implications of problematic race and gender dynamics that can endure "under the skin," even for those who aim to be bias free.

Making sense of a pandemic: Mindsets influence emotions, behaviors, health, and wellbeing during the COVID-19 pandemic.

RATIONALE: As the SARS-COV-2 virus spread across the world in the early months of 2020, people sought to make sense of the complex and rapidly evolving situation by adopting mindsets about what the pandemic was and what it meant for their lives. OBJECTIVE: We aimed to measure the mindsets of American adults over the first six months of the COVID-19 pandemic to understand their relative stability over time and their relationship with emotions, behaviors, experiences, and wellbeing. METHODS: American adults (N = 5,365) were recruited in early March of 2020 to participate in a longitudinal survey with follow-up surveys at 6-weeks and 6-months. Three mindsets that people formed about the COVID-19 pandemic were measured: 'the pandemic is a catastrophe', 'the pandemic is manageable' and 'the pandemic can be an opportunity'. RESULTS: In line with our pre-registered hypotheses, these mindsets were associated with a unique and largely self-fulfilling pattern of emotions (positive, negative), behaviors (healthy, unhealthy, and compliance with CDC guidelines), experiences (growth/connection, isolation/meaninglessness) and wellbeing (physical health, mental health, quality of life). Moreover, mindsets formed in the first week of the pandemic were associated with quality of life 6 months later, an effect that was mediated by emotions and health behaviors. CONCLUSION: The mindsets that people adopted about the COVID-19 pandemic - that it is 'a catastrophe', 'manageable', or 'an opportunity' may explain some of the heterogeneity in the lived experiences of Americans through their self-fulfilling impact on peoples' emotions, health behaviors, and wellbeing.

Language in popular American culture constructs the meaning of healthy and unhealthy eating: Narratives of craveability, excitement, and social connection in movies, television, social media, recipes, and food reviews.

Many people want to eat healthier but struggle to do so, in part due to a dominant perception that healthy foods are at odds with hedonic goals. Is the perception that healthy foods are less appealing than unhealthy foods represented in language across popular entertainment media and social media? Six studies analyzed dialogue about food in six cultural products - creations of a culture that reflect its perspectives - including movies, television, social media posts, food recipes, and food reviews. In Study 1 (N = 617 movies) and Study 2 (N = 27 television shows), healthy foods were described with fewer appealing descriptions (e.g., "couldn't stop eating"; d = 0.59 and d = 0.37, respectively) and more unappealing descriptions (e.g., "I hate peas"; d = -.57 and d = -.63, respectively) than unhealthy foods in characters' speech from the film and television industries. Using sources with richer descriptive language, Studies 3-6 analyzed popular American restaurants' Facebook posts (Study 3, N = 2275), recipe descriptions from Allrecipes.com (Study 4, N = 1000), Yelp reviews from six U.S. cities (Study 5, N = 4403), and Twitter tweets (Study 6, N = 10,000) for seven specific themes. Meta-analytic results across Studies 3-6 showed that healthy foods were specifically described as less craveworthy (d = 0.51, 95% CI: 0.44-0.59), less exciting (d = 0.40, 95% CI: 0.31-0.49), and less social (d = 0.36, 95% CI: 0.04-0.68) than unhealthy foods. Machine learning methods further generalized patterns across 1.6 million tweets spanning 42 different foods representing a range of nutritional quality. These data suggest that strategies to encourage healthy choices must counteract pervasive narratives that dissociate healthy foods from craveability, excitement, and social connection in individuals' everyday lives.

Emphasizing appeal over health promotes preference for nutritious foods in people of low socioeconomic status.

People of low socioeconomic status (SES) have disproportionately poorer dietary health despite efforts to improve access and highlight the health benefits of nutritious foods. While health-focused labels and advertisements make healthier options easier to recognize, they can prime a number of negative associations about healthy foods (e.g., taste, satiety, cost), which may be particularly aversive for low SES groups. This within-subjects study recruited people of low and high SES (those without and with a college degree) and compared their product expectations, experiences, satiety, and choice when consuming a bottled fruit and vegetable smoothie promoted as pleasurable ("Crave") or as healthy ("Nutralean"). Relative to Nutralean, Crave improved product expectations and behavioral measures of satiety across all participants. However, Crave enhanced expectations, experiences, and product choice more for low SES than high SES participants. Importantly, improvements were achieved without deception of nutritional facts and without decreasing perceived healthiness or increasing perceived cost. These findings identify SES as an important moderator in health-focused promotion and suggest how the rapidly growing healthy food industry can more effectively appeal to low SES groups, contexts which the majority of Americans navigate.

Nutritional Analysis of Foods and Beverages Posted in Social Media Accounts of Highly Followed Celebrities.

Importance: Celebrity social media posts engage millions of young followers daily, but the nutritional quality of foods and beverages in such posts, sponsored and unsponsored, is unknown. Objective: To quantify the nutritional quality of foods and beverages depicted in social media accounts of highly followed celebrities and assess whether nutritional quality is associated with post sponsorship, celebrity profession or gender, and followers' likes and comments. Design, Setting, and Participants: This cross-sectional study analyzed the content of food- and beverage-containing posts from Instagram (a photo- and video-sharing social media platform) accounts of 181 highly followed athletes, actors, actresses, television personalities, and music artists. Data were collected from May 2019 to March 2020. Main Outcomes and Measures: The nutritional quality of foods and beverages posted in celebrity social media accounts was rated using the Nutrient Profile Index (NPI) based on the sugar, sodium, energy, saturated fat, fiber, protein, and fruit and/or vegetable content per 100-g sample (a score of 0 indicated least healthy and 100, healthiest); foods with scores less than 64 and beverages with scores less than 70 were rated as "less healthy." Secondary outcomes were whether the nutritional quality of foods and beverages in social media posts was associated with post sponsorship, celebrity profession or gender, and followers' likes and comments. Mixed-effects regression models were used to estimate how outcomes differed across fixed effects. Results: The sample included social media accounts of 181 celebrities (66 actors, actresses, and television personalities [36.5%]; 64 music artists [35.4%]; and 51 athletes [28.2%]). A total of 102 celebrities (56.4%) were male, and the median age was 32 years (range, 17-73 years). Among 3065 social media posts containing 5180 total foods and beverages (2467 foods [47.6%]; 2713 beverages [52.4%]), snacks and sweets (920 [37.3%] of the foods) and alcoholic beverages (1375 [50.7%] of the beverages) were most common. Overall, 158 celebrity social media accounts (87.3%) earned a less healthy overall food nutrition score and 162 (89.5%) earned a less healthy overall beverage nutrition score, which would be unhealthy enough to fail legal youth advertising limits in the UK. For foods, social media posts with healthier nutrition scores were associated with significantly fewer likes (b, -0.003; 95% CI, -0.006 to 0.000; P = .04) and comments (b, -0.006; 95% CI, -0.009 to -0.003; P < .001) from followers. For beverages, nutrition scores were not significantly associated with likes (b, -0.010; 95% CI, -0.025 to 0.005; P = .18) or comments (b, -0.003; 95% CI, -0.022 to 0.016; P = .73). Only 147 food- or beverage-containing posts (4.8%) were sponsored by food- or beverage-relevant companies. Beverages in sponsored posts contained more than twice as much alcohol as those in nonsponsored posts (10.8 g [95% CI, 9.3 g to 12.3 g] per 100 g of beverage vs 5.3 g [95% CI, 4.7 g to 5.9 g] per 100 g of beverage). Conclusions and Relevance: In this cross-sectional study, most highly followed celebrity social media accounts depicted an unhealthy profile of foods and beverages, primarily in nonsponsored posts. These results suggest that influential depictions of unhealthy food and beverage consumption on social media may be a sociocultural problem that extends beyond advertisements and sponsorships, reinforcing unhealthy consumption norms.

Mindset is associated with future physical activity and management strategies in individuals with knee osteoarthritis.

BACKGROUND: Despite the benefits of physical activity for individuals with knee osteoarthritis (KOA), physical activity levels are low in this population. OBJECTIVES: We conducted a repeated cross-sectional study to compare mindset about physical activity among individuals with and without KOA and to investigate whether mindset relates to physical activity. METHODS: Participants with (n = 150) and without (n = 152) KOA completed an online survey at enrollment (T1). Participants with KOA repeated the survey 3 weeks later (T2; n = 62). The mindset questionnaire, scored from 1 to 4, assessed the extent to which individuals associate the process of exercising with less appeal-focused qualities (e.g., boring, painful, isolating, and depriving) versus appeal-focused (e.g., fun, pleasurable, social, and indulgent). Using linear regression, we examined the relationship between mindset and having KOA, and, in the subgroup of KOA participants, the relationship between mindset at T1 and self-reported physical activity at T2. We also compared mindset between people who use medication for management and those who use exercise. RESULTS: Within the KOA group, a more appeal-focused mindset was associated with higher future physical activity (ß=38.72, p = 0.006) when controlling for demographics, health, and KOA symptoms. Individuals who used exercise with or without pain medication or injections had a more appeal-focused mindset than those who used medication or injections without exercise (p<0.001). A less appeal-focused mindset regarding physical activity was not significantly associated with KOA (ß = -0.14, p = 0.067). Further, the mindset score demonstrated strong internal consistency (α = 0.92; T1; n = 150 and α = 0.92; T2; n = 62) and test-retest reliability (intraclass correlation coefficient (ICC) > 0.84, p < 0.001) within the KOA sample. CONCLUSIONS: In individuals with KOA, mindset is associated with future physical activity levels and relates to the individual's management strategy. Mindset is a reliable and malleable construct and may be a valuable target for increasing physical activity and improving adherence to rehabilitation strategies involving exercise among individuals with KOA.

Thriving under pressure: The effects of stress-related wise interventions on affect, sleep, and exam performance for college students from disadvantaged backgrounds.

Nearly all students experience stress as they pursue important academic goals. Because stress can be magnified for students from disadvantaged backgrounds, it becomes important to identify interventions that can help mitigate this stress, particularly for these populations as they enter academic environments. We examine the effects of stress mindset and stress management interventions administered to students from disadvantaged backgrounds (N = 140) before freshman year. We compare effects on affect, sleep, and performance during end-of-year exams seen in a subset of these students who could be tracked via experience sampling (N = 57) to those of a comparison group at the same elite university (N = 74) receiving no such stress interventions. As predicted, we find significant differences in exam-week positive affect between the stress mindset and comparison groups. However, there was no difference in positive affect between the stress mindset and management groups or the stress management and comparison groups. For negative affect, stress, sleep, and exam performance, we find no significant differences between any of the three groups. However, both stress interventions decoupled the significant negative association between exam-week stress and exam performance exhibited by the comparison group, rendering the relationship nonsignificant. The reduction in this association was somewhat more pronounced for the mindset relative to the management group. These findings suggest that mindset and management approaches both confer benefits in certain circumstances and highlight the potential value of targeting mindsets about stress using a "wise intervention" approach for students from disadvantaged backgrounds during stressful times. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Can Exercising and Eating Healthy Be Fun and Indulgent Instead of Boring and Depriving? Targeting Mindsets About the Process of Engaging in Healthy Behaviors.

This paper investigates mindsets about the process of health behaviors-the extent to which people associate physical activity and healthy eating with appealing (pleasurable, fun, indulgent) versus unappealing (unpleasant, boring, depriving) qualities-to promote greater engagement. Study 1 (N = 536) examined how mindsets about physical activity and healthy eating relate to current and future health behavior. Study 2 (N = 149) intervened in actual fitness classes to compare the effects of brief appeal-focused and health-focused interventions on mindsets about physical activity and class engagement. Study 3 (N = 140) designed nutrition education classes that emphasized either the appeal or the importance of fruits and vegetables for health and compared its effects on mindsets about healthy eating and actual fruit and vegetable consumption. Holding more appealing mindsets about health behaviors predicts subsequent physical activity and healthy eating (Study 1). An intervention targeting mindsets about the appeal of physical activity promotes greater participation in fitness classes than emphasizing the importance of meeting activity guidelines (Study 2). Meanwhile, interventions targeting mindsets about the appeal of healthy eating increases in-class fruit and vegetable selection more than emphasizing the importance of eating nutritious foods (Study 3), however additional work is needed to sustain such changes in eating behavior. These studies suggest mindsets about the process of health behaviors can be influential and changeable factors in motivating physical activity and healthy eating.