The role of psychosocial well-being and emotion-driven impulsiveness in food choices of European adolescents.

BACKGROUND: It is unclear whether a hypothetical intervention targeting either psychosocial well-being or emotion-driven impulsiveness is more effective in reducing unhealthy food choices. Therefore, we aimed to compare the (separate) causal effects of psychosocial well-being and emotion-driven impulsiveness on European adolescents' sweet and fat propensity. METHODS: We included 2,065 participants of the IDEFICS/I.Family cohort (mean age: 13.4) providing self-reported data on sweet propensity (score range: 0 to 68.4), fat propensity (range: 0 to 72.6), emotion-driven impulsiveness using the UPPS-P negative urgency subscale, and psychosocial well-being using the KINDLR Questionnaire. We estimated, separately, the average causal effects of psychosocial well-being and emotion-driven impulsiveness on sweet and fat propensity applying a semi-parametric doubly robust method (targeted maximum likelihood estimation). Further, we investigated a potential indirect effect of psychosocial well-being on sweet and fat propensity mediated via emotion-driven impulsiveness using a causal mediation analysis. RESULTS: If all adolescents, hypothetically, had high levels of psychosocial well-being, compared to low levels, we estimated a decrease in average sweet propensity by 1.43 [95%-confidence interval: 0.25 to 2.61]. A smaller effect was estimated for fat propensity. Similarly, if all adolescents had high levels of emotion-driven impulsiveness, compared to low levels, average sweet propensity would be decreased by 2.07 [0.87 to 3.26] and average fat propensity by 1.85 [0.81 to 2.88]. The indirect effect of psychosocial well-being via emotion-driven impulsiveness was 0.61 [0.24 to 1.09] for average sweet propensity and 0.55 [0.13 to 0.86] for average fat propensity. CONCLUSIONS: An intervention targeting emotion-driven impulsiveness, compared to psychosocial well-being, would be marginally more effective in reducing sweet and fat propensity in adolescents.

Associations Between Psychosocial Well-Being, Stressful Life Events and Emotion-Driven Impulsiveness in European Adolescents.

Knowing the extent to which mental well-being and stressful life events during adolescence contribute to personality characteristics related to risk-taking behaviors, such as emotion-driven impulsiveness, is highly relevant for the development of health promotion measures. This study examined whether psychosocial well-being and different stressful life events are associated with emotion-driven impulsiveness. In total, 3,031 adolescents (52% girls; Mage = 13.6 years) were included from the I. Family Study, a cross-sectional examination on lifestyle-related behaviors conducted across eight European countries in 2013/14. Linear mixed-effects regression models showed that higher psychosocial well-being was associated with lower emotion-driven impulsiveness independent of socio-demographic, health-related, and parental variables. A higher number of stressful life events was associated with higher emotion-driven impulsiveness. Psychosocial well-being and stressful life events need to be further considered in the development and tailoring of health promotion strategies that aim to reduce emotion-driven impulsiveness.

Predictors of Self-Determined Module Choice in a Web-Based Computer-Tailored Diet and Physical Activity Intervention: Secondary Analysis of Data From a Randomized Controlled Trial.

BACKGROUND: Tailoring an online intervention to participant preferences (eg, by giving participants a choice which modules to follow) may increase engagement in the intervention, motivation for behavioral change, and possibly intervention effects. So far, little is known about what characteristics predict these module choices. Filling this knowledge gap is useful for optimizing program engagement. OBJECTIVE: We investigated participant choice for a dietary and/or physical activity (PA) promotion module in our web-based computer-tailored intervention based on self-determination theory (SDT) and motivational interviewing (MI). Furthermore, we investigated which demographic characteristics, current behavior, psychosocial constructs and constructs from SDT and MI, and program-related variables such as advice on which module to follow were associated with these choices. METHODS: Observational data were used from the randomized controlled trial MyLifestyleCoach of participants who were randomized into the intervention condition, completed the baseline questionnaire, and made a module choice in the opening session of the intervention. Here, they received advice on their own dietary and PA behavior. At the session's end, they chose which lifestyle modules they would like to follow (both, diet, PA, or no module). Measurements included demographic information; self-reported diet and PA; and several psychosocial, SDT, and MI constructs. In total, data from 619 Dutch adults (59.6% women; mean age was 51.9 [SD 13.5] years) were analyzed. A stepwise multinomial logistic regression analysis was conducted to investigate which characteristics are related to module choice; the diet module served as reference category as almost everyone was advised to follow this module. RESULTS: Of this sample, 54.8% (339/619) chose to do both the diet and PA module, 25.4% (157/619) chose to follow the diet module, 17.8% (110/619) preferred to follow no module, and 2.1% (13/619) chose to do the PA module only. Furthermore, it was found that older people, those who consumed more fruit, and those who scored lower on importance to change their current diet were more likely to choose no module compared to the diet module. People who had more motivation to change their current PA and those who received strong advice compared with slight advice to follow the diet module were more likely to choose both modules compared with the diet module only. CONCLUSIONS: The results show that more than half of the sample was interested in following both the diet and PA module in this online lifestyle intervention. Several characteristics were found to be related to module choice. A future challenge is to examine how this knowledge can be used to improve future interventions, such as tailoring (messages or content) on specific groups or examining where and how MI could be used to motivate people to make a certain module choice. TRIAL REGISTRATION: Netherlands Trial Register NL7333; https://www.trialregister.nl/trial/7333.

Emotion-driven impulsiveness but not decision-making ability and cognitive inflexibility predicts weight status in adults.

In this study we aimed to determine whether decision-making ability, cognitive inflexibility and emotion-driven impulsiveness are associated with weight status as expressed by body mass index (BMI), percentage body fat, waist circumference and skinfold thickness in adults from eight different European countries taking part in the I.Family study. The Bechara Gambling Task was used to assess decision-making ability (n = 1717). The Berg Card Sorting Test was used to measure cognitive inflexibility (n = 1509). Lastly, the negative urgency subscale from the UPPS-P Impulsive Behavior Scale was used to measure emotion-driven impulsiveness (n = 4450). Hierarchical regression analyses showed that more emotion-driven impulsiveness was statistically significantly associated with a higher BMI, a higher percentage body fat, and a larger waist circumference in adults, controlling for age, sex, socioeconomic status, country and binge eating; but not with skinfold thickness. Cognitive inflexibility and decision-making ability were not statistically significantly associated with any of the weight status related variables. These results support that impulsivity in response to negative emotions, but not decision-making ability or cognitive inflexibility, is associated with the susceptibility to excessive weight (as indicated by a higher BMI, a higher percentage body fat, and a larger waist circumference). In people behaving impulsively when emotional, focusing on reducing negative affect or improving coping skills is of interest in interventions targeting obesity. CLINICAL TRIAL REGISTRATION: The I.Family study is registered in the ISRCTN registry (ISRCTN62310987) on February 23, 2018.

Emotion-driven impulsiveness and snack food consumption of European adolescents: Results from the I.Family study.

We aimed to investigate the association between emotion-driven impulsiveness and snack food consumption in 1039 European adolescents aged 12-18 years. During the cross-sectional examination in 2013/2014, complete information was collected on: emotion-driven impulsiveness (using the negative urgency subscale from the Urgency, Premeditation, Perseverance, Sensation seeking, and Positive urgency (UPPS-P) Impulsive Behaviour Scale) and snacking behaviour operationalised as 1) consumption frequency of daily snacks, 2) consumption frequency of energy-dense snacks (both measured using Food Frequency Questionnaire) and 3) usual energy intake of food consumed per snacking occasion in calories. The latter was measured using online self-administered 24-h dietary recalls and was estimated based on the National Cancer Institute (NCI) Method. Anthropometric variables were measured and BMI z-score (zBMI) calculated. Age, sex, highest education level of the family and country of residence were assessed using a questionnaire. Mixed-effect regression analyses were separately conducted for each snacking behaviour outcome with emotion-driven impulsiveness as the exposure. After controlling for zBMI, age, sex, country and socioeconomic status, emotion-driven impulsiveness was positively associated with daily consumption frequency of snacks (ß = 0.07, 95% Confidence Interval (CI) [0.02, 0.12]) and consumption frequency of energy-dense snacks (ß = 0.25, 95% CI [0.19, 0.31]), but not with usual energy intake of food per snacking (ß = 2.52, 95% CI [-0.55, 5.59]). Adolescents with a stronger emotion-driven impulsiveness tendency reported a higher snacking frequency and specifically more energy-dense snacks, whereas the energy intake of snack food seemed less important. These findings have implications for obesity prevention and treatment as they indicate the importance of targeting emotion-driven impulsiveness as a strategy to avoid excessive snacking.

Digital media exposure and cognitive functioning in European children and adolescents of the I.Family study.

The digital environment can pose health risks through exposure to unhealthy content. Yet, little is known about its relation to children's cognitive functioning. This study investigates the association between digital media (DM) exposure and children's cognitive functioning. This cross-sectional study is based on examinations of children aged 8-18 years (N = 8673) of the I.Family cohort (2013-2014). Exposure to television, computer, smartphone and internet was self-reported (hours/day). Media multitasking (MMT) was defined as simultaneous use of computers with other digital or non-screen-based activities. Standard instruments were used to assess cognitive inflexibility (score: 0-39), decision-making ability (- 100 to + 100) and impulsivity (12-48). Adjusted regression coefficients and 99.9%CIs were calculated by generalized linear mixed-effects models. In total, 3261 participants provided data for impulsivity, 3441 for cognitive inflexibility and 4046 for decision-making. Exposure to smartphones and media multitasking were positively associated with impulsivity (ßsmartphone = 0.74; 99.9%CI = 0.42-1.07; ßMMT = 0.73; 99.9%CI = 0.35-1.12) and cognitive inflexibility (ßsmartphone = 0.32; 99.9%CI = -0.02-0.66; ßMMT = 0.39; 99.9%CI = 0.01-0.77) while being inversely associated with decision-making ability. Extensive smartphone/internet exposure combined with low computer/medium TV exposure was associated with higher impulsivity and cognitive inflexibility scores, especially in girls. DM exposure is adversely associated with cognitive functioning in children and adolescents. Children require protection against the likely adverse impact of digital environment.

The effects of a web-based computer-tailored diet and physical activity intervention based on self-determination theory and motivational interviewing: A randomized controlled trial.

Background: According to self-determination theory (SDT), autonomous forms of motivation are more likely to result in sustained behavioral changes than controlled forms. Principles of motivational interviewing (MI) can be applied to facilitate more autonomous forms of motivation. This study investigated whether a combined diet and physical activity (PA) web-based computer-tailored intervention based on SDT and MI, called MyLifestyleCoach, was effective in promoting dietary and PA behaviors. Methods: A two-arm randomized controlled trial with 1142 Dutch adults was conducted. The intervention and control group completed questionnaires at baseline, 6, and 12 months from baseline. Only participants in the intervention condition had access to MyLifestyleCoach. The waiting list control condition had access to the intervention after completing the 12-month follow-up questionnaire. A modified food frequency questionnaire was used to measure dietary behaviors (fruit, vegetables, fish, and unhealthy snacks). The Dutch Short Questionnaire to ASsess Health was used to measure the weekly minutes of moderate-to-vigorous PA (MVPA). Usage data, which is operationalized as completed sessions in this study, was objectively assessed by log data. We conducted two-step linear mixed effect models. In the first step, a model consisting of condition, time, potentially confounding variables and a random intercept for participants was tested. In the second step, an interaction term was added to investigate the intervention's (time × condition) and usage (time × opening session and time × completed sessions) effects over time for the dietary and PA outcomes. Results: The findings showed no differences between the groups for all four dietary behaviors and the weekly minutes of MVPA at any of the time points. In-depth analyses showed that participants who followed the opening session of the intervention, in which they received personalized feedback on their behaviors, had a stronger increase in fruit consumption at 6 months and 12 months than participants who did not follow the interventions' opening session. Lastly, participants who followed more sessions in the diet module had a stronger increase in fruit and vegetable consumption at 6 months, and a stronger decrease in the consumption frequency of unhealthy snacks at 12 months post-baseline. Conclusion: Overall, the intervention was not effective in changing dietary and PA behavior. However, moderation analyses suggest that the intervention is effective in changing dietary behavior for those participants who used the intervention more intensively. Further research should focus on improving intervention use.

Clustering of motivational constructs based on self-determination theory for diet and physical activity and their associations with behaviour: a cross-sectional study.

The present study explored whether motivational constructs for diet and physical activity (PA) cluster and how these motivational constructs relate to dietary and PA behaviour. Data of 1142 participants were used from a randomised controlled trial examining the effects of a web-based diet and PA promotion intervention based on self-determination theory and motivational interviewing. Motivation was assessed using the Treatment Self-Regulation Questionnaire and Behavioural Regulation in Exercise Questionnaire. The dietary outcomes were measured using an adapted Food Frequency Questionnaire. PA was assessed using the Short QUestionnaire to ASsess Health. Spearman rank-order correlations showed large correlation coefficients (rs ≥ 0⋅63) between similar motivational constructs between the two lifestyle domains, except for intrinsic motivation where a medium correlation coefficient was found (rs = 0⋅41). Furthermore, the exploratory factor analysis illustrated that more self-determined forms of motivation seem to be more domain-specific. In contrast, non-self-determined forms of motivation seem to be domain-independent. Last, regression analyses demonstrated that intrinsic motivation towards PA was the only motivational construct significantly positively associated with all PA sub-behaviours (standardised regression coefficients ranging from 0⋅17 to 0⋅28, all P < 0⋅0125). Intrinsic motivation to eat healthily was significantly positively associated with fruits, vegetables and fish intake (standardised regression coefficients ranging from 0⋅11 to 0⋅16, all P < 0⋅0125), but not with unhealthy snacks. Insight of this exploratory study is useful for understanding the interrelationships of motivational induced behaviours, the development of interventions targeting multiple behaviours, and the construction of questionnaires.

An exploration of perceptions and preferences for healthy eating in Dutch consumers: a qualitative pilot study.

BACKGROUND: Unhealthy dietary patterns are highly prevalent in Western countries, and they have been associated with depression, hypertension, heart disease, cancer, type 2 diabetes, and obesity. Many dietary interventions have been developed to promote healthier dietary behavior, yet most do not achieve the intended dietary change. This study aims to provide a better understanding of what Dutch consumers perceive as a healthy diet, how this relates to the current Dutch nutrition guidelines, and their preferences for how to eat more healthily. This is an essential consideration for the development of tailored interventions aimed to help people adopt changes in their dietary behavior. METHODS: Seventy-eight participants filled in an online questionnaire containing both open-ended and closed-ended questions. The qualitative data was analyzed using content analysis resulting in a classification scheme. Two students then identified to which category each part of a participant's answer belonged. RESULTS: For both the perception of a healthy diet and how to eat healthily, four major categories and a residual category were identified: dietary patterns, food processing, food products, content/nutrients, and non-food. These major categories consisted of several categories. The results showed that how people perceived a healthy diet was mostly represented at the level of food product (vegetables and fruit) and the content/nutrient level (carbohydrates), whereas how they would like to eat healthily was mostly represented at the level of food processing (preparation), food product (vegetables), and dietary patterns (amount). CONCLUSIONS: Our findings are mostly in line with how the Dutch dietary guidelines are communicated ("product level"). However, consumers primarily mention single aspects instead of naming the guidelines as a whole. Health policymakers can use this insight in future communications regarding the guidelines to the general public. A challenge for future (eHealth) diet interventions is how to implement and tailor dietary information that optimally connects with the perceptions of the target population.

Use and Appreciation of a Web-Based, Computer-Tailored Diet and Physical Activity Intervention Based on the Self-determination Theory: Evaluation Study of Process and Predictors.

BACKGROUND: eHealth is a promising tool for promoting lifestyle behaviors such as a healthy diet and physical activity (PA). However, making people use interventions is a crucial and challenging problem in eHealth. More insight into use patterns and predicting factors is needed to improve future interventions. OBJECTIVE: This study aims to examine the use, predictors of use, and appreciation of a web-based, computer-tailored, dietary and PA promotion intervention, MyLifestyleCoach, which is based on the self-determination theory. First, we depict the participants' flow in the intervention and identify moments when they are likely to discontinue use. Second, we investigate whether demographic, motivational, and program-related characteristics predict the use of several intervention elements. Finally, we report the appreciation scores for the intervention and the participant and program characteristics associated with these scores. METHODS: This study was based on data from web-based self-report questionnaires. Here, objectively assessed intervention use data were analyzed from participants randomized to the intervention condition. Multiple stepwise (logistic) regression analyses were conducted to examine the predictors of intervention use and evaluation scores. RESULTS: Our findings indicate a low full completion rate for the intervention among those who chose and completed the diet module (49/146, 33.6%), the PA module (2/12, 17%), and both modules (58/273, 21.2%). Several points in the intervention where participants were likely to stop using the intervention were identified. Autonomous and intrinsic motivation toward diet were related to the completion of the initial sessions of the intervention (ie, the opening session in which participants could choose which module to follow and the first session of the diet module). In contrast, controlled motivation was linked to the completion of both modules (initial and follow-up sessions). Appreciation scores were somewhat positive. Appreciation was predicted by several motivational constructs, such as amotivation and basic psychological needs (eg, competence) and program-related features (eg, number of completed sessions). CONCLUSIONS: This study adds meaningful information on the use and appreciation of a web-based, computer-tailored dietary and PA intervention, MyLifestyleCoach. The results indicate that different types of motivations, such as extrinsic and intrinsic motivation, are at play at the points when people are likely to stop using the intervention. The intervention was appreciated fairly well, and several motivational constructs and fulfillment of basic psychological needs were associated with appreciation. Practical implications of these findings have been provided in this study.

A randomized controlled trial into the cognitive effects of a computer-tailored physical activity intervention in older adults with chronic disease(s).

BACKGROUND: Cognitive functioning (CF) is important for wellbeing and an independent life. However, older adults with chronic diseases are at a higher risk of poorer CF levels. Although, research suggests that physical activity (PA) could play an essential role in maintaining good CF, older adults with chronic diseases have low levels of PA. PA interventions to prevent cognitive decline for this specific group exist. Yet, until now these interventions focused on a single specific chronic disease. Active Plus is a proven effective computer-tailored PA stimulating intervention focused on increasing PA in daily life for the older adult population suffering from a broad range of chronic diseases. This study tests the cognitive effects of Active Plus in older adults with chronic diseases. METHODS: In this RCT older adults with at least one chronic disease (≥65 years) were allocated to the intervention group (N = 260, mean age = 74.2) or waiting list control group (N = 325, mean age = 74.5). In total, intervention group participants received three times computer-tailored PA stimulating advice within four months (i.e., at baseline, after two months, and after three to four months). The online and print delivered advice were tailored to the specific needs and wishes of the participant and focused on incorporating PA in daily life. Baseline and follow-up measurements of the CF verbal memory (Verbal Learning Test), shifting (Trailmaking Test), inhibition (Stop-signal Task) and processing speed (Letter Digit Substitution Test) were assessed after six and 12 months. Intervention effects were analyzed with multilevel linear mixed-effects models adjusted for the clustered design and confounding variables. RESULTS: The dropout rate was 19.1% after 6 months and 25.1% after 12 months. Although both conditions improved on all verbal memory outcomes after 6 months, and all CF outcomes except inhibition after 12 months, no intervention effects were found, not even in subgroups (p > .05). CONCLUSIONS: To our knowledge this is the first study to test the cognitive effects of a computer-tailored PA stimulating intervention in older adults suffering from a broad range of chronic diseases. The effects of the Active Plus intervention were not strong enough to improve CF or prevent cognitive decline. A blended approach, in which this computer-tailored intervention is combined with a face-to-face PA intervention and / or cognitive training, might be a good suggestion to increase the effects of Active Plus on PA and CF in older adults with chronic diseases. TRIAL REGISTRATION: Netherlands Trial Register NL6005; Date of Registration 03-21-2017; https://www.trialregister.nl/trial/6005.

Development and Testing of a Personalized Web-Based Diet and Physical Activity Intervention Based on Motivational Interviewing and the Self-Determination Theory: Protocol for the MyLifestyleCoach Randomized Controlled Trial.

BACKGROUND: Unhealthy dietary patterns and insufficient physical activity (PA) are associated with negative health outcomes, such as cardiovascular diseases, type 2 diabetes, cancer, overweight, and obesity. This makes the promotion of healthy dietary and PA behaviors a public health priority. OBJECTIVE: This paper describes the development, design, and evaluation protocol of a Web-based computer-tailored (CT) dietary and PA promotion intervention, MyLifestyleCoach. A Web-based format was chosen for its accessibility and large-scale reach and low-cost potential. To achieve effective and persistent behavioral change, this innovative intervention is tailored to individual characteristics and is based on the self-determination theory and motivational interviewing (MI). METHODS: The 6 steps of the intervention mapping protocol were used to systematically develop MyLifestyleCoach based on the existing effective CT PA promotion intervention I Move. The MyLifestyleCoach intervention consists of 2 modules: I Move, which is aimed at promoting PA, and I Eat, which is aimed at promoting healthy eating. Development of the I Eat module was informed by the previously developed I Move. Both modules were integrated to form the comprehensive MyLifestyleCoach program. Furthermore, I Move was slightly adapted, for example, the new Dutch PA guidelines were implemented. A randomized controlled trial consisting of an intervention condition and waiting list control group will be used to evaluate the effectiveness of the intervention on diet and PA. RESULTS: Self-reported measures take place at baseline, 6 months, and 12 months after baseline. Enrollment started in October 2018 and will be completed in June 2020. Data analysis is currently under way, and the first results are expected to be submitted for publication in 2020. CONCLUSIONS: MyLifestyleCoach is one of the first interventions to translate and apply self-determination theory and techniques from MI in Web-based computer tailoring for an intervention targeting PA and dietary behavior. Intervention mapping served as a blueprint for the development of this intervention. We will evaluate whether this approach is also successful in promoting eating healthier and increasing PA using an randomized controlled trial by comparing the intervention to a waiting list control condition. The results will provide an insight into the short- and long-term efficacy and will result in recommendations for the implementation and promotion of healthy eating and PA among adults in the Netherlands. TRIAL REGISTRATION: Dutch Trial Register NL7333; https://www.trialregister.nl/trial/7333. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14491.

The effect of background noise on the word activation process in nonnative spoken-word recognition.

This article investigates 2 questions: (1) does the presence of background noise lead to a differential increase in the number of simultaneously activated candidate words in native and nonnative listening? And (2) do individual differences in listeners' cognitive and linguistic abilities explain the differential effect of background noise on (non-)native speech recognition? English and Dutch students participated in an English word recognition experiment, in which either a word's onset or offset was masked by noise. The native listeners outperformed the nonnative listeners in all listening conditions. Importantly, however, the effect of noise on the multiple activation process was found to be remarkably similar in native and nonnative listening. The presence of noise increased the set of candidate words considered for recognition in both native and nonnative listening. The results indicate that the observed performance differences between the English and Dutch listeners should not be primarily attributed to a differential effect of noise, but rather to the difference between native and nonnative listening. Additional analyses showed that word-initial information was found to be more important than word-final information during spoken-word recognition. When word-initial information was no longer reliably available word recognition accuracy dropped and word frequency information could no longer be used suggesting that word frequency information is strongly tied to the onset of words and the earliest moments of lexical access. Proficiency and inhibition ability were found to influence nonnative spoken-word recognition in noise, with a higher proficiency in the nonnative language and worse inhibition ability leading to improved recognition performance. (PsycINFO Database Record