Publications by authors named "Andrew Prestwich"

39 Publications

Health effects of psychological interventions for worry and rumination: A meta-analysis.

Health Psychol 2021 Aug 19. Epub 2021 Aug 19.

School of Psychology.

Objective: Evidence suggests that perseverative cognition (PC), the cognitive representation of past stressful events (rumination) or feared future events (worry), mediates the relationship between stress and physical disease. However, the experimental evidence testing methods to influence PC and the subsequent relationship with health outcomes has not been synthesized. Therefore, the current review addressed these gaps.

Method: Studies randomly assigning participants to treatment and control groups, measuring PC and a physical and/or behavioral health outcome after exposure to a nonpharmacological intervention, were included in a systematic review. Key terms were searched in Medline, PsycINFO and CINAHL databases. Of the screened studies ( = 10,703), 36 met the eligibility criteria.

Results: Random-effects meta-analyses revealed the interventions, relative to comparison groups, on average produced medium-sized effects on rumination ( = -.58), small-to-medium sized effects on worry ( = -.41) and health behaviors ( = .31), and small-sized effects on physical health outcomes ( = .23). Effect sizes for PC were negatively associated with effect sizes for health behaviors. (following outlier removal). Effect sizes for PC were significantly larger when interventions were delivered by health care professionals than when delivered via all other methods. No specific intervention type (when directly compared against other types) was associated with larger effect sizes for PC.

Conclusions: Psychological interventions can influence PC. Medium-sized (negative) effect sizes for PC correspond with small (but positive) health behavior effect sizes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000985DOI Listing
August 2021

Do socio-structural factors moderate the effects of health cognitions on COVID-19 protection behaviours?

Soc Sci Med 2021 09 23;285:114261. Epub 2021 Jul 23.

University of Sheffield, UK.

Objective: Adherence to protection behaviours remains key to curbing the spread of the SARS-CoV-2 virus that causes COVID-19, but there are substantial differences in individual adherence to recommendations according to socio-structural factors. To better understand such differences, the current research examines whether relationships between health cognitions based on the Reasoned Action Approach (RAA) and eight COVID-19 protection behaviours vary as a function of participant-level socio-structural factors.

Methods: Within-person design with behaviours nested within participants in a two-wave online survey (one week delay) conducted during the UK national lockdown in April 2020. A UK representative sample of 477 adults completed baseline measures from the RAA plus perceived susceptibility and past behaviour for eight protection behaviours, and self-reported behaviour one week later. Moderated hierarchical linear models with cross-level interactions were used to test moderation of health cognitions by socio-structural factors (sex, age, ethnicity, deprivation).

Results: Sex, ethnicity and deprivation moderated the effects of health cognitions on protection intentions and behaviour. For example, the effects of injunctive norms on intentions were stronger in men compared to women. Importantly, intention was a weaker predictor of behaviour in more compared to less deprived groups. In addition, there was evidence that perceived autonomy was a stronger predictor of behaviour in more deprived groups.

Conclusion: Socio-structural variables affect how health cognitions relate to recommended COVID-19 protection behaviours. As a result, behavioural interventions based on social-cognitive theories might be less effective in participants from disadvantaged backgrounds.
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http://dx.doi.org/10.1016/j.socscimed.2021.114261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299154PMC
September 2021

Postnatal Exercise Partners Study (PEEPS): a pilot randomized trial of a dyadic physical activity intervention for postpartum mothers and a significant other.

Health Psychol Behav Med 2021 Apr 7;9(1):251-284. Epub 2021 Apr 7.

School of Psychology, Curtin University, Perth, Australia.

Research suggests dyadic interventions can increase physical activity; such interventions are untested within postpartum parent couples. A three-armed pilot randomized trial addressed this gap and tested which type of dyadic intervention is most effective. Inactive postpartum mothers and a significant other were recruited in Australia (= 143 assessed for eligibility) and randomised in a single-blinded fashion (i.e. participants were blinded) to 1 of 3 dyadic conditions involving a single face-to-face session with access to web-based group support: a minimal treatment control (= 34), collaborative planning group (= 38), or collaborative planning + need supportive communication group (= 30). Participants were asked to wear their accelerometers for 8 days and completed self-report measures at baseline, end of intervention (week 4), and follow-up (week 12). We expected dyads in the collaborative planning + need supportive communication group would have the greatest increases in Physical Activity (PA), autonomous motivation, and partners' need supportive behaviours; and decreases in controlled motivation and controlling partner behaviours. Results from 51 dyads using Bayesian actor-partner interdependence models provided some evidence for a small positive effect on total PA at follow-up for postpartum mothers in the collaborative planning group and for partners in the collaborative planning + need supportive communication group. Furthermore, partners in the collaborative planning + need supportive communication group were more likely to engage in some vigorous PA. At follow-up, postpartum mothers in the collaborative planning + need supportive communication group scored lower on personal autonomous reasons. The impact of prior specification mean intervention effects need to be interpreted with caution. Progression to a full trial is warranted.
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http://dx.doi.org/10.1080/21642850.2021.1902815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158286PMC
April 2021

Cross-sectional and prospective associations between stress, perseverative cognition and health behaviours.

Psychol Health 2021 Jan 5:1-18. Epub 2021 Jan 5.

School of Psychology, Faculty of Medicine and Health, The University of Leeds, Leeds, UK.

Objectives: The Perseverative Cognition Hypothesis (proposing negative repetitive thinking has detrimental effects on physical health), has been extended to include health behaviours. This study aimed to examine relationships between perseverative cognition, stress and health behaviours.

Design: Participants ( = 336) completed online surveys twice, 3 months apart.

Main Outcome Measures: Cross-sectional and prospective associations between perseverative cognition (worry, brooding and reflection), stress and health behaviours (sleep, diet, physical activity and alcohol).

Results: Analyses demonstrated associations between worry, brooding and reflection and health behaviours, cross-sectionally and prospectively, including sleep and unhealthy snacking. Adding perseverative cognition variables to models simultaneously, only two associations remained (brooding and unhealthy snacking, worry and poorer sleep quality). Controlling for stress, only the cross-sectional association between brooding and more unhealthy snacking remained significant and no significant interactions with stress were found.

Conclusion: This study evidences associations between components of perseverative cognition and health behaviours cross-sectionally and prospectively.
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http://dx.doi.org/10.1080/08870446.2020.1867727DOI Listing
January 2021

Investigating which behaviour change techniques work for whom in which contexts delivered by what means: Proposal for an international collaboratory of Centres for Understanding Behaviour Change (CUBiC).

Br J Health Psychol 2021 02 20;26(1):1-14. Epub 2020 Oct 20.

University of Manchester, UK.

Purpose: Behaviour change techniques are fundamental to the development of any behaviour change intervention, but surprisingly little is known about their properties. Key questions include when, why, how, in which contexts, for which behaviours, in what combinations, compared with what, and for whom behaviour change techniques are typically effective. The aims of the present paper are to: (1) articulate the scope of the challenge in understanding the properties of behaviour change techniques, (2) propose means by which to tackle this problem, and (3) call scientists to action.

Methods: Iterative consensus (O'Connor et al., 2020, Br. J. Psychol., e12468) was used to elicit and distil the judgements of experts on how best to tackle the problem of understanding the nature and operation of behaviour change techniques.

Results: We propose a worldwide network of 'Centres for Understanding Behaviour Change' (CUBiC) simultaneously undertaking research to establish what are the single and combined properties of behaviour change techniques across multiple behaviours and populations. We additionally provide a first attempt to systematize an approach that CUBiC could use to understand behaviour change techniques and to begin to harness the efforts of researchers worldwide.

Conclusion: Better understanding of behaviour change techniques is vital for improving behaviour change interventions to tackle global problems such as obesity and recovery from COVID-19. The CUBiC proposal is just one of many possible solutions to the problems that the world faces and is a call to action for scientists to work collaboratively to gain deeper understanding of the underpinnings of behaviour change interventions.
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http://dx.doi.org/10.1111/bjhp.12479DOI Listing
February 2021

A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health.

Health Psychol Rev 2021 Jun 3;15(2):214-244. Epub 2020 Feb 3.

Department of Medicine, Psychology, and Psychiatry, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, USA.

There are no literature reviews that have examined the impact of health-domain interventions, informed by self-determination theory (SDT), on SDT constructs health indices. Our aim was to meta-analyse such interventions in the health promotion and disease management literatures. Studies were eligible if they used an experimental design, tested an intervention that was based on SDT, measured at least one SDT-based motivational construct, at least one indicator of health behaviour, physical health, or psychological health. Seventy-three studies met these criteria and provided sufficient data for the purposes of the review. A random-effects meta-analytic model showed that SDT-based interventions produced small-to-medium changes in most SDT constructs at the end of the intervention period, and in health behaviours at the end of the intervention period and at the follow-up. Small positive changes in physical and psychological health outcomes were also observed at the end of the interventions. Increases in need support and autonomous motivation (but not controlled motivation or amotivation) were associated with positive changes in health behaviour. In conclusion, SDT-informed interventions positively affect indices of health; these effects are modest, heterogeneous, and partly due to increases in self-determined motivation and support from social agents.
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http://dx.doi.org/10.1080/17437199.2020.1718529DOI Listing
June 2021

Developing a socio-ecological model of dietary behaviour for people living with diabetes or high blood glucose levels in urban Nepal: A qualitative investigation.

PLoS One 2019 25;14(3):e0214142. Epub 2019 Mar 25.

Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.

Instances of non-communicable diseases such as diabetes are on the rise globally leading to greater morbidity and mortality, with the greatest burden in low and middle income countries [LMIC]. A major contributing factor to diabetes is unhealthy dietary behaviour. We conducted 38 semi structured interviews with patients, health professionals, policy-makers and researchers in Kathmandu, Nepal, to better understand the determinants of dietary behaviour amongst patients with diabetes and high blood glucose levels. We created a social ecological model which is specific to socio-cultural context with our findings with the aim of informing culturally appropriate dietary behaviour interventions for improving dietary behaviour. Our findings show that the most influential determinants of dietary behaviour include cultural practices (gender roles relating to cooking), social support (from family and friends), the political and physical environment (political will, healthy food availability) and individuals' motivations and capabilities. Using these most influential determinants, we suggest potentially effective dietary interventions that could be implemented by policy makers. Our findings emphasise the importance of considering socio-cultural context in developing interventions and challenges one-size-fits-all approaches which are often encouraged by global guidelines. We demonstrate how multifaceted and multi layered models of behavioural influence can be used to develop policy and practice with the aim of reducing mortality and morbidity from diabetes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214142PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433239PMC
December 2019

Using the question-behavior effect to change multiple health behaviors: An exploratory randomized controlled trial.

J Exp Soc Psychol 2019 Mar;81:53-60

University of North Carolina at Chapel Hill, United States of America.

Asking questions about a behavior has been found to influence subsequent performance of that behavior, a phenomenon termed the (QBE). The present study addressed two under-researched questions concerning the QBE: (1) Can the QBE be used to change multiple health behaviors, and (2) does enhancing dissonance during questionnaire completion increase the magnitude of the QBE? Participants ( = 1534) were randomized to one of three conditions (dissonance-enhanced QBE; standard QBE; control) that targeted three health-protective behaviors (eating fruit and vegetables, physical activity, dental flossing) and three health-risk behaviors (alcohol intake, sedentariness, unhealthy snacking). The dissonance-enhanced intervention comprised a message designed to pressurize participants into forming healthful behavioral intentions. Behavior was assessed via self-reports at four-week follow up. Findings showed significant overall effects of the QBE both in increasing performance of health-protective behaviors ( = .001) and in reducing performance of health-risk behaviors ( = .04). Compared to the standard QBE condition, the dissonance-enhanced QBE intervention increased performance of health-protective behaviors ( = .04) and marginally reduced performance of health-risk behaviors ( = .07). The dissonance-enhanced QBE intervention outperformed the control condition in all analyses. This is the first report that a brief QBE intervention influences performance of multiple health behaviors. Findings supported the idea that magnifying dissonance increases the impact of the QBE.
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http://dx.doi.org/10.1016/j.jesp.2018.07.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358049PMC
March 2019

Preoperative Interventions for Alcohol and Other Recreational Substance Use: A Systematic Review and Meta-Analysis.

Front Psychol 2019 4;10:34. Epub 2019 Feb 4.

School of Psychology, University of Leeds, Leeds, United Kingdom.

Preoperative alcohol and other recreational substance use (ORSU) may catalyze perioperative complications. Accordingly, interventions aiming to reduce preoperative substance use are warranted. Studies investigating interventions to reduce alcohol and/or ORSU in elective surgery patients were identified from: Cochrane Library; MEDLINE; PSYCINFO; EMBASE; and CINAHL. In both narrative summaries of results and random effects meta-analyses, effects of interventions on perioperative alcohol/ORSU, complications, mortality and length of stay were assessed. Nine studies ( = 903) were included. Seven used behavioral interventions only, two provided disulfiram in addition. Pooled analyses found small effects on alcohol use (: 0.34; 0.05-0.64), though two trials using disulfiram (0.71; 0.36-1.07) were superior to two using behavioral interventions (0.45; -0.49-1.39). No significant pooled effects were found for perioperative complications, length of hospital stay or mortality in studies solely targeting alcohol/ORSU. Too few interventions targeting ORSU ( = 1) were located to form conclusions regarding their efficacy. Studies were generally at high risk-of-bias and heterogeneous. Preoperative interventions were beneficial in reducing substance use in some instances, but more high-quality studies targeting alcohol/ORSU specifically are needed. The literature to date does not suggest that such interventions can reduce postoperative morbidity, length of hospital stay or mortality. Limitations in the literature are outlined and recommendations for future studies are suggested.
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http://dx.doi.org/10.3389/fpsyg.2019.00034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369879PMC
February 2019

How effective are interventions in improving dietary behaviour in low- and middle-income countries? A systematic review and meta-analysis.

Health Psychol Rev 2018 09 7;12(3):312-331. Epub 2018 Jun 7.

b School of Psychology , University of Leeds , Leeds , UK.

Several interventions encouraging people to change their diet have been tested in low- and middle-income countries (LMICs) but these have not been meta-synthesised and it is not known which elements of these interventions contribute to their effectiveness. The current review addressed these issues. Randomised controlled trials of dietary interventions in LMICs were eligible and identified via eight publication databases. Elements of both the intervention and comparison groups (e.g., behaviour change techniques (BCTs), delivery mode), participant characteristics and risk of bias were coded. Random effects meta-analysis of 76 randomised controlled trials found, on average, small- to medium-sized but highly heterogeneous improvement in dietary behaviour following an intervention. Small and homogeneous improvements were found for BMI/weight, waist- and hip-circumference, with medium-sized, but heterogeneous, improvements in blood pressure and cholesterol. Although many BCTs have yet to be tested in this context, meta-regressions suggested some BCTs (action planning, self-monitoring of outcome(s) of behaviour; demonstration of behaviour) as well as individually randomised trials, adult- or hypertensive-samples and lack of blinding were associated with larger dietary behaviour effect sizes. Interventions to encourage people from LMICs to change their diet produce, on average, small-to-medium-sized effects. These effects may possibly be increased through the inclusion of specific BCTs and other study elements.
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http://dx.doi.org/10.1080/17437199.2018.1481763DOI Listing
September 2018

Using Implementation Intentions to Prevent Relapse after Psychological Treatment for Depression - the SMArT Intervention.

Behav Cogn Psychother 2018 Sep 18;46(5):626-632. Epub 2018 Apr 18.

South West Yorkshire Partnership NHS Foundation Trust,UK.

Background: It is recognized that a significant proportion of people with depression are prone to relapse, even after successful treatment, and that self-management interventions should be developed and provided. There is evidence that implementation intentions (IMPS) can be successfully applied to health-related behaviours but their application to self-management of mental health problems has been limited.

Aims: This paper describes the design and initial evaluation of a Self-Management After Therapy (SMArT) intervention, which incorporated IMPS and followed psychological therapy for depression. We sought to assess the feasibility and acceptability of SMArT.

Method: The SMArT intervention was designed with reference to the MRC guidance on developing and evaluating complex interventions and co-designed with and implemented in a UK Improving Access to Psychological Therapies (IAPT) service. Eleven patients who were in remission following treatment for depression received the SMArT intervention, provided by Psychological Wellbeing Practitioners (PWPs). The evaluation used routine IAPT outcome measures at each session, feedback from patients and PWPs, and analysis of the type of IMPS identified and their fidelity with the model. Six patients provided brief feedback about the intervention to an independent researcher.

Results: Feedback from patients and PWPs suggested that the intervention was feasible, acceptable and could potentially help patients to stay well after therapy. Patients confirmed the value of setting their own goals in the form of IMPS, receiving support from PWPs and in some cases from partners, friends and family members.

Conclusions: Implementation intentions are a promising approach to support the self-management of depression.
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http://dx.doi.org/10.1017/S1352465818000255DOI Listing
September 2018

How Can Smoking Cessation Be Induced Before Surgery? A Systematic Review and Meta-Analysis of Behavior Change Techniques and Other Intervention Characteristics.

Front Psychol 2017 7;8:915. Epub 2017 Jun 7.

School of Psychology, University of LeedsLeeds, United Kingdom.

Smokers who continue to smoke up to the point of surgery are at increased risk of a range of complications during and following surgery. To identify whether behavioral and/or pharmacological interventions increase the likelihood that smokers quit prior to elective surgery and which intervention components are associated with larger effects. Systematic review with meta-analysis. MEDLINE, Embase, and Embase Classic, CINAHL, CENTRAL. Studies testing the effect of smoking reduction interventions delivered at least 24 h before elective surgery were included. Potential studies were independently screened by two people. Data relating to study characteristics and risk of bias were extracted. The effects of the interventions on pre-operative smoking abstinence were estimated using random effects meta-analyses. The association between specific intervention components (behavior change techniques; mode; duration; number of sessions; interventionist) and smoking cessation effect sizes were estimated using meta-regressions. Twenty-two studies comprising 2,992 smokers were included and 19 studies were meta-analyzed. Interventions increased the proportion of smokers who were abstinent or reduced smoking by surgery relative to control: = 0.56, 95% CI 0.32-0.80, with rates nearly double in the intervention (46.2%) relative to the control (24.5%). Interventions that comprised more sessions, delivered face-to-face and by nurses, as well as specific behavior change techniques (providing information on consequence of smoking/cessation; providing information on withdrawal symptoms; goal setting; review of goals; regular monitoring by others; and giving options for additional or later support) were associated with larger effects. Rates of smoking can be halved prior to surgery and a number of intervention characteristics can increase these effects. There was, however, some indication of publication bias meaning the benefits of such interventions may be smaller than estimated. Prospero 2015: CRD42015024733.
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http://dx.doi.org/10.3389/fpsyg.2017.00915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461364PMC
June 2017

Exploration of likely engagement with Monetary Contingency Contracts for weight loss: a questionnaire study.

Psychol Health Med 2017 12 27;22(10):1278-1283. Epub 2017 May 27.

c Manchester Centre for Health Psychology, Division Psychology and Mental Health School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre , University of Manchester , Manchester , UK.

Monetary Contingency Contracts (MCCs) are schemes that ask individuals to pledge money that is returned contingent on behaviour change. In relation to weight loss, this study explored likely levels of engagement with MCCs, how much individuals would be willing to pay into an MCC, and how these amounts vary under different contract conditions. Fifty-six individuals with BMI above 25 who were motivated to lose weight were recruited. The majority of participants (87.5%) indicated that they would be willing to engage with weight loss MCCs, but showed more reluctance to subscribe to pair-based MCCs which offered; (a) refunds contingent on the weight loss of a weight loss partner, and (b) 'all or nothing refunds' in which no reward is given for any weight loss below the target weight loss goal. This study provides preliminary evidence that individuals motivated to lose weight may be willing to engage with weight loss MCCs. Further research is needed to explore reasons for reluctance to subscribe to MCCs with certain conditions, to inform the design of future experimental studies testing the efficacy of MCCs as part of an intervention for weight loss.
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http://dx.doi.org/10.1080/13548506.2017.1332373DOI Listing
December 2017

The effect of pair-based monetary contingency contracts for weight loss: Results from a randomized controlled pilot study.

Obesity (Silver Spring) 2017 03 1;25(3):506-509. Epub 2017 Feb 1.

Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK.

Objective: Monetary contingency contracts (MCCs), in which deposited money is returned contingent on weight loss, could promote weight/adiposity reduction. This study piloted individual- and pair-based MCCs (when refunds are contingent on two individuals losing weight) and assessed effects on weight/body composition.

Methods: Seventy-seven participants with BMI greater than 25 kg/m were recruited. In a non-blinded, randomized controlled trial conducted in a university laboratory setting, participants were randomized in pairs via a computer-generated sequence to one of four conditions: partner with pair-based refund (P-PBR), partner with individual refund (P-IR), individual weight loss with individual refund (I-IR), or no MCC (comparison). Refunds were contingent on weight loss after 4 and 8 weeks; weight/body composition was measured at 0, 4, and 8 weeks. Primary outcome measures were change in weight and fat mass.

Results: Seventy-seven participants (P-PBR n = 16; P-IR n = 20; I-IR n = 22; comparison n = 19) were recruited. Deposit amount was significantly positively associated with reductions in weight/BMI. At 8 weeks, the P-PBR condition reduced fat mass more than all other conditions (P < 0.05) and reduced weight/BMI more than the I-IR condition (P < 0.05).

Conclusions: The large effect of P-PBR on fat mass suggests it would be valuable to conduct a fully powered, randomized controlled trial of pair-based MCCs.
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http://dx.doi.org/10.1002/oby.21758DOI Listing
March 2017

Perseverative Cognition and Health Behaviors: A Systematic Review and Meta-Analysis.

Front Hum Neurosci 2016 8;10:534. Epub 2016 Nov 8.

School of Psychology, University of Leeds Leeds, UK.

Recent developments in stress theory have emphasized the significance of perseverative cognition (worry and rumination) in furthering our understanding of stress-disease relationships. Substantial evidence has shown that perseverative cognition (PC) is associated with somatic outcomes and numerous physiological concomitants have been identified (i.e., cardiovascular, autonomic, and endocrine nervous system activity parameters). However, there has been no synthesis of the evidence regarding the association between PC and health behaviors. This is important given such behaviors may also directly and/or indirectly influence health and disease outcomes (triggered by PC). Therefore, the aim of the current review was to synthesize available studies that have explored the relationship between worry and rumination and health behaviors (health risk: behaviors which, if performed, would be detrimental to health; health promoting: behaviors which, if performed, would be beneficial for health). A systematic review and meta-analyses of the literature were conducted. Studies were included in the review if they reported the association between PC and health behavior. Studies identified in MEDLINE or PsycINFO ( = 7504) were screened, of which 19 studies met the eligibility criteria. Random-effects meta-analyses suggested increased PC was generally associated with increased health risk behaviors but not health promoting behaviors. Further analyses indicated that increases in rumination ( = 0.122), but not reflection ( = -0.080), or worry ( = 0.048) were associated with health risk behaviors. In conclusion, these results showed that increases in PC are associated with increases in health risk behaviors (substance use, alcohol consumption, unhealthy eating, and smoking) that are driven primarily through rumination. These findings provide partial support for our hypothesis that in Brosschot et al.'s (2006) original perseverative cognition hypothesis, there may be scope for additional routes to pathogenic disease via poorer health behaviors.
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http://dx.doi.org/10.3389/fnhum.2016.00534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5099163PMC
November 2016

Does changing social influence engender changes in alcohol intake? A meta-analysis.

J Consult Clin Psychol 2016 Oct 30;84(10):845-60. Epub 2016 May 30.

School of Psychology.

Objective: Past research has suggested that social influences on drinking can be manipulated with subsequent reductions in alcohol intake. However, the experimental evidence for this and the best strategies to positively change these social influences have not been meta-analyzed. This research addressed these gaps.

Method: Randomized controlled trials testing social influence-based interventions on adults' drinking were systematically reviewed and meta-analyzed. The behavior change techniques used in each study were coded and the effect sizes showing the impact of each intervention on (a) social influence and (b) alcohol intake were calculated. Metaregressions identified the association between these effect sizes, as well as the effect of specific behavior change techniques on social influences.

Results: Forty-one studies comprising 17,445 participants were included. Changes in social influences were significantly associated with changes in alcohol intake. However, even moderate-to-large changes in social influences corresponded with only a small change in drinking behavior and changing social influences did not reduce alcohol-related problems. Providing normative information about others' behavior and experiences was the most effective technique to change social influences.

Conclusions: Social influences and normative beliefs can be changed in drinkers, particularly by providing normative information about how much others' drink. However, even generating large changes in these constructs are likely to engender only small changes in alcohol intake. (PsycINFO Database Record
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http://dx.doi.org/10.1037/ccp0000112DOI Listing
October 2016

Impact of goal priority and goal conflict on the intention-health-behavior relationship: Tests on physical activity and other health behaviors.

Health Psychol 2016 Sep 16;35(9):1017-26. Epub 2016 May 16.

Unilever Research.

Objectives: Goal intentions are the key proximal determinant of behavior in a number of key models applied to predicting health behavior. However, relatively little previous research has examined how characteristics of goals moderate the intention-health-behavior relations. The present research examined the effects of goal priority and goal conflict as moderators of the intention-health-behavior relationship.

Method: The main outcome measures were self-reported performance of physical activity (Studies 1, 2, and 3) and other health behaviors (Study 4), and objectively measured physical activity (Study 3). Studies 1 and 4 used prospective correlational designs to predict later behavior from earlier cognitions. Studies 2 and 3 were experimental studies manipulating goal priority and goal conflict. Studies 1 and 2 used between-subjects designs while Studies 3 and 4 used within-subjects designs.

Results: Goal priority significantly moderated the intention-health-behavior relationship for physical activity (Study 1) and a range of protective and risk health behaviors (Study 4). Manipulations of goal priority significantly increased the intention-physical-activity relationship when self-reported (Study 2) and objectively measured (Study 3). In contrast, inconsistent effects were observed for goal conflict as an intention-behavior moderator.

Conclusions: When goal priority is high, then intentions are strong predictors of health behaviors. Further studies testing manipulations of goal conflict and in particular goal priority in combination with goal intentions are required to confirm their value as a means to change health behavior. (PsycINFO Database Record
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http://dx.doi.org/10.1037/hea0000340DOI Listing
September 2016

An experimental test of control theory-based interventions for physical activity.

Br J Health Psychol 2016 Nov;21(4):812-826

School of Psychology, University of Leeds, UK.

Objectives: To provide an experimental test of control theory to promote physical activity.

Design: Parallel groups, simple randomized design with an equal chance of allocation to any group.

Methods: Participants not meeting recommended levels of physical activity but physically safe to do so (N = 124) were recruited on a UK university campus and randomized to goal-setting + self-monitoring + feedback (GS + SM + F, n = 40), goal-setting + self-monitoring (GS + SM, n = 40), or goal-setting only (GS, n = 44) conditions that differentially tapped the key features of control theory. Accelerometers assessed physical activity (primary outcome) as well as self-report over a 7-day period directly before/after the start of the intervention.

Results: The participants in the GS + SM + F condition significantly outperformed those in the GS condition, d = 0.62, 95% CI d = 0.15-1.08, and marginally outperformed those in the GS + SM condition in terms of total physical activity at follow-up on the accelerometer measure, d = 0.33, 95% CI d = -0.13 to 0.78. The feedback manipulation (GS + SM + F vs. GS + SM and GS) was most effective when baseline intentions were weak. These patterns did not emerge on the self-report measure but, on the basis of this measure, the feedback manipulation increased the risk that participants coasted in relation to their goal in the first few days of the intervention period.

Conclusions: Using behaviour change techniques consistent with control theory can lead to significant short-term improvements on objectively assessed physical activity. Further research is needed to examine the underlying theoretical principles of the model. Statement of contribution What is already known on this subject? Interventions incorporating more techniques that are consistent with control theory are associated with larger positive changes in health behaviours and related outcomes (see reviews by Dombrowski et al., ; Michie et al., ). However, none of the studies included in these reviews were explicitly based on control theory (see Prestwich et al., ). What does this study add? This study is the first experimental test of the cumulative effects of behaviour change techniques as proposed by control theory. Intervening on all aspects of the feedback loop noted by control theory leads to more change; however, the risk that some participants coast in relation to their set goal is significant. This approach increased physical activity more in those with weaker intentions pre-intervention.
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http://dx.doi.org/10.1111/bjhp.12198DOI Listing
November 2016

Does monitoring goal progress promote goal attainment? A meta-analysis of the experimental evidence.

Psychol Bull 2016 Feb 19;142(2):198-229. Epub 2015 Oct 19.

Department of Psychology, University of North Carolina at Chapel Hill.

Control theory and other frameworks for understanding self-regulation suggest that monitoring goal progress is a crucial process that intervenes between setting and attaining a goal, and helps to ensure that goals are translated into action. However, the impact of progress monitoring interventions on rates of behavioral performance and goal attainment has yet to be quantified. A systematic literature search identified 138 studies (N = 19,951) that randomly allocated participants to an intervention designed to promote monitoring of goal progress versus a control condition. All studies reported the effects of the treatment on (a) the frequency of progress monitoring and (b) subsequent goal attainment. A random effects model revealed that, on average, interventions were successful at increasing the frequency of monitoring goal progress (d+ = 1.98, 95% CI [1.71, 2.24]) and promoted goal attainment (d+ = 0.40, 95% CI [0.32, 0.48]). Furthermore, changes in the frequency of progress monitoring mediated the effect of the interventions on goal attainment. Moderation tests revealed that progress monitoring had larger effects on goal attainment when the outcomes were reported or made public, and when the information was physically recorded. Taken together, the findings suggest that monitoring goal progress is an effective self-regulation strategy, and that interventions that increase the frequency of progress monitoring are likely to promote behavior change.
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http://dx.doi.org/10.1037/bul0000025DOI Listing
February 2016

The utility of monetary contingency contracts for weight loss: a systematic review and meta-analysis.

Health Psychol Rev 2015 14;9(4):434-51. Epub 2015 Jul 14.

b Manchester Centre for Health Psychology, School of Psychological Sciences , University of Manchester , Manchester M13 9PL , UK.

Financial incentives to improve health have received increasing attention, but are subject to ethical concerns. Monetary Contingency Contracts (MCCs), which require individuals to deposit money that is refunded contingent on reaching a goal, are a potential alternative strategy. This review evaluates systematically the evidence for weight loss-related MCCs. Randomised controlled trials testing the effect of weight loss-related MCCs were identified in online databases. Random-effects meta-analyses were used to calculate overall effect sizes for weight loss and participant retention. The association between MCC characteristics and weight loss/participant retention effects was calculated using meta-regression. There was a significant small-to-medium effect of MCCs on weight loss during treatment when one outlier study was removed. Group refunds, deposit not paid as lump sum, participants setting their own deposit size and additional behaviour change techniques were associated with greater weight loss during treatment. Post-treatment, there was no significant effect of MCCs on weight loss. There was a significant small-to-medium effect of MCCs on participant retention during treatment. Researcher-set deposits paid as one lump sum, refunds delivered on an all-or-nothing basis and refunds contingent on attendance at classes were associated with greater retention during treatment. Post-treatment, there was no significant effect of MCCs on participant retention. The results support the use of MCCs to promote weight loss and participant retention up to the point that the incentive is removed and identifies the conditions under which MCCs work best.
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http://dx.doi.org/10.1080/17437199.2015.1030685DOI Listing
August 2016

How can self-efficacy be increased? Meta-analysis of dietary interventions.

Health Psychol Rev 2014 15;8(3):270-85. Epub 2013 Jul 15.

a Institute of Psychological Sciences , University of Leeds , Leeds , UK.

Targeting individuals' beliefs that they are able to eat healthily can improve dietary-related behaviours. However, the most effective behaviour change techniques (BCTs) to promote dietary self-efficacy have not been systematically reviewed. This research addressed this gap. Studies testing the effect of interventions on healthy eating and underlying dietary-related self-efficacy, within randomised controlled trials, were systematically reviewed in MEDLINE, EMBASE and PSYCINFO. Two reviewers independently coded intervention content in both intervention and comparison groups. Data pertaining to study quality were also extracted. Random effects meta-analysis was used to calculate an overall effect size on dietary self-efficacy for each study. The associations between 26 BCTs and self-efficacy effects were calculated using meta-regression. In some of the analyses, interventions that incorporated self-monitoring (tracking one's own food-related behaviour), provided feedback on performance, prompted review of behavioural goals, provided contingent rewards (rewarding diet success), or planned for social support/social change increased dietary self-efficacy significantly more than interventions that did not. Stress management was consistently associated with self-efficacy effects across all analyses. There was strong evidence for stress management and weaker evidence for a number of other BCTs. The findings can be used to develop more effective, theory- and evidence-based behavioural interventions.
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http://dx.doi.org/10.1080/17437199.2013.813729DOI Listing
August 2015

Does theory influence the effectiveness of health behavior interventions? Meta-analysis.

Health Psychol 2014 May 3;33(5):465-74. Epub 2013 Jun 3.

Division of Psychology and Language Sciences, University College London.

Objective: To systematically investigate the extent and type of theory use in physical activity and dietary interventions, as well as associations between extent and type of theory use with intervention effectiveness.

Methods: An in-depth analysis of studies included in two systematic reviews of physical activity and healthy eating interventions (k = 190). Extent and type of theory use was assessed using the Theory Coding Scheme (TCS) and intervention effectiveness was calculated using Hedges's g. Metaregressions assessed the relationships between these measures.

Results: Fifty-six percent of interventions reported a theory base. Of these, 90% did not report links between all of their behavior change techniques (BCTs) with specific theoretical constructs and 91% did not report links between all the specified constructs with BCTs. The associations between a composite score or specific items on the TCS and intervention effectiveness were inconsistent. Interventions based on Social Cognitive Theory or the Transtheoretical Model were similarly effective and no more effective than interventions not reporting a theory base.

Conclusions: The coding of theory in these studies suggested that theory was not often used extensively in the development of interventions. Moreover, the relationships between type of theory used and the extent of theory use with effectiveness were generally weak. The findings suggest that attempts to apply the two theories commonly used in this review more extensively are unlikely to increase intervention effectiveness.
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http://dx.doi.org/10.1037/a0032853DOI Listing
May 2014

Partner- and planning-based interventions to reduce fat consumption: randomized controlled trial.

Br J Health Psychol 2014 Feb 10;19(1):132-48. Epub 2013 May 10.

Institute of Psychological Sciences, University of Leeds, UK.

Objective: The research tested the efficacy of partner- and planning-based interventions to reduce dietary fat intake over a 6-month period.

Design: Randomized controlled, blinded, parallel trial.

Methods: A computer randomization feature was used to allocate council employees (N = 427, of which 393 completed baseline measures) to one of four conditions (partner + implementation intentions, partner-only, implementation intentions, and control group) before they completed measures at baseline and follow-ups at 1, 3, and 6 months post-baseline. Outcome measures were comprised of validated self-report measures of dietary fat intake (saturated fat intake, fat intake, ratio of 'good' fats to 'bad' fats); psychosocial mediators (enjoyment, intention, self-efficacy, social influence, partner support); weight and waist size (baseline and 6 months only).

Results: Data from 393 participants were analysed in accordance with intention-to-treat analyses. All intervention groups reported greater reductions in fat intake than the control group at 3 months. The partner-based groups increased the ratio of 'good' fats to 'bad' fats at 3 and 6 months and lost more inches on their waist, versus the non-partner groups. The impacts of the partner-based manipulations on outcomes were partially mediated by greater perceived social influences, partner support, and enjoyment of avoiding high-fat foods. The partner-based interventions also increased intention and self-efficacy. However, the effects in this study were typically small and generally marginally significant.

Conclusions: Partner-based interventions had some positive benefits on dietary-related outcomes at 3 and 6 months. Support for implementation intentions was more limited.
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http://dx.doi.org/10.1111/bjhp.12047DOI Listing
February 2014

Patients' and practitioners' views on health behaviour change: a qualitative study.

Psychol Health 2013 2;28(6):653-74. Epub 2013 Jan 2.

Research and Development Directorate, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, England.

Objective: This study was designed to examine patients' and health professionals' perspectives on lifestyle behaviour change and to inform the development of a lifestyle behaviour change intervention to be used in primary care.

Design: Focus groups were conducted with seven patients and 13 health professionals where they were asked to discuss lifestyle behaviour change in relation to the design and development phase of a tailored lifestyle behaviour change intervention package.

Results: An inductive thematic analysis of transcripts suggested a range of issues that are relevant to the development and implementation of lifestyle change interventions such as time, lack of resources and starting interventions too late, as well as personal circumstances and the continuous effort that behaviour change requires. They were interpreted as two superordinate themes of 'internal and external influences on behaviour change' and 'behaviour change initiation and maintenance'. The results are discussed in relation to the implications they may have for researchers and health service commissioners designing interventions and practitioners implementing lifestyle change interventions in primary care.

Conclusion: Many factors are involved in patients' and health care professionals' understanding of interventions and lifestyle behaviour change. These should be taken into consideration when designing interventions based on behaviour change theories.
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http://dx.doi.org/10.1080/08870446.2012.744008DOI Listing
August 2013

Exploring the question-behaviour effect: randomized controlled trial of motivational and question-behaviour interventions.

Br J Health Psychol 2013 Feb 23;18(1):31-44. Epub 2012 Apr 23.

University of Leeds, UK.

Purpose: Measuring intentions and other cognitions to perform a behaviour can promote performance of that behaviour (the question-behaviour effect, QBE). It has been suggested that this effect may be amplified for individuals motivated to perform the behaviour. The present research tested the efficacy of combining a motivational intervention (providing personal risk information) with measuring intentions and other cognitions in a fully crossed 2 × 2 design with an objective measure of behaviour in an at-risk population using a randomized controlled trial (RCT).

Methods: Participants with elevated serum cholesterol levels were randomized to one of four conditions: a combined group receiving both a motivational intervention (personalized cardiovascular disease risk information) and a QBE manipulation (completing a questionnaire about diet), one group receiving a motivational intervention, one group receiving a QBE intervention, or one group receiving neither. All participants subsequently had the opportunity to obtain a personalized health plan linked to reducing personal risk for coronary heart disease.

Results: Neither the motivational nor the QBE manipulations alone significantly increased rates of obtaining the health plan. However, the interaction between conditions was significant. Decomposition of the interaction indicated that the combined condition (motivational plus QBE manipulation) produced significantly higher rates of obtaining the health plan (96.2%) compared to the other three groups combined (80.3%).

Conclusions: The findings provide insights into the mechanism underlying the QBE and suggest the importance of motivation to perform the behaviour in observing the effect.

Statement Of Contribution: What is already known on this subject? Research has indicated that merely asking questions about a behaviour may be sufficient to produce changes in that or related behaviours (referred to as the question-behaviour effect; QBE). Previous studies have suggested that the QBE may be moderated by the individual's motivation to change the behaviour, i.e., the QBE will only produce increases in the behaviour among those with strong motivation to perform the behaviour. However, no study has directly tested this prediction by manipulating motivation and examining impacts on the QBE. What does this study add? The present study tested the individual and combined effects of a motivational and a QBE intervention in a fully crossed design using a randomized controlled trial (RCT) and showed that: a combined intervention significantly increased behaviour. effect partially mediated by cognitions.
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http://dx.doi.org/10.1111/j.2044-8287.2012.02075.xDOI Listing
February 2013

Randomized controlled trial of collaborative implementation intentions targeting working adults' physical activity.

Health Psychol 2012 Jul 2;31(4):486-95. Epub 2012 Apr 2.

Institute of Psychological Sciences, University of Leeds, UK.

Objective: The research tested the efficacy of planning and partner-based interventions to promote physical activity over six months.

Method: Local government (council) employees (N = 257) were randomly allocated to one of four conditions (collaborative implementation intentions; partner-only; implementation intentions; control group) before completing measures at baseline and follow-ups at 1, 3 and 6 months. Outcome measures comprised validated self-report measures of physical activity: the international physical activity questionnaire (IPAQ; Craig et al., 2003) and self-report walking and exercise tables (SWET; Prestwich et al., 2012); psychosocial mediators (enjoyment, intention, self-efficacy, social influence); weight and waist size (baseline and 6 months only).

Results: As well as losing the most weight, there was evidence that participants in the collaborative implementation-intention group were more physically active than each of the other three groups at 1-, 3- and 6-month follow-ups. Those in the implementation-intention and partner-only conditions did not outperform the control group on most measures.

Conclusion: Collaborative implementation intentions represent a potentially useful intervention to change important health behaviors that help reduce weight.
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http://dx.doi.org/10.1037/a0027672DOI Listing
July 2012

Do implicit measures of attitudes incrementally predict snacking behaviour over explicit affect-related measures?

Appetite 2012 Jun 2;58(3):835-41. Epub 2012 Feb 2.

Institute of Psychological Sciences, University of Leeds, UK.

Various studies have demonstrated an association between implicit measures of attitudes and dietary-related behaviours. However, no study has tested whether implicit measures of attitudes predict dietary behaviour after controlling for explicit measures of palatability. In a prospective design, two studies assessed the validity of measures of implicit attitude (Implicit Association Test, IAT) and explicit measures of palatability and health-related attitudes on self-reported (Studies 1 and 2) and objective food (fruit vs. chocolate) choice (Study 2). Following regression analyses, in both studies, implicit measures of attitudes were correlated with food choice but failed to significantly predict food choice when controlling specifically for explicit measures of palatability. These consistent relationships emerged despite using different category labels within the IAT in the two studies. The current research suggests implicit measures of attitudes may not predict dietary behaviours after taking into account the palatability of food. This is important in order to establish determinants that explain unique variance in dietary behaviours and to inform dietary change interventions.
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http://dx.doi.org/10.1016/j.appet.2012.01.019DOI Listing
June 2012

The transmission of attitudes towards food: twofold specificity of similarities with parents and friends.

Br J Health Psychol 2012 May 6;17(2):346-61. Epub 2011 Jul 6.

Department of Communication and Economy, University of Modena & Reggio Emilia, Viale Allegri 9, Reggio Emilia, Italy.

Objectives: The present study explored whether similarity of students' food attitudes with those of their parents and friends varies as a function of both the food and type of measurement. We expected greater resemblance with parents for attitudes towards fruit and for implicit attitudes and greater resemblance with friends for attitudes towards snacks and for explicit attitudes.

Design: We compared the resemblance in implicit and explicit attitudes towards fruit and preference for sweet over savoury snacks between target-parent and target-friend pairings. The parental-peer mutual influence effect was separated from cultural effect by comparing real and random dyads.

Methods: Target participants were 85 students who recruited one parent and one best friend each. All participants completed online two Implicit Association Tests and rated their liking for fruit and sweet/savoury snacks.

Results: Our target participants' attitudes towards fruit were predicted by those of their parents rather than friends, with this relationship being detected through implicit but not explicit measures. Conversely, target participants' preference for sweet over savoury snacks was predicted with those of their friends but not parents, with this relationship being detected through explicit but not implicit measures.

Conclusions: Young adults' resemblance to parents and friends, in terms of food attitudes, seems specific both to the food type and to the attitude measure, suggesting that parents' influence concerns healthy food and is exerted at an implicit attitude level; whereas friends' influence concerns junk food and is exerted at an explicit attitude level. The theoretical and practical implications are discussed.
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http://dx.doi.org/10.1111/j.2044-8287.2011.02041.xDOI Listing
May 2012

Implicit shopping: attitudinal determinants of the purchasing of healthy and unhealthy foods.

Psychol Health 2011 Jul 24;26(7):875-85. Epub 2011 May 24.

Institute of Psychological Sciences, University of Leeds, Leeds LS2 9JT, UK.

Implicit attitudes, evaluations that can occur without effort, quickly and without conscious intent, have been shown to predict self-reported diets and objectively measured food choices within the laboratory. We present two studies which extend the literature by demonstrating that implicit attitudes predict objective purchasing of healthy and unhealthy foods. Both Study 1 (N=40) and Study 2 (N=36) utilised an online shopping paradigm and concerned purchasing of fruit and chocolate. In both studies, implicit attitudes predicted purchases. Explicit attitudes towards buying or eating fruit versus chocolate did not predict purchase behaviour. These studies represent an original test of whether implicit attitudes predict healthy consumer behaviour, which involves participants paying for products. This research provides the strongest evidence yet that implicit attitudes play a role in predicting health food purchases. A comprehensive model of health behaviour should take into account the role of implicit attitudes.
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http://dx.doi.org/10.1080/08870446.2010.509797DOI Listing
July 2011

Using aversive images to enhance healthy food choices and implicit attitudes: An experimental test of evaluative conditioning.

Health Psychol 2011 Mar;30(2):195-203

Health Psychology Section, Department of Psychology, King’s College London, London, UK.

Objective: To examine the effect of communicating images of energy-dense snack foods paired with aversive images of the potential health consequences of unhealthy eating, on implicit and explicit attitudes and food choice behavior.

Design: Participants were randomly allocated to either an evaluative conditioning (EC) procedure that paired images of snack foods with images of potential adverse health consequences or a control condition that featured images of snack foods alone.

Main Outcome Measures: Implicit attitudes were assessed pre- and post-intervention. Explicit attitudes and food choice behavior were assessed post-intervention.

Results: The conditioning intervention made implicit attitudes toward energy-dense snacks more negative, with this effect greatest in those with relatively more favorable implicit attitudes toward these snacks at baseline. Participants in the conditioning intervention were more likely to choose fruit rather than snacks in a behavioral choice task, a relationship mediated by changes in implicit attitudes.

Conclusion: Presenting aversive images of potential health consequences with those of specific foodstuffs can change implicit attitudes, which impacts on subsequent food choice behavior.
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http://dx.doi.org/10.1037/a0022261DOI Listing
March 2011
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