Randomized controlled trials of self-monitoring interventions with or without incentives for diet and exercise among individuals with overweight or obesity: Psychological and behavioural effects.

OBJECTIVES: To test the effects of three behavioural interventions (daily monetary incentives + self-monitoring, delayed lump sum monetary incentives + self-monitoring, and self-monitoring only) on psychological constructs and fruit and vegetable consumption or physical activity behaviour change among a sample of adults with overweight or obesity. DESIGN: A pair of 3-arm longitudinal randomized controlled trials compared daily monetary incentives + self-monitoring, delayed lump sum monetary incentives + self-monitoring, and self-monitoring only interventions for either fruit and vegetable consumption or physical activity. METHODS: Individuals reporting elevated weight status and insufficient engagement in one of the target behaviours were randomly assigned to one of three 3-week interventions. All three interventions involved daily self-monitoring of the behaviour, and two provided monetary incentives contingent upon reported behaviour. Participants completed measures of psychological constructs and reported behaviour at baseline, the end of the intervention, and two and four weeks post-intervention. RESULTS: Participants across all three intervention conditions demonstrated increased engagement in the target behaviour from pre- to post-intervention and reported behaviour remained above baseline levels at both follow-up time points. Increases in reported behaviour during the intervention were associated with increases in self-efficacy, and this enhanced self-efficacy prospectively predicted sustained reported behaviour at follow-up. However, contrary to hypotheses, the incentive interventions including self-monitoring were not more efficacious than self-monitoring alone, and increased reported behaviour was not associated with enhancements in attitudes. CONCLUSIONS: Self-monitoring interventions can aid behaviour change efforts, and behavioural practice during these interventions can increase self-efficacy. However, among adults with overweight or obesity who are seeking behaviour change interventions, incentive-based self-monitoring approaches may not be superior to self-monitoring alone in driving behaviour change and maintenance.

Stress and number of servings of fruit and vegetables consumed: Buffering effects of monetary incentives.

Diet is a key factor of human health, and additional research is needed in order to understand the psychological causes, consequences, and moderators of dietary behavior. Participants in two studies in the United States completed a 21-day intervention that involved either self-monitoring their fruit and vegetable consumption or self-monitoring combined with earning monetary incentives for behavior. Each day, participants reported their stress, affect, and consumption of fruits and vegetables. Hierarchical linear mixed effects model results suggest that on average, daily reports of higher stress were associated with fewer fruits and vegetables consumed on that day. This effect was moderated by incentive condition, such that the relationship between stress and fruit and vegetable consumption was reduced among incented participants. There was also a marginal negative effect of time on consumption of fruits and vegetables, but this was also significantly moderated by condition, such that those participants who did not receive incentives decreased their daily servings, while incented participants did not decrease over the course of the intervention. These studies suggest that incentives may be a novel method for buffering against the negative effect of daily stress on eating a healthy diet.

Feel good now or regret it later? The respective roles of affective attitudes and anticipated affective reactions for explaining health-promoting and health risk behavioral intentions.

Evidence supporting the incorporation of affective constructs, such as affective attitudes and anticipated regret, into theoretical models of health behavior has been mounting in recent years; however, the role of positive anticipated affective reactions (e.g., pride) has been largely unexplored. The purpose of the present investigation was to assess how affective attitudes and anticipated affective reactions (both pride and regret for performing a behavior or not) may provide distinct utility for understanding intentions to perform health-promoting and health risk behaviors over and above cognitive attitudes and other established theoretical constructs from the theory of planned behavior (TPB). Participants (N = 210) were recruited via Amazon's Mechanical Turk to complete a one-time online battery assessing TPB and affective constructs. Self-reported intentions served as the main outcome measure, and hierarchical linear modeling was used to examine the effects of TPB and affective constructs across behaviors. Controlling for TPB constructs, more positive affective attitudes and greater anticipated regret, but not anticipated pride, predicted intentions to engage in future health behaviors. Anticipated affective reactions contributed explanatory variance for intentions to perform health risk behaviors, but anticipated pride and regret were not associated with intentions to perform health risk behaviors. Contributions made via the inclusion of both positively and negatively valence anticipated affective reactions for both action and inaction (performing a behavior or not) across a range of health promoting and health risk behaviors are discussed, as well as implications for future intervention work.

Neural activation during delay discounting is associated with 6-month change in risky sexual behavior in adolescents.

Background: Identifying cognitive and neural mechanisms of decision making in adolescence can enhance understanding of, and interventions to reduce, risky health behaviors in adolescence. Delay discounting, or the propensity to discount the magnitude of temporally distal rewards, has been associated with diverse health risk behaviors, including risky sex. This cognitive process involves recruitment of reward and cognitive control brain regions, which develop on different trajectories in adolescence and are also implicated in real-world risky decision making. However, no extant research has examined how neural activation during delay discounting is associated with adolescents' risky sexual behavior. Purpose: To determine whether a relationship exists between adolescents' risky sexual behavior and neural activation during delay discounting. Methods: Adolescent participants completed a delay discounting paradigm during functional magnetic resonance imaging (fMRI) scanning, and they reported risky sexual behavior at baseline, 3-, 6-, 9-, and 12-month follow-up time points. Latent growth curve models were employed to determine relationships between brain activation during delay discounting and change in risky sexual behavior over time. Results: Greater activation in brain regions associated with reward and cognitive control (caudate, putamen, nucleus accumbens, anterior cingulate, insula, orbitofrontal cortex, inferior frontal gyrus, dorsolateral prefrontal cortex) during delay discounting was associated with lower mean levels of risky sexual behavior but greater growth over the period from baseline to 6 months. Conclusions: Neural activation during delay discounting is cross-sectionally and prospectively associated with risky sexual behavior in adolescence, highlighting a neural basis of risky decision-making as well as opportunities for early identification and intervention.

Body mass index, diet, and exercise: testing possible linkages to breast cancer risk via DNA methylation.

PURPOSE: To examine DNA methylation as a mechanism linking diet, physical activity, weight status, and breast cancer risk. METHODS: Insufficiently active women of varying weight status, without a history of cancer, completed a maximal exercise test, clinical measurement of height and weight, and a dietary intake measure. They also provided blood samples, which were analyzed to ascertain average methylation of candidate genes related to breast cancer (BRCA1, RUNX3, GALNT9, and PAX6) and inflammation (TLR4 and TLR6). RESULTS: Elevated weight status (r = - .18, p < .05) and poorer aerobic fitness (r = .24, p < .01) were each associated with decreased methylation of inflammation genes. Methylation of inflammation genes statistically mediated the relationship between weight status and cancer gene methylation (standardized indirect effect = .12, p < .05) as well as between cardiorespiratory fitness and cancer gene methylation (standardized indirect effect = - .172, p < .01). However, recent dietary behavior was not associated with methylation of either inflammation or cancer genes. CONCLUSIONS: Both weight status and cardiovascular fitness are associated with methylation of genes associated with both inflammation and cancer. Methylation of inflammatory genes might serve as a mechanistic link between lifestyle factors and methylation changes in genes that increase risk for breast cancer.

Body mass is positively associated with neural response to sweet taste, but not alcohol, among drinkers.

Obesity is a large and growing public health concern, presenting enormous economic and health costs to individuals and society. A burgeoning literature demonstrates that overweight and obese individuals display different neural processing of rewarding stimuli, including caloric substances, as compared to healthy weight individuals. However, much extant research on the neurobiology of obesity has focused on addiction models, without highlighting potentially separable neural underpinnings of caloric intake versus substance use. The present research explores these differences by examining neural response to alcoholic beverages and a sweet non-alcoholic beverage, among a sample of individuals with varying weight status and patterns of alcohol use and misuse. Participants received tastes of a sweet beverage (litchi juice) and alcoholic beverages during fMRI scanning. When controlling for alcohol use, elevated weight status was associated with increased activation in response to sweet taste in regions including the cingulate cortex, hippocampus, precuneus, and fusiform gyrus. However, weight status was not associated with neural response to alcoholic beverages.

Monetary Incentive Interventions Can Enhance Psychological Factors Related to Fruit and Vegetable Consumption.

BACKGROUND: Incentive interventions have gained popularity to motivate health behavior change, but some psychological theorists caution that they may have deleterious effects on factors that potentiate behavior maintenance. Importantly, no empirical study has tested whether incentives indeed have iatrogenic effects on key psychological constructs associated with health behavior change and maintenance. PURPOSE: The study aims to explore the effects of monetary incentives on theoretically informed psychological constructs and fruit and vegetable consumption. METHODS: Individuals reporting insufficient fruit and vegetable consumption were randomly assigned to receive either daily monetary incentives, delayed monetary incentives, or no incentives for their fruit and vegetable consumption during a 3-week intervention period. Behavior engagement and psychological factors were measured at baseline, at the end of the intervention, and 2 weeks following the cessation of the intervention. RESULTS: Participants in the daily incentive condition demonstrated the greatest increase in self-reported consumption during the intervention and at the follow-up. Moreover, increases in consumption during the intervention period were associated with increases in attitudes and self-efficacy, which, in turn, predicted behavior maintenance at follow-up. Intrinsic motivation to consume fruits and vegetables increased over time across the entire sample but did not differ between groups. CONCLUSIONS: Monetary incentives can alter health behavior engagement without decreasing intrinsic motivation or other relevant cognitive and motivational constructs. Further, although incentives may serve as a vehicle to initiate behavior change, increased experience with the behavior may then lead to enhancements in key psychological constructs that serve as mechanisms to potentiate behavior maintenance following the cessation of incentives. TRIAL REGISTRATION NUMBER: The trial was registered with the ClinicalTrials.gov database (NCT02594319) https://www.clinicaltrials.gov/ct2/show/NCT02594319 .

Moving beyond the trait conceptualization of self-esteem: the prospective effect of impulsiveness, coping, and risky behavior engagement.

Past research has largely focused on examining self-esteem as an independent as opposed to a dependent variable. At the same time, research suggests that during adolescence, self-esteem is subject to yearly, monthly, as well as daily change, and consequently, it is important to identify underlying vulnerability factors and behaviors, which shape self-esteem lability. In the current multi-wave, longitudinal study, 142 adolescents between the ages of 12-18 completed monthly assessments across 4 months. At the initial assessment, adolescents provided self-report data pertaining to impulsiveness, maladaptive coping, risky behavior engagement, and self-esteem. At each of the follow-up assessments, adolescents provided information about risky behavior engagement and self-esteem. Results of time-lagged, idiographic multilevel mediation analyzes indicated that risky behavior engagement mediated the relationship between impulsiveness/maladaptive coping and subsequent low self-esteem. Critically, when included in the same model, impulsiveness was significant above and beyond maladaptive coping. Additionally, the reverse model with self-esteem as the predictor and risky behavior included as the dependent variable was not significant suggesting that our effect was unidirectional. As a whole, these findings suggest that impulsive youth may engage in behaviors, which ultimately precipitate negative self-evaluations and transient declines in self-esteem.

Insecure attachment as a predictor of depressive and anxious symptomology.

BACKGROUND: Most studies have shown that insecure attachment and stress are important risk factors in the development of depression and anxiety. However, it is unclear whether distinct patterns of insecure attachment may relate differently to depression and anxiety following stressful events. Thus, the current study examined whether anxious and avoidant attachment, both of which are operationalized as insecure attachment, predict depressive and anxious symptoms following the occurrence of hassles. METHOD: A sample of 662 Chinese university students was recruited from Hunan, China. At the initial assessment, participants completed self-report measures assessing insecure attachment (i.e. anxious and avoidant attachment), hassles, anxious symptoms, and depressive symptoms. Additionally, hassles and symptoms of anxiety and depression were assessed once a month for the subsequent 6 months. RESULTS: The results of hierarchical linear modeling analyses indicated a significant interaction between anxious attachment and hassles in predicting follow-up depressive symptoms. Specifically, participants with high levels of anxious, but not avoidant, attachment reported high levels of depressive symptoms when experiencing high, as opposed to low, levels of hassles. At the same time, while both anxious and avoidant attachment predicted higher levels of anxious symptoms over time, a cross-level, significant interaction did not emerge. CONCLUSIONS: Insecure attachment styles serve as a vulnerability factor in the development of depressive and anxious symptoms in Chinese young adults. Consequently, fostering the development of secure attachment in prevention and intervention programs may, ultimately, prevent the onset and maintenance of depressive and anxious disorders.