Evaluation of a behavior-centered design strategy for creating demand for oral PrEP among young women in Cape Town, South Africa.

BACKGROUND: There is an urgent need to find effective interventions that reduce young South African women's vulnerability to HIV, and pre-exposure prophylaxis (PrEP) is highly effective when taken consistently. As national programs in Africa launch PrEP programs for young women, it is critical to understand how to effectively create awareness, stimulate interest, and increase uptake of PrEP. METHODS: Behavior-centered design (BCD) guided the development of a PrEP social marketing campaign for young women. Ethnographic observations, in-depth interviews, and focus-group discussions with young South African women informed the content and design of a 90-second PrEP demand creation video and two informational brochures. A short survey was administered to young women at their homes after watching a video to evaluate PrEP interest. Of 800 households with a 16-25-year-old female identified from a Cape Town township census, 320 women in these households viewed the video and completed a survey about the video and their interest in PrEP. RESULTS: In focus groups, young women from the township preferred local characters and messaging that was empowering, simple, and motivational. From the household survey of young women who viewed the video, most reported interest in learning more about PrEP (67.7% 'definitely interested' and 9.4% 'somewhat interested') and taking PrEP (56.4% 'definitely interested' and 12.5% 'somewhat interested'). Factors significantly associated with interest in taking PrEP were having a primary partner with whom they regularly have sex (80.0% vs. 65.2% without a primary partner; adjusted odds ratio (AOR)=3.1, 95% CI: 1.3, 7.0) and being in a sexual partnership for <6 months (86.8% vs. 68.5% for >12 months; AOR=3.0, 95% CI: 1.2, 7.3). CONCLUSIONS: A positively framed PrEP demand creation video generated high interest in PrEP among young South African women, particularly among women with a primary partner and a shorter-term relationship. Registration: NCT03142256; registered on 5 May 2017.

Education, job position, income or multidimensional indices? Associations between different socioeconomic status indicators and chronic low back pain in a German sample: a longitudinal field study.

OBJECTIVE: To investigate associations between socioeconomic status (SES) indicators (education, job position, income, multidimensional index) and the genesis of chronic low back pain (CLBP). DESIGN: Longitudinal field study (baseline and 6-month follow-up). SETTING: Four medical clinics across Germany. PARTICIPANTS: 352 people were included according to the following criteria: (1) between 18 and 65 years of age, (2) intermittent pain and (3) an understanding of the study and the ability to answer a questionnaire without help. Exclusion criteria were: (1) pregnancy, (2) inability to stand upright, (3) inability to give sick leave information, (4) signs of serious spinal pathology, (5) acute pain in the past 7 days or (6) an incomplete SES indicators questionnaire. OUTCOME MEASURES: Subjective intensity and disability of CLBP. RESULTS: Analysis showed that job position was the best single predictor of CLBP intensity, followed by a multidimensional index. Education and income had no significant association with intensity. Subjective disability was best predicted by job position, succeeded by the multidimensional index and education, while income again had no significant association. CONCLUSION: The results showed that SES indicators have different strong associations with the genesis of CLBP and should therefore not be used interchangeably. Job position was found to be the single most important indicator. These results could be helpful in the planning of back pain care programmes, but in general, more research on the relationship between SES and health outcomes is needed.

The choice that matters: the relative influence of socioeconomic status indicators on chronic back pain- a longitudinal study.

BACKGROUND: In health research, indicators of socioeconomic status (SES) are often used interchangeably and often lack theoretical foundation. This makes it difficult to compare results from different studies and to explore the relationship between SES and health outcomes. To aid researchers in choosing appropriate indicators of SES, this article proposes and tests a theory-based selection of SES indicators using chronic back pain as a health outcome. METHODS: Strength of relationship predictions were made using Brunner & Marmot's model of 'social determinants of health'. Subsequently, a longitudinal study was conducted with 66 patients receiving in-patient treatment for chronic back pain. Sociodemographic variables, four SES indicators (education, job position, income, multidimensional index) and back pain intensity and disability were obtained at baseline. Both pain dimensions were assessed again 6 months later. Using linear regression, the predictive strength of each SES indicator on pain intensity and disability was estimated and compared to the theory based prediction. RESULTS: Chronic back pain intensity was best predicted by the multidimensional index (beta = 0.31, p < 0.05), followed by job position (beta = 0.29, p < 0.05) and education (beta = -0.29, p < 0.05); whereas, income exerted no significant influence. Back pain disability was predicted strongest by education (beta = -0.30, p < 0.05) and job position (beta = 0.29, p < 0.05). Here, multidimensional index and income had no significant influence. CONCLUSIONS: The choice of SES indicators influences predictive power on both back pain dimensions, suggesting SES predictors cannot be used interchangeably. Therefore, researchers should carefully consider prior to each study which SES indicator to use. The introduced framework can be valuable in supporting this decision because it allows for a stable prediction of SES indicator influence and their hierarchy on a specific health outcomes.

The development and validation of a Real Time Location System to reliably monitor everyday activities in natural contexts.

INTRODUCTION: The accurate measurement of behaviour is vitally important to many disciplines and practitioners of various kinds. While different methods have been used (such as observation, diaries, questionnaire), none are able to accurately monitor behaviour over the long term in the natural context of people's own lives. The aim of this work was therefore to develop and test a reliable system for unobtrusively monitoring various behaviours of multiple individuals within the same household over a period of several months. METHODS: A commercial Real Time Location System was adapted to meet these requirements and subsequently validated in three households by monitoring various bathroom behaviours. RESULTS: The results indicate that the system is robust, can monitor behaviours over the long-term in different households and can reliably distinguish between individuals. Precision rates were high and consistent. Recall rates were less consistent across households and behaviours, although recall rates improved considerably with practice at set-up of the system. The achieved precision and recall rates were comparable to the rates observed in more controlled environments using more valid methods of ground truthing. CONCLUSION: These initial findings indicate that the system is a valuable, flexible and robust system for monitoring behaviour in its natural environment that would allow new research questions to be addressed.

The pain of being misunderstood: Invalidation of pain complaints in chronic low back pain patients.

A particular form of social pain is invalidation. Therefore, this study (a) investigates whether patients with chronic low back pain experience invalidation, (b) if it has an influence on their pain, and (c) explores whether various social sources (e.g. partner and work) influence physical pain differentially. A total of 92 patients completed questionnaires, and for analysis, Pearson's correlation coefficients and hierarchical linear regression analyses were conducted. They indicated a significant association between discounting and disability due to pain (respective ß = .29, p > .05). Especially, discounting by partner was linked to higher disability ( ß = .28, p > .05).

'I ate too much so I must have been sad': Emotions as a confabulated reason for overeating.

BACKGROUND: Emotional eating (i.e., overeating in response to negative affect) is a commonly accepted explanation for eating behaviors that are not in line with personal eating-norms. However, the empirical evidence for a causal link between self-reported emotional eating and overeating is mixed. The present study tested an alternative hypothesis stating that high emotional eating scores are indicative of a susceptibility to use negative affect as a confabulated, post-hoc reason to explain overeating. METHODS: Female students (N = 46) participated in a 'taste-test' and came back to the lab a day later to receive feedback that they either ate too much (norm-violation condition) or an acceptable amount of food (control condition), whereafter emotional eating was assessed. Negative affect was measured several times throughout the study. RESULTS: In the norm-violation condition, participants with high emotional eating scores retrospectively rated their affect prior to eating as more negative than participants with low emotional eating scores. In the control condition, no effect of emotional score on affect ratings was found. DISCUSSION: For some individuals emotional eating scores may represent a tendency to retrospectively attribute overeating to negative affect. This could explain the lack of consistent findings for a link between self-reported emotional eating and overeating.

Exploring the potential of antimicrobial hand hygiene products in reducing the infectious burden in low-income countries: An integrative review.

BACKGROUND: The purpose of this review was to understand whether adding antimicrobial agents to hand hygiene products could increase the health benefits of handwashing with plain soap (HWWS) in low-income settings. METHODS: A review of experimental studies comparing the effects of HWWS with antimicrobial soap and waterless hand sanitizer on health and hand contamination in naturalistic conditions was conducted. In addition, an analysis was completed of the evidence from laboratory studies examining the factors that may affect the impact of antimicrobial soap, taking into account the conditions in low-income settings. RESULTS: The review found no evidence for a superior effect of antimicrobial products compared with HWWS on disease incidence and limited evidence for an effect on hand contamination under naturalistic conditions. An analysis of the effectiveness of antimicrobial soap in laboratory settings suggested that it was only more effective than HWWS when handwashing frequency, duration, and product concentrations were above levels that could be expected in low-income settings. CONCLUSIONS: The limited available evidence suggests that under naturalistic conditions, antimicrobial products are no more effective than HWWS in removing pathogens from hands. Without significant improvement in efficacy, antimicrobial products are unlikely to produce greater health gains than HWWS in low-income settings.

Thinking before sinning: reasoning processes in hedonic consumption.

Whereas hedonic consumption is often labeled as impulsive, findings from self-licensing research suggest that people sometimes rely on reasons to justify hedonic consumption. Although the concept of self-licensing assumes the involvement of reasoning processes, this has not been demonstrated explicitly. Two studies investigated whether people indeed rely on reasons to allow themselves a guilty pleasure. Participants were exposed to a food temptation after which passive and active reasoning was assessed by asking participants to indicate the justifications that applied to them for indulging in that temptation (Study 1) or having them construe reasons to consume the hedonic product (Study 2). Regression analyses indicated that higher levels of temptation predicted the number of reasons employed and construed to justify consumption. By providing evidence for the involvement of reasoning processes, these findings support the assumption of self-licensing theory that temptations not only exert their influence by making us more impulsive, but can also facilitate gratification by triggering deliberative reasoning processes.

"Because I am worth it": a theoretical framework and empirical review of a justification-based account of self-regulation failure.

Self-regulation failure is often explained as being overwhelmed by impulse. The present article proposes a novel pathway, presenting a theoretical framework and empirical review of a justification-based account of self-regulation failure. With justification we refer to making excuses for one's discrepant behavior, so that when experiencing a self-regulation dilemma between immediate impulses and long-term intentions, people resolve the conflict by developing and employing justifications that allow violations of the goal they endorse. Accordingly, rather than inhibiting motivations from the impulsive system, the reflective system can also facilitate them, leading to self-regulation failure. We bring together empirical evidence from various domains demonstrating that justifications can instigate self-regulation failure and rule out alternative accounts. Having established that justification processes contribute to self-regulation failure, we then propose several mechanisms that may fuel the effect. Finally, routes for future research and the conceptual and practical implications of these novel insights for self-regulation are discussed.

Good mood food. Positive emotion as a neglected trigger for food intake.

UNLABELLED: Research on emotions as a trigger for food intake has mainly been focused on the role of negative emotions. In the present studies the role of positive emotions as a trigger for food intake is investigated in a sample of healthy participants with a normal weight. Two laboratory studies were conducted in which positive emotions or no emotions were induced (Study 1) or in addition negative emotions were induced (Study 2) after which unhealthy food intake was assessed by bogus taste tests. In Study 3, food intake was assessed by registering snack intake in a 7-day diary study together with the emotions accompanying each snacking episode to provide a more ecologically valid test of our hypothesis. Studies 1 and 2 showed that positive emotions, compared to the control conditions, evoked more caloric intake. Dietary restraint did not moderate this effect. Study 2 additionally showed that positive emotions evoked caloric intake to the same extent as negative emotions. Study 3 showed that snack intake in daily life was reported to result from positive emotions more frequently than from negative emotions. CONCLUSIONS: Positive emotions serve as an important but under-investigated trigger for unhealthy food intake that deserves further scrutiny. Future research should further investigate whether food intake results from emotional arousal in general, or from emotional valence in particular.

Double trouble: restrained eaters do not eat less and feel worse.

OBJECTIVE: While high levels of dietary restraint do not appear to reflect actual caloric restraint, it has been found to be a risk factor for a wide array of maladaptive eating patterns. These findings raise the question what, if not caloric restriction, dietary restraint entails. We propose that the very finding that restrained eaters do not eat less than they intend to do can provide an answer. Based on this disparity between the intention to restrain oneself and actual behaviour, we therefore hypothesised that high levels of restraint are associated with eating-related guilt. METHOD: Three studies (N = 148) using unobtrusive measures of food intake; different restraint scales; and different measures of guilt tested whether restraint is related to eating-related guilt. RESULTS: Results indicated that restraint was not associated with food intake, but instead was associated with increased levels of guilt after eating. Guilt was explicitly related to food intake. Moreover, the observed guilt could not be attributed to a general increase in negative affect. CONCLUSION: The results of these studies suggest that restraint is not an indicator of actual restricted food intake, but rather a reflection concerns about food and eating manifested in eating-related guilt.