The role of perceived negative partner behavior in daily snacking behavior: A dynamical systems approach.

Past work suggested that psychological stress, especially in the context of relationship stress, is associated with increased consumption of energy-dense food and when maintained for long periods of time, leads to adverse health consequences. Furthermore, this association is moderated by a variety of factors, including emotional over-eating style. That being said, few work utilized a dynamical system approach to understand the intraindividual and interindividual fluctuations within this process. The current study utilized a 14-day daily diary study, collected between January-March 2020, where participants reported their partner's negative relationship behavior and their own snacking behavior. A differential equation model was applied to the daily dairy data collected. Results showed that snacking behavior followed an undamped oscillator model while negative relationship behavior followed a damped coupled oscillator model. In other words, snacking behavior fluctuated around an equilibrium but was not coupled within dyadic partners. Negative relationship behavior fluctuated around an equilibrium and was amplified over time, coupled within dyadic partners. Furthermore, we found a two-fold association between negative relationship behavior and snacking: while the association between the displacement of negative relationship behavior and snacking was negative, change in negative relationship behavior and snacking were aligned. Thus, at any given time, one's snacking depends both on the amount of negative relationship behaviors one perceives and the dynamical state a dyad is engaging in (i.e., whether the negative relationship behavior is "exacerbating" or "resolving"). This former association was moderated by emotional over-eating style and the latter association was not. The current findings highlight the importance of examining dynamics within dyadic system and offers empirical and methodological insights for research in adult relationships.

Utilising online paradigms to explore the effect of boredom and sadness on children's snack choice: The role of parental feeding practices and child temperament.

Emotional eating (EE) is defined as eating in response to negative emotions (e.g., sadness and boredom). Child temperament and parental feeding practices are predictive of child EE and may interact to shape child EE. Previous research has demonstrated that children eat more when they are experiencing sadness, however, boredom-EE (despite how common boredom is in children) has yet to be explored experimentally using remote methodologies. The current study explores whether feeding practices and child temperament interact with mood to predict children's snack selection in an online hypothetical food choice task. Using online experimental methods, children aged 6-9-years (N = 347) were randomised to watch a mood-inducing video clip (control, sadness, or boredom). Children completed a hypothetical food choice task from images of four snacks in varying portion sizes. The kilocalories in children's online snack choices were measured. Parents reported their feeding practices and child's temperament. Results indicated that the online paradigm successfully induced feelings of boredom and sadness, but these induced feelings of boredom and sadness did not significantly shape children's online food selection. Parental reports of use of restriction for health reasons (F = 8.64, p = .004, n2 = 0.25) and children's negative emotionality (F = 6.81, p = .009, n2 = 0.020) were significantly related to greater total kilocalorie selection by children. Three-way ANCOVAs found no evidence of any three-way interactions between temperament, feeding practices, and mood in predicting children's online snack food selection. These findings suggest that children's hypothetical snack food selection may be shaped by non-responsive feeding practices and child temperament. This study's findings also highlight different methods that can be successfully used to stimulate emotional experiences in children by using novel online paradigms, and also discusses the challenges around using online methods to measure children's intended food choice.

The effects of acute social ostracism on subsequent snacking behavior and future body mass index in children.

BACKGROUND/OBJECTIVES: Ostracism may lead to increased food intake, yet it is unclear whether greater reactivity to ostracism contributes to higher body mass index (BMI). We investigated whether children who exhibited greater stress to social exclusion subsequently consume more energy and whether this predicts BMI 6- and 18-months later. SUBJECTS/METHODS: Children (8.5 years-old) (N = 262, males = 50.4%; Chinese = 58.4%) completed a laboratory-based manipulation of social exclusion (the Cyberball task) prior to an ad-libitum snack. Heart rate variability (HRV) was measured during the inclusion and exclusion conditions and proportionate changes were calculated as a physiological measure of exclusion-related stress. Social anxiety and social-emotional assets were also measured as moderators. RESULTS: Greater stress (as measured physiologically or by self-report) did not directly, or indirectly via energy intake, predict later BMI (at 9- and 10-years). However, among children reporting higher social anxiety, greater stress as measured by proportionate changes in HRV was associated with increased energy intake (B = 532.88, SE = 226.49, t(255) = 2.35, [CI95 = 86.85,978.92]). A significant moderated mediation was also observed (index: (b = 0.01, bootSE = 0.01, [CI95 = 0.001, 0.036]), such that among children reporting higher social anxiety, greater stress from social exclusion predicted increased energy intake from a subsequent snack, which in turn predicted higher BMI 1.5 years later. CONCLUSION: This prospective study suggests that a pattern of greater snack intake in response to heightened vulnerability to the effects of ostracism may contribute to increases in child BMI scores.

Do British and Chinese adolescents snack for different reasons? A cross-country study using the Theory of Planned Behaviour and eating styles.

Snacking is prevalent in adolescents and can have significant health impacts, but there is considerable individual and cross-country variation in determinants on adolescent snacking. The present study examined the role of eating styles (i.e. restrained eating, emotional eating, external eating, mindful eating) and the constructs of an extended Theory of Planned Behaviour (TPB) (i.e. attitudes, subjective norms, perceived behavioural control, habit strength) in predicting adolescent snacking, and the moderating effects of country. A survey was completed by adolescents aged 16-19 years from China (N = 182; mean age = 16.13, SD = 0.87) and England (N = 96; mean age = 17.04, SD = 0.74). Compared to British adolescents, Chinese adolescents showed higher restrained eating (p = .009), lower external eating (p = .004), less positive attitudes (p < .001) and subjective norms (p = .007) to, and less strong habit strength (p = .005) for unhealthy snacking. Mindful eating significantly predicted lower consumption of unhealthy snacks (p = .008) and beverages (p = .001), while restrained eating predicted higher consumption of fruit (p < .001) and vegetables (p < .001), regardless of country. Country showed significant moderating effects of TPB constructs on unhealthy beverages (p = .008) and fruit (p < .001) consumption, and effects on unhealthy snack (p = .023) and vegetable (p = .015) consumption approaching significance. Subjective norms predicted unhealthy snacking frequency regardless of country (p = .001). Habit strength predicted consumption of beverages (p < .001) and fruit (p < .001) only in English adolescents. Mindful eating may be a positive intervention approach to help reduce adolescent unhealthy snacking. TPB-based snacking interventions should carefully consider the country context. Acknowledging country-specific determinants of snacking are recommended.

Music as an alternative self-regulation strategy to snack foods following a negative mood induction in 5-7-year-old children: Interactions with parental use of food as a reward.

This study aimed to extend studies that have looked at snack food consumption following a negative mood induction, and examine whether listening to a happy song would counteract these effects in children. A second aim was to examine whether parental feeding practices (use of food as a reward and the use of food to regulate emotions) and child Body Mass Index (BMI) would moderate any differences. Eighty 5-7-year-old children took part in a negative mood induction and were then assigned to either a happy music condition or a silent control condition. The weight (g) consumed of four snack foods was measured (fruit hearts, crisps, chocolate biscuits, and breadsticks). Parents filled in baseline measures of feeding practices. There were no significant differences in food consumption between conditions. There was, however, a significant interaction between the high use of food as a reward and the condition on the amount of food eaten. In particular, following a negative -mood induction, those children whose parents reported using food as a reward and who were in the silent condition ate significantly more snack foods. There were no significant interactions with child BMI or with parental use of food to regulate emotions. This research suggests that the use of certain parental strategies may influence how children respond to novel emotion regulation techniques. Further research is needed to evaluate the best types of music to regulate emotions in children, and whether parents can be encouraged to replace maladaptive feeding practices with more adaptive non-food practices.

Snacking for a reason: detangling effects of socio-economic position and stress on snacking behaviour.

BACKGROUND: As snacking can be considered a cornerstone of an unhealthy diet, investigating psychological drivers of snacking behaviour is urgent, and therefore the purpose of this study. Socio-economic position (SEP) and stress are known to affect many behaviours and outcomes, and were therefore focal points in the study. METHODS: In a cross-sectional survey study, we examined whether Socio-economic position (SEP) would amplify associations between heightened stress levels and self-reported negative-affect related reasons for snacking. Next, we investigated whether Socio-economic position (SEP) predicted frequency of snacking behaviour, and how stress and other reasons for snacking could explain this association. Outcome measures were reasons people indicated for snacking, and frequency of snacking behaviour. RESULTS: Analyses revealed that people seem to find more reasons to snack when they are stressed, and that this association was more pronounced for people with a high compared to low socio-economic position. Furthermore, a higher socio-economic position was associated with a higher frequency of snacking, and both snacking to reward oneself and snacking because of the opportunity to do so remained significant mediators. CONCLUSION: Whereas low socio-economic position was associated with higher stress levels, this did not translate into increased snacking. Contrarily, those with higher socio-economic position could be more prone to using 'reasons to snack', which may result in justification of unhealthy snacking behaviour.

Exploring acute and non-specific effects of mobile app-based response inhibition training on food evaluation and intake.

Previous studies have demonstrated that response inhibition training can modify the appeal of palatable and energy-dense foods, thus serving as a potential intervention for weight management, via changes in food selection and intake. However, empirical findings of efficacy have been inconsistent across studies due to heterogenous approaches to measuring salient appetitive outcomes, training implementation strategies, and sample recruitment. Systematic assessment of both affective and motivational components of food reward may help characterise to what extent devaluation can be generalised to nutritionally similar foods post-training. In this mixed factorial experiment, a non-clinical, adult sample completed time-matched single sessions with mobile app-based response inhibition training and control tasks of short (12 min; n = 27) or long (20 min; n = 25) duration. Participants were assessed on two discrete facets of food reward pre- and post-training: pleasure (i.e., explicit liking) and desire (i.e., implicit wanting) for non-specific (i.e., novel) food stimuli differing in energy-density. Consumption of snacks categorised by energy density was also assessed in a laboratory ad libitum taste test post-training. No significant differences were found between intervention and control sessions on explicit liking or implicit wanting for non-specific energy-dense foods. Moreover, participants ate a similar volume of snack foods during both sessions. Training duration did not significantly moderate differences between intervention and control sessions in primary outcomes. Variance between intervention and control sessions in chocolate intake and frequency of choice for energy-dense foods, but not explicit liking, was associated with a higher BMI. Methodological and theoretical implications for appropriate intervention implementation and underlying mechanisms, respectively, are discussed.

Factors That Influence Snacking Behaviors of Adolescents From Urban Communities: A Qualitative Study.

OBJECTIVE: To qualitatively explore factors that influence snacking behaviors of adolescents from urban communities. DESIGN: One-time, semistructured phone interviews based on Social Cognitive Theory. SETTING: Boys and Girls Club in New York City. PARTICIPANTS: A total of 30 adolescents (aged 12-18 years; mean age 15.2 years, mostly female [57%], and Black or African American [83%]) were purposively recruited. This sample is representative of adolescent members at this Boys and Girls Club in New York City. PHENOMENON OF INTEREST: Adolescents were asked about personal, environmental, and behavioral factors influencing snacking. ANALYSIS: Interviews were audio-recorded, transcribed, and transcripts were analyzed using the thematic analysis approach in NVivo (version 12). RESULTS: In terms of personal factors, adolescents' snacking was influenced by preference (eg, taste and brand), health benefits, and health concerns. Regarding the social environment, adolescents remarked that snacking with peers promoted unhealthy snacking, while snacking, with family promoted healthier snacking. The family culture was also a salient factor. In addition, adolescents discussed how proximity to corner stores in their physical environment fostered unhealthy snacking. Finally, behavioral factors that influenced frequent snacking were high self-efficacy and food autonomy. CONCLUSIONS AND IMPLICATIONS: Snacking among adolescents from urban communities is influenced by preference, health, family/peer influence, neighborhood availability/access, and high autonomy. These factors can be targeted in interventions to improve snacking among this demographic.

The relative reinforcing value of snack food is a significant predictor of fat loss in women with overweight or obesity.

Reinforcing Relative Value (RRV) of food and impulsivity are associated with energy intake and obesity. This study investigated the degree to which changes in RRV and impulsivity independently or interactively predict changes in body weight and composition in women with overweight or obesity engaged in either fast or slow weight loss programs. Body weight, body composition, impulsivity (Barratt Impulsiveness Scale), and RRV snack (computerized Behavioural Choice Task) were measured at baseline and post-intervention in 30 women with obesity undergoing either slow (n = 14, -500 kcal/day, 20 weeks) or fast (n = 16, -1000 kcal/day, 10 weeks) weight reduction. No group × time effects were noted on body composition, impulsivity, or RRV, so participants from both groups were pooled for analysis. Multiple regression analyses indicated that none of the impulsivity variables predicted weight or fat mass (FM) loss. However, ΔRRV snack predicted ΔFM (r = 0.40, p = 0.046), whereby greater increases in RRV snack were associated with less FM loss. The results indicate that different rates of weight loss do not differentially affect RRV snack or impulsivity traits. However, changes in RRV snack predicted FM loss, suggesting that dietary interventions that either mitigate increases or foster reductions in the RRV snack may yield greater reductions in adiposity. Trial Registration clinicaltrials.gov identifier: NCT04866875. Novelty: No differences in RRV of food were noted between fast and slow weight loss. Weight loss from combined fast and slow groups led to a moderate-sized reduction in total impulsivity. Greater diet-induced increases in RRV snacks were associated with less body fat loss.

Development and Preliminary Feasibility of iByte4Health: A Mobile Health (mHealth) Pediatric Obesity Prevention Intervention to Engage Parents with Low-Income of Children 2-9 Years.

This research describes the development and preliminary feasibility of iByte4Health, a mobile health (mHealth) obesity prevention intervention designed for parents with a low-income of children 2-9 years of age. Study 1 (n = 36) presents findings from formative work used to develop the program. Study 2 (n = 23) presents a 2-week proof-of-concept feasibility testing of iByte4Health, including participant acceptability, utilization, and engagement. Based on Study 1, iByte4Health was designed as a text-messaging program, targeting barriers and challenges identified by parents of young children for six key obesity prevention behaviors: (1) snacking; (2) physical activity; (3) sleep; (4) sugary drinks; (5) fruit and vegetable intake; and (6) healthy cooking at home. In Study 2, participants demonstrated high program retention (95.7% at follow-up) and acceptability (90.9% reported liking or loving the program). Users were engaged with the program; 87.0% responded to at least one self-monitoring text message; 90.9% found the videos and linked content to be helpful or extremely helpful; 86.4% found text messages helpful or extremely helpful. iByte4Health is a community-informed, evidenced-based program that holds promise for obesity prevention efforts, especially for those families at the increased risk of obesity and related disparities. Future work is warranted to test the efficacy of the program.

Snack Food Consumption across the Pune Transect in India: A Comparison of Dietary Behaviors Based on Consumer Characteristics and Locations.

This study examines patterns of snack food consumption (SFC) in the rural-urban-slum transect (RUST) of a large city Pune and its precincts (population 10 million) in India. The transect structure aims to mimic a representative survey for the location capturing differences by age, gender, urbanicity, and socio-economic levels. Dietary data from 1405 individuals were used to describe snacking patterns and other food consumed at different frequencies; extent of physical activity; and Body Mass Index (BMI) and waist circumference of children, adolescents, and adults. Our results indicate high incidence of SFC across all population age groups, gender, socio-economic levels, and locations. A distinctive finding in relation to studies in high income countries is the prevalence of hunger snacking with 70% identifying hunger as the primary reason for SFC. Apart from hunger, particularly for adolescents, peer influence and social interactions played a significant role in SFC. Dietary behaviors of slum dwellers were characterized by three-quarters of them having SFC together with family members at home. SFC supplemented calories for low-income consumers and complemented calorie intake for high income ones. No significant association with BMI is possibly due to obesogenic SFC being likely offset by lower consumption of non-snack food and higher physical activity among poor and slum dwellers. Promoting awareness about diets and lifestyles, improving physical and economic access to healthier snacks and nutrient dense foods can improve diet quality in a large and heterogeneous population such as Pune.

Association between Emotional Eating and Frequency of Unhealthy Food Consumption among Taiwanese Adolescents.

Emotional eating is one factor that increases the consumption of unhealthy food. This study aimed to investigate the association between emotional eating and frequencies of consuming fast food, high-fat snacks, processed meat products, dessert foods, and sugar-sweetened beverages (SSBs) in adolescents. The baseline survey data (2015) from the Taiwan Adolescent to Adult Longitudinal Study (TAALS) were fitted into multivariate logistic regression models adjusted for sex, school type, Body Mass Index (BMI), eating while doing something, nutrition label reading, skipping breakfast, smoking, binge drinking, sedentary lifestyle, physical activity, peer and school support, and parental education level. Among the 18,461 participants (48.5% male and 51.5% female), those exhibiting emotional eating were more likely to consume fast food (Odds ratio (OR) = 2.40, 95% Confidence interval (CI): 2.18-2.64), high-fat snacks (OR = 2.30, 95% CI: 2.12-2.49), processed meat products (OR = 1.92, 95% CI: 1.78-2.08), dessert foods (OR = 2.49, 95% CI: 2.31-2.69), and sugar-sweetened beverages (OR = 1.83, 95% CI: 1.70-1.98). Factors that were positively associated with unhealthy food consumption included eating while doing other activities, binge drinking, smoking, and sedentary lifestyle. Among all the covariates, nutrition label reading was the only factor that was inversely associated with frequent unhealthy food consumption. Sex and school type may moderate the effect of emotional eating on the frequent consumption of specific unhealthy food groups. In conclusion, adolescents with high emotional eating were more likely to report frequent consumption of unhealthy foods in Taiwan. Our findings showed that male participants appeared to consume fast foods, high-fat snacks, processed meat, and SSBs more often and dessert foods less often than females. Future longitudinal studies are recommended for understanding the causal relationship between emotional eating and unhealthy food consumption.

Fat and Carbohydrate Interact to Potentiate Food Reward in Healthy Weight but Not in Overweight or Obesity.

Prior work suggests that actual, but not estimated, energy density drives the reinforcing value of food and that energy from fat and carbohydrate can interact to potentiate reward. Here we sought to replicate these findings in an American sample and to determine if the effects are influenced by body mass index (BMI). Thirty participants with healthy weight (HW; BMI 21.92 ± 1.77; M ± SD) and 30 participants with overweight/obesity (OW/OB; BMI 29.42 ± 4.44) rated pictures of common American snacks in 120-kcal portions for liking, familiarity, frequency of consumption, expected satiety, healthiness, energy content, energy density, and price. Participants then completed an auction task where they bid for the opportunity to consume each food. Snacks contained either primarily carbohydrate, primarily fat, or roughly equal portions of fat and carbohydrate (combo). Replicating prior work, we found that participants with HW bid the most for combo foods in linear mixed model analyses. This effect was not observed among individuals with OW/OB. Additionally, in contrast with previous reports, our linear regression analyses revealed a negative relationship between the actual energy density of the snacks and bid amount that was mediated by food price. Our findings support altered macronutrient reinforcement in obesity and highlight potential influences of the food environment on the regulation of food reward.

Exploring the effects of daily hassles and uplifts on eating behaviour in young adults: The role of daily cortisol levels.

Existing stress-eating research has shown that daily hassles are associated with increases in food intake and that cortisol reactivity to stress has been found to influence the stress-eating relationship. However, the moderating effects of daily cortisol levels (e.g., the cortisol awakening response, CAR) remain unknown. Moreover, recent evidence has shown that daily uplifts, as well as daily hassles, are important in understanding daily influences on eating behaviour. Therefore, in the same study, the current investigation explored the effects of daily hassles and uplifts on eating behaviour and whether these relationships were moderated by mean daily cortisol levels in young female adults. Forty-nine female participants (M age: 19.13 years) recorded the daily hassles and uplifts that they experienced over a 4-day period, together with the between-meal snacks they consumed each day, using an online daily diary. Cortisol samples were provided daily immediately upon waking, at +30 min and +12 h. Mean CAR and mean cortisol levels were calculated across the 4 days. Using multi-level modeling, daily hassles and uplifts were both significantly associated with greater unhealthy snacking. Daily uplifts, but not daily hassles, were also associated with lower healthy snack intake. Higher levels of mean CAR were associated with lower daily healthy snack intake. Moreover, the effects of daily uplifts on healthy snacking were found to be moderated by mean daily cortisol levels, such that participants with the highest levels of mean cortisol consumed less healthy snacks on days when they experienced uplifts. The current study provides novel evidence that mean daily cortisol levels, as well as daily hassles and uplifts, are implicated in daily snack consumption in young female adults. The role of hypothalamic-pituitary adrenal axis activity should be explored further in the context of the daily hassles/uplifts and eating behaviours relationship, in men and in individuals from lower socio-economic status and minority groups.

When Pet Snacks Look Like Children's Toys! The Potential Role of Pet Snacks in Transmission of Bacterial Zoonotic Pathogens in the Household.

Recent foodborne pathogen outbreaks associated with dry pet food and treats have focused the attention on these products as vehicles of pathogens for both pets and their owners. This study investigates the purchasing habits of dog owners and determines if and in what form pet snacks can be potentially dangerous for humans, especially for children. For these purposes, questionnaires collected from 406 dog owners were evaluated and microbiological analyses were performed on 120 dry pet snacks. The shape of the pet snack affects the purchase (median score, Mdn = 6.4) and the star bone was the preferred one (Mdn = 7.1). Most of the participants (76.0%; p < 0.001) stated that snacks are attractive to their children and that the possibility for children to get in contact with pet snacks is rare, but not implausible (Mdn = 3.1). Indeed, more than 6% of respondents admitted that there had been incidents of involuntary ingestion of pet snacks, with fever and gastrointestinal manifestations. Microbiological analyses showed that 119 dry pet snacks analyzed of a total of 120 (99.2%) were in good sanitary condition except for one sample where the presence of Listeria ivanovii was confirmed. The upward trend in the presence of pets in households and the strong and continuous growth in value and volume of the pet food market led researchers to analyze possible public health issues. Children and infants in particular are the most exposed subjects as they are more likely to come into contact with pet snacks, attracted by a shape similar to that of a toy. For this reason, although our findings did not highlight important microbiological contamination of pet snacks, it would be useful to standardize food safety criteria with those for human food from a One Health perspective.

Exploring Patterns of Disturbed Eating in Psychosis: A Scoping Review.

Disturbed eating behaviours have been widely reported in psychotic disorders since the early 19th century. There is also evidence that antipsychotic (AP) treatment may induce binge eating or other related compulsive eating behaviours. It is therefore possible that abnormal eating patterns may contribute to the significant weight gain and other metabolic disturbances observed in patients with psychosis. In this scoping review, we aimed to explore the underlying psychopathological and neurobiological mechanisms of disrupted eating behaviours in psychosis spectrum disorders and the role of APs in this relationship. A systematic search identified 35 studies that met our eligibility criteria and were included in our qualitative synthesis. Synthesizing evidence from self-report questionnaires and food surveys, we found that patients with psychosis exhibit increased appetite and craving for fatty food, as well as increased caloric intake and snacking, which may be associated with increased disinhibition. Limited evidence from neuroimaging studies suggested that AP-naïve first episode patients exhibit similar neural processing of food to healthy controls, while chronic AP exposure may lead to decreased activity in satiety areas and increased activity in areas associated with reward anticipation. Overall, this review supports the notion that AP use can lead to disturbed eating patterns in patients, which may contribute to AP-induced weight gain. However, intrinsic illness-related effects on eating behaviors remain less well elucidated, and many confounding factors as well as variability in study designs limits interpretation of existing literature in this field and precludes firm conclusions from being made.

Can Healthy Checkout Counters Improve Food Purchases? Two Real-Life Experiments in Dutch Supermarkets.

Most snacks displayed at supermarket checkouts do not contribute to a healthy diet. We investigated the effects of introducing healthier snack alternatives at checkouts in supermarkets on purchasing behavior. In Study 1, we investigated the effect of completely substituting less healthy with healthier snacks (one supermarket). In Study 2, we investigated the effect of placing and discounting healthier snacks while the less healthy snacks remain in place (two supermarkets). In both studies, the number of purchased snacks (per 1000 customers) was used as the outcome variable. Results for Study 1 showed that the absolute number of purchased checkout snacks was 2.4 times lower (95% confidence interval (CI): 1.9-2.7) when healthier snacks instead of less healthy snacks were placed at the supermarket checkouts. Results for Study 2 showed that when additional healthier snacks were placed near the checkouts, the absolute number of healthier purchased snacks increased by a factor of 2.1 (95% CI: 1.3-3.3). When additional healthier snacks were placed near the checkouts and discounted, the absolute number of healthier purchased snacks increased by a factor of 2.7 (95% CI: 2.0-3.6), although this was not statistically significant higher than placement only (ratio: 1.1, 95% CI: 0.7-1.9). Purchases of less healthy snacks did not decline, and even slightly increased, during the intervention period (ratio: 1.3, 95% CI: 1.1-1.5). If supermarkets want to promote healthier snack purchases, additional healthier products can be positioned near the checkouts. However, this does not discourages the purchase of less healthy snacks. Therefore, to discourage unhealthy snack purchases at supermarket checkouts, a total substitution of less healthy snacks with healthier alternatives is most effective.

A Health Game Targeting Children's Implicit Attitudes and Snack Choices.

Objective: The present study investigated whether a health game can be used to affect children's implicit attitudes toward food (IAsTF) and subsequent snack choices. Materials and Methods: The health game used was based on an evaluative conditioning paradigm. The experiment followed a between-subjects design with two conditions (health game vs. control), N = 79 (12.42 years ±1.64, body mass index: 25.06 ± 7.40). IAsTF were assessed at baseline and postintervention using an implicit association test (IAT). Baseline IAT scores were used to categorize IAsTF as healthy (favoring fruits) versus unhealthy IAsTF (favoring chocolates). In addition, three digital snack choices were recorded. Results: No main effect of condition on posttest IAsTF was found. However, baseline IAsTF moderated the effect of condition on posttest IAsTF; participants with less healthy baseline IAsTF playing the health game had healthier posttest IAsTF compared to those playing the control game. Regarding the snack choices, participants playing the health game favored fruit over chocolate in one of the snack choices. Baseline IAsTF did not moderate the effect of condition on snack choices. Conclusion: Tentative support was found that health games can be used to improve IAsTF, in particular among participants with less healthy ones at baseline.

Prompting consumers to make healthier food choices in hospitals: a cluster randomised controlled trial.

BACKGROUND: Hospitals in the UK offer snacks for sale to patients, staff and visitors. Despite the NHS's health promoting role, and tightening of regulations around which foods can be sold in hospitals, many snacks purchased in this setting are unhealthy. The present project tests the effectiveness of theory-based point of purchase prompts (PPPs; a form of cognitive nudge) designed to make it cognitively easier for consumers to compare available products and choose healthier options. METHODS: Hospital shops in Scotland (n = 30) were recruited into a cluster randomised controlled trial to test whether a PPP could reduce the average calorie, fat and/or sugar content of purchased snacks. Inclusion criteria stated that eligible sites; sold food; were located in a hospital; and were accessible to staff, patients and visitors. The PPP intervention was a theory-based sign (tailored to the available range in each location) designed to cognitively simplify healthier snack choices by facilitating cross-product comparison. Shops were randomised to display PPPs (intervention; n = 15) or not (control; n = 15) using block randomisation controlling for shop size. Data on all snacks purchased from participating shops were obtained from retailers for a 12-week baseline and 12-week follow-up period. Primary outcomes were the average calorie (kcals), fat(g) and sugar(g) content of snacks purchased each day. Secondary outcomes were the average customer spend per item purchased (£,p) and the total number of snacks purchased daily. Shop staff were not blinded to group assignment but data providers were. Data were analysed using mixed effects multi-level regression models. RESULTS: Data from > 1 million snack purchases were analysed. Snacks purchased from intervention sites were on average significantly lower in calorie (γ = - 1.84, p < .001) and sugar (γ = - 0.18, p = .030) at follow up relative to baseline but only the reduction in calories was significantly different to control. Average spend per item also reduced significantly in intervention (but not control) sites (γ = - 0.89, p < .001). The intervention had no effect on the fat content of snacks or the number of snacks sold. CONCLUSIONS: Simple, theory-based point of purchase prompts can produce small but statistically significant reductions in the energy content of snack purchases from hospital shops. TRIAL REGISTRATION: Retrospectively registered (8/Oct/2018) with ISRCTN (ID: ISRCTN90365793 ).