Bianca Sykes-Muskett

Do electronic cigarettes increase cigarette smoking in UK adolescents? Evidence from a 12-month prospective study.

Background In cross-sectional surveys, increasing numbers of adolescents report using both electronic cigarettes (e-cigarettes) and cigarettes. This study assessed whether adolescent e-cigarette use was associated prospectively with initiation or escalation of cigarette use. Methods Data were from 2836 adolescents (aged 13–14 years at baseline) in 20 schools in England. At baseline, breath carbon monoxide levels, self-reported e-cigarette and cigarette use, sex, age, friends and family smoking, beliefs about cigarette use and percentage receiving free school meals (measure of socioeconomic status) were assessed. At 12-month follow-up, self-reported cigarette use was assessed and validated by breath carbon monoxide levels. Results At baseline, 34.2% of adolescents reported ever using e-cigarettes (16.0% used only e-cigarettes). Baseline ever use of e-cigarettes was strongly associated with subsequent initiation (n=1726; OR 5.38, 95% CI 4.02 to 7.22; controlling for covariates, OR 4.06, 95% CI 2.94 to 5.60) and escalation (n=318; OR 1.91, 95% CI 1.14 to 3.21; controlling for covariates, this effect became non-significant, OR 1.39, 95% CI 0.97 to 1.82) of cigarette use. Conclusions This is the first study to report prospective relationships between ever use of e-cigarettes and initiation and escalation of cigarette use among UK adolescents. Ever use of e-cigarettes was robustly associated with initiation but more modestly related to escalation of cigarette use. Further research with longer follow-up in a broader age range of adolescents is required.

Interventions to reduce consumption of sugar-sweetened beverages or increase water intake: evidence from a systematic review and meta-analysis

A systematic review and meta‐analyses were conducted to evaluate the effects of interventions to reduce sugar‐sweetened beverages (SSB) or increase water intakes and to examine the impact of behaviour change techniques (BCTs) in consumption patterns. Randomized and nonrandomized controlled trials published after January 1990 and until December 2016 reporting daily changes in intakes of SSB or water in volumetric measurements (mL d−1) were included. References were retrieved through searches of electronic databases and quality appraisal followed Cochrane principles. We calculated mean differences (MD) and synthesized data with random‐effects models. Forty studies with 16 505 participants were meta‐analysed. Interventions significantly decreased consumption of SSB in children by 76 mL d−1 (95% confidence interval [CI] −105 to −46; 23 studies, P < 0.01), and in adolescents (−66 mL d−1, 95% CI −130 to −2; 5 studies, P = 0.04) but not in adults (−13 mL d−1, 95% CI −44 to 18; 12 studies, P = 0.16). Pooled estimates of water intakes were only possible for interventions in children, and results were indicative of increases in water intake (MD +67 mL d−1, 95% CI 6 to 128; 7 studies, P = 0.04). For children, there was evidence to suggest that modelling/demonstrating the behaviour helped to reduce SSB intake and that interventions within the home environment had greater effects than school‐based interventions. In conclusion, public health interventions – mainly via nutritional education/counselling – are moderately successful at reducing intakes of SSB and increasing water intakes in children. However, on average, only small reductions in SSBs have been achieved by interventions targeting adolescents and adults. Complementary measures may be needed to achieve greater improvements in both dietary behaviours across all age groups.

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

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.

Impact of Goal Priority and Goal Conflict on the Intention-Health-Behavior Relationship : Tests on Physical Activity and Other Health Behaviors

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

How effective are interventions in improving dietary behaviour in Low and Middle Income countries? A systematic review and meta-analysis.

ABSTRACT 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.

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

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.

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

Abstract 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.