Search results
Found 23087 matches for
We lead multidisciplinary applied research and training to rethink the way health care is delivered in general practice and across the community.
Public acceptability of population-level interventions to reduce alcohol consumption: A discrete choice experiment
Public acceptability influences policy action, but the most acceptable policies are not always the most effective. This discrete choice experiment provides a novel investigation of the acceptability of different interventions to reduce alcohol consumption and the effect of information on expected effectiveness, using a UK general population sample of 1202 adults. Policy options included high, medium and low intensity versions of: Minimum Unit Pricing (MUP) for alcohol; reducing numbers of alcohol retail outlets; and regulating alcohol advertising. Outcomes of interventions were predicted for: alcohol-related crimes; alcohol-related hospital admissions; and heavy drinkers. First, the models obtained were used to predict preferences if expected outcomes of interventions were not taken into account. In such models around half of participants or more were predicted to prefer the status quo over implementing outlet reductions or higher intensity MUP. Second, preferences were predicted when information on expected outcomes was considered, with most participants now choosing any given intervention over the status quo. Acceptability of MUP interventions increased by the greatest extent: from 43% to 63% preferring MUP of £1 to the status quo. Respondents' own drinking behaviour also influenced preferences, with around 90% of non-drinkers being predicted to choose all interventions over the status quo, and with more moderate than heavy drinkers favouring a given policy over the status quo. Importantly, the study findings suggest public acceptability of alcohol interventions is dependent on both the nature of the policy and its expected effectiveness. Policy-makers struggling to mobilise support for hitherto unpopular but promising policies should consider giving greater prominence to their expected outcomes. © 2014 The Authors.
Insecurity, Inequality, and Obesity in Affluent Societies
The problem of obesity is of increasing national and international importance. This book, which provides a solid foundation for the social interpretation of obesity, assessing the role of institutions rather than the individual, argues that obesity is a response to stress and that some types of welfare regimes are more stressful than others. International comparisons show that English-speaking market-liberal societies have higher levels of obesity as well as higher levels of labour and product market competition, leading to inequalities that induce uncertainty and anxiety.
Obesity under Affluence Varies by Welfare Regimes
Among affluent countries, those with market-liberal regimes (which are also Englishspeaking) tend to have the highest prevalence of obesity. The impact of cheap, accessible high-energy food is often invoked in explanation. An alternative approach is that overeating is a response to stress, and that competition, uncertainty and inequality make market-liberal societies more stressful. This chapter reports an ecological regression meta-study that pools 96 surveys from 11 countries, using data collected in the years 1994 to 2004. The fast-food 'shock' impact is found to work most strongly in marketliberal countries. Economic insecurity, measured in several different ways, is almost twice as powerful, while the impact of inequality is weak.
Impact of plain packaging of tobacco products on smoking in adults and children: An elicitation of international experts' estimates
Background: Governments sometimes face important decisions in the absence of direct evidence. In these cases, expert elicitation methods can be used to quantify uncertainty. We report the results of an expert elicitation study regarding the likely impact on smoking rates in adults and children of plain packaging of tobacco products. Methods. Thirty-three tobacco control experts were recruited from the UK (n = 14), Australasia (n = 12) and North America (n = 7). Experts' estimates were individually elicited via telephone interviews, and then linearly pooled. Elicited estimates consisted of (1) the most likely, (2) the highest possible, and (3) the lowest possible value for the percentage of (a) adult smokers and (b) children trying smoking, two years after the introduction of plain packaging (all other things being constant) in a target country in the expert's region of residence. Results: The median estimate for the impact on adult smoking prevalence was a 1 percentage point decline (99% range 2.25 to 0), and for the percentage of children trying smoking was a 3 percentage point decline (99% range 6.1 to 0), the latter estimated impact being larger than the former (P < 0.001, sign test). There were no differences in either estimate by region (I§ssup§2§esup§: Adults: 0; Children: 0) but there was considerable variability between experts' estimates within regions (I§ssup§2§esup§: Adults: 0.91; Children: 0.89). Conclusions: In the absence of direct evidence for the impact of introducing plain packaging on smoking rates in adults and children, this study shows that tobacco control experts felt the most likely outcomes would be a reduction in smoking prevalence in adults, and a greater reduction in the numbers of children trying smoking, although there was substantial variability in the estimated size of these impacts. No experts judged an increase in smoking as a likely outcome. © 2013 Pechey et al.; licensee BioMed Central Ltd.
Using Co-Occurrence to Evaluate Belief Coherence in a Large Non Clinical Sample
Much of the recent neuropsychological literature on false beliefs (delusions) has tended to focus on individual or single beliefs, with few studies actually investigating the relationship or co-occurrence between different types of co-existing beliefs. Quine and Ullian proposed the hypothesis that our beliefs form an interconnected web in which the beliefs that make up that system must somehow "cohere" with one another and avoid cognitive dissonance. As such beliefs are unlikely to be encapsulated (i.e., exist in isolation from other beliefs). The aim of this preliminary study was to empirically evaluate the probability of belief co-occurrence as one indicator of coherence in a large sample of subjects involving three different thematic sets of beliefs (delusion-like, paranormal & religious, and societal/cultural). Results showed that the degree of belief co-endorsement between beliefs within thematic groupings was greater than random occurrence, lending support to Quine and Ullian's coherentist account. Some associations, however, were relatively weak, providing for well-established examples of cognitive dissonance. © 2012 Pechey, Halligan.
Prevalence and correlates of anomalous experiences in a large non-clinical sample
Background. Anomalous experiences occur in many psychiatric conditions, but are also reported by non-patients. Given the continuum account of psychiatric symptoms and reports of dissociation between delusions and anomalous experiences, we predicted that anomalous experiences in a large non-clinical sample would (1) associate with delusion-like beliefs but not with socio-cultural beliefs and (2) that anomalous experiences would also show examples of dissociation with anomalous beliefs. A particular focus was the association between beliefs and experiences theoretically predicted to co-occur in Capgras syndrome. Methods. The study examined the distribution and correlates of differential levels of self-reported anomalous experience in a British sample of 1,000 individuals. Results. Anomalous experiences were found to be relatively common in the general population and were reported (occurring sometimes/often) by 48% of the sample. Being female and endorsing a non-Christian religion were the only two demographic factors related to higher experience scores. Significant relationships were found between anomalous experiences and anomalous beliefs (i.e., delusion-like and paranormal/religious) , but not general societal beliefs. Dissociations between anomalous experiences and anomalous beliefs also were present but not common. No significant relationship was found between Capgras-type beliefs and experiences. Conclusions. This large scale study demonstrated significant association between anomalous experiences and anomalous beliefs in the general population. The relationship was not, however present in all cases similar to cases reported in the clinical literature. © 2011 The British Psychological Society.
Exploring the folk understanding of belief: Identifying key dimensions endorsed in the general population
Abstract Folk psychological accounts consider beliefs to be shared assumptions or internally represented theories that guide or inform the explanations and predictions about what people say and do. There are numerous studies that explore people's beliefs on health, politics, religion, paranormal phenomena and delusional themes, but this paper describes the first study to explicitly evaluate if the general population share a relatively consistent definition of the term. A large stratified British sample (N=1000) was asked to rate a set of 14 qualitative descriptors to characterise key operational features of 'belief '. Individual features showed endorsement rates of 79-90% and a principal components analysis revealed that the majority of features loaded onto a single component. Despite differences in endorsement levels for individual features, the findings suggest that 'belief ' comprises a common set of distinct properties shared by most of the general population. © Koninklijke Brill NV, Leiden, 2012.
The prevalence of delusion-like beliefs relative to sociocultural beliefs in the general population
Background: Delusions are defined as false beliefs different from those that almost everyone else believes. The aim was to develop a new measure (the Cardiff Beliefs Questionnaire, CBQ) to establish the range and prevalence of delusion-like beliefs (DLB) and compare these to other types of beliefs in the general population. Sampling and Methods: A total of 1,000 participants completed the CBQ, which uniquely assesses a broader range of currently held beliefs [delusion-like (bizarre and non-bizarre), paranormal and religious and general political/social beliefs) using this large stratified sample. Results: Strong belief in 1 or more DLB was reported by 39% of the participants (91% reporting 'weak', 'moderate' or 'strong' belief in at least 1 DLB). Moreover, 25% endorsed at least 1 bizarre DLB (76% one or more at any strength). Endorsements of DLB were strongly correlated with paranormal and religious beliefs but not general political/social beliefs. Conclusions: Both bizarre and non-bizarre DLB are frequently found in the general population, lending support to the psychosis continuum account and need to revise key clinical criteria used to diagnose delusions. The good psychometric properties demonstrated by the CBQ indicate that this measure is a useful tool to investigate the wider continuum of beliefs held in the general population. Copyright © 2010 S. Karger AG, Basel.
Obesity under affluence varies by welfare regimes: The effect of fast food, insecurity, and inequality
Among affluent countries, those with market-liberal welfare regimes (which are also English-speaking) tend to have the highest prevalence of obesity. The impact of cheap, accessible high-energy food is often invoked in explanation. An alternative approach is that overeating is a response to stress, and that competition, uncertainty, and inequality make market-liberal societies more stressful. This ecological regression meta-study pools 96 body-weight surveys from 11 countries c. 1994-2004. The fast-food 'shock' impact is found to work most strongly in market-liberal countries. Economic insecurity, measured in several different ways, was almost twice as powerful, while the impact of inequality was weak, and went in the opposite direction. © 2010 Elsevier B.V.
Comparing the impact and mechanistic pathways of micro-environmental interventions targeting healthier vs. more environmentally sustainable food options: an overview of reviews
Background: The potential for interventions that target food environments to influence dietary behaviour has been explored for both healthier and more environmentally sustainable diets, but the extent to which health-focused and sustainability-focused interventions can inform each other is unclear. This overview of reviews compares the characteristics and effectiveness of micro-environmental interventions aimed at health versus sustainability and explores their mediators and moderators. Methods: We searched 10 databases for systematic reviews including randomised controlled trials of micro-environmental interventions targeting healthier or more sustainable food choices. We conducted forwards and backwards citation tracking of included reviews. Review quality was assessed using AMSTAR2. We narratively synthesised results, categorising interventions using the TIPPME typology of micro-environmental interventions. Results: We screened 4154 records and included 31 reviews, of which 26 targeted health and 5 sustainability. Of 228 interventions, 31 (13.6%) targeted sustainability, 194 (85.1%) targeted health, and 3 (1.3%) targeted both. There was little overlap between the intervention types investigated by health and sustainability interventions. Size and position interventions were most common for health interventions, whilst information and presentation interventions were the most frequent sustainability interventions. Default, size, and menu positioning interventions appear particularly promising for both health and sustainability benefits, albeit with limited evidence for the latter in particular. Evidence of effect modifiers was scarce. Almost all reviews had a “critically low” or “low” confidence rating based on the AMSTAR2, limiting confidence in their estimates of intervention effectiveness. Conclusions: There is more evidence for health-focused interventions than sustainability-focused interventions. Size and position interventions seem most promising, but evidence for sustainability is scarce. There is currently no evidence of differential responding to health vs. sustainability interventions, although we were unable to comprehensively assess this. More comparable evidence, and evidence on underlying mechanisms, is needed, prioritising the most effective interventions.
Combining positioning and labelling interventions for healthier and more environmentally sustainable products: A randomised controlled trial in an online experimental supermarket.
Population diets need to become healthier and more sustainable to limit their negative effects on health and environment. This study assessed the effect of a positioning intervention, in isolation and in combination with a labelling intervention, on the a) healthiness and b) environmental sustainability of food choices in an experimental online supermarket. Participants (n=2220) were randomly assigned to one of five trials groups (control; healthier items shown earlier ("health position"); health position & nutri-score labels; environmentally sustainable products shown earlier ("eco position"); eco position & ecolabels) and completed a shopping task in an experimental online supermarket. Linear regressions showed that compared to control, mean scaled nutri-scores of shopping baskets were significantly lower (healthier) for health position (-2.30; 95%CI: -3.07, -1.52) and health position & labels (-2.50; 95%CI: -3.28, -1.72), with no significant difference between health position and health position & labels (-0.20; 95%CI: -0.66, 0.25). The mean eco scores of shopping baskets were significantly reduced (more sustainable) for eco position (-24%; 95%CIs: -15%, -31%)) and eco position & labels (-30%; 95% CIs: -22%, 37%).) compared to control. The eco position & labels group had significantly lower mean eco scores (-8%; 95% CIs: -2%, -14%) compared to eco position. The positioning intervention improved health and environmental sustainability of food selections in an experimental online supermarket, with less robust evidence for a small additional effect of adding labels. There was no suggestion that adding labels that potentially make the positioning intervention more salient had any backfire effects.
Effects of brand-matched alcoholic and alcohol-free and low-alcohol drinks adverts on drink selections: A United Kingdom-based randomised controlled trial in an experimental online supermarket
Background and aims: Restricting alcohol advertising may reduce alcohol consumption and related ill-health. However, advertisements for alcohol-free and low-alcohol drinks (NoLos) with brand-matched alcoholic versions are typically exempt from restrictions, which could lead to surrogate marketing (adverts for NoLo beverages also promoting brand-matched alcoholic options). This study measured the impact of advertisements for brand-matched NoLo beverages on product selections in a simulated online supermarket, in the UK. Design, setting, participants and intervention: We conducted a randomised controlled trial with 1638 UK regular alcohol consumers (aged 18–91), assigned to one of three groups: (1) alcohol adverts (n = 469), where participants viewed an advertisement (embedded within a video) for one of four alcoholic beverages; (2) NoLo adverts (n = 472), for one of four brand-matched NoLo beverages; and (3) unrelated adverts (n = 697), for batteries. Participants then selected food and drinks for a barbecue in a simulated online supermarket. Measurements: We collected data on products selected in the simulated online supermarket (e.g. product name, category, quantity, energy). Risk of alcohol dependence was measured using the Alcohol Use Disorder Identification Test Consumption Questions (AUDIT-C). The primary outcome was selection (yes/no) of advertised alcoholic and NoLo products. Secondary outcomes included the selection (yes/no) of any alcoholic or NoLo products. We also examined the recall of advertised brands and products through survey questions. Findings: Viewing NoLo, but not alcohol, advertisements statistically significantly increased the odds of selecting the advertised products, compared with unrelated advertisements [alcohol group: odds ratio (OR) = 1.62, 95% confidence interval (CI) = 1.03–2.53, Benjamini-Hochberg-adjusted P = 0.11; NoLo group: OR = 2.18, 95% CI = 1.24–3.91, Benjamini-Hochberg-adjusted P = 0.022]. Although the odds of selecting the alcoholic version of the advertised product were higher in those exposed to NoLo adverts vs. control (OR = 1.48, 95% CI = 0.94–2.33, Benjamini-Hochberg-adjusted P = 0.13), this association did not reach statistical significance. Fifty-nine percent of participants in all three groups recalled the advertised brand. Among those who remembered the brand of advertisement, 96% in the alcohol group also correctly recalled the advertised product, while 44% in the NoLo group reported seeing an advert for the alcoholic version of the product (X2 = 297.16, P < 0.001, df = 2). Conclusions: Exposure to advertisements for brand-matched alcohol-free and low-alcohol drinks increases brand (over product) recall, but, while the direction of effects is consistent with these advertisements promoting the selection of alcoholic beverages, evidence of the impact on alcohol selection is inconclusive.
Population-level interventions for sustainable food consumption
Population-level interventions are directed at an entire population, in contrast to individual-level interventions, which target selected groups (e.g., skills training programs directed towards high-risk individuals). As they are delivered across whole populations—or population groups—they can have considerably more reach than individual-level interventions. As everyone in a population stands to benefit from the intervention, population interventions have the potential to be more equitable than individual-level interventions. We discuss some of the approaches that can be used to conceptualize population-level interventions: the Nuffield intervention ladder, the COM-B model, analysis grid for environments linked to obesity, and typology of interventions in physical proximal microenvironments (TIPPME) frameworks. We then move onto discussing the evidence base of different population-level interventions for reducing meat consumption and shifting to more plant-based diets.
Ethnic differences in meat consumption attitudes, norms and behaviors: A survey of White, South Asian and Black ethnic groups in the UK
A reduction in meat consumption is necessary to mitigate negative impacts of climate change and adverse health outcomes. The UK has an increasingly multi-ethnic population, yet there is little research on meat consumption habits and attitudes among ethnic groups in the UK. We ran a survey (N = 1014) with quota samples for ethnic groups and analyzed attitudes, behaviors and norm perceptions of White, South Asian and Black British respondents. Most respondents believe overconsumption of red and processed meat has negative impacts on health (73.3%) and the environment (64.3%).South Asian respondents were statistically significantly less likely to be meat eaters than White respondents (OR = 0.44, 95% CIs: 0.30-0.65, t = −4.15, p = 0.000), while there was no significant difference between White and Black respondents (OR = 1.06, 95% CIs: 0.63–1.76, t = 0.21, p = 0.834). Both South Asian (OR = 2.76, 95% CIs: 1.89–4.03 t = 5.25, p = 0.000) and Black respondents (OR = 2.09, 95% CIs: 0.1.30–3.35, t = 3.06, p = 0.002) were significantly more likely to express being influenced by friends and family in their food choices than White respondents. South Asian (OR = 3.24,95% CIs: 2.17–4.84, t = 5.74, p = 0.000) and Black (OR = 2.02,95% CIs: 1.21–3.39, t = 2.69, p = 0.007) respondents were also both significantly more likely to report they would want to eat similarly to their friends and family than White respondents. Statistical analyses suggested some gender and socioeconomic differences across and among ethnic groups, which are reported and discussed. The differences in meat consumption behaviors and norm conformity between ethnic groups raises the prospect that interventions that leverage social norms may be more effective in South Asian groups than Black and White groups in the UK.
Perceptions of social norms around healthy and environmentally-friendly food choices: Linking the role of referent groups to behavior
Referent groups can moderate the perception of social norms and individuals’ likelihood to model these norms in food choice contexts, including vegetable intake and reduced meat consumption. The present study investigated whether having a close vs. a distant social group as the referent changed perceptions of social norms around making healthy and eco-friendly food choices. It also assessed whether these changes were associated with a difference in the health and environmental impacts of food choice in a virtual grocery shopping task. A nationally representative sample of UK adults (N = 2,488) reported their perceptions of making healthy and eco-friendly food choices being the norm among people they share meals with (close referent group) and most people in the UK (distant referent group). The former was more commonly perceived to be making both healthy (Z = −12.0, p < 0.001) and eco-friendly (Z = −13.27, p < 0.001) food choices than the latter. Perceptions of norms referring to the close group were significantly associated with the environmental (β = −0.90, 95% CIs: −1.49, −0.28) and health (β = −0.38 p < 0.05, 95% CIs: −0.68, −0.08) impacts of participants’ food choices in a virtual shopping task. No such relationship was found for norms referring to the distant group for both environmental (β =0.43, p > 0.05, 95% CIs: −1.12, 0.25) and health (β = −0.06, p > 0.05, 95% CIs: −0.37, 0.25) impacts. Framing social norms around making healthy and eco-friendly food choices to refer to a close referent group may change their perceptions and ability to encourage sustainable and healthy food purchasing.
A dynamic social norm messaging intervention to reduce meat consumption: A randomized cross-over trial in retail store restaurants
Perceptions of social norms around eating behavior can influence food choices. Communicating information about how others are changing their eating behavior over time (dynamic descriptive social norms) may motivate individuals to change their own food selection and consumption. Following a four-week baseline period, 22 in-store restaurants of a major retail chain across the UK were randomized to display a dynamic descriptive social norm message intended to motivate a shift from meat-to plant-based meals either during the first two, or last two weeks of the four-week study period. A linear regression model showed there was no evidence of an effect of the intervention (β = -0.022, p = .978, 95% CIs: −1.63, 1.58) on the percentage sales of meat- vs plant-based dishes. Fidelity checks indicated that adherence to the intervention procedure was often low, with inconsistencies in the placement and display of the intervention message. In four stores with high fidelity the estimated impact of the intervention was not materially different. The lack of apparent effectiveness of the intervention may reflect poor efficacy of the intervention or limitations in its implementation in a complex food purchasing environment. The challenges highlighted by this study should be considered in future design and evaluation of field trials in real-world settings.
Testing the effect of ecolabels on the environmental impact of food purchases in worksite cafeterias: a randomised controlled trial
Background: Reducing the environmental impact of foods consumed is important for meeting climate goals. We aimed to conduct a randomised controlled trial to test whether ecolabels reduce the environmental impact of food selected in worksite cafeterias, alone or in combination with increased availability of more sustainable meal options. Methods: Worksite cafeterias (n = 96) were randomised to one of three study groups, with 54 included for final analysis. One group was intended to increase the availability of meat-free options, but no change was implemented. Therefore, this group was treated as part of the control, creating two groups: (1) control (no ecolabels) (n = 35), and (2) ecolabels (n = 19). Regression analysis assessed the primary outcome of total environmental impact of hot meals sold over a 6-week period. Secondary outcome analyses explored the individual environmental indicators that composed the total environmental impact score (i.e., greenhouse gas emissions, biodiversity loss, eutrophication, and water scarcity). The mean weekly environmental impact scores of hot meal options over the full 12-week trial period were assessed using hierarchical mixed effects models. Results: There was no significant effect of the intervention on the environmental impact scores of meals sold (mean difference between control and intervention sites: -1.4%, 95%CI: -33.6%, + 30.8%). There was no evidence of an effect in mean weekly environmental impact score (-5.4%, 95%CI: -12.6%, + 2.5%), nor in any of the four individual environmental indicators (greenhouse gas emissions: -3.6%, 95%CI: -30.7%, 34.3%; biodiversity loss: 2.0%, 95%CI: -25.8%, 40.2%; eutrophication: -2.4%, 95%CI: -29.3%, 34.7%; water scarcity: -0.4%, 95%CI: -28.7%, 39.1%). Conclusions: Ecolabels may not be an effective tool to shift consumer behaviour in worksite cafeterias towards meals with lower environmental impact. Trial registration: The study was pre-registered prospectively on ISRCTN (https://www.isrctn.com/ISRCTN10268258; 06/01/2022).