What's important to you?: Socioeconomic inequalities in the perceived importance of health compared to other life domains

BACKGROUND: Pressing issues, like financial concerns, may outweigh the importance people attach to health. This study tested whether health, compared to other life domains, was considered more important by people in high versus low socioeconomic positions, with future focus and financial strain as potential explanatory factors. METHODS: A cross-sectional survey was conducted in 2019 among N=1,330 Dutch adults. Participants rated the importance of two health-related domains (not being ill, living a long life) and seven other life domains (e.g., work, family) on a five-point scale. A latent class analysis grouped participants in classes with similar patterns of importance ratings. Differences in class membership according to socioeconomic position (indicated by income and education) were examined using structural equation modelling, with future focus and financial strain as mediators. RESULTS: Three classes were identified, which were defined as: neutralists, who found all domains neutral or unimportant (3.5% of the sample); hedonists, who found most domains important except living a long life, work, and religion (36.2%); and maximalists, who found nearly all domains important, including both health domains (60.3%). Of the neutralists, 38% considered not being ill important, and 30% considered living a long life important. For hedonists, this was 92% and 39%, respectively, and for maximalists this was 99% and 87%, respectively. Compared to belonging to the maximalists class, a low income predicted belonging to the neutralists, and a higher educational level and unemployment predicted belonging to the hedonists. No mediation pathways via future focus or financial strain were found. CONCLUSIONS: Lower income groups were less likely to consider not being ill important. Those without paid employment and those with a higher educational level were less likely to consider living a long life important. Neither future focus nor financial strain explained these inequalities. Future research should investigate socioeconomic differences in conceptualisations of health, and if inequalities in the perceived importance of health are associated with inequalities in health. To support individuals dealing with challenging circumstances in daily life, health-promoting interventions could align to the life domains perceived important to reach their target group and to prevent widening socioeconomic health inequalities

Social contextual influences on unhealthy food consumption : A psychological approach

The current physical food environment, characterized by a high availability energy-dense, palatable foods, is widely held responsible for unhealthy dietary patterns. However, our understanding of how the unhealthy food environment steers unhealthy food consumption, and how this may be of particular importance for individuals with low socioeconomic status, is still limited. The aim of this thesis is to provide insights into potential psychological processes that may explain how aspects of the physical food environment and socioeconomic context may steer unhealthy food consumption. Psychological theories on contextual influences on motivational and decision-making processes are applied specifically to the food environment and food consumption. Part 1 of this thesis (Chapters 2 and 3) focuses on social norms that may be communicated by physical food environments and thereby influence consumption. In part 2 (Chapters 4 and 5), the focus is on resource scarcity and relative deprivation, which may explain how an individual’s deprived socioeconomic context stimulates unhealthier food consumption when unhealthy foods are readily available. In Chapter 2, the aim is to provide a new understanding of how micro food environments may influence consumption, by proposing that social norms are embedded in physical cues in these environments. In this photo study, in-store/restaurant food environments were analysed through a social norm lens. It was demonstrated that a great variety of physical cues in self-service food environments (e.g. food traces, covered presentation, product availability) may communicate normative messages about other consumers’ behaviour or the popularity of/demand for a product (i.e. descriptive norms) and/or the appropriateness of consumption (i.e. injunctive norms). Among a sample of laypeople, a descriptive norm concerning others’ behaviour appeared easier to recognize than an injunctive norm regarding informal rules about appropriate behaviour. Findings suggest that social norms may be inferred from a wide variety of physical cues in the outside-the-home, in-store/restaurant food context. In Chapter 3, the proposition that the physical food environment conveys social norms regarding common and appropriate consumption is examined on the level of the built, neighbourhood environment. We tested whether social norm perceptions regarding fast food consumption in the neighbourhood mediated the relationship between residential exposure to fast food outlets and fast food consumption. Fast food outlet exposure was objectively assessed as the count of fast food outlets within a 400m walking distance buffer around the postcodes of Dutch panel respondents. No direct association between residential fast food exposure and frequency of fast food consumption was found. However, both descriptive and injunctive social norms mediated the association between exposure and consumption. Those who were more exposed to fast food outlets in their direct neighbourhood perceived ‘unhealthier’ social norms, and these ‘unhealthier’ norms were in turn associated with a higher frequency of fast food consumption. Hence, this chapter provides first correlational evidence for the idea that social norms may be inferred from the built physical food environment. In Chapter 4, the aim is to experimentally examine whether experiences of resource scarcity in an absolute sense (i.e. having too few resources) result in a higher consumption of available snacks. Scarcity experiences, including trade-off making, have been proposed to lead to a decreased mental bandwidth and so more impulsive behaviour. In our studies, resource scarcity was manipulated by a self-developed trade-off task, in which participants’ resources were either restricted (scarcity condition) or unrestricted (no-scarcity condition). Two laboratory experiments were conducted among students of Wageningen University. In the first experiment, a non-hypothesized interaction effect between scarcity and hunger bordered on significance. Scarcity appeared to increase snack consumption under low, but not high, hunger levels. In the second experiment, a difference in snack consumption between the two conditions could not be replicated, although participants were explicitly instructed to have eaten prior to participation so as to reduce their level of hunger. Overall, we could not provide conclusive evidence for the notion that resource scarcity results in unhealthier food consumption.  In Chapter 5, the aim is to test whether the experience of personal relative deprivation (PRD, i.e. being worse off than others) results in a higher preference for palatable, high-caloric snack-type foods. PRD has been demonstrated to increase the preference for immediate, small rewards over larger benefits in the long term. In our studies, PRD was manipulated by a computer game in which participants experienced that they earned fewer resources (PRD condition) versus equal resources (control condition) relative to an opponent. The points earned served as resources to be spent on foods in a grocery shopping task. In an online experiment, no main effect of PRD on food choice was found. However, the manipulation appeared to have a differential effect for different levels of chronic PRD. A higher number of snack-type food products was selected by participants that were relatively deprived and also experienced higher chronic relative deprivation. In a lab-in-the-field experiment, where a diverse community sample made real (non-hypothetical) food choices, it was demonstrated that those in the PRD condition selected more snack-type foods compared to those in the control condition, when particularly sensitivity to palatable food was controlled for. Although results need to be interpreted with caution, this study revealed some preliminary evidence that relative deprivation results in unhealthier food choices.  Overall, findings from part 1 indicate that the real-world physical food environment may be a relevant source of social norm perceptions about what is common and appropriate food consumption. Moreover, these findings highlight the importance of human social cognition when a person is interpreting physical contexts, as they show that perceptions of social norms may be a psychological mechanism in the relation between the physical food environment and consumption. The findings in part 2 are somewhat inconclusive, but they indicate that deprivation in a relative sense through upward social comparison may result in unhealthier food choice, but that deprivation in an absolute sense does not consistently result in unhealthier food consumption. In a practical sense, this thesis suggests that social norms and PRD may be relevant psychological processes that need to be considered when the aim is to stimulate healthier consumption and reduce socioeconomic disparities in diet. &nbsp

Dealing with Too Little: The Direct Experience of Scarcity does not Affect Snack Intake

Background: The experience of scarcity provides an explanation for the relatively unhealthy diets of people with low income. Causal evidence for an effect of direct experiences of scarcity on eating behaviour is lacking. Methods: Two studies (N = 81, N = 115) tested and refined a self‐developed trade‐off task, in which participants' resources were restricted (scarcity condition) or unrestricted (no‐scarcity condition), for manipulating experiences of scarcity. Two further studies (N = 95, N = 122) were performed to test whether scarcity results in greater calorie consumption from snacks and lower self‐reported self‐regulation of eating. Results: The scarcity manipulation appeared successful. A significant main effect of scarcity on eating was not found; however, an interaction effect between hunger and scarcity bordered on significance, such that those in the scarcity condition consumed more calories under low hunger. In the second experiment, participants were instructed to eat prior to participation to lower their hunger level. No difference between conditions was found in calorie consumption and self‐regulation of eating. Conclusion: Although the trade‐off task appeared to evoke scarcity experiences, the present research could not support the notion that these result in unhealthier eating. A more nuanced view of the influence of scarcity on eating is needed

Translation strategies in the process of translation : a psycholinguistic invesigation

The article presents and analyzes the mental translation strategies employed by language users and translation students in the process of translation. In the psycholinguistic investigation, presented in this article, the empirical data are elicited by using a special kind of introspection - the method of thinking-aloud. The article defines and highlights the particularities of the procedure used for the analysis of the data, i. e. the interpretive reconstruction by means of indicators. Moreover, it is assigned to provide theoretical framework of the model, which is taken up for the analysis of the mental translation process and strategies as well as to present reliable results of the present investigation

Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity?: Design and methods of a randomized and controlled study

BACKGROUND: (Extreme) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences. Bariatric surgery is an effective intervention for obesity, but approximately 20 to 30% of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies. This study examines the added value of pre-operative cognitive behavioral therapy (CBT) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style. We hypothesize that pre-operative CBT will result in better weight loss maintenance, reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone. METHODS: One hundred and twenty eight patients that are on a waiting list for bariatric surgery are randomly assigned to the control or treatment condition. Patients in the treatment condition receive 10 sessions of CBT before surgery aimed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery. Weight loss, eating behavior, eating disorders, depression, quality of life and psychological distress are assessed before and after treatment, as well as 1, 3, and 5 year following surgery

Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study

Background: (Extreme) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences. Bariatric surgery is an effective intervention for obesity, but approximately 20 to 30% of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies. This study examines the added value of pre-operative cognitive behavioral therapy (CBT) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style. We hypothesize that pre-operative CBT will result in better weight loss maintenance, reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone. Methods: One hundred and twenty eight patients that are on a waiting list for bariatric surgery are randomly assigned to the control or treatment condition. Patients in the treatment condition receive 10 sessions of CBT before surgery aimed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery. Weight loss, eating behavior, eating disorders, depression, quality of life and psychological distress are assessed before and after treatment, as well as 1, 3, and 5 year following surgery. (C) 2015 Elsevier Inc. All rights reserved

Neighbourhood fast food exposure and consumption: the mediating role of neighbourhood social norms

The association between the residential fast food environment and diet has gained growing attention. However, why the food environment affects food consumption is under-examined. This study aimed to investigate neighbourhood social norms with respect to fast food consumption as a potential mediating pathway between residential fast food outlet exposure and residents’ fast food consumption

Neighbourhood fast food exposure and consumption: the mediating role of neighbourhood social norms

The association between the residential fast food environment and diet has gained growing attention. However, why the food environment affects food consumption is under-examined. This study aimed to investigate neighbourhood social norms with respect to fast food consumption as a potential mediating pathway between residential fast food outlet exposure and residents’ fast food consumption

What's important to you?: Socioeconomic inequalities in the perceived importance of health compared to other life domains

BACKGROUND: Pressing issues, like financial concerns, may outweigh the importance people attach to health. This study tested whether health, compared to other life domains, was considered more important by people in high versus low socioeconomic positions, with future focus and financial strain as potential explanatory factors. METHODS: A cross-sectional survey was conducted in 2019 among N=1,330 Dutch adults. Participants rated the importance of two health-related domains (not being ill, living a long life) and seven other life domains (e.g., work, family) on a five-point scale. A latent class analysis grouped participants in classes with similar patterns of importance ratings. Differences in class membership according to socioeconomic position (indicated by income and education) were examined using structural equation modelling, with future focus and financial strain as mediators. RESULTS: Three classes were identified, which were defined as: neutralists, who found all domains neutral or unimportant (3.5% of the sample); hedonists, who found most domains important except living a long life, work, and religion (36.2%); and maximalists, who found nearly all domains important, including both health domains (60.3%). Of the neutralists, 38% considered not being ill important, and 30% considered living a long life important. For hedonists, this was 92% and 39%, respectively, and for maximalists this was 99% and 87%, respectively. Compared to belonging to the maximalists class, a low income predicted belonging to the neutralists, and a higher educational level and unemployment predicted belonging to the hedonists. No mediation pathways via future focus or financial strain were found. CONCLUSIONS: Lower income groups were less likely to consider not being ill important. Those without paid employment and those with a higher educational level were less likely to consider living a long life important. Neither future focus nor financial strain explained these inequalities. Future research should investigate socioeconomic differences in conceptualisations of health, and if inequalities in the perceived importance of health are associated with inequalities in health. To support individuals dealing with challenging circumstances in daily life, health-promoting interventions could align to the life domains perceived important to reach their target group and to prevent widening socioeconomic health inequalities

Neighbourhood fast food exposure and consumption: the mediating role of neighbourhood social norms

The association between the residential fast food environment and diet has gained growing attention. However, why the food environment affects food consumption is under-examined. This study aimed to investigate neighbourhood social norms with respect to fast food consumption as a potential mediating pathway between residential fast food outlet exposure and residents’ fast food consumption