Socioeconomic status (SES), indicated e.g., through educational attainment substantially influences health outcomes through health behaviours. Many health behaviours such as smoking or consuming sugar-sweetened beverages (SSBs) are strongly influenced by momentary environmental and social cues in everyday life. This study examined the moderating role of SES on the relationship between such situational cues and smoking as well as SSB consumption. Data were drawn from two ecological momentary assessment studies with 46 daily smokers (Study 1) and 125 SSB consumers (Study 2) in Germany. Participants provided daily self-reports on behavioral cues and consumption over three weeks. Results revealed that lower educational attainment was associated with increased associations between situational social cues (e.g., observing others engaging in the behavior) and smoking, as well as between situational availability cues (e.g., access to SSBs) and SSB consumption. These findings suggest that individuals with lower educational attainment are both more exposed to and more susceptible to environmental cues promoting health-compromising behaviours. Addressing these disparities may require structural interventions to reduce the density and impact of such cues in disadvantaged environments.

Die Covid-19-Pandemie hat den Bedarf an hochauflösender Evidenz zu sozialen und kontextuellen Bedingungen sowie den gesundheitlichen Folgen solcher Ausnahmesituationen deutlich gemacht. Mit der PULS(Populationsbasierte Umfrage zur Lebenssituation und Sozialen Gesundheit)-Studie soll deshalb eine agile und responsive Echtzeitkohorte etabliert werden. In einem ersten Schritt sollen die Determinanten der Studienteilnahme analysiert werden. Qualitative Studie im Zeitraum 16.12.2024–14.02.2025 mit 7 leitfadengestützten Fokusgruppen mit jeweils 4–7 Teilnehmenden (insg. 22 männlich, 17 weiblich, 2 nonbinär). Aussagen wurden entlang der 14 Domänen des „Theoretical Domains Framework“ deduktiv codiert. Die Teilnehmenden betonten vor allem die Wichtigkeit verschiedener Aspekte, die den Domänen Verstärkung, Erwartungen über Auswirkungen und Umweltbedingungen/Ressourcen sowie Ziele und Überzeugungen über Fähigkeiten zuzuordnen sind. Dabei wurden die einzelnen Aspekte nicht isoliert betrachtet, sondern gegeneinander abgewogen. So waren Teilnehmende beispielsweise eher bereit, zeitliche Ressourcen zu investieren, wenn sie ihren Beitrag zum Gemeinwohl als besonders relevant empfanden – etwa weil ihre persönlichen Ziele mit den politischen und gesellschaftlichen Implikationen der Studie übereinstimmten. Die Teilnahme an einer agilen und langfristig angelegten Kohortenstudie wird unter bestimmten Bedingungen als akzeptabel und umsetzbar eingeschätzt. Insbesondere der wahrgenommene Einfluss auf Gesellschaft und Politik sowie die Aussicht auf eine wirksame Translation wissenschaftlicher Erkenntnisse in politische Maßnahmen können Schlüsselanreize für Bürger:innen sein, die den persönlichen Ressourceneinsatz aufwiegen. Die Ergebnisse haben nicht nur Bedeutung für die Implementierung der PULS-Studie, sondern auch für anschließende Translationsvorhaben.

Behavioral intentions predict behavior better if they are stable over time. A statistical argument suggests that this is due to less measurement error, but recent theoretical advances suggest self-regulatory effects: durable intentions remain temporally stable due to their persistence when faced with challenges. Here, we leverage intensive longitudinal data on adherence with non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic (N = 623; total assessments = 19,740; study duration: 6 months each). We operationalize intention durability as temporal order-dependent variability (reversed root mean square of successive differences [RMSSD] between each valid assessment). We then examine the within- and between-person moderating effects of intention durability on the intention-behavior association as well as the effects of past on current behavior. In line with the theoretical assumptions, we find that more durable intentions are not only associated with a stronger intention-behavior link on a within- and a between-person level but also a stronger effect of past on current adherence with NPIs. Our findings support the hypothesized moderating effects of intention durability and provide a more nuanced understanding of the self-regulatory processes underlying the temporal stability of intentions.

Background: The social environment is important to consider for effective promotion of movement behaviors like increased physical activity (PA) and reduced sedentary behavior (SB); yet, it is less often considered than individual and built environments. One way to advance social environment research is to develop system maps, an innovative, participatory, action-oriented research process that actively engages stakeholders to visualize system structures and explore how systems “work.” The purpose of this research was to develop PA and SB system maps of the social environment embedded within the core/nuclear family system. Methods: The development process began with a 2-day multicountry, 16-researcher, in-person participatory workshop in August 2023, followed by multiple online follow-up consultations. Attendees contributed to the creation of the maps through shared development of critical determinants and their causal pathways. The structure of the final maps was analyzed using network analysis methods to identify indicators of centrality, and key feedback loops and areas for potential intervention were explored. Results: Key central determinants that were likely critical targets for systems intervention to produce changes in PA and SB and featured prominently in most of the reinforcing and balancing feedback loops included shared family interests, values and priorities, family logistical support, family cohesion/organization, and shared experiences. The maps also highlighted key determinants of the broader social environment external to the family. Conclusions: These system maps support current evidence on movement behaviors in family systems and socioecological theories and have the utility to galvanize future research and policy to promote PA and reduce SB.

Background Maintaining a healthy body weight and reaching long-term dietary goals requires ongoing self-monitoring and behavioral adjustments. How individuals respond to successes and failures is described in models of self-regulation: while cybernetic models propose that failures lead to increased self-regulatory efforts and successes permit a reduction of such efforts, motivational models (e.g., social-cognitive theory) make opposite predictions. Here, we tested these conflicting models in an ecological momentary assessment (EMA) context and explored whether effort adjustments are related to inter-individual differences in perceived self-regulatory success in dieting (i.e., weight management). Methods Using linear mixed effects models, we tested in 174 diet-interested individuals whether current day dietary success or failure (e.g., on Monday) was followed by self-regulatory effort adjustment for the next day (e.g., on Tuesday) across 14 days. Success vs. failure was operationalized with two EMA items: first, whether food intake was higher vs. lower than usual and second, whether food intake was perceived as more vs. less goal-congruent than usual. Trait-level perceived self-regulatory success in dieting was measured on a questionnaire. Results Intended self-regulatory effort increased more strongly after days with dietary success (i.e., eating less than usual / rating intake as goal-congruent) than after days with dietary failure (i.e., eating more than usual / rating intake as goal-incongruent), especially in those individuals with lower scores on perceived self-regulatory success in dieting. Conclusions Findings support mechanisms proposed by social-cognitive theory, especially in unsuccessful dieters. Thus, future dietary interventions could focus on preventing the decrease in self-regulatory effort after instances of dietary failures and thereby mitigate the potential risk that a single dietary failure initiates a downward spiral into unhealthy eating.

Zusammenfassung Insbesondere im Kontext der COVID-19-Pandemie sind Falsch- und Desinformationen in sozialen Medien zu einer Herausforderung für effektive Public-health-Maßnahmen geworden. Hier betrachten wir Einflussfaktoren auf das Glauben und Teilen von Falschinformationen auf individueller, sozialer und situativ-kontextueller Ebene und diskutieren Interventionsmöglichkeiten. Auf individueller Ebene spielen Wissensdefizite, mangelnde Kompetenzen und emotionale Motivation eine Rolle. Menschen mit geringer Gesundheitskompetenz und bestimmten Überzeugungen sind anfälliger für Falschinformationen. Auf sozialer Ebene beeinflussen die Glaubwürdigkeit von Informationsquellen und soziale Normen das Teilen von Falschinformationen. Das Bedürfnis nach Status und Gruppenzugehörigkeit spielt ebenfalls eine Rolle. Auf kontextueller Ebene wirken Emotionen und die Wiederholung von Nachrichten auf das Glauben und Teilen von Falschinformationen. Interventionen auf individueller Ebene beinhalten Maßnahmen zur Verbesserung von Wissen und Kompetenzen. Auf sozialer Ebene können soziale Prozesse und soziale Normen angesprochen werden, um das Teilen von Falschinformationen zu reduzieren. Auf kontextueller Ebene wird die Regulierung von sozialen Netzwerken als wichtiger Ansatzpunkt betrachtet. Es wird darauf hingewiesen, dass soziale Ungleichheiten in der Exposition gegenüber Falschinformationen und im Umgang damit eine wichtige Rolle spielen. Es bleibt unklar, ob die Anfälligkeit für Falschinformationen eine generelle Tendenz oder kontextabhängig ist. Die Entwicklung von Interventionen muss daher vielfältige Einflussfaktoren berücksichtigen.

A healthy diet is essential for preventing chronic disease and promoting overall health. Translating one's intention to eat healthy into actual behaviour has, however, proven difficult with a range of internal and contextual factors identified as driving eating behaviour. We leverage Temporal Self-Regulation Theory to examine these momentary determinants' direct and moderating effects on the intention–behaviour relation with Ecological Momentary Assessment (EMA). Eighty-seven healthy participants ( m age  = 24.1 years; 59 women, 28 men) reported, 5 times daily for 10 weekdays, their intentions to stick to a self-set dietary restriction goal for the next 3 hr, the goal congruency of their eating behaviour in the past 3 hr, and a range of factors potentially influencing food intake, such as stress, emotions and environmental eating cues. Two-part multilevel modelling revealed that craving, availability of goal-incongruent foods, social eating cues, giving in to other temptations and weaker momentary intentions directly increased the risk and severity of goal-incongruent intake within the next 3 hr. Social cues, stress and craving further influence behaviour through altering intention implementation. Results imply that people regularly fail to implement intentions for 3-hr periods and that a range of factors influences this, both directly and by disrupting intentional processes. While for some barriers, fostering strong intentions throughout the day could be beneficial, others require different strategies for dietary adherence.

BACKGROUND:To control infections, behavioral non-pharmaceutical interventions (NPIs) such as social distancing and hygiene measures (masking, hand hygiene) were implemented widely during the COVID-19 pandemic. At the same time, adherence to NPIs has also been implied in an increase in mental health problems. However, the designs of many existing studies are often poorly suited to disentangle complex relationships between NPI adherence, mental health symptoms, and health-related cognitions (risk perceptions, control beliefs).PURPOSE:To separate between- and temporal within-person associations between mental health, health-related cognitions, and NPI adherence.METHODS:Six-month ecological momentary assessment (EMA) study with six 4-day assessment bouts in 397 German adults. Daily measurement of adherence, mental health symptoms, and cognitions during bouts. We used dynamic temporal network analysis to estimate between-person, as well as contemporaneous and lagged within-person effects for distancing and hygiene NPIs.RESULTS:Distinct network clusters of mental health, health cognitions, and adherence emerged. Participants with higher control beliefs and higher susceptibility were also more adherent (between-person perspective). Within-person, similar findings emerged, additionally, distancing and loneliness were associated. Lagged findings suggest that better adherence to NPIs was associated with better mental health on subsequent days, whereas higher loneliness was associated with better subsequent hygiene adherence.CONCLUSIONS:Findings suggest no negative impact of NPI adherence on mental health or vice versa, but instead suggest that adherence might improve mental health symptoms. Control beliefs and risk perceptions are important covariates of adherence-both on between-person and within-person level.

ObjectivesA healthy diet is essential for preventing chronic disease and promoting overall health. Translating one's intention to eat healthy into actual behaviour has, however, proven difficult with a range of internal and contextual factors identified as driving eating behaviour.DesignWe leverage Temporal Self-Regulation Theory to examine these momentary determinants' direct and moderating effects on the intention-behaviour relation with Ecological Momentary Assessment (EMA).MethodsEighty-seven healthy participants (mage = 24.1 years; 59 women, 28 men) reported, 5 times daily for 10 weekdays, their intentions to stick to a self-set dietary restriction goal for the next 3 hr, the goal congruency of their eating behaviour in the past 3 hr, and a range of factors potentially influencing food intake, such as stress, emotions and environmental eating cues.ResultsTwo-part multilevel modelling revealed that craving, availability of goal-incongruent foods, social eating cues, giving in to other temptations and weaker momentary intentions directly increased the risk and severity of goal-incongruent intake within the next 3 hr. Social cues, stress and craving further influence behaviour through altering intention implementation.ConclusionsResults imply that people regularly fail to implement intentions for 3-hr periods and that a range of factors influences this, both directly and by disrupting intentional processes. While for some barriers, fostering strong intentions throughout the day could be beneficial, others require different strategies for dietary adherence.

Background: Previous studies have identified substantial regional variations in outpatient antibiotic prescribing, both in the paediatric and adult population. This indicates inappropriate antibiotic prescribing in some regions, which should be avoided to reduce antimicrobial resistance and due to potential side effects. The reasons for regional variations in prescribing are not yet completely understood; socioeconomic and health care density differences between regions do not fully explain such differences. Here, we apply a behavioural perspective by adapting the Theoretical Domains Framework (TDF) to examine regional factors deemed relevant for antibiotic prescriptions by paediatricians and general practitioners. Methods: Qualitative study with guideline-based telephone interviews of 40 (pediatricians and general practitioners) from regions with high and low rates of antibiotic prescriptions, stratified by urbanity. TDF domains formed the basis of an interview guide to assess region-level resources and barriers to rational antibiotic prescription behaviour. Interviews lasted 30-61 minutes (M = 45 minutes). Thematic analysis was used to identify thematic clusters, and relationships between themes were explored through proximity estimation.Results: Both paediatricians and general practitioners in low-prescribing regions reported supporting contextual factors (in particular good collegial support, good collaboration with laboratories) and social factors (collegial support and low patient demand for antibiotics) as important resources. In high-prescribing regions, poor coordination between in-patient and ambulatory health services, lack of region-level information on antimicrobial resistance, few professional development opportunities, and regional variations in patient expectations were identified as barriers to rational prescribing behaviour.Conclusions: Interventions targeting professional development, better collaboration structures with laboratories and clearer and user-friendly guidelines could potentially support rational antibiotic prescribing behaviour. In addition, better networking and social support among physicians could support lower prescription rates.

Objectives: Adhering to behavioral recommendations and non-pharmaceutical interventions (NPIs) is key to control COVID-19 infection rates. However, rates have decreased globally, and potentially modifiable determinants of ongoing adherence and their interaction with social and physical momentary environments are still poorly understood. Here, we comprehensively examine within-person variations and between-person differences in known behavioral determinants (capability, motivation), as well as the moderating role of situationally variable environmental factors (opportunity) in predicting adherence to hygiene and social distancing behaviors. Methods: Ecological momentary assessment study over six months with monthly assessment bouts (four days each, five daily assessments) in 623 German adults. Repeated daily assessments of Capability-Opportunity-Motivation model of behavior (COM-B) factors. Bayesian multilevel logistic regression models were estimated to examine main effects of COM-B factors and moderating effects of momentary environmental factors. Results: Momentary adherence to NPIs was predicted by within-person changes in COM-B factors (motivation: intentions, goal conflict, control beliefs; opportunities: regulations, norms). Between-person differences in capabilities (habit strength) and motivation (intentions, control beliefs) predicted adherence across situations. Situation-specific environmental factors moderated the motivation-behavior association (regulation measures increased; goal conflict, and non-adherent others decreased the association). Conclusions: Individual momentary (within-person) and stable (between-person) motivation indicators predicted adherence. However, situational environmental factors such as regulations or norms have strong main effects and moderate the motivation-behavior translation. These findings have policy implications, supporting recent claims to not rely on the narrative of “personal responsibility”, but instead combine health education measures to increase individual motivation with consistent regulation.

Background Health-related misinformation on social media is a key challenge to effective and timely public health responses. Existing mitigation measures include flagging misinformation or providing links to correct information, but they have not yet targeted social processes. Current approaches focus on increasing scrutiny, providing corrections to misinformation (debunking), or alerting users prospectively about future misinformation (prebunking and inoculation). Here, we provide a test of a complementary strategy that focuses on the social processes inherent in social media use, in particular, social reinforcement, social identity, and injunctive norms. Objective This study aimed to examine whether providing balanced social reference cues (ie, cues that provide information on users sharing and, more importantly, not sharing specific content) in addition to flagging COVID-19–related misinformation leads to reductions in sharing behavior and improvement in overall sharing quality. Methods A total of 3 field experiments were conducted on Twitter’s native social media feed (via a newly developed browser extension). Participants’ feed was augmented to include misleading and control information, resulting in 4 groups: no-information control, Twitter’s own misinformation warning (misinformation flag), social cue only, and combined misinformation flag and social cue. We tracked the content shared or liked by participants. Participants were provided with social information by referencing either their personal network on Twitter or all Twitter users. Results A total of 1424 Twitter users participated in 3 studies (n=824, n=322, and n=278). Across all 3 studies, we found that social cues that reference users’ personal network combined with a misinformation flag reduced the sharing of misleading but not control information and improved overall sharing quality. We show that this improvement could be driven by a change in injunctive social norms (study 2) but not social identity (study 3). Conclusions Social reference cues combined with misinformation flags can significantly and meaningfully reduce the amount of COVID-19–related misinformation shared and improve overall sharing quality. They are a feasible and scalable way to effectively curb the sharing of COVID-19–related misinformation on social media.

A comprehensive small area description of regional variations in outpatient antibiotic prescribing in Germany is lacking. Using the German Pharmacoepidemiological Research Database (GePaRD), a claims database covering ~20% of the German population, we determined the age- and sex-standardized prescription rates of antibiotics (number of outpatient prescriptions per 1000 persons/year). We calculated these prescription rates overall and on the level of 401 German districts for the calendar years 2010 and 2018. In 2018, the standardized prescription rate of antibiotics in the total study population was 23% lower than in 2010 (442 vs. 575 per 1000 persons/year). Among 0–17-year-olds, prescription rates across districts ranged from 312 to 1205 in 2010 and from 188 to 710 in 2018 per 1000 persons/year; among adults (≥18 years), they ranged from 388 to 841 in 2010 and from 300 to 693 in 2018 per 1000 persons/year. Despite the overall decline in outpatient antibiotic prescribing between 2010 and 2018, regional variations at the district level remained high in all age groups in Germany. Identifying reasons that explain the persistently high prescription rates in certain regions will be helpful in designing effective and tailored measures to further improve antibiotic stewardship in these regions.

Subjectively prioritizing health over other life domains is an indicator of health motivation and is associated with higher levels of health behaviors and more effective health behavior self-regulation. However, little is known about when individuals prioritize health over other life domains and which factors predict prioritizing health. Here, we examine 3644 older adults in Germany (mean age 60.79) over a period of 6-9 years from DEAS, a population-representative survey. Latent growth curves were estimated to examine individual change in prioritizing health. Socio-structural (gender, educational attainment) and indicators of health status (baseline status and change in [a] number of illnesses, [b] functional health, and [c] self-rated health) were tested as predictors of changes in health prioritization. Participants prioritized health over other life domains, and this increased over time. Women and those with worse health status (lower functional and lower self-rated health) prioritized health more than men and those with better health status, respectively. Lower educational attainment was associated with higher increases in prioritizing health, and interactions between educational status and health indicators show that increases are larger in those with worse health and lower educational attainment. This indicates individual differences in the degree and the changes of prioritizing health.

Misinformation on social media is a key challenge to effective and timely public health responses. Existing mitigation measures include flagging misinformation or providing links to correct information but have not yet targeted social processes. Here, we examine whether providing balanced social reference cues in addition to flagging misinformation leads to reductions in sharing behavior and improvement of overall sharing quality. In 3 field experiments (N=824, N=322, and N=278) on Twitter, we show that highlighting which content others within the personal network share and, more importantly, not share combined with misinformation flags significantly and meaningfully reduces the amount of misinformation shared and improves sharing quality (Study 1-3). We show that this improvement could be driven by change in injunctive social norms (Study 2) but not social identity (Study 3). Social reference cues, combined with misinformation flags, are feasible and scalable means to effectively curb sharing misinformation on social media.

Background and aims: The sports betting market has been growing rapidly over the last years, as have reports of problematic gambling behavior associated with betting. Due to the well-documented gambling problems of famous athletes and the betting supportive nature of many sports-related environments, athletes have been highlighted as a potential group at-risk for problematic sports betting. However, there currently remains a lack of research on individual-level athlete-specific risk-factors or mechanisms that might contribute to the development and perpetuation of betting-related problems. Here, we examine the influence of two potential risk-factors on sports betting behavior and problems: erroneous beliefs and athletes' emotional involvement. Methods: 201 athletes with different levels of expertise completed a newly developed scale to assess both factors. Participants were sampled from the general German population, predominantly male (83.08%) and on average 29.52 (SD = 11.05) years old. We use principal components analysis to detect patterns of covariation, potentially due to the proposed underlying latent factors, and regression analyses to test associations of these factors with betting behavior and problems. Results: We find that athletes' emotional involvement was strongly associated with betting problems whereas erroneous beliefs were not. However, distorted cognitions/beliefs were associated with higher volumes and more frequent betting activities. Discussion and Conclusions: This might contribute to betting problems in the long run. These results highlight athletes' emotional involvement and erroneous beliefs as potential targets for future intervention and prevention efforts.

Smoking is one of the leading causes of non-communicable disease mortality and morbidity. Smoking behaviour is determined by both stable, person-level (e.g., motivation, nicotine dependence) and variable, situation-level factors (e.g., urges, cues). However, most theoretical approaches to understanding health behaviours so far have not integrated these two spheres of influence. Temporal Self-Regulation Theory (TST) integrates these person-level and situation-level factors, but has not yet been comprehensively applied to predicting smoking behaviour. We use Ecological Momentary Assessment to examine the utility of TST in predicting daily smoking. 46 smokers reported individual and environmental cues right after smoking and at random time points during the day. Cognitions, self-control, past behaviour, and nicotine dependence were assessed at baseline. Multi-level logistic regressions show that smoking is largely guided by momentary cues, but individual motivation can buffer their influence. This suggests that TST is a useful integrative approach to understand modifiable determinants of smoking and thus intervention targets.

Person-environment-interactions play a main role in the process of emotional experience. While Regulatory Focus Theory has been adopted to illustrate how some goal-oriented parts of this process might shape by proposing a regulatory fit between individual and environmental characteristics, whether this fit not only implies feeling “right” but feeling “good” or at least cope better, has not been tested empirically. In this study, we extend earlier research on the influence of regulatory fit to the generation and regulation of emotions. We additionally emphasize the role of the context, by integrating current work on group-based emotion regulation in comparing single- and group-environments. We used a within-subjects design, with 2 (situational focus) x 2 (single/group environment) levels. Thirty-two male football players participated in one football-specific task per level. Emotional experience and cognitive regulation strategies were measured after each. Multilevel regression showed, that a regulatory fit predicted more passive-negative emotions in both and more active-negative emotions in the group-environments. The Regulatory fit predicted stronger use of functional regulation strategies in the single- but less in the group-environment. Group-membership predicted stronger use of group-based regulation strategies and weaker use of other strategies – thus indicating further constraints and new ways to cope. We discuss the counter-intuitive results regarding emotional experience in the light of the athletic context as well as theoretical accounts of regulatory fit and its role in moderating motivational intensity and value assignment. Results regarding influence of group-membership are integrated into current research and we highlight directions for future research.