Sherecce Fields

Studies have demonstrated that medical students’ anti-fat prejudice increases over the course of training, although the mechanisms through which thes

BACKGROUND Our health is shaped significantly by health-related behaviors as diverse as tobacco and other substance use, diet, physical activity, sleep, sexual activities, treatment and care-seeking, and adherence to treatment regimens. Historically, health behavior change models have focused on social and cognitive factors, however, behavior change interventions derived from these models are less than optimally effective. Behavioral economic constructs, such as delay discounting and behavioral economic demand, currently unaccounted for in traditional health behavior change models, are relatively new targets for health behavior change. The application of these constructs in health behavior research represents the novel approach of examining underlying processes generalizable to a wide variety of unhealthy behaviors; however, the clinical utility of these constructs has yet to be explicated. OBJECTIVE This systematic review aims to offer a rigorous, comprehensive, replicable synthesis of the available published scientific literature that examines concomitant changes in delay discounting and/or demand and targeted health behaviors as a consequence of an intervention or treatment. Our objective is to provide evidence, insights, and recommendations that will advance the science in this domain. METHODS The development of this systematic review protocol followed the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. This protocol has been registered on PROSPERO International Prospective Register of Systematic Reviews (CRD420261284218). RESULTS Preliminary searches and reviews were conducted in 2024 and 2025. Formal study selection and data extraction are expected to be complete in February 2026. Data synthesis is expected to be complete in May 2026. CONCLUSIONS This systematic review will identify key aspects of intervention type, health behaviors, delay discounting and demand measures, and analyses useful in identifying knowledge gaps, informing future research, and advancing science in this domain. We expect that these findings will contribute valuable insights for understanding the clinical utility of delay discounting and demand as therapeutic targets for improving health behaviors.

Background: E-cigarettes have become a popular form of nicotine use. The use of protective behavioral strategies (PBS) has been associated with less use of alcohol and fewer alcohol-related consequences. However, the relationship between PBS and e-cigarette-related outcomes have been understudied. Guided by the Theory of Planned Behavior, we examined the associations between the use of PBS for vaping (PBSV), perceived behavioral control over using PBSV, the frequency of past month e-cigarette use, and e-cigarette dependence. Methods: Adults who reported using an e-cigarette for at least once a day were recruited and completed an online survey (N = 298). Results: The path analytic model with e-cigarette dependence as the outcome fit the data well. Greater perceived behavioral control was associated with greater use of PBSV, greater use of PBSV was associated with less e-cigarette use, and less e-cigarette use was associated with less dependence. Conclusions: Our findings contribute to understanding e-cigarette use harm reduction strategies in the context of confidence over using PBS, frequency of e-cigarette use, and e-cigarette dependence. Results highlight the need for continued research and exploration of the potential clinical and public health benefits of PBSV as an intervention for e-cigarette use behaviors and dependence.

Objective: A variety of interventions have been developed to target problematic college student drinking, with minimal long-term effects. Several interventions incorporate alcohol protective behavioral strategies (PBS); however, these remain underdeveloped and underused. Counterfactuals (thoughts about what might have been) can strengthen causal links between behavior and outcome. Recent research has demonstrated counterfactual's effectiveness to increase PBS use. This study examines the effects of brief counterfactual and personalized normative feedback (PNF) interventions to increase PBS use. Method: Undergraduates (N = 239) completed an online 6-week intervention. Participants completed baseline demographics, PBS and alcohol use, and alcohol consequences measures. Participants were randomly assigned to condition: negative event only (Control), negative event with details (Sham), negative event with counterfactuals (CF), and PNF (PBS-PNF). They reported alcohol use, alcohol consequences, and PBS use weekly for 6 wk. Results: PBS use declined in both Control and Sham conditions. By the study's conclusion, CF (d = 0.54) and PBS-PNF (d = 0.46) conditions reported significantly higher PBS use (vs. Control). The Control, Sham, and PBS-PNF (but not CF) conditions had increases in alcohol use across time. In the final week there were indirect associations between alcohol consequences and both CF and PBS-PNF conditions from five weeks prior. Conclusions: This study provides some support for the use of both personalized normative feedback and counterfactual interventions to increase PBS use in college students. The personal relevance of the counterfactual intervention may produce sustained positive outcomes.

This study sought to examine the predictive utility of the theory of planned behavior (TPB) for mask wearing behavior. Data was collected during the Texas public mask mandate (October 11-November 24, 2020) and post-mandate (March 25-April 29, 2021). University students were recruited through the department’s online subject pool. Participants during the mandate ( N = 579; M = 18.70, SD = 1.17; 60.8% female) and post-mandate ( N = 236; M = 19.15, SD = 1.02; 50% female) completed identical TPB measures and demographic measures. Using structural equation modeling (SEM), attitudes, subjective norms and perceived behavioral control were associated with stronger mask wearing intentions. Intentions were positively associated with mask wearing behavior. Perceived behavioral control also had a direct positive association with wearing a mask in public. These findings suggest that the TPB is successful in predicting mask wearing behavior, which could have implications for prevention programs and public health campaigns.

Background: Diabetes self-management plays a vital role in improving clinical outcomes and the quality of life of individuals living with diabetes. Despite considerable research on its impact on clinical outcomes, diabetes self-management continues to be challenging for many individuals living with the condition. As part of the growth in digital health technologies for diabetes care, smartphone applications present potential opportunities to bridge the existing gaps in self-management and improve patient outcomes. Method: Participants ( N = 3241 people with diabetes) were recruited to answer questions about diabetes self-management, including their use of digital tools, their preferences for smartphone applications for diabetes, and the preferred functions of these applications they found useful. Frequency distributions and chi-square analyses were performed to examine the demographic differences among users of diabetes and general wellness applications. Results: Among participants, 30.2% reported using health applications specifically made for diabetes management, while 33.9% reported using health applications that were not diabetes-specific. Considerable differences in demographic characteristics were found between users and nonusers of both diabetes-specific and general health applications groups. The most preferred applications provided the opportunity to engage with continuous glucose monitoring data (i.e., continuous measurement; 47.4%) followed by glucose monitoring (i.e., single reading measurement; 20.9%), food intake trackers (23.6%), and fitness goal trackers (22.8%). Conclusion: These findings suggest that the use of digital health technologies is popular for people living with diabetes, but more needs to be done to ensure wider adoption and sustained use.

Perceived behavioral control over drinking (PBCD) is an important factor in alcohol use, with lower scores linked to higher consumption. Counterfactual thinking (i.e. "If only … then …"), a cognitive strategy that strengthens causal links between antecedents and consequents, may increase PBCD by increasing engagement in Protective Behavioral Strategies (e.g. alternating water and alcohol to minimize negative drinking outcomes). This study examined a brief counterfactual-based intervention and a personalized normative feedback for protective behavioral strategies intervention (PBS-PNF) to increase PBCD among college students, relative to control, across five follow-up weeks. Undergraduate students (n = 239; 76.6% female) were randomly assigned to one of four conditions: control (recall negative drinking event), sham (recall and elaborate on negative drinking event), counterfactual (recall negative drinking event and generate counterfactual strategies), or PBS-PNF (estimate peers' use of protective behavioral strategies). PBCD was measured at baseline and at five follow-up sessions. A Bayesian-approach multi-level model was used to estimate PBCD across follow-up weeks. Those in the counterfactual and PBS-PNF conditions reported greater increases in PBCD across follow-ups compared to those in the sham condition who saw no change. Participants in the control condition saw decreases in PBCD over time. The counterfactual and PBS-PNF conditions did not differ on PBCD across time. This study highlights the effectiveness of a brief counterfactual-based intervention to increase PBCD among early drinking college students. Specifically, personalized interventions that increase use of protective behavioral strategies may be particularly effective for individuals who have not yet solidified their drinking habits.

Background: Iron Deficiency (ID) affects two billion people worldwide, predominantly adolescent girls, and may be associated with increased psychopathology. The associations between ID and symptoms of depression and anxiety in adolescents were examined using data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey of a nationally representative sample of non-institutionalized Americans. Methods: The current analysis included survey cycles where both iron-related markers and mental health-related outcomes were collected in adolescents 12 to 17 years old. Acute and serious medical conditions, acute inflammation, and abnormal birth weight led to exclusion. Linear multivariable regression analyses examined the association between ID status (defined based on the total body iron model) and (1) total Patient Health Questionnaire (PHQ-9) score, (2) one item examining anxiety severity, and (3) one item examining overall mental well-being. Covariates included age, sex, race and ethnicity, body mass index, household income, head-of-household marital status, and psychotropic medication use. Sensitivity analyses examined the robustness of the findings when ID was defined based on the ferritin model. Results: In 1990 adolescents (age [mean ± SD]: 14.5 ± 1.7 years; 85.7% females), ID with and without anemia was significantly associated with a higher PHQ-9 score in multiracial adolescents (Cohen’s d = 1.09, p = 0.0005 for ID without anemia; d = 0.92, p = 0.0395 for ID with anemia). Moreover, ID with anemia was associated with more severe anxiety (d = 3.00, p = 0.0130) and worse mental well-being (d = 2.75, p = 0.0059) in multiracial adolescents. The findings remained significant after adjusting for psychotropic use and in the sensitivity analyses. Conclusions: Iron deficiency is associated with poorer mental health in adolescents of multiracial background. Future studies should confirm these findings prospectively and examine the underlying mechanism.