The present study investigated whether a health game can be used to affect children's implicit attitudes toward food (IAsTF) and subsequent snack choices.
Materials and Methods:
The health game used was based on an evaluative conditioning paradigm. The experiment followed a between-subjects design with two conditions (health game vs. control), N = 79 (12.42 years ±1.64, body mass index: 25.06 ± 7.40). IAsTF were assessed at baseline and postintervention using an implicit association test (IAT). Baseline IAT scores were used to categorize IAsTF as healthy (favoring fruits) versus unhealthy IAsTF (favoring chocolates). In addition, three digital snack choices were recorded.
Results:
No main effect of condition on posttest IAsTF was found. However, baseline IAsTF moderated the effect of condition on posttest IAsTF; participants with less healthy baseline IAsTF playing the health game had healthier posttest IAsTF compared to those playing the control game. Regarding the snack choices, participants playing the health game favored fruit over chocolate in one of the snack choices. Baseline IAsTF did not moderate the effect of condition on snack choices.
Conclusion:
Tentative support was found that health games can be used to improve IAsTF, in particular among participants with less healthy ones at baseline.
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References
1.
KaikkonenJE, MikkilaV, MagnussenCG, et al.Does childhood nutrition influence adult cardiovascular disease risk?—Insights from the Young Finns Study. Ann Med, 2013; 45:120–128.
2.
BoumtjePI, HuangCL, LeeJ-Y, et al.Dietary habits, demographics, and the development of overweight and obesity among children in the United States. Food Policy, 2005; 30:115–128.
DiethelmK, JankovicN, MorenoLA, et al.Food intake of European adolescents in the light of different food-based dietary guidelines: Results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr, 2012; 15:386–398.
5.
WalshEM, KiviniemiMT. Changing how I feel about the food: Experimentally manipulated affective associations with fruits change fruit choice behaviors. J Behav Med, 2014; 37:322–331.
6.
LoweMR, ButrynML, DidieER, et al.The Power of Food Scale. A new measure of the psychological influence of the food environment. Appetite, 2009; 53:114–118.
7.
SheeranP, GollwitzerPM, BarghJA. Nonconscious processes and health. Health Psychol, 2013; 32:460–473.
8.
AldridgeV, DoveyTM, HalfordJCG. The role of familiarity in dietary development. Dev Rev, 2009; 29:32–44.
9.
NederkoornC, HoubenK, HofmannW, et al.Control yourself or just eat what you like? Weight gain over a year is predicted by an interactive effect of response inhibition and implicit preference for snack foods. Health Psychol, 2010; 29:389–393.
10.
VolkowND, WangGJ, TomasiD, et al.Obesity and addiction: Neurobiological overlaps. Obes Rev, 2013; 14:2–18.
11.
SticeE, YokumS. Neural vulnerability factors that increase risk for future weight gain. Psychol Bull, 2016; 142:447–471.
12.
EschenbeckH, Heim-DregerU, SteinhilberA, et al.Self-regulation of healthy nutrition: Automatic and controlled processes. BMC Psychol, 2016; 4:4.
13.
WangY, WangL, CuiX, et al.Eating on impulse: Implicit attitudes, self-regulatory resources, and trait self-control as determinants of food consumption. Eat Behav, 2015; 19:144–149.
14.
HofmannW, De HouwerJ, PeruginiM, et al.Evaluative conditioning in humans: A meta-analysis. Psychol Bull, 2010; 136:390–421.
15.
HollandsGJ, MarteauTM. Pairing images of unhealthy and healthy foods with images of negative and positive health consequences: Impact on attitudes and food choice. Health Psychol, 2016; 35:847–851.
16.
HollandsGJ, PrestwichA, MarteauTM. Using aversive images to enhance healthy food choices and implicit attitudes: An experimental test of evaluative conditioning. Health Psychol, 2011; 30:195–203.
17.
KempsE, TiggemannM, MartinR, et al.Implicit approach-avoidance associations for craved food cues. J Exp Psychol Appl, 2013; 19:30–38.
18.
PrestwichA, HurlingR, BakerS. Implicit shopping: Attitudinal determinants of the purchasing of healthy and unhealthy foods. Psychol Health, 2011; 26:875–885.
19.
CraeynestM, CrombezG, De HouwerJ, et al.Explicit and implicit attitudes towards food and physical activity in childhood obesity. Behav Res Ther, 2005; 43:1111–1120.
20.
MartyL, MiguetM, BournezM, et al.Do hedonic- versus nutrition-based attitudes toward food predict food choices? A cross-sectional study of 6- to 11-year-olds. Int J Behav Nutr Phys Act, 2017; 14:162.
21.
BernsteinIL.Learned taste aversions in children receiving chemotherapy. Science, 1978; 200:1302–1303.
22.
WilloughbyT.A short-term longitudinal study of Internet and computer game use by adolescent boys and girls: Prevalence, frequency of use, and psychosocial predictors. Dev Psychol, 2008; 44:195–204.
23.
GarrisR, AhlersR, DriskellJE. Games, motivation, and learning: A research and practice model. Simul Gaming, 2002; 33:441–467.
24.
Moyer-GuseE.Toward a theory of entertainment persuasion: explaining the persuasive effects of entertainment-education messages. Commun Theory, 2008; 18:407–425.
25.
ParisodH, PakarinenA, KauhanenL, et al.Promoting children's health with digital games: A review of reviews. Games Health J, 2014; 3:145–156.
26.
Van ‘t RietJP, AlblasEE, CrutzenRMM, et al.; The effects of active videogames on BMI among young people: A meta-analysis. In Handbook of Research on Holistic Perspectives in Gamification for Clinical Practice. NovákD, TuluB, BrendryenH, eds. Hershey PA: IGI Global; 2015, pp. 277–292.
27.
BaranowskiT, BaranowskiJ, CullenKW, et al.Squire's Quest! Dietary outcome evaluation of a multimedia game. Am J Prev Med, 2003; 24:52–61.
28.
Johnson-GlenbergMC, Savio-RamosC, HenryH. “Alien Health”: A nutrition instruction exergame using the kinect sensor. Games Health J, 2014; 3:241–251.
29.
RitterfeldU, CodyM, VordererP. Serious Games. Mechanisms and Effects. New York, NY: Routledge; 2009.
30.
BaranowskiT, BudayR, ThompsonDI, et al.Playing for real: Video games and stories for health-related behavior change. Am J Prev Med, 2008; 34:74–82.
31.
BaranowskiT, BlumbergF, BudayR, et al.Games for health for children-current status and needed research. Games Health J, 2016; 5:1–12.
32.
FaulF, ErdfelderE, LangAG, et al.G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods, 2007; 39:175–191.
33.
GreenwaldAG, NosekBA, BanajiMR. Understanding and using the implicit association test: I. An improved scoring algorithm. J Pers Soc Psychol, 2003; 85:197–216.
34.
GreenwaldAG, McGheeDE, SchwartzJL. Measuring individual differences in implicit cognition: The implicit association test. J Pers Soc Psychol, 1998; 74:1464–1480.
35.
NosekBA, GreenwaldAG, BanajiMR. The Implicit Association Test at age 7: A methodological and conceptual review. In Social Psychology and the Unconscious: The Automaticity of Higher Mental Processes. Bargh JA, ed. New York, NY: The Psychology Press; 2007, pp. 265–292.
36.
van KoningsbruggenGM, VelingH, StroebeW, et al.Comparing two psychological interventions in reducing impulsive processes of eating behaviour: Effects on self-selected portion size. Br J Health Psychol, 2014; 19:767–782.
37.
HermanCP, PolivyJ. Restrained eating. In Obesity. Stunkard AJ, ed. Philadelphia, PA: Saunders; 1980, pp. 208–255.
38.
ColeTJ, BellizziMC, FlegalKM, et al.Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ, 2000; 320:1240.
39.
Dickson-SpillmannM, SiegristM, KellerC. Development and validation of a short, consumer-oriented nutrition knowledge questionnaire. Appetite, 2011; 56:617–620.
40.
IBM SPSS Statistics for Windows. Version 22.0. Armonk, NY: IBM Corp.; 2013).
41.
CohenJ, CohenP, WestSG, et al.Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences, 3rd ed. xxviii, 703-xxviii, 703 (Mahwah, NJ: Lawrence Erlbaum Associates Publishers; 2003).
42.
Van DesselP, De HouwerJ, GastA, et al.Instructing implicit processes: When instructions to approach or avoid influence implicit but not explicit evaluation. J Exp Soc Psychol, 2016; 63:1–9.
43.
De HouwerJ.Using the Implicit Association Test does not rule out an impact of conscious propositional knowledge on evaluative conditioning. Learn Motiv, 2006; 37:176–187.
44.
MeissnerF, GrigutschLA, KoranyiN, et al.Predicting behavior with implicit measures: Disillusioning findings, reasonable explanations, and sophisticated solutions. Front Psychol, 2019; 10:2483.
45.
De HouwerJ.The Implicit Association Test as a tool for studying dysfunctional associations in psychopathology: Strengths and limitations. J Behav Ther Exp Psychiatry, 2002; 33:115–133.
46.
KoranyiN, GrigutschLA, AlgermissenJ, et al.Dissociating implicit wanting from implicit liking: Development and validation of the Wanting Implicit Association Test (W-IAT). J Behav Ther Exp Psychiatry, 2017; 54:165–169.
47.
NijsIM, FrankenIH. Attentional processing of food cues in overweight and obese individuals. Curr Obes Rep, 2012; 1:106–113.
48.
StrackF, DeutschR. Reflective and impulsive determinants of social behavior. Pers Soc Psychol Rev, 2004; 8:220–247.
49.
RobinsonTE, BerridgeKC. The incentive sensitization theory of addiction: Some current issues. Philos Trans R Soc Lond B Biol Sci, 2008; 363:3137–3146.
50.
AlblasEE, FolkvordF, AnschützDJ, et al.Investigating the impact of a health game on implicit attitudes towards food and food choice behaviour of young adults. Appetite, 2018; 128:294–302.
51.
FolkvordF, AnschützDJ, BuijzenM, et al.The effect of playing advergames that promote energy-dense snacks or fruit on actual food intake among children. Am J Clin Nutr, 2013; 97:239–245.
52.
PapiesEK, HamstraP. Goal priming and eating behavior: Enhancing self-regulation by environmental cues. Health Psychol, 2010; 29:384–388.
53.
PriceM, HiggsS, LeeM. Snack intake is reduced using an implicit, high-level construal cue. Health Psychol, 2016; 35:923–926.
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