1. Study suggests game design elements can help increase physical activity among adults

    October 17, 2017 by Ashley

    From the JAMA Network Journals press release:

    Physical activity increased among families in a randomized clinical trial as part of a game-based intervention where they could earn points and progress through levels based on step goal achievements, according to a new article published by JAMA Internal Medicine.

    More than half of the adults in the United States don’t get enough physical activity. Gamification, which is the use of game design elements such as points and levels, is increasingly used in digital health interventions. However, evidence of their effectiveness is limited.

    Mitesh S. Patel, M.B.A., M.S., of the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, and coauthors conducted a clinical trial among adults enrolled in the Framingham Heart Study, a long-standing cohort of families. The clinical trial included a 12-week intervention and 12 more weeks of follow-up among 200 adults from 94 families.

    All study participants tracked their daily step counts with either a wearable device or a smartphone to establish a baseline and then selected a step goal increase. They were given performance feedback by text or email for 24 weeks. About half of the adults participated in the gamification arm of the study and were entered into a game with their family where they could earn points and progress through levels as a way to enhance social incentives through collaboration, accountability and peer support, as well as physical activity.

    More than half of the participants were female and the average age was about 55. At the start of the trial, the average number of daily steps was 7,662 in the control group of the study and 7,244 in the group with the game-based intervention.

    During the 12-week intervention period, participants in the gamification arm achieved step goals on a greater proportion of participant-days (difference of 0.53 vs. 0.32) and they had a greater increase in average daily steps compared with baseline (difference of 1,661 vs. 636) than the control group, according to the results.

    While results show physical activity declined during the 12-week follow-up period in the gamification group, it was still better than that in the control group for the proportion of participant-days achieving step goals (difference of 0.44 vs. 0.33) and the average daily steps compared with baseline (difference of 1,385 vs. 798).

    The study notes some limitations, including ones that may limit generalizability such as all participants were members of the Framingham Heart Study, had European ancestry and needed a smartphone or a computer. Researchers also did not test the intervention’s effects in nonfamily networks.

    “Our findings suggest that gamification may offer a promising approach to change health behaviors if designed using insights from behavioral economics to enhance social incentives,” the authors conclude.


  2. Study suggests cellphone ownership may increase incidence of cyberbullying in grade school

    October 2, 2017 by Ashley

    From the American Academy of Pediatrics press release:

    Most research on cyberbullying has focused on adolescents. But a new study that examined cell phone ownership among children in third to fifth grades finds they may be particularly vulnerable to cyberbullying.

    The study abstract, “Cell Phone Ownership and Cyberbullying in 8-11 Year Olds: New Research,” will be presented Monday, Sept. 18 at the American Academy of Pediatrics National Conference & Exhibition in Chicago.

    Researchers collected survey data on 4,584 students in grades 3, 4 and 5 between 2014 and 2016. Overall, 9.5 percent of children reported being a victim of cyberbullying. Children who owned cell phones were significantly more likely to report being a victim of cyberbullying, especially in grades 3 and 4.

    “Parents often cite the benefits of giving their child a cell phone, but our research suggests that giving young children these devices may have unforeseen risks as well,” said Elizabeth K. Englander, Ph.D., a professor of psychology at Bridgewater State University in Bridgewater, Mass.

    Across all three grades, 49.6 of students reported owning a cell phone. The older the student, the more likely to report cell phone ownership: 59.8 percent of fifth graders, 50.6 percent of fourth graders, and 39.5 percent of third graders reported owning their own cell phone. Cell phone owners in grades three and four were more likely to report being a victim of cyberbullying. Across all three grades, more cell phone owners admitted they have been a cyberbully themselves.

    According to the researchers, the increased risk of cyberbullying related to phone ownership could be tied to increased opportunity and vulnerability. Continuous access to social media and texting increases online interactions, provides more opportunities to engage both positively and negatively with peers, and increases the chance of an impulsive response to peers’ postings and messages.

    Englander suggests that this research is a reminder for parents to consider the risks as well as the benefits when deciding whether to provide their elementary school-aged child with a cell phone.

    “At the very least, parents can engage in discussions and education with their child about the responsibilities inherent in owning a mobile device, and the general rules for communicating in the social sphere,” Englander said.


  3. Study suggests drivers find it harder to ignore a ringing phone than to ignore the risk

    September 19, 2017 by Ashley

    From the Queensland University of Technology press release:

    Drivers find it difficult to ignore a ringing phone but they do ignore the dangers, with a new QUT study revealing almost 50 per cent believe locating and answering a ringing phone is not as risky as talking and texting.

    The research undertaken by QUT’s Centre for Accident Research & Road Safety — Queensland (CARRS-Q) and published in the PLOS ONE journal has found locating a ringing phone, checking who is calling, and rejecting or answering the call, is the most frequent mobile phone task undertaken by drivers.

    Lead researcher Oscar Oviedo-Trespalacios said drivers did not believe that locating and answering a ringing phone was as risky as talking, texting or browsing.

    “The study of 484 Queensland drivers found 45 per cent admit to locating and answering a ringing phone, compared to 28 per cent who reported speaking on a handheld device.

    “Also concerning is that more drivers reported looking at a screen for more than 2 seconds or locating and answering a ringing phone, than they did talking on a handheld phone, texting or browsing.”

    Mr Oviedo-Trespalacios said when considering the risk of these different mobile phone tasks, most drivers underestimated the distracting dangers of passive phone use.

    Finding and reaching for a ringing phone is perceived by drivers as having a mid-range crash risk, however research has showed that this task is one of the most risky activities a driver can engage in,” he said.

    “This is because drivers are likely to adapt their driving behaviour when talking, texting and browsing, by reducing their speed, increasing their distance from the vehicle in front and scanning their environment more frequently.

    “On the other hand, a ringing mobile phone can occur at any time without giving time for the driver to adapt their behaviour and therefore increases the likelihood of a crash. “This mismatch in perception of risk is a major concern revealed by the study.”

    Mr Oviedo-Trespalacios said using a mobile phone while driving had been shown to increase crash risk four-fold.

    “Novice drivers are particularly at risk as they are more likely to drive while using a mobile phone.”

    Mr Oviedo-Trespalacios said other findings in the study included:

    • Despite the research, 12 per cent drivers still don’t believe talking on a handheld phone is dangerous
    • Drivers actively avoid police detection, with about 70 per cent admitting to being on the lookout for police when using their phone
    • Drivers keep their phones low and cover them to evade police detection
    • On a typical day, drivers are more likely to look at their mobile phone for more than 2 seconds, than they are to text or browse

  4. Study suggests playing smartphone health app aids concussion recovery in teens

    September 1, 2017 by Ashley

    From the Ohio State University Wexner Medical Center press release:

    Generally, after suffering a concussion, patients are encouraged to avoid reading, watching TV and using mobile devices to help their brains heal. But new research shows that teen-agers who used a mobile health app once a day in conjunction with medical care improved concussion symptoms and optimism more than with standard medical treatment alone.

    Researchers from The Ohio State University Wexner Medical Center and Cincinnati Children’s Hospital Medical Center collaborated on the study with Jane McGonigal of the Institute for the Future, who developed the mobile health app called SuperBetter after she suffered a concussion.

    Results of the study are published online in the journal Brain Injury.

    The 19 teens who participated in the study received standard of care for concussion symptoms that persisted beyond 3 weeks after the head injury, and the experimental group also used the SuperBetter app as a gamified symptoms journal.

    “We found that mobile apps incorporating social game mechanics and a heroic narrative can complement medical care to improve health among teenagers with unresolved concussion symptoms, said first author Lise Worthen-Chaudhari, a physical rehabilitation specialist who studies movement at Ohio State’s Wexner Medical Center’s Neurological Institute.

    The American Academy of Neurology recommends limiting cognitive and physical effort and prohibiting sports involvement until a concussed individual is asymptomatic without using medication. However, this level of physical, cognitive and social inactivity represents a lifestyle change with its own risk factors, including social isolation, depression and increased incidence of suicidal ideology, the researchers noted.

    In addition, cognitive rest often involves limiting screen stimulation associated with popular modes of interpersonal interaction, such as text messaging and social networking on digital platforms, including Facebook, Twitter, Instagram and multiplayer video gaming, thereby blocking common avenues for social connection.

    “Teens who’ve had a concussion are told not to use media or screens, and we wanted to test if it was possible for them to use screens just a little bit each day, and get the bang for the buck with that,” Worthen-Chaudhari said. “The app rewrites things you might be frustrated about as a personal, heroic narrative. So you might start out feeling ‘I’m frustrated. I can’t get rid of this headache,’ and then the app helps reframe that frustration to ‘I battled the headache bad guy today. And I feel good about that hard work’.”

    Concussion symptoms can include a variety of complaints, including headaches, confusion, depression, sleep disturbance, fatigue, irritability, agitation, anxiety, dizziness, difficulty concentrating or thinking clearly, sensitivity to light and noise, and impaired cognitive function.

    Within the SuperBetter app, symptoms were represented as bad guys such as headaches, dizziness or feeling confused, and medical recommendations were represented as power ups, including sleep, sunglasses or an academic concussion management plan. Participants invited allies to join their personal network in the app and they could view their in-app activity and could send resilience points, achievements, comments and personalized emails in response to activity.

    “Since 2005, the rate of reported concussions in high school athletes has doubled, and youth are especially at risk,” said study collaborator Dr. Kelsey Logan, director of the division of sports medicine at Cincinnati Children’s. “Pairing the social, mobile app SuperBetter with traditional medical care appears to improve outcomes and optimism for youth with unresolved concussion symptoms. More study is needed to investigate ways that leveraging interactive media may complement medical care and promote health outcomes among youth with concussion and the general population.”


  5. Signs of distracted driving: Pounding heart, sweaty nose

    August 30, 2017 by Ashley

    From the University of Houston press release:

    Distracted driving — texting or absent-mindedness — claims thousands of lives a year. Researchers from the University of Houston and the Texas A&M Transportation Institute have produced an extensive dataset examining how drivers react to different types of distractions, part of an effort to devise strategies for making driving safer.

    In a paper published Aug. 15 in the journal Scientific Data, the researchers make the dataset publicly available for the first time and describe how they collected the information.

    The study was conducted with 68 volunteers, all of whom had a valid driver’s license and normal or corrected-to-normal vision, on a driving simulator. Drivers were tracked with both thermal and visual cameras, along with palm sensors, sensors to measure heart rate and breathing rate, and an eye tracking system.

    Ioannis Pavlidis, Eckhard Pfeiffer Professor and director of the Computational Physiology Lab at UH, said the study is the first to tackle three types of distracting elementssensorimotor, such as texting; cognitive, such as absorbing thoughts; and emotional distractions.

    Texting, the researchers found, led to far more dangerous driving, while a “sixth sense” appeared to protect those suffering emotional upset or absent-mindedness. Texting interfered with that sixth sense, letting drivers drift out of their traffic lanes. The researchers reported this result in the journal Scientific Reports last year, using a subset of the data they collected.

    Additional investigation showed that “eye tracking and breathing rate proved useful metrics for measuring the impact of texting while driving,” Pavlidis said. “But that wasn’t helpful in cases of emotional or cognitive distractions.” However, he said the researchers found heart rate signals captured via wearable sensors and perinasal perspiration captured via miniature thermal imagers were able to track all forms of distraction — a result that is reported in the current Scientific Data paper.

    That and other findings provide the groundwork for future safety systems, said Robert Wunderlich, director of the Center for Transportation Safety at the Texas A&M Transportation Institute. Given the widespread use of smart watches capable of measuring heart rate, he said this result opens the way for universal sensing of all forms of distraction at the consequential source, that is, the driver’s sympathetic system.

    The potential market for interventions is huge. According to the National Highway Traffic Safety Administration, 3,477 people were killed and 391,000 were injured in motor vehicle crashes involving distracted drivers in 2015. Texas Gov. Greg Abbott signed a law banning texting while driving earlier this summer, leaving just three states that have not banned the practice.

    The experiment worked like this: Volunteers drove the same segment of highway four times in a high-fidelity driving simulator — with no distraction and with cognitive, emotional and physical distraction. They were monitored via standoff and wearable sensors, which recorded perspiration, heart rate, breathing rate, gaze and facial expressions to capture the drivers’ state as they were overloaded by multitasking.

    At the same time, the simulator’s computer recorded driving performance variables including speed, acceleration, braking force, steering angle and lane position.

    In addition to Pavlidis, authors on the paper include Panagiotis Tsiamyrtzis of Athens University of Economics and Business, who spearheaded the data analysis and validation; Salah Taamneh and Ashik Khatri of UH; Malcolm Dcosta of Elizabeth City State University; Pradeep Buddharaju of University of Houston-Clear Lake; Michael Manser and Robert Wunderlich of the Texas A&M Transportation Institute; and Thomas Ferris of Texas A&M University.

    Along with the publication of the paper in Scientific Data, the researchers released the full dataset in the Open Science Framework (OSF) databank.

    This experiment represents an emerging form of multimodal design, where an abundance of highly quantitative variables are measured continuously, providing a 360-degree view of the studied conditions. Pavlidis noted that these designs are now possible because of technological advances in wearable and imaging sensors, as well as the emergence of robust computational algorithms.

    The deluge of data such multimodal experiments produce requires sophisticated curation and complete openness, he said, not only for purposes of reproducibility but also as a means to investigate the dataset’s full potential.


  6. Consumers more likely to spend money on guilty pleasures with touchscreen technology

    August 29, 2017 by Ashley

    From the University of British Columbia Okanagan campus press release:

    You are more likely to indulge in guilty pleasures when shopping online with a touchscreen versus a desktop computer, according to research from UBC’s Okanagan campus.

    Studies conducted by Faculty of Management assistant professor Ying Zhu are shedding new light into consumer behaviour when it comes to touchscreen technology, a rapidly increasing sales technology.

    “Touchscreen technology has rapidly penetrated the consumer market and embedded itself into our daily lives. Given its fast growth and popularity, we know surprisingly little about its effect on consumers,” explains Zhu. “With more than two billion smartphone users, the use of tactile technologies for online shopping alone is set to represent nearly half of all e-commerce by next year.”

    To extend our knowledge on the touchscreen, Zhu and her co-author, Jeffrey Meyer, conducted a series of experiments with university students to measure thinking styles and purchase intentions using devices like touchscreens and desktop computers.

    The study aimed to investigate whether online purchase intentions change when it comes to two different types of products: hedonic, or those that give the consumer pleasure like chocolate or massages; and utilitarian, products that are practical, like bread or printers.

    “The playful and fun nature of the touchscreen enhances consumers’ favour of hedonic products; while the logical and functional nature of a desktop endorses the consumers’ preference for utilitarian products,” explains Zhu.

    Zhu’s study also found that participants using touchscreen technology scored significantly higher on experiential thinking than those using desktop computers. However, those on desktops scored significantly higher on rational thinking.

    “Overall, what we learned is that using a touchscreen evokes consumers’ experiential thinking, which resonates with the playful nature of hedonic products. These results may well be a game-changer for sectors like the retail industry,” says Zhu. “But my advice for consumers who want to save a bit of money is to put away the smartphone when you have urge to spend on a guilty pleasure.”


  7. The importance of influencers on social media

    August 26, 2017 by Ashley

    From the Inderscience Publishers press release:

    Tracking the Twitter updates of a random sample of 300,000 active users over the course of a month reveals that this particular corner of social media and social networking is not quite as equitable and democratic as popular perception might have us believe. Indeed, the research published in the International Journal of Internet Marketing and Advertising reveals that there is a two-step flow of information through which a minority of users accounts for the majority of influence. Opinion leaders follow other opinion leaders and effectively form a community of influencers within the wider user base and the information they disseminate then follows a power-law distribution as everyday users share, retweet and reuse that information.

    Harsha Gangadharbatla of the Department of Advertising, Public Relations and Media Design, College of Media, Communication and Information, at the University of Colorado, Boulder, Colorado, and Masoud Valafar a software engineer at Twitter, in San Francisco, California, USA, explain that there are numerous theories about how information is disseminated and how “word-of-mouth” works to influence popular opinion and consumer decision making. There have also been many studies into how the media and social media influencing individuals and groups.

    One such theory is known as two-step flow theory. This says that most people form an opinion about a given subject when they are exposed to the views of opinion leaders. Those opinion leaders themselves are influenced by the mass media. This is in contrast to the one-step flow theory, colloquially known as the hypodermic needle, or magic bullet theory, in which people are directly influenced by mass media. Obviously, people are constantly exposed to the mass media at the individual level whether that is television, radio, newspapers or the web. But, the researchers suggest that opinions are actually more likely to be formed second hand in a two-step process. This is especially true of opinions shared on social media but might also apply to the influencers in traditional media — TV pundits, newspaper and magazine columnists, and the like.

    It has been claimed that with the wave of new media in the form of Youtube, Twitter, Instagram, and other so-called Web 2.0 sites democratization of information and influence occurred. Gangadharbatla and Valafar suggest that this may not be the case, at least in the Twitter context. Social media is changing radically the way users and consumers receive information, news, opinion, but as with the old vanguard, there still exists the big influencers. These people or organizations, which might include information hubs and news outlets, pressure groups, and even celebrities, act as the primary source of information and opinion.

    “Our study suggests that the way information propagates on social media is not all that different from that of traditional media. In other words, even on supposedly democratic and gatekeeper-less environments like Twitter and Instagram, information propagates mostly through opinion leaders, and, more so, these opinion leaders are all connected to other opinion leaders on the medium resulting in a virtual community of opinion leaders that yield a strong influence on how and how fast information spreads on social media,” the team reports. In the business context, the team adds that their, “results suggest that targeting this virtual community of opinion leaders will be a more effective use of advertising dollars than reaching the masses on Twitter.”


  8. Study suggests Pokémon Go may actually promote healthier lifestyle

    July 26, 2017 by Ashley

    From the Kent State University press release:

    Today marks the one year anniversary of Pokémon GO’s worldwide release that sent crowds hiking through parks, meandering into streets and walking for miles in search of Pokémon, those cute little digital characters that appear in real locations on your smartphone.

    Capturing the little monsters isn’t just fun for the players, it might be good for their health. Too often we sit at a desk all day, spend countless hours in the car, and with a smartphone glued to our hands it is too easy to spend our free time watching videos, playing games and browsing the internet. Such sedentary behaviors cause us to sit more and exercise less.

    However, Kent State University researchers found that playing a popular physically-interactive, smartphone based game, like Pokémon GO, may actually promote exercise.

    Jacob Barkley, Ph.D., Andrew Lepp, Ph.D., and Ellen Glickman, Ph.D., from Kent State’s College of Education, Health and Human Services assessed the ability of the popular, physically-interactive, smartphone based video game Pokémon GO to increase walking and decrease sedentary behavior, like sitting. Over 350 college students reported their physical activity and sedentary behavior the week before they downloaded Pokémon GO, the week immediately after downloading the game, and again several weeks later.

    Results show that, relative to the week before downloading Pokémon GO, students doubled their daily walking behavior (102 percent increase) and reduced sedentary behavior by 25 percent during the first week after downloading. When comparing behavior several weeks after downloading Pokémon GO, to the week before downloading, walking and sedentary behavior was still 68 percent greater and 18 percent lower, respectively, even though frequency of game play decreased by 58 percent.

    “While the largest increases in walking and decreases in sitting occurred during the first week after downloading, when the game was new to the user, those positive effects largely persisted weeks later,” Barkley said. “It is possible that games like Pokémon GO may help people initiate a positive health behavior change, such as more daily walking and less sitting.”

    The researchers suggest that while many smartphone functions may promote sedentary activity, they are hopeful that playing physically-interactive, smartphone based video games like Pokémon GO may help promote walking and reduce sitting in college students.

    The study is published in the Games for Health Journal.


  9. Study looks at manifestations of jealousy at online infidelity

    July 24, 2017 by Ashley

    From the Springer press release:

    When men and women find social media messages indicating that their partner has been cheating on them, they show the same type of jealousy behaviour as finding offline evidence that their partner has been unfaithful. This is according to Michael Dunn and Gemma Billett of Cardiff Metropolitan University in the UK, who investigated how jealousy manifests between the sexes when people find compromising messages on their partner’s social media accounts. The findings are published in Springer’s journal Evolutionary Psychological Science.

    As part of the study, 21 male and 23 female undergraduate students were shown imaginary Facebook messages in a Facebook format, revealing that their partners had been either emotionally or sexually unfaithful. Eight short messages along the lines of: “You must be my soulmate! Feel so bloody connected to you, even though we haven’t slept together,” (Emotional infidelity) and “You must be the best one-night stand I’ve ever had. Last night was out of this world sexy bum!” (Sexual infidelity) were shown to participants. The so-called “discovered” message was either composed and sent by the participant’s partner, or came from someone else. Participants had to rate how distressed they would have felt if they had come across such messages while accessing their partner’s Facebook messaging service without permission.

    Men felt more distressed when they read social media messages that revealed their partners’ sexual rather than emotional infidelity. However, women were more upset than men in response to emotional messages. The researchers also found that women were significantly more upset when a potential rival had written the message, compared to when it was composed by their own partners. For men, the opposite seemed to be true and they appeared to be more upset by imagining their partner sending rather than receiving an infidelity-revealing message. Irrespective of the contents, women overall were more upset than men when they had to imagine discovering an infidelity-related message.

    The study supports evolutionarily derived theories that hold that there are differences in what triggers jealousy among men and women, and in how they subsequently direct such feelings towards the cheating partner or the potential rival.

    According to the researchers, it is important to understand the mechanisms underlying jealousy, and how it plays out in the digital age. Real or suspected partner infidelity that causes sexual or emotional jealousy is often given as the reason for domestic abuse and violence.

    “Applying an evolutionary perspective to understanding the manifestation of jealous behaviour and how infidelity-related anger can trigger partner dissolution and domestic abuse may help counteract inevitable rises in such behaviours in an age where clandestine extra-marital relationships are facilitated by modern forms of media technology,” explains Dunn.


  10. Study identifies four categories of Facebook users

    by Ashley

    From the Brigham Young University press release:

    On an average day, 1.28 billion people check it. Monthly? Nearly 2 billion. And according to one recent estimate, the average Facebook user spends 35 minutes a day on the platform — which makes for a whole lot of daily and monthly minutes.

    In a recently published study, a trio of Brigham Young University communications professors explores why.

    “What is it about this social-media platform that has taken over the world?” asked lead author Tom Robinson. “Why are people so willing to put their lives on display? Nobody has ever really asked the question, ‘Why do you like this?'”

    Based on subject responses, the research team identified four categories of Facebook users: relationship builders, town criers, selfies and window shoppers.

    Relationship builders post, respond to others’ posts and use additional Facebook features primarily in an attempt to fortify relationships that exist beyond their virtual world. “They use it as an extension of their real life, with their family and real-life friends,” Robinson said. People in this group identified strongly with such statements as “Facebook helps me to express love to my family and lets my family express love to me.”

    Town criers, on the other hand, experience a much larger gap between their real and virtual worlds. Unconcerned with sharing photos, stories or other information about themselves, they instead “want to inform everybody about what’s going on,” Robinson said. Like town criers from days of yore, “they’re pushing out information.” They repost news stories, announce events — but may otherwise neglect their profile pages, preferring to update family and friends through alternative means.

    Selfies use Facebook to self promote. Like relationship builders, they post pictures, videos and text updates — but unlike relationship builders, they’re focused on getting attention, likes and comments. Study participants in this category identified highly with the statement “The more ‘like’ notification alarms I receive, the more I feel approved by my peers.” Selfies, said study co-author Kris Boyle, use the platform “to present an image of themselves, whether it’s accurate or not.”

    Window shoppers, like town criers, feel a sense of social obligation to be on Facebook but rarely post personal information. Unlike town criers, these users, said study co-author Clark Callahan, “want to see what other people are doing. It’s the social-media equivalent of people watching.” Window shoppers identified with such statements as “I can freely look at the Facebook profile of someone I have a crush on and know their interests and relationship status.”

    For this study, the researchers compiled a list of 48 statements identifying potential reasons people use Facebook. Subjects sorted the statements in a way that reflected their personal connection to the ideas, then rated each statement on a scale from “most like me” to “least like me.” Finally, the researchers interviewed each subject to get a deeper understanding of their rankings and ratings.

    Though previous Facebook-related research has explored users with relationship-builder and selfie characteristics, Robinson said, the town criers and window shoppers were an unexpected find. “Nobody had really talked about these users before, but when we thought about it, they both made a lot of sense.”

    Facebook users may identify to some degree with more than one category — Boyle noted that most people have at least some selfie tendencies, for example. But users typically identify more with one than others. “Everybody we’ve talked to will say, ‘I’m part of this and part of this, but I’m mostly this,'” said Robinson, who calls himself a relationship builder.

    So what’s the value in the label?

    “Social media is so ingrained in everything we do right now,” Boyle said. “And most people don’t think about why they do it, but if people can recognize their habits, that at least creates awareness.”