This data paper describes a compilation of 73,075 quantitative diet data records for 759 primarily North American bird species, providing standardized information not just on the diet itself, but on the context for that diet information including the year, season, location, and habitat type of each study. The methods used for collecting and cleaning these data are described, and we present tools for summarizing and visualizing diet information by bird species or prey. Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.15088245 One exception is the effort by the United States Department of Agriculture in the early twentieth century to quantify the stomach contents of over 100 North American bird species, identifying prey items to species where possible10. Nevertheless, these data are often reported in verbal summaries, and the taxonomy of both birds and prey items is in many cases outdated.Diet is one of the most fundamental aspects of an organism’s ecology, and a knowledge of diet is required to better understand connections within food webs, potential determinants of population size and distribution, and potential conservation threats. For birds, existing compilations exist that classify diet broadly into categories such as insectivore, omnivore, and frugivoreThis data paper describes a compilation of 73,075 quantitative diet data records for 759 bird species, providing standardized information not just on the diet itself, but on the context for that diet information including the year, season, location, and habitat type of each study. While the species in this compilation are primarily from North America, this dataset will continue to grow and may expand in geographic coverage in the future. Below we describe our procedures for identifying datasets, standardizing those data, and conducting quality control and quality assurance checks.11  species account. In addition, we performed literature searches on Google Scholar and Web of Science using the keywords “[common name] AND (diet OR foraging OR food)”, replacing [common name] with the name of the bird species under investigation. For Anseriformes, studies were located using Google Scholar searches and Birds of North America species accounts, as described previously, in addition to ornithology handbooks14.We searched the literature for studies with quantitative data on diet. For North American bird species, we examined every citation we could access from the “Diet and Foraging” section of each relevant Birds of North AmericaFor each species for which quantitative diet data were found, we recorded details surrounding the study as described in Online-only Table Some studies reported a non-zero, or “trace”, amount of a particular prey type in the diet, or reported an upper bound . In these cases, we entered a value of half of the lowest reported numeric diet fraction, or half of the upper bound. For example, if a study calculated that the prey item with the lowest representation in the diet that was still represented numerically was 0.014, and another prey item was reported as “trace”, that trace item would be entered as having a diet fraction of 0.007.In some cases, researchers reported diet fractions for plant and animal portions of the diet separately . When possible, we used reported sample sizes of each diet portion to recalculate values that reflected the prevalence of those items in the diet as a whole.15. Species names as used in older published studies that did not match any names in the most recent Clements/eBird checklist at the time of data entry were searched in the online database AviBase (https://avibase.bsc-eoc.org/) which has features that allow one to map old names onto current taxonomic concepts. While simple name changes (e.g. genus Dendroica changing to Setophaga) were straightforward to incorporate, taxonomic splits were more complicated. For example, “Western Flycatcher” Empidonax difficilis was split into two species, Pacific-slope Flycatcher which retained the original scientific name, and Cordilleran Flycatcher, Empidonax occidentalis. Where possible, we used the geographic location of the study to determine which of the two split species was likely being referred to by the original study. When this was not possible due to range overlap of the two split species, the name would be reported as, for example, Pacific-slope/Cordilleran Flycatcher and Empidonax difficilis/occidentalis. In the case of taxonomic lumps, the relevant subspecies was listed for formerly distinct species when possible.Bird taxonomy in the database follows the 2019 Clements/eBird Checklist16, while the latest unofficial version to which new studies are continually added can be found in the AvianDietDatabase.txt file on Github (https://github.com/hurlbertlab/dietdatabase). Each record corresponds to a trophic link between one bird species and one prey taxon, along with the metadata detailing the location, date, habitat, and strength of this observation as characterized by the fields described in Online-only Table The latest official release of the database can be found in the file AvianDietDatabase.txt archived on Zenodo15. 2) Data fields for which numeric values were expected were checked to ensure that values were indeed numeric, and potential outlier values were flagged based on accepted ranges of values for each field  Bird common names, scientific names, and family names were checked against the 2019 Clements/eBird checklisthttps://www.itis.gov) taxonomy where possible. If the reported prey name did not match any ITIS taxonomic concept, then it was entered into the Global Names Resolver  to see whether it matched an outdated name that could be mapped to a current taxonomic concept in ITIS. We list the ITIS taxonomic serial number in the Prey_Name_ITIS_ID field and report the Prey_Name_Status as “verified” when a prey name was successfully matched to a concept in ITIS. Some names had no match in ITIS, but were regarded as valid taxonomic concepts by other authorities . In such cases, the Prey_Name_ITIS_ID was assigned ‘NA’ and we reported the Prey_Name_Status as “accepted”.We recorded the names of prey items with as much taxonomic resolution as the original study allowed, following the Integrated Taxonomic Information System ”) allowing us to specify an inclusive suborder designation.https://aviandiet.unc.edu where users can enter a bird species name to explore a summary of diet information known for that species, or a prey name to explore which bird species are known to eat that prey taxon. We also provide an R package (‘aviandietdb’) for exploring the database, which should be loaded in R by typing:In addition to the raw data, we provide two means of exploring the Avian Diet Database and extracting species- or prey-specific summaries. The first is through the website install.packages("devtools")library(devtools)devtools::install_github("ahhurlbert/aviandietdb")library(aviandietdb)Three useful R functions for summarizing records in the database are detailed below.dbSummary.Example usage:dbSummaryThis function returns the total number of database records, the unique number of bird species, and the unique number of publications summarized in the Diet Database. In addition, it provides a tally of the number of records by bird species listed in alphabetical order, as well as a summary for each bird family in the American Birding Association (ABA) Checklist (version 8.0.6a) of 1) the number of species in the family in the database, 2) the total number of species in the family based on the ABA checklist, and 3) the percent of the family represented based on the species expected in North America. This information on taxonomic coverage is also provided in Online-only Table speciesSummary.Example usage:speciesSummaryThis function provides a summary of the total number of records and total number of studies available in the database for this species, along with a summary of how those records are distributed across seasons, years, and geographic regions. The number of records are also summarized by taxonomic level to which prey were identified and by analysis type . Finally, for each analysis type, the mean fraction of diet is given for each prey category at the hierarchical taxonomic level specified with the “by” argument. This is an overall mean, averaged across year, region, and season. If the original data source indicated that specific parts of the prey taxon were consumed  then they are listed in the Prey_Part field.dietSummary.Example usage:dietSummary, by = "Order", dietType = "Items")This function allows one to specify season, region, a year range, analysis type, and taxonomic level for prey summarization, and then provides the mean fraction of diet information based on all studies meeting the stated criteria.dietSummaryByPrey.Example usage:dietSummaryByPrey, season = "summer", preyStage = "larva", speciesMean = TRUE)preyLevel) of that name. Like dietSummary, this function allows one to specify season, region, a year range, and analysis type. There are two additional arguments not present in dietSummary. One is preyStage, which specifies the life stage of the prey item (if applicable) for which a summary should be conducted. By default (‘any’), diet records will be included regardless of prey stage. Alternatively, one can specify that the summary should only be conducted for records including the terms ‘larva’, ‘adult’, or ‘pupa’ in the Diet Database’s ‘Prey_Stage’ field. This is most relevant for Lepidoptera and a few other insect groups, where one might want to single out the importance of caterpillars or other larvae, for example.This function provides a list of all bird species that consume a particular prey taxon in decreasing order of importance. In addition to providing the prey taxon name, you must also specify the taxonomic level .Example code and output is available in the Github README.md document (


The findings support hypothesised mediators of PA in children including self-efficacy, enjoyment, perceived benefit, and social support. Fewer than a quarter of all children were aware of the PA guidelines with varying explanations, while the majority of children perceived their own fitness to be high. Variances also emerged between important barriers  and facilitators  for children from smoking and non-smoking households. This unique study provided a voice to children from low SES and smoking households and these child perspectives could be used to create relevant and effective strategies for interventions to improve PA, fitness, and health.Previous research has shown secondhand tobacco smoke to be detrimental to children’s health. This qualitative study aimed to explore children from low socioeconomic status (SES) families and their reasons for being physically active, attitudes towards physical activity (PA), fitness and exercise, perceived barriers and facilitators to PA, self-perceptions of fitness and physical ability, and how these differ for children from smoking and non-smoking households. A total of 38 children  from the deprived areas of North West England participated in focus groups ( Cardiorespiratory fitness (CRF) is a health-related component of physical fitness defined as the ability of the circulatory, respiratory, and muscular systems to supply oxygen during sustained physical activity . CRF is Deeper understanding of low SES children’s perceptions, barriers, and facilitators of CRF and PA could be helpful in designing intervention and policy strategies. The literature regarding barriers and facilitators to children’s participation in PA ,19,20 haArticle 8 of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) states that individuals have a right to a tobacco smoke-free environment . Since tChildren from low-SES households are more likely to be exposed to secondhand smoke (SHS) ,43 and cWhen it comes to understanding the experiences and views of children, children are the experts with their own unique perspective of the world . Qualita(RQ1) What are the reasons that children from smoking and non-smoking households have for being physically active?(RQ2) What are the attitudes that children from smoking and non-smoking households have towards physical activity, exercise, and fitness? (RQ3) What are the perceived barriers and facilitators to a child’s ability to be physically active and does this differ for children from smoking and non-smoking homes? (RQ4) What are the children’s perceptions of their own fitness and physical ability and does this differ for children from smoking and non-smoking homes?This research was granted ethical approval by the University Research Ethics Committee (Ref: 16/PBH/001) and follows the Consolidated Criteria for Reporting Qualitative studies checklist . The stuParticipants were targeted as being aged 9–11 years old and in year 5 or 6 at a state-funded primary school within two metropolitan boroughs in North West England. This age group was targeted since evidence from North West England has reported low fitness among primary school children  and therAfter receiving written informed gatekeeper consent from headteachers, presentations were given at the participating schools to provide information to the children about the research and to invite children to take part. Information packs, including parental questionnaires, parental consent forms, and child assent forms were given to children to take home to parents and guardians. One-hundred and five children returned parental consent and child assent and those were eligible to take part in the wider programme of research (26.5% response rate from invited families). p = 0.721).Questionnaires intended to determine self-reported household smoking status, using items from the Global Adult Tobacco Survey (GATS) by the Global Adult Tobacco Survey Collaborative Group , were seParticipant (adult and child) demographic information and child medical history were obtained via the parental questionnaire. Household deprivation was assessed via the EIMD using participant home postcode and the Ministry of Housing, Communities, and Local Government postcode lookup tool .n = 4), two focus groups were held: one with children from non-smoking households; and another with children from smoking households. Parental surveys used in the initial phase of the research  help you in your future” (B10B/NS). However, children from smoking homes did not discuss fitness being important for the future. Although not constituting a major theme, self-esteem was discussed by children from both exposure groups . Children reported fitness was important because “…you get more confidence from it [fitness]” (G18D/S) and “It’s [fitness] important to me because you could get bullied and stuff because you’re not fit…” (B7B/NS).All participating children believed that it is important to be physically fit and statements from the participants indicate that children conceptualise fitness more widely than only cardiorespiratory fitness. For example, one child noted that a ‘fast’ child must exercise a lot, “If someone’s faster than me, then I think that they must be doing a lot of exercise.” (B1A/NS). A higher order theme generated for why children believed physical fitness to be important was capability  and weight status . Children from non-smoking homes were more likely to report reasons surrounding the health benefits (n = 7): “Because it’s [fitness] good for your body and your bones and stuff” (G8B/NS), whereas children from smoking homes did not discuss the health benefits directly. Fitness was important to children from smoking and non-smoking homes for reasons linked to weight status (n = 5), with children from both groups relating fitness to fatness.The theme of health benefits of fitness constituted two minor themes including general health .n = 17, 45%), which is a theme constituted of two sub-themes  and sports . In terms of intensity for improving or maintaining CRF, some children stated that they should build up the exercise intensity throughout the activity . For example, “I think we [children] should start at quite light, and then like build up” (G3A/S). Some children believed they should work hard throughout , “Hard [exercise intensity], so… like 100%” (G1A/NS) and some stated they should put ‘medium’ effort in , whereas some children believed they should work as hard as they feel like at the time , “I feel how much I want to do. If you don’t want to do that much that day, don’t do that much.” (B3A/NS). Increasing exercise frequency and intensity were the most common themes discussed by children from non-smoking homes (n = 10) and smoking homes (n = 5).Children believed they could improve their fitness by increasing their level of PA . Children often commented on how going outdoors could improve their fitness. For example: “Going to the park, going out for walks, runs, going on my scooter” (B4A/S). When discussing going outdoors, children often expressed parental restriction due to safety concerns as a limiting factor, for example, “[Adults should] let you go outside all the time, even if it’s raining or anything” (G11C/NS). One participant spoke about how she was often grounded but could improve her fitness by going outside more.Getting outdoors to improve fitness was a major theme generated from the responses from both groups of children  was developed which included three sub-themes: parental support , friends , and dogs . Both groups referred to the importance of friends in improving fitness. However, only children from smoking homes discussed dog ownership, whilst only children from non-smoking homes discussed parental support as a method that they could improve their fitness: “Because Mum and Dad can drive, they can take me out places where I can get fit” (B11C/NS).A theme of significant for others  was considered an important factor for improving fitness by children, with more children from non-smoking homes (n = 4) discussing diet than children from smoking homes (n = 1). One girl explained how, in order to improve her fitness, she might change her diet with the involvement of her parent, “I would say to my Mum, I’m not having any like carbs or junk for maybe two months or something” (G8B/NS).A good diet , but one girl from a smoking household noted how no one in the house uses the treadmill, “But we’re getting rid of [the treadmill] soon. Only the dog uses it” (G4A/S).A second minor theme generated by the responses of children was centred around the provision and availability of equipment, for example, the ownership of bicycles, scooters, trampolines, and treadmills. Some children stated that having a treadmill at the home allowed them to increase their fitness , including screen time  and other general sedentary behaviours . Screen time was described to be a major factor preventing children from being physically active, for example: “If my sister didn’t go to school, she would spend all day in bed, literally, watching YouTube” (B12C/S) and “I’m always on my laptop. That’s all I’m ever on at home” (B7B/NS).Children identified a range of factors which limited their ability to be physically active . The majn = 8, 21%), which was linked to two sub-themes which are money  and time . Children from non-smoking homes were especially concerned with the amount of free time they had available to be active, particularly due to commitments to organised activity clubs outside of school. Money was discussed as a limiting factor by children from both exposure groups in terms of requiring money to pay for various physical activities.A second higher order theme of resources was generated . A negative psychological state, for example feeling lazy or tired, was believed by the children to be a limiting factor relative to their ability to be physically active as they were less motivated to do so.Psychological factors were a theme generated from the responses from both groups of children as a factor which limits a child’s ability to be physically active  were noted as barriers and consisted of two subthemes: dietary habits  and health and injury . The latter was discussed by both groups of children, whilst nutritional factors were only discussed by children from non-smoking homes. Environmental barriers  to activity, consisting of school  and transport , were reported by both agroups and particularly with regard to the sedentary nature of school-work and homework.Physiological factors  that facilitate their ability to be physically active , health , and sleep . Children from non-smoking homes more frequently talked about health and diet compared to children from smoking homes who more often reported sleep as important factor facilitating their ability to be physically active.Children commonly discussed the physiological factors , which consisted of four sub-themes: friends , adults , siblings  and dog ownership . Friends was an important factor for PA facilitation for children from both smoking (n = 3) and non-smoking households (n = 3). Children from smoking households more frequently mentioned the influence of adults (n = 4). For example, ‘Well, my Mum helps me be active. Well, when I ask if I can play out, she’s like, “Just get out”…’ (G14C/S). Dog ownership was referred to as a factor facilitating PA with children from non-smoking households only (n = 3).A theme of significant others was generated  was a theme generated from responses of children from both smoking and non-smoking households, with participation in various clubs and different types of physical activities noted. Although it did not constitute a theme, one child noted that being active from a young age would encourage PA later in life: “Like if you be really active when you’re little, then you can grow up to be more active. Like you want to be active then.” (G6B/NS).Opportunity for physical activity , with children from non-smoking homes (n = 6) and smoking households (n = 3) describing positive attitudes such as ‘determination and commitment’ (B3A/NS) and ‘when you’re energised.’ (G4A/S).Psychological factors were also discussed positively in relation to factors which facilitate a child’s ability to be active  was generated which consisted of outdoors  and transport . Outdoors was a factor only discussed by children from non-smoking homes, e.g., “…like say if you were playing out or something. You could play tag and that’ll give you exercise and things.” (G7B/NS). Transport was discussed by both children from smoking homes .A theme of environment (n = 14) and non-smoking households (n = 10) commonly identified parents as positive influences on their ability to be physically active   for children from smoking  and non-smoking homes . Other family members including siblings were identified as positive influences on PA by children  of non-smoking (n = 3) and smoking homes (n = 1). Coaches and teachers were identified as positive influences by children from non-smoking households only , whereas friends of family were identified as positive influences by children from smoking homes only .Children from smoking  . Less frn = 21, 55%), instruction , encouragement , and restriction . Provision was split into two sub-themes, which are logistical and financial support , and these describe the provision of financial and logistical support for participation in sports clubs, training, and organised activities; and provision of opportunities for PA , which describes physical activities which are not part of sports clubs or regular training. Children from smoking  and non-smoking homes  often commented on how adults facilitate organised PAs through logistical and financial means, for example, “[Adults] take you to football training.” (B2A/NS). Children from smoking homes discussed provision of opportunities for PA  more frequently than children from non-smoking homes : “My Mum and Dad normally walk me round the block and all that, and then sometimes I go on a bike ride with my Dad.” (G4A/S).Four higher order themes were generated in response to the discussion about how adults influence children’s ability to be physically active including provision , for example, “My bother goes to 5Fit and makes me want to go” (B7B/NS), whereas children from smoking homes did not discuss encouragement. Rather, children from smoking homes discussed instruction from adults , as did children from non-smoking homes . Children described how parents (in both smoking and non-smoking homes) will give instructions to be more physically active, for example, “My Mum will tell me to go outside and have a play outside instead of sitting in.” (G4A/S) and “My mum tells me to go on a run with my sister, or if she doesn’t do that, she tells me to take the dogs.” (G15D/NS).Children from non-smoking homes described how encouragement from adults helped them to be physically active  and safety . Children from both groups reported that grounding as a punishment limited their ability to be physically active. One child from a smoking home also reported that parental concerns for safety prevented him from being physically active, whilst another child reported that they were not always able to go places to be physically active for logistical reasons, “I have to stay at home because there’s not enough room in the car.” (G13C/S).The theme of rules and restrictions was comprised of two sub-themes: grounding (p = 0.925). While only 6% (n = 1) of children from non-smoking homes rated their own fitness at the maximum level (10 out of 10), 21% (n = 3) of children from smoking homes rated their own fitness at the maximum level. Two children from smoking homes rated their own fitness as 1, whereas the lowest score provided by the children from non-smoking homes was 2.Children were asked, “How physically fit do you feel, on a scale of 1–10? With 1 being not very fit at all, 10 being the fittest you could be.” The median self-perceived fitness score given by children from non-smoking homes was 8.0 (range 2–9) and 8.0 (range 1–10) for children from smoking homes  and the majority girls  from smoking homes rated running as the hardest activity with descriptions such as “Running, it’s kind of hard because it tires me out” (B4A/S) and “I just don’t like running” (G5A/S). Boys and girls from non-smoking homes did not rate running as the hardest, but most commonly rated gymnastics  and monkey bars , respectively, as the hardest activities. Children were provided with five photographs  and one boy (non-smoking household) are listed below.Participant G4A/S explained her choices in the following:“Walking a one, swimming a two, running a five or a six, gymnastics a three, and the park a four. Walking’s easy because it’s everyday stuff. Swimming, I’ve been swimming since I was three and a half, so it’s kind of in my blood. Gymnastics, I’ve done that for a few years, so it’s like easy. The park, I go to the park all the time with my little brother and my Mum, my Dad and my dog. And running, I just don’t like running.” (G4A/S).Participant B15D/NS explained his choices in the following:“Walking easy, swimming, I find that just easy. Monkey bars are easy as well. Running is like easy at the start, then at the end gets harder. Crab, I can’t do that at all.” (B15D/NS).When asked at which intensity on the PCERT scale the children would prefer to work at during physical activity, most children expressed that they prefer to work hard. The median preferred an intensity of 7 (range 4–10) and 10 (range 3–10) for children from non-smoking homes and smoking homes, respectively. Four children from smoking homes said they would prefer to work at an intensity of 10 out of 10, compared to only one participant from a non-smoking home. Many children commented that they would prefer to work at a range of intensities, “I would prefer to go there [10 out of 10] until I’m all tired out, and then I can just go down to one.” (B13C/S). One participant provided a reason for her choice of 9 out of 10: ‘I would say a nine because if it’s a ten, it [PCERT scale] says “so hard you’re going to stop”. You don’t want to stop, because then you don’t do nothing. But nine’s really, really, hard, so you’re working as hard as you can.’ (G3A/NS).This study aimed to explore attitudes, thoughts, beliefs, and perceptions surrounding physical activity and fitness of low SES children from smoking and non-smoking homes using interactive qualitative methodologies. The results demonstrate similarities and differences for children from smoking and non-smoking homes. Children noted that taking part in PA for reasons linked to positive feelings, social influence, and perceived benefit. Children from non-smoking households also noted that they took part in PA for reasons linked to perceived competence. Fitness was important to children from non-smoking households for health, performance, and future benefit, whereas children from smoking households believed fitness was important to them to avoid negative physiological consequences. Children believed more physical activity, significant others, the outdoors, active equipment, and a good diet could assist them in improving their fitness. The perceived barriers and facilitators to PA were centred around psychological factors, physiological factors, significant others, the environment, resources, sedentary behaviour, and opportunity for PA. The majority of children perceived their CRF to be higher than their actual CRF level. Variances were observed for the ranking of physical activities by difficulty between boys and girls, and exposure group. A handful of themes, including significant others, opportunity for PA, health, and the outdoors, were found to be especially significant to participants and the overlap of these themes was apparent across the research questions.When prompted to describe physical activity in three words, the most common words used by both groups of children included sports, football, running, and swimming. This finding may reflect the sports of the UK national curriculum for key stage 2 , with 68The findings support the main hypothesised mediators of physical activity in children: self-efficacy, enjoyment, perceived benefits , and socChildren from both smoking and non-smoking homes identified reasons for participation related to fun and enjoyment, but only children from non-smoking homes mentioned ‘feeling good’. For example, participants from non-smoking homes described positive feelings they get from swimming “…you feel good after you’ve been swimming” (B7B/NS) and cycling “I like the feeling of being able to go really fast really easily” (B17D/NS). Social Cognitive Theory  identifiChildren also reported taking part in PA for reasons linked to autonomous forms of extrinsic motivation through perceived benefits such as activities, including health and exercise, and to learn skills and techniques. Overall, these findings align with O’Dea , who fouA theme of competence, which consisted of ability and prior experience, was developed from the responses of children from non-smoking households only. Competence motivation theory states that individuals are driven to engage in activities to demonstrate their skills and high perceptions of competence results in increased competence motivation . ReasonsTwenty four percent of participants stated that children should participate in 60 min of PA per day. The current UK guideline for youth PA states children should do at least an average of 60 min MVPA per day . TherefoFitness was important to all participating children but there were similarities and differences between the two exposure groups as to why fitness is important. The most common reason centred around capability, which was made up of physiological consequences, performance, and future capability, with the latter two being more important to children from the non-smoking household group. The theme of future capability encompassed children’s beliefs that being fit would benefit them as adults including in their careers: “because when I’m older I want to be an actress, and I want to be able to do a lot of stunts” (G2A/NS) and in family life: “So when you’re an adult and you have kids, and you take them out and make sure they’re fit as well” (G12C/NS). Children may be reflecting on what they have seen and heard from influential adults in their lives, including parents and teachers. The children are also showing evidence of ‘future thinking’  and an eChildren from non-smoking homes described health reasons for why fitness was important: ‘Because it’s good for your body and your bones and stuff,” (G8C/NS), but for children from smoking homes this was often centred around weight status. Perceptions that fitness is the absence of being overweight has been found in previous research with children , whose rChildren from non-smoking homes also felt fitness was important to them for reasons relating to performance (in PA and sport), whereas children from smoking homes were more concerned with the physiological consequences of fitness. The variation may be explained by differing levels of fitness between the two groups. The children from smoking households have lower CRF  and wereThere was consensus across both exposure groups about how they could improve their fitness, with slight differences in individual, social, and environmental factors . OverallChildren from both groups identified individual factors such as diet and weight for improving fitness, which suggests children are thinking about physical fitness rather than CRF only. A US study with similar age groups found that most children did not usually think about food choices . ChildreChildren identified parents, friends, and dog ownership as social factors for improving fitness. Interestingly, only children from smoking homes identified dogs as a method of improving their fitness , whereas only children from non-smoking homes identified parents. Yet the reverse finding is apparent when children were asked about facilitators for PA see . ParentsFor environmental factors, often the two ideas of more PA and spending time outdoors would go hand-in hand, for example, “Getting outside more and start being more active” (G9B/S). To improve their fitness, children’s recommendations are to be more physically active and spend more time outdoors. These suggestions are sensible as time spent outdoors is positively associated with MVPA ,102,103 The availability of equipment, for example, bicycles, scooters, treadmills, and trampolines, were often referred to by children from both smoking and non-smoking homes. According to Dumuid  possessiAs a number of factors were described as both facilitators and barriers of PA by the participants, such themes are discussed in conjunction below. For example, psychological factors were discussed positively as facilitators, such as ‘feeling motivated’, as well as negatively as barriers, e.g., ‘being in a bad mood’. Psychological status appeared to be an important facilitator and barrier to both groups of participants, which is a finding that is consistent with previous research in youth . IntrinsParticipants believed that opportunities for PA, for example taking part in sports, facilitated their ability to be active. In a similar study in the US which utilised focus groups to explore perceived barriers and facilitators for PA, accessibility to PA was found to be a major barrier as parents and children voiced concerns that there was little access to PA opportunities . Taking In addition to sports, participants often referred to unstructured opportunities for PA such as running, walking, cycling, and playing with friends. Brockman et al.  found thIntervention strategies to improve PA in children should therefore be population and context specific. As participants from non-smoking households appeared to have access to structured PA, interventions could focus on the provision of structured opportunities for PA to low-SES families, perhaps through the provision of sport participation vouchers as described above. The theme of the environment was made up of facilitators (transport and the outdoors) and barriers (transport and school). Children discussed the need for transport to get to places where they can participate in PA. Lack of transport was raised as barrier by one participant from a smoking household and is identified by low-SES groups in previous studies . There iAlthough not discussed as a facilitator by children from smoking homes, a theme of outdoor play was developed from the responses of children from non-smoking households. Access to outdoor space is a correlate of PA  and incrSignificant others, consisting of friends, adults, siblings, and dogs, were important facilitators for participating children, although dogs and siblings were only noted by children from non-smoking households and adults more frequently by children from smoking households. The provision of social support from significant others has been found to be a significant facilitator for children’s PA ,133,134.Hohepa et al.  argued tScreen time was highlighted as a significant barrier by children from both smoking and non-smoking households. Technology has been found to be a perceived barrier to children’s PA in other qualitative studies ,144,145 Physiological factors, such as health, diet, and sleep, were discussed as both barriers and facilitators to PA. Diet was discussed far more frequently by participants from non-smoking homes than those from smoking homes. One participant identified chocolate as both a facilitator and a barrier as “chocolate will give you a sugar rush if you eat too much” (B10C/NS), indicating a consideration for the nutritional cost and benefits of food. Children from non-smoking households appeared to be very aware of the need to eat ‘healthy’ food and less ‘junk food’ and ‘sweets’. O’Dea  used focChildren expressed that adult support was provided in logistical and financial forms, opportunities for PA, and through verbal instruction and encouragement. Restriction from adults was due to punishment (grounding) and safety concerns. The findings of the present study are consistent with Noonan et al. , who alsinstruction from adults as a facilitator for PA, for example ‘get off your computer and go play outside’, children from smoking homes did not refer to verbal encouragement. Noonan et al. [Children from non-smoking homes discussed verbal encouragement from adults as a method in which adults facilitated their PA, referring to adults as ‘motivating’ and that adults encourage the children to ‘do their best’. Although children from smoking homes did report verbal n et al.  found thn et al.  found thn et al.  found thn et al. , as muchChildren from smoking homes identified parental provision of opportunities for PA more than children from non-smoking homes. They talked about parents facilitating their PA by going to the park as a family, walking to the shops or school, and cycling together. Participating parents in a study by Joseph et al.  acknowleNo difference could be observed between the perceived fitness scores for children from smoking and non-smoking households. Most children perceived their own fitness above average . This finding may be explained by the better-than-average-effect; the tendency to evaluate oneself more favourably than an average peer . Some stBoys and girls from smoking homes both rated running as the hardest activity during the pictorial task, for reasons such as not enjoying it and because it is ‘tiring’. For children from non-smoking homes, gymnastics (boys) and monkey bars (girls) were rated as the hardest, followed by running. Children from smoking households generally had lower CRF in this sample and so may genuinely experience running as physiologically more difficult. Children’s perceptions of difficulty suggest that aspects of fitness other than CRF, regardless of the metabolic demand (METs)  of the aThe present study was conducted prior to the COVID-19 pandemic and before national lockdowns were implemented in the UK. Since early 2020 however, COVID-19 restrictions have resulted in children spending more time at home and indoors and physical activity levels have decreased . Such isThe above findings should be interpreted in light of a number of limitations. Although the sample size was relatively small with 38 participants, the small sample permitted the generation of rich data, which is a major strength of the study. Future research could expand on this sample population to include participants from other regions of the UK, as well as participants from a wider age range. Younger children and adolescents may have different thoughts and perceptions surrounding PA and fitness and face different barriers and facilitators. The majority of participants lived in neighbourhoods within the lowest two deciles for deprivation based on the English Indices of Multiple Deprivation (EIMD). However, low-SES areas were targeted in order to recruit as many tobacco smoking families as possible. The findings are therefore less applicable to children of medium-high socioeconomic status. The sample population was diverse and represented a range of ethnicities and backgrounds, with approximately 34% of the sample that were made up of ethnicities other than White British. However, only 26.5% of families invited to participate in the research gave permission for their children to do so, which is likely due to the combination of the contentious nature of the work and the use of the opt-in approach to recruitment. Further research on the topic may benefit from an opt-out approach.The use of self-reported smoking status by parents is a limitation of this study and it is recognised that surveys are potentially subject to biases, including desirability and recall bias. Cotinine analysis could not be used due to financial restrictions and concerns for participant burden, but eCO was used as a measure of acute SHS exposure in children. However, eCO concentrations were not significantly different between groups. Future work would benefit from the use of salivary cotinine as a biochemical indicator for recent SHS exposure in addition to self-report surveys.Due to ethical concerns regarding eliciting anxiety within the children when considering the smoking status of their parents and family members, tobacco smoking was not discussed with the children. As a result, we were not able to gain insight into children’s opinions and thoughts about smoking or second-hand smoking or how having a smoking family member made them feel. This information would be highly valuable and could aid campaigns to prevent smoking uptake as well as smoking cessation. One question in particular, which required children to rate their own fitness level, would have been more suitably posed individually rather than in a group setting where children may be influenced by their peers. In addition, whilst the focus group has strengths in eliciting group discussion, there were some children that were considerably less talkative than other children. Some children may not have felt comfortable sharing thoughts with the group. We attempted to mitigate this barrier by using more interactive methods and this is discussed as a strength below.A major strength of this research is that, to the authors’ knowledge, it is the first to represent the thoughts, beliefs, and perceptions surrounding physical activity and fitness relative to children from smoking households. This research provides a voice to a population of children who may have additional health risks due to second-hand smoke exposure and may face other barriers to PA and fitness than their non-smoking household counterparts. A second strength is the use of activities in addition to discussion. Using sticky notes, writing, photographs, and diagrams aided discussion and allowed shy children to communicate in alternative methods. The research aimed to elicit as much information from children from smoking households as possible, through a multitude of methods. A further strength of the work is that it is informed by a complimentary quantitative study. Analysis was able to utilise information gathered from quantitative aspects, such as fitness scores, which allowed for better informed analysis. This study used focus groups to explore the thoughts, opinions, perceptions, and beliefs surrounding physical activity and fitness of children from non-smoking and smoking households.The findings support the main hypothesised mediators of PA in children including self-efficacy, enjoyment, perceived benefit, and social support. However, the variations in children from smoking and non-smoking households’ reasons for taking part in PA indicate the need for targeted interventions. Strategies to increase participation in PA for children from smoking households could focus on facilitating friendship/peer group physical activities that they regard as ‘fun’ and ‘enjoyable’.As less than a quarter of participants were aware of the PA guidelines, strategies to improve children’s awareness of these guidelines are recommended to increase PA participation. Whilst all children agreed fitness was important to them, differences emerged between groups for why. Interventions to improve CRF in this population should support access to PA participation by providing active equipment and safe outdoor space.Perceived barriers and facilitators are similar to previous research, but variances emerged for important barriers and facilitators in children from smoking and non-smoking homes. Strategies to overcome barriers should be based on household smoking status and focus on using perceived facilitators. The majority of children perceived their own fitness to be high or above average. Variances were observed in ranking physical activities by difficulty between boys and girls and exposure group, with children from smoking households rating running as the hardest.A handful of themes overlap several research questions and thread through children’s responses throughout the study. Examples include health, significant others, opportunity for physical activity, and the outdoors. Significant others  are an important theme for participants from both smoking and non-smoking households concerning why they participate in PA (RQ1), methods to improve fitness (RQ2), and a key facilitator of PA (RQ3). Health was a theme developed in response to children taking part in PA for health benefits (RQ1), why fitness is important to the participants (RQ2), and as a perceived barrier/facilitator to PA (RQ3). The outdoors was a theme relevant to how children can improve their fitness (RQ2) and as a facilitator for PA (RQ3). Diet was discussed as a method to improve fitness (RQ2) and as both a barrier and facilitator to PA (RQ3). These themes are important to participants and should be considered when planning PA and CRF interventions.The difference in perceptions of the health benefits of PA and fitness between children from smoking and non-smoking households warrants further exploration. Throughout the study, participants from non-smoking households demonstrated greater awareness of the PA guidelines, referred to extrinsic motivators of PA, referred to the health benefits of fitness, and had considerations for the future self. Future work should compare physical literacy, in particular the psycho-social/cognitive factors, of children from smoking and non-smoking households.To the authors’ knowledge, this important work is the first to explore perceptions of children from smoking and non-smoking households regarding physical activity and fitness. Interventions to improve the levels of PA and CRF in children from low-SES and smoking households could benefit from these child participant’s perspectives in order to create relevant and effective strategies.


During the recent years, new tobacco and tobacco-like products, e.g., e-cigarettes, have emerged on the market. Adolescents often underestimate health risks in general, including those concerning tobacco. Little is known of adolescents’ perceptions of health risks of the newer products. Our paper compares adolescents’ perceptions of harmfulness of cigarettes, e-cigarettes, snus, water pipes, and nicotine in Finland, a country with a long history of strict tobacco control policy. Online surveys to nationally representative samples of 12–18-year-olds were conducted in 2017 and 2019, with 7578 answering the surveys. Only 3% of boys and 2% of girls did not agree that cigarettes are harmful to health. The percentages were slightly higher for snus  and nicotine  but much higher for e-cigarettes  and water pipes . Those who used the product, whose parents were smokers or had lower education, and whose school performance was lower, less often agreed with the harmful health effects of the products. Our results showed that adolescents understood the harmfulness of older tobacco products better than the harmfulness of the newer ones. Our results also showed the need to strengthen health education and fix adolescents’ misperceptions of the health effects of the newer products. During recent years, new tobacco and tobacco-like products, such as e-cigarettes, have emerged to the market. False information on their health effects is common, e.g., in social media which is widely used by adolescents. Adolescents often believe that they are invulnerable to harm caused by tobacco products and, therefore, they may underestimate the magnitude of their health risks ,2,3. HarTobacco leaves contain thousands of harmful constituents; almost all these products are known to be hazardous to health, including carcinogenic compounds and other toxins and constituents, in addition to other substances added by the manufacturers . Snus isParents’ role in the development of their children’s perceptions on tobacco products and their harmfulness is undoubtedly important. Parents’ positive behavior towards tobacco products creates a kind of positive sentiment feeling  and therPrevious research indicates that smoking among adolescents varies by socio-economic status  which maPoor school performance has been found to be strongly associated with adolescent smoking . PreviouThere are voluminous studies on tobacco use among adolescents but relatively little data on adolescents’ perceptions of the harmful effects of different tobacco and tobacco-like products in the same study which would make comparison of the different products possible. The comparison of adolescents’ perceptions would help in planning the content of health education in schools and on social media, or elsewhere where young people spend their time. Even though the knowledge on health consequences alone is not enough to influence adolescents’ behavior of substance use , it is aThe aim of this study is to assess adolescents’ perceptions of the harmful health effects of four various tobacco and tobacco-related products—namely cigarettes, e-cigarettes, water pipe, and snus—and nicotine as an addictive constituent in Finland, a country with a long history of strict tobacco control policy. In addition, we explore whether the perceptions are related to adolescents’ own use of these products, their school performance, parents’ smoking and socio-economic status.The data used in this cross-sectional study originated from the Adolescent Health and Lifestyle Survey performed in 2017 and 2019, utilizing postal and online questionnaires. The questionnaires were in national languages, Finnish and Swedish. The nationally representative samples were obtained from the Finnish Population Registry Centre. Except for age and gender, that were obtained from the Registry, all other information was reported by the adolescents. The samples included all Finns aged 12, 14, 16 and 18 years old and born on selected dates in June, July, and August. The birthday sampling was used to minimize the age variation within each age group. The number of the respondents was 4058 in 2017 (response rate 43%) and 3520 in 2019 (response rate 37%). Ethics Committee of the Tampere Region approved the study protocol for both survey years. Filling in the questionnaire was considered as adolescent’s consent to participate. This was explained on the cover page of the questionnaire. No parental consent was needed according to the Ethics Committee.The perception on the harmfulness of the different products was assessed with a question: “In your opinion, is the use of the following products harmful to health?” The products were: 1. Cigarettes 2. Electronic cigarettes 3. Water pipe 4. Snus. In 2019, a new item was added: 5. Nicotine. The answering options were “Yes”, “Hard to say” and “No”. In the analyses, the variables were dichotomized as “Yes” and “No” by combining “No” and “Hard to say” options into “No”. We considered “Yes” as an agreement that the adolescent perceived the mentioned product as harmful to health. “No” and “Hard to say” were combined as “No” due to the small size of the “Hard to say” category. We wanted to separate an explicit group who are convinced of health effects from those who are not convinced. For health education programs, this separation is relevant. The variables were coded as binary  for the logistic regression analysis.Adolescents’ experience with the products was defined for each product separately by asking whether the participant had ever tried the product . The answers were dichotomized into “No” and “Yes”. The “No” groups were those who had never tried the product in question.Adolescents’ school performance was based on the respondents’ self-assessment of her/his latest school report compared to the average level in her/his class. The answering options were “Much better”, “Slightly better”, “About the class average”, “Poorer” and “Much poorer”. The five categories were combined into three categories: “Good school performance”, “Average school performance”, and “Poor school performance”.Parents’ smoking was asked separately for father and mother. The variable was categorized as “Neither of them smokes”, “One of them smokes”, and “Both of them smoke”.Parents’ education was asked separately for father and mother with a question “What is your parents’ education (mark the highest level of education)?” The educational levels were combined and categorized according to the highest educational level of either parent with “High level”, “Moderate level”, and “Low level” of education. The high level was college or university degree, and low level meant only basic education.Parents’ work situations were measured separately for father and mother with the question “What is your mother’s/father’s work situation at present?”. The answers were combined and categorized into “Both working”, “One of them working”, “Neither of them working”.First, the differences in the use of each tobacco and tobacco-like products between years 2017 and 2019 were analyzed. No significant differences were found. Therefore, data from the two years were merged leading to the total number of 7578 participants. Descriptive statistics were then calculated. Logistic regression models were conducted to examine the associations between adolescents’ perceptions of the harmfulness of each product, and adolescents’ experience with the product, school performance, parents’ smoking, and parental education and work situation. A crude model was first analyzed, testing the unadjusted associations for adolescents’ perceptions of harmfulness separately for each product. Then, gender and age-adjusted analyses were performed. Age and gender were adjusted for as girls were overrepresented among the respondents (57.8%) and 12-year-olds were underrepresented as their original sample was smaller compared with the other age groups (16.3% of the respondents). Last, all variables were added into the model, namely age, gender, parental highest education, parents’ work situation, school performance, and adolescents’ experimentation with the tobacco product in the analysis. The results of the analyses are presented as Odds Ratios (ORs) and 95% Confidence Intervals (95% CIs). All analyses were performed using IBM SPSS software version 25 .The overall prevalence for trying cigarettes was 29.8%, for e-cigarettes 25.4%, for water pipe 9.4%, and 17.7% for snus . As summOur study showed that Finnish adolescents know very well that cigarettes, snus, and nicotine are harmful to health. However, concerning e-cigarettes, nearly a third was not convinced about the harmfulness of the product. Concerning the water pipe, this proportion was even higher. Disagreement on the health consequences was more common among those adolescents who had tried the tobacco products, whose school performance was lower than average and whose parents smoked, had lower education, or were not working.Our results indicate that perceptions of negative health consequences are much less often related to e-cigarettes and water pipes than to conventional cigarettes. This is in line with earlier studies ,21. It hInformation on the health consequences and environmental effects of cigarettes, and of passive smoking has been delivered in schools’ health education lessons, which are mandatory in Finland. The health consequences of cigarettes are also discussed continuously in the media. Therefore, it is not a surprise that the Finnish adolescents’ knowledge on the harmfulness of smoking and nicotine is at a high level. However, it is likely that education on the health consequences of e-cigarettes and water pipe has been covered less, as they are more recent products in the Finnish tobacco and nicotine market. On the other hand, the sales ban to minors in Finland includes all tobacco products and tobacco substitutes such as e-cigarettes, which could have given an impression of similar health effects. Additionally, legal restrictions, meaning a total ban, for vaping in public places, restaurants or schools are the same as those for smoking with the introduction of new national regulations .Young people are active on social media and skillful in using their smart phones. So, they are likely to be misled by false information about these products presented in social media . For insOur results showed that parents’ smoking was associated with their children’s opinion that cigarettes and other tobacco and tobacco-like products are not harmful to health. This is an expected result as parents act as role models for their children, reflecting the familiarity with the information that tobacco is not harmful. This addresses the role of parents as both a source of knowledge and a positive example for their children by being tobacco-free themselves . RestricThe results on the influence of parents’ education and socio-economic status on children’s smoking has varied, but parents’ smoking is a major influence ,18,35. IOur study found a strong association between poor school performance and misperceptions about the harmfulness of cigarettes, e-cigarettes, water pipe, and snus. This association may be explained by the strong association between the use of tobacco products and low school performance ,25. HoweThe data used in this study was based on self-reporting and thus is subject to misclassification bias. However, the surveys that use self-report are generally valid and reliable . On theAdolescents’ understanding of health harms of the new nicotine and tobacco-like products is not adequate, and more so in vulnerable groups, i.e., those whose school performance is low, and whose parents smoke and have lower education. A key question here is adolescents’ health literacy, and whether they can distinguish false information and unreliable sources from reliable health information, particularly in social media. The new nicotine market with its emerging nicotine products is a challenge for health education, health care, health-related media, and corresponding institutions, making it difficult to keep up to-date-information of the health effects of these products. Putting more efforts into school health education on new and emerging nicotine products as well as on students’ health literacy in general could decrease misperceptions of different tobacco and tobacco-like products’ health effects. Parents’ role in adolescents’ misperceptions is important. Hence, the restrictions at home, and correcting information and potential misperceptions about the risks may also be a powerful tool in reducing adolescents’ use of different tobacco products. Parents may also need the right knowledge of the health effects. This information could be delivered through parents’ meetings by sending leaflets from schools or through health education campaigns targeted to the general population.


Drewelow, Marian Silje Habesland, Marion Amanda Lain, and Pamela R. Buckley, was originally published electronically on the publisher’s internet portal on 08 April 2021 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the article changed on 21 April 2021 to © The Author(s) 2021 and the article is forthwith distributed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The original article has been corrected.


How do affect and cognition interact in managerial decision making? Over the last decades, scholars have investigated how managers make decisions. However, what remains largely unknown is the interplay of affective states and cognition during the decision-making process. We offer a systematization of the contributions produced on the role of affect and cognition in managerial decision making by considering the recent cross-fertilization of management studies with the neuroscience domain. We implement a Systematic Literature Review of 23 selected contributions dealing with the role of affect and cognition in managerial decisions that adopted neuroscience techniques/points of view. Collected papers have been analyzed by considering the so-called reflexive (X-) and reflective (C-) systems in social cognitive neuroscience and the type of decisions investigated in the literature. Results obtained help to support an emerging “unified” mind processing theory for which the two systems of our mind are not in conflict and for which affective states have a driving role toward cognition. A research agenda for future studies is provided to scholars who are interested in advancing the investigation of affect and cognition in managerial decision making, also through neuroscience techniques – with the consideration that these works should be at the service of the behavioral strategy field. From thBehavioral Decision Theory (BDT).Since the birth of the bounded rationality concept by Behavioral Decision Theory was born to understand real human behavior in decision making by studying, for example, models for static risky decision making, utility function, subjective probability, variance preferences, and personality variables, mainly through experimentations and computational models  default-interventionist, whereby, as a default setting, individuals make decisions recurring to intuition/emotions and reflective thinking may intervene dependent on the task at hand  parallel-competitive, whereby, intuitive/emotional and reflective processes operate in parallel, such that “in the event of conflicts between them, they literally compete for the control of thinking and behavior”  and the dorsolateral Prefrontal Cortex (dlPFC). The ACC’s dorsal part is linked with the Prefrontal Cortex (PFC), the Parietal Cortex (PC), the motor system, and the Orbitofrontal Cortex (OFC). In terms of functions executed, the ACC processes top-down and bottom-up stimuli and assigns specific control to other areas of the brain. Regulation of norm enforcement and self-interest, and adaptive response to a changing condition, are juxtaposed with the emotions in this structure . The dlPRegarding the “affect” system, this has been found to include three independent areas known to serve as broad functions in emotional processing, including mind-body integration of affective information and fundamental for experience and expression of emotions: insula, amygdala, and ventromedial Prefrontal Cortex (vmPFC). The insula is a portion of the cerebral cortex folded deep within the fissure, separating the temporal lobe from the parietal and frontal lobes. The amygdala is an almond-shaped set of neurons located deep in the brain’s medial temporal lobe, which has been shown to play a critical role in processing emotions, necessary for triggering aversive emotional states from primary inducers . The vmPThe described brain areas see . This viIn particular, the X-system is associated with non-conscious environmental analysis, which some scholars have described as automatic processing, implicit learning, and even intuition. In practice, the X-system conducts perhaps a vast majority of everyday processing . The X-ssomatic marker hypothesis  of contributions dealing with the role of affect and cognition in managerial decisions that adopted neuroscience techniques/points of view. In this regard, we identified the SLR methodology as the suitable research design to consolidate and synthesize academic research. In particular, this method differs from the traditional narrative reviews in: (a) assisting in linking future research to the questions and concerns that have been posed by past research, and (b) being more explicit in the selection process by employing rigorous and reproducible evaluation methods. In this work, the established SLR procedure by In order to answer the research question: “(a) Business Source Premier (EBSCO); (b) ProQuest’s ABI/Inform; (c) ISI Web of Science; (d) Scopus; (e) PsycINFO; and (f) PubMed (including MedLine);(1) The databases for the identification of the studies were: (2) Only peer-reviewed journal articles published in English have been included to enhance quality control. Furthermore, the research was not restricted to a given starting period  and type of paper . These two criteria enhanced the value-added of this work compared to the one by (3) Only articles adopting a neuroscientific methodology/point of view have been considered by using the keywords: “neuro*” or “brain*” or “Functional Magnetic Resonance Imag*” or “FMRI” or “Electroencephalograph*” or “EEG” or “Magneto Encephalograph*” or “MEG” or “Transcranial Magnetic Stimulation*” or “TMS” or “Transcranial Electric Stimulation” or “tES” or “Positron Emission Tomograph*” or “Functional Near Infrared Spectroscop*” or “fNIRS” or “skin conductance” or “Galvanic Skin Response” or “GSR” or “GRV” or “skin conduct*” or “electrodermal activ*” or “eye track*” or “gaze track*” or “pupillometr*” or “pupil diamet*” or “heart rate*” or “HRV” or “facial expression recognition” or “emotion recognition” or “non-invasive brain stimulation” or “NIBS” or “cortisol” or “testosterone.” These keywords have been derived – and enlarged – following (4) The substantive relevance of contributions to the managerial decision-making theme has been ensured by requiring that the selected abstracts contained at least one of the following words: “decision*” or “choic*” or “preference*” or “judg*.” These keywords have been derived from the SLR by (5) Only articles regarding business issues have been considered by using the keyword “organization*” and its synonyms: “compan*” or “manag*” or “corporat*,” or “firm*” or “business*” or “enterprise*” or “venture*” or “start-up*” (these keywords have been derived following (6) Duplicates from databases were eliminated at this stage thanks to the integration operated through reference-manager software. 401 hits were produced;(7) The resulting articles were scanned by reading all the abstracts to ensure their substantive context, mainly according to their coherence with the review’s aim. When there was doubt about the content regarding the inclusion/exclusion of an article, the full text was examined. 77 results were produced;only scientific contributions dealing with managerial decision-making processes that implement neuroscience techniques/points of view; 20 results were produced. In this regard, we implemented the same exclusion criteria as (8) The remaining papers were fully read to ensure their alignment with the research objective. Thus, we included in the sample N = 12; yet, these two samples are very different too in terms of selected papers; see (9) Snowballing techniques have been applied to the reference lists of the resultant 20 articles. This ensured that important works in the field were included that might have been missed. Three were added arriving a final sample of 23 articles  aim to contribute to the development of managerial decision making, and (ii) apply neuroscience in their research. So, similarly to The selection at points 7 and 8 followed criteria used by Following Among the 23 papers in the sample, only three contributions i.e.,  are presThe Leadership Quarterly.The 23 selected papers cover a period of 18 years, with the distribution shown in (a) ethical decisions, (b) innovation decisions, and (c) data-enabled decisions.An inductive thematic analysis of the 23 selected papers’ manuscripts has been implemented, aimed at identifying the type of decisions treated. In particular, thematic analysis is principally employed to acquire a nuanced comprehension of spontaneous and sophisticated processes , such asreflexively collected and categorized into ethical patterns by the decision maker. The ability to structure information to match multiple prototypes will be positively associated with ethical behavior. Then, the ethical judgment is made, and it would be highly positively correlated to ethical behavior if performed by the C-system rather than by the X-system. This last avenue allows restructuring prototypes in the light of a rationalization process of moral rules and, in sum, substantiates that the C-system would exert control over the X-system to ethically manage organizations.Our systematic review includes many publications on ethical decision-making processes , emphasizing moral aspects. In this vein, (i) the situation faced by the decision maker elicits some memories  that recall actions that have been implemented in the past and that can also have a role in ethical decisions; and (ii) concurrently, emotions provide a frame of reference for cognition; emphasizing some elements of the context over others. Moreover, the emotional reaction is used as an information point in decision making and works as a driver for cognition .However, research has reported that not only the pre-frontal cortex, but also the amygdala  are important for a person’s moral development , suggestIn the same vein, status quo and seek relief by preventing punishment. Yet, other decision makers have neurobiological preferences toward risk-seeking behaviors, galvanized by the hope of reward prospects. In brief, from this study, the X-system seems to orient the risk orientation behavior  managers who look more at strategic performance measures  are more likely to make decisions consistent with the achievement of their subordinates’ strategic objectives, and (ii) when managers are informed about the strategy put in place by their organizations, they are more concentrated on strategic performance measures than others. Therefore, it could be possible to conjecture that the C-system overrides the X-system in shaping managers’ approach to the results depicted in the BSC.Similarly to (i) the C-system has a predominant role over the X-system; (ii) the X-system has a predominant role over the C-system; (iii) the C- and X-systems interact, and neither of the two has a primacy.Generally speaking, the distinction between the X- and C-systems, building upon the lateralization of the brain, although valid, is a coarse classification of many distinct human faculties that pertain to one of two broad domains and their interaction. This general distinction oversimplifies brain lateralization and assumes absolute functional differences in management studies. Our literature review consistently shows that the distinction between reflexive and reflective systems dominates the debate with marginal articulations within each of the systems . In thisFor the first cluster, With reference to the second cluster, many other scholars, instead, have devoted their efforts to analyzing the influence that the X-system has on the C-system. Among them, it is noteworthy to recall the contribution brought by A third cluster supports the idea that there is a mutual influence between the C- and X-systems. Among them, we recall the important works by parallel-competitive and a default-interventionist approach  and reflective (C-) systems, considered alone, cannot be framed as a complete theoretical framework as the nature of the interplay defines specific paradigms. Indeed, many theories assume dual processing of information, but they radically differ in their articulation. A fundamental distinction, mainly discussed in literature with reference to System 1 and System 2, is between a approach . In thisapproach ,b, redirapproach  to a “unapproach  for whicapproach  and Behaapproach . In partNeuroscience can help to deconstruct and reformulate from scratch some traditional problems – i.e., the roots of behavioral strategy  – that c(a) neuroscientific studies are often conducted on non-representative populations, because studies on practitioners are limited, and nothing can grant that the evidence found on non-representative populations  can be generalized; (b) when practitioners are present, samples are often limited or biased, as there is difficulty in balancing the different profiles of participating organizations and teams; and (c) studies are often based on laboratory experiments.The main limits of the papers in our sample are that: The above limitations are commonly connected with the intrinsic difficulty of implementing several neuroscientific tools in ecological conditions  and ethical problems in adopting them. In this regard, as expressed by other scholars e.g., , since mFurthermore, the neuroscientific contributions examined in this study often present limitations concerning the statistical analysis techniques. More specifically, the number of significance tests carried out in neuroimaging analyses  are extremely likely to inflate the risk of Type I error  – in line with The general distinction between reflexive/X-system and reflective/C-system dimensions seems to substitute the further distinctions among specific cognitive phenomena within the reflexive realm. Affect, intuition, insight, instinct, are quite different types of cognitive phenomena – pertaining to the reflexive system – each markedly connoted by distinctive features and neurophysiological systems. What seems to emerge from our literature review is that such a fine-grained distinction is never by scholars. With a few exceptions such as , the selGenerally speaking, this review easily indicates that many reflexive processes do not necessarily present an affective dimension. For instance, numerical cognition involved in the well-known “bat and ball” like problems e.g.,  relies oneural reuse  represents a relatively under-investigated domain of neuroscientific research, also considering its related methodological problems. Indeed, while experiments are rigorously designed (stimuli and responses can be measured with great precision), the measurement of the default activity of the brain can be elusive, as there is no specific theoretical focus. We think that the role of the intrinsic brain represents a future domain of investigation for decision-making research, which is able to shed new light on the affective-cognitive interplay. As shown in The role of the default mode in the affective-cognitive framework helps us to uncover the long-term, stable, not contingent, boundary conditions of decision making. Emerging domain of investigation could be central in organizational neuroscience which, by definition, focuses on the stable “default-experience” of individuals in structured organizational contexts. Notice, incidentally, that this focus on stable default-mode experience can be also useful to investigate the cultural issue (as we expect that specific organizations’ practices enter into the “baseline” in order to affect the way in which decisions are made).How do affect and cognition interact in managerial decision making? This is the research question that we tried to answer through the SLR of contributions produced on managerial decision making, which consider neuroscience techniques/points of view. In terms of originality, this is the first contribution filling this gap, stemming from the fact that the only other SLR produced  primary driving role e.g., ,b.From this work, the relationship between BDT – including its developments – and neuroscience emerges as stronger, because one modifies/reinforces the other in a virtuous scientific debate. However, as advanced by Our study also shows that real novelty in hypothesis generation, informed by cognitive neuroscience, is somehow missing. While neuroscience allows deconstructing consolidated categories – to reformulate old management problems in a fresh manner – this is not what our literature review shows; instead of generating radically novel hypotheses, it seems that management scholars are more prone to use novel neuroscientific tools to investigate old management problems. For example, with reference to innovation decisions, the dynamics that lead to innovation are framed within the traditional paradigms such as organizational myopia  or managHowever, if we think that moving from consolidated neuroscientific evidence and debates can be the solution to a solid generation of hypotheses in management studies, we are wrong. Cognitive neuroscience is a dynamic domain characterized by different theories and views of the brain that are often incommensurable. This is particularly true for affect and cognition that, far from being distinct domains, have been shown entangled as cognition is affectively modulated . What shIn terms of practical implications, managers should take into consideration that their decisions are the concurring product of affective and cognitive influences, with the former having an initial (but not exclusive) role. In this regard, decision makers’ course of action can be regulated acting on the perceived affective state; e.g., decision makers interested in enhancing accurate analyses for a choice should consider planning them after recognizing the dramatic impact that a wrong decision may have – this can be done by referring to the “pre-mortem” technique of The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.MC and APM equally contributed to section introduction. APM contributed to the sections: neuroscience in management and organization studies, and ethical decisions. MC contributed to the sections: affect and cognition in decision making, methodology, data-enabled decisions, and discussion. PG contributed to sections: affect and cognition in neuroscience, results, innovation decisions, and limitations of the research field and future research. AM contributed to the section: an agenda for future research. MC and AM equally contributed to the section implications and conclusion. All authors approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


In Japan, the general medicine category includes various specialties: “family physician,” “hospitalist,” and “hospital family physician.” These specialties can be illustrated from two perspectives for an easy understanding of their characteristics. In Japan, the general medicine category includes various specialties, and there is no precise consensus on its classification. Many expressions refer to practicing physicians as “general medicine physicians,” confusing both lay people and medical professionals. As a result, it is a challenge to easily explain the role of general medicine physicians to medical students and young doctors.In Japan, the specialties of general medicine include “family physician,” “hospitalist,” and “hospital family physician.” These specialties can be illustrated from two perspectives for an easy understanding of their characteristics Figure .The role of a general medicine physician changes according to the demands and requirements of each clinical setting; creating clear boundaries is impossible. Therefore, from the first perspective, we devised a scale based on the differences in clinical settings, such as rural areas, clinics, city hospitals, and university hospitals.From the second but more important perspective, we devised a method to show the ratio of family medicine practices to internal medicine practices. This is very relevant to the thought process and management of the practice, which we have described as the clinical operating system.Since drawing a clear line between specialties is difficult, it is necessary to express them in gradations from each perspective.Family physicians provide home care and outpatient care in clinics, not hospitals. They mainly practice family medicine, rather than internal medicine, and play a central role in primary care in the community. Although physicians who provide primary care in the community at their clinics and practice general medicine do not call themselves family physicians, they can be considered so. The role of family physicians in Japan is equivalent to that of general practitioners in the United Kingdom.Hospitalists mainly practice in medium and large hospitals and do not provide home care. Unlike hospitalists in the United States,Hospital family physicians are family physicians who practice primarily in hospitals. Like hospitalists, they mainly provide inpatient and outpatient care and, occasionally, home care. This style of practice combines those of family physician and hospitalist. Hospital family physicians work in community hospitals that meet a wide range of community health needs and provide inpatient care in all phases ranging from acute to chronic.Family physicians and hospital family physicians can be distinguished by their clinical setting. More hospital family physicians are practicing internal medicine than family physicians. Hospitalists and hospital family physicians provide both inpatient and outpatient care, but the latter practice family medicine more consciously. Hospitalists, by contrast, are involved in organizational management to solve hospital problems and hospital improvement, in addition to practicing internal medicine.Sometimes, the term “general internal medicine” is confused with general medicine in Japan. Many physicians who call themselves “general internists” practice high‐quality general medicine. Similarly, the term “hospitalist” is sometimes used to mean “general internist.” Academically, general internal medicine does not include family medicine.We have looked at how the general medicine specialties in Japan differ from two perspectives. However, although the practice of each specialty varies to some extent, family physicians, hospitalists, and hospital family physicians all share the common practice of responding flexibly to the needs of their respective clinical settings. Therefore, while each specialty has its own identity, it is essential for its members to respect each specialty and cooperate with one another as general medicine physicians. In addition, it is important for these physicians to cooperate with not only specialists but also other generalists, such as home‐visiting physicians, emergency physicians, intensivists, pediatricians, geriatricians, and palliative care physicians, with equal respect for each other.The authors have stated explicitly that there are no conflicts of interest in connection with this article.