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Biomedical subjects

J Wardle

Publications and source records attributed to J Wardle.

At least 19 recordsLinked to original sources
PubMed2006

The association between knowledge of HPV and feelings of stigma, shame and anxiety.

OBJECTIVES: To test the hypotheses that (1) women who know that human papillomavirus (HPV) is sexually transmitted will expect to experience higher levels of stigma, shame and anxiety if they test positive for the virus than women who are not aware of the mode of transmission and (2) women who are aware of the high prevalence of HPV infection will expect to experience lower levels of stigma, shame and anxiety than women who underestimate its prevalence. METHODS: A web-based survey in which information about HPV was manipulated to generate a 2 x 2 design (awareness that HPV is sexually transmitted v no awareness; awareness of the high prevalence of HPV v no awareness). Participants (n = 811) were female students. They were asked to imagine that they had tested positive for HPV. Outcome measures were expected stigma, shame and anxiety. RESULTS: Great differences were observed in emotional reactions to imagining testing HPV positive between the four groups based on knowledge of HPV. Knowledge of the prevalence was associated with lower levels of stigma, shame and anxiety. Knowledge that HPV is sexually transmitted was associated with higher levels of stigma and shame, but not anxiety. Women who knew that HPV is sexually transmitted but not that it is highly prevalent had the highest scores for stigma and shame. CONCLUSIONS: Raising public awareness of the sexually transmitted nature of HPV has the potential to increase women's feelings of stigma and shame if they test positive for the virus. However, our findings suggest that ensuring women's awareness of HPV being common may reduce these feelings and also reduce anxiety, perhaps by "normalising" the infection.

Adolescent↗
PubMed2006

Family-based behavioural treatment of obesity: acceptability and effectiveness in the UK.

OBJECTIVE: To assess the acceptability and impact of family-based behavioural treatment (FBBT) for childhood obesity in a clinical setting in the UK. DESIGN: Pre- and post-treatment assessment for four consecutive treatment groups. SETTING: Treatment groups took place at Great Ormond Street Hospital, London. PATIENTS: Participants were 33 families with obese (BMI >or=98th centile for age and sex) children aged 8-13 years. INTERVENTION: FBBT was delivered over 12 sessions. MAIN OUTCOME MEASURES: Overweight (percentage BMI), self-esteem, mood and eating attitudes were assessed before and after treatment; overweight was re-assessed at 3-month follow-up for those who completed treatment. RESULTS: The FBBT programme materials translated easily to the UK setting and the programme was well-liked by participants. Twenty-seven out of 33 families (82%) completed the sessions. Children lost 8.4% BMI over the time of treatment, and this was maintained at 3-month follow-up. Self-esteem and depression improved significantly and there was no change in food pre-occupation, anorexia or bulimia on the ChEAT. CONCLUSIONS: These results establish that FBBT is feasible and acceptable in a clinical setting in Britain. They indicate that significant loss of overweight can be achieved using the programme without adverse psychological consequences.

Adolescent↗
PubMed2006

Body image and weight control in young adults: international comparisons in university students from 22 countries.

OBJECTIVE: Young women in the United States and Western Europe are notoriously concerned about weight but less is known about attitudes to weight in other regions of the world. This study explores the associations between body mass index (BMI), weight perceptions, and attempts to lose weight in male and female university students from 22 countries. METHODS: Data were collected from 18,512 university students, using standardised methods, as part of the International Health Behaviour Survey. Measures included weight, height, perception of overweight, and weight loss status. BMI was calculated from weight and height, but was categorised into gender and country-standardised deciles rather than the conventional weight categories in response to the inaccuracy of self-reports. Perceived overweight and weight loss status were plotted against country-standardised BMI deciles. The 22 countries were grouped into five geopolitical/economic areas for regional analyses: North-Western Europe and the USA, Central and Eastern Europe, the Mediterranean, Pacific Asia, South America. Perceived overweight compared across the five regions. RESULTS: Perceived overweight increased systematically across BMI deciles in all countries. More women than men felt overweight at any decile. Women had low levels of perceived overweight in the lowest decile but rates rapidly increased to 50% by the 5th decile. Men, even in the highest deciles, were less aware that they are overweight and few of them were trying to lose weight. Women had a faster rise of weight loss attempts over the BMI deciles but nevertheless the proportion trying to lose in the highest decile did not exceed 75%. Perceived overweight profiles across BMI deciles were similar across all regions, suggesting that perceptions of overweight derive from local comparisons. The patterning for trying to lose weight was more diverse, with men and women from Asian countries showing higher levels of trying to lose weight at all deciles. CONCLUSIONS: This study shows the international consistency in perceptions of overweight in educated young men and women across diverse regions of the world. It confirms the patterning of women's overestimation of weight at lower BMI deciles and men's underestimation of weight at the higher deciles. Perceptions of overweight and attempts to lose weight were highest in the group of Asian countries where body weights are generally low, suggesting that local culture and norms could moderate attitudes to weight.

Adolescent↗
PubMed2006

Depression in adolescent obesity: cultural moderators of the association between obesity and depressive symptoms.

OBJECTIVE: Community studies relating depression to obesity in adolescents have generated inconsistent results. It has been argued that the variability in findings is due to effect modification by demographic characteristics that vary across samples. The aim of this study was to test the hypothesis that the strength of the obesity-depression association is moderated by gender, ethnicity and socioeconomic status (SES). RESEARCH METHODS AND PROCEDURES: Data were from two large, school-based, studies of adolescent health and well-being (n=4320; n=1824). Students completed one of two measures of depressive symptoms (SDQ; CES-D) in school and were weighed and measured. Gender and ethnicity were self-reported and SES was indexed by residential neighbourhood characteristics or individual family deprivation. RESULTS: There was barely any association between obesity and depressive symptoms in either sample. There was also no evidence that obese participants who were female, white or from higher SES backgrounds were especially vulnerable to depressive symptoms. DISCUSSION: The results indicate that in community samples of adolescents, regardless of gender, SES or ethnicity, reports of depressive symptoms are not significantly higher in obese than normal-weight groups. The results are discussed in terms of obese adolescents' resilience in the face of multiple social adversities.

Adolescent↗
PubMed2006

Social and psychological impact of HPV testing in cervical screening: a qualitative study.

OBJECTIVE: Human papillomavirus (HPV) testing has been proposed for inclusion in the UK cervical screening programme. While testing may bring some benefits to the screening programme, testing positive for HPV, a sexually transmitted virus, may have adverse social and psychological consequences for women. The aim of this study was to examine the social and psychological impact of HPV testing in the context of cervical cancer screening. METHOD: In-depth interviews generating qualitative data were carried out with 74 women participating in HPV testing in England between June 2001 and December 2003. Purposive sampling was used to ensure heterogeneity in age, ethnic group, marital status, socioeconomic background, cytology, and HPV results among participants. RESULTS: Testing positive for HPV was associated with adverse social and psychological consequences, relating primarily to the sexually transmitted nature of the virus and its link to cervical cancer. Women described feeling stigmatised, anxious and stressed, concerned about their sexual relationships, and were worried about disclosing their result to others. Anxiety about the infection was widespread, but the impact of testing positive varied. The psychological burden of the infection related to women's relationship status and history, their social and cultural norms and practices around sex and relationships, and their understanding of key features of HPV. CONCLUSION: HPV testing should be accompanied by extensive health education to inform women and to de-stigmatise infection with the virus to ensure that any adverse impact of the infection on women's wellbeing is minimised.

Adult↗
PubMed2006

Vulnerability to smoking after trying a single cigarette can lie dormant for three years or more.

OBJECTIVE: To examine the development of smoking behaviour among adolescents who, at age 11, had tried cigarettes just once. DESIGN: A five-year prospective study. SETTING: 36 schools in South London, England. SUBJECTS: A socioeconomically and ethnically diverse sample of students completed questionnaires annually from age 11-16. A total of 5863 students took part, with an annual response rate ranging from 74-85%. 2041 (35%) provided smoking status data every year. MAIN OUTCOME MEASURES: Current smoking (smoking sometimes or more often) for the first time. Cotinine assays provided biochemical verification of smoking status. RESULTS: Students who at age 11 reported having tried smoking cigarettes just once (n = 260), but were not smoking at the time, were more likely to take-up smoking at a later age than those that had not tried smoking (n = 1719), even after a gap of up to three years of not smoking. The odds of starting to smoke at age 14 were 2.1 times greater (95% confidence interval 1.2 to 3.5) in the age 11 "one time triers" than the "non-triers", even once sex, ethnicity, deprivation, parental smoking and conduct disorder were adjusted for. CONCLUSIONS: This is the first clear demonstration of a "sleeper effect" or period of dormant vulnerability. Our findings have implications for understanding the development of cigarette use and for policies to reduce smoking in young people. Preventing children from trying even one cigarette may be important, and the design of interventions should recognise adolescents who have smoked just once, several years previously, as potentially vulnerable to later smoking uptake.

Adolescent↗
PubMed2006

Acceptability of unsupervised HPV self-sampling using written instructions.

OBJECTIVES: The study measured the acceptability of self-sampling for human papillomavirus (HPV) testing in the context of cervical cancer screening. Women carried out self-sampling unsupervised, using a written instruction sheet. SETTING: Participants were women attending either a family planning clinic or a primary care trust for routine cervical screening. METHODS: Women (n = 902) carried out self-sampling for HPV testing and then a clinician did a routine cervical smear and HPV test. Immediately after having the two tests, participants completed a measure of acceptability for both tests, and answered questions about ease of using the instruction sheet and willingness to use self-sampling in the future. RESULTS: The majority of women found self-sampling more acceptable than the clinician-administered test, but there was a lack of confidence that the test had been done correctly. Significant demographic differences in attitudes were found, with married women having more favourable attitudes towards self-sampling than single women, and Asian women having more negative attitudes than women in other ethnic groups. Intention to use self-sampling in the future was very high across all demographic groups. CONCLUSION: Self-sampling for HPV testing was highly acceptable in this large and demographically diverse sample, and women were able to carry out the test alone, using simple written instructions. Consistent with previous studies, women were concerned about doing the test properly and this issue will need to be addressed if self-sampling is introduced. More work is needed to see whether the demographic differences we found are robust and to identify reasons for lower acceptability among single women and those from Asian background.

Adult↗
PubMed2005

Adverse psychological outcomes in colorectal cancer screening: does health anxiety play a role?

People who are anxious about their health are more likely to misinterpret health information as personally threatening and less likely to be reassured by medical investigations that show they are free from disease. Consequently, health anxious people would be expected to react more adversely to cancer screening, but this possibility has rarely been explored. The moderating role of health anxiety on the psychological impact of participating in colorectal cancer screening was examined among a sub-sample of 3535 participants in a large, community-based trial of colorectal cancer screening in the UK. The screening modality was flexible sigmoidoscopy, which examines the bowel for pre-cancerous polyps. It was predicted that health anxiety would be associated with more worry about cancer before screening, a greater increase in worry if polyps were detected, and less reassurance after a clear result. As expected, health anxious participants were more anxious and more worried about bowel cancer both before and after screening. However, they experienced greater reductions in anxiety and worry about cancer following the examination. They reported lower levels of reassurance following screening, but also expressed more positive reactions to the experience. The positive psychological benefits of attending medical investigations should be examined in future work, because this may go some way towards explaining why health anxious people repeatedly seek medical interventions.

Aged↗
PubMed2005

Making sense of information about HPV in cervical screening: a qualitative study.

Introducing human papillomavirus (HPV) testing into cervical cancer screening has the potential to change the way that women understand cervical cancer, the psychological impact of abnormal screening results and the likelihood of future participation in screening. The study used in-depth interviews to examine how women make sense of information about HPV in the context of cervical cancer screening. A total of 74 women were recruited following participation in HPV testing. Women varied widely in their beliefs about the aetiology of cervical cancer and its relationship with sexual activity, as well as in their understanding of the sexually transmitted nature of HPV. While some women who understood that HPV is sexually transmitted were able to integrate this into their existing model of cervical cancer, others were shocked by the link between cervical cancer and sex, of which they had been previously unaware. Women were generally reassured to know that HPV is common, has no symptoms, can lie dormant for many years, can clear up on its own and need not raise concerns about transmission to sexual partners. Women's understanding of HPV varied considerably, even after participation in testing. The way in which information is presented to women will be crucial in minimising the negative psychological impact of testing positive and ensuring that participation in screening remains high.

Adult↗
PubMed2005

Parental perceptions of overweight in 3-5 y olds.

OBJECTIVE: To assess the accuracy of parents' perceptions of their 3 to 5 y old children's weight status in a large UK sample. METHOD: Parental perception and concern about child weight, demographic variables, and children's height and weight were obtained for 564 parent-child dyads. RESULTS: Only 1.9% of parents of overweight children and 17.1% of parents of obese children described their child as overweight. The odds of parents perceiving the child as overweight were increased for overweight (2.7; 95% CI 0.4, 16.5) and obese (28.5; 7.1, 115.4) compared with normal weight children, but were not associated with parental weight or with any demographic factors. Although few parents perceived their overweight children as overweight, more (66.2%) expressed concern about their overweight child becoming overweight in the future. Odds of concern were progressively higher for overweight (2.5; 1.6, 3.9) and obese children (4.6; 2.2, 9.7), and were also higher for parents who were themselves overweight (1.9; 1.2, 2.9) or obese (2.5; 1.3, 4.8). CONCLUSION: These findings suggest that parents of 3-5 y olds show poor awareness of their child's current weight status. Reframing discussions in terms of preventing future overweight may be an effective way to engage parents.

Body Height↗
PubMed2005

Cardiovascular stress responsivity, body mass and abdominal adiposity.

OBJECTIVE: To assess the relationship between adiposity and cardiovascular stress reactivity and recovery in middle-aged men and women, and investigate the influence of impaired poststress cardiovascular recovery on changes in body mass index (BMI) and waist-hip ratio over 3 y. PARTICIPANTS: In total, 225 healthy men and women aged 47-59 y were recruited from the British civil service. METHODS: Laboratory mental stress testing was carried out, with blood pressure (BP), cardiac output and total peripheral resistance being measured at baseline, during moderately challenging tasks, and during recovery 40-45 min poststress. Weight, height, waist and hip circumference were assessed at the time of mental stress testing and 3 y later. RESULTS: Behavioural tasks elicited increases in BP sustained by a combination of cardiac activation and raised peripheral resistance. BMI and waist/hip ratio were associated cross-sectionally with impaired poststress recovery of systolic pressure, diastolic pressure and cardiac index independently of age, gender, socioeconomic status, smoking, alcohol consumption and baseline cardiovascular activity. Increases in waist-hip ratio over 3 y were predicted both by impaired poststress recovery of systolic pressure and cardiac index in men, independently of baseline adiposity and other covariates. No associations between subjective stress and BMI or waist-hip ratio were observed. CONCLUSIONS: Disturbances of cardiovascular responsivity to psychological stress, manifest through impaired poststress recovery, were associated cross-sectionally with BMI, and longitudinally with central adiposity in men. Stress-related cardiovascular dysregulation may contribute to obesity risk.

Blood Pressure↗
PubMed2005

Gender differences in utilization of colorectal cancer screening.

OBJECTIVES: To assess the demographic and psychological mediators of gender differences in uptake of flexible sigmoidoscopy (FS) screening for colorectal cancer. SETTING: A subsample (n=5462) from a large community trial of FS in the UK. METHODS: Men and women randomized to screening as part of the UK Flexible Sigmoidoscopy Trial were sent a postal questionnaire assessing demographic characteristics and attitudes to screening six months before their screening appointment. Attendance at screening was recorded by the screening centres. RESULTS: More men than women attended screening (73% versus 67%). The higher male attendance was partially explained by their lower levels of socioeconomic deprivation, higher levels of marital status and lower perceived barriers to screening. CONCLUSIONS: Contrary to expectations, men were more likely than women to attend FS screening. This was partially explained by socioeconomic and attitudinal differences to screening, but additional research is needed to understand the key aspects of FS screening that will maximize screening uptake in men and women.

Attitude to Health↗
PubMed2004

Socioeconomic gradient in body size and obesity among women: the role of dietary restraint, disinhibition and hunger in the Whitehall II study.

OBJECTIVE: To examine the associations between three psychological eating behaviour variables--restraint, hunger and disinhibition--and body weight and size, and to assess their explanatory power for the employment grade gradients in body measurement. DESIGN: Cross-sectional analysis of self-report and clinical data. SUBJECTS: : In all, 1470 women (aged 45-68 y, mean 56.3, s.d. 6.0 y), body mass index (BMI) 26.3 (4.8) kg/m(2) at phase 5 (1997-98) of the Whitehall II study. MEASUREMENTS: Employment grade was measured in six bands ranging from clerical (lowest) to administrative (highest). Five measures of body size were examined: BMI, weight in kilograms, waist and hip measurement in centimetres and waist-hip ratio. The eating behaviour variables were measured using Stunkard and Messick's (1985) Three-Factor Eating Questionnaire (TFEQ). RESULTS: Disinhibition and hunger scores were strongly and directly associated with all measures of body weight and size. Restraint score was not directly associated with body size and weight. An interaction between restraint and disinhibition scores was found. The low-restraint-high-disinhibition group (based on median score splits) were the heaviest (BMI 28.5 kg/m(2)) and largest (waist 85.8 cm), while the low-restraint-low-disinhibition group were the lightest (BMI 24.2 kg/m(2)) and smallest (waist 76.3 cm). Employment grade gradients in body weight and size remained largely unchanged after adjustment for dietary restraint. Moderate attenuations were found for disinhibition scores (3.6-15.0%) and hunger (4.8-19.9%) on the five body-size measures. CONCLUSION: Among middle-aged women high scores on hunger and disinhibition, as measured by the TFEQ, are associated with greater body size. Restraint relates to body size through its interaction with disinhibition. Individuals with high disinhibition and any level of restraint are heavier and larger than those with low levels of disinhibition. High disinhibition coupled with low levels of restraint is associated with the greatest weight and size. Hunger and disinhibition explain a moderate amount of the gradient in body size across employment grade and may be useful concepts for future work on the socio-economic gradient in obesity and overweight.

Aged↗
PubMed2004

Central adiposity and cortisol responses to waking in middle-aged men and women.

OBJECTIVE: Central obesity is associated with disturbances of hypothalamic-pituitary-adrenocortical (HPA) axis function. We investigated whether central adiposity indexed by waist/hip ratio is related to cortisol responses to waking and other measures of salivary cortisol over the working day. PARTICIPANTS: In total, 89 men and 83 women aged 47-59 y recruited from the British civil service. All were members of the Whitehall II epidemiological cohort. METHODS: Saliva samples were collected on waking, 30 min later, and then at 2-h intervals from 0800-0830 to 2200-2230. A strict procedure for excluding individuals who did not adhere to the sampling schedule was applied. RESULTS: Waist/hip ratio in men was positively correlated with the cortisol response to waking (30 min-waking value) after adjusting for age, socioeconomic position, smoking status, alcohol consumption, time of waking, and cortisol level on waking (r=0.29, P=0.009). The cortisol response to waking was negatively related to high-density lipoprotein (HDL) cholesterol (r=-0.25) and positively with total/HDL cholesterol ratio (r=0.25). Associations between the decline in cortisol over the day and waist/hip ratio, HDL cholesterol and total/HDL cholesterol ratios were also significant. No associations were significant in women, and body mass index was unrelated to cortisol. CONCLUSIONS: The cortisol response to waking is a dynamic indicator of HPA function that has previously been related to chronic psychological stress. These results confirm a recent Swedish study, and indicate that cortisol responses to waking may be indicative of neuroendocrine disturbance in central obesity.

Adipose Tissue↗
PubMed2004

Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children.

OBJECTIVE: To examine the contribution to fruit and vegetable eating in children of potential predictive variables within the domains of demographics, parental feeding practices and personality traits. DESIGN: Cross-sectional survey. SETTING: Questionnaires were distributed to parents through 22 London nursery schools. SUBJECTS: Questionnaires were completed and returned by 564 parents or principal caregivers of 2-6-year-old children. RESULTS: Significant predictors of children's fruit and vegetable intake emerged from all three domains examined. Demographic variables associated with child's vegetable consumption were mother's education and child's age and gender. Only ethnicity was significantly associated with fruit consumption. Parental consumption, breast-feeding and early introduction to fruit and vegetables were related to intake of both. Family meal times were associated with higher intake of vegetables, but not of fruit. Two characteristics of children themselves (food neophobia and enjoyment of food) were strongly related to the consumption of fruit and vegetables. Subsequent multivariate analyses revealed that parental intake and child food neophobia independently predicted intake of both foods. In the presence of these, fruit consumption was affected by breast-feeding and early introduction to fruit, whereas vegetable consumption was related only to child's gender and enjoyment of food. CONCLUSIONS: These findings may be used to inform future interventions aimed at increasing children's consumption of fruit and vegetables. Parents should be made aware of the possible impact of their own behaviour on the eating habits of their children.

Age Distribution↗
PubMed2004

Attitudes to self-sampling for HPV among Indian, Pakistani, African-Caribbean and white British women in Manchester, UK.

OBJECTIVE: To examine attitudes to self-sampling for human papillomavirus (HPV) testing among women from contrasting ethnic groups. SETTING: Manchester, UK. METHODS: Two hundred women of Indian, Pakistani, African-Caribbean and white British origin were recruited from social and community groups to participate in a questionnaire survey. The questionnaire included items on attitudes to self-sampling and intention to use the test. RESULTS: Willingness to try to use the test was high, and women did not foresee religious or cultural barriers to self-sampling; however, a large proportion of women were concerned about doing the test properly. This concern was greatest in the Indian and African-Caribbean groups. CONCLUSIONS: Although women's willingness to try self-sampling for HPV is encouraging, worries about carrying out the procedure correctly must be addressed if women are to feel confident about the results of self-sampling methods and reassured by a negative result.

Adult↗
PubMed2003

Attitudes towards HPV testing: a qualitative study of beliefs among Indian, Pakistani, African-Caribbean and white British women in the UK.

This study examined attitudes to human papillomavirus (HPV) testing among a purposively selected sample of women from four ethnic groups: white British, African Caribbean, Pakistani and Indian. The design was qualitative, using focus group discussion to elicit women's attitudes towards HPV testing in the context of cervical cancer prevention. The findings indicate that although some women welcomed the possible introduction of HPV testing, they were not fully aware of the sexually transmitted nature of cervical cancer and expressed anxiety, confusion and stigma about HPV as a sexually transmitted infection. The term 'wart virus', often used by medical professionals to describe high-risk HPV to women, appeared to exacerbate stigma and confusion. Testing positive for HPV raised concerns about women's sexual relationships in terms of trust, fidelity, blame and protection, particularly for women in long-term monogamous relationships. Participation in HPV testing also had the potential to communicate messages of distrust, infidelity and promiscuity to women's partners, family and community. Concern about the current lack of available information about HPV was clearly expressed and public education about HPV was seen as necessary for the whole community, not only women. The management of HPV within cervical screening raises important questions about informed participation. Our findings suggest that HPV testing has the potential to cause psychosocial harm to women and their partners and families.

Adult↗