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Biomedical subjects

J Wardle

Publications and source records attributed to J Wardle.

At least 37 records · Page 2Linked to original sources
PubMed2003

Higher levels of state depression in masculine than in feminine nations.

Studies using identical measures have identified different levels of depression in different countries or cultures. Until now, however, explanations for such differences, other than methodological ones, have not been empirically addressed. It was hypothesized and found that soft or feminine nations in which both women and men are offered equal opportunities for the fulfillment of multiple social roles that are associated with good self-rated health would score significantly lower on national depression levels than tough or masculine societies in which such opportunities exist to a clearly lesser extent. Analyses of data collected in 14 nations in Europe (total N>5000) demonstrated that higher scores on Hofstede's national masculinity index and lower ones on national wealth were independent predictors of higher national depression levels. National trait neuroticism did not mediate the relationship between national masculinity and national depression levels.

Adolescent↗
PubMed2003

Socioeconomic disparities in cancer-risk behaviors in adolescence: baseline results from the Health and Behaviour in Teenagers Study (HABITS).

BACKGROUND: This study explores the association between socioeconomic deprivation and five factors associated with long-term risk of cancer, in adolescents. METHODS: BMI, fat intake, fruit and vegetable intake, smoking, and exercise were assessed in 4320 students ages 11 to 12, from 36 schools, in the first year of a 5-year longitudinal study of the development of health behaviors (HABITS study). Neighborhood socioeconomic deprivation for each student's area of residence was matched to their postcode (zip code). We used multiple logistic regression analyses to investigate the relationship between risky behaviors and socioeconomic circumstances. RESULTS: Univariate analyses showed boys and girls from more deprived neighborhoods were more likely to have tried smoking, to eat a high fat diet, and to be overweight. Girls living in more deprived areas were also less likely to eat five servings of fruit and vegetables or to exercise at the weekend. Most differences persisted after controlling for ethnicity. A clear deprivation gradient emerged for each risk factor, indicating the linear nature of the relationship. CONCLUSIONS: This study demonstrates the influence of deprivation on engaging in cancer-risk health behaviors. These patterns may set young people from more socioeconomically deprived social environments on a trajectory leading to increased cancer mortality in adult life.

Adolescent↗
PubMed2003

Pulmonary transplantation for cystic fibrosis: pre-transplant recipient characteristics in patients dying of peri-operative sepsis.

BACKGROUND: Pulmonary transplantation has emerged as a successful treatment for end-stage cystic fibrosis. Despite the chronic bronchial sepsis and often multi-resistant organisms seen in this group of recipients, death due to post-operative sepsis is relatively scarce. Identifying potential recipient risk factors for poor outcome may further improve the utilization of a scarce donor pool. METHODS: We assessed the role of pre-operative clinical measures of sepsis, microbial characteristics and recipient characteristics on post-transplant outcome in 85 cystic fibrosis patients who underwent pulmonary transplantation. Ten percent of patients died in the early post-operative period due to sepsis. The prognostic role of recipient factors including markers of sepsis, such as white cells and C-reactive protein (CRP), and the influence of multi-resistant organisms, in particular organisms from the Burkholderia cepacia complex, on outcomes were investigated. RESULTS: We found no prognostic effect of gender, pre-transplant CRP, forced expiratory volume in 1 second (FEV(1)), weight, diabetic status or infection with multi-resistant Pseudomonas organisms. A raised white cell count or temperature or a pre-transplant infection with B cepacia was, however, associated with a significantly poorer prognosis at p = 0.03, 0.03 and 0.001, respectively. CONCLUSIONS: Pre-operative B cepacia complex infection, leukocytosis and pyrexia, but not CRP, weight, diabetes or lung function, were found to be associated with poorer post-transplant outcome. The most clinically relevant of these to the subsequent risk of post-operative death from sepsis appear to be B cepacia infection and pyrexia.

Biomarkers↗
PubMed2003

Examining the relationship between pubertal stage, adolescent health behaviours and stress.

BACKGROUND: This paper examines the associations between puberty and three important health behaviours (smoking, food intake and exercise) and explores whether these associations are mediated by puberty's relationship to stress and psychological difficulties. METHOD: Data were taken from the first year of the ongoing, 5-year, Health and Behaviours in Teenagers Study (HABITS). This is a school-based study set in 36 schools in London. In the first year of the study, 4320 students (2578 boys, 1742 girls) in their first year of secondary education took part. RESULTS: Among girls, being more pubertally advanced was associated with a greater likelihood of having tried smoking. Among boys, being more pubertally advanced was associated with a greater likelihood of having tried smoking, a higher intake of high-fat food and higher levels of exercise. More pubertally advanced girls experienced more stress but not more psychological difficulties. There were no associations between puberty and either stress or psychological difficulties in boys. Stress and psychological difficulties were associated with health behaviours in girls and boys, but neither of these factors mediated the relationship between pubertal stage and health behaviours found in girls. CONCLUSIONS: These results suggest that the onset of puberty has a marked effect on the development of health behaviours. Puberty was related to an acceleration of the development of unhealthy behaviours, except for exercise behaviour in boys, where advanced puberty was associated with more exercise. These changes were unrelated to adolescent issues of stress and a causal explanation for these associations must be sought elsewhere.

Adolescent↗
PubMed2003

Modifying children's food preferences: the effects of exposure and reward on acceptance of an unfamiliar vegetable.

OBJECTIVE: The aim of this study was to evaluate two interventions (one reward-based and one exposure-based) for increasing children's acceptance of an unfamiliar vegetable compared with a no-treatment control. It was predicted that the exposure condition would increase liking for, and consumption of, the vegetable relative to either the reward or control group. DESIGN: Using a randomized controlled design, participants were assigned to one of two intervention groups (exposure or reward) or to a no-treatment control condition, for a 2 week period. Liking for, and consumption of, red pepper was assessed before and after the treatment period. SETTING: The study was conducted in three primary schools in London. SUBJECTS: Parental consent was obtained for 49 out of a possible 72 children. INTERVENTIONS: Interventions comprised eight daily sessions during which participants in the exposure group were offered a taste of sweet red pepper and told that they could eat as much as they liked. Participants in the reward group were shown a sheet of cartoon stickers and told that they could choose one of them on condition that they ate at least one piece of the pepper. RESULTS: The exposure-based intervention significantly increased both liking (P=0.006) and consumption (P=0.03) compared with the control group. The outcome of the reward intervention was intermediate and did not differ significantly from the exposure or control conditions. CONCLUSIONS: Repeated exposure to the taste of unfamiliar foods is a promising strategy for promoting liking of previously rejected foods in children.

Child↗
PubMed2003

Social inequalities in depressive symptoms and physical functioning in the Whitehall II study: exploring a common cause explanation.

STUDY OBJECTIVE: This study investigated which risk factors might explain social inequalities in both depressive symptoms and physical functioning and whether a common set of risk factors might account for the association between depressive symptoms and physical functioning. DESIGN: A longitudinal prospective occupational cohort study of female and male civil servants relating risk factors at baseline (phase 1: 1985-8) to employment grade gradients in depressive symptoms and physical functioning at follow up (phase 5: 1997-9). Analyses include the 7270 men and women who participated at phase 5. SETTING: Whitehall II Study: 20 London based white collar civil service departments. PARTICIPANTS: Male and female civil servants, 35-55 years at baseline. MAIN RESULTS: Depressive symptoms were measured by a subscale of items from the 30 item General Health Questionnaire. Physical functioning was measured by a subscale of the SF-36. Employment grade was used as a measure of socioeconomic position as it reflects both income and status. The grade gradient in depressive symptoms was entirely explained by risk factors including work characteristics, material disadvantage, social supports, and health behaviours. These risk factors only partially explained the gradient in physical functioning. The correlation between depressive symptoms and physical functioning was reduced by adjustment for risk factors and baseline health status but not much of the association was explained by adjustment for risk factors. Among women, the association between depression and physical functioning was significantly stronger in the lower grades both before and after adjustment for risk factors and baseline health. For women, there was only a significant grade gradient in depressive symptoms among those reporting physical ill health. CONCLUSIONS: Some risk factors contribute jointly to the explanation of social inequalities in mental and physical health although their relative importance differs. Work is most important for inequalities in depressive symptoms in men, and work and material disadvantage are equally important in explaining inequalities in depressive symptoms in women while health behaviours are more important for explaining inequalities in physical functioning. These risk factors did not account for the association between mental health and physical health or the greater comorbidity seen in women of lower socioeconomic status. The risk of secondary psychological distress among those with physical ill health is greater in the low employment grades.

Adult↗
PubMed2003

Socioeconomic differences in attitudes and beliefs about healthy lifestyles.

STUDY OBJECTIVE: s: The factors underlying socioeconomic status differences in smoking, leisure time physical activity, and dietary choice are poorly understood. This study investigated attitudes and beliefs that might underlie behavioural choices, including health locus of control, future salience, subjective life expectancy, and health consciousness, in a nationally representative sample. DESIGN: Data were collected as part of the monthly Omnibus survey of the Office of National Statistics in Britain. PARTICIPANTS: A stratified, probability sample of 2728 households was selected by random sampling of addresses. One adult from each household was interviewed. MAIN RESULTS: Higher SES respondents were less likely to smoke and more likely to exercise and eat fruit and vegetables daily. Lower SES was associated with less health consciousness (thinking about things to do to keep healthy), stronger beliefs in the influence of chance on health, less thinking about the future, and lower life expectancies. These attitudinal factors were in turn associated with unhealthy behavioural choices, independently of age, sex, and self rated health. CONCLUSIONS: Socioeconomic differences in healthy lifestyles are associated with differences in attitudes to health that may themselves arise through variations in life opportunities and exposure to material hardship and ill health over the life course.

Adult↗
PubMed2003

Awareness of human papillomavirus among women attending a well woman clinic.

OBJECTIVES: To assess the level and accuracy of public understanding of human papillomavirus (HPV) in the United Kingdom. METHODS: Women attending a well woman clinic were asked to complete a questionnaire assessing HPV awareness and specific knowledge about the virus. RESULTS: Questionnaires were completed by 1032 women, of whom 30% had heard of HPV. Older women, non-smokers, and those with a history of candida, genital warts, or an abnormal smear result were more likely to have heard of HPV. Even among those who had heard of HPV, knowledge was generally poor, and fewer than half were aware of the link with cervical cancer. There was also confusion about whether condoms or oral contraceptives could protect against HPV infection. CONCLUSIONS: In this relatively well educated sample, awareness and knowledge of HPV were poor. Public education is urgently needed so that women participating in cervical cancer screening are fully informed about the meaning of their results, especially if HPV testing is soon to be introduced.

Adolescent↗
PubMed2002

Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial.

BACKGROUND: This randomised controlled trial is examining the hypothesis that a single flexible sigmoidoscopy screening offered at around age 60 years can lower the incidence and mortality of colorectal cancer. We report here on acceptability, safety, feasibility, and yield. METHODS: Men and women aged 55-64 years, in 14 UK centres, who responded to a mailed questionnaire that they would attend for flexible sigmoidoscopy screening if invited, were randomly assigned screening or control (ratio one to two). The control group was not contacted. Small polyps were removed during screening, and colonoscopy was undertaken if high-risk polyps (three or more adenomas, size 1 cm or greater, villous, severely dysplastic, or malignant) were found. FINDINGS: Of 354,262 people asked about their interest in having flexible sigmoidoscopy screening, 194,726 (55%) responded positively, and 170,432 eligible individuals were randomised. Attendance among those assigned screening was 71% (40,674 of 57,254). 2131 (5%) were classified as high-risk and referred for colonoscopy; 38,525 with no polyps or only low-risk polyps detected were discharged. Distal adenomas were detected in 4931 (12.1%) and distal cancer in 131 (0.3%). Proximal adenomas were detected in 386 (18.8% of those undergoing colonoscopy) and proximal cancer in nine cases (0.4%). 62% of cancers were Dukes' stage A or locally excised. There was one perforation after flexible sigmoidoscopy and four after colonoscopy. An average of 48 people were screened, and two or three colonoscopy referrals generated, per centre each week. Interpretation Our flexible sigmoidoscopy screening regimen is acceptable, feasible, and safe. The prevalence of neoplasia is high, and colonoscopy referral rates of 5% are acceptable.

Adenoma↗
PubMed2002

Pre-morbid predictors of psychological adjustment to cancer.

This study examined the potential role of social support, neuroticism, and self-efficacy as predictors of the short-term and long-term adaptation to the diagnosis of cancer. Psychological adjustment was defined in terms of psychological distress. It is argued that these factors may provide insights that might be helpful in the provision of medical care to patients. We hypothesized that they would be especially predictive of long-term psychological adjustment. The study was conducted in a truly prospective design with one pre-morbid assessment and two post-morbid assessments used in the present analyses. Participants of a baseline assessment among 5279 subjects (aged 57 years and older) in 1993 were monitored for cancer incidence by their general practitioners. The study sample included 99 cancer patients who had completed all pre-morbid and post-morbid assessments. Multivariate analyses revealed that high neuroticism was associated with higher levels of distress in the short- and long-term. Higher levels of social support were associated with higher levels of distress in the long-term. The direction of this association was opposite to what might be expected on the basis of the literature. Implications of the findings for health care as well as explanations for the social support findings are discussed.

Adaptation, Psychological↗
PubMed2002

The Adolescent Food Habits Checklist: reliability and validity of a measure of healthy eating behaviour in adolescents.

OBJECTIVE: Amid concerns about the quality of young people's diets, this paper describes the development of a measure of healthy eating behaviour for use with adolescents. DESIGN: Items for the measure were selected from a larger pool on the basis of responses from a pilot study. The 23-item checklist was validated using measures of dietary fat and fibre intake, fruit and vegetable consumption, dietary restraint, nutrition knowledge and a measure of family income. SETTING: Participants came from seven secondary schools in the north-west of England. SUBJECTS: A total of 1822 adolescents aged between 13 and 16 y took part in the study, representing 84% of those invited to participate. RESULTS: Correlations between measures indicate a good level of convergent validity, and the checklist is also shown to have high internal and test-retest reliability. CONCLUSIONS: The focus on choices available to adolescents means that the checklist will provide a useful addition to food frequency-type approaches to the measurement of adolescent eating behaviour. SPONSORSHIP: This research was funded by the Medical Research Council and the Economic and Social Research Council's Health Variations Programme.

Adolescent↗
PubMed2002

Weight and dieting: examining levels of weight concern in British adults.

OBJECTIVE: Amid rising levels of obesity, not all overweight individuals recognize that their weight is too high. At the same time many of those whose weight is within the normal range are dissatisfied with their body size, providing evidence of inappropriate weight aspirations, especially amongst women. This research examines the nature and level of complacency and over-concern in overweight, underweight and normal-weight individuals. METHODS: Data on weight, perceived overweight and dieting status were collected from a stratified probability sample of 1894 British adults, as part of the Office of National Statistics' Omnibus Survey. RESULTS: Most obese adults correctly perceived themselves as overweight, but many were not trying to lose weight, and only a minority had participated in a programme of weight control. Men's awareness was lower than women's. At the other extreme, few men, but around a quarter of normal-weight women felt overweight or were trying to lose weight, but their preferred weight was only slightly below their actual weight. CONCLUSIONS: :These results suggest that weight concern among British women is high, but probably not excessive and there is little evidence for idealization of dangerously low weights. In contrast, many overweight men were unaware of their weight problem. Only around half of those who would benefit from weight reduction were trying to lose weight, and few had received advice from health professionals. In view of the prevalence of obesity, there may be opportunities to provide more guidance on weight control within primary care.

Adult↗
PubMed2002

Assessing socioeconomic status in adolescents: the validity of a home affluence scale.

STUDY OBJECTIVE: To examine the completion rate, internal reliability, and external validity of a home affluence scale based on adolescents' reports of material circumstances in the home as a measure of family socioeconomic status. DESIGN: Cross sectional survey. SETTING: Data were collected from a school based study in seven schools in the north of England Cheshire over a five month period from September 1999 to January 2000. PARTICIPANTS: 1824 students (1248 girls, 567 boys) aged 13-15 years who were attending normal classes in Years 9 and 10 in 7 schools on the days of data collection. MAIN RESULTS: Comparatively poor completion rates were found for questions on parental education and occupation while material deprivation items had much higher completion rates. There was evidence that students with poorer material circumstances were less able to report parental education and occupation whereas material based questions showed less bias. A home affluence scale composed of material items was found to have adequate internal reliability and good external validity. CONCLUSIONS: A home affluence scale based on material markers provides a useful alternative in assessing family affluence in adolescents. Additionally, it prevents exclusion of those less materially well off adolescents who fail to complete conventional socioeconomic status items.

Adolescent↗
PubMed2002

Socioeconomic variation in participation in colorectal cancer screening.

OBJECTIVES: To investigate socioeconomic variation in participation in flexible sigmoidoscopy (FS) screening for colorectal cancer. DESIGN: A prospective study nested within a multicentre randomised controlled trial of the efficacy of FS screening for the prevention and early detection of colorectal cancer (the UK flexible sigmoidoscopy trial). SETTING: Glasgow, Scotland. PARTICIPANTS: 55-64 year old adults, registered with general practitioners participating in the FS trial. MAIN OUTCOME MEASURES: Screening participation measured at three levels: questionnaire return; interest in screening; attendance at screening. RESULTS: Socioeconomic deprivation was a strong predictor of participation. Return of the screening questionnaire, expression of interest in screening, and attendance at the test, were all lower in more deprived groups. CONCLUSIONS: These results highlight the need to consider ways to reduce inequalities in screening uptake, in parallel with the introduction of any new screening programmes, to avoid exacerbating social gradients in cancer mortality.

Aged↗
PubMed2001

Effect of contingent hunger state on development of appetite for a novel fruit snack.

Eating more fruit can reduce risk of cancer and cardiovascular disease. Understanding barriers to this behaviour is critical for strategies to encourage it. We addressed the question whether the level of hunger at which fruit is eaten would influence the development of appetite for fruit. Half the participants were asked to eat a pair of novel fruit snacks (dried fruit bar; 50 kcal each) exclusively when hungry (at least 3 hours since last eating), and half to eat them exclusively when full (20-30 minutes after a meal), twice a day for one week. Rated appetite for the bars, and ad-libitum intake, were measured when hungry and full, on 2 days prior to, and 2 days after this week. Compliance was assessed from dietary diaries. Thirty participants (22 women, 8 men) completed the study satisfactorily. For the group eating the fruit bars only when hungry (hungry-trained), intake increased after the week, but only when full at the time of testing. Other measures of appetite for this group were unaffected, with the exception of a reduced desire to eat the bars when tested hungry. Ranked preference for the trained flavour increased exclusively among hungry-trained subjects, but only for those who had reported their preferred snack food to be fruit. No change in any measure was found for the group eating the fruit bars exclusively when full. The results suggest the hungry-trained group learnt that the bars lacked strong satiation, thus allowing greater intake when full (learnt desatiation). For the same reason, however, the prospect of eating the bars when mildly hungry lost its appeal. Eating fruit between meals may not encourage snacking on fruit, unless hunger is absent at the time of consumption.

Adolescent↗
PubMed2001

Factor-analytic structure of food preferences in four-year-old children in the UK.

Studying the correlative structure of young children's food preferences may help us to understand the influences on the development of eating habits. We investigated patterns of food preferences in 214 same-sex twin pairs aged 4 to 5 years. Mothers completed a questionnaire of their children's likes and dislikes for 94 common foods. The proportion of children having tried each food, and their liking for it, were examined. These two measures were strongly positively correlated (r=0.61). Principal components analysis was used to examine the inter-relationships among preferences for 76 foods that had been tried by at least 75% of the children. Four factors emerged, interpreted from food factor loadings as "Vegetables", "Desserts", "Meat and Fish", and "Fruit", explaining 24% of the variance. Thus, children tended consistently to like or dislike foods within each of these factor categories, independently of patterns of liking in the other factors. Factor loadings were unrelated to average liking for or likelihood of exposure to these foods. The distribution of factor loadings refutes the common assumption that simple sensory properties such as sweetness, saltiness or fattiness predict food preferences. Instead, a preference structure may develop for more complex multimodal sensory syntheses, which could have both biological and learnt bases. Future work comparing the food preference structure of mono- and dizygotic twins should help determine the relative contribution of genetic and environmental influences.

Child Behavior↗