Biomedical subjects

Jane Wardle

Publications and source records attributed to Jane Wardle.

At least 19 recordsLinked to original sources

PubMed2005

Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes.

Negative affective states such as depression are associated with premature mortality and increased risk of coronary heart disease, type 2 diabetes, and disability. It has been suggested that positive affective states are protective, but the pathways through which such effects might be mediated are poorly understood. Here we show that positive affect in middle-aged men and women is associated with reduced neuroendocrine, inflammatory, and cardiovascular activity. Positive affect was assessed by aggregating momentary experience samples of happiness over a working day and was inversely related to cortisol output over the day, independently of age, gender, socioeconomic position, body mass, and smoking. Similar patterns were observed on a leisure day. Happiness was also inversely related to heart rate assessed by using ambulatory monitoring methods over the day. Participants underwent mental stress testing in the laboratory, where plasma fibrinogen stress responses were smaller in happier individuals. These effects were independent of psychological distress, supporting the notion that positive well-being is directly related to health-relevant biological processes.

Affect↗

PubMed2005

Parental control over feeding and children's fruit and vegetable intake: how are they related?

OBJECTIVES: To replicate the finding of a negative association between parental control and fruit and vegetable consumption in girls. To extend the investigation to boys and examine sex differences. To test the hypothesis that children's food neophobia explains this association. DESIGN: Cross-sectional questionnaire survey. MEASURES: The questionnaire included items assessing parents' and children's fruit and vegetable intake, the Parental Control Index, and the Child Food Neophobia Scale. SUBJECTS: Parents of 564 2- to 6-year-old children, recruited from 22 London nursery schools. STATISTICAL ANALYSIS: Relationships between continuous variables were examined with Pearson product moment correlation coefficients. Sex differences were tested using independent sample t tests, and sex differences in correlations were assessed from their 95% confidence intervals. Parental control and children's food neophobia were entered into a hierarchical multiple regression to test the hypothesis that neophobia explains the association between parental control and children's fruit and vegetable intake. RESULTS: We replicated the finding that parental control was correlated with children's fruit and vegetable consumption and found no significant sex differences. Parental fruit and vegetable consumption and children's food neophobia were also strong predictors of children's fruit and vegetable consumption, and both were associated with parental control, suggesting that they might explain the association between control and intake. Controlling for children's food neophobia and parental intake reduced the association of parental control with children's fruit and vegetable intake to nonsignificance. CONCLUSIONS: These findings emphasize the importance of systematic research about associations between parental feeding styles and children's dietary habits so that dietetics professionals can give parents sound advice.

Adult↗

PubMed2005

Dietary restraint, body dissatisfaction, and psychological distress: a prospective analysis.

This study uses prospective data from a survey of 1,177 adolescent girls to examine whether emotional eating, binge eating, abnormal attitudes to eating and weight, low self-esteem, stress, and depression are associated with dietary restraint or body dissatisfaction. In analyses that included both restraint and body dissatisfaction as independent predictors, restraint was associated only with more negative attitudes to eating, whereas body dissatisfaction was significantly associated with all the adverse outcomes. These results cast doubt on the proposition that restrained eating is a primary cause of bulimic symptoms, emotional eating, and psychological distress seen in individuals who are trying to control their weight, and rather suggest that body dissatisfaction is the key factor.

Adolescent↗

PubMed2005

Age and gender differences in children's food preferences.

The present study was conducted to examine the developmental patterning of food preferences in a large sample of British schoolchildren and to investigate possible gender differences. Using a cross-sectional survey design, the study was carried out in three primary and three secondary schools in West London, UK. A total of 1291 children aged from 4 to 16 years completed a 115-item food preference questionnaire in class time, supervised by class teachers and assistants. Children indicated whether they had ever tried each item and, if so, how much they liked it. We observed age-related increases in the number of foods tried (P<0.001), liked (P<0.005) and disliked (P<0.05). Controlling for the number of foods tried rendered the increase in dislikes non-significant and reversed the age effect on the number liked. Girls liked fruit (P<0.05) and vegetables (P<0.001) more than boys did; boys liked fatty and sugary foods (P<0.005), meat (P<0.001), processed meat products (P<0.001) and eggs (P<0.05) more than girls did. Some age differences were apparent in liking for categories of food, although the effects were not linear. Across ages and genders, children rated fatty and sugary foods most highly, although ratings for fruit were also high. Children's food preferences overall are not consistent with a healthy diet. Interventions should focus on increasing the familiarity, availability and accessibility of healthy foods and should be mindful of the need to target messages appropriately for boys who have less healthful food preferences than girls at all ages.

Adolescent↗

PubMed2005

Understanding the aetiology of childhood obesity: implications for treatment.

Childhood obesity poses one of the greatest challenges to paediatric health in the 21st century. Developing effective strategies for treatment and prevention is therefore a priority for clinical medicine and public health. This process is taking place at a time of unprecedented change in the understanding of the role of genetic factors in human health and disease, and genetic research into obesity has challenged assumptions about causal processes. In the spirit of the conference theme, the present paper will discuss the implications of the understanding of genetic and environmental influences on obesity for the development of effective behavioural treatments.

Child↗

PubMed2005

Sociodemographic, developmental, environmental, and psychological correlates of physical activity and sedentary behavior at age 11 to 12.

BACKGROUND: Low levels of physical activity and high levels of sedentary behavior during adolescence are a cause for concern. Sociodemographic, developmental, environmental, and psychological factors may be relevant, but the correlates of these behaviors may differ. PURPOSE: To investigate the multidimensional correlates of physical activity and sedentary behavior in a large sample of 11- to 12-year-old boys and girls. METHODS: Cross-sectional survey of 2,578 boys and 1,742 girls from 36 schools stratified by socioeconomic background and gender mix of students (84% response rate). Questionnaire assessments and objective measurements of height and weight were obtained. RESULTS: Days of vigorous physical activity and hours of sedentary behaviors over the past week were uncorrelated. Ethnicity, socioeconomic factors, developmental stage, environmental factors, and psychological variables were associated with physical activity and sedentary behavior in univariate analyses. In multiple regression, sedentary behavior was greater in ethnic minority groups, in students from more deprived backgrounds, and in those with conduct problems. Girls who were more advanced developmentally and who reported emotional symptoms also engaged in more sedentary behaviors. Vigorous physical activity was associated with good self-rated health, prosocial psychological characteristics, and (in boys) with low emotional symptoms. CONCLUSIONS: A multidimensional approach to understanding the context of physical activity in early adolescence is needed because factors in several domains are relevant. The correlates of physical activity and sedentary behaviors are distinct in this age group, and there are also important gender differences.

Child↗

PubMed2004

A perspective from countries using organized screening programs.

Cancer screening may be offered to a population opportunistically, as part of an organized program, or as some combination of the preceding two options. Organized screening is distinguished from opportunistic screening primarily on the basis of how invitations to screening are extended. In organized screening, invitations are issued from centralized population registers. In opportunistic screening, however, due to the lack of central registers, invitations to screening depend on the individual's decision or on encounters with health care providers. The current article outlines key differences between organized and opportunistic screening. In the current study, literature searches were performed using PubMed and MEDLINE. Additional data were assembled from interviews with health officials in the five countries investigated and from the authors' personal files. Opportunistic screening was found to be distinguishable from organized screening on the basis of whether screening invitations were issued from centralized population registers. Organized screening programs also assumed centralized responsibility for other key elements of screening, such as eligibility requirements, quality assurance, follow-up, and evaluation. Organized programs focused on reducing mortality and morbidity at the level of the population rather than at the level of the individual. Thus, programs did not necessarily offer the most sensitive screening test for a particular cancer, and tests sometimes were offered at suboptimal intervals with respect to individual-level protection. Nonetheless, organized systems paid greater attention to the quality of screening, as measured by factors such as cancer detection rates, tumor characteristics, and false-positive biopsy rates. As a result, participants in organized screening programs received greater protection from the harmful effects associated with screening. In addition, organized programs worked more systematically toward providing value for money in an inevitably resource-limited environment. Although organized and opportunistic models of screening can yield similar uptake rates, organized programs exhibited greater potential ability to reduce cancer incidence and mortality, because of the higher levels of population coverage and centralized commitment to quality and monitoring; were more likely to be cost-effective; and offered greater protection against the harmful effects associated with poor quality or overly frequent screening.

Cost-Benefit Analysis↗

PubMed2004

Sociocultural influences on attitudes to weight and eating: results of a natural experiment.

OBJECTIVE: Exposure to teenage culture is widely believed to contribute to concerns about weight in children and adolescents. The current study tested the hypothesis that greater exposure to older girls at school would be associated with thinner size ideals, increased concern about weight, and more dieting. METHOD: Participants (n = 200) were 9 and 11-year-old girls. The age of the oldest pupils in the school defined the exposure variable. Nine-year-olds in junior schools (oldest pupils = 11) and 11-year-olds in middle schools (oldest pupils = 13) were defined as nonexposed. Nine-year-olds in middle schools (oldest pupils = 13) and 11-year-olds in secondary schools (oldest pupils = 18) were defined as exposed. Girls were weighed and measured and completed measures of ideal size, perceived weight, body esteem, eating attitudes, dieting, and self-esteem. RESULTS: Being at a school with older pupils was associated with having a thinner ideal, feeling more overweight, having more friends who had dieted, scoring higher on the Child Eating Attitudes Test, and having lower self-esteem. Effects were strongest among the 9-year-olds. DISCUSSION: Exposure to older girls in school may accelerate the development of negative attitudes to weight and eating.

Affect↗

PubMed2004

Socioeconomic differences in cancer screening participation: comparing cognitive and psychosocial explanations.

This paper compares psychosocial and cognitive models of socioeconomic variation in participation in screening for colorectal cancer. The psychosocial model suggests that factors such as higher stress and lower social support explain, in part, why people from lower socioeconomic status (SES) environments are less likely to participate in screening. The cognitive model suggests that beliefs about cancer risk and screening will play an important part in differential participation. In practice both sets of factors may contribute to explaining socioeconomic differentials. The data for these analyses are drawn from a randomised controlled trial of colorectal cancer screening (the UK Flexible Sigmoidoscopy Trial). The participants are from the Scottish centre, where recruitment was stratified to generate a socioeconomically diverse sample. The dependent variable was interest in attending screening. A questionnaire covering demographic status, psychosocial and cognitive factors as well as interest in screening was sent to 10,650 adults. The results showed the predicted SES gradient in interest. There were also SES differences in both psychosocial and cognitive variables. A series of logistic regression models were used to test potential mediators of the association between SES and interest in attending screening by successively including psychosocial factors, cognitive factors, and then both, in the equation. Only the inclusion of the cognitive variables significantly reduced the variation associated with SES, providing better support for the cognitive than the psychosocial model.

Colorectal Neoplasms↗

PubMed2004

Beliefs about the risk factors for cervical cancer in a British population sample.

BACKGROUND: The introduction of human papillomavirus (HPV) testing into cervical screening has the potential to alter public perceptions of cervical cancer by making explicit the role of a sexually transmitted virus in its etiology. HPV knowledge has been found to be poor, although there is evidence of public awareness of a link between sexual activity and cervical cancer risk. We explored beliefs about the risk factors for cervical cancer in a large population sample. METHODS: Face-to-face interviews were carried out with a representative sample of the British population. All participants were asked what they thought increased a women's chances of developing cervical cancer. RESULTS: The response rate was 71% (n = 1940). The most common single response was 'don't know' (38%). Forty-one percent of respondents mentioned factors relating to sex, but only 14% were aware of a link with sexual transmission and fewer than 1% named HPV. Women and more educated people had better knowledge of the established risk factors. The patterning of risk factor awareness by age varied across risk factors. CONCLUSIONS: Awareness of the role of a sexually transmitted virus in the etiology of cervical cancer is very low in Britain. Provision of information associated with the introduction of HPV testing could change public perceptions of cervical cancer.

Adolescent↗

PubMed2004

Leisure-time physical activity in university students from 23 countries: associations with health beliefs, risk awareness, and national economic development.

BACKGROUND: Physical inactivity has been linked with chronic disease and obesity in most western populations. However, prevalence of inactivity, health beliefs, and knowledge of the risks of inactivity have rarely been assessed across a wide range of developed and developing countries. METHODS: A cross-sectional survey was carried out with 19,298 university students from 23 countries varying in culture and level of economic development. Data concerning leisure-time physical activity, health beliefs, and health knowledge were collected. RESULTS: The prevalence of inactivity in leisure time varied with cultural and economic developmental factors, averaging 23% (North-Western Europe and the United States), 30% (Central and Eastern Europe), 39% (Mediterranean), 42% (Pacific Asian), and 44% (developing countries). The likelihood of leisure-time physical activity was positively associated with the strength of beliefs in the health benefits of activity and with national economic development (per capita gross domestic product). Knowledge about activity and health was disappointing, with only 40-60% being aware that physical activity was relevant to risk of heart disease. CONCLUSIONS: Leisure-time physical activity is below recommended levels in a substantial proportion of students, and is related to cultural factors and stage of national economic development. The relationship between health beliefs and behavior is robust across cultures, but health knowledge remains deficient.

Adult↗

PubMed2004

Public interest in genetic testing for susceptibility to heart disease and cancer: a population-based survey in the UK.

BACKGROUND: Given the current concerns about the clinical validity of commercially marketed genetic tests for multifactorial diseases, there is a surprising dearth of information about what public demand might be for genetic tests for any complex diseases other than cancer. The aim of this study was to examine interest in genetic testing for the most common multifactorial disease, heart disease, and to compare it with interest in testing for cancer in a general population sample that had not received detailed information about genetic tests. METHODS: Interest in genetic testing for heart disease susceptibility was surveyed and compared to interest in genetic testing for cancer susceptibility among a nationally representative sample of 1,960 British adults as part of the Office for National Statistics Omnibus survey. RESULTS: Sixty-nine percent of respondents expressed interest in being tested for genetic susceptibility to heart disease. Men, people aged 45-60 years, those with less education, and those with a family history were most interested in genetic testing for heart disease. Sixty-four percent of respondents expressed interest in genetic testing for susceptibility to cancer, and gender, age, and education, but not family history, were associated with interest. CONCLUSIONS: Interest in genetic testing for susceptibility to both heart disease and cancer was high, with the most educated individuals being the least interested in testing. Although the shift toward the 'expert patient' is actively encouraged and consistent with today's health policies, there is considerable and justifiable concern about some of the genetic tests for multifactorial diseases that are currently being marketed directly to the public. The high level of initial interest in the general public found in this study supports the need for a public education program around genetic testing for multifactorial diseases.

Adolescent↗

PubMed2004

Mild acute inflammatory stimulation induces transient negative mood.

OBJECTIVE: This study aims to assess the mood changes induced by mild acute inflammatory stimulation (typhoid vaccination). METHODS: Using a double blind study design, 26 healthy volunteers underwent baseline assessments of mood, financial strain and work stress and were randomised to injection of Salmonella typhi vaccine or placebo injection. Mood, symptoms and body temperature was assessed by a modified version of the Profile of Mood States at 1, 2, 3, 4, 6 and 8 h post injection. RESULTS: Typhoid vaccination induces no increases in physical symptoms or temperature. Mood improved over the day in the placebo but not in the vaccine condition. Negative changes in mood following injection were correlated with chronic stress (financial strain) in the vaccination condition (r=-.65, P<.025). CONCLUSION: A mild acute inflammatory stimulus induces transient negative mood, and responses were modulated by chronic stress. Implications for depressed mood in physical illness are discussed.

Acute Disease↗

PubMed2004

Subjective and objective risk of colorectal cancer (UK).

OBJECTIVE: The aim of this study was to see whether individuals who perceive their risk for developing colorectal cancer (CRC) as lower than average are found to be at lower risk as determined by findings at flexible sigmoidoscopy (FS) screening. METHODS: Participants (n = 10,551) were men and women aged 55-64 years from a subset of participants in the UK FS Trial. Self-report questionnaires assessed perceived comparative risk of developing bowel cancer prior to participants being invited to attend FS screening. Objective risk was judged from polyp status during the FS test. RESULTS: A very modest relationship was found between risk judgments and actual risk with 77% of 'optimists' having negative findings compared to 71% of 'pessimists'. More pessimists (14%) had an adenoma compared to optimists (11%). Compared to pessimists the odds of optimists actually being at lower risk of CRC equaled 0.70 (0.57, 0.86). CONCLUSIONS: The results suggest that people may have a limited ability to assess their risk of developing CRC. Health professionals should not assume that individuals have an accurate perception of their risk for cancer. Increasing people's ability to accurately perceive their risk may encourage more appropriate cancer preventive behavior.

Colorectal Neoplasms↗

PubMed2004

Socioeconomic variation in attitudes to eating and weight in female adolescents.

This study was stimulated by J. Sobal and A. J. Stunkard's (1989) theory that differences in deliberate weight control could underlie the socioeconomic gradient in adult weight. Female adolescents (N=1,248) completed measures of socioeconomic status, social norms for weight, weight ideals, attitudes to weight, and weight control behaviors. Higher socioeconomic status adolescents had greater awareness of the social ideals of slimness and had more family and friends who were trying to lose weight. They also defined a lower body mass index as "fat" and were more likely to have used healthy weight control methods. The results support the idea that socioeconomic differences in weight-related attitudes and behaviors may mediate the development of a gradient in weight.

Adolescent↗

PubMed2004

Wide variation in adenoma detection rates at screening flexible sigmoidoscopy.

BACKGROUND & AIMS: Wide between-center variation in adenoma detection rates (ADRs) was observed in the U.K. Flexible Sigmoidoscopy Screening Trial (overall, 12.1%; range, 8.6%-15.9%; P < 0.0001). The aim of this study was to determine whether the observed differences could be attributed to varying performance by endoscopists, to examine the effect of experience on performance, and to identify an attainable, standard ADR to which endoscopists could aspire. METHODS: Thirteen medical endoscopists, one per trial center, each performed about 3000 examinations (200 per month) using the same equipment and protocol. Overall and monthly ADRs were compared using multivariable logistic regression. RESULTS: Differences in ADRs were not explained by patient characteristics, incidence of colorectal cancer in the local population, or the endoscopists' medical specialty or previous experience. Average ADRs increased significantly with screening experience (up to 400 examinations). Endoscopists were classified as higher, intermediate, or lower adenoma detectors, and performance levels were maintained over time. Higher detectors had ADRs of 15% overall (men, 20%; women, 10%) and also detected more adenomas per case (higher/lower detectors, 21.7/10.4 adenomas per 100 examinations). CONCLUSIONS: The differences in ADRs were due to variation in performance of the endoscopists. Long-term follow-up will determine whether this variation is clinically important. We suggest that the standards in higher detecting centers should be achievable by all endoscopists screening unscreened populations aged older than 55 years. Endoscopists should aim to stay above the lower 95% confidence interval band for 200 examinations (10% overall; 5% in women, 15% in men).

Adenoma↗

PubMed2004

Testing positive for human papillomavirus in routine cervical screening: examination of psychosocial impact.

OBJECTIVE: To examine the psychosocial impact of testing positive for high risk human papillomavirus (HPV) among women attending primary cervical screening. DESIGN: Cross sectional survey. Measures were taken at baseline and one week after the receipt of HPV and cytology screening results. SETTING: Well women's clinic in London, UK. Population or Sample Four hundred and twenty-eight women aged 20-64 years. METHODS: Postal questionnaire survey. MAIN OUTCOME MEASURES: Psychosocial and psychosexual outcomes were anxiety, distress and feelings about current, past and future sexual relationships. RESULTS: Women with normal cytology who tested positive for HPV (HPV+) were significantly more anxious and distressed than women who were negative (HPV-) using both a state anxiety measure [F(1,267) = 29, P < 0.0001] and a screening specific measure of psychological distress [F(1,267) = 69, P < 0.0001]. Women with an abnormal or unsatisfactory smear result, who tested HPV+, were significantly more distressed than HPV- women with the same smear result [F(1,267) = 8.8, P = 0.002], but there was no significant difference in state anxiety. Irrespective of cytology result, HPV+ women reported feeling significantly worse about their sexual relationships. Approximately one-third of women who tested positive reported feeling worse about past and future sexual relationships compared with less than 2% of HPV- women. CONCLUSION: The findings suggest that testing positive for HPV may have an adverse psychosocial impact, with increased anxiety, distress and concern about sexual relationships. Psychosocial outcomes of HPV testing need further investigation and must be considered alongside clinical and economic decisions to include HPV testing in routine cervical screening.

Adult↗

PubMed2004

Human papillomavirus and cervical cancer: issues for biobehavioral and psychosocial research.

There is now overwhelming evidence that high-risk, sexually transmitted types of human papillomavirus (HPV) are the main causal agent in cervical cancer. Biobehavioral and psychosocial research is uniquely capable of addressing many of the issues raised by HPV and its link with cervical cancer. In this article we review current findings in this area and identify issues for future research. The first of the three sections explores issues associated with the introduction of HPV testing for the detection and management of cervical abnormalities and the impact of growing public awareness of the sexually transmitted nature of cervical cancer. The implications for public understanding of cervical cancer, psychosocial issues associated with screening, and the potential impact on screening uptake are discussed. The second section addresses the role of biobehavioral factors in the persistence and progression of HPV infection as well as possible interventions to minimize the risk of persistence. Finally, primary prevention of HPV is discussed.

Cervix Uteri↗