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Background: Low cancer awareness may contribute to delayed diagnosis and poor cancer survival. We aimed to quantify socio-demographic differences in cancer symptom awareness and barriers to symptomatic presentation in the English population.Methods: Using a uniquely large data set (n=49 270), we examined the association of cancer symptom awareness and barriers to presentation with age, gender, marital status and socio-economic position (SEP), using logistic regression models to control for confounders.Results: The youngest and oldest, the single and participants with the lowest SEP recognised the fewest cancer symptoms, and reported most barriers to presentation. Recognition of nine common cancer symptoms was significantly lower, and embarrassment, fear and difficulties in arranging transport to the doctor's surgery were significantly more common in participants living in the most deprived areas than in the most affluent areas. Women were significantly more likely than men to both recognise common cancer symptoms and to report barriers. Women were much more likely compared with men to report that fear would put them off from going to the doctor.Conclusions: Large and robust socio-demographic differences in recognition of some cancer symptoms, and perception of some barriers to presentation, highlight the need for targeted campaigns to encourage early presentation and improve cancer outcomes.

Research suggests that repeatedly offering infants a variety of vegetables during weaning increases vegetable intake and liking. The effect may extend to novel foods. The present study aimed to investigate the impact of advising parents to introduce a variety of single vegetables as first foods on infants' subsequent acceptance of a novel vegetable. Mothers of 4- to 6-month-old infants in the UK, Greece and Portugal were randomised to either an intervention group (n 75), who received guidance on introducing five vegetables (one per d) as first foods repeated over 15 d, or a control group (n 71) who received country-specific ‘usual care’. Infant's consumption (g) and liking (maternal and researcher rated) of an unfamiliar vegetable were assessed 1 month post-intervention. Primary analyses were conducted for the full sample with secondary analyses conducted separately by country. No significant effect of the intervention was found for vegetable intake in the three countries combined. However, sub-group analyses showed that UK intervention infants consumed significantly more novel vegetable than control infants (32·8 (sd 23·6) v. 16·5 (sd 12·1) g; P =0·003). UK mothers and researchers rated infants' vegetable liking higher in the intervention than in control condition. In Portugal and Greece, there was no significant intervention effect on infants' vegetable intake or liking. The differing outcome between countries possibly reflects cultural variations in existing weaning practices. However, the UK results suggest in countries where vegetables are not common first foods, advice on introducing a variety of vegetables early in weaning may be beneficial for increasing vegetable acceptance.

A large number of genetic loci are associated with adult body mass index. However, the genetics of childhood body mass index are largely unknown. We performed a meta-analysis of genome-wide association studies of childhood body mass index, using sex- and age-adjusted standard deviation scores. We included 35 668 children from 20 studies in the discovery phase and 11 873 children from 13 studies in the replication phase. In total, 15 loci reached genome-wide significance (P-value < 5 × 10−8) in the joint discovery and replication analysis, of which 12 are previously identified loci in or close to ADCY3, GNPDA2, TMEM18, SEC16B, FAIM2, FTO, TFAP2B, TNNI3K, MC4R, GPR61, LMX1B and OLFM4 associated with adult body mass index or childhood obesity. We identified three novel loci: rs13253111 near ELP3, rs8092503 near RAB27B and rs13387838 near ADAM23. Per additional risk allele, body mass index increased 0.04 Standard Deviation Score (SDS) [Standard Error (SE) 0.007], 0.05 SDS (SE 0.008) and 0.14 SDS (SE 0.025), for rs13253111, rs8092503 and rs13387838, respectively. A genetic risk score combining all 15 SNPs showed that each additional average risk allele was associated with a 0.073 SDS (SE 0.011, P-value = 3.12 × 10−10) increase in childhood body mass index in a population of 1955 children. This risk score explained 2% of the variance in childhood body mass index. This study highlights the shared genetic background between childhood and adult body mass index and adds three novel loci. These loci likely represent age-related differences in strength of the associations with body mass index. Refereed/Peer-reviewed

Colorectal cancer (CRC) is the second largest cause of cancer death in the UK. Since 2010, CRC screening based on Faecal Occult Blood testing has been offered by the NHS in England biennially to all persons age 60-69 years. Several studies have demonstrated a gradient in uptake using area-level markers of socio-economic status (SES), but few have examined the individual-level contributors to the gradient. We aimed to quantify the extent of SES inequality in CRC screening uptake in England using individual-level data, and to identify individual factors associated with this inequality. We used data from 1833 participants (aged 61-69) in Wave 5 (collected in years 2010/11) of the English Longitudinal Study of Ageing (ELSA) eligible for having been sent at least one CRC screening invitation. Uptake was defined by self-report of ever having been screened as part of the National Screening Programme. We assessed socio-economic inequality using the corrected concentration index of uptake against SES rank, which was derived by regressing a range of SES markers against net non-pension household wealth. Other demographic and health-related variables were included in the analysis. Factors associated with inequality were measured using concentration index decomposition. There was a significant pro-rich gradient in screening uptake (concentration index: 0.16, 95% CI:0.11-0.22), mostly explained within our model by differences in non-pension wealth (38.7%), partner screening status (15.9%), sickness/disability (13.5%), and health literacy (8.5%). Interventions aimed at reducing inequalities in CRC screening uptake should focus on improving acceptability of screening in populations with low levels of education and literacy barriers.

Introduction Patients diagnosed with intermediate-risk adenomas following a positive guaiac faecal occult blood test in the English NHS Bowel Cancer Screening Programme (BCSP) are invited to attend a surveillance colonoscopy after three years. As demand for colonoscopy services increases, effective non-colonoscopic approaches to surveillance are needed. The FIT for Follow-Up study aims to determine the programme sensitivity and specificity of three annual faecal immunochemical tests for haemoglobin (FIT) in detecting advanced adenomas (AA) and/or colorectal cancers in patients undergoing surveillance, compared with findings at the gold standard colonoscopy. Method Eligible participants are invited to complete annual FIT tests (OC-SENSOR, Eiken Chemical Co. Ltd) whilst awaiting their surveillance colonoscopy. If a FIT is positive (≥40μg Hb/g faeces) participants are offered an earlier surveillance colonoscopy. If a FIT is negative participants are offered further annual FIT tests and their original three year surveillance colonoscopy. Results Recruitment to the study began in January 2012. In round 1, 8009 eligible patients were invited to participate, 74% (5925) consented and returned a valid FIT kit, and the positivity rate was 5.8% (346/5925). Of the FIT positive participants, 88.2% (305/346) attended an earlier colonoscopy, 23.9% (73/305) had AA and 1.9% (6/305) were diagnosed with cancer. In round 2, 5510 participants were invited to complete a FIT, 96.9% (5340/5510) returned a valid kit, and the positivity rate was 4.5% (239/5340). Of the FIT positive participants, 81.2% (194/239) attended an earlier colonoscopy, 16.5% (32/194) had AA and 4.1% (8/194) were diagnosed with cancer. Round 3 of the study is now underway. To date, 3118 participants have been invited to complete a FIT, 93.0% have returned a valid kit (2900/3118), and the positivity rate is 4.0% (117/2900). All participants in round 3 are invited to attend colonoscopies: earlier if they are positive, three year surveillance exams if they are negative. Attendance rates at round 3 colonoscopies are currently over 80% and we have collected 984 colonoscopy reports from 62 screening centres. Conclusion We have experienced a very high response and retention rate in all rounds of the study. We are now focused on encouraging participants to attend their surveillance colonoscopies, and collecting reports from screening centres, to maximise the benefits to the study of the high uptake rates achieved to date. Disclosure of interest None Declared.

Background: Appreciating variation in the length of pre- or post-presentation diagnostic intervals can help prioritise early diagnosis interventions with either a community or a primary care focus. Methods: We analysed data from the first English National Audit of Cancer Diagnosis in Primary Care on 10 953 patients with any of 28 cancers. We calculated summary statistics for the length of the patient and the primary care interval and their ratio, by cancer site. Results: Interval lengths varied greatly by cancer. Laryngeal and oropharyngeal cancers had the longest median patient intervals, whereas renal and bladder cancer had the shortest (34.5 and 30 compared with 3 and 2 days, respectively). Multiple myeloma and gallbladder cancer had the longest median primary care intervals, and melanoma and breast cancer had the shortest (20.5 and 20 compared with 0 and 0 days, respectively). Mean patient intervals were longer than primary care intervals for most (18 of 28) cancers, and notably so (two- to five-fold greater) for 10 cancers (breast, melanoma, testicular, vulval, cervical, endometrial, oropharyngeal, laryngeal, ovarian and thyroid). Conclusions: The findings support the continuing development and evaluation of public health interventions aimed at shortening patient intervals, particularly for cancers with long patient interval and/or high patient interval over primary care interval ratio.

This overview describes the principles of the 4th edition of the European Code against Cancer and provides an introduction to the 12 recommendations to reduce cancer risk. Among the 504.6 million inhabitants of the member states of the European Union (EU28), there are annually 2.64 million new cancer cases and 1.28 million deaths from cancer. It is estimated that this cancer burden could be reduced by up to one half if scientific knowledge on causes of cancer could be translated into successful prevention. The Code is a preventive tool aimed to reduce the cancer burden by informing people how to avoid or reduce carcinogenic exposures, adopt behaviours to reduce the cancer risk, or to participate in organised intervention programmes. The Code should also form a base to guide national health policies in cancer prevention. The 12 recommendations are: not smoking or using other tobacco products; avoiding second-hand smoke; being a healthy body weight; encouraging physical activity; having a healthy diet; limiting alcohol consumption, with not drinking alcohol being better for cancer prevention; avoiding too much exposure to ultraviolet radiation; avoiding cancer-causing agents at the workplace; reducing exposure to high levels of radon; encouraging breastfeeding; limiting the use of hormone replacement therapy; participating in organised vaccination programmes against hepatitis B for newborns and human papillomavirus for girls; and participating in organised screening programmes for bowel cancer, breast cancer, and cervical cancer.

Background: English Be Clear on Cancer (BCOC) campaigns aim to promote early presentation of potential cancer symptoms by (i) giving information on symptoms to look out for, and (ii) emphasising the approachability of the general practitioner (GP). This study examined public awareness of the targeted symptoms and perceived approachability of the GP before and after the national bowel and lung campaigns. Methods: The Cancer Research UK Cancer Awareness Measure (CAM) was included in the Opinions and Lifestyle survey (known then as the ‘Opinions Survey') run by the Office for National Statistics in October and November 2010 and 2012. Change in awareness of symptoms and barriers to help-seeking related to those targeted in the campaigns between the 2010 and 2012 surveys, was compared with change in awareness of symptoms and barriers not targeted by the campaigns. Results: Recall of ‘persistent cough' or ‘hoarseness' as a sign of cancer increased from 18% in 2010 to 26% in 2012 (P0.02). Barriers to visiting the GP targeted in the campaign (the doctor would be difficult to talk to and being worried about wasting the doctor's time) did not change, although several non-targeted barriers reduced. Conclusions: BCOC campaigns run in England in 2012 were associated with increased public awareness of some key symptoms of lung and bowel cancer. Barriers to visiting the GP that were targeted in the campaign were not reduced, indicating that a different approach may be needed to shift public attitudes towards GPs.

The poor outcomes for cancers diagnosed at an advanced stage have been the driver behind research into techniques to detect disease before symptoms are manifest. For cervical and colorectal cancer, detection and treatment of "precancers" can prevent the development of cancer, a form of primary prevention. For other cancers-breast, prostate, lung, and ovarian-screening is a form of secondary prevention, aiming to improve outcomes through earlier diagnosis. International and national expert organizations regularly assess the balance of benefits and harms of screening technologies, issuing clinical guidelines for population-wide implementation. Psychological research has made important contributions to this process, assessing the psychological costs and benefits of possible screening outcomes (e.g., the impact of false positive results) and public tolerance of overdiagnosis. Cervical, colorectal, and breast screening are currently recommended, and prostate, lung, and ovarian screening are under active review. Once technologies and guidelines are in place, delivery of screening is implemented according to the health care system of the country, with invitation systems and provider recommendations playing a key role. Behavioral scientists can then investigate how individuals make screening decisions, assessing the impact of knowledge, perceived cancer risk, worry, and normative beliefs about screening, and this information can be used to develop strategies to promote screening uptake. This article describes current cancer screening options, discusses behavioral research designed to reduce underscreening and minimize inequalities, and considers the issues that are being raised by informed decision making and the development of risk-stratified approaches to screening.

Background:Sociodemographic inequalities in the stage of diagnosis and cancer survival may be partly due to differences in the appraisal interval (time from noticing a bodily change to perceiving a reason to discuss symptoms with a health-care professional). A number of symptom appraisal models have been developed describing the psychological factors that underlie how people make sense of symptoms, although none explicitly focus on sociodemographic characteristics.Methods:We therefore conducted a conceptual review synthesising all symptom appraisal models, and focus on potential links with sociodemographics that could be the focus of future research.Results:Common psychological elements across nine symptom appraisal models included knowledge, attention, expectation and identity, all of which could be sensitive to sociodemographic factors. For example, lower socioeconomic status (SES), male sex and older age are associated with lower health literacy generally and lower cancer symptom knowledge. Limited attentional resources, lower expectations about health and lack of social support also hamper symptom interpretation, and would be likely to be more prevalent in those from lower SES backgrounds. Symptom heuristics (‘rules of thumb’) may lead to symptoms being normalised because they are common within the social network, potentially disadvantaging older populations.Conclusions:A better understanding of the processes through which people interpret their symptoms, and the way these processes differ by sociodemographic factors, could help guide the development of interventions with the aim of reducing inequalities in cancer outcomes.British Journal of Cancer advance online publication, 3 March 2015; doi:10.1038/bjc.2015.39 www.bjcancer.com.

BackgroundHealth behavior change following a cancer diagnosis has the potential to improve long-term outcomes. However, many patients do not receive professional advice about lifestyle and are therefore increasingly using the Internet to seek further information. The statutory and charitable sectors and cancer centers all play an important role in the provision of information and have been found to be favored by cancer survivors searching for information. However, to date there has been no systematic evaluation of the lifestyle information available online for cancer survivors. ObjectiveThe purpose of this review was to identify the lifestyle information provided for cancer survivors by statutory and charitable sector organizations and cancer centers in the United Kingdom. We aimed to identify information on tobacco, physical activity, diet, weight, and alcohol designed for people who have been diagnosed with breast, prostate, or colorectal cancer. MethodsThe National Health Service (NHS) website was the focus of the search for information provided by the statutory sector. Cancer centers were identified from the Organization of European Cancer Institutes and an Internet search, and charitable sector organizations were identified by searching the Charity Commission database. The three largest generic, breast, prostate, and colorectal cancer charitable organizations were included. A systematic search of the organizations was conducted to identify lifestyle information for cancer survivors. ResultsTen organizations had some lifestyle information for cancer survivors on their websites. The Christie NHS Foundation Trust, Macmillan Cancer Support, and Prostate Cancer UK had the most comprehensive guides, covering physical activity, diet, weight management, smoking, and alcohol. The NHS website did not provide any information but had a link to Cancer Research UK’s information about diet. Eight organizations suggested talking to a health professional before making any changes. ConclusionsThe majority of organizations included in this review would benefit from updating their websites to include adequate information and advice about lifestyle for cancer survivors, or they risk cancer survivors turning to less reliable sources of information. Health professionals should be appropriately trained to deal with questions about lifestyle and to advise cancer survivors about lifestyle changes following their diagnosis.

To examine the medium-term stability of anthropometric and cardio-metabolic parameters in the general population.Participants were 5160 men and women from the English Longitudinal Study of Ageing (age ≥50 years) assessed in 2004 and 2008. Anthropometric data included height, weight, BMI and waist circumference. Cardio-metabolic parameters included blood pressure, serum lipids (total cholesterol, HDL, LDL, triglycerides), hemoglobin, fasting glucose, fibrinogen and C-reactive protein.Stability of anthropometric variables was high (all intraclass correlations0.92), although mean values changed slightly (-0.01 kg weight, +1.33 cm waist). Cardio-metabolic parameters showed more variation: correlations ranged from 0.43 (glucose) to 0.81 (HDL). The majority of participants (71-97%) remained in the same grouping relative to established clinical cut-offs.Over a 4-year period, anthropometric and cardio-metabolic parameters showed good stability. These findings suggest that when no means to obtain more recent data exist, a one-time sample will give a reasonable approximation to average levels over the medium-term, although reliability is reduced.

A healthy lifestyle following a cancer diagnosis is linked with better long-term outcomes. Health professionals can play an important role in promoting healthy lifestyles after cancer, but little is known about the factors that influence whether or not they give lifestyle advice. We conducted an online survey to examine levels of, and predictors of, health professionals' provision of lifestyle advice to cancer patients in the United Kingdom. The survey included questions on awareness of lifestyle guidelines for cancer survivors, current practices with regard to giving advice on smoking, diet, exercise, weight and alcohol, and perceived barriers to giving advice. Nurses, surgeons and physicians (N=460) responded to the survey. Many (36%) were not aware of any lifestyle guidelines for cancer survivors, but 87% reported giving some lifestyle advice; although this was lower for individual behaviours and often to50% of patients. Respondents who were aware of lifestyle guidelines were more likely to give lifestyle advice on all behaviours (all OR's1.76, all P's0.05). Not believing lifestyle would affect outcomes was associated with lower odds of giving lifestyle advice (all OR's0.48, all P's0.05). Improved survivorship education for health professionals may increase the number of patients receiving lifestyle advice, and improve their long-term outcomes.

Objective Little is known about the trajectory of health and well‐being from before to after a cancer diagnosis. This study aimed to examine changes in health and well‐being across three time points (0–2 years before a cancer diagnosis, 0–2 years post‐diagnosis and 2–4 years post‐diagnosis) in individuals receiving a new cancer diagnosis, and at matched time points in a cancer‐free comparison group. Methods Data were from waves 1–6 of the English Longitudinal Study of Ageing. Repeated‐measures ANOVAs were used to examine differences in self‐rated health, mobility impairments, activities of daily living impairments, quality of life, depressive symptoms and life satisfaction by group and time, and group‐by‐time interactions. Results Of the 4565 participants with data from three time points, 444 (9.7%) reported a new cancer diagnosis. Those in the cancer group reported poorer self‐rated health (p

We argued that multiple pre-referral consultations have a range of underlying causes, beyond the clinical reasoning skills of individual doctors.1 2 We therefore agree with Taylor that for some patients multiple pre-referral consultations will be generated by guideline concordant expectant management or investigations.3 Repeat consultations are nonetheless associated …

Background Delay in help seeking for cancer ‘alarm’ symptoms has been identified as a contributor to delayed diagnosis. Aim To understand people’s help-seeking decision making for cancer alarm symptoms, without imposing a cancer context. Design and setting Community-based, qualitative interview study in the UK, using purposive sampling by sex, socioeconomic status, and prior help seeking, with framework analysis of transcripts. Method Interviewees (n = 48) were recruited from a community-based sample (n = 1724) of adults aged ≥50 years who completed a health survey that included a list of symptoms. Cancer was not mentioned. Participants reporting any of 10 cancer alarm symptoms (n = 915) and who had consented to contact (n = 482) formed the potential pool from which people were invited to an interview focusing on their symptom experiences. Results Reasons for help seeking included symptom persistence, social influence, awareness/fear of a link with cancer, and ‘just instinct’. Perceiving the symptom as trivial or ‘normal’ was a deterrent, as was stoicism, adopting self-management strategies, and fear of investigations. Negative attitudes to help seeking were common. Participants did not want to be seen as making a fuss, did not want to waste the doctor’s time, and were sometimes not confident that the GP could help. Conclusion Decision making about cancer alarm symptoms was complex. Recognition of cancer risk almost always motivated help seeking (more so than the fear of cancer being a deterrent), assisted by recent public-awareness campaigns. As well as symptom persistence motivating help seeking, it could also have the reverse effect. Negative attitudes to help seeking were significant deterrents.

ObjectiveParental decision-making around extended formula feeding (12 months+) has not been explored previously. This study tested the hypotheses that extended formula milk use (i) is associated with poorer appetite and (ii) supplements lower food intake.MethodsAppetite was assessed with the Child Eating Behaviour Questionnaire (CEBQ) in 3854 twin children aged 16 months. Diet was assessed from 3-day diaries in 2714 children at 21 months. Parents reported their children's weight at 24 months. Associations between formula feeding and (1) appetite, (2) energy intake and (3) weight were examined. 35 mothers were interviewed when the children were 7 years old to explore retrospectively their reasons for extended formula feeding.ResultsFormula consumers (13% of the sample) scored significantly differently than non-formula consumers on five of the six CEBQ subscales, indicating lower appetite avidity: ‘food responsiveness’ (2.02 vs 2.22, respectively),‘enjoyment of food’ (3.99 vs 4.20), ‘satiety responsiveness’ (2.89 vs 2.65), ‘slowness in eating’ (2.63 vs 2.46) and ‘food fussiness’ (2.34 vs 2.14). Formula consumers had a significantly lower percentage of daily energy intake from food (70% vs 74%); however, total daily energy intake did not differ significantly from non-consumers (4315 vs 4373 kJ). At interview, mothers reported supplementing their child's diet with formula because of ‘picky eating’ and concerns about inadequate food intake.ConclusionsHigh formula milk intake is associated with picky-eating behaviours, but seems to act as a substitute for rather than a supplement to solid food. Prospective and intervention studies are needed to determine whether extended formula feeding has an enduring impact on weight trajectories, eating behaviours or health.

Context The importance of physical activity to paediatric health warrants investigation into its determinants. Objective measurement allows a robust examination of genetic and environmental influences on physical activity. Objective To systematically review the evidence on the extent of genetic and environmental influence on children's objectively-measured activity levels from twin studies. Data sources and search terms Medline, EMBASE, PsycINFO, Health and Psychosocial Instruments and all Ovid Databases. Search terms: “accelerometer” OR “actometer” OR “motion sensor” OR “heart rate monitor” OR “physical activity energy expenditure” AND “twin”. Limited to Human, English language and children (0–18 years). Results Seven sets of analyses were included in the review. Six analyses examined children's daily-life activity and found that the shared environment had a strong influence on activity levels (weighted mean 60%), with a smaller contribution from genetic factors (weighted mean 21%). Two analyses examined short-term, self-directed activity in a standard environment and found a smaller shared environment effect (weighted mean 25%) and a larger genetic estimate (weighted mean 45%). Conclusions Although genetic influences may be expressed when children have brief opportunities for autonomous activity, activity levels in daily-life are predominantly explained by environmental factors. Future research should aim to identify key environmental drivers of childhood activity., Highlights • Genetic influences may be expressed when children have brief opportunities for autonomous activity. • Activity levels in daily-life are predominantly explained by environmental factors. • Future research should aim to identify key environmental drivers of childhood activity.

Background.Dogs are compelling models in which to study obesity since the condition shares many characteristics between humans and dogs. Differences in eating behaviour are recognised to contribute to obesity susceptibility in other species but this has not been systematically studied in dogs.Aim.To develop and validate an owner-reported measure of canine eating behaviour and owner or dog related factors which can alter the development of obesity. Further, to then test variation in food-motivation in dogs and its association with obesity and owner management.Methods.Owner interviews, a literature review and existing human appetite scales were used to identify relevant topics and generate items for the questionnaire. Following a pilot phase, a 75 item online questionnaire was distributed via social media. Responses from 302 dog/owner dyads were analysed and factor structure and descriptive statistics calculated. Results were compared with descriptions of dog behaviour and management from a subset of respondents during semi-structured interviews. The optimum questions were disseminated as a 34 item final questionnaire completed by 213 owners, with a subset of respondents repeating the questionnaire 3 weeks later to assess test–retest reliability.Results.Analysis of responses to the final questionnaire relating to 213 dog/owner dyads showed a coherent factor structure and good test–retest reliability. There were three dog factors (food responsiveness and satiety, lack of selectivity, Interest in food), four owner factors (owner motivation to control dog weight, owner intervention to control dog weight, restriction of human food, exercise taken) and two dog health factors (signs of gastrointestinal disease, current poor health). Eating behaviour differed between individuals and between breed groups. High scores on dog factors (high food-motivation) and low scores on owner factors (less rigorous control of diet/exercise) were associated with obesity. Owners of more highly food-motivated dogs exerted more control over their dogs’ food intake than those of less food-motivated dogs.Conclusions.The DORA questionnaire is a reliable and informative owner-reported measure of canine eating behaviour and health and management factors which can be associated with obesity development. The tool will be applicable to study of the canine obesity model and to clinical veterinarians. Results revealed eating behaviour to be similarly associated with obesity as exercise and owners giving titbits.

BackgroundThe extent that controlled diabetes impacts upon mortality, compared with uncontrolled diabetes, and how pre-diabetes alters mortality risk remain issues requiring clarification.MethodsWe carried out a cohort study of 22,106 Health Survey for England participants with a HbA1C measurement linked with UK mortality records. We estimated hazard ratios (HRs) of all-cause, cancer and cardiovascular disease (CVD) mortality and 95% confidence intervals (CI) using Cox regression.ResultsAverage follow-up time was seven years and there were 1,509 deaths within the sample. Compared with the non-diabetic and normoglycaemic group (HbA1C ConclusionsWe found higher rates of all-cause and CVD mortality among those with raised HbA1C, but not for those with pre-diabetes, compared with those without diabetes. This excess differed by sex and diabetes status. The large number of deaths from cancer and CVD globally suggests that controlling blood glucose levels and policies to prevent hyperglycaemia should be considered public health priorities.

Aim To examine the relationship between dating and smoking behaviour. Design A 5-year prospective study. Setting Thirty-six schools in South London, England. Participants A socio-economically and ethnically diverse sample of students (n = 4319 at baseline) took part in the study, providing annual assessments from age 11–16 years. Measurements Questionnaire items assessed dating status, smoking status, friends and family smoking, psychological wellbeing, popularity and conduct, pubertal status, gender, ethnicity and deprivation. Cotinine assays provided biochemical verification of smoking status. Findings At age 11–12, 29% of girls and 18% of boys reported having a boyfriend or girlfriend. Logistic regressions showed being an early ‘dater’ to be a strong predictor of later smoking uptake at each study year, with odds ratios ranging from 3.03 to 8.96 among girls and 1.87 to 5.85 among boys. These associations remained significant after controlling for potential confounding factors, including past smoking and pubertal stage. There was minimal evidence that having smoked by age 11–12 predicted later dating. Conclusions The association between early dating and later smoking is strong, and not explained by obvious confounders or dependent on the influence of past smoking experience. The use of smoking to maintain a popular image, and the link between both behaviours and aspirations towards maturity, are potential explanations for the effect. Identification of adolescents dating early could help to target prevention of later smoking uptake.

Objectives This study examined the influence of marital status and inviting both partners together on participation in colorectal cancer screening. Setting Data were from a subset of participants from the UK Flexible Sigmoidoscopy Trial (1996–1999). Methods Marital status was self-reported, and co-invitation of partner was obtained from the trial database. Screening intentions were assessed in 16,527 adults aged 55–64 years. Attendance was recorded in the 4130 respondents who were subsequently invited. Results Multivariate analyses, controlling for age and educational level, indicate that married (or cohabiting) people have more positive intentions (odds ratio [OR] 1.26; 95% confidence interval [CI] 1.14–1.38) and higher attendance rates at screening (OR = 1.23; 95% CI 1.04–1.45) than non-married people. After adjusting for the marriage effect, inviting partners together (co-invitation) significantly increased screening intentions among women (OR = 1.17; 95% CI 1.04–1.31) but not men (OR = 0.97; 95% CI 0.85–1.10). Co-invitation significantly increased attendance at screening in both genders (OR = 1.34; 95% CI 1.14–1.58). Conclusions In this age group, married adults are more likely to participate in colorectal cancer screening than the non-married, and inviting both members of a couple together further increases screening uptake. The positive effect of marriage was as strong for women as men.

Background: The objective of this study was to compare testicular self-examination (TSE) practice in 13 European countries over a 10-year period. Testicular cancer predominantly affects young men. It is rare but on the increase and is most common in Caucasian ethnic groups living in industrialised nations, particularly northern Europe. Stage and prognosis are related to early diagnosis and TSE has been advocated to help achieve this. Over the last 15 years there have been efforts to increase disease awareness and self-examination practice. Recent reductions in patients’ delay in seeking help have been attributed to the success of this education, although no evidence has been available to substantiate this claim. Methods: Data from two successive international surveys in male student populations in Europe (n = 4322, n = 4358) carried out in 1990 and 2000, respectively, are described. Results: Although TSE practice rates are low, there have been significant increases over this 10-year period. Concl...

The authors studied the prevalence of heavy drinking among students in 21 developed and developing countries using an anonymous survey of 7,846 male and 9,892 female students aged 17 to 30 years. There were wide variations in the prevalence of drinking among countries, and the highest rates of heavy drinking (defined as 5 or more drinks for men and 4 or more drinks for women on at least 1 occasion over the past 2 weeks) were reported in Belgium, Colombia, Ireland, and Poland (men), and Ireland and England (women). Heavy drinking was associated with living away from home, having a wealthier family background, and having well-educated parents. Beliefs about the dangers to health of excessive consumption were negatively related to heavy drinking. Heavy drinking is a concern among students in several countries and is associated with greater affluence. Challenging beliefs concerning health risks is a crucial aspect of prevention in this population.

Human papillomavirus (HPV) testing has clearly demonstrated a higher sensitivity but somewhat lower specificity than cytology. However, there are still issues regarding how best to use it in primary screening. In countries where cytology is of good quality, the most interesting possibility for primary screening is to use HPV testing as the sole screening modality with cytology reserved for triage of HPV-positive women. In countries with a less established infrastructure, however, use of HPV alone would also be attractive, although rapid, simple tests followed by immediate treatment are needed to minimize the number of visits and make best use of limited resources. Several approaches to deal with the lower specificity of HPV testing are also examined. These include HPV typing with a different management strategy for HPV-16 and -18/45, use of viral load to exclude infections unlikely to be associated with > or =CIN-2, and markers of proliferative lesions such as p16 and mRNA or cell-cycle markers such as cdc6 or the mcm5 proteins. Micro-array studies offer the prospect of discovering new, better DNA- or RNA-based diagnostics. The fact that HPV is a sexually transmitted infection may lead to anxiety and concerns about sexual relationships and these issues are also discussed. Ongoing HPV studies are identified and briefly reviewed.

A kardiovaszkularis korkepek okozta halalozas a fejlett tarsadalmakban vezető helyen all. Vizsgalatunkban felmertuk, hogy a rizikotenyezők ismerete es az egeszseges eletmod kulonboző aspektusaihoz valo hozzaallas milyen osszefuggest mutat a kockazati es az egeszsegmagatartassal. Modszerek: Az International Health and Behaviour Survey nemzetkozi kutatas kereteben orszagos reprezentativ keresztmetszeti vizsgalatot vegeztunk egyetemistak es főiskolasok kozott. Onkitoltős kerdőivet alkalmazva a kardiovaszkularis rizikofaktorok kozul az egeszsegtelen eletmodra (dohanyzas, keves mozgas, tulsuly, egeszsegtelen etrend) kerdeztunk ra, es vizsgaltuk a rizikotenyezők ismeretet, illetve az egeszseges eletmoddal kapcsolatos attitűdoket is. A felmeresben 590 hallgato vett reszt: 237 ferfi (40,2%) es 353 nő (59,8%). A hallgatok eletkora 18 es 28 ev kozott volt, atlageletkoruk 21,8 ev (±1,8). Tobbvaltozos logisztikus regresszios modelleket alkalmaztunk, eredmenyeinket nemre es korra kontrollaltuk. Eredmenyek:Magatartas: ...

There is accumulating evidence that positive affect may protect against ill-health and risk of disease. Here, we summarize results from our research program into the biological correlates of positive affect. Data have been collected from middle-aged men and women, with positive affect assessed through repeated ratings of happiness over a working day. The results indicate that greater happiness is associated with lower salivary cortisol both on working and nonworking days, reduced fibrinogen stress responses, and lower ambulatory heart rate in men. These effects are independent of age, socioeconomic status, smoking, body mass and psychological distress. A 3 year follow-up has confirmed these biological associations with happiness. In addition, we found that happiness was inversely related to ambulatory systolic blood pressure on follow-up, again independently of potential confounders including negative affect. These results suggest that positive affective states are linked to favorable health outcomes through their influence on health-related biology, and may be particularly relevant in old age, when the accumulation of risk factors leads to increased risk of chronic disease.

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. 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. 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. 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.

Children and adolescents with obesity face stigmatization and discrimination in many areas of their lives, and it has been assumed that their psychological well-being will be compromised as a result. This chapter examines the most recent empirical evidence on the relationship between childhood obesity and body dissatisfaction, self-esteem and depression. Studies of clinical samples typically report poorer psychological well-being in treatment seekers when compared with population-based obese and normal weight controls. However, research in community samples suggests that despite moderate levels of body dissatisfaction, few obese children are depressed or have low self-esteem. A number of important moderators and mediators of the association between obesity and well-being have emerged, with females, Caucasians and adolescents being particularly at risk. Implications for treatment and future research priorities are suggested.

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.

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.

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.

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.

Objective. Because of the rising rates of childhood obesity, we set out to determine what is known about its causes and what could be done to pre- vent additional increases. Methodology. A meeting was convened of experts in areas that bear on prevention of obesity development during intrauterine life, infancy, and very early child- hood. They presented recent data and their interpreta- tions of the stage of our current knowledge in related areas. They also proposed possible useful interventions and future directions for research. Findings. The speakers' talks indicated that (1) breast- feeding as currently practiced seems to be significantly (albeit weakly) protective against obesity and should be encouraged as the preferred method of feeding infants for as long a duration as practical during the first year of life; (2) infant-feeding practices are changing in a way that may predispose to obesity (eg, soda and french fries are being fed to infants as young as 7 months of age), possibly altering taste preferences for foods and bever- ages that are energy dense and nutrient poor; (3) although little is known about parenting styles (eg, authoritative versus permissive), parenting style is likely to be a fruit- ful area of current research into childhood obesity etiol- ogy; and (4) the pattern of weight changes in the first few years of life may contribute to later risk of obesity. Conclusions. Children's obesity will continue to be a growing problem unless we improve understanding of the key factors likely to be operative during intrauterine life, infancy, and very early childhood, identify those in whom intervention would have the greatest effect, de- sign and evaluate preventive interventions, and promote those that are successful. Pediatrics 2004;114:1146-1173; obesity, pediatrics, prevention, infant feeding, birth weight, activity, dietary choices, maternal weight, feeding styles. ABBREVIATIONS. IOM, Institute of Medicine; SES, socioeco- nomic status; BMI, body mass index; NCHS, National Center for Health Statistics; LGA, large for gestational age; SGA, small for gestational age; NHANES, National Health and Nutrition Exam- ination Survey; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children; OR, odds ratio; CI, confidence interval; FITS, Feeding Infants and Toddlers Study; IFSQ, Infant Feeding Style Questionnaire; ALSPAC, Avon Longitudinal Study of Parents and Children.

Alcohol-impaired driving is a major problem in many countries. We assessed drinking and driving and associated attitudes and legislative practices in 8282 male and 10 816 female students at universities in 23 countries. The age-adjusted prevalence of drinking and driving was 20% in men, and 7% in women. There was wide variation between countries, with the highest levels in men and women from the USA and men from South American and Mediterranean countries. Rates correlated significantly with national surveys of drinking and driving, and with national road traffic accident death rates. Drinking and driving was more prevalent in country samples in which the legal blood alcohol threshold was higher. Attitudes to drinking and driving and other aspects of hazardous driving were strongly associated with drinking and driving both within and between countries. A multi-level approach involving changes in blood alcohol laws and efforts to shift the attitudes of individuals who drink and drive is suggested by the current results.

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.

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%; P0.0001). 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.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.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).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).

Background: Gender differences in health behaviors have been reported in many studies but causal mechanisms have been neglected.Purpose and Methods: This study examines 4 food choice behaviors in a large sample of young adults from 23 countries and tests 2 possible explanatory mechanisms for the gender differences—women’s greater likelihood of dieting and women’s greater beliefs in the importance of healthy diets.Results: Women were more likely than men to report avoiding high-fat foods, eating fruit and fiber, and limiting salt (to a lesser extent) in almost all of the 23 countries. They were also more likely to be dieting and attached greater importance to healthy eating. Dieting status explained around 22% of the gender difference in fat choices, 23% of fiber choices, and 7% of fruit, but none of the gender difference in salt. Health beliefs explained around 40% of the differences in each of the dietary behaviors and together they explained almost 50%. Gender differences in food choices therefore appear to be partly attributable to women’s greater weight control involvement and partly to their stronger belifs in healthy eating.Conclusions: Further research is needed to understand the additional factors that could promote men’s participation in simple healthy eating practices.

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 mealtimes 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.

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. (C) 2003 Elsevier Science Ltd. All rights reserved.

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.

Objective: Body dissatisfaction is reported in girls as young as 9 years old in Western countries. in the current study, internalization of the "thin ideal" was predicted to be a critical influence on the development of body dissatisfaction. Method: Participants (n = 356) were weighed and completed measures of body dissatisfaction, awareness and internalization of the thin ideal, and peer and maternal attitudes and behavior. Exposure to relevant print media was also assessed. Results: Body dissatisfaction was associated with a higher body mass index, although it was not restricted to overweight girls. Internalization mediated the relationship between awareness of the sociocultural standard of appearance and body dissatisfaction. Media exposure and peer and maternal weight-related attitudes and behavior were, in turn, related to awareness, supporting the hypothesized sociocultural processes. Discussion: Internalization operates as a central component in the development of body dissatisfaction, occurring at a young age in some girls. Internalization maybe a suitable target for preventive strategies. (C) 2003 by Wiley Periodicals, Inc.

Despite considerable epidemiological evidence of the health benefits of a diet high in fruit and vegetables, consumption in pre-school children remains well below recommended levels. This study evaluated the effectiveness of an exposure-based intervention, carried out by parents in the home, in increasing children's liking for a previously disliked vegetable. 156 parents of 2-6 year old children were randomly assigned to Exposure, Information or Control groups after a pre-intervention taste test at which a 'target' vegetable was selected. Parents in the Exposure group gave their child a taste of this vegetable daily for 14 days, parents in the Information group were given nutritional advice and a leaflet, and parents in the Control group received no further intervention. All participants took part in a post-intervention taste test. Greater increases in liking, ranking and consumption of the 'target' vegetable from pre- to post-intervention occurred in the Exposure group than in either of the other two groups. Only the Exposure group showed significant increases across all three outcomes. It can be concluded that a parent-led, exposure-based intervention involving daily tasting of a vegetable holds promise for improving children's acceptance of vegetables. These findings suggest a parental advice strategy which could be disseminated directly to parents or by health professionals.

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.

Objective:The present study was designed to investigate the psychophysiologic effects of “Applied Tension” (AT) on the emotional fainting response to blood and injury in a controlled experiment. Method: Twenty-two persons reporting to generally feel faint or to have fainted at the sight of blood or injury and 22 participants classified as Non-Fainters were randomly allocated to a treatment or control condition. Psychophysiologic responses were continuously monitored while individuals watched a video depicting open-heart surgery and a control film. Prior to the surgery film, participants in the treatment condition were instructed in the use of AT. Results: All participants classified as Fainters showed a diphasic response pattern while watching the surgery film. This response, however, was significantly attenuated in Fainters in the treatment condition. Conclusions: These results suggest that AT provides an effective treatment strategy for the prevention of fainting responses in persons with a fear of blood and injury.

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.

Aims To assess the prevalence of current tobacco smoking, associations with beliefs about the health benefits of not smoking and awareness of risks for lung cancer and heart disease in university students sampled from 23 countries, and to explore the utility of the World Health Organization (WHO) model of the world-wide tobacco epidemic in understanding differences between countries.Design Anonymous questionnaire survey.Participants A total of 19 298 university students (8482 men, 10 816 women) aged 17-30 years from 23 countries, studying courses unrelated to health.Measurements Standardized measures of smoking, wish to stop smoking, ratings of beliefs in the importance of not smoking for health and awareness of the influence of smoking on lung cancer and heart disease.Findings Prevalence varied widely, being highest in samples from South European countries and lowest in developing countries (Thailand, South Africa). The pattern of tobacco use and differences between men and women conformed largely to the WHO model. Health beliefs were associated strongly with smoking behaviour both within and between countries. Awareness of specific health risks of smoking was very variable, with particularly low levels in Asian, South American and developing country samples. Risk awareness was inconsistently related to behaviour.Conclusions The pattern of tobacco smoking in well-educated young adults appears to conform with wider international patterns of tobacco use. Awareness of specific health risks is poor, and modifying attitudes must be a central element in modifying tobacco use world-wide.