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

This study investigated variation in body dissatisfaction among obese women in relation to age of onset of obesity, and evaluated the contribution of teasing about weight and self-esteem as possible causes of higher body dissatisfaction in the early-onset group. One hundred and five obese women (body mass index [BMI] greater than or equal to 30), recruited from clinical settings in England, completed a mailed questionnaire. The early-onset group (by age 16) had a higher BMI, greater body dissatisfaction, and lower self-esteem. Predictably, they also reported more childhood teasing. Path analyses confirmed our expectation that early onset of obesity has an adverse effect on body image, which is independent of current BMI. Regression analyses failed to support the hypothesized mediating role of either childhood teasing or lower self-esteem. The possible direction of causal effects between body dissatisfaction and self-esteem is discussed, with the suggestion that early onset of obesity increases the risk of body dissatisfaction, which in turn impairs self-esteem. (C) 2002 Elsevier Science Ltd. All rights reserved.

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

Objective: This study was designed to determine whether a community sample of obese mothers with young children used different feeding styles compared with a matched sample of normal-weight mothers. Four aspects of feeding style were assessed: emotional feeding, instrumental feeding (using food as a reward), prompting/encouragement to eat, and control over eating.Research Methods and Procedures: Participants were from 214 families with same-sex twins; 100 families in which both parents were overweight or obese and 114 in which both parents were normal weight or lean.Results: We found that obese mothers were no more likely than normal-weight mothers to offer food to deal with emotional distress, use food as a form of reward, or encourage the child to eat more than was wanted. The obese and normal-weight mothers did differ on "control"; obese mothers reported significantly less control over their children's intake, and this was seen for both first-born and second-born twins. Twin analyses showed that these differences were not in response to children's genetic propensities, because monozygotic correlations were no greater than dizygotic correlations for maternal feeding style.Discussion: These results suggest that the stereotype of the obese mother, who uses food in nonnutritive ways so that her child also becomes obese, is more likely to be myth than fact. However, the results raise the possibility that lack of control of food intake might contribute to the emergence of differences in weight.

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

We examined associations between numeracy and sociocognitive factors associated with colorectal cancer screening uptake ( n = 964). Nearly half (45.7%) of the respondents incorrectly answered a numeracy question (low numeracy). Low numeracy respondents were less knowledgeable about colorectal cancer ( p

Background Advances in genetic technologies are expected to make population-wide genetic testing feasible. This could provide a basis for risk stratified cancer screening; but acceptability in the target populations has not been explored. Methods We assessed attitudes to risk-stratified ovarian cancer (OC) screening based on prior genetic risk assessment using a survey design. Home-based interviews were carried out by the UK Office of National Statistics in a population-based sample of 1095 women aged 18–74. Demographic and personal correlates of attitudes to risk-stratified OC screening based on prior genetic risk assessment were determined using univariate analyses and adjusted logistic regression models. Results Full data on the key analytic questions were available for 829 respondents (mean age 46 years; 27 % ‘university educated’; 93 % ‘White’). Relatively few respondents felt they were at ‘higher’ or ‘much higher’ risk of OC than other women of their age group (7.4 %, n = 61). Most women (85 %) said they would ‘probably’ or ‘definitely’ take up OC genetic testing; which increased to 88 % if the test also informed about breast cancer risk. Almost all women (92 %) thought they would ‘probably’ or ‘definitely’ participate in risk-stratified OC screening. In multivariate logistic regression models, university level education was associated with lower anticipated uptake of genetic testing (p = 0.009), but with more positive attitudes toward risk-stratified screening (p

Objectives To assess the proportion of the adult obese population in Great Britain who would describe their weight using the terms ‘obese’ and ‘very overweight’ in 2007 and 2012, and identify factors associated with more accurate weight perceptions. Design Analysis of weight perception data from two population-based surveys. Setting Population surveys conducted in Great Britain. Participants Survey respondents (N=657) whose self-reported weight and height placed them in the obese category: body mass index (BMI) ≥30. Primary outcome measure Self-identification using the terms ‘obese’ and ‘very overweight’. Results The proportion of obese adults selecting the term ‘obese’ to describe their body size was very low in both women (13% in 2007 and 11% in 2012) and men (4% in 2007 and 7% in 2012) and did not change significantly. Recognition of a substantial degree of overweight (as indexed by endorsement of either of the terms ‘obese’ or ‘very overweight’) declined substantially in women, from 50% in 2007 to 34% in 2012. It was not significantly changed in men (27% in 2007 and 23% in 2012). Having a higher BMI, and being able to identify the BMI threshold for obesity were associated with self-identifying as obese or very overweight. Conclusions The majority of the adult obese population of Great Britain do not identify themselves as either ‘obese’ or even ‘very overweight’. Public health initiatives to tackle obesity are likely to be hampered by this lack of recognition of weight status. It is important to understand whether moves to increase personal awareness of weight status in the obese population can facilitate beneficial behaviour change, and what role health professionals can play in increasing awareness of weight status in obese patients.

Purpose To explore public attitudes towards modifying frequency of mammography screening based on genetic risk. Methods Home-based interviews were carried out with a population-based sample of 942 women aged 18–74 years in the UK. Demographic characteristics and perceived breast cancer (BC) risk were examined as predictors of support for risk-stratified BC screening and of the acceptability of raised or lowered screening frequency based on genetic risk, using multivariate logistic regression. Results Over two-thirds of respondents (65.8%) supported the idea of varying screening frequency on the basis of genetic risk. The majority (85.4%) were willing to have more frequent breast screening if they were found to be at higher risk, but fewer (58.8%) were willing to have less frequent screening if at lower risk (t (956) = 15.6, p

Background The English NHS Bowel Cancer Screening Programme has offered biennial faecal occult blood testing to people aged 60–69 years since 2006, and to those aged 60–74 years since 2010. Analysis of the first 2.6 million screening invitations found that 54% of eligible people took up the invitation. The reasons for this low uptake are unclear. We investigated whether participation in screening varies according to cognitive ability and personality. Methods Participants were members of The English Longitudinal Study of Ageing. In 2010–2011, respondents were asked about participation in bowel cancer screening, and cognitive ability and the ‘Big Five’ personality traits were assessed. Logistic regression was used to examine the cross-sectional relationships between cognitive ability and personality and screening participation in 2681 people aged 60–75 years who were eligible to have been invited to take part in the UK national screening programme for bowel cancer. Results In age-adjusted and sex-adjusted analyses, better cognition and higher conscientiousness were associated with increased participation in cancer screening. ORs (95% CIs) per SD increase were 1.10 (1.03 to 1.18) for cognitive ability and 1.10 (1.01 to 1.19) for conscientiousness. After further adjustment for household wealth and health literacy—shown previously to be associated with participation—these associations were attenuated (ORs were 1.07 (1.00 to 1.15) and 1.07 (0.97 to 1.18), respectively). Conclusions We found some indication that better cognitive function and greater conscientiousness may be linked with a slightly increased likelihood of participation in bowel cancer screening. These relationships need investigation in other cohorts of older people.

Background Ethnic minority women are less likely to attend cervical screening. Aim To explore self-perceived barriers to cervical screening attendance among ethnic minority women compared to white British women. Design Qualitative interview study. Setting Community groups in ethnically diverse London boroughs. Methods Interviews were carried out with 43 women from a range of ethnic minority backgrounds (Indian, Pakistani, Bangladeshi, Caribbean, African, Black British, Black other, White other) and 11 White British women. Interviews were recorded, transcribed verbatim and analysed using Framework analysis. Results Fifteen women had delayed screening/had never been screened. Ethnic minority women felt that there was a lack of awareness about cervical cancer in their community, and several did not recognise the terms ‘cervical screening’ or ‘smear test’. Barriers to cervical screening raised by all women were emotional (fear, embarrassment, shame), practical (lack of time) and cognitive (low perceived risk, absence of symptoms). Emotional barriers seemed to be more prominent among Asian women. Low perceived risk of cervical cancer was influenced by beliefs about having sex outside of marriage and some women felt a diagnosis of cervical cancer might be considered shameful. Negative experiences were well remembered by all women and could be a barrier to repeat attendance. Conclusions Emotional barriers (fear, embarrassment and anticipated shame) and low perceived risk might contribute to explaining lower cervical screening coverage for some ethnic groups. Interventions to improve knowledge and understanding of cervical cancer are needed in ethnic minority communities, and investment in training for health professionals may improve experiences and encourage repeat attendance for all women.

Cancer stigma can have widespread effects, influencing the behaviour and wellbeing of patients as well as the community and even research funding. Patients with lung cancer report feeling particularly stigmatised because of the association with a behaviour (smoking) that is perceived to be personally controllable. However, there are other dimensions of cancer stigma, that might be more severe for other cancers. The present study therefore examined differences in attitudes towards lung cancer and four other cancer types, using a multidimensional measure of cancer stigma, to extend findings beyond personal responsibility attributions.Participants were a non-patient sample (n=1205) who were randomised to complete a survey online relating to one of five cancer types (lung, colorectal, skin, breast and cervical). Stigma was assessed using the Cancer Stigma Scale (CASS).There were significant differences across the five cancer types on all CASS subscales: awkwardness (F(4, 1009)=5.16, p0.001), severity (F(4, 984)=26.24, p0.001), avoidance (F(4, 1008)=5.38, p0.001), policy opposition (F(4, 1009)=8.38, p0.001), personal responsibility (F(4, 995)=31.67, p0.001) and financial discrimination (F(4, 957)=9.45, p0.001). Lung cancer attracted higher stigma scores than breast and cervical cancer on all subscales. Lung cancer was similar to skin cancer on personal responsibility, avoidance, and policy opposition, but attracted higher stigma in the domains of awkwardness, severity and financial discrimination. Lung cancer was similar to colorectal cancer for awkwardness, but significantly higher on all other subscales.Lung cancer stigma extends beyond personal responsibility attributions to other dimensions, particularly perceived severity of the disease and tolerance of financial discrimination against patients with the disease. Future work is needed to develop and evaluate interventions designed to limit cancer stigma for patients, health professionals and the community. Health policies should acknowledge the existence of lung cancer stigma and make a commitment to minimising this.

Background Cancer is often described as the ‘number one’ health fear, but little is known about whether this affects quality of life by translating into high levels of worry or distress in everyday life, or which population groups are most affected. This study examined the prevalence of three components of cancer fear in a large community sample in the UK and explored associations with demographic characteristics. Methods Questions on cancer fear were included in a survey mailed to a community sample of adults (n = 13,351; 55–64 years). Three items from a standard measure of cancer fear assessed: i) whether cancer was feared more than other diseases, ii) whether thinking about cancer caused discomfort, and iii) whether cancer worry was experienced frequently. Gender, marital status, education, and ethnicity were assessed with simple questions. Anxiety was assessed with the brief STAI and a standard measure of self-rated health was included. Results Questionnaire return rate was 60% (7,971/13,351). The majority of respondents agreed or strongly agreed that they feared cancer more than other diseases (59%), and felt uncomfortable thinking about it (52%), and a quarter (25%) worried a lot about cancer. All items were significantly inter-correlated (r = .35 to .42, p’s

Earlier diagnosis of symptomatic cancer has become increasingly recognised as holding the key to better cancer outcomes. Many Western governments have prioritised actions to achieve earlier diagnosis of cancer. England revised its cancer policy in 2007 to address this, with a National Awareness and Early Diagnosis Initiative (NAEDI) to drive forward research, development, and service improvement. Actions to improve care in England were led by the National Cancer Action Team (NCAT) through Cancer Networks (now NHS Improving Quality and Strategic Clinical Networks), with GP cancer leads playing a key role to influence general practices. Public awareness of cancer has been raised through a sustained programme of media campaigns, currently led by Public Health England. The purpose of this article is to show how research to improve diagnosis of symptomatic cancer undertaken by the authors, together and in collaboration with others, has influenced policy and practice. Close engagement with the research community has been a feature of NAEDI throughout, and the research of this collaborative group has been supported via a designated NAEDI funding stream, through an National Institute for Health Research funded programme grant (DISCOVERY), and through the Department of Health’s Policy Research Unit for Cancer Awareness, Screening and Early Diagnosis. The Cancer Reform Strategy identified public awareness of ‘cancer warning signs’ and attitudes to help seeking as key domains for promoting early diagnosis. This resulted in development of a validated instrument, the Cancer Awareness Measure (CAM),1 followed by the Awareness and Beliefs about Cancer scale (ABC), which added questions on beliefs.2 The first national CAM survey found low public awareness of warning signs, with average recall of 2.4 symptoms, and most responders recalling only ‘lump’. Awareness was lower in men, the younger and oldest age-groups, and people of lower socioeconomic status and from ethnic minority backgrounds, and …

Objectives Cancer's insidious onset and potentially devastating outcomes have made it one of the most feared diseases of the 20th century. However, advances in early diagnosis and treatment mean that death rates are declining, and there are more than 30 million cancer survivors worldwide. This might be expected to result in more sanguine attitudes to the disease. The present study used a qualitative methodology to provide an in-depth exploration of attitudes to cancer and describes the balance of negative and positive perspectives. Design A qualitative study using semistructured interviews with thematic analysis. Setting A university in London, UK. Participants 30 participants (23–73 years), never themselves diagnosed with cancer. Results Accounts of cancer consistently incorporated negative and positive views. In almost all respondents, the first response identified fear, trauma or death. However, this was followed—sometimes within the same sentence—by acknowledgement that improvements in treatment mean that many patients can survive cancer and may even resume a normal life. Some respondents spontaneously reflected on the contradictions, describing their first response as a ‘gut feeling’ and the second as a more rational appraisal—albeit one they struggled to believe. Others switched perspective without apparent awareness. Conclusions People appear to be ‘in two minds’ about cancer. A rapid, intuitive sense of dread and imminent death coexists with a deliberative, rational recognition that cancer can be a manageable, or even curable, disease. Recognising cancer's public image could help in the design of effective cancer control messages.

Limited functional health literacy among adults is a major public health problem. Functional health literacy is defined as an individual’s capacity to obtain, process, and understand basic health information and services sufficiently to make appropriate health decisions and will be used interchangeably with the term “health literacy” in this review (Institute of Medicine, 2004). Limited health literacy is of particular concern among older adults, who often have increased needs for health information and services to maintain their health and well-being. National literacy surveys indicate that more than 70% of adults aged older than 65 years in North America lack the basic health literacy skills required for successful interactions with health systems (Canadian Council on Learning, 2008; Kutner, Greenberg, Jin, & Paulsen, 2006). Outcomes of limited health literacy among older adults include incorrect taking of prescription medication, poor chronic disease management, low use of preventive health services, and increased risk of overall mortality (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011; Sudore et al., 2006b). The nature of the association between aging and health literacy is unclear. Functional health literacy skills reflect, at least in part, the cognitive abilities used to manage health (Federman, Sano, Wolf, Siu, & Halm, 2009; Reeve & Basalik, 2014; Wolf et al., 2012). “Fluid” cognitive abilities such as verbal fluency, working memory, and reasoning are essential to health literacy skills and undergo mild decline during aging in the absence of dementia as early as mid-adulthood, whereas “crystallized” abilities such as generalized knowledge and vocabulary are more stable with age (O’Carroll, 1995; Singh-Manoux et al., 2012). Therefore, performance on health literacy tests that require the use of fluid cognitive abilities in the context of medical and health-related information may decline with age (e.g., the Test of Functional Health Literacy in Adults [TOFHLA] or the Newest Vital Sign [NVS]; Parker, Baker, Williams, & Nurss, 1995; Weiss et al., 2005), whereas tests that assess health literacy as medical vocabulary may show little decline in performance with age (e.g., the Rapid Estimate of Adult Literacy in Medicine [REALM]; Davis et al., 1993). If health literacy skills represent the functional use of cognitive abilities in health contexts, then certain health literacy skill sets, but not necessarily others, would be expected to decline with age. Furthermore, any association between age and health literacy would be expected to be at least partly explained by cognitive aging. We hypothesized that the functional health literacy skills assessed by TOFHLA and similar tests (representing fluid cognitive abilities) would be more likely to show an inverse association with age than health literacy skills assessed by the REALM and similar tests (representing crystallized cognitive abilities). We aimed to review the evidence on the association between age and health literacy, overall and by health literacy test, and to investigate the mediating role of cognitive function.

Objectives Obesity is associated with an increased cancer incidence and mortality and therefore cancer screening is particularly important for obese individuals. However, some US studies find lower screening uptake in this group. This study explored whether rates of breast and colorectal screening in England are lower for obese than healthy weight individuals. Setting Data were from the English Longitudinal Study of Ageing (ELSA). Methods We analysed data from adults who were eligible to have been invited to the UK national screening programmes for breast or colorectal cancer (CRC) in the last five years, and had been given the screening module in Wave 5 of ELSA (N = 1804 for CRC screening, N = 2401 for breast cancer screening). Weight and height were measured by a nurse at Wave 4 (two years earlier). Logistic regression was used to calculate the odds of breast and CRC screening (ever) for participants in higher weight categories (Body Mass Index [BMI] ≥ 25) compared with healthy weight individuals (BMI Results Of ELSA participants, 63% reported CRC screening, and 92% of the women reported breast cancer screening. Obesity was associated with lower CRC screening, but effects were strongest for class III obesity (BMI ≥40) (45% screened; OR = 0.48, 95% CI = 0.32–0.93, P = .029). There was no association between weight status and breast cancer screening. Conclusion Severe obesity appears to be a deterrent to CRC screening but not breast cancer screening. Targeted interventions may be required to promote CRC screening uptake in this group, which already has a heightened risk as a consequence of weight.

Background Illness-related stigma has attracted considerable research interest, but few studies have specifically examined stigmatisation of cancer in the non-patient population. The present study developed and validated a Cancer Stigma Scale (CASS) for use in the general population. Methods An item pool was developed on the basis of previous research into illness-related stigma in the general population and patients with cancer. Two studies were carried out. The first study used Exploratory factor analysis to explore the structure of items in a sample of 462 postgraduate students recruited through a London university. The second study used Confirmatory factor analysis to confirm the structure among 238 adults recruited through an online market research panel. Internal reliability, test-retest reliability and construct validity were also assessed. Results Exploratory factor analysis suggested six subscales, representing: Awkwardness, Severity, Avoidance, Policy Opposition, Personal Responsibility and Financial Discrimination. Confirmatory factor analysis confirmed this structure with a 25-item scale. All subscales showed adequate to good internal and test-retest reliability in both samples. Construct validity was also good, with mean scores for each subscale varying in the expected directions by age, gender, experience of cancer, awareness of lifestyle risk factors for cancer, and social desirability. Means for the subscales were consistent across the two samples. Conclusions These findings highlight the complexity of cancer stigma and provide the Cancer Stigma Scale (CASS) which can be used to compare populations, types of cancer and evaluate the effects of interventions designed to reduce cancer stigma in non-patient populations.

Objective To evaluate the impact of a diet and physical activity intervention (BeWEL) on weight change in people with a body mass index >25 weight (kg)/height (m)2 at increased risk of colorectal cancer and other obesity related comorbidities. Design Multicentre, parallel group, randomised controlled trial. Setting Four Scottish National Health Service health boards. Participants 329 overweight or obese adults (aged 50 to 74 years) who had undergone colonoscopy after a positive faecal occult blood test result, as part of the national bowel screening programme, and had a diagnosis of adenoma confirmed by histopathology. 163 were randomised to intervention and 166 to control. Intervention Participants were randomised to a control group (weight loss booklet only) or 12 month intervention group (three face to face visits with a lifestyle counsellor plus monthly 15 minute telephone calls). A goal of 7% reduction in body weight was set and participants received a personalised energy prescription (2508 kJ (600 kcal) below that required for weight maintenance) and bodyweight scales. Motivational interviewing techniques explored self assessed confidence, ambivalence, and personal values concerning weight. Behavioural strategies included goal setting, identifying intentions of implementation, self monitoring of body weight, and counsellor feedback about reported diet, physical activity, and weight change. Main outcome measures The primary outcome was weight change over 12 months. Secondary outcomes included changes in waist circumference, blood pressure, fasting cardiovascular biomarkers, and glucose metabolism variables, physical activity, diet, and alcohol consumption. Results At 12 months, data on the primary outcome were available for 148 (91%) participants in the intervention group and 157 (95%) in the control group. Mean weight loss was 3.50 kg (SD 4.91) (95% confidence interval 2.70 to 4.30) in the intervention group compared with 0.78 kg (SD 3.77) (0.19 to 1.38) in the control group. The group difference was 2.69 kg (95% confidence interval 1.70 to 3.67). Differences between groups were significant for waist circumference, body mass index, blood pressure, blood glucose level, diet, and physical activity. No reported adverse events were considered to be related to trial participation. Conclusions Significant weight loss can be achieved by a diet and physical activity intervention initiated within a national colorectal cancer screening programme, offering considerable potential for risk reduction of disease in older adults. Trial registration Current Controlled Trials ISRCTN53033856.

Importance A better understanding of the cause of obesity is a clinical priority. Obesity is highly heritable, and specific genes are being identified. Discovering the mechanisms through which obesity-related genes influence weight would help pinpoint novel targets for intervention. One potential mechanism is satiety responsiveness. Lack of satiety characterizes many monogenic obesity disorders, and lower satiety responsiveness is linked with weight gain in population samples. Objective To test the hypothesis that satiety responsiveness is an intermediate behavioral phenotype associated with genetic predisposition to obesity in children. Design, Setting, and Participants Cross-sectional observational study of a population-based cohort of twins born January 1, 1994, to December 31, 1996 (Twins Early Development Study). Participants included 2258 unrelated children (53.3% female; mean [SD] age, 9.9 [0.8] years), one randomly selected from each twin pair. Exposure Genetic predisposition to obesity. We created a polygenic risk score (PRS) comprising 28 common obesity-related single-nucleotide polymorphisms identified in a meta-analysis of obesity-related genome-wide association studies. Main Outcomes and Measures Satiety responsiveness was indexed with a standard psychometric scale (Child Eating Behavior Questionnaire). Using 1990 United Kingdom reference data, body mass index SD scores and waist SD scores were calculated from parent-reported anthropometric data for each child. Information on satiety responsiveness, anthropometrics, and genotype was available for 2258 children. We examined associations among the PRS, adiposity, and satiety responsiveness. Results The PRS was negatively related to satiety responsiveness (β coefficient, −0.060; 95% CI, −0.019 to −0.101) and positively related to adiposity (β coefficient, 0.177; 95% CI, 0.136-0.218 for body mass index SD scores and β coefficient, 0.167; 95% CI, 0.126-0.208 for waist SD scores). More children in the top 25% of the PRS were overweight than in the lowest 25% (18.5% vs 7.2%; odds ratio, 2.90; 95% CI, 1.98-4.25). Associations between the PRS and adiposity were significantly mediated by satiety responsiveness ( P = .006 for body mass index SD scores and P = .005 for waist SD scores). Conclusions and Relevance These results support the hypothesis that low satiety responsiveness is one of the mechanisms through which genetic predisposition leads to weight gain in an environment rich with food. Strategies to enhance satiety responsiveness could help prevent weight gain in genetically at-risk children.

Background:\ud Despite the widespread recognition that obesity in pregnant women is associated with adverse outcomes for mother and child, there is no intervention proven to reduce the risk of these complications. The primary aim of this randomised controlled trial is to assess in obese pregnant women, whether a complex behavioural intervention, based on changing diet (to foods with a lower glycemic index) and physical activity, will reduce the risk of gestational diabetes (GDM) and delivery of a large for gestational age (LGA) infant. A secondary aim is to determine whether the intervention lowers the long term risk of obesity in the offspring.\ud \ud Methods/Design:\ud Multicentre randomised controlled trial comparing a behavioural intervention designed to improve glycemic control with standard antenatal care in obese pregnant women.\ud \ud Inclusion criteria; women with a BMI ≥30 kg/m2 and a singleton pregnancy between 15+0 weeks and 18+6 weeks’ gestation. Exclusion criteria; pre-defined, pre-existing diseases and multiple pregnancy. Randomisation is on-line by a computer generated programme and is minimised by BMI category, maternal age, ethnicity, parity and centre. Intervention; this is delivered by a health trainer over 8 sessions. Based on control theory, with elements of social cognitive theory, the intervention is designed to improve maternal glycemic control. Women randomised to the control arm receive standard antenatal care until delivery according to local guidelines. All women have a 75 g oral glucose tolerance test at 27+0- 28+6 weeks’ gestation.\ud \ud Primary outcome; Maternal: diagnosis of GDM, according to the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria. Neonatal; infant LGA defined as >90th customised birth weight centile.\ud \ud Sample size; 1546 women to provide 80% power to detect a 25% reduction in the incidence of GDM and a 30% reduction in infants large for gestational age.\ud \ud Discussion:\ud All aspects of this protocol have been evaluated in a pilot randomised controlled trial, with subsequent optimisation of the intervention. The findings of this trial will inform whether lifestyle mediated improvement of glycemic control in obese pregnant women can minimise the risk of pregnancy complications.

Background: Health professionals identify food provision in the home as a key influence on children’s food preferences. In contrast, parents often perceive children’s food preferences to be inborn. One explanation for this discrepancy could be that environmental and genetic influences vary by food type. Objective: We assessed genetic and environmental contributions to preferences for a wide variety of foods in a large pediatric twin sample. Design: Data were from Gemini, which is a cohort of UK twins born in 2007. Preferences for 114 foods were assessed by parentcompleted questionnaire when children were aged 3 y (n = 2686). Foods tried by .75% of respondents were grouped into protein, vegetables, fruit, dairy, starches, and snacks. Quantitative modelfitting analyses were used to assess genetic and environmental influences for each food group. Results: The genetic influence was higher for vegetables (54%; 95% CI: 47%, 63%), fruit (53%; 95% CI: 45%, 61%) and protein (48%; 95% CI: 40%, 57%) but lower for starches (32%; 95% CI: 26%, 38%), snacks (29%; 95% CI: 24%, 35%), and dairy (27%; 95% CI: 20%, 35%). In contrast, shared-environment effects were higher for snacks (60%; 95% CI: 54%, 65%), starches (57%; 95% CI: 51%, 62%), and dairy (54%; 95% CI: 47%, 60%) and lower for vegetables (35%; 95% CI: 27%, 42%), fruit (35%; 95% CI: 26%, 43%), and protein (37%; 95% CI: 27%, 45%). Nonshared environment effects were small for all foods (11‐19%). Conclusions: Both genetic and environmental effects were significant for all food groups, but genetic effects dominated for more nutrient-dense foods (vegetables, fruit, and protein), whereas shared environmental effects dominated for snacks, dairy, and starches. These findings endorse the view of health professionals that the home environment is the main determinant of children’s liking for energy-dense foods implicated in excessive weight gain but suggest that parents are also correct by identifying innate differences in liking, particularly for nutrient-dense foods that parents and health educators try to encourage. Am J Clin Nutr doi: 10.3945/ajcn. 113.077867.

Life expectancy and other indices of health have deteriorated markedly in the former socialist countries of Eastern Europe over recent decades. The possible roles of lifestyles, knowledge about health and behaviour, emotional wellbeing and perceptions of control were assessed in a cross-sectional survey of young adults of similar educational status in Eastern and Western Europe. As part of the European Health and Behaviour Survey, data were collected in 1989-1991 from 4170 university students aged 18-30 years from Austria, Belgium, the Federal Republic of Germany, the Netherlands and Switzerland, and from 2293 students from the German Democratic Republic, Hungary and Poland. Measures were obtained of health behaviours, awareness of the role of lifestyle factors in health, depression., social support. health locus of control, and the value placed on health. After adjustment for age and sex, East European students had less healthy lifestyles than Western Europeans according to a composite index of 11 health behaviours, with significant differences for seven activities: regular exercise, drinking alcohol, avoiding dietary fat, eating fibre, adding salt to food, wearing a seat-belt, and using sunscreen protection. East European students were less likely to be aware of the relationship between lifestyle factors (smoking, exercise, fat and salt consumption) and cardiovascular disease risk. In addition, they were more depressed (adjusted odds of elevated scores on the Beck Depression Inventory of 2.46, 95% C.I. 1.95-3.09). reported lower social support. and had higher beliefs in the "chance" and "powerful others" locus of control. Internal locus of control levels did not differ across regions, and Eastern Europeans placed a higher valuation on their health. Unhealthy lifestyles associated with lack of information about health and behaviour, greater beliefs in uncontrollable influences, and diminished emotional well-being, may contribute to poor health status in Eastern Europe. (C) 2001 Elsevier Science Ltd. All rights reserved.

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

Qualitative methods were used to investigate decision-making among a group of older adults who declined the offer of flexible sigmoidoscopy screening for bowel cancer. Interviews were conducted with 60 people (30 men and 30 women) who either had not responded to the screening letter or who responded saying that they were not interested in participating. The findings suggest that low perceived susceptibility to bowel cancer, in terms of current health status, family history or absence of bowel symptoms, was an important factor in the decision to decline screening. Procedural barriers such as embarrassment, pain/discomfort and perceived unpleasantness of the test were reported as relatively minor, although the test was considered more physically intrusive than other screening tests. Avoidant attitudes emerged as an important theme and were reported by a third of respondents. Distinct patterns of decision-making were also observed and three groups emerged from accounts: (i) forgetting or avoiding making a decision about the test (ii) a confident rejection of the test based on a few salient factors, and (iii) a more careful consideration of the test focusing on issues of susceptibility. The findings are discussed in the context of models of health behaviour and bowel cancer screening participation research.

BACKGROUND: Children of obese parents have a substantially higher risk of adult obesity than children of lean parents. Adoption and twin studies have shown that this risk is largely genetic but the proximal mechanisms of the genetic risk are not known. Comparisons of energy intake or expenditure in children of obese and lean parents have produced mixed, but generally negative results. An alternative hypothesis is that the early expression of obesity risk is through food and activity preferences, which provides a basis for later weight gain. The aim of this study was therefore to compare food and activity preferences in a large sample of young children from obese and lean families using parental obesity as a marker of the obesity-risk phenotype. Because the children from the families with obese parents were not yet overweight, differences observed in the two types of families are more likely to be causes than effects of obesity. METHODS: A total of 428 children aged 4–5 y, whose parents were either obese/overweight or normal-weight/lean were selected from a population sample of families with twin births. Food and activity preferences were assessed with a combination of food intake and taste tasks, and questionnaires completed by the mother during a home visit. FINDINGS: Children from the obese/overweight families had a higher preference for fatty foods in a taste test, a lower liking for vegetables, and a more ‘overeating-type’ eating style. They also had a stronger preference for sedentary activities, and spent more time in sedentary pastimes. There were no differences in speed of eating or reported frequency of intake of high-fat foods. CONCLUSION: Part of the process whereby a genetic risk of obesity is transmitted to the next generation could be through differences in diet and activity preferences, which would place susceptible individuals at risk of positive energy balance in the permissive nutritional environment of industrialised countries today.

Health Psychology Updateis pleased to introduce an article by Jane Wardle, the current Chair of the DHP, that was presented as the discussion to the DHP symposium held at the Society’s 2001 Annual Conference entitled, ‘State of the Science of Health Psychology’.Updatehopes to feature articles like Jane’s each year to introduce the thoughts, plans and vision of the DHP and the Chairs themselves. Jane will become Deputy Chair of the Division after the Annual General Meeting of the DHP which is being held at the Annual Conference, and Suzanne Skevington, who is currently Chair Elect, will then become Chair.

STUDY OBJECTIVE—Attitudes and practices concerning weight control in British adults were examined to test the hypothesis that variation in concern about weight and deliberate weight control might partly explain the socioeconomic status (SES) gradient in obesity. Higher SES groups were hypothesised to show more weight concern and higher levels of dieting. SETTING—Data were collected as part of the monthly Omnibus Survey of the Office of National Statistics in March 1999. PARTICIPANTS—A stratified, probability sample of 2690 households was selected by random sampling of addresses in Britain. One randomly selected person in each household was interviewed at their home. MAIN RESULTS—As predicted, higher SES men and women had higher levels of perceived overweight, monitored their weight more closely, and were more likely to be trying to lose weight. Higher SES groups also reported more restrictive dietary practices and more vigorous physical activity. CONCLUSIONS—The results are consistent with the idea that part of the protection against weight gain in higher SES groups could be a higher frequency of weight monitoring, a lower threshold for defining themselves as overweight, and a greater likelihood of deliberate efforts at weight control. Keywords: socioeconomic status; weight control; obesity

Background: The objective of this study was to establish the level of public awareness of warning signs for cancer in Britain. Methods: An interview-based survey of a representative sample of the UK population was undertaken; 3693 men and women completed the interview (69% response rate). The data from this survey included demographic characteristics as well as recognition of the ‘seven warning signs for cancer’. Findings: Results revealed that recognition of signs ranged from 81% (‘thickening or lump’; n = 2994) to 37% (‘indigestion/difficulty swallowing’; n = 1356). On average participants identified 4.2 of the signs, with only 1.6% (n = 58) identifying all seven. There were strong associations with demographic characteristics, with better recognition being associated with being female, married, higher socioeconomic status (SES), higher income, a home-owner and having more years of education. Interpretation: From these results we conclude that fewer than one in ten of the UK population can recognize seven warning signs for cancer, but the mean number recognized (4.2 signs) suggests that there is a reasonable level of public awareness. It must be cause for concern that most markers of lower SES are independently associated with poorer recognition, suggesting that public education needs to do more to narrow the inequalities in health knowledge.

This study investigated the relationship of depressive symptoms, social support, and a range of personal health behaviors in 2,091 male and 3,438 female university students from 16 countries. Depressive symptoms and social support were measured using the short Beck Depression Inventory and the Social Support Questionnaire; 9 personal health behaviors were also assessed. After the authors took age, social support, and clustering by country into account, depressive symptoms were significantly associated with lack of physical activity, not eating breakfast, irregular sleep hours, and not using a seat belt in both men and women, and additionally with smoking, not eating fruit, and not using sunscreen among women. Low social support was independently associated with low alcohol consumption, lack of physical activity, irregular sleep hours, and not using a seat belt in men and women. Bidirectional causal pathways are likely to link health behaviors with depressed mood.

OBJECTIVE: To evaluate a modified cognitive–behavioural treatment (M-CBT) for weight management which addresses both the psychosocial costs and the physiological health risks of obesity, without a focus on weight loss. DESIGN: Randomized controlled trial comparing M-CBT with standard cognitive–behavioural therapy (S-CBT). SUBJECTS: Sixty-three overweight women with body mass index (BMI)≥28 kg/m2, mean age=47.5 and mean BMI=35.4. MEASURES: Weight, waist and hip circumference, blood lipids, blood glucose, blood pressure, psychological well-being, depression, self esteem, stress, binge eating, eating style, body image, nutrient intake, aerobic fitness, activity levels, patient satisfaction with treatment. RESULTS: Both M-CBT and S-CBT achieved improvements in a broad range of physical, psychological and behavioural variables. Weight loss in the S-CBT group was greater than in the M-CBT group immediately after treatment, but both groups lost weight. Participants in the M-CBT group continued to lose weight up to the 1 y follow-up. M-CBT was evaluated positively by participants. CONCLUSIONS: Both M-CBT and S-CBT programmes were successful at inducing modest weight loss, as well as improving emotional well-being, reducing distress, increasing activity and fitness, improving dietary quality and reducing cardio-vascular disease risk factors. The improvements were maintained or continued at 1 y follow-up. These results suggest that treatment based on the new weight-control paradigm which emphasizes sustained lifestyle change without emphasis on dieting, can produce modest benefits to health and well-being.

Background . As part of a multicenter, randomized controlled trial of the efficacy of flexible sigmoidos copy for the prevention of bowel cancer, an investigation of the predictors of screening interest was carried out in a subsample of older adults. Method . The aim of the study was to establish the predictive power of the Health Belief Model (HBM) and to evaluate the contribution of HBM elements in mediating the effect of other demographic and health variables which have been found to be associated with screening interest and participation. A total of 5,099 participants were sent a postal questionnaire which examined screening interest, attitudes toward screen ing (benefits and barriers), perceived bowel cancer risk, bowel cancer worry, bowel symptoms, health status, state anxiety, and optimism. A total of 3,648 questionnaires were returned completed, giving a response rate of 71.5%. Results . The results showed that threat, barriers, and benefits explained 47% of the variance in interest. Demographic and health variables were also associated with screening interest, although most of their effect was mediated by the HBM constructs. Discussion . This community study in older adults showed a high level of interest in participating in screening. The large sample size provided the opportunity to test the value of the HBM model and to examine mediation of demographic and health variables. The HBM proved to be a good model of screening interest. These results further our understanding of the decision processes in participating in cancer screening and point to directions to increase the level of participation in community samples.

This article aims to help health professionals who do not have a knowledge of survey design to evaluate and design nutrition knowledge measures. Historically, these measures have been poorly designed and therefore may not assess nutrition knowledge accurately, with the consequence that the results may have little meaning. This paper highlights the factors to look for in existing measures or, if a suitable measure cannot be found, shows how to modify or design one that will give useful and interpretable results. General design concepts are covered including the generation of items, the use of a pilot study and item analyses, and assessment of validity and reliability, as well as particular issues posed in the nutrition field, such as the interpretability of food terms. Researchers are advised to use an existing measure, or modify an existing measure if possible, before developing a new one. Whether evaluating or developing a measure, the importance of the content, structure, and statistical evaluation is discussed. Collaboration between nutritional and behavioral scientists is recommended to provide complementary areas of expertise in the evaluation/development of nutrition knowledge measures.

Food preferences are widely agreed to be important determinants of eating behaviour in young children. Existing studies of methods of assessing preferences have suggested tasting and ranking foods can generate reliable responses with young children, but there have been few attempts to assess other methods which might provide a more convenient alternative in situations where the use of real foods could be difficult (e.g. outside the laboratory), or tasting could be undesirable (e.g. if there are large numbers of foods, or foods which children would be unwilling to taste). The present study is a comparison of the reliability of preferences measured using: (i) real foods; (ii) food photographs; and (iii) food models, in 3 to 5-year-old children. The results showed that the tasting method produced good results, replicating existing data from U.S. samples. Food photographs came a close second in reliability but food models produced unreliable rankings, especially in the youngest group. Five-year-olds produced significantly more consistent results than the younger children. These results indicate that using real foods as the stimuli produces the most reliable taste preferences with children in this young age range, but photographs may provide a convenient alternative with adequate reliability.

Objective: To compare the acceptability and efficacy of two methods of self administered bowel preparation for flexible sigmoidoscopy screening: a single phosphate enema and a single sachet of Picolax. Design: Single blind, randomised trial. Setting: Endoscopy units of two general hospitals. Participants: 1442 men and women aged 55-64 years who had agreed to be screened by flexible sigmoidoscopy. Main outcome measures: Attendance rates, compliance with allocated preparations, adverse effects, quality of bowel preparation, procedure time, and yield of neoplasia. Results: Compliance with the enema was higher than with the Picolax (608 (84%) v 566 (79%); difference 6%, 95% confidence interval 2% to 10%). Almost half of those who refused Picolax used an enema at home. Wind, incontinence, and sleep disturbance were more frequent in the Picolax group than the enema group; bottom soreness was more frequent in the enema group. Around 30% (187) found the diet restriction required by Picolax difficult; 78% (471) found the enema easy to administer. The quality of preparation was better with the enema; the proportion of procedures complete to the descending colon was greater and the mean duration of the procedure was shorter. There was no significant difference in polyp detection rates. Conclusion: A single phosphate enema self administered around one hour before leaving home is a more acceptable and effective method of preparing the distal bowel for flexible sigmoidoscopy than Picolax.

In many studies, correlations between nutrition knowledge and dietary behaviour have failed to reach statistical significance, leading researchers to question the relevance of nutrition knowledge to food choice, and the value of nutrition education campaigns. This study aimed to investigate the relationship between knowledge and intake of fat, fruit and vegetables using a well-validated measure of nutrition knowledge. The study was a postal survey, using 1040 adult participants selected at random from General Practitioners' lists in England. Nutrition knowledge and food intake followed the expected demographic patterns. Knowledge was significantly associated with healthy eating, and the effect persisted after controlling for demographic variables. Logistic regression showed that respondents in the highest quintile for knowledge were almost 25 times more likely to meet current recommendations for fruit, vegetable and fat intake than those in the lowest quintile. Nutrition knowledge was shown to be a partial mediator of the socio-demographic variation in intake, especially for fruit and vegetables. This demonstrates the value of using more sophisticated statistical techniques to investigate associations between knowledge and food intake and indicates that knowledge is an important factor in explaining variations in food choice. The results support the likely value of including nutrition knowledge as a target for health education campaigns aimed at promoting healthy eating.

PURPOSE: Epidemiological studies have suggested that cholesterol lowering could affect psychological functioning. This study was designed to test whether cholesterol-lowering diets adversely affect mood and cognitive function. SUBJECTS AND METHODS: We randomly assigned 176 adults with elevated serum cholesterol levels (>5.2 mM [198 mg/dL]) to either a low-fat diet, a Mediterranean diet, or a waiting-list control. Cholesterol levels, psychological well-being (depression, anxiety, hostility), and cognitive function were assessed at baseline, 6 weeks, and 12 weeks. RESULTS: Total serum cholesterol levels fell significantly more in the intervention groups (8.2% reduction) than in the control group ( P P r = 0.21, P = 0.01). CONCLUSIONS: Two dietary interventions that successfully lowered serum cholesterol levels had no adverse effect on mood. There was some evidence for a relative impairment in cognitive function in the treated groups in one of four cognitive tests, but additional studies will be required to determine the relevance of this finding.

Objectives To assess the acceptability of bowel cancer screening using flexible sigmoidoscopy (FS). Setting Adults aged 55 to 64 recruited from general practices in Welwyn Garden City and Leicester, which were the pilot and start up centres of a multicentred randomised controlled trial of FS screening (the ICRF/MRC Flexible Sigmoidoscopy Screening Trial). Methods Screenees (n=4422) were sent a three month follow up questionnaire that included measures of satisfaction with information given before the test, facilities at the test unit, attitudes of the staff, and explanation of the results. Measures of pain, embarrassment, feelings of being “in control” during the test, willingness to encourage others to have the test, and gladness to have participated were also included. In addition, semistructured telephone interviews were conducted with 60 screenees, stratified by screening outcome and gender. Results The follow up questionnaire was completed by 94% of screenees. Responses indicated a high level of satisfaction with the procedure: 99% were satisfied with the information given before the test, the facilities, the attitudes of the staff, and the explanation of their results; 91% reported only mild or no pain; 97% reported little or no embarrassment; and 99% were glad they had the test. Satisfaction ratings varied little by gender or outcome group. The quantitative results were reinforced by the qualitative data, which also revealed high acceptability. Conclusion In the context of a clinical trial with dedicated trial staff, FS is a well tolerated procedure. There are high levels of satisfaction with service provision and positive attitudes towards the programme.

Promotion of healthy diets often involves provision of information about which food types are most favourable for health. This is based on the assumption that the rational consumer will, other things being equal, choose the food that they know is healthier. However, health information may not always have a positive effect, since there is evidence that some people, particularly children, believe that healthiness and tastiness are mutually exclusive characteristics. To the extent that taste governs preferences and consumption, the characterization of a food as healthy could reduce its anticipated pleasantness. The present study tested the idea that a 'healthy' label would reduce liking for a novel drink. The results showed that the children rated a 'healthy labelled' drink as less pleasant and said they would be less likely to ask their parents to buy it than the same drink presented with control information. These results suggest that care may need to be exercised in promoting foods to children through an emphasis on health, unless the implications of healthiness can be rendered more positive.

This paper describes a study designed to test the cognitive-attentional model of panic. This model suggests that attention to internal sensations is likely to increase misinterpretation of them as representing a serious threat to health, which in turn might increase anxiety. In the present study, instructions for internal attentional focus were predicted to increase symptom reporting, anxiety, and catastrophic symptom attributions. Two groups, patients diagnosed with panic disorder with agoraphobia (PDA) and normal controls, watched a stressful film; half of each group was asked to attend to their internal sensations while watching, and the other half to focus on the film. In the normal controls, the manipulation was effective in modifying attentional focus, and the self-focused attention group became more anxious, reported more symptoms, and made more negative symptom attributions. However, in the PDA group, attentional focus was high in both conditions, and perhaps for this reason the intervention had no effect on mood, symptoms, catastrophic cognitions, or symptom attribution. (C) 2000 Wiley-Liss, Inc.

We examined psychologic responses to information about human papillomavirus (HPV) in young women within the age range of the UK's HPV vaccination "catch-up" program (13-16 years). Respondents absorbed HPV information without becoming worried, were receptive to cervical screening and vaccination, and these attitudes were enhanced by presentation of relevant information.

Self-reported effects of stress on eating behaviour and food were assessed in a brief questionnaire in 212 students. Snacking behaviour was reportedly increased by stress in the majority of respondents (73%) regardless of gender or dieting status. The overall increase in snacking during stress was reflected by reports of increased intake of "snack-type" foods in all respondents, regardless of dieting status. In contrast, intake of "meal-type" foods (fruit and vegetables, meat and fish) was reported to decrease during stressful periods. The majority of the respondents reported an effect of stress on overall amount eaten, but while snacking, roughly equal numbers reporting decreased intake (42%) and increased intake (38%). The direction of change in intake could be predicted in part by dieting status, with dieters being more likely to report stress hyperphagia and nondieters being more likely to report stress hypophagia. (C) 1999 Elsevier Science Inc.

Dietary intake of fat and fibre has a major influence on disease risk, and fibre consumption is inversely associ ated with socioeconomic status. The role of motives for food choice in mediating socio-economic variations in dietary intake was assessed in a postal survey of adults for the general population. The sample of 374 women and 290 men were divided on the basis of educational qualifications into high and low socioeconomic status groups. Education attainment groups defaced in income and occupation. with higher incomes and a greater pro portion of employed people in the high education group. As expected, education groups did not differ in fat intake assessed using a standardised measure (the Dietary Instrument for Nutrition Education). but the high education group ate more fibre, fruit, vegetables and cereds than the low education group. Analysis of the Food Choice Questionnaire. a multidimensional measure of motives for food choice, showed differences by educational status in the importance ...

Objective: This paper describes the development of a reliable and valid questionnaire to provide a comprehensive measure of the nutritional knowledge of UK adults. The instrument will help to identify areas of weakness in people’s understanding of healthy eating and will also provide useful data for examining the relationship between nutrition knowledge and dietary behaviour which, up until now, has been far from clear. Design: Items were generated paying particular attention to content validity. The initial version of the questionnaire was piloted and assessed on psychometric criteria. Items which did not reach acceptable validity were excluded, and the final 50 item version was administered to two groups differing in nutritional expertise on two occasions to assess the construct validity and test-retest reliability. Setting: The questionnaire was developed in 1994 in the UK. Subjects: Three hundred and ninety-one members of the general public, recruited via their places of work, completed the questionnaire at the piloting stage. The final version was administered to 168 dietetics and computer science students following a university lecture. Results: The internal consistency of each section was high (Cronbach’s alpha=0.70–0.97) and the test-retest reliability was also well above the minimum requirement of 0.7. Nutrition experts scored significantly better than computer experts [F(1167)=200.5, P

Understanding the pattern of associations between mood and consumption of alcohol, coffee and tea may provide information about the factors governing beverage drinking. The associations between mood and the consumption of alcohol, coffee and tea during everyday life were assessed. A naturalistic study was carried out with 18 male and 31 female volunteers from two working groups (psychiatric nursing and school teaching). Participants completed daily records of drink consumption, together with ratings of anxious and positive moods for 8 weeks. Potential moderators of associations were self-reported drinking to cope, high perceived job demands and social support at work. Day-by-day associations were analysed using Spearman correlations. There were substantial individual-differences in associations between mood and daily alcohol, coffee and tea consumption. Overall, alcohol intake was associated with high positive and low anxious mood. This effect was not present among participants with high drinking to cope ratings. Coffee and tea drinking were not consistently related to mood across the entire sample. However, job demands influenced the association between coffee consumption and anxious mood in men, and those who experienced high job demands drank more coffee on days on which they felt anxious. In contrast, women but not men who enjoyed high social support at work felt more relaxed on days on which they drank more tea. These results indicate that people vary widely in the extent to which mood is related to the drinking of alcohol, coffee and tea. The strength of associations is influenced by gender, motivational factors, and by stress and coping resources.

Increasing fruit and vegetable consumption is an important health behaviour. Parental and other psychosocial influences on children's fruit and vegetable consumption are poorly understood. The contribution of a variety of psychosocial and environmental factors to consumption of fruit and vegetables by children aged 9-11 years was explored. Ninety-two mothers and children (48 girls and 44 boys) were recruited via urban primary health-care practices. Socio-economic and educational level, nutritional knowledge and health- and diet-related beliefs and attitudes were assessed in mothers and children by questionnaires and semistructured interviews. Mothers' diets were measured by a food frequency questionnaire, while children's diets were assessed by 3-day diaries (N = 80). The pattern of influence of the various measures on fruit and vegetable consumption was compared with that on children's confectionery intake. The children's intakes of macronutrients were typical for the U.K. (37% fat, 50% carbohydrate and 13% protein by energy; 12 g/day fibre), while median fruit, fruit juice and vegetable intake amounted to about 2.5 servings/day. Univariate correlations and subsequent multiple regression analyses revealed quite different influences on the three food types. Independent predictors of children's fruit intake included mothers nutritional knowledge (beta = 0.37), mothers' frequency of fruit consumption (beta = 0.30) and mothers' attitudinal conviction that increasing fruit and vegetable consumption by their children could reduce their risk of developing cancer (beta = 0.27; multiple beta = 0.37, p

Objective. To compare health locus of control scores in women from different ethnic backgrounds. Method. One‐hundred and twenty‐eight Caucasian, South Asian and Afro‐Caribbean women completed written or orally presented versions of the multidimensional health locus of control scale, as well as ratings of religiousness, health status and occupational status. Results. South Asian women scored higher on ‘chance’ and ‘powerful others’ locus of control as predicted. They also had higher scores on internality. The ethnic differences persisted after controlling for occupation and health status. High religiousness among the South Asians appeared to explain some, but not all, of their higher scores. Conclusion. South Asians may differ from British Caucasians in relation to their beliefs about internal and external influences on health.