Biomedical subjects

Jane Wardle

Publications and source records attributed to Jane Wardle.

At least 19 recordsLinked to original sources

PubMed2007

Women's experiences of repeated HPV testing in the context of cervical cancer screening: a qualitative study.

OBJECTIVE: To evaluate the psychosocial impact of taking part in repeated testing for human papillomavirus (HPV) in the context of cervical cancer screening. METHODS: In-depth interviews were carried out with 30 women who were HPV positive with normal cytology at trial baseline, and attended for a repeat HPV test 12 months later. Interview transcripts were analysed qualitatively using Framework Analysis to identify emergent themes. RESULTS: Although women often experienced serious negative emotional consequences at the time of their first positive result, these did not generally last during the year between tests once questions about HPV had been resolved. The emotional impact of testing positive a second time was greater for many women, sometimes causing them to overcome their embarrassment about having a sexually transmitted infection in order to disclose their result and seek support. Among the women interviewed there was an overwhelming preference for immediate colposcopy rather than continued surveillance for persistent HPV. This was associated with the desire for a speedy resolution, and fears about progression to cancer. CONCLUSIONS: Although most women did not appear to suffer on-going anxiety while waiting for a second HPV test, this seemed contingent on their information needs being met. Women appeared to be more distressed by a second HPV positive result than a single one, and expressed a clear preference for immediate colposcopy over continued surveillance. This finding might have implications for the way in which HPV testing could be used in cervical cancer screening programmes.

Adaptation, Psychological↗

PubMed2007

Associations between multiple measures of parental feeding and children's adiposity in United Kingdom preschoolers.

OBJECTIVE: Research into the association between parental control over feeding and children's adiposity has produced inconclusive results. Some studies have found parental control to be associated with unhealthy food choices and disordered intake regulation, whereas others have found favorable or null associations between control and adiposity. This study hypothesized that variability in measures of parental feeding could contribute to these discrepancies. Scales from a range of existing parental feeding questionnaires were used together, in the same large sample of children, to examine associations with adiposity. RESEARCH METHODS AND PROCEDURES: Associations between scores on scales from three published parental feeding questionnaires [Child Feeding Questionnaire (CFQ); Preschooler Feeding Questionnaire (PFQ); and Parental Feeding Style Questionnaire (PFSQ)] and children's BMI z-scores, calculated from measured heights and weights, were examined in a socioeconomically diverse sample of 439 parents and their 3- to 5-year-old children. RESULTS: Higher scores on CFQ Pressure to Eat and PFQ Pushing the Child to Eat More were significantly associated with lower BMI z-score, while PFSQ Prompting to Eat, CFQ Restriction, PFSQ Instrumental Feeding, and PFSQ Emotional Feeding were unassociated with BMI z-score. DISCUSSION: These results suggest that parents of leaner children are more likely to encourage their children to eat. Other feeding strategies seemed to have negligible relationships with children's BMI z-scores at this stage. Longitudinal and genetically informed designs are needed to clarify the causal pathways between parental feeding and children's adiposity.

Adult↗

PubMed2006

Trends in physical activity and sedentary behaviour in adolescence: ethnic and socioeconomic differences.

OBJECTIVE: To assess developmental trends in physical activity and sedentary behaviour in British adolescents in relation to sex, ethnicity and socioeconomic status (SES). DESIGN: A 5-year longitudinal study of a diverse cohort of students aged 11-12 years at baseline in 1999. SETTING: 36 London schools sampled using a stratified random sampling procedure. PARTICIPANTS: A total of 5863 students categorised as white, black or Asian, and stratified for SES using the Townsend Index. MAIN OUTCOME MEASURES: Number of days per week of vigorous activity leading to sweating and breathing hard. Hours of sedentary behaviour, including watching television and playing video games. Data were analysed using multilevel, linear, mixed models. RESULTS: Marked reductions in physical activity and increases in sedentary behaviour were noticed between ages 11-12 and 15-16 years. Boys were more active than girls, and the decline in physical activity was greater in girls (46% reduction) than in boys (23%). Asian students were less active than whites, and this was also true of black girls but not boys. Black students were more sedentary than white students. Levels of sedentary behaviour were greater in respondents from lower SES. Most differences between ethnic and SES groups were present at age 11 years, and did not evolve over the teenage years. CONCLUSIONS: Physical activity declines and sedentary behaviour becomes more common during adolescence. Ethnic and SES differences are observed in physical activity and sedentary behaviour in British youth that anticipate adult variations in adiposity and cardiovascular disease risk. These are largely established by age 11-12 years, so reversing these patterns requires earlier intervention.

Adolescent↗

PubMed2006

Neuroendocrine and cardiovascular correlates of positive affect measured by ecological momentary assessment and by questionnaire.

The relationships between positive affect, salivary cortisol over the day, and cardiovascular responses to laboratory mental stress tests, were assessed in 72 healthy non-smoking men (mean age 33.6+/-8.8 years). Positive affect was measured by aggregating ecological momentary assessments (EMA) of happiness obtained at four times on each of 2 working days, and by questionnaire using the Positive and Negative Affect Schedule (PANAS). Saliva was sampled on 2 days, on waking, 30 and 60 min later, and four other times over the day. Blood pressure and heart rate responses to speech and mirror tracing tasks were measured over two sessions 4 weeks apart. Data were analysed using regression of positive affect on biology adjusting for age, body mass and negative affect, with additional adjustment for time of waking in cortisol analyses and for work stress in cardiovascular analyses. EMA positive affect was inversely associated with cortisol early in the day and with the cortisol increase after waking, controlling for age, body mass index, and negative affect (P=0.012). There was no relationship between PANAS positive affect and cortisol, or between EMA positive affect and cortisol later in the day. Diastolic pressure recovery post-stress was more rapid among participants with high positive affect (P=0.022) and with lower systolic pressure throughout the stress sessions, after controlling for covariates including negative affect. PANAS positive affect was also inversely associated with systolic pressure, but not with diastolic stress or heart rate. We conclude that positive affect is related to biological responses in the laboratory and everyday life that may be health protective. Effects were substantially stronger when positive affect was assessed by aggregating EMA samples than with questionnaire measures.

Adult↗

PubMed2006

The effects of tea on psychophysiological stress responsivity and post-stress recovery: a randomised double-blind trial.

RATIONALE: Tea has anecdotally been associated with stress relief, but this has seldom been tested scientifically. OBJECTIVES: To investigate the effects of 6 weeks of black tea consumption, compared with matched placebo, on subjective, cardiovascular, cortisol and platelet responses to acute stress, in a parallel group double-blind randomised design. MATERIALS AND METHODS: Seventy-five healthy nonsmoking men were withdrawn from tea, coffee and caffeinated beverages for a 4-week wash-out phase during which they drank four cups per day of a caffeinated placebo. A pretreatment laboratory test session was carried out, followed by either placebo (n = 38) or active tea treatment (n = 37) for 6 weeks, then, a final test session. Cardiovascular measures were obtained before, during and after two challenging behavioural tasks, while cortisol, platelet and subjective measures were assessed before and after tasks. RESULTS: The tasks induced substantial increases in blood pressure, heart rate and subjective stress ratings, but responses did not differ between tea and placebo treatments. Platelet activation (assessed using flow cytometry) was lower following tea than placebo treatment in both baseline and post-stress samples (P < 0.005). The active tea group also showed lower post-task cortisol levels compared with placebo (P = 0.032), and a relative increase in subjective relaxation during the post-task recovery period (P = 0.036). CONCLUSIONS: Compared with placebo, 6 weeks of tea consumption leads to lower post-stress cortisol and greater subjective relaxation, together with reduced platelet activation. Black tea may have health benefits in part by aiding stress recovery.

Adaptation, Psychological↗

PubMed2006

The effects of chronic tea intake on platelet activation and inflammation: a double-blind placebo controlled trial.

BACKGROUND: Tea drinking appears to protect against the development of coronary heart disease (CHD), but the mediating pathways are uncertain. We studied the effects of 6 weeks of black tea or placebo on platelet activation, C-reactive protein (CRP), total antioxidant status, and soluble (s) P-Selectin in a randomized double-blind trial. METHODS: Healthy non-smoking men aged 18-55 years were randomized to black tea (N=37) or placebo (N=38) following a 4-week washout period during which they drank no tea, coffee or caffeinated beverages, but consumed caffeinated placebo tea. Bloods were drawn after 6 weeks of treatment. Platelet activation was assessed by measuring leukocyte-platelet aggregates using whole blood flow cytometry. RESULTS: Following treatment, the tea group had fewer monocyte-platelet aggregates (means 5.84 versus 6.60%, P=0.027), neutrophil-platelet aggregates (P=0.017), total leukocyte-platelet aggregates (P=0.027), and lower plasma C-reactive protein (means 0.76 versus 0.97 mg/L, P=0.05) than the placebo group. There were no differences in total antioxidant status or soluble P-Selectin. CONCLUSIONS: Chronic tea consumption reduces platelet activation and plasma C-reactive protein in healthy men. Effects cannot be attributed to observer bias or lifestyle confounders. These effects of tea may contribute to sustained cardiovascular health.

Adolescent↗

PubMed2006

The impact of illustrations on public understanding of the aim of cancer screening.

OBJECTIVE: To study the effectiveness of visual illustrations in improving people's understanding of the preventive aim of flexible sigmoidoscopy (FS) screening. METHODS: Three-hundred and eighteen people aged 60-64 were offered an appointment to attend FS screening and randomly allocated to receive either written information alone or written information plus illustrations. The illustrations showed the adenoma-carcinoma sequence and how it can be interrupted by removing polyps found during FS. Telephone interviews were conducted with a randomly selected sub-set of people prior to their screening appointment to assess their knowledge and understanding of the test (n=65). The interviews were tape-recorded, transcribed and content analysed by researchers blind to the condition people had been allocated to. RESULTS: In the written information only group, 57% understood that the test was looking for polyps rather than just cancer, whilst in the group who received written information and illustrations, 84% understood this. Logistic regression analyses confirmed that addition of illustrations resulted in significantly better understanding (OR=3.75; CI: 1.16-12.09; p=0.027), and this remained significant controlling for age, gender and Townsend scores (an area-based measure of deprivation) (OR=10.85; CI: 1.72-68.43; p=0.01). CONCLUSION: Illustrations improved understanding of the preventive aim of FS screening. PRACTICE IMPLICATIONS: Pictoral illustrations could be used to facilitate patient understanding of screening.

Audiovisual Aids↗

PubMed2006

Parental adiposity and cortisol awakening responses in young men and women.

A heightened cortisol awakening response (CAR) is associated with adiposity in middle-aged men, but the causal significance of this effect is not known. We hypothesised that if disturbance in cortisol secretion is involved in the development of overweight and obesity, then it might be present in normal weight adults at increased risk of obesity on account of parental adiposity. The CAR and cortisol profile over the day were measured in 33 men and 62 women aged 18-25 years. Parental adiposity was assessed with figure ratings derived from the Contour Drawing Rating Scale, and these were correlated with parental self-reported body mass index (BMI) in a subset of participants (r=0.66-0.79). In men, a positive association was observed between the CAR and their judgements of their fathers' adiposity after controlling for age, smoking status, time of waking, and the participants' own BMI; the correlation was 0.56 (P=0.008) for the cortisol increase between waking and 30 min, and 0.47 (P=0.028) for the cortisol area under the curve. The correlation between the CAR and fathers' own reported BMI and figures ratings were also significant. The relationship between parental adiposity and the CAR in women was inconsistent, and the associations between the CAR and opposite gender parental adiposity were not significant. Parental adiposity was not related to cortisol output over the rest of the day or to the slope between waking and evening in either sex. The results of this study suggest that disturbances of cortisol secretion may present before the emergence of heightened adiposity in young men at raised risk for obesity.

Adiposity↗

PubMed2006

Sleep duration and health in young adults.

BACKGROUND: Both long and short sleep durations have been associated with negative health outcomes in middle-aged and older adults. This study assessed the relationship between sleep duration and self-rated health in young adults. METHODS: Using anonymous questionnaires, data were collected from 17 465 university students aged 17 to 30 years who were taking non-health-related courses at 27 universities in 24 countries. The response rate was greater than 90%. Sleep duration was measured by self-report; the health outcome was self-rated health; and age, sex, socioeconomic background, smoking, alcohol consumption, body mass index, physical activity, depression (Beck Depression Inventory), recent use of health services, and country of origin were included as covariates. RESULTS: Sixty-three percent of respondents slept for 7 to 8 hours; 21% were short sleepers (6%, <6 hours; 15%, 6-7 hours); and 16% were long sleepers (10%, 8-10 hours; 6%, >10 hours). Compared with the reference category (7-8 hours), the adjusted odds ratio of poor health was 1.56 (95% confidence interval [CI], 1.22-1.99) for respondents sleeping 6 to 7 hours and 1.99 (95% CI, 1.31-3.03) for those sleeping less than 6 hours. The same significant pattern was seen when the results were analyzed separately by sex. When respondents from Japan, Korea, and Thailand (characterized by relatively short sleep durations) were excluded, the adjusted odds ratios were 1.33 (95% CI 1.03-1.73) and 1.62 (95% CI, 1.06-2.48) for those sleeping 6 to 7 hours and less than 6 hours, respectively. There were no significant associations between self-rated health and long sleep duration. CONCLUSION: Our data suggest that short sleep may be more of a concern than long sleep in young adults.

Adolescent↗

PubMed2006

Measuring behavioural susceptibility to obesity: validation of the child eating behaviour questionnaire.

The Child Eating Behaviour Questionnaire (CEBQ; [Wardle, J., Guthrie, C.A., Sanderson, S., & Rapoport, L. (2001). Development of the children's eating behaviour questionnaire. Journal of Child Psychology and Psychiatry, 42, 963-970]) is a parent-report questionnaire designed to assess eating styles related to obesity risk. It has been shown to have a robust factor structure and good internal reliability, but has not been validated against behavioural measures of eating. In the present study, associations were examined between three CEBQ scales (Satiety Responsiveness, SR; Food Responsiveness, FR; Enjoyment of Food, EF) and four aspects of eating behaviour (eating without hunger, caloric compensation, eating rate and energy intake at a meal) aggregated across up to five occasions, in a sample of 4-5-year olds. In multiple regression, the aggregated behavioural measures of eating explained 56% of the variance in SR, 33% of the variance in FR and 40% of the variance in EF. These findings support the validity of the CEBQ as a parent-report instrument to assess 'obesogenic' eating behaviours in children. An easily-administered measure such as the CEBQ will be valuable in gathering data on the scale required to study the behavioural phenotype associated with obesity risk.

Child, Preschool↗

PubMed2006

Ten-year changes in sun protection behaviors and beliefs of young adults in 13 European countries.

OBJECTIVE: Sun protection behaviors are important to the prevention of skin cancers, but little is known about changes over time in attitudes and behavior. METHODS: Cross-sectional surveys were carried out among university students in thirteen European countries in 1990 (n = 10,241) and 2000 (n = 10,161). Sun protection behavior and beliefs about the importance of sunscreen use for health were measured. RESULTS: There was little change in the proportion of men and women who sunbathed, but use of sun protection increased over the 10-year interval from 52% to 63% in men and 80% to 87% in women. There was wide variation in sun protection use and strength of health beliefs between countries. The association between strength of beliefs and behavior was more marked in 2000 than 1990. Sun protection behavior was positively associated with the socioeconomic background of participants. CONCLUSION: The use of sunscreen increased among educated young Europeans from several countries over the 1990s, but important sex differences remain. Awareness of the risk to health of unprotected sunbathing is high, but there is scope of strengthening attitudes to sunscreen use.

Adult↗

PubMed2006

Low levels of breast cancer risk awareness in young women: an international survey.

At least a fifth of breast cancer cases in Western countries are likely to be due to modifiable lifestyle factors. Previous work has found that while women in Western countries are aware that breast cancer can be hereditary, their knowledge of the influence of lifestyle is poor. This survey investigated on the awareness of breast cancer risk factors in university students from 23 countries between 1999 and 2001. Data were collected on awareness of links with heredity, alcohol use, exercise, obesity, stress, smoking and diet. Almost a third of women were not aware that any of these factors influenced breast cancer. Just 57% were aware of the genetic link and fewer than 1 in 20 women correctly identified alcohol, exercise or obesity as factors influencing breast cancer. Stress and smoking were the most commonly chosen lifestyle risk factors although current data suggest that they have little actual impact on breast cancer risk. There was considerable international variation, with highest levels of awareness in students in the United States of America (USA). Knowledge of risk in this sample was poorer than previously observed in older women. Health messages concerning cancer in general may be more relevant for this age group, because of the lower salience of breast cancer for younger women.

Adolescent↗

PubMed2006

Food neophobia and mealtime food consumption in 4-5 year old children.

BACKGROUND: Previous research has documented a negative association between maternal report of child food neophobia and reported frequency of consumption of fruit, vegetables, and meat. This study aimed to establish whether neophobia is associated with lower intake of these food types in naturalistic mealtime situations. METHODS: One hundred and nine parents of 4-5 year olds completed questionnaires which included a six-item version of the Child Food Neophobia Scale (CFNS). The children took part in a series of 3 test lunch meals at weekly intervals at school at which they were presented with: chicken, cheese, bread, cheese crackers, chocolate biscuits, grapes and tomatoes or carrot sticks. Food items served to each child were weighed before and after the meal to assess total intake of items in four categories: Fruit and vegetables, Protein foods, Starchy foods and Snack foods. Pearson Product Moment Correlations and independent t tests were performed to examine associations between scores on the CFNS and consumption during lunches. RESULTS: Neophobia was associated with lower consumption of fruit and vegetables, protein foods and total calories, but there was no association with intake of starch or snack foods. CONCLUSION: These results support previous research that has suggested that neophobia impacts differentially on consumption of different food types. Specifically it appears that children who score highly on the CFNS eat less fruit, vegetables and protein foods than their less neophobic peers. Attempts to increase intake of fruit, vegetables and protein might usefully incorporate strategies known to reduce the neophobic response.

Journal Article↗

PubMed2006

Chapter 10: New dimensions in cervical cancer screening.

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.

Female↗

PubMed2006

Can cancer risk information raise awareness without increasing anxiety? A randomized trial.

OBJECTIVE: Promoting public awareness of cancer risk factors is an important public health goal, but there is concern that it could heighten anxiety. This study examined the impact of mailed information about colorectal cancer on awareness of risk factors, emotional well-being, and interest in attending screening in a population not previously exposed to screening. METHOD: Individuals (3,185) aged 45-66 years registered with general practitioners in South-West England in 2004 were randomized to (1) control group (no information), (2) information on colorectal cancer risk factors, or (3) information on risk factors and colorectal screening. All participants were sent a questionnaire assessing knowledge, anxiety, worry about colorectal cancer, and interest in screening. RESULTS: Questionnaires (1,945; 61%) were returned. As expected, participants receiving information had significantly greater knowledge than the control group. Anxiety scores were in the normal range and neither anxiety nor worry about cancer differed significantly between the groups. Ninety-three percent of respondents indicated they would be interested in screening, with equally high levels across groups. CONCLUSION: This study suggests that information leaflets can promote knowledge of cancer risk factors without increasing anxiety. Low-cost educational materials have the potential to contribute to public engagement with health promotion and disease prevention.

Aged↗

PubMed2006

Heritability of food preferences in young children.

BACKGROUND: There is persisting interest in the idea that taste preferences are heritable characteristics, but few twin studies have found evidence for a significant genetic component. Small sample sizes and idiosyncratic selection of foods may have contributed to the negative results. We hypothesized that using a larger twin sample and empirical groupings of food types, would give stronger evidence for the heritability of food preferences. OBJECTIVE: We examined the heritability of preferences for four food groups in a sample of young twins. DESIGN: We administered a food preference questionnaire with 95 foods to 214 mothers of same-sex twin pairs (103 monozygotic and 111 dizygotic pairs) aged 4 to 5. 18 foods were excluded because they had been tried by fewer than 25% of the children. Foods were grouped into 'Vegetables', 'Fruits', 'Desserts' and 'Meat and Fish' on the basis of a factor analysis of the preference data. Genetic analyses were carried out on mean liking across these four groups, using model fitting techniques. RESULTS: Over all 77 foods, MZ correlations were higher than DZ correlations for 72 of them, with a higher mean MZ correlation (r = 0.76) than DZ correlation (r = 0.56). Using model fitting techniques with the factor scores, significant heritability estimates were obtained for all four food groups. Heritability was modest for dessert foods (0.20), moderate for vegetables (0.37) and fruits (0.51), and high for liking for protein foods (0.78). Shared environmental effects were strong for desserts, fruits and vegetables, while non-shared environmental influences were low for all four food groups. CONCLUSIONS: These results provide strong evidence for modest heritability of food preferences when using empirically-derived groupings of foods.

Child, Preschool↗

PubMed2006

Development of adiposity in adolescence: five year longitudinal study of an ethnically and socioeconomically diverse sample of young people in Britain.

OBJECTIVE: To examine the developmental trajectory of obesity in adolescence in relation to sex, ethnicity, and socioeconomic status. DESIGN: Five year longitudinal cohort study of a socioeconomically and ethnically diverse sample of school students aged 11-12 years at baseline. SETTING: 36 London schools recruited to the study in 1999 by a stratified random sampling procedure. PARTICIPANTS: 5863 students participated in one or more years. MAIN OUTCOME MEASURES: Weight, height, and waist circumference measured annually by trained researchers; overweight and obesity defined according to International Obesity Task Force criteria; adiposity and central adiposity indexed by body mass index (BMI) and waist standard deviation scores relative to 1990 British reference values. RESULTS: In school year 7 (age 11-12), the prevalence of overweight and obesity combined was almost 25%, with higher rates in girls (29%) and students from lower socioeconomic backgrounds (31%) and the highest rates in black girls (38%). Prevalence of obesity increased over the five years of the study at the expense of overweight, but no reduction occurred in the proportion of students with BMIs in the healthy range. Waist circumferences were high compared with 1990 norms at age 11 (by 0.79 SD in boys and by 1.15 SD in girls) and increased further over time. Both BMI and waist circumference tracked strongly over the five years. CONCLUSIONS: Prevalence of overweight and obesity was high in London school students, with significant socioeconomic and ethnic inequalities. Little evidence was found of new cases of overweight or obesity emerging over adolescence, but few obese or overweight adolescents reduced to a healthy weight. The results indicate that persistent obesity is established before age 11 and highlight the need to target efforts to prevent obesity in the early years.

Adipose Tissue↗

PubMed2006

Early dating predicts smoking during adolescence: A prospective study.

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, 18% [corrected] of girls and 29% [corrected] 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.

Adolescent↗